Tenn. Comp. R. & Regs. 1200 — Health, Environment and Conservation

1200-01 Bureau of Environmental Health Services Division of Food and General Sanitation (F and GS) Division of Solid and Hazardous Waste Management (S and HWM) Division of Ground Water Protection (GWP) Division of Remediation Division of Superfund (DSF)

Chapter 1200-01-01 Health, Sanitation and Enforcement of Disease (F and GS)

Tenn. Comp. R. & Regs. 1200-01-01-.01 DEFINITIONS

The following definitions shall apply to these Regulations:

(a)Assembly — a gathering of 5,000 or more people which is conducted or can reasonably be expected to be conducted for eighteen (18) or more hours continuously; whether on public or private property.

(b)Department — the Tennessee Department of Public Health.

(c)EMT — Emergency Medical Technicians certified by the State of Tennessee.

(d)LPN — Licensed Practical Nurse with current registration granted by the State of Tennessee.

(e)PEA — the number of persons expected to attend a given Assembly.

(f)Person — includes any individual, natural human being, partnership, corporation, firm, company, association, society or group.

(g)RN — Registered Nurse with a current registration granted by the State of Tennessee.

History

• Authority: T.C.A. §53—105.
• Administrative History: Original Rule certified June 7, 1974. Rule Amended: filed December 13, 1974, effective January 12, 1975.

Tenn. Comp. R. & Regs. 1200-01-01-.02 MEDICAL CARE

(1)Physicians — Physician services shall be as follows:

(a)There must be a minimum of one (1) physician on duty at all times.

(b)The person proposing or holding an assembly shall employ one (1) physician for each 10,000 PEA. These physicians must agree to schedule so that there will be the following ratios around the clock for each consecutive eight hour period. The ratio of physicians per 10,000 per shift shall be: 1.8 a.m. to 4 p.m.-0.4 physician per 10,000 PEA 2.4 p.m. to 12 midnight-0.4 physician per 10,000 PEA 3.12 midnight to 8 a.m.-0.2 physician per 10,000 PEA (2)Nurses — Nursing services shall be as follows:

(a)There must be at least one (1) R.N. and one (1) L.P.N. on duty at all times.

(b)The person proposing or holding an Assembly shall employ two (2) R.N.’s and two (2) L.P.N.’s for each 10,000 for each consecutive eight hour period. The ratio of nursing staff per shift per 10,000 shall be: 1.8 a.m. to 4 p.m.-0.8 R.N.’s, 0.8 L.P.N.’s 2.4 p.m. to 12 midnight-0.8 R.N.’s, 0.8 L.P.N.’s 3.12 midnight to 8 a.m.-0.4 R.N.’s, 0.4 L.P.N.’s (c)The person proposing an Assembly shall present to the Commissioner evidence of employment by contractural arrangement or otherwise of each nurse by name and address and their Tennessee license number, along with the schedule of hours to be worked. Said evidence shall be filed with the application for license.

(3)Emergency Medical Technicians — EMT services shall be provided as follows:

(a)There must be at least two (2) EMT’s on duty at all times.

(b)The person proposing or holding an Assembly shall employ one (1) EMT for each 10,000 PEA.

The EMT personnel must agree to a schedule so that there will be the following ratios around the clock for each consecutive eight hour period. The ratio of EMT’s per 10,000 per shift shall be: 1.8 a.m. to 4 p.m.-0.4 EMT’s per 10,000 PEA 2.4 p.m. to 12 midnight-0.4 EMT’s per 10,000 PEA 3.12 midnight to 8 a.m.-0.2 EMT’s per 10,000 PEA (c)The person proposing an Assembly shall present to the Commissioner evidence of employment by contractural arrangement or otherwise of each EMT by name and address and their current Tennessee EMT Certification number, along with the schedule of hours to be worked. Said evidence shall be filed with the application for license.

(4)Back-up Medical Personnel — a person proposing or holding an Assembly shall show evidence of adequate back-up physicians, nurses and EMT’s in addition to the medical personnel required in sections (1), (2), and (3) of these Regulations.

History

• Authority: T.C.A. §53—105.
• Administrative History: Original Rule certified June 7, 1974. Rule Amended: filed December 13, 1974, effective January 12, 1975.

Tenn. Comp. R. & Regs. 1200-01-01-.03 EMERGENCY TRANSPORTATION

(1)In addition to medical personnel, the person proposing or holding an Assembly shall provide emergency transport services. A plan for emergency transport services shall be submitted with the application for license. One licensed emergency vehicle shall be stationed at the assembly site per 50,000 PEA and must be capable of arriving at a case within five (5) minutes after notice. The person holding an Assembly shall provide an unimpeded entrance and exit route for emergency vehicles.

(2)There shall be a written agreement between the person proposing or holding an Assembly and the hospitals that patients will be admitted which are transported from an Assembly. This agreement shall be presented with the application for license.

(3)An application for license of an emergency vehicle not previously licensed shall be submitted to the Division of Emergency Medical Services. This application shall be submitted 60 days prior to a proposed Assembly or filed with the application for license to hold an Assembly. All emergency vehicles shall be properly licensed before a license for an Assembly is granted.

(4)Adequate communications between the emergency vehicle or Assembly and the receiving hospital shall be provided and included in the plans submitted. Manpower requirements essential for licensing of emergency vehicles shall be included in plans submitted.

History

• Authority: T.C.A. §53—105.
• Administrative History: Original Rule certified June 7, 1974. Rule Amended: filed December 13, 1974, effective January 12, 1975.

Tenn. Comp. R. & Regs. 1200-01-01-.04 FACILITIES FOR MEDICAL TREATMENT

(1)There shall be facilities for physicians to give out-patient and emergency care on the premises. There shall be sufficient quantities of medical care items as determined by the physician in charge. The facilities shall:

(a)Be designed and located so as to provide adequate protection from wind, extreme temperature conditions, precipitation, and air-borne contamination.

(b)Consist of a minimum of receiving, triage, treatment and holding areas.

(c)Be marked and advertised so as to be easily identified.

(d)Have independent electrical power with back-up capability (auxiliary generator).

(e)Have hot and cold water, facilities for storage and removal of solid waste, facilities for disposal of liquid waste and ready access to toilet facilities.

(f)Have adequate security at all times.

There shall be provided for each physician on duty three (3) treatment enclosures. The enclosures must provide sufficient space for medical personnel to function. The holding area must provide one bed per 5,000 PEA.

(2)The Department shall have the authority to determine the quantitative and qualitative adequacy of medical supplies available.

History

• Authority: T.C.A. §53—105.
• Administrative History: Original Rule certified June 7, 1974. Rule Amended: filed December 13, 1974, effective January 12, 1975.

Tenn. Comp. R. & Regs. 1200-01-01-.05 ACCESS TO DETERMINE COMPLIANCE

After proper identification, the Department shall be permitted to enter, at any reasonable time, the premises of an Assembly for the purpose of determining compliance with Chapter 454, Public Acts of 1974 and these Regulations.

History

• Authority: T.C.A. §53—105.
• Administrative History: Original Rule certified June 7, 1974. Rule Amended: filed December 13, 1974, effective January 12, 1975.

Chapter 1200-01-02 Rental Premises Unfit For Habitation (F and GS)

Tenn. Comp. R. & Regs. 1200-01-02-.01 DEFINITIONS

(1) Accessory Structure shall mean a detached structure located on or partially on any premises which is not used or not intended to be used for living or sleeping by human occupants.

(2) Dwelling shall mean any enclosed space that is wholly or partly used for living or sleeping by human occupants, providing that temporary housing shall not be regarded as a dwelling.

(3) Dwelling Unit shall mean any room or group of rooms forming a single habitable unit with facilities which are used for living, sleeping, cooking, and eating.

(4) Flush Water Closet shall mean a toilet bowl flushed with water under pressure with a water filled trap above the floor level. Such toilet bowls shall have a smooth, easily cleanable surface.

(5) Habitable Room shall mean a room or enclosed floor space used or intended to be used for living, sleeping, cooking or eating purposes, excluding bathrooms, water closet compartments, laundries, furnace room, pantries, kitchenettes and utility rooms with less than 50 square feet, foyers or communicating corridors, stairways, and closets, storage spaces and work shops, hobby and recreation areas in unceiled or uninsulated parts of structures below ground level or in attics.

(6) Health Department shall mean the city or county health department having jurisdiction in the political subdivision in which a complaint is filed.

(7) Multiple Dwelling shall mean any dwelling containing more than two dwelling units.

(8) Ordinary Winter Conditions shall mean a temperature 15°F. above the lowest recorded temperature in locality for prior ten year period.

(9) Rooming House shall mean any dwelling or that part of any dwelling containing one or more rooms or groups of rooms forming a single habitable unit used for living and sleeping but not provided with facilities for cooking. This definition does not include those hotels used as rooming houses and which are regulated under the provisions of Chapter 21 of Title 53, Tennessee Code Annotated.

(10) Where Water Under Pressure is Available shall mean that a connection has been or can be made to an existing water supply, public or private, which is within 200 feet of the dwelling and such private supply is owned by the landlord.

History

• Authority: T.C.A. § 53-5502.
• Administrative History: Original Rule certified June 7, 1974.

Tenn. Comp. R. & Regs. 1200-01-02-.02 MINIMUM STANDARDS FOR BASIC EQUIPMENT AND FACILITIES

(1) Every dwelling unit shall have a space in which food may be prepared and/or cooked which shall be equipped with the following except where central food service is provided by the owner:

(a) Where water under pressure is available a kitchen sink in each dwelling unit properly connected to the hot and cold potable water supply pipes and to a sewer system approved by the health department.

(b) A stove, or similar device for cooking food, and a refrigerator or similar device for the safe storage of food at temperatures less than 50°F. but more than 32°F. under ordinary maximum summer conditions, which are properly installed with all necessary connections for safe, sanitary and efficient operation, provided that such stove, refrigerator and/or similar devices need not be installed when the occupant is expected to provide same on occupancy, and that sufficient space and adequate connections for the safe and efficient installation and operation of a stove, refrigerator and/or similar devices are provided.

(2) Where water under pressure is available every dwelling unit shall have a tub or shower and a flush water closet located in a room affording privacy and lavatory properly connected with hot and cold water supply pipes and sewer system approved by the health department. Where water under pressure is not available, a sanitary pit privy shall be provided. A bathroom containing a tub or shower, lavatory and flush water closet may be shared by two (2) dwelling units if:

(a) It is enclosed in a separate room affording privacy to the occupant.

(b) The habitable area of such dwelling unit shall not exceed more than four-hundred (400) square feet of floor area.

(c) The fixtures are placed in a room used solely for toilet purposes and accessible without passing through the other dwelling unit or outside the dwelling.

(d) Each dwelling unit shall have facilities for storage of drugs and household poisons that are out of sight and out of reach of small children.

(e) Access to or egress from each dwelling unit shall be provided without passing through any other dwelling unit.

(f) All exterior doors, windows and other openings of the dwelling unit shall be equipped with safe, functioning locking devices.

History

• Authority: T.C.A. § 53—5502.
• Administrative History: Original Rule certified June 7, 1974.

Tenn. Comp. R. & Regs. 1200-01-02-.03 MINIMUM STANDARDS FOR LIGHT AND VENTILATION

(1) Ventilation shall be provided by openable doors and at least one (1) openable window equal to at least four percent (4%) of total floor area of each room except where there is supplied some other device affording adequate ventilation.

(2) Electric lighting facilities shall consist of at least two (2) separate wall type convenience outlets or one (1) ceiling type fixture and one (1) wall type outlet for every habitable room. Every bathroom or water closet compartment, hall and stairway, shall have at least one (1) lighting fixture which shall provide adequate light. All electrical systems shall be properly installed and maintained in a safe condition.

History

• Authority: T.C.A. § 53—5502.
• Administrative History: Original Rule certified June 7, 1974.

Tenn. Comp. R. & Regs. 1200-01-02-.06 ROOMLNG HOUSES

(1) Every house shall be equipped with at least one flush water closet, one lavatory, and one tub or shower for each persons or fraction thereof within the rooming house, including members of the family if they are to share the use of facilities. In rooming houses in which rooms are let only to males, flush urinals may be substituted or riot more than one-half of the required number of water closets. All such facilities shall be properly connected to the hot and cold water supply and sewer system.

(2) Every flush water closet, flush urinal, lavatory, tub or shower required above shall be located within the rooming house in a room or rooms, which:

(a) affords privacy (b) is accessible by a common hall without going outside of the rooming house (c) is accessible from a common hall without going through the sleeping quarters of others (d) is not more than one story removed from the room of an occupant intended to share the facilities (3) Every rooming house shall be provided adequate refuse storage facilities.

History

• Authority: T.C.A. §53—5502.
• Administrative History: Original rule certified June 7, 1974.

Tenn. Comp. R. & Regs. 1200-01-02-.04 MINIMUM THERMAL STANDARDS

(1) Every dwelling unit shall have heating facilities which are properly installed, and are maintained in safe and good working condition, and are capable of safely and adequately heating all habitable rooms, bathrooms and water closet compartments in every dwelling unit located therein to a temperature of at least 68°F. at a distance of eighteen (18) inches above floor level under ordinary winter conditions provided that such heating facilities need not be installed when the occupant is expected to provide same on occupancy and that adequate connections for the safe installation and operation of a heating facility are provided.

(2) Heating equipment employing a flame must be vented outside the structure in an approved manner unless such equipment is Underwriters Laboratory approved for installation without venting. If employing solid or liquid fuel a fire-resistant panel shall be installed beneath the heating device.

History

• Authority: T.C.A. § 53—5502.
• Administrative History: Original Rule certified June 7, 1974.

Tenn. Comp. R. & Regs. 1200-01-02-.05 GENERAL REQUIREMENTS RELATING TO THE SAFE AND SANITARY

MAINTENANCE OF PARTS OF DWELLING UNITS.

(1) Every foundation, roof and exterior wall, door, skylight, and window shall be reasonably weathertight, watertight, and dampfree, and shall be kept in sound condition and good repair. Toxic paint and materials shall not be used where readily accessible to children. Floors, interior walls, and ceilings shall be sound and in good repair. Walls shall be capable of affording visual privacy to the occupants. Every premises shall be graded, drained, and free of standing water which would be conducive to mosquito breeding.

(2) During that portion of the year when there is a need for protection against mosquitoes, flies and other flying insects, every door opening directly from a dwelling unit to outside space shall have supplied properly fitting screens having at least sixteen (16) mesh and self-closing devices; and every window or other device with openings to outdoor space, used or intended to be used for ventilation, shall likewise be supplied with screens, except that such screens shall not be required (a) in rooms in the upper stories of a building free from such insects (b) in rooms located in areas which are deemed by the health department to have so few insects as to render screens unnecessary.

(3) Every window located at or near ground level used or intended to be used for ventilation, and every other opening located at or near ground level which might provide an entry for rodents, shall be supplied with adequate screen or such other devices as will effectively prevent their entrance in areas with heavy rat infestations as determined by the health department.

(4) Every multiple dwelling or rooming house shall be kept reasonably free of household vermin provided that the landlord shall not be required to carry out treatment measures more than twice per year.

(5) The landlord of multiple dwellings must provide two (2) garbage cans per dwelling unit with a capacity of at least twenty (20) gallons each and not more than thirty-two (32) gallons each. Bulk containers that can be emptied mechanically may be used in lieu of garbage cans when service is available for emptying such containers. These containers shall have a capacity of 1/4 cubic yard per dwelling unit. (These capacities are based on twice per week service.)

(a) All containers both individual and bulk shall be of such design as to be rodentproof, and they shall be covered. These containers must be of an easily cleanable construction and must be cleaned at such intervals as to prevent health hazards, odors, and other nuisances.

(b) Containers must be located so that each dwelling unit will be within a reasonable distance of a solid waste container.

(c) All containers shall be emptied at least one (1) time per week.

(6) All fences provided by the landlord shall be maintained in safe condition or shall be removed.

(7) Accessory structures provided by the landlord shall be structurally sound, and shall be maintained in safe repair or such structures shall be removed from the premises.

(8) Every foundation, roof, floor, exterior and interior wall, ceiling, inside and outside stair, every porch and every appurtenance thereto, shall be safe to use and capable of supporting the loads that normal use may cause to be placed thereon; and shall be kept in sound condition and good repair.

(9) Every water closet compartment, bathroom, and kitchen floor surface shall be constructed and maintained so as to be reasonably impervious to water and to permit such floor to be easily kept in a clean and sanitary condition.

(10) Every dwelling unit shall have at least one safe and unobstructed means of egress leading to a safe and open space at ground level.

(11) Every dwelling unit shall have at least one outside window or other opening which can be readily opened from the inside without the use of tools and which is adequate in size of opening, configuration, and location to provide a safe emergency escape or rescue.

(12) Stairways with four (4) or more risers (three steps) shall be equipped with structurally sound handrails.

Every inside and outside stairway shall have uniform risers and uniform treads. Stair railings with balusters spaced no greater than six (6) inches apart shall be provided on unenclosed stairways and ramps.

Porches and/or balconies located more than three (3) feet higher than the adjacent area shall have structurally sound protective guardrails with balusters spaced no greater than six (6) inches apart on all unenclosed sides. Handrails, stairrails, and protective guardrails shall be at least thirty (30) inches high.

Alternate systems providing at least the same degree of protection, if approved by the inspecting

authority, shall be acceptable.

History

• Authority: T.C.A. § 53—5502.
• Administrative History: Original Rule certified June 7, 1974.

Chapter 1200-01-03 Repealed

Tenn. Comp. R. & Regs. 1200-01-03 Repealed

RULES

TENNESSEE DEPARTMENT OF PUBLIC HEALTH

BUREAU OF ENVIRONMENTAL HEALTH SERVICES

DIVISION OF SANITATION AND SOLID WASTE MANAGEMENT

REPEALED

Authority: T.C.A. §§53-2549 and 53-2550. Administrative History: Original rule certified June 7, 1974.

Repealed by Chapter 14, Public Acts of 1977.

Chapter 1200-01-04 Repealed

Tenn. Comp. R. & Regs. 1200-01-04 Repealed

RULES

OF TENNESSEE DEPARTMENT OF PUBLIC HEALTH

BUREAU OF ENVIRONMENTAL HEALTH SERVICES

DIVISION OF SANITATION AND SOLID WASTE MANAGEMENT

REPEALED

Authority: T.C.A. §§53-801 et. seq., 53-805 and 68-7-101. Administrative History: Original Chapter filed June 7, 1974. Repealed by Public Chapter 805 of 1984.

Chapter 1200-01-05 Organized Camps (F and GS)

Tenn. Comp. R. & Regs. 1200-01-05-.01 DEFINITIONS

(1)“Commissioner” means the Commissioner of the Department of Health or the Commissioner’s authorized representative.

(2)“Critical item” means an aspect of operation or condition of facilities or equipment which, if in violation, constitutes the greatest hazard to health and safety.

(3)“Day Camp” means an organized camp program that campers attend for an established period of time, returning to their homes at night, and which provides creative, recreational and educational opportunities in the out-of-doors.

(4)“Department” means the Department of Health.

(5)“Extensively remodeled” means alteration to change bed or sleeping capacity, as well as the increase or decrease of floor space.

(6)“Imminent health hazard” means any condition, deficiency, or practice which, if not corrected, is very likely to result in illness, injury, or loss of life.

(7)“Motor home” means any motorized vehicle designed as a temporary dwelling for travel, recreational, or vacation use.

(8)“Natural swimming area” means a portion of a river, lake, reservoir, creek, pond, or stream used for swimming within the organized camp.

(9)“Organized camp” means an area, place, parcel or tract of land on which facilities are established or maintained to provide an outdoor group-living experience for children or adults, or where one (1) or more permanent or semi-permanent structures are established or maintained as living or sleeping quarters for children or adults, and operated for educational, social, recreational, religious instruction or activity, physical education or health, or vacation purposes either gratuitously or for compensation; provided, however, that this definition is not intended to include (a)a hunting, fishing or other camp privately owned and used exclusively for the personal pleasure of the owner and the owner’s guests;

(b)a camp site on property owned by a church and used exclusively for the personal benefit of the members of the church and such members’ guests, if: 1.no permanent or semi-permanent structures or buildings are established or maintained on the camp site as living or sleeping quarters, restrooms, or for a cafeteria or kitchen, to provide an outdoor group-living experience for children or adults; 2.the camp site is used for occasional weekend or overnight camping experiences for such persons; and the camp site contains no electrical, sewage, or water hookups or pads to accommodate travel trailers, truck coaches or campers, tent campers, and other similar camping vehicles.

(c)facilities permitted as hotels as defined in Hotel Rules 1200-23-4.

(10)“Owner/Operator” means the applicant, permittee, or other person to be in charge of an organized camp.

(11)“Permanent structure” means a building and appurtenances at a fixed location maintained for living, sleeping, educational, social, recreational, religious instruction, physical education, health, or vacation purposes.

(12)“Person” means any and all persons, including an individual, firm, association, municipal or private corporation, state, municipality, commission, political subdivision of a state, interstate body, governmental agency of this state and a department, agency, or instrumentality of the branches of the federal government.

(13)“Primitive camp” means an organized camp established for tent camping only.

(14)“Public health officer” means the director of a city, county, or district health department having jurisdiction over the community health in a specific area, or the officer’s authorized representative.

(15)“Resident camp” means one or more permanent or semi-permanent structures maintained for living, sleeping, educational, social, recreational, religious instruction, physical education, health, or vacation purposes.

(16)“Semi-permanent structure” means any temporary or portable facility maintained for living, sleeping, educational, social, recreational, religious instruction, physical education, health, or vacation purposes.

(17)“State Fire Marshal’s Office” means the Department of Commerce and Insurance, Division of Fire Prevention.

(18)“Tent camper” means a towed vehicle constructed so that the sides or top may be extended when parked and retracted while towed and designed as a temporary dwelling for travel, recreational, or vacation use.

(19)“Travel camp” means one or more sites for motor homes, travel trailers, truck campers, tent campers, or tents.

(20)“Travel camp sites” means designated camping spaces which are equipped with utility hookups.

(21)“Travel trailer” means a towed vehicle designed as a temporary dwelling for travel, recreational, or vacation use.

(22)“Truck camper” means a portable structure without a chassis or wheels and built for transport by truck and designed as a temporary dwelling for travel, recreational, or vacation use.

History

• Authority: T.C.A. §§4-5-202, 53-3802, 68-110-101, and 68-110-102.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed May 6, 2002; effective July 20, 2002.

Tenn. Comp. R. & Regs. 1200-01-05-.02 PLANS AND SPECIFICATIONS

(1)Construction or extensive remodeling of an organized camp shall require approval of plans which shall show:

(a)area and dimensions of the site to a scale of not less than 1” = 100’;

(b)property lines;

(c)number, location, and dimensions of all camping spaces;

(d)number, size, type, and location of all permanent and semi-permanent structures;

(e)location of water supply and sewage disposal;

(f)location and width of roads; and (g)number, location, and type of acceptable fire fighting equipment.

(2)Plans and specifications shall indicate the proposed layout arrangement, mechanical plans, construction materials, work areas, and the type and model of proposed fixed equipment and facilities.

(3)No person shall commence construction, extensive remodeling or conversion, within an organized camp, of any permanent structure which is two or more stories in height consisting of twelve or more units until plans or specifications therefor have been submitted to and approved in writing by the State Fire Marshal’s Office or other authority having jurisdiction in accordance with applicable law and rules.

(4)No person shall commence construction, extensive remodeling or conversion, within an organized camp, of any place of assembly having a capacity of three hundred (300) or more persons until plans and specifications therefor have been submitted to and approved in writing by the State Fire Marshal’s Office or other authority having jurisdiction in accordance with applicable law and rules.

(5)Except as specified in paragraphs (3) and (4), no person shall commence construction, extensive remodeling or conversion, within an organized camp, of any permanent structure until plans and specifications therefor have been submitted to and approved in writing by the Commissioner.

(6)All structures within an organized camp shall be designed and constructed in compliance with all applicable state and local building and fire codes.

History

• Authority: T.C.A. §§4-5-202, 53-3802, and 68-110-102.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed May 6, 2002; effective July 20, 2002.

Tenn. Comp. R. & Regs. 1200-01-05-.03 PERMITTING AND INSPECTION

(1)Application Procedures (a)A person planning to construct, operate, or change ownership of an organized camp shall submit a written permit application with the proper fee, as set forth in T.C.A. 68-110-103, to the Commissioner.

(b)A person planning to operate an organized camp must obtain a written application for a permit on a form provided by the Commissioner through the local county health department prior to operating an organized camp.

(c)An application for a permit is required for an organized camp that has not previously been permitted or in instances when ownership changes.

(d)For the purposes of determining a change of ownership of an organized camp, a “person” shall include a change of ownership of the organized camp by a corporation (e.g., Corporation A sells its organized camp to Corporation B) or a change of ownership of a corporation which owns an organized camp. If there is no change in the federal tax identification number applicable to the corporation which owns the organized camp, there is no change of ownership for permit purposes.

(e)The Commissioner shall issue an organized camp permit 1.upon receiving a completed application with applicable fees; and 2.after an inspection of the proposed facility reveals that the facility is in compliance with requirements of these rules.

(2)Inspection Procedures (a)The Commissioner shall inspect or cause to be inspected every organized camp at least once every six (6) months or as often as deemed necessary by the Commissioner.

(b)Inspection results for organized camps shall be recorded on standard departmental forms which summarize the requirements of the law and rules.

(c)The scoring system shall include a weighted point value for each requirement in which critical items are assigned values, at the discretion of the department, of either four (4) or five (5) points, with non-critical items having assigned values of either one (1) or two (2) points.

(d)The rating score of the facilities shall be the total of the weighted point values for all violations subtracted from one hundred (100).

(3)The organized camp shall be accessible for inspection and not be subject to flooding during the camping season.

(4)Critical item violations shall be corrected within ten (10) calendar days from the date of the inspection.

The inspection report shall state that failure to comply with any time limits for correction may result in suspension of permit or cessation of operation.

(5)The citation of a violation of a non-critical item may be appealed, upon receipt of a written request submitted to the Director of General Environmental Health within ten (10) calendar days following the date of the inspection report. If the tenth (10 th ) day falls on a weekend or state holiday, the first work day following shall be treated as the tenth (10 th ) day. The request for appeal shall identify the noncritical item(s) being appealed. The final determination on the appeal shall be made by the Director or the Director’s Designee in writing and within a reasonable time after receipt of the request for an appeal.

(6)The citation of a violation of a critical item may also be appealed upon the receipt of a written request submitted to the Director of General Environmental Health within ten (10) calendar days following the date of the inspection report. If the tenth (10 th ) day falls on a weekend or state holiday, the first work day following shall be treated as the tenth (10 th ) day. The request for appeal shall identify the critical item(s) being appealed. The decision of the Director shall be final and made in writing within a reasonable time of the request for an appeal.

(7)Upon declaration of an imminent health hazard by the Commissioner, the facility shall immediately cease operations until authorized to reopen. A request for a hearing may be made in writing to the Commissioner postmarked or received within ten (10) calendar days of the decision of the Director.

(8)The Commissioner shall suspend an organized camp permit, if the Commissioner has reasonable cause to believe that the permittee is not in compliance with the provisions of this part; provided, however, the permittee shall be given the opportunity to correct violations as provided in Rule 1200-1-5-.03(4).

The Commissioner may provide a notice of suspension on the regular inspection report or by letter. A written request for a hearing on a suspension must be filed by the permittee within ten (10) days of receipt of notice. If a hearing is requested, it shall be held within a reasonable time of the request. If no request for a hearing is made within ten (10) days of receipt of notice, the suspension becomes final and not subject to review. When a permit suspension is effective, all operations must cease. The Commissioner may end the suspension at any time, if reasons for suspension no longer exist in the opinion of the Commissioner.

(9)Permit Revocation (a)After providing an opportunity for a hearing, the Commissioner or his duly authorized representative may revoke a permit for serious or repeated violations of requirements of this part or for interference with the Commissioner in the performance of the Commissioner’s duty.

(b)Prior to revocation, the Commissioner shall notify, in writing, the permittee of the specific reason(s) for which the permit is to be revoked. The permit shall be revoked at the end of ten (10) days following service of such notice, unless a written request for a hearing is filed with the Commissioner within such ten-day period. If no request for hearing is filed within the ten-day period, the revocation of the permit becomes final.

(10)Whenever a facility is required under this rule to cease operations by order to cease operation, or by suspension or revocation of permit, it shall not resume operations until it is shown on re-inspection that conditions responsible for the cessation of operations no longer exist. Opportunity for re-inspection shall be offered within a reasonable time.

(11)A notice provided for in this part is properly served when it is hand delivered to the permittee or person in charge, or alternatively, five (5) days from the mailing, by certified mail, return receipt requested, to the last known address of the permittee. A copy of the notice shall be filed in the records of the Commissioner.

History

• Authority: T.C.A. §§4-5-202, 53-3802, 68-110-102, 68-110-103, 68-110-104, and 68-110-105.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed May 6, 2002; effective July 20, 2002.

Tenn. Comp. R. & Regs. 1200-01-05-.04 FACILITIES AND GROUNDS

(1)Motor homes, travel trailers, truck campers, tent campers, and tents shall be located fifteen feet or more apart in clearly marked spaces.

(2)The campgrounds shall be free of refuse and debris. Dogs, cats, and other domestic animals shall be leashed, confined, and/or otherwise under control at all times.

(3)Permanent and semi-permanent structures shall be clean and maintained in good repair and provided with adequate lighting.

(4)The organized camp operator shall keep a register for a period of one (1) year at the organized camp facility. Such register shall contain each camper’s name, address, telephone number, and camping dates.

(5)Fire Safety (a)Fire Extinguishers 1.Portable fire extinguishers shall be provided in hazardous areas, including storage rooms, laundry, linen, and gas-fired equipment rooms. 2.Fire extinguishers shall be of a type approved by the State Fire Marshal’s office and installed, operated, and maintained in accordance with State Fire Marshal’s Office law and rules. 3.No soda-acid types of extinguishers are to be used.

(b)Smoke Detectors and Fire Alarms 1.All sleeping rooms and sleeping areas shall be provided with a single-station smoke detector. Smoke detectors shall be of a type approved by the State Fire Marshal’s Office or local jurisdiction and shall be installed, operated, and maintained in accordance with State Fire Marshal’s Office law and rules. Single-station smoke detection shall not be required when sleeping rooms contain smoke detectors connected to a central alarm system which also alarms locally. 2.A fire alarm system of a type approved by the State Fire Marshal’s Office shall be installed, operated, and maintained in accordance with State Fire Marshal’s Office law and rules in organized camps having more than fifteen (15) guest rooms, with exceptions being organized camps.

(i)in which all individual guest rooms have a direct exit to the outside or (ii)having buildings three (3) stories or less with each guest room having two (2) or more directions to exit from the entrance door of the room. 3.Travel and resident camps shall provide a telephone at the office or in an area which is accessible at all times for the immediate notification of the public fire department or private fire brigade in case of fire and to access emergency health services.

(c)Electrical Hazards, Heating, and Flammable 1.Visible and/or obvious fire and electrical hazards are prohibited. 2.There shall be no storage of flammables, lawnmowers, gas powered string trimmers, or other similar flammable operated equipment in boiler or electrical panel rooms. Separate secured storage areas shall be provided for plainly marked flammables, explosives, and hazardous chemicals. 3.Flammable liquids shall be stored in a well ventilated, separate building away from guest sleeping rooms, which is constructed and rated for storage of flammables in accordance with State Fire Marshal’s Office law and rules and shall be clearly marked. 4.Draperies, curtains, and other similar loosely hanging furnishings and decorations shall be flame resistant. 5.Furnishings or decorations of an explosive or highly flammable character shall not be used.

(d)Exits and Evacuation Plans 1.Each guest room door that opens into an interior corridor shall be self-closing. 2.Exits shall be clear of obstructions, marked, lighted, and maintained at all times. 3.Stairways shall be open and free of obstructions at all times. 4.A floor diagram reflecting the actual floor arrangement, exit locations, and room identifications shall be posted in a location and in an acceptable manner on or immediately adjacent to every guest room door.

(6)Permanent sleeping quarters shall conform to the following.

(a)Each shall have adequate ventilation, and there shall be at least three (3) feet between sides of each bed and adequate space to provide movement between beds.

(b)Articles of bedding shall be clean and in good repair.

(c)Permanent sleeping quarters shall have a minimum of forty (40) square feet per person floor space.

(d)Waterproof mattresses or mattress covers shall be provided.

(e)Each stacked bunk bed shall have a guardrail. The lower edge of the guardrail and the top surface of the mattress shall close the space between the lower edge of the guardrail and the upper edge of the bedframe to 3½ inches or less.

(f)Children of less than six (6) years of age shall not be allowed on the upper bunks.

(7)Storage area(s) for luggage and personal effects shall be provided in resident camps.

(8)A first aid kit for minor injuries shall be provided at the office or an area which is open or accessible at all times.

(9)Natural swimming areas shall have no drop-offs, potholes, rock outcroppings, stumps, other obstacles, heavy vegetative growth or pollution. Depths and boundaries shall be conspicuously marked and lifesaving equipment, as required for public swimming pools, shall be available.

(10)Each organized camp shall be provided with adequate restroom and/or bathing facilities. The ratio of water closets, urinals, lavatories, and showers in bathhouses and restrooms shall be in compliance with applicable local and/or state building and plumbing codes. Toilet tissue and covered, fire-resistant waste containers shall be provided.

(a)In the absence of applicable building or plumbing codes, fixtures shall be provided in the following ratios. # SpacesWater ClosetsUrinalsLavatoriesShowers or SitesMenWomenMenWomenMenWomen 1-151101111 16-301212211 31-452213311 46-602323322 61-803424422 81-1004524433 1.In the absence of urinals, the ratio of water closets for men and women shall be the same. 2.There shall be one (1) additional water closet and lavatory per gender for each additional twenty-five (25) camp spaces/sites and one (1) additional shower per gender for each additional forty (40) spaces/sites.

(b)In the absence of applicable building or plumbing codes, the ratio of water closets, lavatories, urinals, bathing facilities, and other fixtures for occupants of organized resident camps shall be as follows. The table identifies the number of individuals or persons per facility.

Water ClosetsUrinalsLavatoriesShowers MenWomen*MenWomenMenWomen 1/121/101/251/121/121/121/12 *In the absence of urinals, ratio of water closets for men and women shall be the same.

(c)There shall be one (1) drinking fountain for every seventy-two (72) persons at resident camps.

(d)Service buildings with toilet, bathing, and lavatory facilities shall be provided for motor homes, travel trailers, truck campers, and tent campers which do not have sewage holding tanks.

(e)Primitive camps and camps offering services to recreational or similar vehicles (e.g., motor homes and travel trailers) with sewage holding tanks are exempt from the restroom and/or bathing facility requirements.

History

• Authority: T.C.A. §§4-5-202, 53-3802, and 68-110-102.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed May 6, 2002; effective July 20, 2002.

Tenn. Comp. R. & Regs. 1200-01-05-.05 WATER SUPPLY, SEWAGE AND SOLID WASTE DISPOSAL

(1)Water supply and sewage disposal systems shall be provided from a source constructed and operated according to law. The potable water system shall be installed to preclude the possibility of backflow.

Primitive camps shall not be required to have water. Ice shall be from an approved source and protected from contamination.

(2)Durable, easily cleanable, and enclosed potable drinking water containers shall be maintained in a sanitary condition. Common use of cups or dippers is prohibited.

(3)Sanitary stations with a covered sewage disposal inlet surrounded by a concrete apron sloped inward to the drain with wash down facilities or capped, four (4) inches, above-ground sewer connections shall be provided for motor homes, travel trailers, truck campers, and tent campers with sewage holding tanks.

(4)All garbage and refuse shall be disposed of according to applicable laws or ordinances.

(5)An adequate number of clean, covered, garbage and refuse containers in good repair shall be provided.

Tied plastic bags are acceptable if removed daily.

History

• Authority: T.C.A. §§4-5-202, 53-3802, and 68-110-102.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed May 6, 2002; effective July 20, 2002.

Tenn. Comp. R. & Regs. 1200-01-05-.06 GENERAL PROVISIONS

(1)Posting of Permit. T.C.A. 68-110-103(e) requires the display or posting of permits “in a conspicuous manner.” This shall mean at a place so designated by the inspector at the time of inspection. No person except an authorized representative of the Commissioner shall modify, remove, cover up, or otherwise make the permit less conspicuous in any way.

(2)Loss of Permit Document. Any organized camp establishment or operator who loses, misplaces, or destroys the permit or license shall, as soon as the fact becomes apparent, immediately apply for a duplicate. The fee for the duplicate permit shall be three dollars ($3.00). This fee shall accompany the application for such duplicate.

(3)Penalties. Any person who violates the provisions of these rules or fails to perform the reasonable requirements of such, after receipt of ten (10) days’ written notice, may be subject to fines of not less than ten dollars ($10.00) nor more than fifty dollars ($50.00) for each offense. Each day of continued violation, upon a finding of fault in a court of law, constitutes a separate offense. These violations shall include, but not limited to:

(a)operating under a suspended permit;

(b)operating without a permit;

(c)failure to allow an inspection; or (d)failure to post permit.

(4)Waiver. With the exception of required compliance with applicable building and fire codes, one or more of these regulations may be waived in whole or part when, in the opinion of the Commissioner, there are factors or circumstances which render compliance with such regulations unnecessary, provided that such waiver shall not constitute a health or safety hazard as determined by the Commissioner, and provided that such regulations waiver shall be in writing by the Commissioner. A request for waiver of one or more of these regulations shall be in writing to the Commissioner.

(5)Any organized camp permitted at the effective time of these rules shall have one (1) year from the effective date of these rules to comply with any construction items.

History

• Authority: T.C.A. §§4-5-202, 53-3802, 68-110-101, 68-110-102, 68-110-103, 68-110-104, and 68-110-106.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed May 6, 2002; effective July 20, 2002.

Tenn. Comp. R. & Regs. 1200-01-05-.07 THROUGH 1200-1-5-.20 REPEALED

History

• Authority: T.C.A. §53-3802.
• Administrative History: Original rule certified June 7, 1974. Repeal filed May 6, 2002; effective July 20, 2002.

Chapter 1200-01-06 Repealed (Renumbered 0400-48-01)

Tenn. Comp. R. & Regs. 1200-01-06-.01 REPEALED

History

• Authority: T.C.A. § 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 1, 1975; effective December 30, 1975. Amendment filed December 21, 1989; effective February 4, 1990. Amendment filed January 9, 1991; effective February 23, 1991. Amendment filed June 1, 1994; effective August 15, 1994. Amendment filed February 3, 1997; effective April 19, 1997. Amendment filed December 27, 2000; effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.02 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 1, 1975; effective December 30, 1975. Amendment filed July 12, 1976; effective August 11, 1976. Amendment filed May 17, 1978; effective June 16, 1978. Amendment filed December 21, 1989; effective February 4, 1990. Amendment filed January 9, 1991; effective February 23, 1991. Amendment filed September 3, 1991; effective October 18, 1991. Amendment filed June 1, 1994; effective August 15, 1994. Amendment filed February 3, 1997; effective April 19, 1997. Amendment filed December 27, 2000; effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.03 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 21, 1989; effective February 4, 1990. Amendment filed January 9, 1991; effective February 23, 1991. Amendment filed February 3, 1997; effective April 19, 1997. Amendment filed February 3, 1997; effective April 19, 1997. Amendment filed December 27, 2000; effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.04 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed May 17, 1978; effective June 16, 1978. Amendment filed December 21, 1989; effective February 4, 1990. Amendment filed January 9, 1991; effective February 23, 1991. Amendment filed February 3, 1997; effective April 19, 1997. Amendment filed December 27, 2000; effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.05 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 21, 1989; effective February 4, 1990. Amendment filed January 9, 1991; effective February 23, 1991. Amendment filed May 12, 1994; effective July 26, 1994. Amendment filed June 1, 1994; effective August 15, 1994. Amendment filed December 27, 2000; effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.06 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 21, 1989; effective February 4, 1990. Amendment filed January 9, 1991; effective February 23, 1991; Amendment filed February 3, 1997; effective April 19, 1997. Amendment filed December 27, 2000; effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.07 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed May 17, 1978; effective June 16, 1978. Amendment filed December 21, 1989; effective February 4, 1990. Amendment filed December 27, 2000; effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.08 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 21, 1989; effective February 4, 1990. Amendment filed January 9, 1991; effective February 23, 1991. Amendment filed June 1, 1994; effective August 15, 1994. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.09 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed February 3, 1997; effective April 19, 1997. Amendment filed December 27, 2000; effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.10 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 21, 1989; effective February 4, 1990. Amendment filed February 3, 1997; effective April 19, 1997. Amendment filed December 27, 2000; effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.11 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 21, 1989; effective February 4, 1990. Amendment filed January 9, 1991; effective February 23, 1991. Amendment filed September 3, 1991; effective October 18, 1991. Amendment filed June 1, 1994; effective August 15, 1994. Amendment filed February 3, 1997; effective April 19, 1997. Amendment filed December 27, 2000, effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.12 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq. .
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 21, 1989; effective February 4, 1990. (Formerly numbered 1200-01-06-.10.) Amendment filed February 3, 1997, effective April 19, 1997. Amendment filed December 27, 2000; effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.13 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed May 17, 1978; effective June 16, 1978. Amendment filed December 21, 1989; effective February 4, 1990. (Formerly numbered 1200-01-06-.11.) Amendment filed February 3, 1997; effective April 19, 1997. Amendment filed December 27, 2000; effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.14 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed May 17, 1978; effective June 16, 1978. Amendment filed December 21, 1989; effective February 4, 1990. Amendment filed January 9, 1991; effective February 23, 1991. Amendment filed September 3, 1991; effective October 18, 1991. Amendment filed June 1, 1994; effective August 15, 1994. Amendment filed February 3, 1997; effective April 19, 1997. Amendment filed December 27, 2000; effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.15 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 21, 1989; effective February 4, 1990. Amendment filed December 27, 2000; effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.16 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed May 17, 1978; effective June 16, 1978. Amendment filed December 21, 1989; effective February 4, 1990. Amendment filed June 1, 1994; effective August 15, 1994. Amendment filed February 3, 1997; effective April 19, 1997. Amendment filed December 27, 2000; effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.17 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed May 17, 1978; effective June 16, 1978. Amendment filed December 21, 1989; effective February 4, 1990. Amendment filed December 27, 2000; effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.18 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed February 3, 1975; effective March 5, 1975. Amendment filed December 21, 1989; effective February 4, 1990. Amendment filed January 9, 1991; effective February 23, 1991. Amendment filed September 3, 1991; effective October 18, 1991. Amendment filed February 3, 1997; effective April 19, 1997. Amendment filed December 27, 2000; effective March 12, 2001. Amendment filed September 22, 2003; effective December 6, 2003. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.19 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 21, 1989; effective February 4, 1990. Amendment filed September 3, 1991; effective October 18, 1991. Amendment filed June 1, 1994; effective August 15, 1994. Amendment filed December 27, 2000; effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.20 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 21, 1989; effective February 4, 1990. Amendment filed June 1, 1994; effective August 15, 1994. Amendment filed February 3, 1997; effective April 19, 1997. Amendment filed December 27, 2000; effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.21 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed September 3, 1991; effective October 18, 1991. Amendment filed June 1, 1994; effective August 15, 1994. Amendment filed February 3, 1997; effective April 19, 1997. Amendment filed December 27, 2000; effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Public necessity rule filed June 29, 2009; effective through December 11, 2009. Amendment filed September 9, 2009; effective December 8, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.22 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 1989; effective February 4, 1990. Amendment filed January 9, 1991; effective February 23, 1991. Amendment filed September 3, 1991; effective October 18, 1991. Amendment filed December 27, 2000; effective March 12, 2001. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Amendment filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.23 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01.

Tenn. Comp. R. & Regs. 1200-01-06-.24 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 26, 2009; effective November 24, 2009. Repeal filed June 20, 2013; effective September 18, 2013. Chapter renumbered 0400-48-01. Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.

Chapter 1200-01-07 Repealed (Renumbered 0400-11-01)

Tenn. Comp. R. & Regs. 1200-01-07-.01 REPEALED

History

• Authority: T.C.A. §§ 68-203-101 et seq., 68-211-101 et seq., 68-211-801 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed February 1, 1990; effective March 18, 1990. Amendment filed August 6, 1991; effective September 20, 1991. Amendment filed May 15, 1992; effective June 29, 1992. Amendment filed May 26, 1993; effective July 10, 1993. Amendment filed July 15, 1993; effective September 29, 1993. Amendment filed November 17,1995; effective January 31, 1996. Amendment filed April 22, 1997; effective July 6, 1997. Amendment filed October 8, 1998; effective December 28, 1998. Amendment filed April 17, 2000; effective July 1, 2000. Amendment filed July 27, 2001; effective October 10, 2001. Amendment filed July 1, 2003; effective September 14, 2003. Amendment filed November 17, 2004; effective January 31, 2005. Amendment filed May 23, 2006; effective August 6, 2006. Amendment filed February 16, 2010; effective May 17, 2010. Repeal filed June 19, 2012; effective September 17, 2012. Chapter renumbered 0400-11-01.

Tenn. Comp. R. & Regs. 1200-01-07-.02 REPEALED

History

• Authority: T.C.A. §§ 68-203-101 et seq., 68-211-101 et seq., 68-211-801 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed February 1, 1990; effective March 18, 1990. Amendment filed August 6, 1991; effective September 20, 1991. Amendment filed May 15, 1992; effective June 29, 1992. Amendment filed May 26, 1993; effective July 10, 1993. Amendment filed June 21, 1993; effective August 5, 1993. Amendment filed April 22, 1997; effective July 6, 1997. Amendment filed May 7, 1997; effective July 21, 1997. Amendment filed October 8, 1998; effective December 28, 1998. Amendment filed April 17, 2000; effective July 1, 2000. Amendment filed July 27, 2001; effective October 10, 2001. Amendment filed July 1, 2003; effective September 14, 2003. Amendment filed September 29, 2003; effective December 13, 2003. Amendment filed November 17, 2004; effective January 31, 2005. Amendments filed May 23, 2006; effective August 6, 2006. Amendments filed September 12, 2008; effective November 26, 2008. Repeal filed June 19, 2012; effective September 17, 2012. Chapter renumbered 0400-11-01.

Tenn. Comp. R. & Regs. 1200-01-07-.03 REPEALED

History

• Authority: T.C.A. §§ 68-203-101 et seq., 68-211-101 et seq., 68-211-801 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed February 1, 1990; effective March 18, 1990. Amendment filed May 26, 1993; effective July 10, 1993. Amendment filed April 22, 1997; effective July 6, 1997. Amendment filed April 17, 2000; effective July 1, 2000. Amendment filed July 27, 2001; effective October 10, 2001. Amendment filed September 29, 2003; effective December 13, 2003. Amendment filed May 23, 2006; effective August 6, 2006. repeal filed June 19, 2012; effective September 17, 2012. Chapter renumbered 0400-11-01. September, 2012 2

Tenn. Comp. R. & Regs. 1200-01-07-.10 REPEALED

History

• Authority: T.C.A. §§ 68-203-101 et seq., 68-211-101 et seq., 68-211-801 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 21, 1993; effective August 5, 1993. Amendment filed December 8, 1993; effective February 27, 1994. Amendment filed November 17, 1995; effective January 31, 1996. Amendment filed April 22, 1997; effective July 6, 1997. Amendment filed May 7, 1997; effective July 21, 1997. Amendment filed April 17, 2000; effective July 1, 2000. Amendment filed May 23, 2006; effective August 6, 2006. Repeal filed June 19, 2012; effective September 17, 2012. Chapter renumbered 0400-11-01.

Tenn. Comp. R. & Regs. 1200-01-07-.04 REPEALED

History

• Authority: T.C.A. §§ 68-203-101 et seq., 68-211-101 et seq., 68-211-801 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 17, 1976; effective January 16, 1977. Amendment filed February 1, 1990; effective March 18, 1990. Amendment filed August 6, 1991; effective September 20, 1991. Amendment filed May 15, 1992; effective June 29, 1992. Amendment filed May 26, 1993; effective July 10, 1993. Amendment filed November 17, 1995; effective January 31, 1996. Amendment filed April 22, 1997; effective July 6, 1997. Amendment filed April 17, 2000; effective July 1, 2000. Amendment filed July 27, 2001; effective October 10, 2001. Amendment filed July 1, 2003; effective September 14, 2003. Amendments filed May 23, 2006; effective August 6, 2006. Amendments filed September 12, 2008; effective November 26, 2008. Repeal filed June 19, 2012; effective September 17, 2012. Chapter renumbered 0400-11-01.

Tenn. Comp. R. & Regs. 1200-01-07-.11 REPEALED

History

• Authority: T.C.A. §§ 68-203-101 et seq., 68-211-101 et seq., 68-211-801 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed October 8, 1998; effective December 28, 1998. Amendment filed April 17, 2000; effective July 1, 2000. Amendment filed July 27, 2001; effective October 10, 2001. Amendment filed September 29, 2003; effective December 13, 2003. Amendment filed May 23, 2006; effective August 6, 2006. Repeal filed June 19, 2012; effective September 17, 2012. Chapter renumbered 0400-11-01.

Tenn. Comp. R. & Regs. 1200-01-07-.05 REPEALED

History

• Authority: §§ 68-203-101 et seq., 68-211-101 et seq., 68-211-801 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 17, 1976; effective January 16, 1977. Repeal filed February 1, 1990; effective March 18, 1990. Repeal filed June 19, 2012; effective September 17, 2012. Chapter renumbered 0400-11-01.

Tenn. Comp. R. & Regs. 1200-01-07-.12 REPEALED

History

• Authority: T.C.A. §§ 68-203-101 et seq., 68-211-101 et seq., 68-211-801 et seq. and 4-5-201 et seq.
• Administrative History: Original filed April 22, 1997; effective July 6, 1997. Amendment filed April 17, 2000; effective July 1, 2000. Amendment filed July 27, 2001; effective October 10, 2001. Amendment filed September 12, 2008; effective November 26, 2008. Repeal filed June 19, 2012; effective September 17, 2012. Chapter renumbered 0400-11-01.

Tenn. Comp. R. & Regs. 1200-01-07-.06 REPEALED

History

• Authority: §§ 68-203-101 et seq., 68-211-101 et seq., 68-211-801 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed September 10, 1975; effective October 10, 1975. Amendment filed December 17, 1976; effective January 16, 1977. Amendment filed April 4, 1977; effective May 4, 1977. Repeal filed February 1, 1990; effective March 18, 1990. Repeal filed June 17, 2012; effective September 19, 2012. Chapter renumbered 0400-11-01.

Tenn. Comp. R. & Regs. 1200-01-07-.13 REPEALED

History

• Authority: T.C.A. §§ 68-203-101 et seq., 68-211-101 et seq., 68-211-801 et seq. and 4-5-201 et seq.
• Administrative History: New rule filed November 17, 2004; effective January 31, 2005. Repeal filed June 19, 2012; effective September 17, 2012. Chapter renumbered 0400-11-01.

Tenn. Comp. R. & Regs. 1200-01-07-.07 REPEALED

History

• Authority: T.C.A. §§ 68-203-101 et seq., 68-211-101 et seq., 68-211-801 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed September 12, 1991; effective October 27, 1991. Amendment filed June 21, 1993; effective August 5, 1993. Amendment filed April 22, 1997; effective July 6, 1997. Amendment filed April 17, 2000; effective July 1, 2000. Amendment filed November 27, 2000; effective February 10, 2001. Amendment filed July 27, 2001; effective October 10, 2001. Amendment filed June 5, 2002; effective August 19, 2002. Amendment filed July 1, 2003; effective September 14, 2003. Amendment filed February 4, 2004; effective April 19, 2004. Amendment filed January 11, 2006; effective March 27, 2006. Amendment filed May 23, 2006; effective August 6, 2006. Amendments filed September 12, 2008; effective November 26, 2008. Amendments filed February 16, 2010; effective May 17, 2010. Repeal filed June 19, 2012; effective September 17, 2012. Chapter renumbered 0400-11-01.

Tenn. Comp. R. & Regs. 1200-01-07-.08 REPEALED

History

• Authority: T.C.A. §§ 68-203-101 et seq., 68-211-101 et seq., 68-211-801 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed September 12, 1991; effective October 27, 1991. Amendment filed May 7, 1997; effective July 21, 1997. Repeal filed June 19, 2012; effective September 17, 2012. Chapter renumbered 0400-11-01.

Tenn. Comp. R. & Regs. 1200-01-07-.09 REPEALED

History

• Authority: T.C.A. §§ 68-203-101 et seq., 68-211-101 et seq., 68-211-801 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 15, 1993; effective September 29, 1993. Amendment filed May 7, 1997; effective July 21, 1997. Amendment filed April 17, 2000; effective July 1, 2000. Amendment filed July 27, 2001; effective October 10, 2001. Amendments filed May 23, 2006; effective August 6, 2006. Repeal filed July 19, 2012; effective September 17, 2012. Chapter renumbered 0400- 11-01. September, 2012 3

Chapter 1200-01-08 Repealed

Tenn. Comp. R. & Regs. 1200-01-08 Repealed

RULES

OF TENNESSEE DEPARTMENT OF PUBLIC HEALTH

BUREAU OF ENVIRONMENTAL HEALTH SERVICES-DIVISION OF SANITATION

AND SOLID WASTE MANAGEMENT

TABLE OF CONTENTS

REPEALED

Authority: T.C.A. §53-4322 et. seq., 53-4324 and 68-211-401 et. seq. Administrative History: Original chapter filed June 7, 1974. Repealed by §48 of Public Chapter 846 of 1996.

Chapter 1200-01-09 Repealed

Tenn. Comp. R. & Regs. 1200-01-09 Repealed

RULES

OF TENNESSEE DEPARTMENT OF HEALTH

BUREAU OF HEALTH SERVICES

DIVISION OF GENERAL ENVIRONMENTAL HEALTH

Authority: T.CA. §4-5-202 and 68-1-103. Administrative History: Original Rule certified June 7, 1974. Repeal filed August 31, 2000; effective December 29, 2000.

Chapter 1200-01-10 Repealed (Renumbered 0400-10-01)

Tenn. Comp. R. & Regs. 1200-01-10-.01 THROUGH 1200-01-10-.22 REPEALED

History

• Authority: T.C.A. §§ 68-211-101 et seq., 68-212-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed May 5, 1976; effective June 4, 1976. Amendment filed June 23, 2004; effective September 6, 2004. Repeal filed November 15, 2011; effective February 13, 2012. Chapter renumbered 0400-10-01

Chapter 1200-01-12 Repealed

Tenn. Comp. R. & Regs. 1200-01-12 Repealed

RULES

TENNESSEE DEPARTMENT OF PUBLIC HEALTH

BUREAU OF ENVIRONMENTAL HEALTH SERVICES

DIVISION OF SANITATION AND SOLID WASTE MANAGEMENT

Chapter 1200-01-13 Repealed (Renumbered 0400-15-01)

Tenn. Comp. R. & Regs. 1200-01-13-.01 REPEALED

History

• Authority: T.C.A. §§ 68-212-201 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed January 5, 1984; effective February 4, 1984. Amendment filed July 12, 1984; effective August 11, 1984. Amendment filed April 23, 1985; effective May 23, 1985. Amendment filed January 24, 1989; effective March 10, 1989. Repeal and new rule filed December 6, 1993; effective February 19, 1994. Repeal and new rule filed June 23, 1995; effective September 6, 1995. Repeal filed June 19, 2012; effective September 17, 2012. Rule was renumbered 0400-15-01.

Tenn. Comp. R. & Regs. 1200-01-13-.02 REPEALED

History

• Authority: T.C.A. §§ 68-212-201 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed January 5, 1984; effective February 4, 1984. Amendment filed July 12, 1984; effective August 11, 1984. Repeal and new rule filed June 17, 1985; effective July 17, 1985. Amendment filed February 19, 1988; effective April 4, 1988. Amendment filed May 25, 1989; effective July 9, 1989. Amendment filed November 17, 1989; effective January 1, 1990. Amendment filed August 13, 1990; effective September 27, 1990. Amendment filed February 17, 1993; effective April 2, 1992. Repeal and new rule filed December 6, 1993; effective February 19, 1994. Repeal and new rule filed June 23, 1995; effective September 6, 1995. Repeal filed June 19, 2012; effective September 17, 2012. Rule was renumbered 0400-15-01.

Tenn. Comp. R. & Regs. 1200-01-13-.03 REPEALED

History

• Authority: T.C.A. §§ 68-212-201 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed April 23, 1985; effective May 23, 1985. Amendment filed January 6, 1985; effective February 5, 1986. Amendment filed June 12, 1987; effective July 27, 1987. Amendment filed February 9, 1988; effective March 25, 1988. Amendment filed November 7, 1988; effective December 22, 1988. Amendment filed January 24, 1989; effective March 10, 1989. Amendment filed February 23, 1989; effective May 29, 1989. Amendment filed July 20, 1989; effective October 29, 1989. Amendment filed January 29, 1990; effective March 12, 1990. Amendment filed June 25, 1990; effective August 9, 1990. Amendment filed February 5, 1991; effective March 22, 1991. Amendment filed May 21, 1991; effective July 5, 1991. Amendment filed October 7, 1991; effective November 21, 1991. Amendment filed November 7, 1991; effective December 22, 1991. Amendment filed January 24, 1992; effective March 9, 1992. Amendment filed February 25, 1992; effective April 10, 1992. Amendment filed June 22, 1992; effective August 6, 1992. Amendment filed October 6, 1992; effective November 20, 1992. Amendment filed January 12, 1993; effective February 26, 1993. Amendment filed February 17, 1993; effective April 2, 1993. Repeal and new rule filed December 6, 1993; effective February 19, 1994. Repeal and new rule filed June 23, 1995; effective September 6, 1995. Amendment filed August 13, 1998; effective October 27, 1998. Amendment filed September 3, 2004; effective November 17, 2004.Amendment filed July 18, 2006; effective October 1, 2006. Amendments filed July 28, 2008; effective October 11, 2008. Repeal filed June 19, 2012; effective September 17, 2012. Rule was renumbered 0400-15-01.

Tenn. Comp. R. & Regs. 1200-01-13-.04 REPEALED

History

• Authority: §§ 68-212-201 et seq. and 4-5-201 et seq.
• Administrative History: Repeal filed June 19, 2012; effective September 17, 2012. Rule was renumbered 0400-15-01.

Tenn. Comp. R. & Regs. 1200-01-13-.05 REPEALED

History

• Authority: T.C.A. §§ 68-212-201 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed December 6, 1993; effective February 19, 1994. Repeal filed June 19, 2012; effective September 17, 2012. Rule was renumbered 0400-15-01.

Tenn. Comp. R. & Regs. 1200-01-13-.06 REPEALED

History

• Authority: §§ 68-212-201 et seq. and 4-5-201 et seq.
• Administrative History: Repeal filed June 19, 2012; effective September 17, 2012. Rule was renumbered 0400-15-01.

Tenn. Comp. R. & Regs. 1200-01-13-.07 REPEALED

History

• Authority: T.C.A. §§ 68-212-201 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed December 6, 1993; effective February 19, 1994. Repeal and new rule filed June 23, 1995; effective September 6, 1995. Amendment filed December 13, 2000; effective February 26, 2001. Repeal filed June 19, 2012; effective September 17, 2012. Rule was renumbered 0400-15-01.

Tenn. Comp. R. & Regs. 1200-01-13-.08 REPEALED

History

• Authority: T.C.A. §§ 68-212-201 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed December 6, 1993; effective February 19, 1994. Repeal and new rule filed June 23, 1995; effective September 6, 1995. Amendment filed December 13, 2000; effective February 26, 2001. Repeal filed June 19, 2012; effective September 17, 2012. Rule was renumbered 0400-15-01.

Tenn. Comp. R. & Regs. 1200-01-13-.09 REPEALED

History

• Authority: T.C.A. §§ 68-212-201 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed December 6, 1993; effective February 19, 1994. Repeal and new rule filed June 23, 1995; effective September 6, 1995. Amendment filed December 13, 2000; effective February 26, 2001. Repeal filed June 19, 2012; effective September 17, 2012. Rule was renumbered 0400-15-01.

Tenn. Comp. R. & Regs. 1200-01-13-.10 REPEALED

History

• Authority: T.C.A. §§ 68-212-201 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed December 6, 1993; effective February 19, 1994. Repeal and new rule filed June 23, 1995; effective September 6, 1995. Amendment filed December 13, 2000; effective February 26, 2001. Repeal filed June 19, 2012; effective September 17, 2012. Rule was renumbered 0400-15-01.

Tenn. Comp. R. & Regs. 1200-01-13-.11 REPEALED

History

• Authority: T.C.A. §§ 68-212-201 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed December 6, 1993; effective February 19, 1994. Repeal and new rule filed June 23, 1995; effective September 6, 1995. Repeal filed June 19, 2012; effective September 17, 2012. Rule was renumbered 0400-15-01.

Tenn. Comp. R. & Regs. 1200-01-13-.12 REPEALED

History

• Authority: T.C.A. §§ 68-212-201 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed December 6, 1993; effective February 19, 1994. Repeal and new rule filed June 23, 1995; effective September 6, 1995. Amendment filed December 13, 2000; effective February 26, 2001. Repeal filed June 19, 2012; effective September 17, 2012. Rule was renumbered 0400-15-01.

Tenn. Comp. R. & Regs. 1200-01-13-.13 REPEALED

History

• Authority: T.C.A. §§ 68-212-201 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed December 6, 1993; effective February 19, 1994. Amendment filed March 2, 1994; effective May 16, 1994. Amendment filed March 10, 1994; effective May 24, 1994. Amendment filed March 29, 1994; effective June 12, 1994. Amendment filed May 16, 1994; effective July 30, 1994. Amendment filed January 25, 1995; effective April 10, 1995. Amendment filed March 29, 1995; effective June 14, 1995. Repeal and new rule filed June 23, 1995; effective September 6, 1995. Amendment filed August 27, 1996; effective November 10, 1996. Amendment filed October 16, 1996; effective December 30, 1996. Amendment filed February 19, 1997; effective May 5, 1997. Amendment filed May 27, 1997; effective August 10, 1997. Amendment filed September 29, 1997; effective December 12, 1997. Amendment filed October 22, 1997; effective January 9, 1998. Amendment filed December 23, 1997; effective March 8, 1998. Amendment filed August 13, 1998; effective October 27, 1998. Amendment filed January 25, 1999; effective April 13, 1999. Amendment filed February 8, 1999; effective April 13, 1999. Amendment filed March 15, 1999; effective May 26, 1999. Amendment filed June 15, 1999; effective August 29, 1999. Amendment filed November 12, 1999; effective January 26, 2000. Amendment filed November 12, 1999; effective January 26, 2000. Amendment filed March 29, 2000; effective June 12, 2000. Amendments filed May 12, 2000; effective July 26, 2000. Amendment filed July 26, 2000; effective October 8, 2000. Amendment filed July 31, 2000; effective October 14, 2000. Amendment filed September 27, 2000; effective December 11, 2000. Amendment filed January 4, 2001; effective March 21, 2001. Amendment filed June 11, 2001; effective August 25, 2001. Amendment filed September 18, 2001; effective December 2, 2001. Amendment filed September 18, 2001; effective January 28, 2002. Amendment filed November 16, 2001; effective January 30, 2002. Amendment filed January 23, 2002; effective April 8, 2002. Amendment filed March 20, 2002; effective June 3, 2002. Amendment filed June 17, 2002; effective August 31, 2002. Amendment filed August 26, 2002; effective November 9, 2002. Amendment filed November 26, 2002; effective February 9, 2003. Amendment filed January 31, 2003; effective April 16, 2003. Amendment filed February 27, 2003; effective May 13, 2003. Amendment filed June 2, 2003; effective August 16, 2003. Amendment filed December 16, 2003; effective February 29, 2004. Amendment filed July 2, 2004; effective September 15, 2004. Amendments filed January 19, 2005; effective April 4, 2005. Amendments filed August 19, 2005; effective November 2, 2005. Amendments filed June 26, 2006; effective September 9, 2006. Amendments filed November 27, 2006; effective February 10, 2007. Amendment filed June 27, 2007; effective September 10, 2007. Amendment filed December 13, 2007; effective February 26, 2008. Amendments filed June 24, 2008; effective September 7, 2008. Amendment filed July 23, 2009; effective October 21, 2009. Amendment filed June 22, 2011; effective September 20, 2011. Repeal filed June 19, 2012; effective September 17, 2012. Rule was renumbered 0400-15-01.

Chapter 1200-01-14 Repealed (Renumbered 0400-12-02)

Tenn. Comp. R. & Regs. 1200-01-14-.01 REPEALED

History

• Authority: T.C.A. §§ 68-212-101 et seq., 68-212-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed November 29, 1984; effective December 29, 1984. Amendment filed June 13, 1990; effective July 28, 1990. (On July 26, 1990, a Writ of Supersedeas was entered by the Davidson County Chancery Court temporarily staying the effectiveness of these rules. The Writ of Supersedeas was dissolved by order of the Davidson County Chancery Court on September 13, 1990.) Amendment filed March 19, 1993; effective May 3, 1993. Amendment filed November 30, 1993; effective February 13, 1994. Amendment filed January 29, 1997; effective April 14, 1997. Amendment filed June 23, 2004; effective September 6, 2004. Repeal filed June 19, 2012; effective September 17, 2012. Chapter renumbered 0400-12-02.

Tenn. Comp. R. & Regs. 1200-01-14-.02 REPEALED

History

• Authority: T.C.A. §§ 68-212-101 et seq., 68-212-201 et seq., and 4-5-201 et seq.
• Administrative History: Original Rule filed November 29, 1984; effective December 29, 1984. Amendment filed January 26, 1988; effective March 11, 1988. Amendment filed June 13, 1990; effective July 28, 1990. (On July 26, 1990, a Writ of Supersedeas was entered by the Davidson County Chancery Court temporarily staying the effectiveness of these Rules. The Writ of Supersedeas was dissolved by order the Davidson County Chancery Court on September 13, 1990.) Amendment filed August 3, 2001; effective October 17, 2001. Amendment filed October 29, 2003; effective January 12, 2004. Repeal filed June 19, 2012; effective September 17, 2012. Chapter renumbered 0400-12-02.

Tenn. Comp. R. & Regs. 1200-01-14-.03 REPEALED

History

• Authority: T.C.A. §§ 68-212-101 et seq., 68-212-201 et seq., and 4-5-201 et seq.
• Administrative History: Original Rule filed June 13, 1990; effective July 28, 1990. (On July 26, 1990, a Writ of Supersedeas was entered by the Davidson County Chancery Court temporarily staying the effectiveness of these Rules. The Writ of Supersedeas was dissolved by order the Davidson County Chancery Court on September 13, 1990.). Amendment filed December 21, 1998; effective March 6, 1999. Amendments filed March 23, 2009; effective June 6, 2009. Repeal filed June 19, 2012; effective September 17, 2012. Chapter renumbered 0400-12-02.

Chapter 1200-01-15 Repealed (Renumbered 0400-18-01)

Tenn. Comp. R. & Regs. 1200-01-15-.01 REPEALED

History

• Authority: T.C.A. §§ 68-215-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed March 1, 1990; effective April 15, 1990. Amendment filed July 3, 1991; effective August 17, 1991. Amendment filed March 6, 2000; effective May 20, 2000. Public necessity rules 1200-01-15-.01 (3) filed August 29, 2005; effective through February 10, 2006. Amendment filed August 11, 2005; effective October 25, 2005. Public necessity rules 1200-01-15-.01 (3) filed August 29, 2005; expired on February 10, 2006. Amendment filed November 29, 2005; effective February 12, 2006. Amendment filed April 5, 2007; effective June 19, 2007. Amendment filed May 10, 2007; effective July 24, 2007. Amendment filed March 28, 2008; effective July 29, 2008. Amendments filed August 19, 2009; effective November 17, 2009. Amendment filed November 30, 2009; effective February 28, 2010. Amendment filed November 4, 2010; effective February 2, 2011. Amendment filed July 11, 2011; effective October 9, 2011; amendment stayed September 21, 2011 for 40 days by the Government Operations Committee; new effective date November 17, 2011. Repeal filed December 8, 2011; effective March 7, 2012. Chapter renumbered 0400-18-01.

Tenn. Comp. R. & Regs. 1200-01-15-.02 REPEALED.

History

• Authority: T.C.A. §§ 68-215-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed March 1, 1990; effective April 15, 1990. Amendment filed July 3, 1991; effective August 17, 1991. Amendment filed July 28, 1995; effective October 10, 1995. Amendment filed February 4, 1998; effective April 20, 1998. Amendment filed March 6, 2000; effective May 20, 2000. Amendment filed August 11, 2005; effective October 25, 2005. Emergency rule filed October 28, 2005; effective through April 11, 2006. Emergency rule 1200-01-15-.02 filed October 28; 2005, expired on April 11, 2006. On April 12, 2006, 1200-01-15-.02 reverted to rule in effect on October 27, 2005. Amendment filed February 9, 2006; effective April 25, 2006. Amendment filed April 5, 2007; effective June 19, 2007. Amendment filed May 10, 2007; effective July 24, 2007. Amendments filed March 28, 2008; effective July 29, 2008. Amendments filed August 19, 2009; effective November 17, 2009. Amendment filed July 11, 2011; effective October 9, 2011; amendment stayed by the Government Operations Committee September 21, 2011 for 40 days; new effective date November 17, 2011. Withdrawal of amendment 1200-01-15-.02(1) filed July 11, 2011 and to have been effective November 17, 2011 was withdrawn by the Department of Environment and Conservation on September 28, 2011. Repeal filed December 8, 2011; effective March 7, 2012. Chapter renumbered 0400-18-01.

Tenn. Comp. R. & Regs. 1200-01-15-.03 REPEALED

History

• Authority: T.C.A. §§ 68-215-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed March 1, 1990; effective April 15, 1990. Amendment filed February 4, 1998; effective April 20, 1998. Amendment filed March 6, 2000; effective May 20, 2000. Amendment filed April 5, 2007; effective June 19, 2007. Amendment filed May 10, 2007; effective July 24, 2007. Amendments filed August 19, 2009; effective November 17, 2009. Amendment filed November 4, 2010; effective February 2, 2011. Amendments filed July 11, 2011; effective October 9, 2011; amendments stayed September 21, 2011 for 40 days; new effective date November 17, 2011. Amendment 1200-01-15-.03(1)(a)3 filed July 11, 2011 and to have been effective November 17, 2011 was withdrawn by the Department of Environment and Conservation on September 28, 2011. Repeal filed December 8, 2011; effective March 7, 2012. Chapter renumber 0400-18-01.

Tenn. Comp. R. & Regs. 1200-01-15-.04 REPEALED

History

• Authority: T.C.A. §§ 68-215-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed March 1, 1990; effective April 15, 1990. Amendment filed February 4, 1998; effective April 20, 1998. Amendment filed March 6, 2000; effective May 20, 2000. Amendment filed April 5, 2007; effective June 19, 2007. Amendment filed May 10, 2007; effective July 24, 2007. Amendment filed July 17, 2008; effective September 30, 2008. Amendments filed August 19, 2009; effective November 17, 2009. Repeal filed December 8, 2011; effective March 7, 2012. Chapter renumbered 0400-18-01.

Tenn. Comp. R. & Regs. 1200-01-15-.05 REPEALED

History

• Authority: T.C.A. §§ 68-215-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed March 1, 1990; effective April 15, 1990. Amendment filed July 28, 1995; effective October 10, 1995. Amendment filed February 4, 1998; effective April 20, 1998. Amendment filed March 6, 2000; effective May 20, 2000. Amendment filed April 5, 2007; effective June 19, 2007. Amendments filed August 19, 2009; effective November 17, 2009. Repeal filed December 8, 2011; effective March 7, 2012. Chapter renumbered 0400-18-01.

Tenn. Comp. R. & Regs. 1200-01-15-.06 REPEALED

History

• Authority: T.C.A. §§ 68-215-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed March 1, 1990; effective April 15, 1990. Amendment filed July 28, 1995; effective October 10, 1995. Amendment filed August 6, 1996; effective October 20, 1996. Amendment filed February 4, 1998; effective April 20, 1998. Repeal and new rule filed August 11, 2005; effective October 25, 2005. Amendment filed March 28, 2008; effective July 29, 2008. Amendments filed August 19, 2009; effective November 17, 2009. Repeal filed December 8, 2011; effective March 7, 2012. Chapter renumbered 0400-18-01.

Tenn. Comp. R. & Regs. 1200-01-15-.07 REPEALED

History

• Authority: T.C.A. §§ 68-215-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed March 1, 1990; effective April 15, 1990. Amendment filed July 28, 1995; effective October 10, 1995. Amendment filed March 6, 2000; effective May 20, 2000. Amendment filed August 11, 2005; effective October 25, 2005. Amendment filed April 5, 2007; effective June 19, 2007. Amendment filed May 10, 2007; effective July 24, 2007. Amendment filed March 28, 2008; effective July 29, 2008. Amendment filed July 17, 2008; effective September 30, 2008. Amendment filed August 19, 2009; effective November 17, 2009. Repeal and new rule filed July 11, 2011; effective October 9, 2011; repeal and new rule stayed September 21, 2011 by the Government Operations Committee; new effective date November 17, 2011. Repeal filed December 8, 2011; effective March 7, 2012. Chapter renumbered 0400-18-01.

Tenn. Comp. R. & Regs. 1200-01-15-.08 REPEALED

History

• Authority: T.C.A. §§ 68-215-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed March 1, 1990; effective April 15, 1990. Amendment filed July 3, 1991; effective August 17, 1991. Amendment filed July 28, 1995; effective October 10, 1995. Amendment filed February 4, 1998; effective April 20, 1998. Amendment filed August 19, 2009; effective November 17, 2009. Repeal filed December 8, 2011; effective March 7, 2012. Chapter renumbered 0400-18-01.

Tenn. Comp. R. & Regs. 1200-01-15-.09 REPEALED

History

• Authority: T.C.A. §§ 68-215-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed March 1, 1990; effective April 15, 1990. Amendment filed July 3, 1991; effective August 17, 1991. Amendment filed November 24, 1992; effective January 9, 1993. Amended by Public Chapter 467; effective May 31, 1993. Amendment filed July 28, 1995; effective October 10, 1995. Amendment filed August 6, 1996; effective October 20, 1996. Amendment filed February 4, 1998; effective April 20, 1998. Amendment filed March 6, 2000; effective May 20, 2000. Public necessity rule filed August 29, 2005; effective through February 10, 2006. Amendments filed August 11, 2005; effective October 25, 2005. Public necessity rule 1200-01-15-.09 (8) filed August 29, 2005; expired February 10, 2006. Amendments filed November 29, 2005; effective February 12, 2006. Amendment filed April 5, 2007; effective June 19, 2007. Amendment filed May 10, 2007; effective July 24, 2007. Amendments filed March 28, 2008; effective July 29, 2008. Amendments filed August 19, 2009; effective November 17, 2009. Repeal filed December 8, 2011; effective March 7, 2012. Chapter renumbered 0400-18-01.

Tenn. Comp. R. & Regs. 1200-01-15-.10 REPEALED

History

• Authority: T.C.A. §§ 68-215-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed March 1, 1990; effective April 15, 1990. Amendment filed July 3, 1991; effective August 17, 1991. Amendment filed February 4, 1994; effective June 28, 1994. Amendment filed February 4, 1994; effective June 28, 1994. Amendment filed July 28, 1995; effective October 10, 1995. Amendment filed July 24, 1995; effective November 28, 1995. Amendment filed February 4, 1998; effective April 20, 1998. Amendment filed March 6, 2000; effective May 20, 2000. Amendment filed April 5, 2007; effective June 19, 2007. Amendment filed May 10, 2007; effective July 24, 2007. Amendment filed March 28, 2008; effective July 29, 2008. Amendments filed August 19, 2009; effective November 17, 2009. Repeal filed December 8, 2011; effective March 7, 2012. Chapter renumbered 0400-18-01.

Tenn. Comp. R. & Regs. 1200-01-15-.11 REPEALED

History

• Authority: T.C.A. §§ 68-215-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 24, 1989; effective December 8, 1989. Amendment filed December 19, 1989; effective February 2, 1990. Amendment filed July 3, 1991; effective August 17, 1991. Amendment filed February 4, 1998; effective April 20, 1998. Repeal filed December 8, 2011; effective March 7, 2012. Chapter renumbered 0400-18-01.

Tenn. Comp. R. & Regs. 1200-01-15-.12 REPEALED

History

• Authority: T.C.A. §§ 68-215-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed March 6, 2000; effective May 20, 2000. Amendment filed April 5, 2007; effective June 19, 2007. Amendments filed March 28, 2008; effective July 29, 2008. Amendments filed August 19, 2009; effective November 17, 2009. Repeal filed December 8, 2011; effective March 7, 2012. Chapter renumber 0400- 18-01.

Tenn. Comp. R. & Regs. 1200-01-15-.13 REPEALED

History

• Authority: T.C.A. §§ 68-215-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed February 9, 2006; effective April 25, 2006. Amendment filed March 28, 2008; effective July 29, 2008. Repeal filed December 8, 2011; effective March 7, 2012. Chapter renumbered 0400-18-01.

Tenn. Comp. R. & Regs. 1200-01-15-.14 REPEALED

History

• Authority: T.C.A. §§ 68-215-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed April 26, 2007; effective August 28, 2007. Amendments filed August 19, 2009; effective November 17, 2009. Repeal filed December 8, 2011; effective March 7, 2012. Chapter renumbered 0400-18-01.

Tenn. Comp. R. & Regs. 1200-01-15-.15 REPEALED

History

• Authority: T.C.A. §§ 68-215-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 19, 2009; effective November 17, 2009. Repeal filed December 8, 2011; effective March 7, 2012. Chapter renumbered 0400-18-01.

Tenn. Comp. R. & Regs. 1200-01-15-.16 REPEALED

History

• Authority: T.C.A. §§ 68-215-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed November 4, 2010; effective February 2, 2011. Repeal filed December 11, 2011; effective March 7, 2012. Chapter renumbered 0400-18-01.

Chapter 1200-01-16 Repealed (Renumbered 0400-11-02)

Tenn. Comp. R. & Regs. 1200-01-16-.01 REPEALED

History

• Authority: T.C.A. §§ 68-212-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed May 31, 1989; effective August 29, 1989. Repeal filed June 19, 2012; effective September 17, 2012. Chapter renumbered 0400-11-02.

Tenn. Comp. R. & Regs. 1200-01-16-.02 REPEALED

History

• Authority: T.C.A. §§ 68-212-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed May 31, 1989; effective August 29, 1989. Repeal filed June 19, 2012; effective September 17, 2012. Chapter renumbered 0400-11-02.

Tenn. Comp. R. & Regs. 1200-01-16-.03 FUNDING

History

• Authority: T.C.A. §§ 68-212-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed May 31, 1989; effective August 29, 1989. Repeal filed June 19, 2012; effective September 17, 2012. Chapter renumbered 0400-11-02.

Tenn. Comp. R. & Regs. 1200-01-16-.04 PROPOSAL

History

• Authority: T.C.A. §§ 68-212-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed May 31, 1989; effective August 29, 1989. Repeal filed June 19, 2012; effective September 17, 2012. Chapter renumbered 0400-11-02.

Tenn. Comp. R. & Regs. 1200-01-16-.05 REPORTS

History

• Authority: T.C.A. §§ 68-212-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed May 31, 1989; effective August 29, 1989.

Tenn. Comp. R. & Regs. 1200-01-16-.06 REPEALED

History

• Authority: T.C.A. §§ 68-212-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed May 31, 1989; effective August 29, 1989. Repeal filed June 19, 2012; effective September 17, 2012. Chapter renumbered 0400-11-02.

Chapter 1200-01-17 Repealed (Renumbered 0400-15-03)

Tenn. Comp. R. & Regs. 1200-01-17-.01 REPEALED

History

• Authority: T.C.A. §§ 68-217-101, et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 1, 1997; effective October 15, 1997. Amendment filed September 27, 2010; effective December 26, 2010. Repeal filed June 19, 2012; effective September 17, 2012. Chapter was renumber 0400-15-03.

Tenn. Comp. R. & Regs. 1200-01-17-.02 REPEALED

History

• Authority: T.C.A. §§ 68-217-101, et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 1, 1997; effective October 15, 1997. Amendment filed July 31, 2003; effective October 14, 2003 Amendment filed November 27, 2006; effective February 10, 2007. Amendment filed September 27, 2010; effective December, 26, 2010. Repeal filed June 19, 2012; effective September 17, 2012. Chapter was renumbered 0400-15-03.

Tenn. Comp. R. & Regs. 1200-01-17-.03 REPEALED

History

• Authority: T.C.A. §§ 68-217-101, et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 1, 1997; effective October 15, 1997. Amendment filed January 12, 2000; effective March 27, 2000. Amendment filed July 31, 2003; effective October 14, 2003. Amendment filed August 1, 2005; effective October 15, 2005. Amendment filed November 27, 2006; effective February 10, 2007. Amendment filed September 27, 2010; effective December 26, 2010. Repeal filed June 19, 2012; effective September 17, 2012. Chapter was renumbered 0400-15-03.

Tenn. Comp. R. & Regs. 1200-01-17-.04 REPEALED

History

• Authority: T.C.A. §§ 68-217-101, et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 1, 1997; effective October 15, 1997. Amendment filed March 18, 1999; effective June 1, 1999. filed July 31, 2003; effective October 14, 2003.Amendment filed November 27, 2006; effective February 10, 2007. Amendment filed September 27, 2010; effective December 26, 2010. Repeal filed June 19, 2012; effective September 17, 2012. Chapter was renumbered 0400-15-03.

Tenn. Comp. R. & Regs. 1200-01-17-.05 REPEALED

History

• Authority: T.C.A. §§ 68-217-101, et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 1, 1997; effective October 15, 1997. Amendment filed July 31, 2003; effective October 14, 2003. Amendment filed August 1, 2005; effective October 15, 2005. Amendment filed November 27, 2007; effective February 10, 2007. Amendment filed September 27, 2010; effective December 26, 2010. Repeal filed June 19, 2012; effective September 17, 2012. Chapter was renumbered 0400-15-03.

Tenn. Comp. R. & Regs. 1200-01-17-.06 REPEALED

History

• Authority: T.C.A. §§68-217-101, et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 1, 1997; effective October 15, 1997. Amendment filed July 31, 2003; effective October 14, 2003. Amendment filed November 27, 2006; effective February 10, 2007. Amendment filed September 27, 2010; effective December 26, 2010.

Tenn. Comp. R. & Regs. 1200-01-17-.07 RESERVED FOR CLEANUP GOALS / CLEANUP ACTIONS

History

• Authority: T.C.A. §§68-217-101, et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 1, 1997; effective October 15, 1997. Amendment filed September 27, 2010; effective December 26, 2010.

Tenn. Comp. R. & Regs. 1200-01-17-.08 REPEALED

History

• Authority: T.C.A. §§ 68-217-101, et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 1, 1997; effective October 15, 1997. Amendment filed January 12, 2000; effective March 27, 2000. Amendment filed July 31, 2003; effective October 14, 2003. Amendment filed August 1, 2005; effective October 15, 2005. Amendment filed November 27, 2007; effective February 10, 2007. Amendment filed September 27, 2010; effective December 26, 2010. Repeal filed June 19, 2012; effective September 17, 2012. Chapter was renumbered 0400-15-03.

Tenn. Comp. R. & Regs. 1200-01-17-.09 REPEALED

History

• Authority: T.C.A. §§ 68-217-101, et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 1, 1997; effective October 15, 1997. Amendment filed July 31, 2003; effective October 14, 2003. Amendment filed November 27, 2006; filed February 10, 2007. Amendment filed September 27, 2010; effective December 26, 2010. Repeal filed June 19, 2012; effective September 17, 2012. Chapter was renumbered 0400-15-03.

Tenn. Comp. R. & Regs. 1200-01-17-.10 REPEALED

History

• Authority: T.C.A. §§ 68-217-101, et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 1, 1997; effective October 15, 1997. Amendment filed September 27, 2010; effective December 26, 2010. Repeal filed June 19, 2012; effective September 17, 2012. Chapter was renumbered 0400-15-03.

Chapter 1200-01-18 Repealed (Renumbered 0400-13-01)

Tenn. Comp. R. & Regs. 1200-01-18-.01 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 11-1-101; and 68-131-401, et seq.
• Administrative History: Original rule filed July 13, 2000; effective September 26, 2000. Amendment filed December 5, 2003; effective February 18, 2004. Amendments filed July 6, 2020; effective October 4, 2020. Repeal and transfer to chapter 0400-13-01 filed March 7, 2024; effective June 5, 2024.

Tenn. Comp. R. & Regs. 1200-01-18-.06 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 11-1-101; and 68-131-401, et seq.
• Administrative History: Original rule filed December 5, 2003; effective February 18, 2004. Repeal and transfer to chapter 0400- 13-01 filed March 7, 2024; effective June 5, 2024.

Tenn. Comp. R. & Regs. 1200-01-18-.02 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 11-1-101; and 68-131-401, et seq.
• Administrative History: Original rule filed December 5, 2003; effective February 18, 2004. Repeal filed March 7, 2024; effective June 5, 2024.

Tenn. Comp. R. & Regs. 1200-01-18-.03 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 11-1-101; and 68-131-401, et seq.
• Administrative History: Original rule filed December 5, 2003; effective February 18, 2004. Repeal filed March 7, 2024; effective June 5, 2024.

Tenn. Comp. R. & Regs. 1200-01-18-.04 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 11-1-101; and 68-131-401, et seq.
• Administrative History: Original rule filed December 5, 2003; effective February 18, 2004. Repeal filed March 7, 2024; effective June 5, 2024.

Tenn. Comp. R. & Regs. 1200-01-18-.05 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 11-1-101; and 68-131-401, et seq.
• Administrative History: Original rule filed December 5, 2003; effective February 18, 2004. Repeal and transfer to chapter 0400- 13-01 filed March 7, 2024; effective June 5, 2024.

Chapter 1200-01-19 Repealed (Renumbered 0400-15-02)

Tenn. Comp. R. & Regs. 1200-01-19-.01 REPEALED

History

• Authority: T.C.A. §§ 68-212-501, et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed November 5, 2004; effective January 19, 2005. Repeal filed August 2, 2012; effective January 29, 2013. Chapter renumbered 0400-15-02.

Tenn. Comp. R. & Regs. 1200-01-19-.02 REPEALED

History

• Authority: T.C.A. §§ 68-212-501, et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed November 5, 2004; effective January 19, 2005. Repeal filed August 2, 2012; effective January 29, 2013. Chapter renumbered 0400-15-02.

Chapter 1200-01-20 Repealed (Renumbered 0400-13-02)

Tenn. Comp. R. & Regs. 1200-01-20-.01 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 11-1-101; and 62-41-101, et seq.
• Administrative History: Original rule filed April 9, 2009; effective June 23, 2009. Repeal and transfer to chapter 0400-13-02 filed February 19, 2025; effective May 20, 2025.

Tenn. Comp. R. & Regs. 1200-01-20-.08 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 11-1-101; and 62-41-101, et seq.
• Administrative History: Original rule filed April 9, 2009; effective June 23, 2009. Repeal and transfer to chapter 0400-13-02 filed February 19, 2025; effective May 20, 2025.

Tenn. Comp. R. & Regs. 1200-01-20-.02 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 11-1-101; and 62-41-101, et seq.
• Administrative History: Original rule filed April 9, 2009; effective June 23, 2009. Repeal and transfer to chapter 0400-13-02 filed February 19, 2025; effective May 20, 2025.

Tenn. Comp. R. & Regs. 1200-01-20-.03 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 11-1-101; and 62-41-101, et seq.
• Administrative History: Original rule filed April 9, 2009; effective June 23, 2009. Repeal and transfer to chapter 0400-13-02 filed February 19, 2025; effective May 20, 2025.

Tenn. Comp. R. & Regs. 1200-01-20-.04 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 11-1-101; and 62-41-101, et seq.
• Administrative History: Original rule filed April 9, 2009; effective June 23, 2009. Repeal and transfer to chapter 0400-13-02 filed February 19, 2025; effective May 20, 2025.

Tenn. Comp. R. & Regs. 1200-01-20-.05 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 11-1-101; and 62-41-101, et seq.
• Administrative History: Original rule filed April 9, 2009; effective June 23, 2009. Repeal and transfer to chapter 0400-13-02 filed February 19, 2025; effective May 20, 2025.

Tenn. Comp. R. & Regs. 1200-01-20-.06 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 11-1-101; and 62-41-101, et seq.
• Administrative History: Original rule filed April 9, 2009; effective June 23, 2009. Repeal and transfer to chapter 0400-13-02 filed February 19, 2025; effective May 20, 2025.

Tenn. Comp. R. & Regs. 1200-01-20-.07 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 11-1-101; and 62-41-101, et seq.
• Administrative History: Original rule filed April 9, 2009; effective June 23, 2009. Repeal and transfer to chapter 0400-13-02 filed February 19, 2025; effective May 20, 2025.

1200-02 Bureau of Environmental Health Services Division of Radiological Health

Chapter 1200-02-01 Repealed

Tenn. Comp. R. & Regs. 1200-02-01 Repealed

RULES

OF THE

TENNESSEE DEPARTMENT OF HEALTH

THE TENNESSEE DEPARTMENT OF ENVIRONMENT AND CONSERVATION

DIVISION OF RADIOLOGICAL HEALTH

Chapter 1200-02-02 Repealed

Tenn. Comp. R. & Regs. 1200-02-02 Repealed

RULES

OF THE

TENNESSEE DEPARTMENT OF HEALTH

THE TENNESSEE DEPARTMENT OF ENVIRONMENT AND CONSERVATION

DIVISION OF RADIOLOGICAL HEALTH

Chapter 1200-02-03 Repealed

Tenn. Comp. R. & Regs. 1200-02-03 Repealed

RULES

OF THE

TENNESSEE DEPARTMENT OF HEALTH

THE TENNESSEE DEPARTMENT OF ENVIRONMENT AND CONSERVATION

DIVISION OF RADIOLOGICAL HEALTH

Chapter 1200-02-04 Repealed (Transferred to chapter 0400-20-04)

Tenn. Comp. R. & Regs. 1200-02-04-.01 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed September 17, 1980; effective November 3, 1980. Amendment filed April 3, 1986; effective May 31, 1986. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-04.

Tenn. Comp. R. & Regs. 1200-02-04-.02 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-04.

Tenn. Comp. R. & Regs. 1200-02-04-.03 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-04.

Tenn. Comp. R. & Regs. 1200-02-04-.04 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed September 17, 1980; effective November 3, 1980. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed January 8, 1990; effective May 1, 1990. Amendment filed May 9, 1990; effective August 29, 1990. Amendment filed March 31, 1992; effective May 15, 1992. Amendment filed July 18, 2002; effective October 1, 2002. Amendment filed November 17, 2005; effective January 31, 2006. Amendments filed December 21, 2009; effective March 21, 2010. Amendment filed November 9, 2010; effective February 7, 2011. Amendments filed September 7, 2011; effective December 6, 2011. Amendments filed September 9, 2011; effective December 8, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-04.

Tenn. Comp. R. & Regs. 1200-02-04-.05 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed March 31, 1992; effective May 15, 1992. Repeal filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-04.

Tenn. Comp. R. & Regs. 1200-02-04-.06 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed May 9, 1990; effective August 29, 1990. Repeal filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-04.

Tenn. Comp. R. & Regs. 1200-02-04-.07 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-04.

Tenn. Comp. R. & Regs. 1200-02-04-.08 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-04.

Tenn. Comp. R. & Regs. 1200-02-04-.09 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed December 15, 1982; effective January 14, 1983. Amendment filed April 3, 1986; effective May 31, 1986. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-04.

Tenn. Comp. R. & Regs. 1200-02-04-.10 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed March 22, 1990; effective June 26, 1990. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-04.

Tenn. Comp. R. & Regs. 1200-02-04-.11 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq. and 68-202-101 et seq.
• Administrative History: Original rule filed July 18, 2002; effective October 1, 2002. Amendment filed November 17, 2005; effective January 31, 2006. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-04.

Tenn. Comp. R. & Regs. 1200-02-04-.12 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 18, 2002; effective October 1, 2002. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-04.

Tenn. Comp. R. & Regs. 1200-02-04-.13 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 18, 2002; effective October 1, 2002. Repeal and new rule filed September 7, 2011; effective December 6, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-04.

Chapter 1200-02-05 Repealed (Transferred to chapter 0400-20-05)

Tenn. Comp. R. & Regs. 1200-02-05-.01 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.165 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.02 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.03 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.04 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.05 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.06 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.07 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.08 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.09 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.10 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.11 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed May 5, 1988; effective August 29, 1988. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.12 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.13 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.14 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.15 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.16 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed January 8, 1990; effective May 1, 1990. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.17 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed July 11, 1988; effective August 25, 1988. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.18 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed May 9, 1990; effective August 29, 1990. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.19 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.20 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed March 9, 1990; effective June 26, 1990. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.21 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.22 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.23 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.24 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.25 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.26 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.27 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.28 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed March 22, 1990; effective June 2, 1990. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20- 05.

Tenn. Comp. R. & Regs. 1200-02-05-.29 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.30 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.31 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.32 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed July 18, 2002; effective October 1, 2002. Amendments filed November 17, 2005; effective January 31, 2006. Amendment filed March 12, 2007; effective May 26, 2007. Amendments filed December 21, 2009; effective March 21, 2010. Amendment filed September 9, 2011; effective December 8, 2011. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.33 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.34 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.35 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.36 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Repeal filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20- 05.

Tenn. Comp. R. & Regs. 1200-02-05-.37 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.38 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.39 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.40 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed July 18, 2002; effective October 1, 2002. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.41 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.42 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.43 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.44 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.45 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.46 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.47 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.48 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.49 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.50 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed July 18, 2002; effective October 1, 2002. Amendment filed March 12, 2007; effective May 26, 2007. Amendment filed September 9, 2011; effective December 8, 2011. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.51 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.52 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed July 18, 2002; effective October 1, 2002.

Tenn. Comp. R. & Regs. 1200-02-05-.53 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.54 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.55 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.56 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.57 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.58 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.59 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.60 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed July 18, 2002; effective October 1, 2002. Amendment filed December 21, 2009; effective March 21, 2010. Amendment filed December 21, 2009; effective March 21, 2010. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.61 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.62 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.63 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.64 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.65 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.66 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.67 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.68 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.69 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.70 REPEALED

History

• Authority: T.C.A.. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendments filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.71 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed November 17, 2005; effective January 31, 2006. Amendment filed December 21, 2009; effective March 21, 2010. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.72 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.73 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.74 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.75 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.76 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.77 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.78 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.79 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.80 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.81 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.82 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.83 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.84 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05. 1200-02-05.85 REPEALED. Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.

Tenn. Comp. R. & Regs. 1200-02-05-.86 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.87 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.88 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.89 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.90 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.91 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.92 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed July 18, 2002; effective October 1, 2002. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.93 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.94 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.95 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.96 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.97 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.98 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.99 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.100 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.101 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.102 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.103 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.104 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.105 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.106 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.107 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.108 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.109 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.110 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed December 21, 2009; effective March 21, 2010. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400- 20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.111 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed July 18, 2002; effective October 1, 2002. Amendment filed November 17, 2005; effective January 31, 2006. Amendment filed December 21, 2009; effective March 21, 2010. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.112 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.113 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.114 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.115 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed November 17, 2005; effective January 31, 2006. Amendment filed December 21, 2009; effective March 21, 2010. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.116 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.117 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.118 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.119 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.120 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed September 9, 2011; effective December 8, 2011. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.121 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.122 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed April 18, 2006; effective July 2, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.123 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.124 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.125 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed July 18, 2002; effective October 1, 2002. Amendment filed September 9, 2011; effective December 8, 2011. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.126 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.127 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed September 9, 2011; effective December 8, 2011. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.128 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.129 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.130 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed July 18, 2002; effective October 1, 2002. Amendments filed November 17, 2005; effective January 31, 2006.

Tenn. Comp. R. & Regs. 1200-02-05-.131 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994.

Tenn. Comp. R. & Regs. 1200-02-05-.132 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.133 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed July 18, 2002; effective October 1, 2002. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20- 05.

Tenn. Comp. R. & Regs. 1200-02-05-.134 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.135 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed July 18, 2002; effective October 1, 2002. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.136 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994.

Tenn. Comp. R. & Regs. 1200-02-05-.137 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed December 21, 2009; effective March 21, 2010. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400- 20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.138 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.139 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.140 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994.

Tenn. Comp. R. & Regs. 1200-02-05-.141 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed July 18, 2002; effective October 1, 2002. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20- 05.

Tenn. Comp. R. & Regs. 1200-02-05-.142 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 18, 2002; effective October 1, 2002. Amendment filed December 21, 2009; effective March 21, 2010. Amendments filed September 9, 2011; effective December 8, 2011. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.143 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed October 16, 1996; effective December 30, 1996. Amendment filed July 18, 2002; effective October 1, 2002. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.144 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.145 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 18, 2002; effective October 1, 2002. Amendment filed December 21, 2009; effective March 21, 2010. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20- 05.

Tenn. Comp. R. & Regs. 1200-02-05-.146 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed September 9, 2011; effective December 8, 2011. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.147 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.148 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.149 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.150 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.151 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.152 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.153 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.154 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.155 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.156 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.157 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.158 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.159 REPEALED

History

• Authority: §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.160 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.161 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 19, 1993; effective January 2, 1994. Amendment filed July 18, 2002; effective October 1, 2002. Amendment filed November 17, 2005; effective January 31, 2006. Amendment filed April 18, 2006; effective July 2, 2006. Amendment filed December 21, 2009; effective March 21, 2010. Amendment filed September 9, 2011; effective December 8, 2011. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.162 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.163 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Tenn. Comp. R. & Regs. 1200-02-05-.164 REPEALED

History

• Authority: T.C.A. §§ 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Repeal of chapter filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-05.

Chapter 1200-02-06 Repealed (Transferred to chapter 0400-20-06)

Tenn. Comp. R. & Regs. 1200-02-06-.01 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter filed February 22, 2012; effective May 22, 2012.

Tenn. Comp. R. & Regs. 1200-02-06-.02 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter filed February 22, 2012; effective May 22, 2012.

Tenn. Comp. R. & Regs. 1200-02-06-.03 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed December 21, 2009; effective March 21, 2010. Repeal of chapter filed February 22, 2012; effective May 22, 2012.

Tenn. Comp. R. & Regs. 1200-02-06-.04 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012.

Tenn. Comp. R. & Regs. 1200-02-06-.05 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter filed February 22, 2012; effective May 22, 2012.

Tenn. Comp. R. & Regs. 1200-02-06-.06 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter filed February 22, 2012; effective May 22, 2012. May, 2012 2

Tenn. Comp. R. & Regs. 1200-02-06-.07 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendments filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012.

Tenn. Comp. R. & Regs. 1200-02-06-.08 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendments filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2012; effective May 22, 2012.

Tenn. Comp. R. & Regs. 1200-02-06-.09 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter filed February 22, 2012; effective May 22, 2012.

Chapter 1200-02-07 Repealed (Transferred to chapter 0400-20-07)

Tenn. Comp. R. & Regs. 1200-02-07-.01 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq..
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal and new rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.02 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal and new rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.03 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendments filed November 17, 2005; effective January 31, 2006. Repeal and new rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.04 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed July 18, 2002; effective October 1, 2002. Amendment filed November 17, 2005; effective January 31, 2006. Repeal and new rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.05 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Amendments filed September 9, 2011; effective December 8, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.06 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.07 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.08 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.09 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.10 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.11 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.12 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.13 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.14 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Repeal and new rule filed September 9, 2011; effective December 8, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.15 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Amendment filed September 9, 2011; effective December 8, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.16 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.17 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.18 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.19 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.20 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.21 REPEALED

History

• Authority: §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.22 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.23 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Amendment filed September 9, 2011; effective December 11, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.24 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Amendments filed September 9, 2011; effective December 8, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.25 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.26 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Amendment filed September 9, 2011; effective December 8, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.27 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.28 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.29 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.30 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Repeal and new rule filed September 9, 2011; effective December 8, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.31 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.32 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.33 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.34 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.35 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.36 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.37 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.38 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Amendment filed September 9, 2011; effective December 8, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.39 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Amendments filed September 9, 2011; effective December 8, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.40 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Amendment filed September 9, 2011; effective December 8, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.41 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Amendment filed September 9, 2011; effective December 8, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.42 RESERVED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.43 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Amendments filed September 9, 2011; effective December 8, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.44 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Amendment filed September 9, 2011; effective December 8, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.45 REPEALED

History

• Authority: §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.46 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.47 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Amendments filed September 9, 2011; effective December 8, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.48 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Amendments filed September 9, 2011; effective December 8, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.49 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Amendments filed September 9, 2011; effective December 8, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.50 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Amendment filed September 11, 2011; effective December 8, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.51 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.52 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.53 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.54 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.55 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.56 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.57 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.58 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.59 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Amendment filed September 9, 2011; effective December 8, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.60 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Amendment filed September 9, 2011; effective December 9, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.61 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.62 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.63 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.64 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.65 REPEALED

History

• Authority: T.C.A. § 68-202-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.66 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.67 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.68 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.69 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.70 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.71 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.72 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.73 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.74 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.75 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.76 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.77 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.78 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.79 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.80 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Amendment filed September 9, 2011; effective December 8, 2011. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.81 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.82 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.83 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.84 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.85 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.86 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.87 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.88 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.89 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.90 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.91 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.92 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.93 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.94 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.95 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.96 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.97 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.98 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.99 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.100 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.101 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.102 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.103 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.104 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.105 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.106 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.107 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.108 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.109 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.110 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.111 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.112 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Tenn. Comp. R. & Regs. 1200-02-07-.113 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 21, 2009; effective March 21, 2010. Chapter repeal filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-07.

Chapter 1200-02-08 Repealed (Transferred to chapter 0400-20-08)

Tenn. Comp. R. & Regs. 1200-02-08-.01 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Repeal of Chapter 1200-02-08 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-08.

Tenn. Comp. R. & Regs. 1200-02-08-.02 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Repeal of Chapter 1200-02-08 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-08.

Tenn. Comp. R. & Regs. 1200-02-08-.03 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed June 19, 1989; effective September 27, 1989. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Amendment filed July 18, 2002; effective October 1, 2002. Amendments filed April 10, 2006; effective June 24, 2006. Amendment filed December 21, 2009; effective March 21, 2010. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Repeal of Chapter 1200-02-08 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-08.

Tenn. Comp. R. & Regs. 1200-02-08-.04 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Amendment filed July 18, 2002; effective October 1, 2002. Amendments filed April 10, 2006; effective June 24, 2006. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Repeal of Chapter 1200-02-08 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-08.

Tenn. Comp. R. & Regs. 1200-02-08-.05 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Amendment filed July18, 2002; effective October 1, 2002. Amendment filed November 17, 2005; effective January 31, 2006. Amendments filed April 10, 2006; effective June 24, 2006. Amendment filed December 21, 2009; effective March 21, 2010. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Repeal of Chapter 1200-02-08 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-08.

Tenn. Comp. R. & Regs. 1200-02-08-.06 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed June 19, 1989; effective September 27, 1989. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Amendment filed July 18, 2002; effective October 1, 2002. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Repeal of Chapter 1200-02-08 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-08.

Tenn. Comp. R. & Regs. 1200-02-08-.07 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Amendment filed July 18, 2002; effective October 1, 2002. Amendment filed November 17, 2005; effective January 31, 2006. Amendment filed December 21, 2009; effective March 21, 2010. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Repeal of Chapter 1200-02-08 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-08.

Tenn. Comp. R. & Regs. 1200-02-08-.08 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Repeal of Chapter 1200-02-08 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-08.

Tenn. Comp. R. & Regs. 1200-02-08-.09 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Repeal of Chapter 1200-02-08 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-08.

Tenn. Comp. R. & Regs. 1200-02-08-.10 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed June 19, 1989; effective September 27, 1989. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Amendments filed November 17, 2005; effective January 31, 2006. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Repeal of Chapter 1200-02-08 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-08.

Tenn. Comp. R. & Regs. 1200-02-08-.11 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Amendment filed December 21, 2009; effective March 21, 2010. filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-08.

Tenn. Comp. R. & Regs. 1200-02-08-.12 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 27, 1993; effective January 10, 1994. Amendment filed November 17, 2005; effective January 31, 2006. Amendment filed April 10, 2006; effective June 24, 2006. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Repeal of Chapter 1200-02-08 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-08.

Tenn. Comp. R. & Regs. 1200-02-08-.13 RESERVED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of Chapter 1200-02-08 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-08.

Tenn. Comp. R. & Regs. 1200-02-08-.14 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of Chapter 1200-02-08 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-08.

Tenn. Comp. R. & Regs. 1200-02-08-.15 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 18, 2002; effective October 1, 2002. Amendment filed November 17, 2005; effective January 31, 2006. Repeal and new rule filed April 10, 2006; effective June 24, 2006. filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-08.

Tenn. Comp. R. & Regs. 1200-02-08-.16 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 18, 2002; effective October 1, 2002. Repeal and new rule filed October 27, 1993; effective January 10, 1994. Repeal of Chapter 1200-02-08 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-08.

Chapter 1200-02-09 Repealed (Transferred to chapter 0400-20-09)

Tenn. Comp. R. & Regs. 1200-02-09-.01 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter 1200-02-09 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-09.

Tenn. Comp. R. & Regs. 1200-02-09-.02 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter 1200-02-09 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-09.

Tenn. Comp. R. & Regs. 1200-02-09-.03 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendments filed December 21, 2009; effective March 21, 2010. Repeal of chapter 1200-02-09 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-09.

Tenn. Comp. R. & Regs. 1200-02-09-.04 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed December 21, 2009; effective March 21, 2010. Repeal of chapter 1200-02-09 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-09.

Tenn. Comp. R. & Regs. 1200-02-09-.05 REPEALED

History

• Authority: T.C.A. §68-23-101 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter 1200-02-09 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-09.

Tenn. Comp. R. & Regs. 1200-02-09-.06 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed December 21, 2009; effective March 21, 2010. Repeal of chapter 1200-02-09 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-09.

Tenn. Comp. R. & Regs. 1200-02-09-.07 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter 1200-02-09 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-09.

Tenn. Comp. R. & Regs. 1200-02-09-.08 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter 1200-02-09 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-09.

Tenn. Comp. R. & Regs. 1200-02-09-.09 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter 1200-02-09 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-09.

Tenn. Comp. R. & Regs. 1200-02-09-.10 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter 1200-02-09 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-09.

Tenn. Comp. R. & Regs. 1200-02-09-.11 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter 1200-02-09 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-09.

Tenn. Comp. R. & Regs. 1200-02-09-.12 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter 1200-02-09 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-09.

Tenn. Comp. R. & Regs. 1200-02-09-.13 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter 1200-02-09 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-09.

Tenn. Comp. R. & Regs. 1200-02-09-.14 REPEALED

History

• Authority: §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter 1200-02-09 filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-09.

Tenn. Comp. R. & Regs. 1200-02-09-.15 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986.

Tenn. Comp. R. & Regs. 1200-02-09-.16 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986.

Tenn. Comp. R. & Regs. 1200-02-09-.17 REPEALED

History

• Authority: T.C.A. §§§§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed November 17, 2005; effective January 31, 2006. Amendment filed December 21, 2009; effective March 21, 2010.

Tenn. Comp. R. & Regs. 1200-02-09-.18 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986.

Tenn. Comp. R. & Regs. 1200-02-09-.19 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986.

Tenn. Comp. R. & Regs. 1200-02-09-.20 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed November 17, 2005; effective January 31, 2006.

Tenn. Comp. R. & Regs. 1200-02-09-.21 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendments filed November 17, 2005; effective January 31, 2006.

Tenn. Comp. R. & Regs. 1200-02-09-.22 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986.

Chapter 1200-02-10 Repealed (Transferred to chapter 0400-20-10)

Tenn. Comp. R. & Regs. 1200-02-10-.01 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.02 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal and new rule filed September 9, 2011; effective December 8, 2011. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.03 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed December 21, 2009; effective March 21, 2010. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.04 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed June 5, 1991; effective September 28, 1991. Amendment filed November 17, 2005; effective January 31, 2006. Amendment filed December 21, 2009; effective December 21, 2010. Amendments filed September 9, 2011; effective December 8, 2011. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.05 REPEALED

History

• Authority: §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.06 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.07 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.08 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed March 12, 2007; effective May 26, 2007. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.09 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.10 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed July 18, 2002; effective October 1, 2002. Amendments filed November 17, 2005; effective January 31, 2006. Amendment filed March 12, 2007; effective May 26, 2007. Amendment filed December 21, 2009; effective March 21, 2010. Amendments filed September 9, 2011; effective December 8, 2011. Repeal of chapter 1200-02- 10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.11 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal and new rule filed September 9, 2011; effective December 8, 2011. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.12 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed October 22, 1987; effective December 6, 1987. Amendment filed September 7, 2011; effective December 6, 2011. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20- 10.

Tenn. Comp. R. & Regs. 1200-02-10-.13 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed March 31, 1992; effective May 15, 1992. Amendment filed July 18, 2002; effective October 1, 2002. Amendments filed November 17, 2005; effective January 31, 2006. Amendment filed March 12, 2007; effective May 26, 2007. Amendments filed December 21, 2009; effective March 21, 2010. Amendments filed September 9, 2011; effective December 8, 2011. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.14 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed July 18, 2002; effective October 1, 2002. Amendment filed November 17, 2005; effective January 31, 2006. Repeal filed December 21, 2009; effective March 21, 2010. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.15 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.16 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed May 5, 1988; effective August 29, 1988. Amendment filed July 18, 2002; effective October 1, 2002. Amendment filed November 17, 2005; effective January 31, 2006. Amendment filed March 12, 2007; effective May 26, 2007. Amendments filed December 21, 2009; effective March 21, 2010. Repeal and new rule filed September 9, 2011; effective December 8, 2011. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.17 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed March 12, 2007; effective May 26, 2007. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.18 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed December 21, 2009; effective March 21, 2010. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.19 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.20 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.21 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.22 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed March 12, 2007; effective May 26, 2007. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.23 REPEALED

History

• Authority: T.C.A. § §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed December 21, 2009; effective March 21, 2010. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.24 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed January 26, 1993; effective March 12, 1993. Amendment filed October 1, 2001; effective December 15, 2001. Amendment filed October 17, 2001; effective December 31, 2001. Amendment filed September 4, 2003; effective November 18, 2003. Amendment filed November 17, 2005; effective January 31, 2006. Amendment filed September 7, 2011; effective December 6, 2011. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.25 REREALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed January 26, 1993; effective March 12, 1993. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.26 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed December 21, 2009; effective March 21, 2010. Amendment filed September 7, 2011; effective December 6, 2011. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.27 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed January 26, 1993; effective March 12, 1993. Amendment filed October 17, 2001; effective December 31, 2001. Amendment filed July 18, 2002; effective October 1, 2002. Amendment filed September 4, 2003; effective November 18, 2003. Amendment filed November 17, 2005; effective January 31, 2006. Amendment filed December 21, 2009; effective March 21, 2010. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.28 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.29 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed September 9, 2011; effective December 8, 2011. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.30 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed January 8, 1990; effective May 1, 1990. Amendment filed July 18, 2002; effective October 1, 2002. Repeal and new rule filed September 7, 2011; effective December 6, 2011. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.31 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed September 3, 1991; effective October 18, 1991. Amendment filed March 31, 1992; effective May 15, 1992. Amendment filed October 1, 2001; effective December 15, 2001. Amendments filed December 21, 2009; effective March 21, 2010. Amendment filed November 9, 2010; effective February 7, 2011. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.32 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed September 3, 1991; effective October 18, 1991. Amendments filed November 17, 2005; effective January 31, 2006. Amendment filed December 21, 2009; effective March 21, 2010. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.33 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed August 15, 1978; effective October 2, 1978. Amendment filed April 3, 1986; effective May 31, 1986. Amendment filed June 5, 1991; effective September 28, 1991. Amendment filed December 21, 2009; effective March 21, 2010. Repeal of rule filed December 21, 2009; effective March 21, 2010; withdrawal of repeal filed February 24, 2010. Repeal filed November 9, 2010; effective February 7, 2011. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.34 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed Apri1 11, 2001; effective June 25, 2001. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.35 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 18, 2002; effective October 1, 2002. Repeal filed December 21, 2009; effective March 21, 2010. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.36 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 18, 2002; effective October 1, 2002. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.37 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 18, 2002; effective October 1, 2002. Repeal filed November 9, 2010; effective February 7, 2011. Repeal of chapter 1200-02-10 filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Tenn. Comp. R. & Regs. 1200-02-10-.38 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq. Administrative filed February 22, 2012; effective May 22, 2012. Chapter renumbered 0400-20-10.

Chapter 1200-02-11 Repealed (Transferred to chapter 0400-20-11)

Tenn. Comp. R. & Regs. 1200-02-11-.01 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-11.

Tenn. Comp. R. & Regs. 1200-02-11-.02 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-11.

Tenn. Comp. R. & Regs. 1200-02-11-.03 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-11.

Tenn. Comp. R. & Regs. 1200-02-11-.04 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-11.

Tenn. Comp. R. & Regs. 1200-02-11-.05 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-11.

Tenn. Comp. R. & Regs. 1200-02-11-.06 REPEALED

History

• Authority: §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-11.

Tenn. Comp. R. & Regs. 1200-02-11-.07 REPEALED

History

• Authority: §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-11.

Tenn. Comp. R. & Regs. 1200-02-11-.08 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-11.

Tenn. Comp. R. & Regs. 1200-02-11-.09 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-11.

Tenn. Comp. R. & Regs. 1200-02-11-.10 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-11.

Tenn. Comp. R. & Regs. 1200-02-11-.11 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-11.

Tenn. Comp. R. & Regs. 1200-02-11-.12 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-11.

Tenn. Comp. R. & Regs. 1200-02-11-.13 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-11.

Tenn. Comp. R. & Regs. 1200-02-11-.14 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Amendment filed September 9, 2011; effective December 8, 2011. Repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-11.

Tenn. Comp. R. & Regs. 1200-02-11-.15 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Amendment filed December 21, 2009; effective March 21, 2010. Repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-11.

Tenn. Comp. R. & Regs. 1200-02-11-.16 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-11.

Tenn. Comp. R. & Regs. 1200-02-11-.17 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Amendment filed November 17, 2005; effective January 31, 2006. Repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-11.

Tenn. Comp. R. & Regs. 1200-02-11-.18 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-11.

Tenn. Comp. R. & Regs. 1200-02-11-.19 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repeal filed February 22, 2012; effective May 22, 2012. Chapter was renumbered 0400-20-11.

Chapter 1200-02-12 Repealed (Transferred to chapter 0400-20-12)

Tenn. Comp. R. & Regs. 1200-02-12-.01 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.02 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.03 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Amendment filed July 18, 2002; effective October 1, 2002. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20- 12.

Tenn. Comp. R. & Regs. 1200-02-12-.04 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.05 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.06 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Amendments filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.07 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Amendments filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.08 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.09 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Amendments filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.10 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.11 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.12 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Repeal and new rule filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.13 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.14 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.15 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.16 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.17 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.18 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.19 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.20 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Amendment filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.21 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.22 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.23 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Amendment filed July 18, 2002; effective October 1, 2002. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.24 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.25 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.26 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 9, 1992; effective November 23, 1992. Amendments filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.27 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

Tenn. Comp. R. & Regs. 1200-02-12-.28 REPEALED

History

• Authority: T.C.A. §§ 68-202-101 et seq., 68-202-201 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed November 17, 2005; effective January 31, 2006. Repeal of chapter filed February 22, 2912; effective May 22, 2012. Chapter was renumbered 0400-20-12.

1200-03 Division of Air Pollution Control

Chapter 1200-03-01 General Provisions (Please see 0400-30 for additional Air Pollution Control rules)

Tenn. Comp. R. & Regs. 1200-03-01-.01 GENERAL RULES

(1)These regulations are intended to implement provisions of the “Tennessee Air Quality Act”

(Tennessee Code Annotated, Section 53-3408, et seq.) and shall be known and cited as the Tennessee Air Pollution Control Regulations.

(2)These regulations are based upon the premise that the basic and foremost function of the air is to sustain life and that air in its purest state is best suited for this need. It is intended that these regulations assist in maintaining an equitable balance between benefits of clean air and the economic cost of achieving clean air. More specifically, it is intended that these regulations define ambient air quality standards to be achieved and maintained and to provide for an orderly and equitable regulation of air quality by limiting emissions of air contaminants.

(3)The ambient air is the air surrounding us. Ambient air quality standards determine the level of air quality in which we will live, and should be used as tools in achieving cleaner air, not as a permit to unnecessarily degrade air quality. Polluted air can be a menace to all forms of life and, therefore, the disposal of wastes into the atmosphere must be controlled.

(4)Ambient air quality standards are further intended to promote the maximum use of property. When the problems involved are aesthetic in nature, an equitable economic balance must be achieved. When a health hazard is involved, there can be no compromise.

(5)The requirements for limiting airborne contaminants must relate effects on men, animals, vegetation, and property to pollutant concentration at the point of contact. This, in turn, must be correlated with the source or sources. When multiple sources of a pollutant exist in an area, a limitation of the emission from each source must be exercised, and the individual contribution to the total pollutant load in the area must be reduced to insure compliance with the ambient air quality standards. This is accomplished by the application of emission standards.

(6)An emission standard is a limit on the amount of air contaminant emitted from a source, and is intended to bring the ambient air within acceptable air quality limits.

(7)These standards will be modified from time to time, as additional information on air contaminants and sources of air pollution are developed and evaluated.

History

• Authority: T.C.A. Section 53-3412. Administrative History. Original Rule certified June 7, 1974. Rule Amended: Filed January 10, 1977; Effective February 9, 1977.

Tenn. Comp. R. & Regs. 1200-03-01-.02 SEVERABILITY

The provisions of this Division 1200-3, the Tennessee Air Pollution Control Regulations, are severable and if any chapter, rule, paragraph, subparagraph, part, subpart, item, subitem, section, subsection, sentence, or phrase therein shall be adjudged to be invalid or unconstitutional by any court of competent jurisdiction, the judgment shall not effect, impair or invalidate the remainder of this Division 1200-3, but shall be confined to the Chapter, rule, paragraph, subparagraph, part, subpart, item, subitem, section, subsection, sentence or phrase of this Division that shall be directly involved in the controversy in which such judgment shall have been rendered.

History

• Authority: T.C.A. Section 53-3412. Administrative History. Original Rule filed August 28, 1979, effective October 12, 1979.

Chapter 1200-03-02 Definitions

Tenn. Comp. R. & Regs. 1200-03-02-.01 GENERAL DEFINITIONS

(1) When used in Rule Division 1200-03, unless the context clearly indicates otherwise:

(a) Air Contaminant is particulate matter, dust, fumes, gas, mist, smoke, or vapor, or any combinations thereof.

(b) Air Contaminant Source is any and all sources of emission of air contaminants, whether privately or publicly owned or operated. Without limiting the generality of the foregoing, this term includes all types of business, commercial and industrial plants, works, shops, and stores, and heating and power plants and stations, building and other structures of all types, including multiple family residences, apartment houses, office buildings, hotels, restaurants, schools, hospitals, churches and other institutional buildings, automobiles, trucks, tractors, buses and other motor vehicles, garages and vending and service locations and stations, railroad locomotives, ships, boats and other water-borne craft, portable fuel-burning equipment, incinerators of all types, indoor and outdoor, refuse dumps and piles, and all stack and other chimney outlets from any of the foregoing; provided, however, that neither automobiles, trucks, tractors, buses, or other motor vehicles powered by any fuel other than diesel oil and which were manufactured prior to September 1, 1967, automobiles, trucks, tractors, buses, or other motor vehicles which are equipped to comply and do comply with the Federal “Motor Vehicle Air Pollution Control Act” shall be considered or determined to be an “air contaminant source.”

(c) “Air Curtain Destructor or Air Curtain Incinerator” is a portable or stationary combustion device that directs a plane of high velocity forced draft air through a manifold head into a burn chamber with vertical walls in such a manner as to maintain a curtain of air over the surface of the burn chamber and a recirculating motion of air under the curtain.

(d) Air Pollution means presence in the outdoor atmosphere of one or more air contaminants in sufficient quantities and of such characteristics and duration as to be injurious to human, plant or animal life, or to property, or which unreasonably interfere with the enjoyment of life and property.

(e) Alternative Method means any method of sampling and analyzing for an air pollutant which is not a reference method or an equivalent method, but which has been demonstrated to the Technical Secretary’s satisfaction to produce, in specific cases, results adequate for its determination of compliance, or any method so designated by these regulations.

(f) Ambient Air is that portion of the atmosphere, external to buildings.

(g) “Best Available Control Technology (BACT)” means an emission limitation (including a visible emission standard) based on the maximum degree of reduction for each pollutant subject to regulation under these rules which would be emitted from any proposed new or modified air contaminant source that the Technical Secretary, on a case-by-case basis, taking into account energy, environmental, and economic impacts and other costs, determines is achievable for such source or modification through application of production processes or available methods, systems, and techniques, including fuel cleaning or treatment or innovative fuel combustion techniques for control of such pollutant. In no event shall application of best available control technology result in emissions of any pollutant that would exceed the emissions allowed by any applicable standard under Chapters 0400-30-38 or 0400-30-39 of these rules. If the Technical Secretary determines that technological or economic limitations on the application of measurement methodology to a particular class of sources would make the imposition of an emission standard infeasible, a design, equipment, work practice, or operational standard, or combination thereof, may be prescribed instead to require the application of best available control technology. Such standard must, to the degree possible, set forth the emission reduction achievable by implementation of such design, equipment, work practice, or operation, and must provide for compliance by means that achieve equivalent results.

(h) Board means the Air Pollution Control Board of the State of Tennessee.

(i) Commenced means that an owner or operator has undertaken a continuous program of construction or modification or that an owner or operator has entered into a contractual obligation to undertake and complete, within a reasonable time a continuous program of construction or modification.

(j) Construction means fabrication, erection, or installation of a stationary source or modification.

(k) Continuous Monitoring is sampling and analysis of air contaminants in a continuous or timed sequence, using techniques which will adequately reflect actual emission levels or ambient concentrations on a continuous basis.

(l) Cupola is a stack-type furnace in which fuel, metal, and fluxing agents are intermixed and is used for producing molten metal. It consists primarily of, but is not limited to, furnace proper, tuyeres, fans or blowers, tapping ports, other auxiliary equipment.

Cupolas are further categorized for the purpose of these regulations as follows:

1. Ferrous - a cupola in which the major component of the metal produced is iron.

2. Jobbing - a cupola used in an intermittent type operation where the process weight is not in excess of 20,000 pounds per hour and the operating (firing) time is not in excess of 4 hours per day.

3. Existing - a cupola placed in operation at its present location prior to April 3, 1972.

(m) Department is the Department of Environment and Conservation of the State of Tennessee.

(n) Effective Date of these regulations is April 3, 1972.

(o) Emission is the release of material to the ambient air.

(p) Equivalent Method is any method of monitoring, sampling, and analyzing for an air contaminant which can be demonstrated to the Technical Secretary’s satisfaction to have a consistent and quantitatively known relationship to the reference method, under specific conditions, or any method so designated by these regulations.

(q) Existing Source is, with respect to any rule, any air contaminant source which is not a new source.

(r) Fuel Burning Equipment is any equipment, device, or contrivance and all appurtenances thereto, in which fuel is burned for the primary purpose of producing thermal or mechanical energy and in which the material being heated is not contacted by, and adds no substance to, the products of combustion.

(s) Fuel Burning Installation consists of one or more units of fuel-burning equipment where the products of combustion are discharged through a single stack or where the products of combustion are discharged through more than one stack the plumes from which tend to merge into a single plume.

(t) Fugitive Dust is any visible emission, other than water droplets, issuing from any source other than through a stack.

(u) Garbage is putrescible animal or vegetable waste.

(v) Hazardous Air Contaminant is any air contaminant which may cause, or contribute to, an increase in mortality or an increase in serious irreversible, or incapacitating reversible illness and has been so designated by the Board.

(w) Incinerator is any equipment, device, or contrivance used for disposal of waste or refuse by burning, including wigwam burners, air curtain destructors, and air curtain incinerators.

(x) Isokinetic Sampling means sampling in which the linear velocity of the gas entering the sampling nozzle is equal to that of the undisturbed gas stream at the sampling point.

(y) Kraft Mill is any pulping process which uses for a cooking liquor an alkaline sulfide solution containing sodium hydroxide and sodium sulfide.

(z) Malfunction means any sudden and unavoidable failure of air pollution control equipment or process equipment, or for a process to operate in an abnormal and unusual manner. Failures that are caused by poor maintenance, careless operation, or any other preventable upset condition or preventable equipment breakdown shall not be considered malfunctions.

(aa) Modification is any physical change in or change in the method of operation of an air contaminant source, which increases the amount of any air contaminant (to which an emission standard applies) emitted by such source or which results in the emission of any air contaminant (to which an emission standard applies) not previously emitted except that:

1. Routine maintenance, repair, and replacement shall not be considered physical changes, and 2. The following shall not be considered a change in the method of operation:

(i) An increase in the production rate, if such increase does not exceed the operating design capacity nor the stated production rate on the permit of the affected source.

(ii) An increase in hours of operation if such increase does not exceed the operating hours stipulated as a permit condition of the source.

(iii) The use of an alternative fuel if the source is designed to accommodate such alternative fuel.

(iv) Required alterations to equipment for the use of an alternative fuel or raw material by reason of an order under Section 2(a) and (b) of the Energy Supply and Environmental Coordination Act of 1974 (or any superseding legislation) or by reason of a natural gas curtailment plan in effect pursuant to the Federal Power Act.

3. Any physical change in or change in the method of operation of an air contaminant source subject to a major source operating permit issued under paragraph 1200-03-09-.02(11), which does not meet the definition of “Title I Modification” under part 1200-03-09-.02(11)(b)28. but which qualifies as an operational flexibility change under part 1200-03-09-.02(11)(a)4., as a minor permit modification under subpart 1200-03-09-.02(11)(f)5.(ii), or for group processing of minor permit modifications under subpart 1200-03-09- .02(11)(f)5.(iii), shall not require a construction permit under subparagraph 1200- 03-09-.01(1)(a).

4. Any physical change in or change in the method of operation of an air contaminant source not subject to requirements of paragraphs 1200-03-09- .02(11), 1200-03-09-.01(4), and 1200-03-09-.01(5) and which does not result in emissions exceeding the emissions allowable under the existing operating permit and which does not result in the emission of any air contaminant (to which an emission standard applies) not previously emitted, shall not require a construction permit under subparagraph 1200-03-09-.01(1)(a). The air contaminant source, to make changes pursuant to this part, shall provide the Technical Secretary with written notification of at least 7 days in advance of the proposed change. The written notification shall contain a brief description of the change, the date on which the change will occur, pollutants emitted, declaration of any change in emissions, and any applicable requirements that would apply as a result of the change. The written notice shall also contain a statement that the change does not result in emissions exceeding the emissions allowable under the existing operating permit. The Technical Secretary and the air contaminant source shall attach each such notice to their copy of the relevant permit.

5. The burden of proof establishing that a change is excepted under parts 1., 2., 3., and 4., is on the owner or operator. Further expansions or restrictions of the definition may be listed in specific chapters or rules.

6. “Major modification” is defined in paragraph 1200-03-09-.01(4) and shall be overriding for the purposes of that paragraph.

(bb) New Nitric Acid Plant is any air contaminant source producing weak nitric acid (acid which is 30 to 70 percent in strength) by either the pressure or atmospheric pressure process.

(cc) New Source is, with respect to any rule, any air contaminant source the construction or modification of which is commenced on or after the date specified in that rule. (If no date is specified in a rule, then the effective date of the rule, or the specific applicable provision of the rule, is the cut off date). However, if an effective earlier date rule is contained in the same provision, then that earlier date is the cut off date whether such commencement was for an entirely or substantially new source or the modification of an existing source. The word substantially here means replacing virtually all of an existing source, excluding the foundation and utility and/or control lines to the site. The construction of a new source at an air contaminant source subject to a major source operating permit issued under paragraph 1200-03-09-.02(11), which is not subject to paragraphs 1200-03-09-.01(4) and 1200-03-09-.01(5) but which qualifies as a minor permit modification under subpart 1200-03-09-.02(11)(f)5.(ii), shall not require a construction permit under subparagraph 1200-03-09-.01(1)(a).

(dd) New Source Performance Standard is a standard for the emission of an air contaminant promulgated by the Administrator of the Environmental Protection Agency and published in the Federal Register.

(ee) New Sulfuric Acid Plant is any air contaminant source producing sulfuric acid by the contact process by burning elemental sulfur, alkylation acid, hydrogen sulfide, organic sulfides and mercaptans, or acid sludge, but does not include air contaminant sources where conversion to sulfuric acid is utilized primarily as a means of reducing emissions to the atmosphere of sulfur dioxide or other sulfur compounds.

(ff) Opacity is the degree to which emissions reduce the transmission of light and obscure the view of an object in the background.

(gg) “National Emission Standards for Hazardous Air Pollutants” are standards for the emissions of hazardous air pollutants promulgated by the Administrator of the Environmental Protection Agency and published in the Federal Register.

(hh) Owner or Operator is any person who owns, leases, operates, controls, or supervises an air contaminant source.

(ii) Particulate Matter is any material, except uncombined water, that exists in a finely divided form as a liquid or a solid.

(jj) Part Per Billion (ppb) is a term describing parts of an air contaminant per billion parts of gas by volume (1 ppb equals 0.0000001 percent by volume).

(kk) Parts Per Million (ppm) is a term describing parts of an air contaminant per million parts of gas by volume (1 ppm equals 0.0001 percent by volume).

(ll) Person is any individual, partnership, copartnership, firm, company, corporation, association, joint stock company, trust, estate, political subdivision, an agency,

authority, Commission, or Department of the United States Government, or of the State of Tennessee Government; or any other legal entity, or their legal representative, agent, or assigns.

(mm) Point Source shall have the same meaning as defined in Part 51 of Title 40 of the Code of Federal Regulations.

(nn) Political Subdivision is any municipality, city, incorporated town, county, district or

authority, or any portion or combination of two or more thereof.

(oo) Portland Cement Plant is any air contaminant source manufacturing portland cement by either the wet or dry process.

(pp) Process Emission is any emission of an air contaminant to the ambient air other than that from fuel burning equipment, incinerator, wigwam burners, or open burning.

(qq) Process Emission Source is one or more units of processing equipment which may be operated independently of other parts of the operations at any given manufacturing or processing facility; also, where it is common practice to group more than one unit of like or similar processing equipment together and to apply a single or combined unit of air pollution control equipment to the emissions of the entire group, such group of units shall be construed as a process emission source.

(rr) Process Weight means the total weight of all materials introduced into any specific process that may cause any emission of particulate matter. Solid fuels charged are considered as part of the process weight, but liquid and gaseous fuels and combustionair are not.

(ss) Process Weight Rate is a rate established as follows:

1. For continuous or long-run, steady-state, operations, it is the total process weight for the entire period of continuous operation or for a typical portion thereof, divided by the number of hours of such period or portion thereof.

2. For cyclical or batch source operations, it is the total process weight for a period which covers a complete or an integral number of cycles, divided by the hours of actual process operation during such period.

3. Where the nature of any process or operation or the design of any equipment is such as to permit more than one interpretation of this definition, that interpretation which results in the minimum value for allowable emissions shall apply.

(tt) Proportional Sampling means sampling at a rate that produces a constant ratio of sampling rate to stack gas flow rate.

(uu) Referenced Method is a method of monitoring, sampling, and analyzing for an air contaminant as described in these regulations.

(vv) Reserved.

(ww) Salvage Operation is any business, trade, or industry engaged in whole or in part, in reclaiming one or more items of value.

(xx) Shutdown means the cessation of operation of an air contaminant source for any

purpose.

(yy) Smoke is small gas-borne particles resulting from incomplete combustion, consisting predominantly, but not exclusively, of carbon and other combustible material. It does not include water vapor or water droplets.

(zz) Reserved.

(aaa) Stack is any chimney, flue, conduit, exhaust, vent, or opening of any kind whatsoever, capable of, or used for, the emission of air contaminants.

(bbb) Standard means a standard of performance promulgated under these regulations.

(ccc) Startup is the setting in operation of an air contaminant source for the production of product for sale or use as raw materials or stream or heat production.

(ddd) Stationary Source means any building, structure, facility, or installation which emits or may emit any air contaminant.

(eee) Suspended Particulates is particulate matter which will remain suspended in air for an appreciable period of time.

(fff) Technical Secretary is the Technical Secretary of the Air Pollution Control Board of the State of Tennessee.

(ggg) Wigwam Burner is a type of burner commonly known as tepee, truncated cone conical burner, or silo burner.

(hhh) Excess Emissions means an emission rate which exceeds any applicable emission limitation prescribed by subsequent chapters of these regulations. The averaging time and test procedures for determining such excess emissions shall be as specified as

part of the applicable emission limitation.

(iii) Liquid Sulfur Dioxide Plants are any plants designed to produce compressed liquid sulfur dioxide as a final product.

(jjj) Pellet Plants are plants designed to produce iron oxide pellets for manufacture of iron or prereduction utilizing iron calcones produced from a natural bearing iron ore source.

(kkk) Mine Shaft Heaters are fuel burning equipment used during cold weather to prevent ice from forming in a mine shaft with the primary purpose of safety assurance for miners and protection of shaft equipment.

(lll) “Exempt compounds” means any of the following compounds:

1. Carbon monoxide; carbon dioxide; carbonic acid; metallic carbides and carbonates; ammonium carbonate; propylene carbonate; dimethyl carbonate; methane; ethane; methylene chloride (dichloromethane); 1,1,1-trichloroethane (methyl chloroform); 1,1,2-trichloro-1,2,2-trifluoroethane (CFC-113); trichlorofluoromethane (CFC-11); dichlorodifluoromethane (CFC-12); chlorodifluoromethane (HCFC-22); trifluoromethane (HFC-23); 1,2-dichloro 1,1,2,2-tetrafluoroethane (CFC-114); chloropentafluoroethane (CFC-115); 1,1,1trifluoro 2,2-dichloroethane (HCFC-123); 1,1,1,2-tetrafluoroethane (HFC-134a); 1,1-dichloro 1-fluoroethane (HCFC-141b); 1-chloro 1,1-difluoroethane (HCFC- 142b); 2-chloro-1,1,1,2-tetrafluoroethane (HCFC-124); pentafluoroethane (HFC- 125); 1,1,2,2-tetrafluoroethane (HFC-134); trans-1,3,3,3-tetrafluoropropene (HFO-1234ze); 1,1,1-trifluoroethane(HFC-143a);1,1-difluoroethane (HFC-152a); parachlorobenzotrifluoride (PCBTF); cyclic, branched, or linear completely methylated siloxanes; acetone; perchloroethylene (tetrachloroethylene); 3,3dichloro-1,1,1,2,2-pentafluoropropane (HCFC-225ca); 1,3-dichloro-1,1,2,2,3pentafluoropropane (HCFC-225cb); 1,1,1,2,3,4,4,5,5,5-decafluoropentane (HFC- 43-10mee); difluoromethane (HFC-32); ethylfluoride (HFC-161); 1,1,1,3,3,3hexafluoropropane (HFC-236fa); 1,1,2,2,3-pentafluoropropane (HFC-245ca); 1,1,2,3,3-pentafluoropropane (HFC-245ea); 1,1,1,2,3-pentafluoropropane (HFC- 245eb); 1,1,1,3,3-pentafluoropropane (HFC-245fa); 1,1,1,2,3,3hexafluoropropane (HFC-236ea); 1,1,1,3,3-pentafluorobutane (HFC-365mfc); chlorofluoromethane (HCFC-31); 1-chloro-1-fluoroethane (HCFC-151a); 1,2dichloro-1,1,2-trifluoroethane (HCFC-123a); 1,1,1,2,2,3,3,4,4-nonafluoro-4methoxy-butane (C F OCH or HFE-7100); 2-(difluoromethoxymethyl)- 1,1,1,2,3,3,3-heptafluoropropane ((CF )

CFCF

OCH ); 1-ethoxy- 1,1,2,2,3,3,4,4,4-nonafluorobutane (C F OC H or HFE-7200); 2- (ethoxydifluoromethyl)-1,1,1,2,3,3,3-heptafluoropropane ((CF )

CFCF

OC H ); methyl acetate; 1,1,1,2,2,3,3-heptafluoro-3-methoxy-propane (n-C F OCH , HFE-7000); 3-ethoxy-1,1,1,2,3,4,4,5,5,6,6,6-dodecafluoro-2-(trifluoromethyl) hexane (HFE-7500); 1,1,1,2,3,3,3-heptafluoropropane (HFC 227ea); methyl formate (HCOOCH ); 1,1,1,2,2,3,4,5,5,5-decafluoro-3-methoxy-4-trifluoromethylpentane (HFE-7300); trans-1,3,3,3-tetrafluoropropene; HCF OCF H (HFE-134);

HCF OCF

OCF H (HFE-236cal2); HCF OCF CF OCF H (HFE-338pcc13);

HCF OCF

OCF CF

OCF H (H-Galden 1040x or H-Galden ZT 130 (or 150 or 180)); trans 1-chloro-3,3,3-trifluoroprop-1-ene; 2,3,3,3-tetrafluoropropene; 2amino-2-methyl-1-propanol (AMP); t-butyl acetate; 1,1,2,2-Tetrafluoro-1-(2,2,2trifluoroethoxy) ethane (HFE-347pcf2) and perfluorocarbon compounds which fall into these classes:

(i) Cyclic, branched, or linear, completely fluorinated alkanes;

(ii) Cyclic, branched, or linear, completely fluorinated ethers with no unsaturations;

(iii) Cyclic, branched, or linear, completely fluorinated tertiary amines with no unsaturations; and (iv) Sulfur containing perfluorocarbons with no unsaturations and with sulfur bonds only to carbon and fluorine.

2. Reserved.

(mmm)“Volatile Organic Compounds (VOC)” means any compound of carbon, excluding carbon monoxide, carbon dioxide, carbonic acid, metallic carbides or carbonates, and ammonium carbonate, which participates in atmospheric photochemical reactions.

1. This includes any such organic compound other than the following, which have been determined to have negligible photochemical reactivity: methane; ethane; methylene chloride (dichloromethane); 1,1,1-trichloroethane (methyl chloroform); 1,1,2-trichloro-1,2,2-trifluoroethane (CFC-113); trichlorofluoromethane (CFC-11); dichlorodifluoromethane (CFC-12); chlorodifluoromethane (HCFC-22); trifluoromethane (HFC-23); 1,2-dichloro 1,1,2,2-tetrafluoroethane (CFC-114); chloropentafluoroethane (CFC-115); 1,1,1-trifluoro 2,2-dichloroethane (HCFC- 123); 1,1,1,2-tetrafluoroethane (HFC-134a); 1,1-dichloro 1-fluoroethane (HCFC- 141b); 1-chloro 1,1-difluoroethane (HCFC-142b); 2-chloro-1,1,1,2tetrafluoroethane (HCFC-124); pentafluoroethane (HFC-125); 1,1,2,2tetrafluoroethane (HFC-134); trans-1,3,3,3-tetrafluoropropene (HFO-1234ze); 1,1,1-trifluoroethane (HFC-143a); 1,1-difluoroethane (HFC-152a); parachlorobenzotrifluoride (PCBTF); cyclic, branched, or linear completely methylated siloxanes; acetone; perchloroethylene (tetrachloroethylene); 3,3dichloro-1,1,1,2,2-pentafluoropropane (HCFC-225ca); 1,3-dichloro-1,1,2,2,3pentafluoropropane (HCFC-225cb); 1,1,1,2,3,4,4,5,5,5-decafluoropentane (HFC- 43-10mee); difluoromethane (HFC-32); ethylfluoride (HFC-161); 1,1,1,3,3,3hexafluoropropane (HFC-236fa); 1,1,2,2,3-pentafluoropropane (HFC-245ca); 1,1,2,3,3-pentafluoropropane (HFC-245ea); 1,1,1,2,3-pentafluoropropane (HFC- 245eb); 1,1,1,3,3-pentafluoropropane (HFC-245fa); 1,1,1,2,3,3hexafluoropropane (HFC-236ea); 1,1,1,3,3-pentafluorobutane (HFC-365mfc); chlorofluoromethane (HCFC-31); 1-chloro-1-fluoroethane (HCFC-151a); 1,2dichloro-1,1,2-trifluoroethane (HCFC-123a); 1,1,1,2,2,3,3,4,4-nonafluoro-4methoxy-butane (C F OCH or HFE-7100); 2-(difluoromethoxymethyl)- 1,1,1,2,3,3,3-heptafluoropropane ((CF )

CFCF

OCH ); 1-ethoxy- 1,1,2,2,3,3,4,4,4-nonafluorobutane (C F OC H or HFE-7200); 2- (ethoxydifluoromethyl)-1,1,1,2,3,3,3-heptafluoropropane ((CF )

CFCF

OC H ); methyl acetate; 1,1,1,2,2,3,3-heptafluoro-3-methoxy-propane (n-C F OCH , HFE-7000); 3-ethoxy-1,1,1,2,3,4,4,5,5,6,6,6-dodecafluoro-2-(trifluoromethyl) hexane (HFE-7500); 1,1,1,2,3,3,3-heptafluoropropane (HFC 227ea); methyl formate (HCOOCH ); 1,1,1,2,2,3,4,5,5,5-decafluoro-3-methoxy-4-trifluoromethylpentane (HFE-7300); propylene carbonate; dimethyl carbonate; trans-1,3,3,3tetrafluoropropene; HCF OCF H (HFE-134); HCF OCF OCF H (HFE-236cal2);

HCF OCF

CF OCF

H (HFE-338pcc13); HCF OCF OCF CF OCF H (H-Galden 1040x or H-Galden ZT 130 (or 150 or 180)); trans 1-chloro-3,3,3-trifluoroprop-1ene; 2,3,3,3-tetrafluoropropene; 2-amino-2-methyl-1-propanol (AMP); t-butyl acetate; 1,1,2,2-Tetrafluoro-1-(2,2,2-trifluoroethoxy) ethane (HFE-347pcf2) and perfluorocarbon compounds which fall into these classes:

(i) Cyclic, branched, or linear, completely fluorinated alkanes;

(ii) Cyclic, branched, or linear, completely fluorinated ethers with no unsaturations;

(iii) Cyclic, branched, or linear, completely fluorinated tertiary amines with no unsaturations; and (iv) Sulfur containing perfluorocarbons with no unsaturations and with sulfur bonds only to carbon and fluorine.

2. For purposes of determining compliance with emissions limits, VOC will be measured by the test methods in the approved State Implementation Plan (SIP) or 40 C.F.R. part 60, Appendix A, as applicable. Where such a method also measures compounds with negligible photochemical reactivity, these negligibly-reactive compounds may be excluded as VOC if the amount of such compounds is accurately quantified, and such exclusion is approved by the Technical Secretary.

3. As a precondition to excluding these compounds as VOC or at any time thereafter, the Technical Secretary may require an owner or operator to provide monitoring or testing methods and results demonstrating, to the satisfaction of the Technical Secretary, the amount of negligibly-reactive compounds in the source’s emissions.

4. For purposes of enforcement for a specific source, the test methods specified in these regulations, in the approved SIP, or in a permit issued pursuant to these regulations shall be used.

5. Reserved.

(nnn) Reasonably Available Control Technology (RACT) is the lowest emission limit that a particular source is capable of meeting by the application of control technology that is reasonably available considering technological and economic feasibility.

(ooo) Recover Furnace Stack means the stack from which the products of combustion are emitted to the ambient air from the recovery furnace.

(ppp) Total Reduced Sulfur (TRS) means the sum of the listed compounds: hydrogen sulfide, mercaptans, dimethyl sulfide, and dimethyl disulfide.

(qqq) Lime Kiln means a unit used to calcine lime mud, which consists primarily of calcium carbonate, into quicklime, which is calcium oxide.

(rrr) Smelt Dissolving Tank means a vessel used for dissolving the smelt collected from the recovery furnace.

(sss) Digester System means each continuous digester or each batch digester used for the cooking of wood in white liquor, and associated flash tank(s), blow tank(s), chip streamer(s), and condenser(s).

(ttt) Black Liquor Solids means the dry weight of the solids which enter the recovery furnace in the black liquor.

(uuu) Multiple-effect Evaporator System as it applies to the paper industry in paragraph 1200-03-07-.07(4) means the multiple-effect evaporators, associated condenser(s), and hotwell(s) used to concentrate the spent cooking liquid that is separated from pulp (black liquor).

(vvv) Primary Aluminum Reduction Plant means any source manufacturing aluminum by eletrolytic reduction.

(www) Potroom means a building unit which houses a group of electrolytic cells in which aluminum is produced.

(xxx) Potroom Group means an uncontrolled potroom, a potroom which is controlled individually or a group of potrooms or potroom segments ducted to a common control system.

(yyy) Roof Monitor means that portion of the roof of a potroom where gases not captured at the cell exit from the potroom.

(zzz) Total Fluorides means the particulate and gaseous fluorides generated and emitted from a potroom at a primary aluminum reduction plant.

(aaaa)Center Worked Prebake means a cell in a potroom that can be worked from the end or internally without removing the side covers.

(bbbb)Side Worked Prebake means a cell in a potroom that must be worked manually along both sides with the side covers removed.

(cccc) Soda Recovery Boiler is a boiler used in the soda pulping process for the purpose of converting concentrated black liquor, by incineration, into sodium carbonate (Na CO ) where the remaining organic matter from the sodium salts is burned to produce heat for steam generation.

(dddd)Calendar Quarter means a period of time beginning at the first minute of the first date and ending at midnight of the date of each of the following intervals: January 1 to March 31, April 1 to June 30, July 1 to September 30, or October 1 to December 31.

(eeee)A Continuous Emission Monitor is an instrument capable of measuring and recording emissions of various pollutants and meeting the performance specifications stated by

Rule 1200-03-10-.02.

(ffff) Nonattainment Area shall mean either as follows:

1. A geographical area designated by the U.S. Environmental Protection Agency or the Board as nonattainment for an air contaminant (pollutant) for which there is a national ambient air quality standard; or 2. For any other air contaminant for which there is an ambient air quality standard in

Chapter 1200-03-03, a geographical area designated by the Board as not attaining that standard.

(gggg)“PM ” means particulate matter with an aerodynamic diameter less than or equal to a nominal 10 micrometers as measured by a reference method based on Appendix J, as referenced in the Federal Register, July 1, 1987, Vol. 52, No. 126, pp 24665-24666 and designated in accordance with 40 C.F.R. 53 as amended on July 1, 1987, Federal Register, Vol. 52, No. 126, pp 24727-24735, or by equivalent method designated in accordance with 40 C.F.R. 53.

(hhhh)“PM Emissions” means finely divided solid or liquid material, with an aerodynamic diameter less than or equal to a nominal 10 micrometers emitted to the ambient air as measured by an applicable reference method, or an equivalent or alternative method, specified in the regulations, or by a test method specified in the State Implementation Plan.

(iiii) “Total Suspended Particulate (TSP)” means particulate matter as measured by the method described in Appendix B, 40 C.F.R. 50.

(jjjj) “Particulate Matter Emissions” means all finely divided solid or liquid material, other than uncombined water, emitted to the ambient air as measured by applicable reference methods, or an equivalent or alternative method specified in the regulations, or by a test method specified in the State Implementation Plan.

(kkkk) Reserved.

(llll) Reserved.

(mmmm)“Hazardous Air Pollutant” or “HAP” means the air contaminants listed in this subparagraph:

CAS No. Chemical name 75070 Acetaldehyde 60355 Acetamide 75058 Acetonitrile 98862 Acetophenone 53963 2-Acetylaminofluorene 107028 Acrolein 79061 Acrylamide 79107 Acrylic acid 107131 Acrylonitrile 107051 Allyl chloride 92671 4-Aminobiphenyl 62533 Aniline 90040 o-Anisidine 1332214 Asbestos 71432 Benzene (including benzene from gasoline) 92875 Benzidine 98077 Benzotrichloride 100447 Benzyl chloride 92524 Biphenyl 117817 Bis(2-ethylhexyl)phthalate (DEHP) 542881 Bis(chloromethyl) ether 75252 Bromoform 106945 1-Bromopropane 106990 1,3-Butadiene 156627 Calcium cyanamide 133062 Captan 63252 Carbaryl 75150 Carbon disulfide 56235 Carbon tetrachloride 463581 Carbonyl sulfide 120809 Catechol 133904 Chloramben 57749 Chlordane 7782505 Chlorine 79118 Chloracetic acid 532274 2-Chloroacetophenone 108907 Chlorobenzene 510156 Chlorobenzilate 67663 Chloroform 107302 Chloromethyl methyl ether 126998 Chloroprene 1319773 Cresols/Cresylic acid (isomers and mixture) 95487 o-Cresol 108394 m-Cresol 106445 p-Cresol 98828 Cumene 94757 2,4-D, salts and esters 3547044 DDE 334883 Diazomethane 132649 Dibenzofurans 96128 1,2-Dibromo-3-chloropropane 84742 Dibutylphthalate 106467 1,4-Dichlorobenzene(p) 91941 3,3-Dichlorobenzidene 111444 Dichloroethyl ether (Bis(2-chloroethyl)ether) 542756 1,3-Dichloropropene 62737 Dichlorvos 111422 Diethanolamine 121697 N,N-Diethyl aniline (N,N-Dimethylaniline) 64675 Diethyl sulfate 119904 3,3-Dimethoxybenzidine 60117 Dimethyl aminoazobenzene 119937 3,3’-Dimethylbenzidine 79447 Dimethyl carbamoyl chloride 68122 Dimethyl formamide 57147 1,1-Dimethyl hydrazine 131113 Dimethyl phthalate 77781 Dimethyl sulfate 534521 4,6-Dinitro-o-cresol, and salts 51285 2,4-Dinitrophenol 121142 2,4-Dinitrotoluene 123911 1,4-Dioxane (1,4-Diethyleneoxide) 122667 1,2-Diphenylhydrazine 106898 Epichlorohydrin (1-Chloro-2,3-epoxypropane) 106887 1,2-Epoxybutane 140885 Ethyl acrylate 100414 Ethyl benzene 51796 Ethyl carbamate (Urethane) 75003 Ethyl chloride (Chloroethane) 106934 Ethylene dibromide (Dibromoethane) 107062 Ethylene dichloride (1,2-Dichlorethane) 107211 Ethylene glycol 151564 Ethylene imine (Aziridine) 75218 Ethylene oxide 96457 Ethylene thiourea 75343 Ethylidene dichloride (1,1-Dichloroethane) 50000 Formaldehyde 76448 Hepotachlor 118741 Hexachlorobenzene 87683 Hexachlorobutadiene 77474 Hexachlorocyclepentadiene 67721 Hexachloroethane 822060 Hexamethylene-1,6-diisocyanate 680319 Hexamethylphosphoramide 110543 Hexane 302012 Hydrazine 7647010 Hydrochloric acid 7664393 Hydrogen fluoride (Hydrofluoric acid) 123319 Hydroquinone 78591 Isophorone 58899 Lindane (all isomers) 108316 Maleic anhydride 67561 Methanol 72435 Methoxychlor 74839 Methyl bromide (Bromomethane) 74873 Methyl chloride (Chloromethane) 71556 Methyl chloroform (1,1,1-Trichloroethane) 60344 Methyl hydrazine 74884 Methyl iodide (Iodomethane) 108101 Methyl isobutyl ketone (Hexone) 624839 Methyl isocyanate 80626 Methyl methacrylate 1634044 Methyl tert butyl ether 101144 4,4-Methylene bis(2-chloroniline) 75092 Methylene chloride (Dichloromethane) 101688 Methylene diphenyl diisocyanate (MDI) 101779 4,4-Methylenedianilne 91203 Naphthalene 98953 Nitrobenzene 92933 4-Nitrobiphenyl 100027 4-Nitrophenol 79469 2-Nitropropane 684935 N-Nitroso-N-methylurea 62759 N-Nitrosodimethylamine 59892 N-Nitrosomorpholine 56382 Parathion 82688 Pentachloronitrobenzene (Quintobenzene) 87865 Pentachlorophenol 108952 Phenol 106503 p-Phenylenediamine 75445 Phosgene 7803512 Phosphine 7723140 Phosphorus 85449 Phthalic anhydride 1336363 Polychlorinated biphenyls (Arochlors) 1120714 1,3-Propane sultone 57578 beta-Propiolactone 123386 Propionaldehyde 114261 Propoxur (Baygon) 78875 Propylene dichloride (1,2-Dichloropropane) 75569 Propylene oxide 75558 1,2-Propylenimine (2-Methyl aziridine) 91225 Quinoline 106514 Quinone 100425 Styrene 96093 Styrene oxide 1746016 2,3,7,8-Tetrachlorodibenzo-p-dioxin 79345 1,1,2,2-Tetrachloroethane 127184 Tetrachoroethylene (Perchloroethylene) 7550450 Titanium tetrachloride 108883 Toluene 95807 2,4-Toluene diamine 584849 2,4-Toluene diisocyanate 95534 o-Toluidine 8001352 Toxaphene (chlorinated camphene) 120821 1,2,4-Trichlorobenzene 79005 1,1,2-Trichloroethane 79016 Trichloroethylene 95954 2,4,5-Trichlorophenol 88062 2,4,6-Trichlorophenol 121448 Triethylamine 1582098 Trifluralin 540841 2,2,4-Trimethylpentane 108054 Vinyl acetate 593602 Vinyl bromide 75014 Vinyl chloride 75354 Vinylidene chloride (1,1-Dichloroethylene) 1330207 Xylenes (isomers and mixture) 95476 o-Xylenes 108383 m-Xylenes 106423 p-Xylenes 0 Antimony Compounds 0 Arsenic Compounds (inorganic including arsine) 0 Beryllium Compounds 0 Cadmium Compounds 0 Chromium Compounds 0 Cobalt Compounds 0 Coke Oven Emissions 0 Cyanide Compounds 0 Glycol Ethers 2, 6 0 Lead Compounds 0 Manganese Compounds 0 Mercury Compounds 0 Fine Mineral Fibers 0 Nickel Compounds 0 Polycyclic Organic Matter 0 Radionuclides (including radon) 0 Selenium Compounds X’ CN where X = H’ or any other group where a formal dissociation may occur. For example KCN or Ca(CN) 2.

Include mono- and di-ethers of ethylene glycol, diethylene glycol, and triethylene glycol R-(OCH CH ) n - OR’.

Where: n = 1, 2, or 3:

R = alkyl C7 or less; or R = phenyl or alkyl substituted phenyl; R’ = H or alkyl C7 or less; or OR’ consisting of carboxylic acid ester, sulfate, phosphate, nitrate, or sulfonate.

This action deletes each individual compound in a group called the surfactant alcohol ethoxylates and their derivatives (SAED) from the glycol ethers category in the list of hazardous air pollutants established by section 112(b)(1) of the Clean Air Act (CAA).

Includes mineral fiber emissions from facilities manufacturing or processing glass, rock, or slag fibers (or other mineral derived fibers) of an average diameter of one micrometer or less.

Includes organic compounds with more than one benzene ring, and which have a boiling point greater than or equal to 100°C.

A type of atom that spontaneously undergoes radioactive decay.

The substance ethylene glycol monobutyl ether (EGBE, 2-Butoxyethanol) (Chemical Abstract Service (CAS)

Number 111-76-2) is deleted from the list of hazardous air pollutants established by 42 U.S.C. § 7412(b)(1).

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; 68-201-105; and 68-201-201, et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed January 10, 1977; effective February 9, 1977. Amendment filed February 28, 1978; effective March 30, 1978. Amendment filed May 17, 1978; effective June 16, 1978. Amendment filed February 5, 1979; effective March 21, 1979. Amendment filed May 7, 1979; effective June 21, 1979. Amendment filed September 10, 1979; effective October 25, 1979. Amendment filed December 31, 1979; effective February 14, 1980. Amendment filed May 13, 1980; effective June 27, 1980. Amendment filed December 8, 1981; effective January 22, 1982. Amendment filed December 18, 1981; effective February 1, 1982. Amendment filed July 3, 1984; effective August 1, 1984. Amendment filed September 22, 1988; effective November 6, 1988. Amendment filed April 18, 1990; effective June 2, 1990. Amendment filed May 17, 1990; effective July 1, 1990. Amendment filed May 12, 1993; effective June 26, 1993. Amendment filed June 14, 1993; effective July 29, 1993. Amendment filed December 30, 1999; effective March 14, 2000. Amendment filed June 4, 2001; effective August 18, 2001. Amendment filed January 17, 2003; effective April 1, 2003. Amendments filed September 9, 2005; effective November 23, 2005. Amendments filed April 1, 2015; effective June 30, 2015. Amendments filed April 27, 2015; effective July 26, 2015. Amendments filed June 6, 2018; effective September 4, 2018. Amendments filed September 29, 2022; effective December 28, 2022. Amendments filed December 4, 2023; effective March 3, 2024. Amendments filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-02-.02 ABBREVIATIONS

(1) The following abbreviations shall, unless the context clearly indicated otherwise, have the following meaning:

(a) ASTM = American Society for Testing and Materials (b) Btu = British thermal unit (c) C = degrees Centigrade (d) cal = calorie (e) CO = carbon monoxide (f) CO = carbon dioxide (g) dscf = dry cubic foot at standard conditions (h) dscm = dry cubic meter at standard conditions (i) F = degrees Fahrenheit (j) g = gram (k) gr = grain (l) H S = hydrogen sulfide (m) H SO = sulfuric acid (n) Hg = Mercury (o) hr = hour (p) kg = kilogram (q) lb = pound (r) mg = milligram (s) mm = millimeter (t) MW = megawatt (u) NO = nitric oxide (v) NO = nitrogen dioxide (w) NOx = nitrogen oxides (x) ppb = parts per billion (y) ppm = parts per million (z) psia = pounds per square inch absolute (aa) sec = second (bb) SO = sulfur dioxide (cc) ug = microgram

History

• Authority: T.C.A. §§ 4-5-201, et seq. and 68-201-105.
• Administrative History: Original rule filed January 10, 1977; effective date February 9, 1977.

Chapter 1200-03-03 Ambient Air Quality Standards

Tenn. Comp. R. & Regs. 1200-03-03-.01 PRIMARY AIR QUALITY STANDARDS

Primary ambient air quality standards define levels of air quality believed adequate, with an appropriate margin of safety, to protect public health.

History

• Authority: T.C.A. §§ 68-201-105 and 4-5-202.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977.

Tenn. Comp. R. & Regs. 1200-03-03-.02 SECONDARY AIR QUALITY STANDARDS

Secondary ambient air quality standards define levels of air quality believed adequate, with an appropriate margin of safety, to protect the public welfare from any known anticipated adverse effects of the pollutant.

History

• Authority: T.C.A. §§68-201-105 and 4-5-202.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977.

Tenn. Comp. R. & Regs. 1200-03-03-.03 TENNESSEE’S AMBIENT AIR QUALITY STANDARDS

(1) Ambient air quality standards as given in this rule are applicable throughout Tennessee.

(a) TENNESSEE AMBIENT AIR QUALITY STANDARDS for Total Suspended Particulates TSP), PM 10, Sulfur Dioxide, Carbon Monoxide, Ozone, Nitrogen Dioxide, and Lead.

Rule 1200-3-3-.03, continued Table I ug/m - Micrograms per cubic meter AAM - Annual arithmetic mean Contaminants Primary Standard Averaging Interval Secondary Standard Concentration Averaging Interval 1. Total Suspended Particulates (TSP)

(Note 1) ug/m ppm by vol. - ug/m ppm by vol. - - 24 hr.

2. PM

(Note 2)

AAM 24 hr.

AAM 24 hr.

3. Sulfur Dioxide 0.03 0.14 AAM 24 hr. 1,300 0.5 3 hr.

4. Carbon Monoxide 10,000 40,000 9.0 35.0 8 hr. 1 hr. 10,000 40,000 9.0 35.0 8 hr. 1 hr.

5. Ozone (Note 3) 0.12 1 hr. 0.12 1 hr.

6. Nitrogen Dioxide 0.05 AAM 0.05 AAM 7. Lead 1.5 Calendar quarter 1.5 Calendar quarter All values other than annual values are maximum concentrations, not to be exceeded more than once per year (except for lead). For lead, the first exceedance is considered a violation of the standard. Parts per million (PPM) values are approximate only. All concentrations relate to air at standard conditions of 25 degrees centigrade temperature and 760 millimeters mercury pressure.

Note:

1. The value of 150 ug/m for a 24-hour averaging interval is maintained as a guide to be used in assessing particulate problem areas. In those areas where it is exceeded, PM-10 monitoring will be required, unless it is determined that the data is biased by an activity or event such as short term construction. Such monitor(s) shall be operated for a least a period of one calendar year (i.e., January 1 through December 31) following the federally designated six day sampling schedule. In any area where a single air contaminant source is the predominant particulate emitter the Technical Secretary shall order the source to install and operate said PM-10 monitoring network. In other areas the Technical Secretary shall be responsible for insuring that said monitoring is accomplished.

2. The 24-hour guideline is attained when the expected number of days per calendar year with maximum hourly concentration above 0.12 ppm(235 ug/m ) is equal to or less than 1 as determined by the Federal Register, Volume 44, No. 28, February 8, 1979, Part V,

Appendix H.

3. The standard is attained when the expected number of days per calendar year with maximum hourly concentration above 150 ug/m , as determined by Appendix K in Federal Register, Volume 52, No. 126, July 1, 1987, is equal to or less than one.

Rule 1200-3-3-.03, continued (b) Tennessee Ambient Air Quality Standards for Gaseous Fluorides Expressed as HF. Sources that emit gaseous fluorides, including hydrogen fluoride, and that are within a source category (including sources that would otherwise be included in the source category but fall below emissions or size thresholds for the source category) for which the United States Environmental Protection Agency has promulgated standards under section 112 of the Clean Air Act are deemed to be in compliance with any requirements under this section if they meet any and all applicable requirements of the federal standards. This subparagraph is not applicable to sources subject to 40 CFR 63, Subpart LL.

Table II Secondary Standards Concentration Averaging ppb ug/m by vol. Interval 1.2 1.5 30 days 1.6 2.0 7 days 2.9 3.5 24 hrs. 3.7 4.5 12 hrs.

NOTE: All values are maximum not to be exceeded more than once per year. Concentrations in micrograms per cubic meter (ug/m ) are approximate only. All conditions relate to air at standard conditions of 25 o C temperature and 760 millimeters of mercury pressure. All averaging intervals are consecutive time periods.

(c) A hydrogen chloride (expressed as HCL) value of 70.0 ug/m HCL, 24-hour average, shall be used as a guidance level in assessing air quality impact, excluding the burning of fossil fuels.

(d) Tennessee Ambient Air Quality Standards for Gaseous Fluorides expressed as HF in the vicinity of Primary Aluminum Reduction Plants in operation on or before December 31, 1973.

Table III Secondary Standard Concentration Averaging ppb Interval ug/m by vol. 0.5 0.6 30 days NOTE 1: All values are maximum not to be exceeded more than once per year. Concentrations in micrograms per cubic meter (ug/m ) are approximate only. All conditions relate to air at standard conditions of 25 o Centigrade and 760 mm mercury.

NOTE 2: This standard shall be attained at a distance of 13.8 km downwind from plants in operation on or before December 31, 1973.

NOTE 3: The 30 day standard contained in Table II shall be met in the vicinity of the plant at locations designated in Note 4.

NOTE 4: Air quality sensors to monitor attainment and maintenance of these air quality standards shall be placed in the primary downwind direction from the plant at locations approved by the Technical Secretary. An air quality sensor to monitor attainment with the standard contained in Table II

Rule 1200-3-3-.03, continued shall be at a location not less than 2.9 km or greater than 5.5 from the plant. An air quality sensor to monitor attainment with the standard contained in Table III shall be at a distance greater than 13.8 km from the plant.

NOTE 5: Any controls installed before the effective date of this standard, in addition to those required at Primary Aluminum Reduction Plants in operation on or before December 31, 1973, shall continue to be operated and maintained.

History

• Authority: T.C.A. §§68-201-105 and 4-5-202 et. seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed January 10, 1977; effective February 9, 1977. Amendment filed October 2, 1979; effective November 16, 1979. Amendment filed November 5, 1984; effective December 5, 1984. Amendment filed April 18, 1990; effective June 2, 1990. Amendment filed September 7, 1993; effective November 21, 1993. Amendment filed November 30, 1993; effective February 13, 1994. Amendment filed August 10, 1995; effective October 24, 1995. Amendment filed February 20, 1997; effective May 6, 1997. Amendment to rule filed August 15, 2006; effective October 29, 2006.

Tenn. Comp. R. & Regs. 1200-03-03-.04 NONDEGRADATION

These ambient air quality standards shall not be construed, applied, or interpreted to allow an significant deterioration of the existing air quality in any portion of the State.

History

• Authority: T.C.A. §§68-201-105 and 4-5-202.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977.

Tenn. Comp. R. & Regs. 1200-03-03-.05 ACHIEVEMENT

(1) The nitrogen dioxide standard in this chapter is to be achieved statewide by July 1, 1975, and maintained thereafter. The total suspended particulate and sulfur dioxide standards, with the exception of those areas identified in chapter 1200-3-19, are to be achieved by July 1, 1975, and maintained thereafter. For those total suspended particulate and sulfur dioxide areas identified in chapter 1200-3-19 the primary standards are to be achieved by December 31, 1982, and maintained thereafter. The standard for lead is to be achieved by October 31, 1981, and maintained thereafter. The standards for ozone and carbon monoxide are to be achieved by December 31, 1982, and maintained thereafter except for areas where a five-year extension has been granted. The standards in the area where the extension has been granted are to be achieved by December 31, 1987, and maintained thereafter. For the New Johnsonville nonattainment area for sulfur dioxide, the secondary standard is to be achieved by December 31, 1987, and maintained thereafter.

History

• Authority: T.C.A. §§68-201-105 and 4-5-202.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed May 7, 1979; effective June 21, 1979. Amendment filed October 2, 1979; effective November 16, 1979. Amendment filed November 12, 1982; effective December 13, 1982. Amendment filed September 7, 1993; effective November 21, 1993.

Chapter 1200-03-04 Open Burning

Tenn. Comp. R. & Regs. 1200-03-04-.01 PURPOSE

It is the purpose of this chapter to establish controls on open burning so as to prevent undesirable levels of air contaminants in the atmosphere.

History

• Authority: T.C.A. §§ 4-5-202 and 68-25-105.
• Administrative History: Original rule certified June 7, 1974. Amendment filed January 10, 1977; effective February 9, 1977. Amendment filed September 21, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-04-.02 DEFINITIONS

(1) As used in this Rule Chapter, all terms not defined herein shall have the meaning given them in Rule Chapter 1200-03-02.

(a) Repealed.

(b) “Air Pollution Emergency Episode” is defined as air pollution alerts, warnings, or emergencies declared by the Tennessee Division of Air Pollution Control during adverse air dispersion conditions that may result in harm to public heath or welfare.

(c) “Natural Disaster” is defined as any event commonly referred to as an “Act of God” and includes but is not limited to the following weather-related or naturally-occurring categories of events: tornadoes, hail and wind storms, snow or ice storms, flooding, and earthquakes.

(d) “Open Burning” is the burning of any matter under such conditions that products of combustion are emitted directly into the open atmosphere without passing directly through a stack. Open burning includes, but is not limited to, fires located or burning in a pile on the ground, a barrel, a fire pit, or other semi-enclosure. The use of an air curtain destructor or air curtain incinerator is considered incineration subject to the permitting requirements of Rule Chapter 1200-03-09, and is explicitly not considered open burning.

(e) “Person” is any individual, partnership, co-partnership, firm, company, corporation, association, joint stock company, trust, estate, political subdivision, an agency,

authority, commission, or department of the United States government, or of the State of Tennessee government; or any other legal entity, or their legal representative, agent, or assigns.

(f) Repealed.

(g) “Wood Waste” is defined as any product which has not lost its basic character as wood, such as bark, sawdust, chips and chemically untreated lumber whose “disposition” by open burning is to solely get rid of or destroy. Plant life of a herbaceous nature, such as leaves, whether attached, fallen, and/or collected, evergreen needles, and grasses, are not considered “wood waste”. Additionally, manufactured lumber products, such as plywood, fiberboard, particleboard, and paneling, are not considered “wood waste.”

Painted or artificially stained wood is not considered “wood waste.”

History

• Authority: T.C.A. §§ 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed January 10, 1977; effective February 9, 1977. Amendment filed February 5, 1979; effective March 21, 1979. Amendment filed September 21, 1988; effective November 6, 1988. Amendment filed May 17, 1990; effective July 1, 1990. Amendment filed June 26, 2001; effective September 7, 2001. Amendment filed January 17, 2003; effective April 1, 2003. Amendment filed September 9, 2005; effective November 23, 2005. Amendment filed June 28, 2007; effective September 11, 2007.

Tenn. Comp. R. & Regs. 1200-03-04-.03 OPEN BURNING PROHIBITED

(1) No person shall cause, suffer, allow, or permit open burning except as specifically exempted by Rule 1200-03-04-.04 Exceptions to Prohibition.

(2) Repealed.

(3) Repealed.

(4) The open burning of tires and other rubber products, vinyl shingles and siding, other plastics, asphalt shingles and other asphalt roofing materials, and/or asbestos containing materials is expressly prohibited, and such materials shall not be included in any open burning conducted under the provisions of Rule 1200-03-04-.04 Exceptions to Prohibition.

(5) Repealed.

(6) Repealed.

History

• Authority: T. C.A. §§ 4-5-202; 68-25-104; and 68-201-101, et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed January 10, 1977; effective February 9, 1977. Amendment filed September 21, 1988; effective November 6, 1988. Amendment filed March 5, 1993; effective April 19, 1993. Amendment filed November 22, 1993; effective February 5, 1994. Amendment filed April 7, 1995; effective June 21, 1995. Amendment filed June 26, 2001; effective September 7, 2001. Amendment filed July 9, 2001; effective September 22, 2001. Amendment filed January 17, 2003; effective April 1, 2003. Amendment filed September 9, 2005; effective November 23, 2005.

Tenn. Comp. R. & Regs. 1200-03-04-.04 EXCEPTIONS TO PROHIBITION

(1) Open burning, as listed below, may be conducted subject to specified limitations. This grant of exception shall in no way relieve the person responsible for such burning from the consequences, damages, injuries, or claims resulting from such burning.

(a) Repealed.

(b) Fires used for cooking of food or for ceremonial, recreational or comfort-heating purposes, including barbecues, campfires, and outdoor fireplaces.

(c) Fires set by or at the direction of responsible fire control persons solely for training purposes, such as, for fire source training at fire academies or for local fire department training. However, routine demolition of structures via supervised open burning by responsible fire control persons is not considered fire training. Additionally, the person responsible for such burning, unless conducted at a recognized fire training academy, must certify compliance with the following requirements by written statement. The certification must be delivered to the Division of Air Pollution Control at the appropriate regional Environmental Field Office at least ten (10) working days prior to commencing the burn:

1. The open burning is being conducted solely for fire training purposes;

2. All vinyl siding, carpet, vinyl flooring, asphalt roofing materials, and any other materials expressly prohibited in Rule 1200-03-04-.03, have been removed.

However, the provisions of Rule 1200-03-04-.03(4) as it pertains solely to “other rubber products” and “other plastics” are waived for incidental plastic or rubber materials which are an integral part of a structure used for fire training, such as plastic plumbing, fixtures, and conduit; electrical wiring insulation, connections, switches, and fixtures; interior trim; glues and resins in manufactured wood products; and vinyl window and door frames. Sheathing, decking, roofing, exterior siding and trim, and structural load-bearing members whose composition is primarily rubber or plastics are not considered incidental;

3. All regulated asbestos containing materials have been removed in accordance with part (2)(b)13. of Rule 0400-30-38-.01; and 4. A traffic hazard will not be caused by the air contaminants generated by the fire training.

(d) Fires consisting solely of vegetation grown on the property of the burn site. Priming materials used to facilitate such burning shall be limited to #1 or #2 grade fuel oils, wood waste, or other ignition devices approved by the Technical Secretary.

(e) Fires disposing of “wood waste” solely for the disposition of such wood waste as provided in T.C.A. § 68-201-115(c). Priming materials used to facilita te such burning shall be limited to #1 or #2 grade fuel oils.

(f) Fires solely for the burning of bodies of dead animals, including poultry, where no other safe and/or practical disposal method exists. Priming materials used to facilitate such burning shall be limited to #1 or #2 grade fuel oils, vegetation grown on the property of the burn site, and wood waste.

(g) Smokeless flares or safety flares for the combustion of waste gases, provided other remaining applicable conditions of these regulations are met.

(h) Such other open burning as may be approved by the Tennessee Air Pollution Control Board where there is no other practical, safe, and/or lawful method of disposal.

Documentation demonstrating why the general open burning regulations cannot be met must be submitted.

(i) Fires set at the direction of law enforcement agencies or courts solely for the purpose of destruction of controlled substances and legend drugs seized as contraband.

Priming materials used to facilitate such burning shall be limited to #1 or #2 grade fuel oils, and wood waste. The provisions of Rule 1200-03-04-.03(4) as it pertains solely to “other rubber products” and “other plastics” are waived for incidental plastic or rubber containers of said contraband.

(j) Fires consisting solely of vegetation, manufactured lumber products not chemically treated to prevent insect or rot damage, such as plywood, fiberboard, and paneling, uncoated paper and uncoated cardboard subject to the following conditions:

1. The site of such burning is not nearer than one-half mile to an airport, hospital, nursing home, school, Federal or State highway, national reservation, national or state park, wildlife area, national or state forest, and/or occupied structures except such structures as may be located on the same property as the burning site.

2. Priming materials used to facilitate such burning shall be limited to #1 or #2 grade fuel oils, and wood waste.

3. The person responsible for such burning must certify compliance with the distance requirements by written statement. The certification must include the types and amounts of materials projected to be burned, and must be delivered to the Division of Air Pollution Control at the appropriate regional Environmental Field Office at least ten (10) working days prior to commencing the burn.

(k) Fires consisting solely of non-radioactive, explosive, shock sensitive, chemically unstable, or highly reactive wastes, packaging, or contaminated or potentially contaminated combustible materials. Priming materials used to facilitate such burning shall be limited to #1 or #2 grade fuel oils, and wood waste. The provisions of Rule 1200-03-04-.03(4) as it pertains solely to “other rubber products” and “other plastics” are waived for this exception. Open burning conducted under this exception is only allowed where no other safe means of disposal exists.

(l) Fires consisting solely of materials resulting from a natural disaster, and when conducted in conformity with the following conditions:

1. Fires disposing of structural and household materials and vegetation are allowed only when those structures or materials are destroyed or severely damaged by natural disaster. Input from Emergency Management personnel may be requested in determining qualification with this criterion. The provisions of Rule 1200-03-04-.03(4) pertaining to structural and household materials may be waived if the persons seeking to open burn under this provision make a reasonable effort to remove all expressly prohibited material from the structural remains before ignition. The Technical Secretary reserves the right to inspect the proposed materials to be burned before ignition. The alternative use of chippers and grinders, landfilling, or on-site burial of waste in lieu of burning, if lawful, is encouraged;

2. If a governmental collective burn site for disposing of structural and household materials and vegetation damaged by a natural disaster is planned, the person responsible for such burning must notify the Division of Air Pollution Control of the proposed location. The notification must be delivered to the Division of Air Pollution Control at the appropriate regional Environmental Field Office at least three (3) days prior to commencing the burn. The Division may request that alternate sites be identified to minimize impact to air quality. The alternative use of chippers and grinders in lieu of burning is encouraged;

3. A traffic hazard will not be caused by the air contaminants generated by the fire;

4. No fire shall be ignited while any air pollution emergency episode is in effect in the area of the burn; and 5. Open burning conducted under this exception is only allowed where no other safe and/or practical means of disposal is available.

(2) The Technical Secretary reserves the right to require a person to cease or limit open burning if emissions from the fires are deemed by the Technical Secretary or his designee to jeopardize public health or welfare, create a public nuisance or safety hazard, create a potential safety hazard, or interfere with the attainment or maintenance of the air quality standards.

(3) Any exception to the open burning prohibition granted by this Rule Chapter does not relieve any person of the responsibility to obtain a permit required by any other agency, or of complying with other applicable requirements, ordinances, or restrictions.

(4) Failure to adhere to any applicable provision or condition of an exception to the open burning prohibition shall be construed as a violation of this Rule Chapter and is subject to applicable provisions of the rules and statutes of the Tennessee Department of Environment and Conservation, Division of Air Pollution Control and such corrective/punitive measures that may be deemed appropriate by the Technical Secretary of the Tennessee Air Pollution Control Board.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed January 10, 1977; effective February 9, 1977. Amendment filed February 5, 1979; effective March 21, 1979. Amendment filed May 7, 1979; effective June 21, 1979. Amendment filed September 21, 1988; effective November 6, 1988. Amendment filed May 17, 1990; effective July 1, 1990. Amendment filed March 5, 1993; effective April 19, 1993. Amendment filed April 7, 1995; effective June 21, 1995. Amendment filed June 26, 2001; effective September 7, 2001. Amendment filed March 25, 2003; effective June 8, 2003. Amendment filed September 9, 2005; effective November 23, 2005. Amendment filed June 28, 2007; effective September 11, 2007. Amendments filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-04-.05 REPEALED

History

• Authority: T.C.A. §§ 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 21, 1988; effective November 6, 1988. Amendment filed April 18, 1994; effective July 2, 1994. Amendment filed April 7, 1995; effective June 21, 1995. Amendment filed June 26, 2001; effective September 7, 2001.

Chapter 1200-03-05 Visible Emission Regulations

Tenn. Comp. R. & Regs. 1200-03-05-.01 GENERAL STANDARDS

(1) No person shall cause, suffer, allow or permit discharge of a visible emission from any air contaminant source with an opacity in excess of twenty (20) percent for an aggregate of more than five (5) minutes in any one (1) hour or more than twenty (20) minutes in any twenty-four (24) hour period; provided, however, that, for fuel burning installations with fuel burning equipment of input capacity greater than 600 x 10 Btu per hour, no person shall cause, suffer, allow, or permit discharge of a visible emission from any fuel burning installation with an opacity in excess of twenty (20) percent (6-minute average) except for one six-minute period per one (1) hour of not more than forty (40) percent opacity.

(2) Regardless of the visible emission standard contained in this chapter, all sources identified in

Chapter 1200-03-19 of these regulations shall comply with the visible emission standards contained therein.

(3) Upon mutual agreement of any air contaminant source and the Technical Secretary, an emission limit more restrictive than that otherwise specified in this chapter may be established. This emission limit shall be stated as a special condition for any permit or order issued concerning the source. Violation of this agreed to, more stringent emission standard shall result in revocation of the issued permit.

(4) Regardless of the visible emissions standard contained in this chapter, all sources identified in Rule 1200-03-09-.01(4) of these regulations shall comply with the visible emission standards set pursuant to Rule 1200-03-09.

(5) The visible emission limits set forth in Rule 1200-03-05-.01, shall apply unless a specific visible emission standard is set in a subsequent paragraph of this rule or subsequent rule of this Division 1200-03.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-25-105.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed February 5, 1979; effective March 21, 1979. Amendment filed May 7, 1979; effective June 21, 1979. Amendment filed October 29, 1981; effective December 14, 1981. Amendment filed June 29, 1984; effective July 29, 1984. Amendment filed September 21, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-05-.02 EXCEPTIONS

(1) Consistent with the requirements of Chapter 1200-03-20, due allowance may be made for visible emissions in excess of that permitted in this chapter which are necessary or unavoidable due to routine startup and shutdown conditions. However, no visible emission in excess of that permitted in this chapter shall be allowed which can be proved to cause or contribute to any violations of the Ambient Air Quality Standards contained in Chapter 1200- 03-03 and the National Ambient Air Quality Standards. The owner or operator shall maintain a continuous, current log of all excess visible emissions showing the time at which such conditions began and ended. Such record shall be available to the Technical Secretary or the Technical Secretary’s representative upon request.

(2) In the event of a dispute between the owner or operator of an air contaminant source and the Tennessee Air Pollution Control Division as to what constitutes due allowance, the Technical Secretary may conduct an Administrative Hearing for the determination of this matter.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed February 5, 1979; effective March 21, 1979. Amendment filed July 21, 1980; effective September 4, 1980. Amendment filed December 20, 1984; effective January 19, 1985. Amendment filed September 21, 1988; effective November 6, 1988. Amendment filed August 18, 2016; effective November 16, 2016.

Tenn. Comp. R. & Regs. 1200-03-05-.03 METHOD OF EVALUATION AND RECORDING

(1) A determination of visible emissions shall be made by a certified evaluator and compliance with the standards contained in rules of this chapter shall be evaluated in terms of opacity.

(2) Evaluators shall be certified by the criteria approved by the Board.

(3) Visible emission readings by certified evaluators shall be performed by methods approved by the Board.

(4) Obscuration of vision due to uncombined water droplets shall not be considered a violation of the standards in this chapter.

(5) Where the Technical Secretary has agreed in writing, an opacity monitor meeting the criteria contained in Rule 1200-03-10-.02 shall determine compliance with the visible emission standards contained in the rules of this chapter. The opacity monitor shall meet the operational availability and quality assurance requirements specified as a permit condition to preclude enforcement action against the source based upon visible conducted by certified evaluators. In each case where this is done, the operating permit of the affected source shall be modified to include this provision and said operating permit shall then be incorporated as a part of the State Implementation Plan.

(6) On or after July 7, 1992, all new and/or modified sources subject to the provisions of this

Chapter 1200-03-05 shall utilize six-minute averaging. Roads and parking lots shall utilize two-minute averaging.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-25-105.
• Administrative History: Original rules filed January 10, 1977; effective February 9, 1977. Amendment filed September 21, 1988; effective November 6, 1988. Amendment filed April 23, 1992; effective June 7, 1992.

Tenn. Comp. R. & Regs. 1200-03-05-.04 EXEMPTION

(1) Visible emissions from fuel-burning equipment used exclusively to provide space heating in a building containing not more than two (2) dwelling units shall not be subject to the provisions of this chapter.

(2) Unless the visible emission standard was set under the authority of paragraph (2), (3), or (4) of Rule 1200-03-05-.01, the visible emission standards of this chapter shall not apply where a source has an applicable visible emissions standard under Chapter 0400-30-39.

(3) If the installation of an in-stack opacity monitor is required by a standard contained in Chapter 0400-30-39, then for an identical existing source to obtain the less restrictive opacity standard contained in Chapter 0400-30-39, the installation of an in-stack opacity monitor meeting the specifications contained in part (1)(d)1. of Rule 1200-03-10-.02 shall be required.

For situations where the installation of an in-stack opacity monitor would be required to obtain an opacity standard for an existing source equivalent to that set forth for an identical new source subject to Chapter 0400-30-39, it is the responsibility of the source owner or operator to notify the Technical Secretary in writing that this revision to the source’s existing opacity standard is requested and that the required in-stack opacity monitor will be installed in accordance with Rule 1200-03-10-.02.

(4) The standards in this chapter shall not apply to fog obscurant screens generated for training purposes by the United States military on military bases. Provided that:

(a) No hazardous air pollutants, as defined in Paragraph 1200-03-31-.02(6) of these Regulations, shall be used for the generation of the fog obscurant screens.

(b) The fog obscurant screens shall comply with the provisions of Chapter 1200-03-08 and Paragraph 1200-03-09-.03(3) of these Regulations.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed September 21, 1988; effective November 6, 1988. Amendment filed November 29, 2001; effective February 12, 2002. Amendments filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-05-.05 STANDARD FOR CERTAIN EXISTING SOURCES

(1) Air contaminant sources meeting the conditions in paragraphs (2) and (3) of this rule and for which a certificate of validation has been issued by the Technical Secretary indicating that to his satisfaction the conditions in paragraph (2) are met, must in lieu of meeting the requirements of rule .01 of this chapter, meet the following emission standards of no visible emissions in excess of forty (40) percent opacity for an aggregate of more than five (5) minutes in any one (1) hour or more than twenty (20) minutes in any one twenty-four (24) hour period.

(2) The Technical Secretary must issue a certificate of validation if applied for and the owner or operator of the air contaminant source demonstrates to the satisfaction of the Technical Secretary the following conditions exist:

(a) The air contaminant source shall be subject to the rules contained in either Chapter 1200-03-06 or Chapter 1200-03-07 and shall be meeting the appropriate emission standard contained in those chapters.

(b) The air contaminant source is not regulated under Chapters 0400-30-38, 0400-30-39, 1200-03-25, or paragraph (4) of Rule 1200-03-09-.01.

(c) The air contaminant source does not include a gas or oil-fired boiler. However, if the particulate emissions of the fuel burning installation are less than that which Rule 1200- 03-06-.02 would allow for a fuel burning installation of the size Qs where Qs is the heat input rate from solid fuels and/or liquid fuels other than oil, then the previous sentence will not prohibit, in and of itself, the issuance of a certificate of validation.

(d) Each emission point, suitable for the installation of a continuously recording opacity monitor of the air contaminant source, whether a process emission source, fuel burning installation, incinerator, or wigwam, having a flow rate of 100,000 ACFM or more shall be equipped with continuously recording opacity monitors of the reference method type as outlined in the Federal Register, Vol. 48, No. 62, March 30, 1983, beginning on page 13327, or an equivalent or alternate type approved by the Technical Secretary.

However, a monitor will not have to be installed on those emission points of the air contaminant source for which the owner or operator does not wish to be allowed to emit more than twenty percent opacity. In this event these points must be clearly specified on any application for a certificate of validation. The Technical Secretary may still require these other points to install such a monitoring system. This provision shall not apply to gas streams containing moisture which interferes with proper instrument operation.

(e) The air contaminant source meets all emission standards in these regulations outside this chapter. Demonstration of this will require, as a minimum, an acceptable stack test report for particulate matter. This test must be conducted in the presence of personnel from the Division of Air Pollution Control.

(f) The PM ambient air quality standards are being met in the vicinity of the air contaminant source. The Technical Secretary may require this to be demonstrated.

(g) A certificate of validation has never been revoked for this air contaminant source.

(h) A fee of five hundred dollars ($500.00) has been paid to the Department to cover the costs of review of the request for the certificate of validation.

(3) The owner or operator of the air contaminant source must:

(a) Post on the operating premises the certificate of validation;

(b) Maintain for at least one year the readout from the opacity monitor(s) and keep this record available for inspection by the personnel of the Division of Air Pollution Control;

(c) Keep the air pollution control equipment and the opacity monitor in good operating condition and utilize said equipment at all times.

(4) After Administrative Hearing the certificate of validation will be revoked by the Technical Secretary if he finds any of the requirements of paragraph (2) have been violated and/or if the requirements of paragraph (3) have been frequently and flagrantly violated after its issuance.

(5) Upon the granting of a construction permit for the modification of an air contaminant source for which a certificate of validation has been issued, the certificate of validation shall become void.

(6) Air contaminant sources required to conduct in-stack opacity monitoring as per subparagraph (2)(d) above may elect to have visible emissions determined by Method 9 outlined in the Federal Register, Vol. 39, No. 219, November 12, 1974, beginning on page 39874. For a source electing to have visible emissions determined by this method, the applicable visible emission standard under the certificate of validation shall be as follows: No visible emissions in excess of forty (40) percent opacity for more than one six (6) minute period in any one (1) hour or more than twenty-four (24) minutes in any one twenty-four (24) hour period. For an affected source the choice of methods of the determination of visible emissions must be made with the application for the certificate of validation, otherwise the standard set forth in paragraph (1) of Rule 1200-03-05-.05 shall apply.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-25-105; 68-201-101, et seq; 68-201-105; and 68-201-201, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed September 21, 1988; effective November 6, 1988. Amendment filed April 18, 1990; effective June 2, 1990. Amendment filed May 17, 1990; effective July 1, 1990. Amendments filed June 6, 2018; effective September 4, 2018. Amendments filed September 29, 2022; effective December 28, 2022. Amendments filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-05-.06 WOOD-FIRED FUEL BURNING EQUIPMENT

(1) Wood-fired fuel burning equipment, which commenced operation before March 1, 1978, with a heat input of 100 million Btu/hr or greater must meet an emission limit of forty (40) percent opacity except for four six (6) minute periods per day not to exceed one six (6) minute period per hour.

(2) Wood-fired fuel burning equipment, subject to Rule 1200-03-06-.05(1)(a), (c), (d), (e), or (2) must meet an emission limit of twenty (20) percent opacity except for one six (6) minute period per hour.

(3) Wood-fired fuel burning equipment subject to Rule 1200-03-06-.05(8)(d) must meet an emission limit of forty (40) percent opacity except for one six (6) minute period per hour.

(4) Opacity for purposes of this rule shall be determined by the reference method as specified in the Federal Register, Vol. 39, No. 219, November 12, 1974.

(5) Other emission sources constructed on or after June 16, 1978, that exhaust through the same stack as wood-fired fuel burning equipment subject to Rule 1200-03-05-.06 shall meet an opacity standard where V is:

40.0 V

W + (x) V R V= ___________________ V W + V R Where, V = opacity standard in percent opacity, six (6) minute average.

X = opacity standard in percent opacity that applies to other sources or sources discharging through same stack.

V W = exhaust flow rate in dry standard cubic feet per minute from the wood-fired fuel burning equipment and other equipment present before June 16, 1978.

V R = exhaust flow rate in dry standard cubic feet per minute from the equipment (not being wood-fired fuel burning equipment) constructed so as to exhaust through the stack and commenced on or after June 16, 1978.

(6) This rule does not apply in Davidson, Hamilton, Knox, and Shelby Counties but facilities in these counties will be subject to Rule 1200-03-05-.01.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-25-105.
• Administrative History: Original rule filed May 17, 1978; effective June 16, 1978. Amendment filed December 20, 1984; effective January 19, 1985. Amendment filed September 21, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-05-.07 RESERVED

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-101, et seq.
• Administrative History: Original rule filed February 5, 1979; effective March 21, 1979. Repeal filed June 29, 1984; effective July 29, 1984. Amendment filed February 5, 2015; effective May 6, 2015.

Tenn. Comp. R. & Regs. 1200-03-05-.08 RESERVED

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-101, et seq.
• Administrative History: Original rule filed February 5, 1979; effective March 21, 1979. Amendment filed May 7, 1979; effective June 21, 1979. Amendment filed August 2, 1999; October 16, 1999. Repeal of rule and amended to reserved status filed February 5, 2015; effective May 6, 2015.

Tenn. Comp. R. & Regs. 1200-03-05-.09 RESERVED

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-101, et seq.
• Administrative History: Original rule filed December 18, 1981; effective February 1, 1982. Amendment filed September 21, 1988; effective November 6, 1988. Amendment filed January 21, 1998; effective April 6, 1998. Repeal of rule and amended to reserved status filed February 5, 2015; effective May 6, 2015.

Tenn. Comp. R. & Regs. 1200-03-05-.10 CHOICE OF VISIBLE EMISSION STANDARD FOR CERTAIN FUEL BURNING

EQUIPMENT.

(1) A fuel burning installation having fuel burning equipment with a heat input of between 50 million Btu/hr and 600 million Btu/hr, in operation or having a construction authorization, on July 31, 1981 and subject to Rule 1200-03-05-.01 shall have the option of electing an alternate visible emission standard contained in Paragraph 1200-03-05-.10(2). The owner or operator of such fuel burning equipment electing to be regulated by the alternate standard shall make this election known in writing, by certified mail, to the Technical Secretary within 90 days of the effective date of this rule.

(a) The election of the alternate standard will apply to all fuel burning equipment at the fuel burning installation.

(b) If the alternate standard is not elected, all fuel burning equipment at the fuel burning installation will remain subject to Rule 1200-03-05-.01.

(2) No person electing the alternate visible emission standard shall cause, suffer, allow, or permit the discharge of a visible emission from any fuel burning equipment in excess of twenty (20) percent opacity (6 minute average) except for one six-minute period per one (1) hour or more than twenty-four (24) minutes in any twenty-four (24) hour period.

(3) Opacity for the purpose of Paragraph 1200-03-05-.10(2) shall be determined by the reference method as specified in the Federal Register, Vol. 39, No. 219, November 12, 1974.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-25-105.
• Administrative History: Original rule filed June 16, 1981; effective July 31, 1981.

Tenn. Comp. R. & Regs. 1200-03-05-.11 RESERVED

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-101, et seq.
• Administrative History: Original rule filed November 12, 1982; effective December 13, 1982. Amendment filed January 21, 1998; effective April 6, 1998. Amendment filed February 5, 2015; effective May 6, 2015.

Tenn. Comp. R. & Regs. 1200-03-05-.12 RESERVED

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-25-105.
• Administrative History: Original rule filed September 21, 1988; effective November 6, 1988. Repeal of rule and amended to reserved status filed February 5, 2015; effective May 6, 2015.

Chapter 1200-03-06 Non-Process Emission Standards

Tenn. Comp. R. & Regs. 1200-03-06-.01 GENERAL NON-PROCESS EMISSIONS

(1) No person shall cause, suffer, allow, or permit emissions in excess of the standards in this

Chapter.

(2) In any area where one or more sources are emitting particulates at rates in conformity with applicable maximum allowable emission rates and the ambient air quality standard for particulate matter is being exceeded, the Board shall be responsible for setting an appropriate emission standard for each source contributing to the particulate matter in the ambient air of the area, at such value as the Board may consider necessary to achieve the desired air quality. Certain areas in the state have been identified as needing additional control beyond that required by this Chapter. These areas and the additional control requirements are stated in Chapter 1200-03-19.

(3) The owner or operator of an existing fuel burning installation proposing to make a modification of this source or to rebuild or replace it shall only take such action if it will result in the source meeting the maximum allowable emission standards for a new fuel burning installation.

(4) As used in this Chapter, existing installations or equipment shall mean such as were under construction or in operation prior to April 3, 1972 and non-portable equipment which was not relocated more than 1.0 km from the previous position after November 6, 1988.

(5) For the purpose of determining the applicable emission standards in this Chapter, a change in fuel from natural gas, propane, butane, and/or fuel oil to any of these herein named fuels and any required alterations to existing fuel burning equipment to accommodate these fuels shall not be considered a modification. This shall not apply to sources identified in Rule 1200- 03-09-.01(4). However, the allowable emissions for the source will not change unless Best Available Control Technology is required.

(6) Regardless of the specific emission standards contained in this Chapter a new or modified non-process source locating in or significantly impacting upon a nonattainment area shall comply with the provisions of 1200-03-09-.01(5) prior to receiving a construction permit.

(7) Upon mutual agreement of the owner or operator of any air contaminant source and the Technical Secretary, an emission limit more restrictive than that otherwise specified in this

Chapter may be established. The emission limit shall be stated as a special condition for any permit or order issued concerning the source. Violation of this agreed to, more stringent emission standard is grounds for revocation of the issued permit and/or other enforcement measures provided for in the Tennessee Air Quality Act.

(8) Regardless of the specific emission standards contained in this Chapter, all non-process sources identified in 1200-03-09-.01(4) of these regulations shall comply with the standards set pursuant to Chapter 1200-03-09.

History

• Authority: T.C.A. §§ 4-5-202 and 68-25-105.
• Administrative History: Original rule certified June 7, 1974. Amendment filed January 10, 1977; effective date February 9, 1977. Amendment filed May 17, 1978; effective June 16, 1978. Amendment filed February 5, 1979; effective March 21, 1979. Amendment filed May 7, 1979; effective June 21, 1979. Amendment filed September 22, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-06-.02 NON-PROCESS PARTICULATE EMISSION STANDARDS

(1) Existing Fuel Burning Equipment The maximum hour allowable particulate emissions for a fuel burning installation commenced before April 3, 1972, shall be determined from the following equations:

E = 0.600 for Q less than or equal to 10.0 X 10 Btu hr.

E = 0.600 (10/Q) 0.2594 for 10.0 X 10 Btu less than Q less than 10.0 X 10 Btu hr. hr.

E = 0.100 for Q ] 10.0 X 10 Btu hr.

Where:

E = allowable particulate emissions in lb per million Btu.

Q = total installation heat input in million Btu per hour.

(2) New Fuel Burning Equipment (a) The maximum allowable particulate emissions for a fuel burning installation commenced on or after April 3, 1972, shall be determine from the following equations:

E = 0.600 for Q less than or equal to 10.0 X 10 Btu hr.

E = 0.600 (10/Q) 0.5566 for 10.0 X 10 Btu less than Q less than 250 x 10 Btu hr. hr.

E = 0.100 for Q greater than or equal to 250 X 10 Btu hr. where, E and Q are as defined in paragraph (1) above.

(b) Where only part of the fuel burning equipment in a fuel burning installation is constructed or modified on or after April 3, 1972, the maximum allowable particulate emissions is determined by the following equation:

Et = (Qx) (Ex) + (Qy) (Ey)

Where, Et = allowable particulate emission in lb/hr, Qx = total heat input for existing equipment in million Btu/hr, Ex = allowable emissions for installation of size Qx as determined by paragraph (1) above in lb per million Btu, Qy = total heat input for new equipment in million Btu/hr.

Ey = allowable emissions for installation of size Qy as determined by subparagraph (a) above in lb per million Btu.

(c) In lieu of (a) above, the maximum allowable particulate emissions from any wood refuse boiler built after April 3, 1972, in which 3% or more of the total heat input is obtained from ammonium sulfite spent liquor, shall not exceed .24 pounds per million BTU heat input. This rule applies to that fuel burning equipment designed to burn wood and when the burning of wood provides at least 30% of the heat input of the unit. This

rule does not apply to units burning coal.

(3) Incinerators (a) The maximum allowable particulate emissions from incinerators is 0.200 percent of the charging rate for incinerators with a 2000 pound per hour charging rate or less and 0.100 percent of the charging rate for incinerators with a charging rate greater than 2000 pounds per hour.

(b) Reserved.

(c) The particulate emission standards of this paragraph are not applicable to wigwam burners, air curtain destructors, and air curtain incinerators.

(4) Repealed.

(5) Relocated non-portable fuel burning equipment. The maximum allowable particulate emissions for non-portable fuel burning equipment which is relocated more than 1.0 km from the previous position after November 6, 1988 shall be the greater of the actual emissions at its previous site or the allowable emissions for new fuel burning equipment.

History

• Authority: T.C.A. §§ 4-5-202, 68-25-105, and 68-201-105.
• Administrative History: Original rule certified June 7, 1974. Amendment filed January 10, 1977; effective February 9, 1977. Amendment filed February 5, 1979; effective March 21, 1979. Amendment filed May 7, 1979; effective June 21, 1979. Amendment filed July 21, 1980; effective September 8, 1980. Amendment filed September 22, 1988; effective November 6, 1988. Amendment filed January 15, 2009; effective March 31, 2009.

Tenn. Comp. R. & Regs. 1200-03-06-.03 GENERAL NON-PROCESS GASEOUS EMISSIONS

(1) No person shall cause, suffer, allow, or permit gaseous emissions in excess of the standards in this Chapter.

(2) Any person constructing or otherwise establishing a non-portable air contaminant source emitting gaseous air contaminants after April 3, 1972, or relocating an air contaminant source more than 1.0 km from the previous position after November 6, 1988, shall install and utilize the best equipment and technology currently available for controlling such gaseous emissions.

History

• Authority: T.C.A. §§ 4-5-202 and 68-25-105.
• Administrative History: Original rule certified June 7, 1974. Amendment filed May 7, 1979; effective June 21, 1979. Amendment filed September 22, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-06-.04 REPEALED

History

• Authority: T.C.A. §§ 4-5-202 and 68-25-105.
• Administrative History: Original rule certified June 7, 1974. Repeal filed May 15, 1979, effective June 29, 1979

Tenn. Comp. R. & Regs. 1200-03-06-.05 WOOD-FIRED FUEL BURNING EQUIPMENT

(1) Any wood-fired fuel burning equipment commenced before March 1, 1978, must comply with the following emission standards shown below:

(a) 0.330 grains of particulate matter per standard dry cubic foot of exhaust gasses, corrected to 12% carbon dioxide, for fuel burning equipment up to and including 50 million Btu per hour heat input.

(b) 0.300 grains of particulate matter per standard dry cubic foot of exhaust gasses, corrected to 12% carbon dioxide, for fuel burning equipment of 100 million Btu per hour heat input or in excess thereof.

(c) The allowable emissions for wood-fired fuel burning equipment between 50 million and 100 million Btu per hour heat input is that determined by linear interpolation between the values in subparagraphs (a) and (b).

(d) 0.56 grains of particulate matter per dry standard cubic foot of exhaust gases, corrected to 12% carbon dioxide, for fuel burning equipment up to and including 50 million Btu per hour heat input for counties identified in paragraph (8)(d) of this rule.

(e) The allowable for wood-fired fuel burning equipment between 50 million and 100 million Btu per hour heat input is that determined by linear interpolation between the values in subparagraph (d) and (b) for counties identified in paragraph (8)(d) of this rule.

(2) Any wood-fired fuel burning equipment commenced on or after March 1, 1978, must comply with the emission standards shown below:

(a) 0.330 grains of particulate matter per standard dry cubic foot of exhaust gasses, corrected to 12% carbon dioxide, for fuel burning equipment up to, and including, 25 million Btu per hour heat input.

(b) 0.200 grains of particulate matter per standard dry cubic foot of exhaust gasses, corrected to 12% carbon dioxide, for fuel burning equipment of 100 million Btu per hour heat input or in excess thereof.

(c) The allowable emissions for wood-fired fuel burning equipment between 25 million and 100 million Btu per hour heat input is that determined by linear interpolation between the values in subparagraphs (a) and (b).

(3) Wood as used in this rule means:

(a) Bark.

(b) Sawdust or other woody plant tissues (lignified xylem) mechanically reduced in size, but not chemically changed.

(c) Any combination of the materials in (a) and (b).

(4) Any fuel burning installation with wood-fired burning equipment such that said wood-fired fuel burning equipment has 100 million Btu heat input per hour or in excess thereof, shall install, calibrate, maintain, and operate a photoelectric or any other type opacity monitor and recorder that has been approved by the Technical Secretary and is of the type referred to in

Rule 1200-03-05-.05. This paragraph does not apply where the moisture content of the exhaust is so high that condensation occurs in the stack.

(5) This rule only applies to that fuel burning designed to burn wood and when the burning of wood provides at least 30% of the heat input of the unit. At other times the unit will revert to being regulated by Rule 1200-03-06-.02. This Rule 1200-03-06-.05 does not apply to units burning coal or liquid fuels other than fuel oils.

(6) Where fuel burning equipment units are the same fuel burning installation are subject to this

rule and are regulated by two different grain loading limits, an average weighted directly on the flow rates will determine the allowable emission limit.

(7) When a wood-fired fuel burning equipment is on a common stack with other air contaminant sources, then the wood-fired units shall be considered independent of the other air contaminant sources.

(8) The applicability of this rule shall be as follows:

(a) Paragraph (2) of this rule shall apply to all wood-fired fuel burning equipment commenced on or after March 1, 1978, except for those units in Davidson, Hamilton, Knox, and Shelby counties.

(b) Subparagraphs (1)(a) and (1)(c) of this rule shall apply to all wood-fired fuel burning equipment commenced before March 1, 1978 in Madison, Bedford, Hamblen, and Coffee counties.

(c) Subparagraph (1)(b) of this rule shall apply to wood-fired fuel burning equipment commenced before March 1, 1978 except for units in Davidson, Hamilton, Knox, and Shelby counties.

(d) Subparagraphs (1)(d) and (1)(e) of this rule shall apply to all wood-fired fuel burning equipment commenced before March 1, 1978 in Bradley, Claiborne, Cocke, Cumberland, Dickson, Fentress, Franklin, Gibson, Giles, Grainger, Greene, Henry, Jefferson, Lawrence, Loudon, Macon, Marion, Marshall, McMinn, Montgomery, Polk, Putnam, Rhea, Rutherford, Scott, Sevier, Sumner, Warren, Wayne, Weakley, White, Williamson, and Wilson counties whose emissions have been strategy tested and included in the State Implementation Plan. Any wood-fired fuel burning equipment which except for not having had its emissions strategy tested and included in the State Implementation Plan would be wood-fired fuel burning equipment designated by the preceding sentence of this subparagraph shall be regulated by subparagraph (1)(a), (b), or (c) of this rule.

(9) Except as mentioned in paragraph (8) of this rule, all existing wood-fired fuel burning equipment of 50 million Btu per hour heat input or less shall be regulated by Rule 1200-03- 06-.02.

History

• Authority: T.C.A. §§ 4-5-202 and 68-25-105.
• Administrative History: Original rule filed May 17, 1978; effective June 16, 1978. Amendment filed February 5, 1979; effective March 21, 1979. Amendment filed May 15, 1979; effective June 29, 1979. Amendment filed October 22, 1979; effective December 6, 1979. Amendment filed April 30, 1987; effective June 14, 1987. Amendment filed September 22, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-06-.06 RESERVED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed January 17, 2003; effective April 1, 2003. Amendments filed September 16, 2024; effective December 15, 2024.

Chapter 1200-03-07 Process Emission Standards

Tenn. Comp. R. & Regs. 1200-03-07-.01 GENERAL PROCESS PARTICULATE EMISSION STANDARDS

(1) No person shall cause, suffer, allow, or permit particulate emissions in excess of the standards in this Chapter.

(2) In any area where one or more sources are emitting particulates at rates in conformity with applicable maximum allowable emission rates and the ambient air quality standard for particulate matter is being exceeded, the Board shall be responsible for setting an appropriate emission standard for each source contributing to the particulate matter in the ambient air of the area, at such value as the Board may consider necessary to achieve the desired air quality.

Certain areas in the state have been identified as needing additional control beyond that required by this Chapter. These areas and the additional control requirements are stated in

Chapter 1200-03-19.

(3) The owner or operator of an existing process emission source proposing to make a modification of this source or to rebuild or to replace it shall only take such action if it will result in the source meeting the maximum allowable particulate emissions standard for a new process emission source.

(4) Limiting the Effect of the Definition of Modification. For the purpose of determining the applicable particulate matter emission standards in this Chapter, a change in fuel from natural gas, propane, butane, and/or fuel oil to any of these herein named fuels and any required alternations to existing fuel burning equipment to accommodate these fuels, shall not be considered a modification.

(5) Upon mutual agreement of the owner or operator of any air contaminant source and the Technical Secretary, an emission limit more restrictive than that otherwise specified in this

Chapter may be established. This emission limit shall be stated as a special condition for any permit or order issued concerning the source. Violation of this agreed to, more stringent emission standard is grounds for revocation of the issued permit and/or other enforcement measures provided for in the Tennessee Air Quality Act

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 53-3412; 68-25-105; 68-201-101, et seq.; 68-201-105; and 68-201-201, et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed May 17, 1978; effective June 16, 1978. Amendment filed February 5, 1979; effective March 21, 1979. (1200-03-07-.01, continued) Amendment filed September 21, 1988; effective November 6, 1988. Amendments filed June 6, 2018; effective September 4, 2018.

Tenn. Comp. R. & Regs. 1200-03-07-.02 CHOICE OF PARTICULATE EMISSION STANDARDS - EXISTING PROCESS

(1) For any process emission source operating within the State of Tennessee, which was in operation or under construction prior to August 9, 1969, the allowable emission standard shall be obtained from either the diffusion equations presented in 1200-03-07-.02(3) below or the process weight table presented in 1200-03-07-.02(4) below. The owner or operator of such a process emission source shall make known, in writing, to the Technical Secretary by July 1, 1972, his choice of emission standard. If no choice is so indicated, the Technical Secretary shall designate the emission standard of 1200-03-07-.02(4) below as the applicable standard. The emission standard chosen, either by the owner or operator or by the Technical Secretary, must be attained on or before August 9, 1973.

(2) For any process emission source operating within the State of Tennessee, construction of which began on or after August 9, 1969, and before June 7, 1974, the allowable emission standard shall be the diffusion equations presented in 1200-03-07-.02(3) below. This standard must have been attained at the time such process emission source first commenced operation. The owner or operator of such a source shall make known in writing to the Technical Secretary by July 1, 1972, whether he wishes to continue under the diffusion equations standard or to switch to the process weight table standard presented in 1200-03- 07-.02(4). If no choice is so indicated, the Technical Secretary shall designate the emission standard of 1200-03-07-.02(4) below as the applicable standard. If the process weight table standard is chosen by such owner or operator or by the Technical Secretary, then such owner or operator shall have until August 9, 1973 to convert fully to the process weight table standard. It is expressly stipulated that in the interim period such a process emission source shall continue to observe the diffusion equations standard originally applicable.

(3) For those owners or operators of process emission sources who elect to have their process emission regulated by diffusion equations, the maximum allowable particulate emissions from such sources shall be determined by the procedures defined in (a), (b), and (c) below.

(a) Stack gas exit temperature less than 100 ° F (See Note)

Q = 3.02 x 10 -4 V s h s (d s /h s ) 0.71 (b) Stack gas exit temperature of 125 ° F or greater (See Note)

1. Stacks less than 500 feet in height Q = 0.2h s (Q T x 0.02 x (T s -60)) 0.25 2. Stacks 500 feet in height and greater Q = 0.3h s (Q T x 0.02 x (T s -60)) 0.25 (c) 1. For stack gas exit temperatures from 100 ° F to 124 ° F calculate allowable emissions as in (a) and either (b)1., or (b)2., depending upon stack height (using T s of 125 ° F), and make linear interpolation based upon actual stack gas exit temperature.

2. The terms of the preceding equation shall have the following meaning and units:

(i) d s - inside diameter or equivalent diameter of stack tip in feet (1200-03-07-.02, continued)

(ii) h s - stack height in feet (Vertical distance above grade directly below tip of stack) equal to the height in existence or approved pursuant to (State) review as of January 31, 1972 except as follows:

(I) In cases where the actual height is less than that stated above, the actual height shall be used.

(II) In cases where the actual height is greater than that stated above, and the stack height increase was constructed (grading and pouring of concrete was done) prior to February 8, 1974, the actual height shall be used up to two and one half times the height of the facility it serves.

(iii) Q - maximum allowable emission rate in pounds per hour (iv) Q T - volume rate of stack gas flow in cubic feet per second calculated to ° F.

(v) T s - temperature of stack gases at stack tip in F (vi) V s - velocity of stack gases at stack tip in feet per second (vii) NOTE - In determining applicability of equations in this paragraph based upon the exit gas temperature, the actual exit gas temperature must equal or exceed the stated temperature during ninety (90) percent or more of the operating time.

(4) For those owners or operators of process emissions sources who elect to have their process emissions regulated by the Process Weight Table, the maximum allowable particulate emissions from a process emission source shall be determined by Table 1.

(5) Whichever standard is chosen, all sources at the same facility must be regulated by that standard.

(6) The owner or operator of a facility having elected to be regulated under the diffusion equations in paragraph (3) of this rule may apply to the Technical Secretary for having said facilities regulated under the process weight table specified in paragraph (4) of this rule.

Once said application is approved the facility cannot return to being regulated by the diffusion equations.

History

• Authority: T.C.A. §§ 4-5-202, 53-3412, and 68-25-105.
• Administrative History: Original rule certified June 7, 1974. Amendment filed March 13, 1978; April 12, 1978.

Tenn. Comp. R. & Regs. 1200-03-07-.03 NEW PROCESSES

(1) The allowable emission level of particulate matter from any process emission source beginning operation on or after April 3, 1972, shall be determined by Table 2.

(2) Regardless of the specific emission standards for particulate matter in other places in these Regulations, the Board may require any new or modified air contaminant source constructing in a nonattainment area to apply best available control technology for control of particulate emissions as determined by the Technical Secretary at the time the application for the construction permit is approved.

(1200-03-07-.03, continued)

(3) Regardless of the specific emission standards contained in this Chapter a new or modified process emission source locating in or significantly impacting upon a nonattainment area shall comply with the provisions of 1200-03-09-.01(5) prior to receiving a construction permit.

(4) Regardless of the specific emission standards contained in this Chapter, all sources identified in 1200-03-09-.01(4) of these regulations shall comply with the standards set pursuant to

Chapter 1200-03-09.

History

• Authority: T.C.A. §§ 4-5-202, 53-3412, and 68-25-105.
• Administrative History: Original Rule certified June 7, 1974. Amendment filed January 10, 1977; effective February 9, 1977. Amendment filed February 5, 1978; effective March 21, 1979. Amendment filed May 7, 1979; effective June 21, 1979. (This space intentionally left blank). TABLE 1 EXISTING PROCESS EMISSION SOURCES ALLOWABLE RATE OF EMISSION BASED ON PROCESS WEIGHT RATE a ___________________________________________________________________________________ Process Weight Rate of Process Weight Rate of Rate Emission Rate Emission Lb/hr Tons/Hr Lb/hr Lb/hr Tons/hr Lb/hr ___________________________________________________________________________________ 100 0.05 0.551 . 16,000 8.00 16.5 200 0.10 0.877 . 18,000 9.00 17.9 400 0.20 1.40 20,000 10.00 19.2 600 0.30 1.83 30,000 15. 25.2 800 0.40 2.22 40,000 20. 30.5 1,000 0.50 2.58 50,000 25. 35.4 1,500 0.75 3.38 60,000 30. 40.0 2,000 1.00 4.10 70,000 35. 41.3 2,500 1.25 4.76 80,000 40. 42.5 3,000 1.50 5.38 90,000 45. 43.6 3,500 1.75 5.96 100,000 50. 44.6 4,000 2.00 6.52 120,000 60. 46.3 5,000 2.50 7.58 140,000 70. 47.8 6,000 3.00 8.56 160,000 80. 49.0 7,000 3.50 9.49 200,000 100. 51.3 8,000 4.00 10.4 1,000,000 500. 69.0 9,000 4.50 11.2 2,000,000 1,000. 77.6 10,000 5.00 12.0 6,000,000 3,000. 92.7 12,000 6.00 13.6 a Interpolation of the data in this table for process weight rates up to 60,000 lb/hr shall be accomplished by using the equation E = 4.10 P 0.67 and interpolation and extrapolation of the data for process weight rates in excess of 60,000 lb/hr shall be accomplished by use of the equation: E = 55.0 P 0.11 - 40, where E = rate of emission in lb/hr and P = process weight rate in tons/hr. TABLE 2 NEW PROCESS EMISSION SOURCES ALLOWABLE RATE OF EMISSION BASED OF PROCESS WEIGHT RATE a ___________________________________________________________________________________ Process Weight Rate of Process Weight Rate of Rate Emission Rate Emission Lb/Hr Tons/Hr Lb/hr Lb/hr Tons/Hr Lb/Hr ___________________________________________________________________________________ 50 0.025 0.36 16,000 8.00 13.0 100 0.05 0.55 18,000 9.00 14.0 200 0.10 0.86 20,000 10. 15.0 400 0.20 1.32 600 0.30 1.70 30,000 15. 19.2 800 0.40 2.03 40,000 20. 23.0 1,000 0.50 2.34 50,000 25. 26.4 1,500 0.75 3.00 60,000 30. 29.6 2,000 1.00 3.59 70,000 35. 30.6 2,500 1.25 4.12 80,000 40. 31.2 3,000 1.50 4.62 90,000 45. 31.8 3,500 1.75 5.08 100,000 50. 32.4 4,000 2.00 5.52 120,000 60. 33.3 5,000 2.50 6.34 140,000 70. 34.2 6,000 3.00 7.09 160,000 80. 34.9 7,000 3.50 7.81 200,000 100. 36.2 8,000 4.00 8.5 1,000,000 500 46.8 9,000 4.50 9.1 10,000 5.00 9.7 12,000 6.00 10.9 a Interpolation of the data in Table 2 for the process weight rates up to 60,000 lbs/hr shall be accomplished by the use of the equation: E = 3.59 P 0.62 for P less than or equal to 30 tons/hr and interpolation and extrapolation of the data for process weight rates in excess of 60,000 lbs/hr shall be accomplished by use of the equation: E = 17.31 P 0.16 for P greater than 30 tons/hr Where: E = Emissions in pounds per hour P = Process weight rate in tons per hour

Tenn. Comp. R. & Regs. 1200-03-07-.04 LIMITING ALLOWABLE EMISSIONS

(1) Irrespective of the maximum allowable emission as determined by any of the preceding equations or Process Weight Tables in this Chapter, the concentration of particulate process emissions shall not be required to be less than 0.02 grain per dry cubic foot of stack gases corrected to 70 ° F and 1 atmosphere unless a lesser concentration is found by the Board to be necessary.

(2) Irrespective of the maximum allowable emission as determined by any of the preceding equations or Process Weight Tables in this Chapter, the maximum allowable concentration of particulate process emissions shall be 0.25 grains per dry cubic foot of stack gases corrected to 70 ° F and 1 atmosphere. This shall be achieved by all air contaminant sources on or before August 9, 1973. Air contaminant sources constructed after August 9, 1969, shall meet the above emission standard when they commence operation. This paragraph shall not apply to vents from storage tanks for liquids.

(3) Irrespective of the maximum allowable emission as determined by any of the preceding equations or Process Weight Tables in this Chapter, the maximum allowable particulate emissions for processes which are relocated more than 1.0 km from the previous position after November 6, 1988, shall not exceed the greater of the actual emissions at its previous location or the allowable emissions for a new process source.

History

• Authority: T.C.A. §§ 4-5-202 and 68-25-105.
• Administrative History: Original rule certified June 7, 1974. Amendment filed February 5, 1979; effective March 21, 1979. Amendment filed September 22, 1988; effective November 6, 1988. Amendment filed May 17, 1990; effective July 1, 1990.

Tenn. Comp. R. & Regs. 1200-03-07-.05 SPECIFIC PROCESS EMISSION STANDARDS

The emission limits set forth in rules 1200-03-07-.02, .03, and .04 will apply unless a specific process emission standard for a specifically designated type of process emission source is contained in a subsequent rule of this Chapter.

History

• Authority: T.C.A. §§ 4-5-202 and 68-25-105.
• Administrative History: Original rule certified June 7, 1974.

Tenn. Comp. R. & Regs. 1200-03-07-.06 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal filed September 8, 2025; effective December 7, 2025.

Tenn. Comp. R. & Regs. 1200-03-07-.07 GENERAL PROVISIONS AND APPLICABILITY FOR PROCESS GASEOUS

EMISSION STANDARDS.

(1) No person shall cause, suffer, allow, or permit gaseous emissions in excess of the standards in this Chapter.

(2) Any person constructing or otherwise establishing an air contaminant source emitting gaseous air contaminants after April 3, 1972, or relocating an air contaminant source more than 1.0 km from the previous position after November 6, 1988, shall install and utilize equipment and technology which is deemed reasonable and proper by the Technical Secretary.

(3) Reserved.

(1200-03-07-.07, continued)

(4) Total Reduced Sulfur Emissions from Kraft Mills. The owner or operator of a kraft mill constructed or modified prior to September 24, 1976, shall meet the emission standards listed in subparagraphs (a), (b), (c) and (d) of this paragraph no later than six years (i.e., January 22, 1988) for recovery furnaces; two years (i.e., January 22, 1984) for digesters, multiple effect evaporators, smelt dissolving tanks and four years (i.e., January 22, 1986) for lime kilns.

(a) Total reduced sulfur emissions from the recovery furnace shall not exceed 20 ppm by volume, expressed as H S, on a dry basis, corrected to 8 percent oxygen on a 12-hour averaging basis.

(b) Total reduced sulfur emissions from the lime kiln shall not exceed 20 ppm by volume, expressed as H S on a dry basis, corrected to 10 percent oxygen on a 12-hour averaging basis.

(c) Total reduced sulfur emissions from any digester system or multiple effect evaporator system shall not exceed 5 ppm by volume, expressed as H S, on a dry basis, corrected to 10 percent oxygen on a 24-hour averaging basis.

(d) Total reduced sulfur emissions from any smelt dissolving tank shall not exceed 0.0168 grams/kilogram black liquor solids on a 24-hour averaging basis. In lieu of meeting the emissions standard the use of fresh water on the particulate control system will be deemed as being in compliance.

(e) The Technical Secretary will not consider periods of excess emissions to be indicative of a violation of the standards in this rule provided that:

1. The percent of total number of possible continguous periods of excess emissions in a quarter (excluding periods of startup, shutdown or malfunction) during which excess emissions occur does not exceed:

(i) One percent for TRS emissions from the recovery furnaces, or (ii) Two percent for TRS emissions from lime kilns, and 2. The Technical Secretary determines that the sources involved, including air pollution control equipment, are maintained and operated in a manner which is consistent with good air pollution control practice for minimizing emissions during periods of excess emissions.

(5) Reserved.

(6) Reserved.

(7) Reserved. (See Rule 0400-30-39-.03.)

(8) Reserved (9) Reserved. (See Rule 0400-30-39-.03.)

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 8, 1981; effective January 22, 1982. Amendment filed September 21, 1988; effective November 6, 1988. Amendment filed September 22, 1988; effective November 6, 1988. Amendment filed March 5, 1993; effective April 19, 1993. Amendment filed October 15, 1998; effective December 28, 1998. Amendment filed January 15, 2009; (1200-03-07-.07, continued) effective March 31, 2009. Amendment filed February 3, 2009; effective April 19, 2009. Amendments filed July 10, 2023; effective October 8, 2023.

Tenn. Comp. R. & Regs. 1200-03-07-.08 SPECIFIC PROCESS EMISSION STANDARDS

(1) Existing Ferrous Jobbing Cupolas No later than August 9, 1973, the maximum particulate emission rate from existing ferrous jobbing cupolas shall be as given in Table 3.

TABLE 3 ALLOWABLE RATE OF PARTICULATE EMISSION

BASED ON PROCESS WEIGHT RATE EXISTING FERROUS JOBBING CUPOLAS

Maximum Weight Process Weight Discharge (lb/hr) (lb/hr) . 1,000 3.05 2,000 4.70 3,000 6.35 4,000 8.00 5,000 9.58 6,000 11.30 7,000 12.90 8,000 14.30 9,000 15.50 10,000 16.65 12,000 18.70 16,000 21.60 18,000 23.40 20,000 25.10 The emission rate for a process weight intermediate to those shown in the Table shall be determined by linear interpolation.

(2) Emissions from Nitric Acid Plants (a) Existing Nitric Acid Plants After July 1, 1975, no person shall cause, suffer, allow, or permit the emission into the air of nitrogen oxides from any nitric acid plant under construction or in operation prior to April 3, 1972, which are:

1. In excess of 5.5 lbs per ton of acid produced, maximum 2 hour average, expressed as NO ; or 2. 400 ppm (0.04% by volume dry basis) of nitrogen oxides, measured as NO , whichever is the more restrictive.

(3) New and Existing Cotton Gins (a) For the purpose of this paragraph, the following definitions apply:

1. “Cotton Gin” means any facility or plant which removes seed, lint, and trash from raw cotton and bales the lint cotton for further processing. All individual pieces of (1200-03-07-.08, continued) equipment located at a cotton gin shall be considered as being a single process emission source.

2. “Cotton Gin Site or Gin Site” means the land upon which a cotton gin is located and all contiguous land having an identical ownership.

3. “High Efficiency Cyclone” means any cyclone type collector of the 2D-2D or 1D- 3D configuration. The 2D-2D design for small diameter cyclones is set forth in Agricultural Handbook 503, U.S. Dept. of Agriculture, Cotton Ginners Handbook, 1977 Edition, pages 81-84. The 1D-3D design for small diameter cyclones is the Texas A & M University long-cone cyclone design. Design specifics of this type of cyclone are set forth in Figure 6 of the article titled, “Air Utilization”, by E.P.

Columbus, which was presented at the Cotton Ginners Shortcourse which was held on July 27-31, 1987 at Stoneville, Mississippi.

4. “Low Pressure Exhausts” means the exhaust air systems at a cotton gin which handles air from the cotton lint handling system and battery condenser.

5. “High Pressure Exhausts” means all other exhaust air systems located at a cotton gin which are not defined as “low pressure exhausts.”

6. “Dust House” means a gravity settling chamber utilized for the control of particulate emissions from a cotton gin and meeting the specifications set forth in Agriculture Handbook 260, U.S. Dept. of Agriculture, Handbook for Cotton Ginners, 1964 Edition, page 93.

(b) The following conditions apply to owners and operators of cotton gins subject to the provisions of this paragraph:

1. Reserved.

2. The owner or operator of a cotton gin which was in operation or under construction on or prior to July 16, 1990, shall meet the standards set forth in Table 4 of rule 1200-03-07-.08 no later than July 1, 1991.

3. The owner or operator of a cotton gin for which construction begins after July 16, 1990 shall meet the standards set forth in Table 4 at the time the cotton gin commences operation.

4. In lieu of demonstrating compliance with the applicable emission standard contained in Table 4 of this rule the following control devices may be utilized:

(i) For emission control from low pressure exhausts, the use of screens with a mesh size of 80 by 80 or finer, or the use of perforated condenser drums with holes not exceeding .045 inches in diameter, or the use of a dust house.

(ii) For emission control from high pressure exhausts the use of high efficiency cyclones shall be deemed as demonstrating compliance.

5. If compliance with the emission standard specified in Table 4 is required, then the testing methodology to be utilized shall be that specified in Chapter 2 of the Department of Health and Environment’s Source Sampling Manual (dated December 10, 1987).

(1200-03-07-.08, continued)

6. Effective July 1, 1991, the burning of cotton gin waste at the gin site in a wigwam or any other type of enclosed burner shall be prohibited.

(c) The allowable particulate emission standards for new and existing cotton gins shall be determined by Table 4.

TABLE 4 ALLOWABLE RATE OF PARTICULATE EMISSIONS

BASED ON PROCESS WEIGHT RATE FOR NEW AND EXISTING COTTON GINS ___________________________________________________________________________________ Process Weight Rate of Process Weight Rate of Rate Emission Rate Emission ______________ ___________ ______________ _________________ Lb/Hr Lb/Hr Lb/Hr Lb/Hr ___________________________________________________________________________________ 1,000 1.6 9,000 13.7 1,500 2.4 10,000 15.2 2,000 3.1 12,000 18.2 2,500 3.9 14,000 21.2 3,000 4.7 16,000 24.2 3,500 5.4 18,000 27.2 4,000 6.2 20,000 30.1 5,000 7.7 30,000 44.9 6,000 9.2 40,000 59.7 7,000 10.7 50,000 64.0 8,000 12.2 60,000 or more 67.4 The allowable emission rate for a cotton gin with process weight rates intermediate to those shown in Table 4 shall be determined by linear interpolation.

(NOTE: All publications mentioned in paragraph (3) of this rule are available upon request by writing to:

Tennessee Division of Air Pollution Control 401 Church Street 9th Floor, L & C Annex Nashville, Tennessee 37243-1531 (A reasonable charge may apply for copying said materials.)

(4) New and Existing Kraft Mills The owner or operator of a kraft mill on which construction begins after January 1, 1973, shall meet the standards listed in subparagraphs (a), (b), and (c) of this paragraph at the time of operation of such mill commences. After August 9, 1973, no person shall cause, suffer, allow or permit particulate emissions from a kraft mill under construction or operation prior to September 11, 1980, in excess of the standard chosen in 1200-03-07-.02(1) or 1200-03-07- .02(2) provided, however, that after July 1, 1977, said emissions are as follows:

(a) Particulate matter from all recovery stacks shall not exceed three pounds per ton of equivalent air-dried kraft pulp.

(1200-03-07-.08, continued)

(b) Particulate matter from all lime kilns shall not exceed one pound per ton of equivalent air dried kraft pulp.

(c) Particulate matter from all smelt tanks shall not exceed on-half pound per ton of equivalent air dried kraft pulp.

(5) Existing Asphalt Plants After August 9, 1973, no person shall cause, suffer, allow or permit the discharge of particulate emissions from any asphalt plant under construction or in operation prior to April 3, 1972, in excess of the standard selected in accordance with the provisions of 1200-03-07- .02(1) or 1200-03-07-.02(2). It is expressly provided that no later than July 1, 1975, these emissions shall not be in excess of the standards set forth in Table 1 of chapter 1200-03-07, entitled “Existing Process Emission Sources: Allowable Rate of Emission Based on Process Weight Rate.” It is further stipulated that after that date, the rate of emission for existing asphalt plants with a process weight rate in excess of 200,000 pounds (100 tons) per hour shall not exceed 51.2 pounds per hour. Asphalt plants which are relocated more than 1.0 km from the previous position and did not receive a construction permit prior to November 6, 1988, shall not be allowed to emit more than the greater of the actual emissions at its previous location or the allowable emissions for a new asphalt plant.

History

• Authority: T.C.A. §§ 4-5-202 and 68-25-105.
• Administrative History: Original rule certified June 7, 1974; effective June 16, 1974. Amendment filed January 10, 1977; effective June 16, 1974. Amendment filed July 28, 1980; effective September 11, 1980. Amendment filed September 22, 1988; effective November 6, 1988. Amendment filed June 1, 1990; effective July 16, 1990.

Tenn. Comp. R. & Regs. 1200-03-07-.09 SULFURIC ACID MIST

(1) Sulfuric acid plants of any type commenced on or before April 3, 1972, must not emit more than 0.500 pounds of sulfuric acid mist per ton of 100% H SO produced, maximum one hour average expressed as H SO .

(2) Sulfuric acid plants of any type commenced after April 3, 1972, must not emit more than 0.150 pounds of sulfuric acid mist per ton of 100% H SO produced, maximum one hour average expressed as H SO .

History

• Authority: T.C.A. §§ 4-5-202 and 68-25-105.
• Administrative History: Original rule effective February 9, 1977.

Tenn. Comp. R. & Regs. 1200-03-07-.10 GRAIN LOADING LIMIT FOR CERTAIN EXISTING SOURCES

(1) A certificate of validation shall be issued by the Technical Secretary to air contaminant sources meeting the conditions of paragraphs (2) and (3) below. The applicable standard for a source with a certificate of validation is 1.0 grains per dry standard cubic foot of stack gases corrected to 70 ° F and 1 atmosphere in lieu of paragraph 1200-03-07-.04(2).

(2) The owner or operator of the air contaminant source must demonstrate to the satisfaction of the Technical Secretary that the following conditions exist:

(a) The air contaminant source was commenced before April 3, 1972; and no modification has been made to the source since that date.

(b) The air contaminant source meets all applicable emission standards outside of paragraph 1200-03-07-.04(2). Demonstration of this compliance with other regulations will require as a minimum an acceptable stack test report for particulate matter mass emissions (lbs/hr.) and verification of meeting the requirements of chapter 1200-03-05.

(1200-03-07-.10, continued)

(c) The particulate matter ambient air quality standards are being met in the vicinity of the air contaminant source, and no deterioration in air quality will result from the granting of a certificate of validation. The Technical Secretary may require this achievement of air quality to be demonstrated.

(d) A fee of five hundred dollars ($500) has been paid to the Department of Environment and Conservation to cover the cost of review of the request for the certificate of validation.

(e) The owner or operator shall submit an engineering report demonstrating that the investment cost of attaining 0.25 grains per dry standard cubic foot (gr/dscf) will exceed $50,000 per pound of particulate matter emissions prevented from entering the atmosphere per hour; or demonstrate attainment of 0.25 gr/dscf is technically unfeasible. The investment cost per pound per hour shall be calculated by the following formula:

Investment Cost per lb/hr = Capital Cost_________________________ (Present Grain Loading/DSCF - .25 gr/DSCF) (DSCF/hr)

(7000 gr/lb) where:

DSCF = dry standard cubic foot capital cost = expenditures covering the procurement and erection of air pollution control systems or necessary process modifications.

(f) The particulate matter emissions from the process emission source do not exceed 100 lbs/hr.

(3) The owner or operator of the air contaminant source must, in addition:

(a) Post on the operating premises the certificate of validation.

(b) Keep the air pollution control equipment in good operating condition and utilize said equipment at all times.

(4) Upon receipt of information by the Technical Secretary that any of the requirements of Paragraph (2) have been violated and any requirement of Paragraph (3) has been violated three times in any two year period, the Technical Secretary shall call a show cause meeting pursuant to T.C.A. § 68-25-107(8) to inquire into the alleged violations. After hearing sufficient proof and making findings of fact, the Technical Secretary shall revoke the certificate of validation previously granted to the offending air Contaminant source. After the certificate of validation has been revoked, the offending source shall comply with 1200-03-07-.04(2) as expeditiously as possible in a compliance schedule contained in an administrative order.

(5) After granting of a construction permit for the modification of an air contaminant source for which a certificate of validation has been issued, the certificate of validation shall become void on the date of expiration of the construction permit and Paragraph 1200-03-07-.04(2) shall apply.

History

• Authority: T.C.A. §§ 4-5-202 and 68-25-105.
• Administrative History: Original rule effective March 21, 1979.

Tenn. Comp. R. & Regs. 1200-03-07-.11 CARBON MONOXIDE, ELECTRIC ARC FURNACES

Electric arc furnaces used in producing iron or steel and located in Knox County shall emit no more than 18.0 pounds of carbon monoxide per ton of metal produced, one hour average.

History

• Authority: T.C.A. §§ 4-5-202 and 68-25-105.
• Administrative History: Original rule filed September 10, 1977; effective October 25, 1979.

Tenn. Comp. R. & Regs. 1200-03-07-.12 CARBON MONOXIDE, CATALYTIC CRACKING UNITS

After July 1, 1980, all catalytic cracking units at petroleum refineries located in Shelby County must not discharge to the atmosphere carbon monoxide in excess of 0.050 per cent by volume.

History

• Authority: T.C.A. §§ 4-5-202 and 68-25-105.
• Administrative History: Original rule filed November 8, 1981; effective January 22, 1982.

Chapter 1200-03-08 Fugitive Dust

Tenn. Comp. R. & Regs. 1200-03-08-.01 FUGITIVE DUST

(1) No person shall cause, suffer, allow, or permit any materials to be handled, transported, or stored; or a building, its appurtenances, or a road to be used, constructed, altered, repaired, or demolished without taking reasonable precautions to prevent particulate matter from becoming airborne. Such reasonable precautions shall include, but not be limited to, the following:

(a) Use, where possible, of water or chemicals for control of dust in demolition of existing buildings or structures, construction operations, grading of roads, or the clearing of land;

(b) Application of asphalt, water, or suitable chemicals on dirt roads, material stock piles, and other surfaces which can create airborne dusts;

(c) Installation and use of hoods, fans, and fabric filters to enclose and vent the handling of dusty materials. Adequate containment methods shall be employed during sandblasting or other similar operations.

(2) No person shall cause, suffer, allow, or permit fugitive dust to be emitted in such manner to exceed five (5) minutes per hour or twenty (20) minutes per day as to produce a visible emission beyond the property line of the property on which the emission originates, excluding malfunction of equipment as provided in Chapter 1200-03-20.

(3) Compliance Schedule.

(a) For those operations in existence before April 3, 1972, fugitive dust control must be achieved by August 9, 1973.

(b) For those operations, the construction of which commences after April 3, 1972, fugitive dust control must be achieved at the time operation commences.

(4) Regardless of the specific emission standards contained in this Chapter, all sources identified in rule 1200-03-09-.01(4) of these regulations shall comply with the standards set pursuant to

Chapter 1200-03-09.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 53-3412; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed May 7, 1979; effective June 21, 1979. Amendment filed June 21, 1979. Amendment filed July 11, 1980. Amendments filed June 6, 2018; effective September 4, 2018.

Tenn. Comp. R. & Regs. 1200-03-08-.02 SPECIAL ADDITIONAL CONTROL AREA FUGITIVE DUST REQUIREMENTS

Certain areas of the state have been identified as needing additional control beyond that required by this

Chapter. These areas and the additional control requirements are stated in Chapter 1200-03-19.

History

• Authority: T.C.A. §§ 4-5-202 and 68-25-105.
• Administrative History: Original rule filed February 5, 1979; effective March 21, 1979. Amendment filed September 22, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-08-.03 NEW AND/OR MODIFIED SOURCE

All air contaminant sources constructed and/or modified after November 6, 1988, shall meet the fugitive dust emission standards specified on their construction permit and subsequently transferred to their operating permits. These standards shall be prescribed in the form of a Board approved visible emission standard and reading technique on the permits.

History

• Authority: T.C.A. §§ 4-5-202 and 68-25-105.
• Administrative History: Original rule file September 22, 1988; effective November 6, 1988.

Chapter 1200-03-09 Construction and Operating Permits

Tenn. Comp. R. & Regs. 1200-03-09-.01 ; and VI. Are not otherwise required in paragraph 1200-03-09-.02(11) to be processed as a significant modification.

(II) Application An application requesting the use of minor permit modification procedures shall meet the requirements of part 1200-03-09- .02(11)(d)3. and shall include the following:

I. A description of the change, the emissions resulting from the change, and any new applicable requirements that will apply if the change occurs;

II. The source’s suggested draft permit;

III. Certification by a responsible official, consistent with part 1200-03-09-.02(11)(d)4., that the proposed modification meets the criteria for use of minor permit modification procedures and a request that such procedures be used; and IV. Completed forms for the Technical Secretary to use to notify the Administrator and affected States as required under subparagraph 1200-03-09-.02(11)(g).

(III) EPA and affected State notification.

Within 5 working days of receipt of a complete permit modification application the Technical Secretary shall notify the Administrator and affected States of the requested permit modification consistent with the provisions of subpart 1200-03-09-.02(11)(g)1.(i) and subpart 1200-03-09-.02(11)(g)2.(i). The Technical Secretary shall promptly send any notice required under subpart 1200-03-09-.02(11)(g)2.(ii) to the Administrator.

(IV) The Technical Secretary shall not issue a final permit modification until after EPA’s 45-day review period or until EPA has notified the Technical Secretary that EPA will not object to the issuance of the permit modification, whichever is first, although the Technical Secretary can approve the permit modification prior to that time.

Within 90 days of the Technical Secretary’s receipt of an application under minor permit modification procedures or 15 days after the end of the Administrator’s 45-day review period under the provisions of

subpart 1200-03-09-.02(11)(g)3., whichever is later, the Technical Secretary shall:

I. Issue the permit modifications as proposed; or II. Deny the permit modification application; or III. Determine that the requested modification does not meet the minor permit modification criteria and should be reviewed under the significant modification procedures; or IV. Revise the draft permit modification and transmit to the Administrator the new proposed permit modification as required by part 1200-03-09-.02(11)(g)1.

(V) The source may make the change proposed in its minor permit modification immediately after it files such application. After the source makes the change allowed by the preceding sentence, and until the Technical Secretary takes any of the actions specified in subitems 1200-03-09-.02(11)(f)5.(ii)(IV)I.-III. the source must comply with both the applicable requirements governing the change and the proposed permit terms and conditions. During this time period, the source need not comply with the existing permit terms and conditions it seeks to modify. However, if the source fails to comply with its proposed permit terms and conditions during this time period, the existing permit terms and conditions it seeks to modify may be enforced against it.

(VI) Permit Shield - The permit shield under part 1200-03-09-.02(11)(e)6. may not extend to minor permit modifications.

(VII) Reserved.

(iii) Group processing of minor permit modifications:

A source may group its applications for certain modifications eligible for minor permit modification processing according to the following requirements:

(I) Criteria - Group processing of modifications may be used only for those permit modifications:

I. That meet the criteria for minor permit modification procedures under item 1200-03-09-.02(11)(f)5.(ii)(I); and II. That are collectively below the least of the following threshold criteria levels:

A. 10 percent of the emissions allowed by the permit for the emissions unit for which the change is requested;

B. 20 percent of the applicable definition of “major source” in part 1200-03-09-.02(11)(b)14.; or C. 5 tons per year.

(II) Application An application requesting the use of the group processing of minor permit modifications procedure shall meet the requirements of part 1200-03-09-.02(11)(d)3. and shall include the following:

I. A description of the change, the emissions resulting from the change, and any new applicable requirements that will apply if the change occurs;

II. The source’s suggested draft permit;

III. Certification by a responsible official consistent with part 1200- 03-09-.02(11)(d)4., that the proposed modification meets the criteria for use of group processing procedures and a request that such procedures be used.

IV. A list of the source’s other pending applications awaiting group processing, and a determination of whether the requested modification, aggregated with these other applications, equals or exceeds the threshold set under subitem 1200-03-09- .02(11)(f)5.(iii)(I)II.

V. Certification, consistent with the provisions of part 1200-03-09- .02(11)(d)4., that the source has notified EPA of the proposed modification. Such notification need only contain a brief description of the requested modification.

VI. Completed forms for the Technical Secretary to use to notify the Administrator and affected States as required under subparagraph 1200-03-09-.02(11)(g).

(III) EPA and affected State Notification;

On a quarterly basis or within 5 business days of receipt of an application demonstrating that the aggregate of a source’s pending applications equals or exceeds the threshold level set under subitem 1200-03-09-.02(11)(f)5.(iii)(I)II., whichever is earlier, the Technical Secretary promptly shall meet his obligation under subpart 1200-03- 09-.02(11)(g)1.(i) and subpart 1200-03-09-.02(11)(g)2.(i) to notify the Administrator and affected States of the requested permit modifications. The Technical Secretary shall send any notice required under subpart 1200-03-09-.02(11)(g)2.(ii) to the Administrator.

(IV) Timetable for issuance;

The provisions of item 1200-03-09-.02(11)(f)5.(ii)(IV) shall apply to modifications eligible for group processing except that the Technical Secretary shall take one of the actions specified in subitems 1200- 03-09-.02(11)(f)5.(ii)(IV)I. through IV. within 180 days of receipt of the application or 15 days after the end of the Administrator’s 45 day review period under part 1200-03-09-.02(11)(g)3., whichever is later.

(V) Source’s ability to make change;

The provisions of item 1200-03-09-.02(11)(f)5.(ii)(V) shall apply to modifications eligible for group processing.

(VI) Permit Shield The provisions of item 1200-03-09-.02(11)(f)5.(ii)(VI) shall apply to modifications eligible for group processing.

(iv) Significant modification procedures (I) Criteria Significant modification procedures shall be used for applications requesting permit modifications that do not qualify as minor permit modifications or as administrative amendments. In addition to the criteria of the preceding sentence, a relaxation of monitoring, reporting or recordkeeping requirements shall be considered significant. In the event that the Technical Secretary issues a statement of clarification to clarify a permit requirement that is ambiguous or otherwise unclear, such clarification will not be considered a significant modification if it results in the less restrictive interpretation, provided however, that the less restrictive interpretation was the intent of the Technical Secretary in issuing the original permit requirement. Nothing herein shall be construed to preclude the permittee from making changes consistent with paragraph 1200-03-09-.02(11) that would render existing permit compliance terms and conditions irrelevant.

(II) Significant modifications shall meet all requirements of paragraph 1200-03-09-.02(11) including those for applications, public participation, review by affected States, and review by EPA, as they apply to permit issuance and permit renewal. The Technical Secretary shall endeavor to process all significant permit modification requests within 9 months after receipt of a complete application. The Technical Secretary is directed to program the resources of the Department’s Division of Air Pollution Control such that at least 51 percent of the significant modification requests are processed within the 9 month period on a calendar year basis.

6. Reopening for Cause (i) Each issued permit shall include provisions specifying the conditions under which the permit will be reopened prior to the expiration of the permit. A permit shall be reopened and revised under any of the following circumstances:

(I) Additional applicable requirements under the Federal Act become applicable to a major source subject to paragraph 1200-03-09- .02(11) with a remaining permit term of 3 or more years. Such a reopening shall be completed not later than 18 months after promulgation of the applicable requirement. No such reopening is required if the effective date of the requirement is later than the date on which the permit is due to expire, unless the original has been extended pursuant to part 1200-03-09-.02(11)(a)2.

(II) Additional requirements (including excess emission requirements) become applicable to an affected source under the acid rain program. Upon approval by the Administrator, excess emissions offset plans shall be deemed to be incorporated into the permit.

(III) The Technical Secretary or EPA determines that the permit contains a material mistake or that inaccurate statements were made in establishing the emissions standards or other terms or conditions of the permit.

(IV) The Technical Secretary or EPA determines that the permit must be revised or revoked to assure compliance with the applicable requirements.

(ii) Proceedings to reopen and issue a permit shall follow the same proceedings as apply to initial permit issuance and shall affect only those parts of the permit for which cause to reopen exists, and not the entire permit. Such reopening shall be made as expeditiously as practicable.

(iii) Reopening under subpart 1200-03-09-.02(11)(f)6.(i) shall not be initiated before a notice of such intent is provided to the permittee by the Technical Secretary at least 30 days in advance of the date that the permit is to be reopened except that the Technical Secretary may provide a shorter time period in the case of an emergency. An emergency shall be established by the criteria of T.C.A. § 68-201-109 or other compelling reasons that public welfare is being adversely effected by the operation of a source that is in compliance with its permit requirements.

7. Reopenings for Cause by EPA (i) If the Administrator finds that cause exists to terminate, modify, or revoke and reissue a permit pursuant to part 1200-03-09-.02(11)(f)6., he is required under federal rules to notify the Technical Secretary and the permittee of such findings in writing. Upon receipt of such notification, the Technical Secretary shall investigate the matter in order to determine if he agrees or disagrees with the Administrator’s findings. If he agrees with the Administrator’s findings, the Technical Secretary shall conduct the reopening in the following manner:

(ii) The Technical Secretary shall within 90 days after receipt of such notification, forward to EPA a proposed determination of termination, modification, or revocation and reissuance, as appropriate. If the Administrator grants additional time to secure permit applications or additional information from the permittee, the Technical Secretary shall have the additional time period added to the standard 90 day time period.

(iii) EPA will evaluate the Technical Secretary’s proposed revisions and respond as to their evaluation.

(iv) If EPA agrees with the proposed revisions, the Technical Secretary shall proceed with the reopening in the same manner prescribed under subparts 1200-03-09-.02(11)(f)6.(ii) and (iii).

(v) If the Technical Secretary disagrees with either the findings of the Administrator that a permit should be reopened or an objection of the Administrator to a proposed revision to a permit submitted pursuant to

subpart 1200-03-09-.02(11)(f)7.(ii), he shall bring the matter to the Board at its next regularly scheduled meeting for instructions as to how he should proceed. The permittee shall be required to file a written brief expressing their position relative to the Administrator’s objection and have a responsible official present at the meeting to answer questions of the Board. If the Board agrees that EPA is wrong in their demand for a permit revision, they shall instruct the Technical Secretary to conform to EPA’s demand, but to issue the permit under protest preserving all rights available for litigation against EPA.

8. Public Participation (i) Except for modifications qualifying for minor permit modifications procedures, all permit proceedings, including initial permit issuance, significant modifications and renewals, shall provide adequate procedures for public notice including offering an opportunity for public comment and a hearing on the draft permit. These procedures shall include the following:

(I) Notice shall be given via electronic notice on the Department’s website or by other means designated by the Technical Secretary if necessary to assure adequate notice to the affected public. Should newspaper publication of the notice be deemed necessary the applicant shall bear the expense of publishing the newspaper notice in a newspaper of general circulation in the area where the source is located. The electronic notice shall be available for the duration of the public comment period and any notice under this item shall include the notice of public comment, the draft permit, information on how to access the administrative record for the draft permit, and how to request and/or attend a public hearing on the draft permit. Notice shall also be given by the Technical Secretary to persons on a mailing list who meet the following criteria:

I. Such persons shall request to be on the list in writing on an annual basis.

II. Such persons shall pay a fee of $10.00 per year to the Department to defray the cost of postage and handling and list management.

(II) The notice shall identify the facility to be permitted; the name and address of the permittee; the Technical Secretary and his address; the activity or activities involved in the permit action; the emission change involved in any permit modification; the name, address and telephone number of a person from whom interested parties may obtain additional information, including copies of the permit draft, the application, all relevant supporting materials including the source’s compliance plan and monitoring reports, and all other materials available to the Technical Secretary that are relevant to the permit decision. These materials will be placed in a public depository for public inspection. Those persons unwilling to view these materials at the public depositories may request copies to be mailed to them at a cost of $0.50 (50 cents) per page. The notice shall also include a brief description of the comment procedure specified in part 1200- 03-09-.02(11)(f)8.; and the time and place of any hearing that may be held, including a statement of procedures to request a hearing (unless a hearing has already been scheduled);

(III) The Technical Secretary shall provide such notice and opportunity for participation by affected States as is provided for by subparagraph 1200-03-09-.02(11)(g);

(IV) The Technical Secretary shall provide at least 30 days for public comment and shall give notice of any public hearing at least 30 days in advance of the hearing.

(V) The Technical Secretary shall keep a record of the commentors and also of the issues raised during the public participation process so that the Administrator may fulfill his obligation under Section 505(b)(2) of the Federal Act to determine whether a citizen petition may be granted, and such records shall be available to both the public and the applicant.

(g) Permit Review by EPA and Affected States 1. Transmission of Information to the Administrator (i) The Technical Secretary shall provide a copy of each permit application submitted pursuant to the provisions of paragraph 1200-03-09-.02(11) to the Administrator. Upon agreement with the Administrator the Technical Secretary is permitted to send less than a complete copy to the Administrator as long as the Administrator is satisfied with the level of detail in the partial submittal. Additionally, the Technical Secretary shall provide the Administrator a copy of each proposed permit and each final permit that will be issued to a source subject to the provisions of paragraph 1200-03-09-.02(11).

(ii) The Technical Secretary shall keep for 5 years such records and submit to the Administrator such information as the Administrator may reasonably require to ascertain whether or not the provisions of paragraph 1200-03- 09-.02(11) are being followed.

2. Review by affected States (i) The Technical Secretary shall give notice of each draft permit prepared pursuant to the provisions of paragraph 1200-03-09-.02(11) to any affected State on or before the time that he provides this notice to the public under

part 1200-03-09-.02(11)(f)8., except to the extent that subpart 1200-03-09- .02(11)(f)5.(ii) or subpart 1200-03-09-.02(11)(f)5.(iii) requires the timing of the notice to be different. The affected State review and comment period shall close simultaneously with the closure of the public review and comment period. The affected States will have thirty days to review and comment upon minor modifications.

(ii) The Technical Secretary shall notify the Administrator and any affected State in writing of his refusal to accept all recommendations for the proposed permit that the affected State submitted during the public or affected State review period. Said notice shall be filed when the proposed permit is sent to the Administrator or as soon as possible after the submittal for minor permit modification procedures allowed under subpart 1200-03-09-.02(11)(f)5.(ii) or subpart 1200-03-09-.02(11)(f)5.(iii). The notice shall include the Technical Secretary’s reasons for not accepting any such recommendation. The Technical Secretary is not required to accept recommendations that are not based upon applicable requirements or the requirements of 40 C.F.R. Part 70.

3. EPA Objection (i) No permit for which an application must be transmitted to the Administrator under part 1200-03-09-.02(11)(g)1. shall be issued if the Administrator objects to its issuance in writing within 45 days of receipt of the proposed permit and its level of supporting information as prescribed in subpart 1200-03-09-.02(11)(g)1.(i).

(ii) The Technical Secretary shall respond to the objections of the Administrator and restructure the permit consistent with the provisions of the Federal Act, federal regulations promulgated thereunder or any lawfully promulgated federal policy and the provisions of the State Act, the regulations comprising Division 1200-03 and any policies of the Board.

4. Public Petitions to the Administrator Any person can petition the Administrator to object to a permit according to the criteria of 40 C.F.R. 70.8(d). An objection to a permit by the Administrator that is filed in response to a public petition under the provisions of paragraph 40 C.F.R. 70.8(d) shall be answered by the Technical Secretary in the same manner prescribed by subpart 1200-03-09-.02(11)(g)3.(ii). If the Technical Secretary has issued the permit prior to the Administrator’s objection in response to a public petition, the Administrator’s modification, revocation or termination of the issued permit shall not cause the source to be in violation of the requirement to have submitted a timely and complete application as specified in part 1200-03-09- .02(11)(d)1. and in keeping with the application shield provisions of part 1200-03- 09-.02(11)(f)2. If the Technical Secretary disagrees with the Administrator’s objections and demand for revision of the permit, the provisions of subpart 1200- 03-09-.02(11)(f)7.(v) shall apply.

(12) The Technical Secretary may elect to issue minor source combination construction/operating permits. Sources issued such permits are considered to be in compliance with paragraph (1) of Rule 1200-03-09-.01 and paragraphs (1), (2), and (3) of this rule if all conditions in the permit are complied with and the permittee applies for renewal of the operating permit as specified in the permit.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-101, et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed and effective February 9, 1977. Amendment filed and effective March 21, 1979. Amendment filed May 17, 1990; effective July 1, 1990. Amendment filed July 8, 1994; effective September 20, 1994. Amendment filed May 11, 1998; effective July 25, 1998. Amendment filed October 15, 1998; effective December 28, 1998. Amendment filed November 12, 1998; effective January 26, 1999. Amendment filed December 14, 1999; effective February 27, 2000. Amendment filed December 30, 1999; effective March 14, 2000. Amendments filed February 24, 2009; effective May 10, 2009. Amendments filed November 10, 2010; effective February 8, 2011. Amendment filed August 29, 2011; effective November 27, 2011. Amendment filed September 11, 2015; effective December 10, 2015. Amendments filed May 17, 2017; effective August 15, 2017. Amendments filed June 6, 2018; effective September 4, 2018. Amendments filed October 23, 2020; effective January 21, 2021. Amendments filed September 29, 2022; effective December 28, 2022. Amendments filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-09-.02 OPERATING PERMITS

(1) Any person planning to operate an air contaminant source constructed or modified in accordance with a construction permit issued by the Technical Secretary in Rule 1200-03-09- .01 shall apply for and receive from the Technical Secretary an operating permit or, if applicable, submit a notice of intent and obtain a notice of coverage or authorization after initial start-up of the air contaminant source. Ninety (90) days shall be allowed for this, provided paragraph (3) of this rule is complied with. This time period is extended from ninety (90) to one hundred twenty (120) days if stack sampling has been required as a condition on the construction permit, which is further extended to sixty (60) days after the stack sampling report is required on the construction permit if a certain time is specified, provided the stack sampling report is filed with the Division within sixty (60) days of initial start-up or the time specified on the construction permit and paragraph (3) of this rule is complied with, except as otherwise allowed in paragraph (11) of this rule.

(2) No person shall operate an air contaminant source in Tennessee without first obtaining from the Technical Secretary an operating permit or, if applicable, submitting a notice of intent and obtaining a notice of coverage or authorization, except as specifically exempted in Rule

Tenn. Comp. R. & Regs. 1200-03-09-.03 GENERAL PROVISIONS

(1) Notwithstanding the provisions of the preceding paragraphs of this chapter, the owner or operator of any air contaminant source shall be responsible for complying with emission regulations as contained in other chapters of these regulations at the earliest practicable time and for this purpose the Board shall have the authority and responsibility to require compliance with these regulations at an earlier date than indicated where such earlier compliance may reasonably be accomplished.

(2) No person shall use any plan, activity, device, or contrivance which the Technical Secretary determines will, without resulting in an actual reduction of air contaminants, conceal or appear to minimize the effects of an emission which would otherwise constitute a violation of these regulations. Methods considered circumvention of the regulations include but are not limited to the following:

(a) Air (or other gases) introduced for dilution purposes only.

(b) The staggered installation and operation of a facility to avoid coverage by a standard that applies only to operations larger than a specified size.

(3) No person shall discharge from any source whatsoever such quantities of air contaminant, uncombined water, or other materials which cause a traffic hazard.

(4) Any person affected by any of these regulations shall file emissions data with the Technical Secretary on forms available from the Secretary. If any changes are made that invalidate this data, the owner or operator shall file within thirty (30) days new forms with the appropriate revisions to the data.

(5) Any source operating under a variance or Board Order (whether effective under T.C.A. §§ 68- 25-116 or 68-25-118) shall prominently and conspicuously display a copy of said variance or Board Order on the operating premises.

(6) Ownership Change (a) An operating permit, construction permit, notice of coverage, or notice of authorization is transferable from one person to another person provided that:

1. Written notification of the ownership change is submitted to the Technical Secretary no later than thirty (30) days after the change; and 2. The new owner or operator:

(i) Does not make any changes to the stationary source that meet the definition of modification as defined in this Division 1200-03 or Division 0400-30, and (ii) Agrees to abide by the terms of the permit or notice of coverage or authorization, Division 1200-03, Division 0400-30, the Tennessee Air Quality Act, and any documented agreements made by the previous owner to the Technical Secretary.

(b) No operating permit, construction permit, notice of coverage, or notice of authorization is transferable from one air contaminant source to another air contaminant source or from one location to another location. The new operating permit, construction permit, notice of coverage, or notice of authorization required by this subparagraph will be governed by rules in effect at the time of its issuance.

(7) The Technical Secretary may suspend or revoke any construction permit, operating permit, notice of coverage, or notice of authorization if the holder fails to comply with the provisions, stipulations, or compliance schedules specified in the permit, notice of coverage, or notice of authorization; Division 1200-03; Division 0400-30; and the Tennessee Air Quality Act. Upon suspension or revocation of a permit or notice of coverage or authorization, if the holder fails to take remedial action, then the holder shall become immediately subject to additional enforcement actions prescribed by law.

(8) The Technical Secretary may include on all permits issued under the Tennessee Air Quality Act conditions to directly impose all provisions applicable to sources that are necessary under the federal Clean Air Act and effective federal regulations pursuant to this act, e.g., National Emission Standards for Hazardous Air Pollutants, as well as provisions necessary under Tenn. Code Ann. §§ 68-201-101 et seq. and rules of this Division 1200-03. Issuance of a permit containing conditions imposing such applicable provisions necessary under the federal Clean Air Act and effective federal regulations pursuant to this act shall not be treated as a repeal by implication of any otherwise applicable provisions of Division 1200-03. That is, simply the inclusion of such conditions containing federal standards or requirements that are less restrictive than standards or requirements in Division 1200-03 concerning the same matter shall not thereby effect a relaxation of the more restrictive provisions of Division 1200- 03.

History

• Authority: T.C.A. §§ 4-5-202, et seq.; 68-25-105; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule certified June 7, 1974. Amendment filed and effective February 9, 1977. Amendment filed September 22, 1988; effective November 6, 1988. Amendment filed May 17, 1990; effective July 1, 1990. Amendment filed July 20, 1999; effective October 2, 1999. Amendment filed July 22, 2003; effective October 5, 2003. Amendment filed February 24, 2009; effective May 10, 2009. Amendments filed May 17, 2017; effective August 15, 2017.

Tenn. Comp. R. & Regs. 1200-03-09-.04 EXEMPTIONS

(1) The permit exemptions listed in paragraph (4) of this rule do not apply if an air contaminant source is subject to a standard or requirement contained in the following, except if the air contaminant source belongs to a source category listed in paragraph (5) of Rule 1200-03-09- .07, even if the source itself is not eligible for authorization, or except where specifically stated:

Chapter 0400-30-38 (Emission Standards for Hazardous Air Pollutants);

Chapter 1200-03-18 (Volatile Organic Compounds);

Chapter 1200-03-19 (Emission Standards and Monitoring Requirements for Additional Control Areas);

Chapter 1200-03-22 (Lead Emission Standards);

Chapter 1200-03-27 (Nitrogen Oxides); and Paragraph (2) of Rule 1200-03-31-.05 (Standards for New Sources).

In addition, the exemption provided for the air contaminant sources in paragraph (4) of this

rule does not exempt the sources from inclusion in determining if a major stationary source or major modification construction permit is required under paragraphs (4) and (5) of Rule 1200- 03-09-.01.

(2) (a) Definitions.

As used in paragraphs (1), (2), (3), and (4) of this Rule, all terms not defined herein shall have the meaning given them in Paragraph 1200-03-09-.02(11) and Chapter 1200-03-02 with the terms in Paragraph 1200-03-09-.02(11) taking precedence over

Chapter 1200-03-02.

1. “Emissions unit” means any part or activity of a stationary source that emits or has the potential to emit any regulated air pollutant or any pollutant listed in paragraph 1200-03-31-.02(6). Emissions unit includes within its meaning the smallest discrete or identifiable structure, device, item, equipment, or enclosure or group of discrete or identifiable structures, devices, items, equipment, or enclosures that emit or have the potential to emit any regulated air pollutant or any pollutant listed in paragraph 1200-03-31-.02(6). A point of origin of fugitive emissions resulting from equipment leaks of individual pieces of equipment, e.g., valves, flanges, pumps, and compressors, shall not be considered an individual emissions unit. Such equipment leaks shall be collectively considered an emissions unit based on their relationship to the associated process unit and shall be considered separately from other emissions from the process unit when defining insignificant emissions.

2. “Fugitive emissions” are those emissions which could not reasonably pass through a stack, chimney, vent, or other functionally-equivalent opening.

3. “Insignificant activity” or “insignificant emissions unit” means any activity or emissions unit at a stationary source for which the emissions unit or activity has the potential to emit less than 5 tons per year of each air contaminant and each regulated air pollutant that is not a hazardous air pollutant, and less than 1,000 pounds per year of each hazardous air pollutant unless specifically excluded from designation as an insignificant activity or insignificant emissions unit elsewhere in this Division 1200-03 or Division 0400-30.

4. “Potential to emit” means the maximum capacity of a stationary source to emit any air pollutant under its physical and operational design. Any physical or operational limitation on the capacity of a source to emit an air pollutant, including air pollution control equipment and restrictions on hours of operation or on the type or amount of material combusted, stored, or processed, shall be treated as part of its design if the limitation is federally enforceable.

5. “Process unit” means equipment assembled and connected by pipes or ducts to manufacture an intended product. A process unit can operate independently if supplied with sufficient feed or raw materials and sufficient storage facilities for the product.

6. “Regulated air pollutant” has the same definition as found in subparagraph 1200- 03-09-.02(11)(b)19.

7. “Stationary source” means any building, structure, facility, or installation that emits or may emit any regulated air pollutant or any pollutant listed under paragraph 1200-03-31-.02(6).

8. “Applicable requirement” has the same definition as in part 1200-03-09-.02 (11)(b)5.

9. “Federally enforceable” means any emission standard and/or procedural requirement that can be enforced against an air contaminant source by EPA or citizens under authority granted them by the Federal Act.

10. “Hazardous air pollutant” means any air contaminant regulated in Chapter 0400- 30-38, or listed in paragraph (6) of Rule 1200-03-31-.02.

(b) Notwithstanding the permit exemptions granted in paragraph (4) of this rule, no person shall discharge, from any source whatsoever, such quantities of air contaminants or other materials which cause or have a tendency to cause injury, detriment, annoyance, or adverse effect to the public.

(c) Notwithstanding any other provision of Division 1200-03 and Division 0400-30, no emissions unit or activity subject to a federally enforceable applicable requirement not included in this Division 1200-03 or Division 0400-30 (other than generally applicable requirements of the state implementation plan) shall qualify as an insignificant emissions unit or activity. For purposes of this paragraph, generally applicable requirements of the state implementation plan are those federally enforceable requirements that apply universally to all emission units or activities without reference to specific types of emission units or activities except for the sulfur dioxide standards for those categories and classes included in Chapter 1200-03-14.

(d) Designation of an emissions unit or activity as insignificant for purposes of this rule does not exempt the unit or activity from any applicable requirement.

(e) The emissions from any exempt air contaminant source shall comply with all applicable rules and regulations of the Tennessee Air Pollution Control Board.

(3) Any person may request that a federally enforceable permit be issued for any of the air contaminant sources that are exempted in paragraph 1200-03-09-.04(4). “Federally enforceable” shall have the meaning as provided in paragraph 1200-03-09-.02(11).

(4) The list of exempted air contaminant sources contained in this paragraph shall not be used as “insignificant activities” or “insignificant emission units” when applying for a major source operating permit under paragraph 1200-03-09-.02(11). These exemptions shall not be used to lower the source’s potential to emit below “major source” applicability thresholds or to avoid any “applicable requirement”. Otherwise, no person shall be required to obtain or file a request for a permit due to ownership, operation, construction, or modification of the following types of air contaminant sources unless specifically required to do so by the Board or as provided for in paragraph (3) of this rule:

(a) Any “insignificant activity” or “insignificant emissions unit”:

In order to receive designation as an “insignificant activity” or “insignificant emissions unit”, a written notification must be submitted to the Technical Secretary. The notification for designation shall include calculations and sufficient documentation to substantiate the applicant’s claim. Upon receipt of the notification, the Technical Secretary will respond with a determination of agreement or disagreement with the applicant’s claim. In issuance of determination as “insignificant”, the Technical Secretary may base the determination upon any criteria that are relevant to the determination. For new sources, the request for designation must be made at least 30 days prior to the estimated starting date of construction. For new sources, if it is determined that the emissions unit does not qualify as an “insignificant emissions unit”, the source must apply for a construction permit. The request for designation as an “insignificant emissions unit” may be made at any time for an existing source. In the absence of being designated as an “insignificant emissions unit” by the Technical Secretary under subparagraph 1200-03-09-.04(4)(a) or in the absence of being exempt under subparagraphs 1200-03-09-.04(4)(b) or 1200-03-09-.04(4)(c), any emission unit or activity must have a valid construction and / or operating permit.

(b) The categorical emission units or activities listed in subparagraph 1200-03-09-.04(5)(f), excluding parts 1. and 2.

To be categorically insignificant, with the exception of parts 19. and 84., the emissions unit or activity must have a potential to emit less than 5 tons per year of each air contaminant and each regulated air pollutant that is not a hazardous air pollutant, and less than 1,000 pounds per year of each hazardous air pollutant. Such emission units or activities, with the exception of parts 19. and 84., are not required to be listed in the construction or operating permit applications for the facility.

(c) The emission units or activities listed in subparagraph 1200-03-09-.04(5)(g). Such emission units or activities are not required to be listed in the construction or operating permit applications for the facility.

(d) Any one of the following emission units or activities:

Such emission units or activities are not required to be listed in the construction or operating permit applications for the facility.

1. Fuel burning equipment of less than 500,000 Btu per hour capacity. This exemption shall not apply where the total capacity of such equipment operated by one person exceeds 2.00 million Btu per hour.

2. Single stack of an air contaminant source that emits no hazardous air contaminants or pollutants, and which does not have the potential for emitting more than 0.50 pounds per hour of nonhazardous particulates and 0.5 pounds per hour of any regulated nonhazardous gas (particulates and gases not defined as hazardous air contaminants or pollutants), provided that the total potential particulate emissions from the air contaminant source amounts to less than two (2) pounds per hour, and the total regulated gaseous emissions from the air contaminant source amounts to less than two (2) pounds per hour. For the

purpose of this part, an air contaminant source includes all sources located within a contiguous area, and under common control.

3. Any air contaminant source constructed and operated at a domestic residence solely for domestic use.

4. Equipment used exclusively to store, hold, or distribute natural gas or propane excluding all associated fuel burning equipment not specifically exempted.

5. Brazing, soldering, or welding equipment which does not emit lead in amounts equal to or greater than 0.5 tons per year.

6. Sources that are not owned or operated by the State within the counties of Shelby, Davidson, Hamilton, and Knox until such time as the Board shall determine that air pollution is not being controlled in such county to a degree at least as stringent as the substantive provisions of the Tennessee Air Quality Act and regulations adopted pursuant thereto. This exemption does not apply to any air contaminant source in those counties if the local regulation is less stringent than the applicable state regulation.

7. Automobile body shops not subject to the requirements of 40 C.F.R. 63 subpart HHHHHH, including paint spraying, grinding and polishing operations. This exemption does not apply to sources in ozone nonattainment areas which emit more than 15 pounds per day of volatile organic compounds.

8. Any process emission source emitting less than 0.1 pounds per hour of a pollutant.

9. Any emission unit with the potential to emit radionuclides which will result in a dose to the most exposed member of the public of less than 0.1 millirem per year. Even though radionuclide air contaminant sources are regulated under

Chapter 0400-30-38, this exemption is still valid except that recordkeeping and reporting requirements must be met.

10. Any modification (as defined in Rule 1200-03-02-.01) to an existing process emission source, incinerator, or fuel-burning installation to add sources of equipment leaks (e.g. valves, flanges, pumps, compressors, etc.) as long as the estimated increase in annual emissions attributable to the modification does not exceed 5 tons per year. However, such emissions increases shall be considered when making major modification determinations pursuant to paragraphs 1200- 03-09-.01(4) and (5).

11. All livestock (including poultry) operations and associated fuel burning and incineration equipment. This exemption from permitting requirements does not extend to:

(i) An incineration unit which has a manufacturer’s rated capacity greater than 500 pounds per hour or has a total burner rated capacity greater than 400,000 Btu per hour.

(ii) An incineration unit into which is charged materials or wastes other than livestock and poultry carcasses; or (iii) A commercial incineration unit.

12. All storage tanks with a capacity less than 10,000 gallons and all process tanks with a capacity less than 3,000 gallons.

13. Mobile sources such as: automobiles, trucks, buses, locomotives, planes, boats, and ships. This exemption only applies to the emissions from the internal combustion engines used exclusively to propel such vehicles.

14. Diesel fuel or fuel oil storage tanks with a capacity of forty thousand (40,000) gallons or less.

15. Surface coating and degreasing operations which do not exceed a combined total usage of more than 60 gallons/month of coatings, thinners, clean-up solvents, and degreasing solvents at any one plant location, and do not exceed 1,000 pounds per year of each hazardous air pollutant.

16. Repair and maintenance, cleaning and degreasing operations which do not exceed more than 145 gallons in any twelve (12) month period, and do not exceed 1,000 pounds per year of each hazardous air pollutant.

17. Fuel burning sources that are either gas fired or #2 oil fired with a heat input rate under 10 million Btu/hour, where the combined total heat input rate at each location does not exceed 10 million Btu/hour.

18. Machining of metals where total solvent usage does not exceed more than 60 gallons/month at any one plant location, and does not exceed 1,000 pounds per year of each hazardous air pollutant.

19. Equipment used exclusively for steam or dry cleaning of fabrics, plastics, rubber, wood, or vehicle engines or drive trains, provided the total solvent usage on all equipment of this type at the same plant location is less than 60.0 gallons per month, and does not exceed 1,000 pounds per year of each hazardous air pollutant.

20. Heat treating, soaking, case-hardening, or surface conditioning of metal objects, such as carbonizing, nitriding, carbonnitriding, siliconizing, or diffusion treating using sweet natural gas or liquid petroleum gas as in process fuel and where the heat input rate is under 10 million Btu per hour.

21. Natural gas fired and #2 oil fired ovens which have no emissions other than products of combustion which have a heat input rate under 10 million Btu per hour.

22. Degreasing operations with solvent usage less than 30 gallons/month, and where hazardous air pollutant emissions are less than 1,000 pounds per year.

23. Silk screen operations with solvent usage less than 30 gallons per month, and where hazardous air pollutant emissions are less than 1,000 pounds per year.

24. The procedures for the on-site remediation of soil or water contaminated with organic compounds as follows:

(i) Landspreading, aeration or bioremediation of contaminated soil.

(ii) Negative pressure venting of contaminated soil, provided the remediation is completed within 18 months and volatile organic compound emissions do not exceed one (1) pound per hour.

(iii) Installation and use of air strippers for treatment of contaminated water, provided the remediation is completed within 18 months, and the emissions are no more than 5 tons per year of any regulated pollutant that is not a hazardous air pollutant, and less than 1,000 pounds per year of each hazardous air pollutant.

25. Temporary-use air curtain destructors or temporary-use air curtain incinerators used in disaster recovery solely for disposal of materials resulting from a natural disaster, and when conducted in conformity with the following conditions:

(i) Fires disposing of structural and household materials and vegetation are allowed only when those structures or materials are destroyed or severely damaged by natural disaster. The air curtain destructor or air curtain incinerator shall only be used to combust debris in an area declared a State of Emergency by a local or State government, or the President, under the authority of the Stafford Act, has declared that an emergency or a major disaster exists in the area. Input from Emergency Management personnel may be requested in determining qualification with this criterion.

(ii) The maximum rated capacity for each temporary-use air curtain destructor or temporary-use air curtain incinerator shall not exceed 35 tons per day per unit.

(iii) The persons using temporary-use air curtain destructors or temporary-use air curtain incinerators under this provision must make a reasonable effort to remove all tires and other rubber products, vinyl shingles and siding, vinyl flooring, carpet, other plastics, asphalt shingles and other asphalt roofing materials, and/or asbestos containing materials from the materials to be burned before ignition. The Technical Secretary reserves the right to inspect the proposed materials to be burned before ignition. The alternative use of chippers and grinders, landfilling, or on-site burial of waste in lieu of burning, if lawful, is encouraged.

(iv) The person responsible for such burning must notify the Division of Air Pollution Control of the proposed location. The notification must be delivered to the Division of Air Pollution Control at the appropriate regional Environmental Field Office at least three (3) days prior to commencing the burn. The Division may request that alternate sites be identified to minimize impact to air quality. The alternative use of chippers and grinders in lieu of burning is encouraged.

(v) No fire shall be ignited while any air pollution emergency episode is in effect in the area of the burn.

(vi) The air curtain destructor or air curtain incinerator shall only be used during a period that begins on the date the unit started operation and lasts 8 weeks or less within the boundaries of the same emergency or disaster declaration area.

(vii) Disposal via temporary-use air curtain destructors or temporary-use air curtain incinerators conducted under this exception is only allowed where no other safe and/or practical means of disposal is available.

(viii) The Technical Secretary reserves the right to require a person to cease or limit burning if emissions from the air curtain destructor or air curtain incinerator are deemed by the Technical Secretary or his designee to jeopardize public health or welfare, create a public nuisance or safety hazard, create a potential safety hazard, or interfere with the attainment or maintenance of the air quality standards.

(5) Major Source Operating Permits Insignificant Emission Units (a) Definitions.

As used in this Rule, all terms not defined herein shall have the meaning given them in Paragraph 1200-03-09-.02(11) and Chapter 1200-03-02 with the terms in Paragraph 1200-03-09-.02(11) taking precedence over Chapter 1200-03-02.

1. “Emissions unit” means any part or activity of a stationary source that emits or has the potential to emit any regulated air pollutant or any pollutant listed in paragraph 1200-03-31-.02(6). Emissions unit includes within its meaning the smallest discrete or identifiable structure, device, item, equipment, or enclosure or group of discrete or identifiable structures, devices, items, equipment, or enclosures that emit or have the potential to emit any regulated air pollutant or any pollutant listed in paragraph 1200-03-31-.02(6). A point of origin of fugitive emissions resulting from equipment leaks of individual pieces of equipment, e.g., valves, flanges, pumps, and compressors, shall not be considered an individual emissions unit. Such equipment leaks shall be collectively considered an emissions unit based on their relationship to the associated process unit and shall be considered separately from other emissions from the process unit when defining insignificant emissions.

2. “Federal Act” has the same definition as found in subparagraph 1200-03-09- .02(11)(b).

3. “Fugitive emissions” are those emissions which could not reasonably pass through a stack, chimney, vent, or other functionally-equivalent opening.

4. “Insignificant activity” or “insignificant emissions unit” means any activity or emissions unit which qualifies as insignificant based on any one of the following:

(i) Any air emissions from an air emissions unit or activity at a stationary source for which the emissions unit or activity has a potential to emit less than 5 tons per year of each regulated air pollutant that is not a hazardous air pollutant, and less than 1,000 pounds per year of each hazardous air pollutant. Such emission units and activities or types of emission units and activities must be listed in the permit application.

(ii) The emission unit or activity, with the exception of parts 19. and 84., is listed in subparagraph (5)(f) as not having to be included in a Title V application. For an activity listed in subparagraph (5)(f), with the exception of parts 1., 2., 19., and 84., the emissions unit or activity must have a potential to emit less than 5 tons per year of each regulated air pollutant that is not a hazardous air pollutant, and less than 1,000 pounds per year of each hazardous air pollutant.

(iii) The emission unit or activity is listed in subparagraph (5)(g) as not having to be included in a Title V application.

(iv) Any emission unit with the potential to emit radionuclides which will result in a dose to the most exposed member of the public of less than 0.1 millirem per year. Such emission unit must be listed in the permit application.

(v) Any emission units or activities considered by the Division to be insignificant and approved by EPA. The Division shall maintain a list of emission units or activities which are considered to be insignificant by the Division and EPA. Such emission units or activities must be listed in the permit application.

5. “Potential to emit” means the maximum capacity of a stationary source to emit any air pollutant under its physical and operational design. Any physical or operational limitation on the capacity of a source to emit an air pollutant, including air pollution control equipment and restrictions on hours of operation or on the type or amount of material combusted, stored, or processed, shall be treated as part of its design if the limitation is enforceable by the Administrator.

This term does not alter or affect the use of this term for any other purposes under the Federal Act, or the term “capacity factor” as used in title IV of the Federal Act or the Federal regulations promulgated thereunder or Chapter 1200- 03-30.

6. “Process unit” means equipment assembled and connected by pipes or ducts to manufacture an intended product. A process unit can operate independently if supplied with sufficient feed or raw materials and sufficient storage facilities for the product.

7. “Regulated air pollutant” has the same definition as found in subparagraph 1200- 03-09-.02(11)(b).

8. “Stationary source” means any building, structure, facility, or installation that emits or may emit any regulated air pollutant or any pollutant listed under paragraph 1200-03-31-.02(6).

9. “Major source” has the same definition as in part 1200-03-09-.02(11)(b)14.

10. “Applicable requirement” has the same definition as in part 1200-03-09-.02 (11)(b)5.

11. “EPA” or the “Administrator” means the Administrator of the EPA or his designee.

12. “Permit revision” means any permit modification or administrative permit amendment.

13. “Renewal” means the process by which a permit is reissued at the end of its term.

14. “Federally enforceable” means any emission standard and/or procedural requirement that can be enforced against an air contaminant source by EPA or citizens under authority granted them by the Federal Act.

15. “Hazardous air pollutant” means any air contaminant regulated in Chapter 0400- 30-38 or listed in paragraph (6) of Rule 1200-03-31-.02.

(b) General 1. This paragraph contains criteria for identifying insignificant emission units or activities for purposes of issuance of major stationary source operating permits, Paragraph 1200-03-09-.02(11).

2. Notwithstanding the classifications as insignificant emissions units or activities granted in this paragraph, no person shall discharge, from any source whatsoever, such quantities of air contaminants or other materials which cause or have a tendency to cause injury, detriment, annoyance, or adverse effect to the public.

3. Designation of an emission unit or activity as insignificant for purposes of this paragraph and paragraph 1200-03-09-.02(11) does not exempt the unit or activity from any applicable requirement.

4. No insignificant activities or emission units shall be exempt from inclusion in the permit application if the information omitted is needed to:

(i) Determine or impose any applicable requirement, or the requirement to obtain a permit under paragraph 1200-03-09-.02(11).

(ii) Determine if a source is major.

(c) Applicable Requirements 1. Notwithstanding any other provision of paragraph (11) of Rule 1200-03-09-.02, no emissions unit or activity subject to a federally enforceable applicable requirement not included in this Division 1200-03 or Division 0400-30 (other than generally applicable requirements of the state implementation plan) shall qualify as an insignificant emissions unit or activity. For purposes of this paragraph, generally applicable requirements of the state implementation plan are those federally enforceable requirements that apply universally to all emission units or activities without reference to specific types of emission units or activities except for the sulfur dioxide standards for those categories and classes included in

Chapter 1200-03-14.

2. The permit application shall list and the permit shall contain all generally applicable requirements that apply to insignificant emission units or activities at the major source. For compliance purposes, the Technical Secretary may require monitoring, recordkeeping, and reporting for insignificant emission units or activities.

3. Any emission unit or activity which is a subset of a process emission source, fuel burning installation, or incinerator, and which has a potential to emit less than 5 tons per year of a regulated air pollutant, by annual certification of compliance as required in item (11)(d)1.(ii)(I) of Rule 1200-03-09-.02, may, at the discretion of the Technical Secretary, be considered to meet the monitoring and related recordkeeping and reporting requirements of subpart (11)(e)1.(iii) of Rule 1200- 03-09-.02 and part (2)(b)1. of Rule 1200-03-10-.04, and the compliance requirements of subpart (11)(e)3.(i) of Rule 1200-03-09-.02 for that regulated air pollutant except where generally applicable requirements of the state implementation plan specifically impose monitoring and related record keeping and reporting requirements, or except where any applicable procedures and methods are required pursuant to Rule 1200-03-10-.04. This provision shall not relieve any emissions unit or activity from any applicable standard or requirement under Chapters 0400-30-38 and 1200-03-31, and subparagraph (1)(dd) of Rule

Tenn. Comp. R. & Regs. 1200-03-09-.05 APPEAL OF PERMIT APPLICATION DENIALS AND PERMIT CONDITIONS

(1) In any case where the Technical Secretary or the Department denies a permit application, this denial is appealable to the Board if a petition of appeal is received by the Technical Secretary within thirty (30) days of receipt of the denial letter by the owner or operator.

(2) The letter of denial of the application shall include the basis for denial and notify the party of their right to appeal and of the right to legal counsel.

(3) The reasons the petitioner feels the permit should have been granted must be filed as part of the petition. Additionally a party may request prehearing discovery, as provided in T.C.A. § 4- 5-306, by filing and detailing the request with the petition.

(4) Within thirty (30) days of receipt of the petition for appeal of a permit denial, the Technical Secretary shall notify the petitioner of the time and place for the hearing.

(5) In any case where a condition is placed on a permit, the imposition of that permit condition may be appealed by filing a petition for reconsideration of the permit conditions. The petition for reconsideration of permit conditions shall specify which conditions and portions of conditions are objected to and specifying in detail the objections. The petition of appeal must be delivered to the Technical Secretary within thirty (30) days after the mailing date of the permit.

If the Technical Secretary is considering denying the petition he shall schedule a conference with the petitioner to discuss the matters under appeal within forty-five (45) days of receipt of the petition. If the Technical Secretary’s resultant decision on the matter under appeal aggrieves the petitioner, the petitioner may request a hearing pursuant to T.C.A. § 68-25-108.

(6) All applicable provisions of T.C.A. §§ 4-5-301 et seq., on contested cases shall apply to the hearing before the Board on such appeals.

(7) The denial of a permit application by the Technical Secretary stands, unless the majority of a quorum of the Board votes to overturn the denial after the hearing.

(8) A permit condition specified by the Technical Secretary after the hearing provided for in paragraph (5) stands unless on appeal the Board votes to modify or delete the condition by a majority of a quorum of the Board.

History

• Authority: T.C.A. §§ 4-5-202, et seq., and 68-25-105.
• Administrative History: Original rule filed October 1, 1979; effective November 16, 1979. Amendment filed May 17, 1990; effective July 1, 1990. Administrative History has been edited to delete a November 6, 1988 Amendment. No evidence of this fil ing exists, and this is an editorial mistake by the Secretary of State. June 30, 2001.

Tenn. Comp. R. & Regs. 1200-03-09-.06 GENERAL PERMITS

(1) Applicability (a) This rule does not apply to sources that are subject to the provisions of paragraph (11) of Rule 1200-03-09-.02.

(b) Sources located in a nonattainment area are not eligible for a general permit for construction of a new or modified air contaminant source if the source emits the pollutant and/or a precursor to the pollutant for which the area has been designated nonattainment by the United States Environmental Protection Agency or the Tennessee Air Pollution Control Board.

(2) The Technical Secretary may issue general permits for the purpose of covering numerous similar sources that are owned or operated by different persons at different facilities.

(3) Notwithstanding the provisions of the preceding rules of this chapter, a general permit may serve as both a construction permit and an operating permit.

(4) (a) A notice of intent for coverage under a general permit serving as a construction permit shall be subjected to public notice and an opportunity for public participation, as specified in subparagraph (1)(h) of Rule 1200-03-09-.01.

(b) A general permit serving as a construction permit shall be subjected to public notice and an opportunity for public participation by prominent advertisement in each air quality control region. The notice shall specify the types of sources to be covered by the permit and the terms of the permit and opportunity for public comment. Comments shall be in writing and delivered to the Technical Secretary within thirty (30) days after the publication of the public notice.

(5) The general permit shall specify the eligibility criteria by which sources may qualify for the general permit and shall state both the process by which an owner or operator of a source notifies the Technical Secretary that the owner or operator requests the source to be covered under the general permit and the means by which the Technical Secretary confirms that the source is either covered by the general permit or requires an individual permit. The owner or operator constructing or operating a source under the provisions of a general permit shall be subject to enforcement action for construction or operation without a permit required by this

chapter if the owner or operator of the source requested coverage under a general permit by representing the source to be eligible for a general permit in the notice of intent and it is later determined that the source does not qualify for the eligibility terms and conditions of the general permit.

(6) Owners or operators of sources subject to the provisions of this chapter that would qualify for a general permit shall submit a notice of intent to the Technical Secretary for coverage under the terms of the general permit. The Technical Secretary may, in the general permit, specify requirements for the notice of intent which deviate from the requirements of Rules 1200-03- 09-.01 and 1200-03-09-.02, provided that the notice of intent includes all information necessary to determine qualifications for, and to assure compliance with, the general permit.

(7) If either an owner or operator of a source covered by a general permit or the Technical Secretary determines that the source no longer qualifies for such permit, the source shall submit a notice of the change in status to the Division within thirty (30) days of either such determination by the source or notification by the Technical Secretary, whichever occurs first.

(8) General permits shall be issued for a fixed term, not to exceed ten (10) years, which shall be stated in the permit.

(9) For the purposes of this rule the following terms shall have the following meanings:

(a) “Notice of coverage” or “NOC” means a confirmation from the Technical Secretary of coverage under a general permit.

(b) “Notice of intent” or “NOI” means a written notification requesting coverage under a general permit.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-101, et seq.
• Administrative History: Original rule filed September 11, 2015; effective December 10, 2015. Amendments filed May 17, 2017; effective August 15, 2017.

Tenn. Comp. R. & Regs. 1200-03-09-.07 PERMITS-BY-RULE

(1) Definitions As used in this rule and Rule 1200-03-09-.06, all terms not defined by this paragraph shall have the meaning given to them in this chapter and all terms not defined in this chapter shall have the meaning given to such terms in Chapter 1200-03-02.

(a) “Permit-by-rule” means authorization from the Technical Secretary for the owner or operator to construct, modify, or operate an eligible true minor air contaminant source if such construction, modification, or operation is in compliance with this rule and rules promulgated in carrying out this rule specifically applicable to such source.

(b) “Notice of authorization” or “NOA” means a confirmation from the Technical Secretary of authorization to construct, modify, or operate a minor air contaminant source under a permit-by-rule.

(c) “Notice of intent” or “NOI” means a written notification requesting coverage under a general permit or authorization under a permit-by-rule.

(2) Applicability (a) 1. An owner or operator of a source that is a member of a category of air contaminant sources listed in paragraph (5) of this rule may obtain a notice of authorization under a permit-by-rule to construct, modify, or operate the source instead of obtaining an individual construction or operating permit for such construction, modification, or operation if the air contaminant source is eligible.

An eligible air contaminant source is an air contaminant source that is not excluded by paragraph (4) of this rule and meets the qualifying criteria established by the applicable permit-by-rule. The Technical Secretary may, with cause, refuse to issue a notice of authorization and require an owner or operator to follow the standard permitting procedures as otherwise required by this

chapter.

2. An owner or operator remains authorized pursuant to an NOA to construct, modify, or operate an air contaminant source under a permit-by-rule if the air contaminant source continues to be eligible and the owner or operator is in compliance with this rule and the applicable permit-by-rule. When required in writing by the Technical Secretary, the owner or operator of a source that fails to meet the qualifying criteria established in the applicable permit-by-rule or fails to comply with this rule and the applicable permit-by-rule shall submit an application for an individual construction or operating permit or both.

(b) This rule does not exempt any air contaminant source from any requirements of the federal Clean Air Act, the Tennessee Air Quality Act, Division 0400-30 (including being considered for purposes of determining whether a facility constitutes a major source or is otherwise regulated under this Division 1200-03), Division 0400-30, or any requirement to list insignificant activities and emission levels in a Title V permit application. In addition, this rule does not relieve the owner or operator from the requirement of including the emissions associated with the exempt sources in any major NSR permitting action.

(3) General provisions The provisions of this paragraph apply to any owner or operator constructing, modifying, or operating an air contaminant source under an NOA unless otherwise stated in a permit-by-

rule specific to such source.

(a) Recordkeeping requirements 1. The owner or operator shall collect and maintain the records required for each air contaminant source to which an NOA applies. These records shall be retained in the owner or operator’s files for a period of not less than five (5) years and shall be made available to the Technical Secretary or any authorized representative of the Technical Secretary for review upon request.

2. For the purposes of this subparagraph, records include, but are not limited to, any monitoring data, testing data, and support information required by the applicable permit-by-rule and shall be retained for a period of five (5) years from the date the record was created. Support information includes, but is not limited to, all calibration and maintenance records and all original strip-chart recordings for continuous monitoring instrumentation, and copies of all reports required by the specific permit-by-rule. Records may be maintained in computerized form.

(b) Notification requirements for new installations The owner or operator of an air contaminant source to be installed on or after the effective date of a permit-by-rule electing to be authorized to construct, modify, or operate under the permit-by-rule shall submit an NOI in a form and manner prescribed by the Technical Secretary prior to installation of the air contaminant source. The NOI must be submitted to the Technical Secretary not less than seven (7) days prior to the estimated start date of construction, and shall contain the following information, at a minimum:

1. The owner’s or operator’s name and the facility contact’s name;

2. The facility mailing address and telephone number;

3. The location of the air contaminant source(s);

4. A description of the air contaminant source(s), including any pollution control(s);

5. A statement by the owner or operator that indicates the permit-by-rule under which construction, modification, or operation of the air contaminant source will be authorized;

6. The estimated start date of construction; and 7. A signed statement that the proposed air contaminant source(s) qualifies to be covered under this rule and the applicable permit-by-rule.

(c) Notification requirements for existing permitted sources 1. An owner or operator of an air contaminant source which is operating under an existing construction or operating permit may continue to operate in compliance with that permit or may submit an NOI in the form and manner prescribed by the Technical Secretary that contains at a minimum the applicable information required by the Technical Secretary under subparagraph (b) and a written notification to the Technical Secretary that the owner or operator intends to relinquish the existing permit or permits.

2. The Technical Secretary may issue the requested NOA and allow the owner or operator to relinquish a construction or operating permit pursuant to this paragraph if an NOA may be issued to the permittee pursuant to paragraph (2) and the Technical Secretary determines that the relinquishment will not result in the violation of any applicable laws. When an owner or operator submits an NOI and relinquishment notification pursuant to this paragraph, the Technical Secretary, without prior hearing, shall make a final determination on the relinquishment notification and either issue the NOA and allow the relinquishment of the existing permit or permits or inform the permittee in writing of the Technical Secretary’s denial. The NOA is effective on the date the existing permit is relinquished.

(d) Reporting requirements The owner or operator shall submit required reports in the following manner:

1. Reports of any monitoring or recordkeeping information required by a permit-by-

rule shall be submitted to the Division at the physical address or e-mail address provided in the notice of authorization or as specified in an official notification from the Division.

2. A written report of any deviations (excursions) from emission limitations, operational restrictions, qualifying criteria, and control equipment operating parameter limitations that have been detected by the testing, monitoring, and recordkeeping requirements specified in the permit-by-rule shall be submitted to the Division within thirty (30) days of the date the deviation occurred. The report shall describe the specific limitation or operational restriction exceeded, the probable cause of such deviation, and any corrective actions or preventive measures that have been or will be taken.

(e) Scheduled maintenance/malfunction reporting Any scheduled maintenance of air pollution control equipment shall be performed in accordance with the requirements of the applicable permit-by-rule. The malfunction of any emissions units or any associated air pollution control system(s) shall be reported to the Division in accordance with Chapter 1200-03-20. Except as provided in Chapter 1200-03-20, any scheduled maintenance or malfunction necessitating the shutdown or bypassing of any air pollution control system(s) shall be accompanied by the shutdown of the emissions unit(s) that is served by such control system(s).

(f) Any person in possession of a notice of authorization under a permit-by-rule shall ensure that the notice of authorization is readily available for inspection by the Technical Secretary or the Technical Secretary’s designated representative on the operating premises or an alternate location approved by the Technical Secretary.

(4) Exclusions from eligibility (a) No stationary source with the potential to emit one hundred (100) tons per year or more of any air pollutant subject to regulation is eligible to be authorized under a permit-by-

rule.

(b) No stationary source with the potential to emit ten (10) tons per year or more of a single hazardous air pollutant or twenty-five (25) tons per year or more of any combination of hazardous air pollutants is eligible to be authorized under a permit-by-rule.

(c) Stationary sources of nitrogen oxides or volatile organic compounds located in areas designated serious, severe, or extreme non-attainment for ozone by the U.S. EPA that otherwise would be eligible to be authorized under a permit-by-rule but have the potential to emit ten (10) tons per year or more of these precursor pollutants cannot be authorized under a permit-by-rule.

(5) Source categories potentially eligible for permit-by-rule:

(a) Gasoline dispensing facilities (GDFs) subject to the provisions of Rule 1200-03-18-.24.

(b) Emergency stationary reciprocating internal combustion engines subject to the provisions of part (1)(b)102. of Rule 0400-30-38-.01.

(c) Emergency stationary compression ignition internal combustion engines subject to the provisions of part (1)(b)108. of Rule 0400-30-39-.01.

(d) Emergency stationary spark ignition internal combustion engines subject to the provisions of part (1)(b)109. of Rule 0400-30-39-.01.

(e) Auto body refinishing operations, which includes paint stripping and surface coating of motor vehicles and mobile equipment, subject to the provisions of part (1)(b)136. of

Rule 0400-30-38-.01. However, no emission source subject to a rule in Chapter 1200- 03-18 shall qualify for permit-by-rule.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-101, et seq.
• Administrative History: New rule filed May 17, 2017; effective August 15, 2017. Amendments filed January 8, 2018; effective April 8, 2018. Amendments filed September 16, 2024; effective December 15, 2024. Amendments filed August 6, 2025; effective November 4, 2025.

Tenn. Comp. R. & Regs. 1200-03-20-.03 . For the purposes of this item 1200-03-09- .02(11)(e)7.(iii)(IV), “emergency” shall be substituted for “malfunctions(s)” in rule 1200-03-20-.03 to determine the relevant notification threshold. The notice shall include a description of the emergency, any steps taken to mitigate emissions, and corrective actions taken.

(iv) In any enforcement proceeding the permittee seeking to establish the occurrence of an emergency has the burden of proof.

(v) The provisions of this part 1200-03-09-.02(11)(e)7. are in addition to any emergency, malfunction or upset requirement contained in Division 1200- 03 or other applicable requirement.

(f) Permit Issuance, Renewal, Reopening and Revision 1. Action on an Application (i) A permit, permit modification, or renewal may be issued only if all of the following conditions have been met:

(I) The Technical Secretary has received a complete application for a permit, permit modification, or permit renewal, except that a complete application need not be received before issuance of a general permit under part 1200-03-09-.02(11)(e)4.;

(II) Except for modifications qualifying for the minor permit modification procedures under subpart 1200-03-09-.02(11)(f)5.(ii) or subpart 1200-03-09-.02(11)(f)5.(iii), the Technical Secretary has complied with the requirements for public participation under part 1200-03-09- .02(11)(f)8.;

(III) The Technical Secretary has complied with the requirements for notifying and responding to affected States under part 1200-03-09- .02(11)(g)2.;

(IV) The conditions of the permit provide for compliance with all applicable requirements and the requirements of paragraph 1200- 03-09-.02(11);

(V) The Administrator has received a copy of the proposed permit and any notices required under part 1200-03-09-.02(11)(g)1. and part 1200-03-09-.02(11)(g)2., and has not objected to the issuance of the permit under part 1200-03-09-.02(11)(g)3. within the time period specified therein.

(ii) Except as otherwise required by subparagraph 1200-3-30-.06(4)(d) affected sources shall have final action taken on permit applications filed with the Technical Secretary within 18 months of the date that they file their complete permit application. The Technical Secretary is authorized to set the due date of their initial applications to mesh with their Phase II acid rain permit applications such that their initial permit will contain both acid rain requirements and standard emission/procedural requirements. The Technical Secretary is instructed to consider any guidance promulgated by the Administrator relative to meshing Title V and Title IV at affected facilities when setting such application submittal dates.

(iii) To the extent practicable, the Technical Secretary shall give priority to the processing of operating permit applications to sources which are subject to either paragraph 1200-03-09-.01(4) or paragraph 1200-03-09-.01(5).

Sources subject to paragraph 1200-03-09-.02(11) shall have final action taken on permit applications filed with the Technical Secretary within 18 months of the date that their application is deemed complete.

(iv) The Technical Secretary shall provide notice to the applicant of whether the application is complete within 60 days of receipt of an application in his office. Unless the Technical Secretary requests additional information or otherwise notifies the applicant of incompleteness within 60 days of receipt of an application, the application shall be deemed complete. For modifications processed through minor permit modification procedures, such as those in subpart 1200-03-09-.02(11)(f)5.(ii) or subpart 1200-03-09- .02(11)(f)5.(iii) a completeness determination shall not be required of the Technical Secretary. An application that defaults to complete status through the Technical Secretary’s failure to notify the applicant of its incompleteness within 60 days of his receipt, does not relieve the applicant of the duty to provide such supplemental information that the Technical Secretary must have in order to process the permit application.

(v) The Technical Secretary shall provide a statement that sets forth the legal and factual basis for the draft permit conditions (including references to the applicable statutory or regulatory provisions). The Technical Secretary shall send this statement to EPA and to any other person provided that such person requests the statement in writing and pays a fee sufficient to pay for postage, copying costs and staff time to respond to the request.

(vi) The submittal of a complete operating permit application shall not affect the requirement that any source have a construction permit as required under

rule 1200-03-09-.01.

2. Requirement for a Permit Except as provided in the following sentence, item 1200-03-09-.02(11)(a)4.(i)(I)

Section 502(b)(10) changes, and item 1200-03-09-.02(11)(f)5.(ii)(V) and item 1200-03-09-.02(11)(f)5.(iii)(V), no source subject to paragraph 1200-03-09- .02(11) may operate after the time that it is required to submit a timely and complete application as provided for in subpart 1200-03-09-.02(11)(d)1.(i), except in compliance with a permit issued pursuant to paragraph 1200-03-09- .02(11). Consistent with the provisions of parts 1200-03-09-.02(11)(a)1. and 2., a source subject to paragraph 1200-03-09-.02(11) that submits a timely and complete application for permit issuance (including for renewal) will not be considered in violation of paragraph 1200-03-09-.02(11) until the Technical Secretary takes final action on the permit application, except as otherwise noted in paragraph 1200-03-09-.02(11). If the final action on a permit by the Technical Secretary has been appealed to the Board as a contested case, the application shield will remain in effect until final action of the Board. This protection shall cease to apply if, subsequent to the completeness determination made pursuant to subpart 1200-03-09-.02(11)(f)1.(iv), and as required by subpart 1200-03-09- .02(11)(d)1(ii), the applicant fails to submit by the deadline specified in writing by the Technical Secretary any additional information identified as being needed to process the application.

3. Permit Renewal and Expiration (i) Permits that are being renewed are subject to the same procedural requirements, including those for public participation, affected State and EPA review, that apply to initial permit issuance; and (ii) Consistent with the provisions of part 1200-03-09-.02(11)(a)2. permit expiration terminates the source’s right to operate unless a timely and complete renewal application has been submitted consistent with part 1200-03-09-.02(11)(f)2. and item 1200-03-09-.02(11)(d)1.(i)(III).

4. Administrative Permit Amendments (i) An “administrative permit amendment” is a permit revision that:

(I) Corrects typographical errors;

(II) Identifies a change in the name, address, or phone number of any person identified in the permit, or provides a similar minor administrative change at the source;

(III) Requires more frequent monitoring or reporting by the permittee;

(IV) Allows for a change of ownership or operational control of a source where the Technical Secretary determines that no other change in the permit is necessary, provided that a transfer of ownership permit application is filed consistent with the provisions of paragraph 1200- 03-09-.03(6) and further provided that a written agreement containing a specific date for transfer of permit responsibility, coverage, and liability between the current and new permittee has been submitted to the Technical Secretary;

(V) Incorporates into the operating permit issued pursuant to paragraph 1200-03-09-.02(11) the requirements of a construction permit issued pursuant to rule 1200-03-09-.01 provided that the construction permit meets the requirements of subparagraph 1200-03-09-.02(11)(f), subparagraph 1200-03-09-.02(11)(g) and the compliance requirements of subparagraph 1200-03-09-.02(11)(e).

(ii) Administrative permit amendments for purposes of the acid rain portion of the permit shall be governed by regulations promulgated under title IV of the Federal Act and corresponding regulations in Chapter 1200-03-30.

(iii) Administrative permit amendment procedures shall be made according to the following criteria:

(I) The Technical Secretary shall take no more than 60 days from receipt of a request for an administrative permit amendment to take final action on such request, and may incorporate such changes without providing notice to the public or affected States provided that he designates any such permit revisions as having been made pursuant to part 1200-03-09-.02(11)(f)4.

(II) After making an administrative permit amendment, the Technical Secretary shall submit a copy of the revised permit to the Administrator.

(III) The source may implement the changes addressed in the request for an administrative amendment immediately upon submittal of the request.

(iv) The Technical Secretary may extend the permit shield as part of an administrative permit amendment revision consistent with the provisions of

part 1200-03-09-.02(11)(e)6. for such revisions made pursuant to item 1200-03-09-.02(11)(f)4.(i)(V) which meet the relevant requirements of subparagraph 1200-03-09-.02(11)(e), subparagraph 1200-03-09-.02(11)(f) and subparagraph 1200-03-09-.02(11)(g) for significant permit modifications.

(v) Proceedings to review and grant administrative permit amendments shall be limited to only those parts of the permit for which cause to amend exists, and not the entire permit.

5. Permit Modifications (i) A permit modification is any revision to a permit issued pursuant to paragraph 1200-03-09-.02(11) that cannot be accomplished as an administrative permit amendment. A permit modification for purposes of the acid rain portion of the permit shall be governed by regulations promulgated under Title IV of the Federal Act and corresponding regulations at Chapter 1200-03-30. Proceedings to review and modify permits shall be limited to only those parts of the permit for which cause to modify the permit exists, and not the entire permit.

(ii) Minor permit modification procedures:

(I) Minor permit modification procedures may be used only for those permit modifications that:

I. Do not violate any applicable requirement;

II. Do not involve significant changes to existing monitoring, reporting or recordkeeping requirements in the permit;

III. Do not require or change a case-by-case determination of an emission limitation or other standard required by the Federal Act, or a source-specific determination for temporary sources of ambient impacts as required by the Federal Act, or a visibility or increment analysis as required by the Federal Act;

IV. Do not seek to establish or change a permit term or condition for which there is no corresponding underlying applicable requirement and that the source has assumed to avoid an applicable requirement to which the source would otherwise be subject. Such terms and conditions include:

A. A federally enforceable emissions cap assumed to avoid classification as a modification under any provision of Title I of the Federal Clean Air Act. Further, federally enforceable emission caps assumed to avoid classification as a modification under Chapter 0400-30- 38, Chapter 0400-30-39, Chapter 1200-03-31, paragraph (4) of Rule 1200-03-09-.01, or paragraph (5) of Rule 1200-03-09-.01 are included in the criteria of this sectio.

B. An alternate emission limit approved pursuant to section 112(i)(5) of the Federal Act or rule 1200-03-31-.06;

V. Are not modifications under Title I of the Federal Clean Air Act or the federal regulations promulgated pursuant thereto.

Further, the minor permit modification process may be used only for changes that are not modifications under Chapter 0400-30-38, Chapter 0400-30-39, Chapter 1200-03-31, paragraph (4) of Rule 1200-03-09-.01, or paragraph (5) of Rule

Tenn. Comp. R. & Regs. 1200-03-02-.01 .

(d) Reserved.

(e) Documentation 1. Upon request from the Technical Secretary the applicant must provide sufficient documentation to enable the Technical Secretary to determine that the emission unit or activity has been appropriately listed on the permit application as insignificant.

2. Upon request from the Technical Secretary, at any time during the term of the permit, an applicant who lists an activity or emissions unit as insignificant under

subpart 1200-03-09-.04(5)(a)4.(i) of this paragraph shall demonstrate to the Technical Secretary that the actual emissions of the unit or activity are below the emission thresholds listed in that subpart.

(f) Unless specifically required under part (b)4. of this paragraph, the following emission units or activities, or stationary sources that qualify as ‘insignificant activities’, with the exception of parts 19. and 84. of this subparagraph, are not required to be included in a permit application under paragraph (11) of Rule 1200-03-09-.02. For the following listed activities to be considered insignificant, with the exception of parts 1., 2., 19. and 84. of this subparagraph, the emissions unit or activity must have a potential to emit less than 5 tons per year of each regulated air pollutant that is not a hazardous air pollutant and less than 1,000 pounds per year of each hazardous air pollutant. No emissions unit or activity subject to a federally enforceable applicable requirement not included in this Division 1200-03 or Division 0400-30 (other than generally applicable requirements of the state implementation plan) shall qualify as an insignificant emissions unit or activity.

1. Unpaved roadways and parking areas unless permits have specific conditions limiting fugitive emissions. This activity is not insignificant if it is subject to new source performance standards for nonmetallic mineral processing plants under

Chapter 0400-30-39 or under 40 C.F.R. Part 60.

2. Paved roadways and parking areas unless permits have specific conditions limiting fugitive emissions. This activity is not insignificant if it is subject to new source performance standards for nonmetallic mineral processing plants under

Chapter 0400-30-39 or under 40 C.F.R. Part 60.

3. Equipment used on farms for soil preparation, tending or harvesting of crops, or for preparation of feed to be used on the farm where prepared. This activity is not insignificant if it is subject to new source performance standards under Chapter 0400-30-39 or under 40 C.F.R. Part 60.

4. Barbecue pits and cookers; if the products are edible (intended for human consumption), and are sold on site, or at one location.

5. Vacuum pump exhausts when evacuating air conditioning units. This activity is not insignificant if emissions exhausted are subject to any standard or other requirement of the regulations promulgated to protect stratospheric ozone under title VI of the Federal Act.

6. Wood smoking operations to cure tobacco in barns.

7. Operations regulated under Chapter 1200-03-04 (Open Burning) of these Regulations.

8. Sewer vents. This activity is not insignificant if it is subject to the new source performance standards for petroleum refinery wastewater systems under

Chapter 0400-30-39 or under 40 C.F.R. Part 60.

9. Natural gas mixing and treatment operations including sampling and testing. This activity is not insignificant if it is subject to the new source performance or under 40 C.F.R. Part 60.

10. Wire drawing including drawing coolants and lubricants provided that they are water based.

11. Air drying of wood.

12. Washing of trucks and vehicles where no solvent cleaners are used.

13. Sealing or cutting plastic film or foam with heat or hot wires provided no chlorofluorocarbons (CFCs) are emitted.

14. Combustion units designed and used exclusively for comfort heating purposes employing liquid petroleum gas, or propane or natural gas as fuel.

15. Water cooling towers (except for those at nuclear power plants), water treating systems for process cooling water or boiler feedwater, and water tanks, reservoirs, or other water containers designed to cool, store, or otherwise handle water (including rainwater) that has not been used in direct contact with gaseous or liquid process streams containing carbon compounds, sulfur compounds, halogens or halogen compounds, cyanide compounds, inorganic acids, or acid gases. This activity is not insignificant if chromium-based water treatment chemicals are used.

16. Equipment used exclusively to store, hold, or distribute natural gas. This activity is not insignificant if it is subject to the new source performance standards for onshore natural gas processing plants under Chapter 0400-30-39 or under 40 C.F.R. Part 60.

17. Gasoline, diesel fuel, and fuel oil handling facilities, equipment, and storage tanks, except those subject to new source performance standards and those subject to standards in Chapter 1200-03-18. However, facilities, equipment, and storage tanks which are subject only to Chapter 1200-03-18 requirements for submerged fill and for maintenance of records documenting quantities of gasoline, diesel fuel, and fuel oil dispensed are entitled to the exemption provided by this paragraph, despite the qualification of exemption specified in the first sentence of this subparagraph. This activity is not insignificant if it is subject to the new source performance standards for bulk gasoline terminals under

Chapter 0400-30-39 or under 40 C.F.R. Part 60 and the Stage I gasoline distribution MACT standard under Chapter 1200-03-31.

18. Blast cleaning equipment using a suspension of abrasives in water.

19. Laboratory equipment, used for research and development or for chemical and physical analyses, including ventilating and exhaust systems for laboratory hoods used for air contaminants.

20. Equipment used for inspection of metal products.

21. Portable, hand operated brazing, soldering, or welding equipment. Portable means as being able to be moved by hand from one location to another by an individual without the assistance of any motorized or non-motorized vehicle, conveyance, or device.

22. Equipment used for washing or drying products fabricated from metal or glass, provided no volatile organic compounds (solvents) are used in the process and that no oil or solid fuel is burned.

23. Foundry sand mold forming equipment to which no heat is applied, and from which no organics are emitted.

24. Equipment used for compression molding and injection molding of plastics which emit no hazardous air pollutants.

25. Mixers, blenders, roll mills, or calendars for rubber or plastics where no materials in powder form are added and in which no organic solvents, dilluents, or thinners are used.

26. Equipment used exclusively to package pharmaceuticals and cosmetics or to coat pharmaceutical tablets where no hazardous air pollutants are emitted. Any associated fuel burning is not included.

27. Electrically heated equipment used exclusively for heat treating, soaking, case hardening, or surface conditioning of metal objects, such as carbonizing, nitriding, carbonitriding, siliconizing, or diffusion treating.

28. Vacuum cleaning systems used exclusively for industrial, commercial, or residential housekeeping purposes, except those systems used to collect hazardous air contaminants regulated by Chapter 0400-30-38.

29. Sewage treatment facilities (excluding combustion or incineration equipment, land farms, storage silos for dry material, or grease trap waste handling or treatment facilities). This activity is not insignificant if it is subject to new source performance standards for volatile organic compounds emissions under Chapter 0400-30-39 or under 40 C.F.R. Part 60, MACT standard under Chapter 1200-03- 31, and hazardous organic NESHAP under 40 C.F.R. Part 63.

30. Emergency smoke relief vents that activate only in the event of fire.

31. Alkaline/phosphate washers and associated burners.

32. Outdoor kerosene heaters.

33. Livestock and poultry feedlots.

34. Wire insulation marking provided the marking materials are water based.

35. Portable equipment used for the on-site painting of buildings, towers, bridges, and roads.

36. Powder coating operations.

37. The following equipment, when used exclusively for emergency replacement or standby service:

Internal combustion engines burning natural gas, gasoline, or diesel fuel including stationary reciprocating engines, internal combustion (IC) engine driven compressors, IC engine driven electric generator sets and IC driven water pumps, and equipment components for gas dehydration units, gas-oil separators, free water knockouts, iron sponge units, production tank batteries, and natural gas liquids separation plants.

38. Equipment used exclusively to mill or grind coatings and holding compounds where all materials charged are in paste form.

39. Stenciling of cartons or boxes for purposes of shipment and content identification provided the inks are water based.

40. Firefighting equipment and the equipment used for training of firefighting.

41. Clean steam condensate and steam relief vents where steam has not contacted any process organics or other production materials.

42. End paper labeling of books or other reading material provided no organic or solvent based materials are used.

43. Pressurized vessels designed to operate in excess of 30 psig storing a petroleum fuel. This activity is not insignificant if it is subject to new source performance standards for petroleum liquid storage vessels under Chapter 0400-30-39 or under 40 C.F.R. Part 60.

44. Herbicide and pesticide mixing, application, and storage activities for on site use.

45. Maintenance activities, such as: machining of metals and plastic curing for nonproduction related operations, vehicle repair shops, carpenter shops, spraying, grinding and polishing operations, maintenance shop vents, and miscellaneous non-production surface cleaning, preparation, and painting operations. Repairs not involving structural changes where no new or permanent stationary source is installed. Internal combustion (IC) engine driven welders not part of a production process. Any maintenance activity is not insignificant if it is part of a manufacturing process.

46. Miscellaneous activities and equipment, such as: aerosol spray cans, cafeteria vents, locker room vents, photo copying, photographic processes, blue print machines, decommissioned equipment, solid waste dumpsters, fire training, and space heaters. Miscellaneous means as being unrelated to the primary business activity of the source.

47. Cold storage refrigerator equipment powered by electric motors and that do not use Class I or Class II ozone depleting substances.

48. Sampling systems used to withdraw materials for testing and analysis, and vents from process instrumentation systems, including area monitors.

49. Laboratories in primary and secondary schools and in schools of higher education used for instructional purposes.

50. Hydrovactor air separator tanks.

51. Equipment used exclusively for rolling, forging, pressing, stamping, spinning, or extruding either hot or cold plastics provided hazardous air pollutants are not emitted.

52. Grain, metal or mineral extrusion process. This activity is not insignificant if it is subject to new source performance standards for metallic mineral processing plants under Chapter 0400-30-39 or under 40 C.F.R. Part 60.

53. Bioremediation operations.

54. Equipment used exclusively for rolling, forging, pressing, stamping, spinning, drawing, or extruding either hot or cold metals.

55. Equipment used exclusively for sintering of ceramics, glass or metals, but not exempting equipment used for sintering metal-bearing ores, metal scale, clay, fly ash, or metal compounds. This activity is not insignificant if it is subject to new source performance standards for primary zinc smelters and glass manufacturing operations under Chapter 0400-30-39 or under 40 C.F.R. Part 60.

56. Equipment for the mining and screening of uncrushed native sand and gravel.

This activity is not insignificant if it is subject to new source performance or under 40 C.F.R. Part 60.

57. Equipment used exclusively for mixing and blending water-based adhesives and coatings at ambient temperatures. Materials containing less than 5 percent volatile organic compounds qualify as water-based for purposes of this exemption.

58. Pulp and paper industry, and cellulosic fiber industry insignificant activities: Any of the following activities is not insignificant if it is subject to new source performance standards for kraft pulp mills under Chapter 0400-30-39 or under 40 C.F.R. Part 60, and MACT standard under Chapter 1200-03-31.

(i) Ash sluice tanks (ii) Black liquor mix boxes (e.g., for sulfur addition)

(iii) Caustic tanks (iv) Chemical spills less than reportable quantity (v) Deinking cell (vi) Demineralized water tanks (vii) Dredging (viii) Dregs washer (ix) Dryer can steam/condensate blowdown (x) Electrical charging station (xi) Green liquor clarifiers (xii) Green liquor tanks (xiii) Grinding/blasting for nondestructive testing of metals (xiv) High density pulp storage tanks (xv) Hydrapulper (xvi) Hydroblasting (e.g., evaporators)

(xvii) Instrument air dryers and distribution (xviii) Lime mud filter filtrate tanks (xix) Lime mud piles (xx) Liquid sodium hydrosulfide storage tanks (xxi) Log flumes (xxii) Neutralized spent cooking acid tanks (xxiii) Oilers on chain, etc.

(xxiv) Open containers (xxv) Paper machine “blowdown” with air for cleanup (xxvi) Pressure filters (xxvii) Pressurized pulp washers (xxviii)Process raw water treatment (e.g., phosphate)

(xxix) Pulp tanks and stock chests (xxx) Railroad flares (xxxi) Saltcake storage tanks vented to the recovery system (xxxii) Slaker vents (xxxiii)Smelt spout cooling water tanks (xxxiv)Smelt spout covers (dog houses)

(xxxv) Starch or dye make-down tanks (xxxvi)Strong black liquor tanks (xxxvii)Tank interior coatings (epoxy resins)

(xxxviii)Turpentine loading (xxxix)Weak wash tanks (xl) Wheel barrows (xli) White liquor clarifiers (xlii) White liquor oxidizer (xliii) White liquor tanks (xliv) Winder 59. Steam heated wood drying kilns excluding chemically treated wood.

60. Warehouse storage of packaged raw materials and finished goods emitting no hazardous air pollutants.

61. Electric stations, including transformers, and substations, unless a federal requirement not incorporated into this Division 1200-03 or Division 0400-30 applies.

62. Groundwater monitoring wells.

63. Lubricants and waxes used for machinery lubrication.

64. Use of materials for marking and grading of lumber, and the storage of lumber.

65. Equipment used exclusively to package photographic chemicals, and food preservatives excluding any associated fuel burning.

66. Air purification systems. This activity is not insignificant if emissions exhausted are from any manufacturing or other industrial processes and subject to any standard or other requirement of the regulations promulgated to protect stratospheric ozone under title VI of the Federal Act.

67. Equipment used in the production of enteric food coatings.

68. Equipment used in the production of aqueous inks in which no organic solvents, dilutents, or thinners are used.

69. Equipment used to transport or store process wastewater streams to a wastewater treatment facility (i.e. floor drains, sumps, drain headers, manhole covers). This activity is not insignificant if it is subject to the new source performance standards for petroleum refinery wastewater systems under

Chapter 0400-30-39 or under 40 C.F.R. Part 60.

70. Drum melter operations for low-volatility solid and semi-solid materials using steam or electrical heating. This activity is not insignificant if it is subject to the new source performance standards for electric arc furnaces under Chapter 0400- 30-39 or under 40 C.F.R. Part 60.

71. Vacuum producing equipment including vacuum seal pots and vacuum pumps.

Any associated internal combustion engines are excluded.

72. Presses used exclusively for extruding metals, minerals, plastics, rubber, or wood except where halogenated carbon compounds or hydrocarbon organic solvents are used as foaming agents. Presses used for extruding scrap materials or reclaiming scrap materials are not exempt.

73. Tank trucks, railcars, barges, and trailers excluding transfer operations at loading and unloading stations, and internal cleaning operations.

74. Portable dumpsters and other containers for liquids (excluding transfer operations), and solid waste dumpsters, including handling equipment and associated activities.

75. Environmental field sampling activities.

76. Parts washer where the vapor pressure of cleaners is less than 1.52 psia. Any activity is not insignificant if it is subject to the halogenated solvent cleaning MACT standard under Chapter 1200-03-31.

77. Instrument air dryers and distribution.

78. Automatic oiling operations (e.g., oiler on chains).

79. Machine blowdown with air for cleanup.

80. Storage tanks of any size containing exclusively soaps, detergents, surfactants, waxes, glycerine, vegetable oils, greases, animal fats, sweeteners, corn syrup, aqueous salt solutions or aqueous caustic solutions provided an organic solvent has not been mixed with such materials. This activity is not insignificant if appropriate lids and/or covers are not utilized.

81. Loading and unloading systems for railcars, tank trucks, or watercraft that handle only the following liquid materials provided an organic solvent has not been mixed with such materials: soaps, detergents, surfactants, waxes, glycerine, vegetable oils, greases, animal fats, sweeteners, corn syrup, aqueous salt solutions, or aqueous caustic solutions. This activity is not insignificant if appropriate lids and/or covers are not utilized.

82. Sanitary sewer systems.

83. Treatment systems for potable water.

84. Any pilot plant provided that the following conditions are satisfied:

(i) Pilot plant facilities which demonstrate to the satisfaction of the Technical Secretary, that such facilities do not significantly impact ambient air quality.

Air quality modeling may be required by the Technical Secretary.

(ii) The facility is constructed and operated only for the purpose of:

(I) Testing the manufacturing or marketing potential of a proposed product, or (II) Defining the design of a larger plant or future processes, or (III) Studying the behavior of an existing plant through modeling in the pilot plant.

85. Sodium hypochlorite storage tanks.

86. Industrial-Commercial-Institutional Steam Generating Facility exemptions are as follows: Any of the following activities is not insignificant if it is subject to new source performance standards for steam generating facilities under Chapter 0400-30-39 or under 40 C.F.R. Part 60.

(i) Bunker room exhaust (ii) Coal sampling and weighing operations (iii) Alternative solid fuel handling (iv) Vents from ash transport systems not operating at positive pressure (e.g. ash hoppers)

(v) Coal combustion by-product disposal (except for dry stacking and intermittent ash hauling and disposal)

(vi) Building ventilation other than boiler room, coal handling, and ash loading (e.g. turbine room, battery room)

(vii) Lubrication of equipment (viii) Hydrogen vents (ix) Steam vents (x) Air compressor and distribution systems (xi) Emergency equipment (xii) Fugitive dust from operation of a passenger automobile, station wagon, pickup truck, or van.

(xiii) Pressure relief valves (xiv) Test gases and bottled gases (xv) Emissions from a laboratory. If a facility manufactures or produces products for profit in any quantity, it may not be considered to be a laboratory under this item. Support part of the laboratory. Support activities do not include the provision of power to the laboratory from sources that provide power to multiple projects or from sources which would otherwise require permitting, such as boilers that provide power to an entire facility.

(xvi) Safety devices such as fire extinguishers (xvii) Equipment used for hydraulic or hydrostatic testing (xviii) Food preparation for onsite consumption (xix) Oil vapor extractor (e.g. turbine seal oil, turbine lube oil)

87. Sulfuric acid tanks. This activity is not insignificant if it is subject to new source performance standards for sulfuric acid plants under Chapter 0400-30-39 or under 40 C.F.R. Part 60.

88. Soil “borrow” pits. This activity is not insignificant if it is subject to new source performance standards for nonmetallic mineral processing plants under Chapter 0400-30-39 or under 40 C.F.R. Part 60.

89. Phosphoric acid tanks. This activity is not insignificant if it is subject to new source performance standards for phosphate fertilizer industry under Chapter 0400-30-39 or under 40 C.F.R. Part 60.

90. Sodium carbonate tanks.

91. Firearms, firing ranges, and protective services facilities.

92. Physical testing of air filtration. This activity is not insignificant if emissions exhausted are from any manufacturing or other industrial processes and subject to any standard or other requirement of the regulations promulgated to protect stratospheric ozone under title VI of the Federal Act.

93. Safe venting of compressed gas cylinders which have lost structural integrity.

94. Testing, inspection, cleaning or drying of personal protective equipment such as respirators, clothing, gloves, shoe scuffs, etc.

95. Equipment used to process or handle solid materials or solid wastes such as bottle smashers, bulb crushers, balers, compactors, and can puncturers.

(g) Unless specifically required under part 1200-03-09-.04(5)(b)4., the following emission units or activities, or stationary sources that qualify as ‘insignificant activities’ are not required to be included in a permit application under paragraph 1200-03-09-.02(11).

1. Combustion emissions from propulsion of mobile sources, except for vessel emissions from Outer Continental Shelf sources.

2. Air-conditioning units used for human comfort that do not have applicable requirements under title VI of the Act.

3. Ventilating units used for human comfort that do not exhaust air pollutants into the ambient air from any manufacturing/industrial or commercial process.

4. Non-commercial food preparation.

5. Consumer use of office equipment and products, not including printers or businesses primarily involved in photographic reproduction.

6. Janitorial services and consumer use of janitorial products.

7. Internal combustion engines used for landscaping purposes.

8. Laundry activities, except for dry-cleaning and steam boilers.

9. Bathroom/toilet vent emissions.

10. Emergency (backup) electrical generators at residential locations.

11. Tobacco smoking rooms and areas.

12. Blacksmith forges.

13. Plant maintenance and upkeep activities (e.g., grounds-keeping, general repairs, cleaning, painting, welding, plumbing, re-tarring roofs, installing insulation, and paving parking lots) provided these activities are not conducted as part of a manufacturing process, are not related to the source’s primary business activity, and not otherwise triggering a permit modification.

14. Repair or maintenance shop activities not related to the source’s primary business activity, not including emissions from surface coating or de-greasing (solvent metal cleaning) activities, and not otherwise triggering a permit modification.

15. Portable electrical generators that can be moved by hand from one location to another.

16. Hand-held equipment for buffing, polishing, cutting, drilling, sawing, grinding, turning or machining wood, metal or plastic.

17. Brazing, soldering and welding equipment, and cutting torches related to manufacturing and construction activities that do not result in emission of HAP metals.

18. Air compressors and pneumatically operated equipment, including hand tools.

19. Batteries and battery charging stations, except at battery manufacturing plants.

20. Storage tanks, vessels, and containers holding or storing liquid substances that will not emit any VOC or HAP.

21. Storage tanks, reservoirs, and pumping and handling equipment of any size containing soaps, vegetable oil, grease, animal fat, and nonvolatile aqueous salt solutions, provided appropriate lids and covers are utilized.

22. Equipment used to mix and package, soaps, vegetable oil, grease, animal fat, and nonvolatile aqueous salt solutions, provided appropriate lids and covers are utilized.

23. Drop hammers or hydraulic presses for forging or metalworking.

24. Equipment used exclusively to slaughter animals, but not including other equipment at slaughterhouses, such as rendering cookers, boilers, heating plants, incinerators, and electrical power generating equipment.

25. Vents from continuous emissions monitors and other analyzers.

26. Natural gas pressure regulator vents, excluding venting at oil and gas production facilities.

27. Hand-held applicator equipment for hot melt adhesives with no VOC in the adhesive formulation.

28. Equipment used for surface coating, painting, dipping or spraying operations, except those that will emit VOC or HAP.

29. CO lasers, used only on metals and other materials which do not emit HAP in the process.

30. Consumer use of paper trimmers/binders.

31. Electric or steam-heated drying ovens and autoclaves, but not the emissions from the articles or substances being processed in the ovens or autoclaves or the boilers delivering the steam.

32. Salt baths using nonvolatile salts that do not result in emissions of any regulated air pollutants.

33. Laser trimmers using dust collection to prevent fugitive emissions.

34. Bench-scale laboratory equipment used for physical or chemical analysis, but not lab fume hoods or vents.

35. Routine calibration and maintenance of laboratory equipment or other analytical instruments.

36. Equipment used for quality control/assurance or inspection purposes, including sampling equipment used to withdraw materials for analysis.

37. Hydraulic and hydrostatic testing equipment.

38. Environmental chambers not using hazardous air pollutant (HAP) gasses.

39. Shock chambers.

40. Humidity chambers.

41. Solar simulators.

42. Fugitive emission related to movement of passenger vehicles, provided the emissions are not counted for applicability purposes and any required fugitive dust control plan or its equivalent is submitted.

43. Process water filtration systems and demineralizes.

44. Demineralized water tanks and demineralizer vents.

45. Boiler water treatment operations, not including cooling towers.

46. Oxygen scavenging (de-aeration) of water.

47. Ozone generators.

48. Fire suppression systems.

49. Emergency road flares.

50. Steam vents and safety relief valves.

51. Steam leaks.

52. Steam cleaning operations.

53. Steam sterilizers.

(6) Municipal solid waste landfills with a design capacity less than 2.5 million megagrams by mass or 2.5 million cubic meters by volume shall satisfy the applicable provisions of 40 C.F.R. 60 Subparts WWW or XXX, or any applicable federal or state plan established pursuant to Section 111(d) of the Clean Air Act, but shall otherwise be exempt from the requirement to obtain a construction or operating permit. This exemption shall not apply to any major stationary source or major modification as defined by paragraph (4) of Rule 1200- 03-09-.01 or to any major source as defined by paragraph (11) of Rule 1200-03-09-.02.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule certified June 7, 1974. Amendment filed January 10, 1977; effective February 9, 1977. Amendment filed March 31, 1987; effective May 10, 1987. Amendment filed September 27, 1989; effective November 11, 1989. Amendment filed May 17, 1990; effective July 1, 1990. Amendment filed April 22, 1993; effective June 5, 1993. Amendment filed September 7, 1993; effective November 21, 1993. Amendment filed June 12, 1995; effective August 26, 1995. Amendment filed July 25, 1996; effective October 6, 1996. Amendment filed November 30, 1999; effective February 6, 2000. Amendment filed November 29, 2001; effective February 12, 2002. Amendments filed September 9, 2005; effective November 23, 2005. Amendment filed June 1, 2009; effective August 15, 2009. Amendment filed April 28, 2017; effective July 27, 2017. Amendments filed May 17, 2017; effective August 15, 2017. Amendments filed September 29, 2022; effective December 28, 2022. Amendments filed September 16, 2024; effective December 15, 2024.

Chapter 1200-03-10 Required Sampling, Recording, and Reporting

Tenn. Comp. R. & Regs. 1200-03-10-.01 SAMPLING REQUIRED TO ESTABLISH AIR CONTAMINANT EMISSION LEVELS

(1) New Facilities (a) There shall be provided for any stack or duct adequate sampling facilities as follows:

1. Sampling ports of a size, number, and location as the Technical Secretary may require;

2. Safe access to each port; and 3. Such other sampling and testing facilities as the Technical Secretary may require.

(b) The Technical Secretary may at his discretion require the applicant for an operating permit to conduct or have conducted such tests as are necessary to establish the amount of air contaminants emitted from such equipment or control apparatus. Such tests shall be conducted in a manner approved by the Technical Secretary. The Technical Secretary may require that such tests be conducted in the presence of this representative.

(c) The Technical Secretary may conduct tests of air contaminant emissions from any source. Upon request of the Technical Secretary the person responsible for the source to be tested shall provide, at no expense to the Technical Secretary, reasonable and necessary openings in stacks, vents, and ducts, along with safe and easy access thereto including a suitable power source to the point of testing for proper determination of the level of air contaminant emissions.

(2) Existing Facilities (a) Whenever the Technical Secretary has reason to believe that the emission limits of the regulations set forth herein are being violated, he may require the owner to conduct or have conducted at the owner’s expense, tests to determine the emission level of specific air contaminants. The Technical Secretary may require that such tests be conducted in the presence of his representative.

(b) The Technical Secretary may at his discretion require the applicant for an operating permit to conduct or have conducted such tests as are necessary to establish the amount of air contaminants emitted from such equipment or control apparatus. Such tests shall be made at the expense of the applicant and shall be conducted in a manner approved by the Technical Secretary. The Technical Secretary may require that such tests be conducted in the presence of this representatives.

(c) The Technical Secretary may conduct tests of air contaminant emissions from any source. Upon request of the Technical Secretary, the person responsible for the source to be tested shall provide, at no expense to the Technical Secretary, reasonable and necessary openings in stacks, vents, and ducts, along with safe and easy access thereto, including a suitable power source to the point of testing for proper determination of the level of air contaminant emissions.

(3) Periodic Testing Required (a) The Technical Secretary may require the owner or operator of an air contaminant source, as a condition of his operating permit, to conduct or have conducted periodic tests to establish the amount of air contaminants emitted. The nature, extent, and frequency of such required testing shall be specified in the operating permit. Such tests shall be made at the expense of the owner or operator and shall be conducted in a manner approved by the Technical Secretary. The Technical Secretary shall be supplied with such data as stipulated in the operating permit.

(b) Any person affected by any of these regulations and directed to do so by the Technical Secretary, shall file emission data, as a minimum of one year, with the Technical Secretary on forms available from the Secretary.

History

• Authority: T.C.A. §§ 4-5-202, et seq.; 53-3412; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule certified June 7, 1974. Amendments filed June 6, 2018; effective September 4, 2018.

Tenn. Comp. R. & Regs. 1200-03-10-.02 MONITORING OF SOURCE EMISSIONS, RECORDING, AND REPORTING OF THE

SAME ARE REQUIRED.

(1) Monitoring of Emissions (a) The Technical Secretary may require the owner or operator of any air contaminant source discharging air contaminants, at the expense of the owner or operator, to install, calibrate, operate, and maintain such monitoring equipment as the Technical Secretary shall prescribe; sample such emissions in accordance with methods as the Technical Secretary shall prescribe; establish and maintain such records; and make periodic emission reports as required in paragraph (2).

(b) 1. The specific source categories listed below are required to complete the installation and performance testing of the respective equipment and begin maintaining and recording within 18 months of the effective date of each rule.

(i) Fossil fuel-fired steam generators with an annual average capacity factor of greater than 30 percent, as reported to the Federal Power Commission for calendar year 1974 or as otherwise demonstrated to the Technical Secretary by the owner or operator, shall conform with the following monitoring requirements. For purposes of this rule, “fossil fuel-fired steam generator” means a furnace or boiler used in the process of burning fossil fuel for the purpose of producing steam by heat transfer.

(I) A continuous monitoring system for the measurement of opacity shall be installed, calibrated, maintained, and operated by the owner or operator of any such steam generator of greater than 250 million Btu per hour heat input except for generators operated as described in subitem I., II., or III. of this item.

I. Gaseous fuel is the only fuel burned.

II. Oil or a mixture of gas and oil are the only fuels burned, and the source is able to comply with the applicable particulate matter and opacity regulations without utilization of particulate matter collection equipment, and where the source has never been found, through any administrative or judicial proceedings, to be in violation of any visible emission standard of these regulations.

III. The owner or operator installs, certifies, operates, and maintains a particulate matter continuous emissions monitoring system (PM CEMS) or particulate matter continuous parameter monitoring system (PM CPMS) in accordance with the requirements of 40 C.F.R. Part 63

Subpart UUUUU, and the PM CEMS or PM CPMS is subject to and complies with:

A. The filterable particulate matter standards established by 40 C.F.R. § 63.9991(a)(1) and Table 1 or Table 2 of

Subpart UUUUU;

B. The monitoring requirements established by 40 C.F.R. §§ 63.10010(h) or (i); and C. The work practice standards established by 40 C.F.R. § 63.10007(a)(1) and Table 3 of Subpart UUUUU.

IV. The provisions of 40 C.F.R § 63.9991(a)(1), § 63.10007(a)(1), §§ 63.10010(h) and (i), and Tables 1 through 3 of Subpart UUUUU (2020) are hereby adopted by reference.

(ii) Each sulfuric acid plant of greater than 300 tons per day production capacity, the production being expressed as 100 percent acid, shall install, calibrate, maintain, and operate a continuous monitoring system for the measurement of sulfur dioxide for each sulfuric acid producing facility within such plant.

(iii) Each catalyst regenerator for fluid bed catalytic cracking units of greater than 20,000 barrels per day fresh feed capacity shall install, calibrate, maintain, and operate a continuous monitoring system for the measurement of opacity.

2. Any source which is subject to a regulation in Chapter 1200-03-16 or which is scheduled for retirement within five years of the effective date of the appropriate designating subparts of part 1. above, provided that adequate evidence and guarantees are provided that clearly shows that the source will cease operation prior to such date, will not be subject to the monitoring requirements of this subparagraph.

(c) 1. All monitoring equipment specified in this paragraph shall meet the performance specifications in the Federal Register, Volume 40, No. 194, October 6, 1975. The equipment shall also be installed, calibrated, operated, and maintained in accordance with the procedures in this reference.

2. Reserved.

3. A 30-day notice shall be given to the Technical Secretary of the date upon which any sampling or testing will be conducted as required under this subparagraph.

4. The sampling point for continuous emission monitoring shall be representative of the concentration of the parameter being monitored at the source emission point.

If the monitor is located at any position except the stack, the Technical Secretary will require evidence of the representativeness of the location.

(d) 1. Each owner or operator of any air contaminant source directed by the Technical Secretary to monitor and report on specified air contaminants shall develop and submit a detailed monitoring program; and order and install sampling equipment within the following time schedule:

(i) Within 60 days after designation by the Technical Secretary of those air contaminants to be monitored, the owner or operator of the air contaminant source shall submit a detailed monitoring program for approval by the Technical Secretary.

(ii) Within 30 days after the monitoring program has been approved in writing by the Technical Secretary, sampling and monitoring equipment shall be ordered. The order shall specify a delivery date that is as expeditious as possible.

(iii) Within 90 days after delivery of the equipment the owner or operator of the air contaminant source shall place said equipment in effective operation in accordance with its approved monitoring program.

2. Any owner or operator required by subparagraph (b) to monitor must follow the schedule outlined in part 1. above with the exception that the detailed monitoring program must be submitted to the Technical Secretary within one hundred twenty (120) days of the effective date of the appropriate designating subpart of subparagraph (b) and not as specified in subpart (I) of the above part 1.

(e) Monitoring System Malfunction Due allowance for failure to monitor shall be made during any period of monitoring system malfunction, provided that the source owner or operator shows, to the satisfaction of the Technical Secretary, that the malfunction was unavoidable and is being repaired as expeditiously as practicable and that a log of all such malfunctions is being kept by the owner or operator, including time malfunction began, when it was detected, what was wrong, what was done to correct the malfunction, and when the malfunction was corrected.

(f) Owners and operators of fossil fuel-fired steam generators that install a continuous sulfur dioxide monitoring system as provided in Rule 1200-03-12-.04 are required to complete the installation and performance testing of the applicable equipment and begin maintaining and recording within eighteen months of the effective dates of this subparagraph unless a revised time frame is agreed to by the Technical Secretary because of the installation of sulfur dioxide control equipment.

1. The owner or operator shall develop and submit a detailed monitoring program; and order and install measuring equipment for sulfur dioxide and either oxygen or carbon dioxide within the following time schedule:

(i) Within 150 days after the effective date of this subparagraph, the owner or operator shall submit a detailed monitoring program for approval by the Technical Secretary.

(ii) Within 30 days after the monitoring program has been approved in writing by the Technical Secretary, sampling and monitoring equipment shall be ordered. The order shall specify delivery date but as expeditious as possible.

(iii) Within 90 days after delivery of the equipment the owner or operator of the air contaminant source shall place said equipment in effective operation in accordance with the approved monitoring program.

2. The sampling point for the carbon dioxide or oxygen monitor shall be same as that for the sulfur dioxide monitor except as specified for installations using flue gas desulfurization systems.

(g) Owners and/or operators of sources required to install a continuous sulfur dioxide monitoring system as provided in paragraph 1200-03-12-.04(3) are required to complete the installation and performance testing of the applicable equipment and begin maintaining and recording within twelve months of the effective date of this subparagraph.

(2) Recording and Reporting (a) Records and reports as the Technical Secretary shall prescribe on air contaminant emissions, ambient air concentrations, or fuel analyses shall be recorded, compiled, and submitted in a format prescribed by the Technical Secretary.

(b) 1. Owners or operators of facilities subject to subparagraph (1)(b) of this rule, are required to submit a written report of excess emissions for each calendar quarter and the nature and cause of the excess emissions, if known. The requirements of this subparagraph must be followed by all owners and operators when making these required reports.

2. For opacity measurements the summary shall consist of the magnitude in actual percent opacity of all one minute averages of opacity greater than the opacity standard in the applicable rule in Chapter 1200-03-05 for each hour of operation and the facility minus the five-minute exempt period.

Average values may be obtained by integration over the averaging period or by arithmetically averaging a minimum of four equally spaced, instantaneous opacity measurements per minute. The averaging period used for data reporting is one minute for opacity measurements and one hour for measurements of sulfur dioxide; provided, however, that for opacity measurements for fuel burning installations with fuel burning equipment of input capacity greater than 600 x 10 Btu per hour, the summary shall consist of the magnitude in actual percent opacity of all six-minute averages of opacity greater than the opacity standard in the applicable plan for each hour of operation of the facility minus one six-minute exempt period per hour of no more than 40 percent opacity. Averaging values may be obtained by integration over the averaging period or by arithmetically averaging a minimum of twenty-four hours for measurements of sulfur dioxide for fuel burning installations with fuel burning equipment of input capacity greater than 600 x 10 Btu per hour. The averaging period used for data reporting from all other sources is one minute for opacity measurements and one hour for measurements of sulfur dioxide except as denoted in other Chapters of these regulations.

3. For gaseous measurements the summary shall consist of emission averages, in the units of the applicable standard, for each averaging period during which the applicable standard was exceeded.

4. The date and time identifying each period during which the continuous monitoring system was inoperative, except for zero and span checks, and the nature of system repairs or adjustments shall be reported. The Technical Secretary may required proof of continuous monitoring system performance whenever system repairs or adjustments have been made.

5. When no excess emissions have occurred and the continuous monitoring system(s) have not been inoperative, repaired, or adjusted, such information shall be included in the report.

6. Maintain a file of all information reported in the quarterly summaries, and all other data collected either by the continuous monitoring system or as necessary to convert monitoring data to the units of the applicable standard for a minimum of two years from the date of collection of such data or submission of such summaries.

7. Owners or operators of air contaminant sources subject to subparagraph (1)(b) of this Rule are required to use the procedures outlined in the October 6, 1975, Federal Register, Vol. 40, No. 194 (Appendix P, Paragraph 5.0), Page 46249 for converting monitoring data to units of the standard where necessary. These procedures are essentially the same as those in subparagraphs 1200-03-16- .02(6)(e) and (f). Where applicable, the procedures outlined in the October 12, 1976, Federal Register, Volume 41, Number 198, pages 44838-44839 may be used.

(c) Owners or operators of facilities subject to Rule 1200-03-12-.04 are required to submit a written report on emissions for each calendar quarter and the nature and cause of excess emissions, if known. The Technical Secretary will specify details of the reports required after the monitor has been performance tested.

1. General Procedures:

(i) The source owner or operator shall report all 3-hour averages in excess of the applicable emission standard or all 24-hour averages in units of the applicable emission standard. The 3-hour and 24-hour values shall be computed by taking the average of three contiguous or 24 contiguous onehour values of sulfur dioxide emissions. The one-hour average values may be obtained by integration over the one-hour period or be computed from four or more data points equally spaced over each one-hour period. Data recorded during periods of monitoring system break downs, repairs, calibration checks, and zero and span adjustments shall not be included in the data averages.

(ii) In the event that the fuel burning installation contains discharge points utilizing continuous sulfur dioxide monitoring systems and discharge points which do not require monitoring systems (or where an individual monitoring system is inoperative), and the data from the monitoring system indicates a violation, an administrative hearing may be conducted by the Technical Secretary to determine the compliance status of the entire fuel burning installation.

(iii) To determine compliance where multiple units of fuel burning equipment are involved, an average weight on the basis of heat input shall be used.

2. The owners and operators of these sources must follow the same procedures as specified in parts (2)(b)4., 6., and 7. of Rule 1200-03-10-.02. Alternative methods for converting sulfur dioxide monitoring instrument data to units of the applicable emission standard may be approved by the Technical Secretary if demonstrated to yield equivalent results.

(d) Any source located at a facility required to obtain a major source operating permit in accordance with the provisions of paragraph (11) of Rule 1200-03-09-.02 may submit the reports required by this rule on a semi-annual basis.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule certified June 7, 1974. Amendment filed January 10, 1977; effective February 9, 1977. Amendment filed March 13, 1978; effective April 12, 1978. Amendment filed May 7, 1979; effective June 21, 1979. Amendment filed October 28, 1981; effective December 14, 1981. Amendment filed January 27, 1993; effective March 13, 1993. Amendment filed January 31, 1997; effective April 16, 1997. Amendment filed November 7, 2012; effective February 5, 2013. Amendments filed June 6, 2018; effective September 4, 2018. Amendments filed June 2, 2022; effective August 31, 2022.

Tenn. Comp. R. & Regs. 1200-03-10-.03 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, et seq., and 68-25-105.
• Administrative History: Original rule certified June 7, 1974. Rule certified June 7, May 17, 1974; effective June 16, 1974. Repeal filed February 5, 1979; effective March 21, 1979.

Tenn. Comp. R. & Regs. 1200-03-10-.04 SAMPLING, RECORDING, AND REPORTING REQUIRED FOR MAJOR

STATIONARY SOURCES.

(1) The provisions of the rule shall apply to all sources required to obtain a major stationary source operating permit in accordance with the provisions of paragraph 1200-03-09-.02(11).

Such sources are also subject to the provisions of Rule 1200-03-10-.01 and Rule 1200-03- 10-.02.

(2) The Technical Secretary is authorized to require by permit condition any periodic or enhanced monitoring, recording and reporting that he deems necessary for the verification of the source's compliance with the applicable requirements as defined in paragraph 1200-03- 09-.02(11).

(a) Monitoring may include, but is not limited to: source testing; in-stack monitoring; process parameter monitoring of material feed rates, temperature, pressure differentials, power consumption or fuel consumption; chemical analysis of feed stocks, coatings, or solvents; ambient monitoring; visible emissions evaluations; control equipment performance parameters of pressure differentials, power consumption, air or liquid flow rates or amount of air contaminants collected for disposal; air contaminant leak detection tests from process or control equipment; and any other such monitoring that the Technical Secretary may prescribe.

1. The monitoring must be conducted in a manner acceptable to the Technical Secretary. This includes, but is not limited to: sampling methods, analytical methods, sensor locations and frequency of sampling.

2. The monitoring method must have at least a 95% operational availability rate to prove compliance directly or indirectly with the applicable requirements unless otherwise stipulated by the Technical Secretary in the permit. Ambient air monitors shall have their minimum operational availability rates prescribed by

Chapter 1200-03-12. Missing data in excess of these levels shall be grounds for enforcement action.

(b) Recordkeeping may include handwritten or computerized records and shall be kept in accordance with the manner approved by the Technical Secretary. The Technical Secretary or an employee of the Department authorized by the Technical Secretary shall have the authority to inspect the records during reasonable hours at the place where such records are kept. The source owner or operator must provide copies of the records to the Technical Secretary upon request. If the records are computerized, the owner or operator may provide them to the Technical Secretary in an electronic format compatible with the Department's electronic data processing equipment for initial review. Upon discovery of electronic data that may reveal noncompliance, the Technical Secretary shall ask for excerpts documenting the noncompliance, and the owner or operator shall comply with the request. All electronic submittals shall be in "read only" format such that the submittal cannot be written over with different electronic data.

1. In the absence of a specific recordkeeping procedure, it is the general duty of a person required to keep the records required under this rule in such a fashion that compliance with the applicable requirement can be readily ascertained.

2. Records must be legible, quantifiable and supported by documentation to validate the entries.

(c) Reporting shall be in the manner prescribed by the Technical Secretary in the permit or approved by him in the source's operating permit application.

(d) All reports submitted to the Technical Secretary shall be signed by a responsible official consistent with the provisions of part 1200-03-09-.02(11)(d)4.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule effective September 12, 1994. Amendments filed June 6, 2018; effective September 4, 2018.

Tenn. Comp. R. & Regs. 1200-03-10-.05 EMISSIONS INVENTORY REQUIREMENTS

(1) Stationary sources that exceed the emission thresholds specified in 40 CFR 51 Subpart A shall submit emissions inventories of the pollutants listed in § 51.15(a)(1), as follows:

(a) Electricity generating units (EGUs), as defined in subpart (9)(d)2.(i) of Rule 1200-03- 26-.02, shall submit emissions inventories no later than July 1 of each calendar year, in accordance with § 51.30 and Table 1 to Appendix A of 40 C.F.R. 51 Subpart A.

(b) All other stationary sources shall submit emissions inventories no later than June 1 of each calendar year, in accordance with § 51.30 and Table 1 to Appendix A of 40 C.F.R. 51 Subpart A.

(2) Emissions inventories shall be submitted and certified in accordance with forms and guidance issued by the Technical Secretary.

(3) The Technical Secretary may make the forms issued pursuant to paragraph (2) of this rule available electronically. If an emission inventory is submitted electronically, then the submission shall be in accordance with the requirements of Chapter 0400-01-40.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-101, et seq.
• Administrative History: New rule filed November 14, 2017; effective February 12, 2018.

Chapter 1200-03-11 Repealed

Tenn. Comp. R. & Regs. 1200-03-11-.01 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed May 17, 1978; effective June 16, 1978. Amendment filed September 21, 1988; effective November 6, 1988. Amendment filed May 17, 1990; effective July 1, 1990. Amendment filed March 7, 2006; effective May 21, 2006. Amendment fil ed May 25, 2011; effective August 23, 2011. Amendment filed April 1, 2015; effective June 30, 2015. Repeal filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-11-.17 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed August 14, 1995; effective October 28, 1995. Repeal filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-11-.02 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed April 17, 1978; effective June 16, 1978. Amendment filed August 21, 1981; effective October 5, 1981. Amendment filed March 5, 1993; effective April 19, 1993. Amendment filed March 10, 1995; effective May 24, 1995. Amendment filed January 31, 1997; effective April 16, 1997. Amendment filed December 22, 1997; March 7, 1998. Amendments filed June 6, 2018; effective September 4, 2018. Repeal filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-11-.03 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed January 10, 1977; effective February 9, 1977. Amendment filed September 10, 1979; effective October 25, 1979. Repeal filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-11-.04 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-25-105; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule certified June 7, 1974. Amendment filed January 10, 1977; effective February 9, 1977. Amendment filed September 21, 1988; effective November 6, 1988. Amendment filed January 15, 2009; effective March 31, 2009. Repeal filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-11-.05 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed March 13, 1978, effective April 12, 1978. Amendment filed September 10, 1979, effective October 25, 1979. Amendment filed September 21, 1988; effective November 6, 1988. Repeal filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-11-.06 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 21, 1988; effective November 6, 1988. Repeal filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-11-.07 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 21, 1988; effective November 6, 1988. Repeal filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-11-.08 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed August 14, 1995; effective October 28, 1995. Repeal filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-11-.09 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 21, 1988; effective November 6, 1988. Repeal filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-11-.10 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 21, 1988; effective November 6, 1988. Repeal filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-11-.11 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 21, 1988; effective November 6, 1988. Repeal filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-11-.12 THROUGH 1200-03-11-.16 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq. and 68-201-101, et seq.
• Administrative History: Original rule filed August 14, 1995; effective October 28, 1995. Repeal filed September 29, 2022; effective December 28, 2022.

Chapter 1200-03-12 Methods of Sampling and Analysis

Tenn. Comp. R. & Regs. 1200-03-12-.01 GENERAL

(1) It is explicitly implied that in addition to and consistent with specific methods of sampling and analysis described herein, that samples will be taken in such number, duration and location as to be statistically significant and representative of the condition which the sample(s) purport to evaluate.

(2) Where specific materials, equipment procedures are specified, it shall be permissible to use other materials, equipment or procedures where it has been reliably demonstrated that their use produces results comparable to that which would have been obtained by use of the specified materials, equipment or procedures.

History

• Authority: T.C.A. § 53-3412.
• Administrative History: Original rule certified June 7, 1974.

Tenn. Comp. R. & Regs. 1200-03-12-.02 PROCEDURES FOR AMBIENT SAMPLING AND ANALYSIS

(1) The reference method for the sampling and the analytical procedures for sulfur dioxide, total suspended particulates, carbon monoxide, nitrogen dioxide, lead, PM-10 and ozone are found in 40 CFR Part 50, Chapter 1, Subchapter C (7-1-92 Edition) which is incorporated in its entirety by reference. The procedure for sampling and analyzing atmospheric fluorides shall conform with the method adopted by the American Society for Testing Materials and found in the Annual Book of ASTM Standards published each year by the American Society for Testing Materials with a designation of D3266 “Standard Test Method for Automated Separation and Collection of Particulate and Acidic Fluoride in the Atmosphere (“Double Paper Tape Sampler Method”).” Persons required to conduct ambient air monitoring may obtain a copy of 40 CFR Part 50, Chapter 1, Subchapter C from the Technical Secretary.

(2) For those air contaminants which the EPA has established reference and equivalent monitoring methods, the use of alternative sampling procedures shall be approved by the Technical Secretary and EPA. For those air contaminants which the EPA has not established reference and equivalent methods, the use of alternative sampling procedures shall be approved by the Technical Secretary.

(3) Each owner or operator of an air monitoring network required by the Technical Secretary shall submit in writing to the Technical Secretary a Quality Control/Quality Assurance plan for approval prior to commencing air monitoring. This plan shall be reviewed and approved prior to start-up of new monitoring networks or whenever any significant change is made to an existing network. The Technical Secretary will determine if a change that is made is significant.

(4) All ambient monitoring data generated by continuous operating monitors, or intermittent sampling techniques, shall be submitted in a format acceptable to the Technical Secretary.

September, 2018 (revised)

(5) Each ambient monitor sited in the field for the purpose of generating data for the monitoring procedures listed in 1200-03-12-.02(1) must have a valid data recovery of at least 75 percent.

Information which documents the cause of missing data shall be submitted in writing to the Technical Secretary for all missing data.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202, et seq.; 53-3412; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed January 10, 1977; effective February 9, 1977. Amendment filed May 7, 1979; effective June 21, 1979. Amendment filed December 4, 1979; effective January 18, 1980. Amendment filed June 28, 1990; effective August 12, 1990. Amendment filed November 30, 1993; effective February 13, 1994. Amendment filed March 18, 1994; effective June 1, 1994. Amendments filed June 6, 2018; effective September 4, 2018.

Tenn. Comp. R. & Regs. 1200-03-12-.03 SOURCE SAMPLING AND ANALYSIS

The methods set forth in this section shall be applicable for determining compliance with emission standards.

(1) SAMPLE AND VELOCITY TRAVERSES. - Sample and velocity traverses shall be determined by Method 1 outlined in the Federal Register, Volume 42, Number 160, August 18, 1977, as amended in the Federal Register, Volume 43, Number 57, March 23, 1978.

(2) STACK GAS VELOCITY DETERMINATION. - Stack gas velocity shall be determined by Method 2 outlined in the Federal Register, Volume 42, Number 160, August 18, 1977, as amended in the Federal Register, Volume 43, Number 57, March 23, 1978, except in such instances where a Type S pitot tube is not applicable.

(3) GAS ANALYSIS. - Gas analysis for carbon dioxide, oxygen, excess air, and dry molecular weight shall be determined by Method 3 outline in the Federal Register, Volume 42, Number 160, August 18, 1977, as amended in the Federal Register, Volume 43, Number 57, March 23, 1978, or another type of test procedure that is direct indicating and/or recording approved by the Technical Secretary.

(4) DETERMINATION OF MOISTURE CONTENT IN STACK GASES. - Moisture content shall be determined by Method 4 outline in the Federal Register, Volume 42, Number 60, August 18, 1977, as amended in the Federal Register, Volume 43, Number 57, March 23, 1978, or other technique approved by the Technical Secretary.

(5) DETERMINATION OF PARTICULATE EMISSIONS. - The basic design of the sampling train is left to the individual, if certain criteria are observed to assure high collection efficiency and standard analysis of the collected particulates.

(a) DESCRIPTION OF SAMPLING APPARATUS.

1. This apparatus shall include interchangeable sampling nozzles or probes, of various diameters, a filter effective for the removal of particulates exceeding 0.3 micron diameter of solid or liquid, a suitable number of impingers to reduce condensable vapors to liquid or solid particulate matter, and appropriate connecting tubing at temperatures above the aqueous dewpoint of the gases. All materials of construction shall be resistant to corrosive elements in the flue gases, e.g., SO , NO x and elevated temperatures.

2. This filter assembly shall be maintained above the aqueous dewpoint of the flue gases throughout the sampling operation. To accomplish this, the filter assembly may be disposed inside the gas flue to be completely bathed by the hot gas September, 2018 (revised) stream; or it may be disposed outside the gas stream, provided the following precautions are taken.

(i) If the filter is disposed outside the hot gas flue, a temperature indicator, e.g., thermocouple, shall be provided at the sample filter gas exit to monitor the filter temperature above the aqueous dewpoint of the flue gases at all times. Auxiliary heating elements for tubing and filter holder shall be provided to maintain specified temperatures when required.

(ii) Deposits in the tube connecting the probe to the exterior filter shall be quantitatively removed by washing with a suitable liquid and by brushing, the weight of solids recovered therefrom being added to the weight found in the filter.

3. Provisions shall be included for cooling the gas stream to standard conditions (70 ° F) to reduce condensable vapors to liquid or solid particulate matter, and for cooling the condensed particles, including water that may be formed by condensation of water vapor in the sample. This shall be accomplished by passage through bubblers provided with an orifice submerged in water through which the gas stream passes at a velocity of approximately 100 meters per second. The bubblers should be immersed in an ice bath to minimize evaporation. A trap of suitable shape and dimensions for the collection of overflow or overspray shall be provided downstream from the bubblers.

4. An indicating flowmeter shall be provided and preferably located in the train at a point preceding the source of suction, preceded by a trap to prevent condensed water from entering the flowmeter; and a vacuum gauge adjacent to the flowmeter to indicate the absolute pressure of the gas passing through the orifice meter.

5. Operation charts comprising either graphs or tables shall be prepared and be available as a part of the apparatus, to indicate proper sampling rates as a function of gas density in the stack and at the flowmeter.

(b) ANALYTICAL RESULTS. Analytical results shall be accomplished as outlined in the

appendix of the Federal Register, Volume 36, Number 160, August 18, 1977, as amended in the Federal Register, Volume 43, Number 57, March 23, 1978, for the filter catch and washings up to the filter. Inclusion or exclusion of material collected in the impinger train as “particulate matter” and method of analysis will be determined on an individual air contaminant source basis.

(c) EQUIVALENT METHODS. Those procedures demonstrated to yield equivalent results and approved by the Technical Secretary may be used for sampling and analysis of particulate matter. Stack sampling methods promulgated by the Environmental Protection Agency for specified air contaminant sources are considered to be equivalent methods and therefore acceptable.

(6) Measurement of Sulfur Dioxide in Stack Gases.

(a) The approved procedure for measuring sulfur dioxide in stack gases is the method contained in Chapter 3 of the Tennessee Department of Public Health’s January, 1975 edition of the Source Sampling Manual as amended on August 11, 1975.

(b) Equivalent Methods. Many new and improved methods of continuous gaseous monitoring in stacks are now in use. Any method of stack sampling approved by the Technical Secretary may be used in accordance with good professional practice. Stack September, 2018 (revised) sampling methods promulgated by the Environmental Protection Agency for specified air contaminant sources are considered to be equivalent methods and therefore acceptable.

(7) Determination of Sulfuric Acid (H SO ) in Stack Gases. Sulfuric acid in stack gases shall be determined by Method 8 outlined in the Federal Register, Volume 42, Number 160, August 18, 1977, as amended in the Federal Register, Volume 43, Number 57, March 23, 1978.

(8) Determination of Nitrogen Oxides in Stack Gases. Nitrogen oxides in stack gases shall be determined by Method 7 outlined in the Federal Register, Volume 42, Number 160, August 18, 1977, as amended in the Federal Register, Volume 43, Number 57, March 23, 1978.

(9) Determination of the Efficiency of Fluoride Control Devices for Potrooms of Primary Aluminum Reduction Plants as follows:

(a) The determination shall consist of three sample runs, each of which shall consist of a simultaneous inlet and outlet sample upon the control device or an equivalent test procedure approved by the Technical Secretary. Each sample shall be of eight (8) hours duration and shall contain a minimum of two hundred and forty (240) dry standard cubic feet of air.

(b) Other details as to the collection of the samples and their analysis shall be accomplished by either Method 13A or 13B or approved equivalent as outlined in the Federal Register, Volume 40, Number 152, August 6, 1975 and as amended in the Federal Register, Volume 41, Number 230, November 29, 1976.

(c) The average efficiency of each fluoride control device shall be calculated as the average of the three control device collection efficiencies as determined by the three sample runs.

(10) Determination of Inorganic Lead Emissions in Stack Gases. Lead emissions in stack gases shall be determined by Method 12 outlined in the Federal Register, Volume 47, April 16, 1982, pp 16574-16579.

History

• Authority: T.C.A. §§ 68-25-105, et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed March 22, 1976; effective April 21, 1976. Amendment filed March 13, 1978; effective April 12, 1978. Amendment filed October 2, 1979; effective November 16, 1979. Amendment filed December 8, 1981; effective January 22, 1982. Amendment filed July 3, 1984; effective August 1, 1984.

Tenn. Comp. R. & Regs. 1200-03-12-.04 MONITORING REQUIRED FOR DETERMINING COMPLIANCE OF CERTAIN LARGE

SOURCES.

(1) For a fossil fuel-fired steam generator using solid fuel subject to subparagraph 1200-03-14- .02(1)(d), the source owner or operator may choose the method of measuring sulfur dioxide in the stack gases depending upon the type of fuel burned. No later than 30 days after the effective date of this regulation, the source owner or operator must inform the Technical Secretary be certified mail of the method to be utilized. If no choice is made by that date the owner or operator must monitor using the method outlined in subparagraph (2)(b) of this rule.

(2) The available sulfur dioxide measurement methods are as follows:

(a) If low sulfur coal is the only solid fuel burned, fuel analysis procedures and methods of calculations as prescribed by the Technical Secretary may be used. The purpose of this rule, low sulfur coal is defined as coal containing less than 1.00% sulfur be weight on a dry basis. Determination will be based on records of fuel burning during calendar year 1974. The procedures used to determine if the sulfur content of the fuel meet this September, 2018 (revised) 1.00% limitation during this time period will be subject to approval by the Technical Secretary. If the source owner or operator elects this method, the Technical Secretary will specify the data to be submitted to verify that the sulfur content is less than the 1.00% limitation. For facilities that elect to use fuel analysis procedures, fuels are not required to be sampled or analyzed for preparation of reports of compliance until the Technical Secretary specifies the procedures and requirements. If the 1.00% limit is ever exceeded then the method specified in subparagraph (b) of this paragraph must be used for monitoring.

(b) Measurement of sulfur dioxide in the stack gases may be accomplished by the installation and operation of a continuous in-stack sulfur dioxide monitoring instrument.

The type of monitor and its location will be subject to approval by the Technical Secretary. The in-stack monitoring instrument will be subject to the provisions of paragraph 1200-03-10-.02(1)(f) of these regulations.

(3) For sulfuric acid plants and liquid sulfur dioxide plants located in a Class I county and existing on January 1, 1979, the measurement of sulfur dioxide in the stack gases must be accomplished by the installation and operation of a continuous in-stack sulfur dioxide monitor. The type of monitor and its location will be subject to approval by the Technical Secretary. The in-stack monitoring instrument will be subject to the provisions of paragraph 1200-03-10-.02(1) of these regulations.

(4) For recovery furnaces and lime kilns located at kraft mills the measurement of total reduced sulfur compounds in stack gases must be accomplished by the installation and operation of a continuous in-stack total reduced sulfur (TRS) monitor. Such TRS monitor shall be accompanied by a continuous monitoring system for the measurement of the percent oxygen.

The type of monitor and its location will be subject to approval by the Technical Secretary.

The in-stack monitoring instrument will be subject to the provisions of paragraph 1200-03-10- .02(1) of these regulations.

History

• Authority: T.C.A. §§ 4-5-201 and 68-201-105, et seq.
• Administrative History: Original rule filed March 13, 1978; effective April 12, 1978. Amendment filed May 7, 1979; effective June 21, 1979. Amendment filed August 26, 1981; effective October 13, 1981. Amendment filed November 12, 1982; effective December 13, 1982. Amendment filed October 14, 1996; effective December 28, 1996.

Chapter 1200-03-13 Violation

Tenn. Comp. R. & Regs. 1200-03-13-.01 VIOLATION STATEMENT

Failure to comply with any of the provisions of these regulations shall constitute a violation thereof and shall subject the person or persons responsible therefore to any and all the penalties provided by law.

History

• Authority: T.C.A. Section 53-3412.
• Administrative History: Original Rule certified June 7, 1974.

Chapter 1200-03-14 Control of Sulfur Dioxide Emissions

Tenn. Comp. R. & Regs. 1200-03-14-.01 GENERAL PROVISIONS

(1) (a) For the purpose of this chapter, each county in Tennessee will be classified by the Board into one of seven categories, defined as Class I, Class II, Class III, Class IV, Class V, Class VI, and Class VII.

(b) Each class has been established with the essential limit necessary to attain and/or maintain ambient air quality standards based on measured and predicted air quality.

(2) The county classifications are as follows:

(a) Class I - Polk (b) Class IIA - Maury (c) Class IIB - Humphreys (d) Class III - Sullivan (e) Class IV - Shelby (f) Class V - Anderson, Davidson, Hamilton, Hawkins, Knox, Rhea (g) Class VI - All counties not specifically classified (h) Class VII - Roane (3) Upon mutual agreement of the owner or operator of any air contaminant source and the Technical Secretary, an emission limit more restrictive than that otherwise specified in this

Chapter may be established. This emission limit shall be stated as a special condition for any permit or order issued concerning the source. Violation of this agreed to, more stringent emission standard is grounds for revocation of the issued permit and/or other enforcement measures provided in the Tennessee Air Quality Act.

(4) Regardless of the specific emission standards contained in this Chapter, all sources identified in paragraph 1200-03-09-.01(4) of these regulations shall comply with the standards set pursuant to Chapter 1200-03-09.

(5) Regardless of the specific emission standards contained in this Chapter, new and/or modified sources in or significantly impacting upon a nonattainment area must comply with the provisions of paragraph 1200-03-09-.01(5).

(6) Except as otherwise allowed by subparagraph (d) of this paragraph, every owner or operator of a fuel burning installation having a total rated capacity greater than 1,000 million BTU per hour or of a process emission source emitting more than 1,000 tons per year of sulfur dioxide during any calendar year shall:

(a) Demonstrate to the satisfaction of the Technical Secretary that the sulfur dioxide emitted, either alone or in contribution to other sources, will not interfere with attainment and maintenance of any primary or secondary air quality standard. Any such demonstration must be based on the allowable emission rate specified in the source’s construction or operating permit(s) and the source’s maximum rated capacity.

(b) Install and maintain air quality sensors to monitor attainment and maintenance of ambient air quality standards in the areas influenced by the emissions from such installation. Monitoring shall be performed, and results of such monitoring shall be provided in the manner and form directed by the Technical Secretary. Owners or operators may petition and be granted permission by the Technical Secretary to terminate ambient air quality monitoring provided two complete calendar years of air quality data have been generated in the area under the influence of the source’s emissions. Petitions may be granted only if the conditions of parts 2. and 3. of this subparagraph are met. For the purpose of this paragraph, “complete” shall mean that all data were collected in accordance with the requirements for data collection, completeness, and quality assurance specified in the source’s Title V Operating Permit.

1. Reserved.

2. The source must be located in an attainment area and must not significantly impact a sulfur dioxide nonattainment area.

3. Measurements of air quality in the vicinity of the source demonstrate that ambient sulfur dioxide levels do not exceed 75 percent of the Tennessee Ambient Air Quality Standards.

(c) Reserved.

(d) The requirements of subparagraph (b) of this paragraph shall not apply to any fuel burning installation or process emission source located in an area in which the Technical Secretary operates one or more ambient sulfur dioxide air quality monitors in the area under the influence of the source’s emissions.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed June 7, 1974. Repeal and new rule filed February 19, 1976; effective March 20, 1976. Amendment filed February 5, 1979; effective March 21, 1979. Amendment filed May 7, 1979; effective June 21, 1979. Amendment filed October 2, 1979; effective November 16, 1979. Amendment filed June 16, 1981; effective July 31, 1981. Amendment filed November 12, 1982; effective December 13, 1982. Amendment filed July 3, 1984; effective August 1, 1984. Amendment filed September 21, 1988; effective November 6, 1988. Amendment filed March 30, 2009; effective June 13, 2009. Amendments filed March 2, 2021; effective May 31, 2021.

Tenn. Comp. R. & Regs. 1200-03-14-.02 NON-PROCESS EMISSION STANDARDS

(1) Fuel Burning Installation in Operation Prior to April 3, 1972.

(a) The owner or operator of a fuel burning installation shall not cause, suffer, allow, or permit the emissions from that source of sulfur dioxide in excess of that contained in Table 1:

TABLE 1

ALLOWABLE SO

EMISSIONS FOR FUEL BURNING INSTALLATIONS

IN TERMS OF POUNDS PER MILLION BTU/HR. HEAT INPUT

(One Hour Average - Exceptions Mentioned in this Chapter)

Rated Capacity Class I Class IIA Class IIB Class III Class V Class VI Class VII greater than 1.2 1.2 3.4 2.4 4.0 5.0 2.8 1000 x 10 BTU/hr. less than 1000 x 10 1.6 5.0 5.0 2.4 4.0 5.0 5.0 BTU/hr.

(b) The owner or operator of a fuel burning installation in a Class IV County shall not cause, suffer, allow, or permit emissions from that source of sulfur dioxide in excess of those listed in Table 2 or the following equation:

TABLE 2

FUEL EMISSION LIMIT

(one hour average) ____________________________________________________________________________________ Coal 4.0 lbs. SO /10 BTU No. 5 and No. 6 fuel oil and solid fuels other than coal 2.7 lbs. SO /10 BTU All other fuels 0.5 lbs. SO /10 BTU Q SO = 4.0 X + 2.7Y + 0.5Z X + Y + Z Q SO = Allowable Sulfur Dioxide Emissions in lbs. SO /10 BTU X = Heat input from coal Y = Heat input from No. 5 or No. 6 fuel oil and solid fuels other than coal Z = Heat input from all other fuel (c) For purpose of this rule, the total heat input (based on maximum rated capacity) from all fuel combustion units at a plant, premises, or installation shall be used for determining the maximum allowable emission of sulfur dioxide that passes through a stack or stacks. The heat value of the fuel that is not released within the fuel burning equipment shall not be considered as part of the heat input to the fuel burning installation.

(d) Fuel burning installations containing units of fuel burning equipment larger than 600 million BTU per hour heat input and which were commenced before April 3, 1972 shall comply with the applicable sulfur dioxide emission limit specified in Table 1 or Table 2 for fuel burning installations greater than 1 billion BTU per hour heat input. However, for fuel burning installations containing fuel burning equipment meeting these requirements, a 24-hour averaging basis shall be utilized rather than a one hour basis.

For units of fuel burning equipment in a fuel burning installation of less than 600 million BTU per hour heat input, the allowable sulfur dioxide emission limits shall be those determined by Table 1 or Table 2 of Rule 1200-14-.02(1)(a) or (1)(b).

(2) Fuel Burning Equipment Constructed After April 3, 1972.

(a) Fuel burning equipment with a rated capacity of 250 million BTU per hour or less heat input, shall not cause, suffer, allow, or permit the emission of sulfur dioxide in excess of 1.6 pounds per million BTU heat input (one hour average) in a Class I county, 2.4 pounds in a Class III county, 4.0 pounds in a Class V county, nor in excess of 5.0 pounds per million BTU heat input (one hour average) in a Class II, VI, or VII county.

Emission limits for Class IV counties shall be those listed in Table 2.

(b) The owner or operator of fuel burning equipment with a rated capacity greater than 250 million BTU per hour heat input shall not cause, suffer, allow, or permit the emissions from that source of sulfur dioxide in excess of the following:

1. .80 lbs. per million BTU heat input, maximum 1 hour average, when liquid fossil fuel is burned.

2. 1.2 lbs. per million BTU heat input, maximum 1 hour average, when solid fossil fuel is burned.

3. Where different fossil fuels are burned simultaneously in any combustion, the applicable standard shall be determined by proration. Compliance shall be determined by using the following formula:

Y (0.80) + Z (1.2)

Y + Z

(c) Where:

1. Y is the percent of total heat input derived from liquid fossil fuel and, 2. Z is the percent of total heat input derived from solid fossil fuel.

(3) Limiting the Effect of the Definition of Modification. If an owner or operator of fuel burning equipment is ordered by the U.S. Department of Energy under the Energy Supply and Environmental Coordination Act of 1974, or any amendments thereto, or any subsequent enactment which supersedes such provisions, to switch fuels, required alterations to existing fuel burning equipment to accommodate these additional fuels shall not be deemed a modification for purposes of determining the allowable emissions as established by this rule.

(4) Fuel Burning Equipment Relocated After November 6, 1988.

Irrespective of the maximum allowable emission as determined in the preceding paragraphs in this rule, the maximum allowable sulfur dioxide emissions for non-portable fuel burning equipment which is relocated more than 1.0 km from the previous position after November 6, 1988, shall not exceed the greater of the actual emissions at its previous location or the allowable emissions for new fuel burning equipment.

History

• Authority: T.C.A. §§ 4-5-202 and 68-25-105.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed February 19, 1976; effective March 20, 1976. Amendment filed March 13, 1978; effective April 12, 1978. Amendment filed May 17, 1978; effective June 16, 1978. Amendment filed February 5, 1979; effective March 21, 1979. Amendment filed October 2, 1979; effective November 16, 1979. Amendment filed November 12, 1982; effective December 13, 1982. Amendment filed July 3, 1984; effective August 1, 1984. Amendment filed September 21, 1988; effective November 6, 1988. Amendment filed May 17, 1990; effective July 1, 1990.

Tenn. Comp. R. & Regs. 1200-03-14-.03 PROCESS EMISSION STANDARDS

(1) On and after July 1, 1975, the owner or operator of an air contaminant source located in a Class I county shall not cause, suffer, allow, or permit the emission from that source of sulfur oxides (calculated as sulfur dioxide) in excess of 500 parts per million, 0.05 percent by volume, dry basis (one hour average). Different standards and averaging times may be met as an alternative, or as required, where they are specified in Chapter 1200-03-19.

(2) On and after July 1, 1975, the owner or operator of an air contaminant source located in a Class II, III, or VII county shall not cause, suffer, allow, or permit the emission from that source of sulfur dioxide in excess of 1000 parts per million, 0.10 percent by volume, dry basis (one hour average).

(3) On and after July 1, 1975, the owner or operator of an air contaminant source located in a Class IV, V or VI county shall not cause, suffer, allow, or permit the emission from that source of sulfur dioxide in excess of 2,000 parts per million, 0.20 percent by volume, dry basis (one hour average).

(4) A process source in a Class IV county as an alternative to the standard in paragraph (3) above may request from the Technical Secretary of the Tennessee Air Pollution Control Board to be regulated by not being allowed to exceed their sulfur dioxide emission capacity in 1974, on a twenty-four hour and an annual basis. These emissions will be specified in a Board Order, as a permit condition, or other legally enforceable manner. This document will be incorporated into the State Implementation Plan. The cost of the legal notice involved must be paid by the requesting source. The Technical Secretary may approve such a request after being given adequate proof that this alternative standard will not cause any air quality standards to be violated, and the company has an adequate continuous air monitoring network for determining the impact of its emissions.

(5) No person shall cause, suffer, allow, or permit the emissions from any new air contaminant source in excess of those limits specified in Chapter 1200-03-14-.03, paragraph (1), (2) or (3), whichever is applicable. Regardless of the specific emission standard, new sources shall utilize the best available control technology as deemed appropriate by the Technical Secretary of the Tennessee Air Pollution Control Board.

(6) For purposes of this chapter, thermal oxidizers, and incinerators shall be construed as process emission sources.

(7) Limiting the Effect of the Definition of Modification. For the purpose of determining the applicable sulfur dioxide emission standards in this rule, a change in fuel from natural gas, propane, butane, and/or fuel oil to any of these herein named fuels and any required alterations to existing fuel burning equipment to accommodate these fuels shall not be considered a modification.

(8) Irrespective of the maximum allowable emission as determined in the preceding paragraphs of this rule, the maximum allowable sulfur dioxide emissions for a process emission source which is relocated more than 1.0 km from the previous position after November 6, 1988, shall not exceed the greater of the actual emissions at its previous location or the allowable emissions for a new process emission source.

History

• Authority: T.C.A. §§ 4-5-202 and 68-25-105.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed February 19, 1976; effective March 20, 1976. Amendment filed March 13, 1978; effective April 12, 1978. Amendment filed May 17, 1978; effective June 16, 1978. Amendment filed May 7, 1979; effective June 21, 1979. Amendment filed July 3, 1984; effective August 1, 1984. Amendment filed September 21, 1988; effective November 6, 1988. Amendment filed May 17, 1990; effective July 1, 1990. Amendment filed February 4, 1993; effective March 21, 1993.

Tenn. Comp. R. & Regs. 1200-03-14-.04 RESERVED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: New rule filed August 10, 2006; effective October 10, 2006. Amendments filed November 21, 2016; effective February 19, 2017.

Chapter 1200-03-15 Emergency Episode Plan

Tenn. Comp. R. & Regs. 1200-03-15-.01 PURPOSE

It is the purpose of this chapter to establish criteria so as to prevent undesirable levels of air contaminants during adverse meteorological conditions. Primary responsibility to initiate activity required by this chapter during stagnant atmosphere periods rests with the Technical Secretary according to T.C.A. §53-3414(G).

History

• Authority: T.C.A. §§53-3412.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977.

Tenn. Comp. R. & Regs. 1200-03-15-.02 EPISODE CRITERIA

(1)Conditions justifying the proclamation of an air pollution alert, air pollution warning, or air pollution emergency shall be deemed to exist when the Technical Secretary will be guided by the criteria in the remaining paragraphs of this rule.

(2)“Air Pollution Forecast”: An internal watch by the Division of Air Pollution Control shall be actuated by a National Weather Service advisory that Atmospheric Stagnation Advisory is in effect or the equivalent local forecast or stagnant atmospheric conditions.

(3)“Air Pollution Alert”: The Alert level is that concentration of pollutions at which emissions reductions must begin. An Alert will be declared when any one of the following levels is reached at any monitoring site:

(a)SO -800 ug/m (0.3 ppm), 24-hour average.

(b)PM -350 ug/m , 24-hour average.

(c)Reserved (d)CO--17 mg/m (15 ppm), 8-hour average.

(e)Ozone (O )--400 ug/m (0.2 ppm)--1 hr. average.

(f)NO --1130 ug/m (0.6 ppm), 1-hr. average; 282 ug/m (0.15 ppm), 24-hour average.

And meteorological conditions are such that pollutant concentrations can be expected to remain at the above levels for twelve (12) or more hours or increase unless control actions are taken, or in the case of ozone, the situation is likely to reoccur within the next twenty-four (24) hours unless control actions are taken.

(4)“Air Pollution Warning”: The warning level indicates that air quality is continuing to degrade and that additional control actions are necessary. A warning will be declared when any one of the following levels is reached at any monitoring site:

(a)SO -1,600 ug/m (0.6 ppm), 24-hour average.

(b)PM -420 ug/m , 24-hour average.

(c)Reserved.

(d)CO-34 mg/m (30 ppm), 8-hour average.

(e)Ozone (0 )-800 ug/m (0.4 ppm), 1-hour average.

(f)NO -2,260 ug/m (1.2 ppm)--1 hour average; 565 ug/m (0.3 ppm), 24-hour average.

And meteorological conditions are such that pollutant concentrations can be expected to remain at the above levels for twelve (12) or more hours or increase unless control actions are taken, or in the case of ozone, the situation is likely to reoccur within the next twenty-four (24) hours unless control actions are taken.

(5)“Air Pollution Emergency”: The emergency level indicates that air quality is continuing to degrade to a level which could cause an unreasonable risk to public health, and that the most stringent control actions are necessary. An emergency will be declared when any one of the following levels is reached at any monitoring site:

(a)SO -2,100 ug/m 3 (0.8 ppm), 24-hour average.

(b)PM -500 ug/m , 24-hour average.

(c)Reserved.

(d)CO-46 mg/m (40 ppm), 8-hour average.

(e)Ozone (0 )-1,000 ug/m (0.5 ppm), 1-hour average.

(f)NO --3,000 ug/m (1.6 ppm) 1-hour average; 750 ug/m (0.4 ppm), 24-hour average.

And meteorological conditions are such that this condition can be expected to continue for twelve (12) or more hours, or in the case of ozone, the situation is likely to reoccur within the next twenty-four (24) hours unless control actions are taken.

(6)“Terminations”: Once declared, any status reached by application of these criteria will remain in effect until the criteria for that level are no longer met. At such time, the next lower status will be assumed.

History

• Authority: T.C.A. §§68-201-105 and 4-5-202 et. seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed May 12, 1993; effective June 26, 1993.

Tenn. Comp. R. & Regs. 1200-03-15-.03 REQUIRED EMISSIONS REDUCTIONS

(1)When the Technical Secretary has declared that an air pollution alert, an air pollution warning, or an air pollution emergency exists, all persons must follow the requirements for that episode level as outlined in Tables 1, 2, or 3 or the air pollution episode emissions reduction plan approved in accordance with paragraphs (2), (3), (4), (5), or (6) on this rule. If a plan has been approved emissions must be reduced to that level or lower.

(2)Major sources in or significantly impacting a nonattainment area must submit to the Technical Secretary an acceptable air pollution episode emissions reduction plan to be followed during the alert, warning, and emergency levels or an air pollution episode. The term “Major source” as used above means any of the following types of stationary sources of air pollutants which emit, or have the potential to emit, one hundred tons per year or more of any air pollutant from the following types of stationary sources: fossil fuel fired steam electric plants of more than two hundred fifty-million British thermal units per hour heat input, coal cleaning plants (thermal dryers), kraft pulp mills, Portland cement plans, primary zinc smelters, iron and steel plants, primary aluminum ore reduction plants, primary copper smelters, municipal incinerators capable of charging more than two hundred fifty tons of refuse per day, hydrofluoric, sulfuric, and nitric acid plants, petroleum refineries, lime plants, phosphate rock processing plants, coke oven batteries, sulfur plants, phosphate rock processing plants, sulfur recovery plants, carbon black plants (furnace process), primary lead smelters, fuel conversion plants, sintering plants, secondary metal production facilities, chemical process plants, fossil-fuel boilers of more than two-hundred and fifty million British thermal units per hour heat input, petroleum storage and transfer facilities with a capacity exceeding three hundred thousand barrels, taconite ore processing facilities, glass fiber processing plants, charcoal production facilities. Such term also includes any other sources with the potential to emit two hundred and fifty tons per year or more of any air pollutant. Only the pollutants for which the area is nonattainment are considered in determining whether a source is a major source.

(3)Any source subject to paragraph (2) above must submit a revised air pollution episode emissions reduction plan at the request of the Technical Secretary should the nature and quality of the source’s emissions change or the original plan be deemed inadequate.

(4)The owners and operators of other air contaminant sources, having a smaller potential for emissions than one hundred tons per year, may file an acceptable air pollutant episode emissions reduction plan for use during an air pollution episode if they feel they can contribute through other measures as much or more benefit to the reduction of the health hazard in the area at a lower cost to themselves.

(5)Where specific actions may be necessary to relieve a health hazard by sources emitting at lower levels that indicated in paragraph (2) above, the Technical Secretary may require the submittal of an acceptable plan from the owner or operators of that source. The owner or operator will have thirty (30) days to submit the plan, once it has been required.

(6)If the owners or operators of any source required to have an approved air pollution episode emissions reduction plan on file with the Technical Secretary by paragraphs (2), (3), or (5) above, fail to submit an approvable plan, the Technical Secretary may schedule an Administrative Hearing to set an approved air pollution episode emissions reduction plan for that air pollution source.

TABLE 1

EMISSION REDUCTION PLANS

ALERT LEVEL

Part A.GENERAL 1.There shall be no open burning by any persons of tree waste, vegetation, refuse, or debris in any form. 2.The use of incinerators for the disposal of any form of solid waste shall be limited to the hours between 12:00 noon and 4:00 p.m. 3.Persons operating fuel-burning equipment which requires boiler lancing or soot blowing shall perform such operations only between the hours of 12:00 noon and 4:00 p.m. 4.The Tennessee Air Pollution Control Division encourages persons operating motor vehicles to eliminate all unnecessary operation.

Part B.SOURCE CURTAILMENT Any person responsible for the operation of a source of air pollutants listed below shall take all required control actions for this Alert Level.

Source of Air PollutionControl Action 1.Coal or oil-fired electric power generating facilities.a.Substantial reduction by utilization of fuels having low ash and sulfur content. b.Maximum utilization of mid-day (12:00 noon to 4:00 p.m.) atmospheric turbulence for boiler lancing and soot blowing. c.Substantial reduction by diverting electric power generation to facilities outside of Alert Area. ___________________________________________________________________________________________ 2.Coal and oil-fired process steam generating facilities.a.Substantial reduction by utilization of fuels having low ash and sulfur content. b.Maximum utilization of mid-day (12:00 noon to 4:00 p.m.) atmospheric turbulence for boiler lancing and soot blowing. c.Substantial reduction of steam load demands consistent with continuing plant operations. ___________________________________________________________________________________________ 3.Manufacturing industries of the followinga.Substantial reduction of air contaminants April, 1999 (Revised0 classifications:from manufacturing operations by curtailing, postponing, or deferring Primary Metals Industryproduction and all operations.

Petroleum Refining Operationsb.Maximum reduction by deferring trace waste disposal operations which emit Chemical Industriessolid particles, gases, vapors or malodorous substance.

Mineral Processing Industries Paper and Allied Productsc.Maximum reduction of heat load demands for processing.

Grain Industry d.Maximum utilization of mid-day (12:00 noon to 4:00 p.m.) atmospheric turbulence for boiler lancing or soot blowing.

TABLE 2

EMISSION REDUCTION PLANS

WARNING LEVEL

Part A.GENERAL 1.There shall be no open burning by any persons of tree waste, vegetation, refuse, or debris in any form. 2.The use of incinerators for the disposal of any form of solid waste shall be limited to the hours between 12:00 noon and 4:00 p.m. 3.Persons operating fuel-burning equipment which requires boiler lancing or soot blowing shall perform such operations only between the hours of 12:00 noon and 4:00 p.m. 4.The Tennessee Air Pollution Control Division encourages persons operating motor vehicles to reduce operations by the use of car pools and increase use of public transportation and the elimination of unnecessary operation.

Part B.SOURCE CURTAILMENT Any person responsible for the operation of a source of air pollutants listed below shall take all required control actions for this Warning Level.

Source of Air PollutionControl Level 1.Coal or oil-fired electric power generating facilities.a.Maximum reduction by utilization of fuels having lowest ash and sulfur content. b.Maximum utilization of mid-day (12:00) noon to 4:00 p.m.) atmospheric turbulence for boiler lancing and soot blowing.

C.Maximum reduction by diverting electric April, 1999 (Revised0 power generation to facilities outside of Warning area. ____________________________________________________________________________________________ 2.Coal and oil-fired process steam generating facilities.a.Maximum reduction by utilization of fuels having the lowest available ash and sulfur content. b.Maximum utilization of mid-day (12:00) noon to 4:00 p.m.) atmospheric turbulence for boiler lancing and soot blowing. c.Making ready for use a plan of action to be taken if an emergency develops. ____________________________________________________________________________________________ 3.Manufacturing industries which require considerablea.Maximum reduction of air contaminants lead time for shut-down including the followingfrom manufacturing operations by, if classifications:necessary, assuming reasonable economic hardship by postponing production and Petroleum Refiningallied operation.

Chemical Industriesb.Maximum reduction by deferring trade waste disposal operations which emit solid Primary Metal Industriesparticles, gases, vapors, or malodorous substances.

Glass Industries c.Maximum reduction of heat load demands Paper and Allied Productsfor processing. d.Maximum utilization of mid-day (12:00 noon to 4:00 p.m.) atmospheric turbulence for boiler lancing or soot blowing. ____________________________________________________________________________________________ 4.Manufacturing industries which require relativelya.Elimination of air contaminants from short lead times for shut-down including the manufacturing operations by ceasing, following classifications:curtailing, postponing, or deferring production and allied operations to the Primary Metals Industriesextent possible without causing injury to persons or damage.

Chemical Industries b.Elimination of air contaminants from Mineral Processing Industriestrade waste disposal processes which emit solid particles, gases, vapors, or Grain Industrymalodorous substances. c.Maximum reduction of heat load demands for processing. d.Maximum utilization of mid-day (12:00 noon to 4:00 p.m.) atmospheric turbulence for boiler lancing or soot blowing.

April, 1999 (Revised0 _____________________________________________________________________________________ TABLE 3 EMISSION REDUCTION PLANS EMERGENCY LEVELS

Part A.GENERAL 1.There shall be no open burning by any persons of tree waste, vegetation, refuse or debris in any form. 2.The use of incinerators for the disposal of any form of solid or liquid waste shall be prohibited. 3.All places of employment described below shall immediately cease operations. a.Mining and quarrying of non-metallic minerals. b.All construction work except that which must proceed to avoid emergent physical harm. c.All air contaminant sources except those required to have in force an air pollution emergency plan. 4.Any commercial and manufacturing establishments not included in this order will institute such actions as will result in maximum reduction of air pollutants from their operations by ceasing, curtailing, or postponing operations which emit air pollutants to the extent possible without causing injury to persons or damage to equipment. 5.The Tennessee Air Pollution Control Division encourages the users of motor vehicles to cease usage except in emergencies.

Part B.SOURCE CURTAILMENT Any person responsible for the operation of a source of air pollutants listed below shall take all required control actions for this Emergency Level.

Source of Air PollutionControl Level 1.Coal or oil-fired electric power generating facilities.a.Maximum reduction by utilization of fuels having lowest ash and sulfur content. b.Maximum utilization of mid-day (12:00) noon to 4:00 p.m.) atmospheric turbulence for boiler lancing and soot blowing.

C.Maximum reduction by diverting electric power generation to facilities outside of Emergency area. ____________________________________________________________________________________________ April, 1999 (Revised0 2.Coal and oil-fired process steam generating facilities.a.Maximum reduction by reducing heat and steam demands to absolute necessities consistent with preventing equipment damage. b.Maximum utilization of mid-day (12:00 noon to 4:00 p.m.) atmospheric turbulence for boiler lancing and soot blowing. c.Taking the action called for in the emergency plan. ____________________________________________________________________________________________ 3.Manufacturing industries of the following a.Elimination of air contaminants from classifications:manufacturing operations by ceasing, curtailing, postponing or deferring Primary Metals Industriesproduction and allied operations to the extent possible without causing injury Petroleum Refining to persons or damage to equipment.

Chemical Industriesb.Elimination of air contaminants from trade waste disposal processes which emit solid Mineral Processing Industriesparticles, gases, vapors, or malodorous substances.

Grain Industry c.Maximum reduction of heat load demands for processing.

Paper and Allied Products d.Maximum utilization of mid-day (12:00 noon to 4:00 p.m.) atmospheric turbulence for boiler lancing or soot blowing.

History

• Authority: T.C.A. Section 53-3412.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed March 31, 1981; effective May 15, 1981.

Chapter 1200-03-16 Repealed

Tenn. Comp. R. & Regs. 1200-03-16-.01 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed February 5, 1979; effective March 21, 1979. Amendment filed effective May 7, 1979; effective June 21, 1979. Amendment filed November 19, 1981; effective January 4, 1982. Amendment filed December 2, 1981; effective January 18, 1982. Amendment filed January 31, 1983; effective March 2, 1983. Amendment filed July 3, 1984; effective August 1, 1984. Amendment filed September 26, 1986; effective November 10, 1986. Amendment filed September 21, 1988; effective November 6, 1988. Amendment filed August 29, 2011; effective November 27, 2011. Amendments filed September 29, 2022; effective December 28, 2022. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.02 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed March 13, 1978; effective April 12, 1978. Amendment filed July 21, 1980; effective September 8, 1980. Amendment filed September 21, 1988; effective November 6, 1988. Amendment filed January 21, 2009; effective April 6, 2009. Amendments filed March 7, 2016; effective June 5, 2016. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.03 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed July 21, 1980; effective September 8, 1980. Amendment filed September 21, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.04 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed June 7, 1974; effective February 9, 1977. Amendment filed September 4, 1981; effective October 19, 1981. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.05 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.06 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.07 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed September 10, 1981; effective October 19, 1981. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.08 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed September 21, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.09 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed May 17, 1978; effective June 16, 1978. Amendment filed June 3, 1981; effective July 20, 1981. Amendment filed September 4, 1981; effective October 19, 1981. Amendment filed September 21, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.10 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed June 2, 1981; effective July 17, 1981. Amendment filed April 18, 1990; effective June 2, 1990. Amendments filed March 7, 2016; effective June 5, 2016. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.11 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed March 12, 1982; effective April 26, 1982. Amendment filed April 18, 1990; effective June 2, 1990. Amendment filed April 23, 1998; effective July 7, 1998. Amendments filed March 7, 2016; effective June 5, 2016. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.12 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.13 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.14 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed May 17, 1978; effective June 16, 1978. Amendment filed January 31, 1983; effective March 2, 1983. Amendment filed September 21, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.15 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule effective February 9, 1977. Amended June 16, 1978. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.16 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule effective February 9, 1977. Amendment filed September 21, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.17 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule effective February 9, 1977. Amendment filed September 21, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.18 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed May 17, 1978; effective June 16, 1978. Amendment filed September 21, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.19 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed September 22, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.20 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed May 17, 1978; effective June 16, 1978. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.21 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed September 4, 1981; effective October 19, 1981. Amendment filed March 24, 1986; effective April 23, 1986. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.22 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Repeal and new rule filed August 29, 2011; effective November 27, 2011. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.23 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.24 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed September 4, 1981; effective October 19, 1981. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.25 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed September 4, 1981; effective October 18, 1981. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.26 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed September 4, 1981; effective October 19, 1981. Amendment filed September 21, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.27 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 10, 1977; effective February 9, 1977. Amendment filed September 4, 1981; effective October 19, 1981. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.28 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed July 27, 1979; effective September 10, 1979. Amendment filed September 21, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.29 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed August 28, 1979; effective October 12, 1979. Amendment filed September 4, 1981; effective October 30, 1981. Amendment filed September 21, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.30 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed April 26, 1979; effective December 10, 1979. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.31 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed March 9, 1981; effective May 15, 1981. Amendment filed September 21, 1988; effective November 6, 1988. Amendment filed January 31, 1997; effective April 16, 1997. Repeal of rule filed January 21, 2009; effective April 6, 2009. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.32 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed January 27, 1983; effective February 28, 1983. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.33 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-101, et seq.
• Administrative History: Original rule filed January 31, 1983; effective March 2, 1983. Amendment filed September 21, 1988; effective November 6, 1988. Amendment filed March 21, 2013; effective June 19, 2013. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.34 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 21, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.35 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 21, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.36 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 21, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.37 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 21, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.38 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 21, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.39 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 21, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.40 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 21, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.41 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 21, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.42 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 21, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.43 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Amendment filed March 21, 2013; effective June 19, 2013. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.44 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.45 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.46 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.47 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.48 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.49 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.50 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-108; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.51 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.52 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.53 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Amendment filed May 18, 2000; effective August 1, 2000. Repeal and new rule filed August 29, 2011; effective November 27, 2011. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.54 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.55 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.56 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.57 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.58 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-101, et seq.
• Administrative History: Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.59 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Amendments filed January 21, 2009; effective April 6, 2009. Amendments filed March 7, 2016; effective June 5, 2016. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.60 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-101, et seq.
• Administrative History: Original rule filed April 18, 1990; effective June 2, 1990. Amendment filed March 21, 2013; effective June 19, 2013. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.61 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed April 18, 1990; effective June 2, 1990. Amendments filed March 7, 2016; effective June 5, 2016. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.62 THROUGH 1200-03-16-.73 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-101, et seq.
• Administrative History: Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.74 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original ruled filed May 21, 1997; effective August 4, 1997. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.75 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-101, et seq.
• Administrative History: Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.76 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original ruled filed December 30, 1997; effective March 16, 1998. Repeal filed January 21, 2009; effective April 6, 2009. Repeal filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-16-.77 THROUGH 1200-03-16-.99 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-101, et seq.
• Administrative History: Repeal filed September 16, 2024; effective December 15, 2024.

Chapter 1200-03-17 Repealed (Chapter renumbered 0400-30-17)

Tenn. Comp. R. & Regs. 1200-03-17-.01 REPEALED

History

• Authority: T.C.A. §§ 68-201-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 5, 1996; effective September 18, 1996. Repeal filed June 25, 2013; effective September 23, 2013. Rule renumbered 0400-30-17.

Tenn. Comp. R. & Regs. 1200-03-17-.02 REPEALED

History

• Authority: T.C.A. §§ 68-201-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 5, 1996; effective September 18, 1996. Repeal filed June 25, 2013; effective September 23, 2013. Rule renumbered 0400-30-17.

Tenn. Comp. R. & Regs. 1200-03-17-.03 REPEALED

History

• Authority: T.C.A. §§ 68-201-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 5, 1996; effective September 18, 1996. Repeal filed June 25, 2013; effective September 23, 2013. Rule renumbered 0400-30-17.

Chapter 1200-03-18 Volatile Organic Compounds

Tenn. Comp. R. & Regs. 1200-03-18-.01 DEFINITIONS

For the purpose of this chapter, the following definitions apply:

(1) “Actual emissions” means the quantity of volatile organic compounds (VOC’s) emitted from a source during a particular time period.

(2) “Ambient air” means that portion of the atmosphere, external to buildings, to which the general public has access.

(3) “As applied” means including dilution solvents added before application of the coating.

(4) “Automobile” means a motor vehicle capable of carrying no more than 12 passengers.

(5) “Bulk gasoline plant” means a gasoline storage and distribution facility, other than a bulk gasoline terminal or a gasoline dispensing facility.

(6) “Bulk gasoline terminal” means a gasoline storage facility that receives gasoline from refineries, delivers gasoline to bulk gasoline plants or to commercial or retail accounts, and has a daily throughput of more than 76,000 L (20,000 gal) of gasoline on a 30-day rolling average.

(7) “Capture efficiency” means the weight per unit time of VOC entering a capture system and delivered to a control device divided by the weight per unit time of total VOC generated by a source of VOC, expressed as a percentage.

(8) “Capture system” means all equipment (including, but not limited to, hoods, ducts, fans, booths, ovens, dryers, etc.) that contains, collects, and transports an air pollutant to a control device.

(9) “Carbon adsorber” means a control device which uses activated carbon to adsorb volatile organic compounds from a gas stream.

(10) “Carbon adsorption system” means a carbon adsorber with an inlet and outlet for exhaust gases and a system to regenerate the saturated adsorbent.

(11) “Coating” means a material applied onto or impregnated into a substrate for protective, decorative, or functional purposes. Such materials include, but are not limited to, paints, varnishes, sealants, adhesives, maskants, and temporary protective coatings.

(12) “Coating line” means a series of one or more coating applicators and any associated drying area and/or oven wherein a coating is applied, dried, and/or cured. A coating line ends at the point where the coating is dried or cured, or prior to any subsequent application of a different coating. It is not necessary to have an oven or a flashoff area in order to be included in this definition. This definition does not apply to web coating.

(13) “Complying coating” means a coating which satisfies the VOC content or emission standard or formulation standard, as applied, specified in this chapter for its use.

(14) “Complying ink” means an ink which satisfies the VOC content or emission standard or formulation standard, as applied, specified in this chapter for its use.

(15) “Condensate” means volatile organic compound (VOC) liquid, separated from natural gas, that condenses due to changes in temperature and/or pressure and remains liquid at standard conditions.

(16) “Condenser” means any heat transfer device used to liquify vapors by removing their latent heats of vaporization. Such devices include, but are not limited to, shell and tube, coil, surface, or contact condensers.

(17) “Construction” means on-site fabrication, erection, or installation of a source, air pollution control or monitoring equipment, or a facility.

(18) “Continuous vapor control system” means a vapor control system that treats vapors displaced from tanks during filling on a demand basis without intermediate accumulation.

(19) “Control device” means equipment (such as an incinerator or carbon adsorber) used to reduce, by destruction or removal, the amount of air pollutant(s) in an air stream prior to discharge to the ambient air.

(20) “Control system” means a combination of one or more capture system(s) and control device(s) working in concert to reduce discharges of pollutants to the ambient air.

(21) “Crude oil” means a naturally occurring mixture that consists of hydrocarbons and/or sulfur, nitrogen, and/or oxygen derivatives of hydrocarbons and that is liquid at standard conditions.

(22) “Day” means a period of 24 consecutive hours beginning at midnight local time, or beginning at a time consistent with a facility’s operating schedule.

(23) “Destruction or removal efficiency” means the amount of VOC destroyed or removed by a control device expressed as a percent of the total amount of VOC entering the device.

(24) “Double block-and-bleed system” means two block valves connected in series with a bleed valve or line that can vent the line between the two block valves.

(25) “Emission” means the release or discharge, at the facility, whether directly or indirectly, of VOC into the ambient air.

(26) Reserved.

(27) “External floating roof” means a cover over an open-top storage tank consisting of a double deck or pontoon single deck that rests upon and is supported by the volatile organic liquid being contained and is equipped with a closure seal or seals to close the space between the roof edge and tank shell.

(28) “Facility” means any source or group of sources located within a contiguous area, and under common control.

(29) “First attempt at repair” means to take rapid action for the purpose of stopping or reducing leakage of organic material to the atmosphere using best practices.

(30) “Flashoff area” means the space between the coating application area and the oven.

(31) “Gasoline” means any petroleum distillate or petroleum distillate/alcohol blend having a Reid vapor pressure of 27.6 kilopascals (kPa) (8.15 inches of mercury [in. Hg]) or greater that is used as a fuel for internal combustion engines.

(32) “Gasoline dispensing facility” means any site where gasoline is transferred from a stationary storage tank to a motor vehicle gasoline fuel tank.

(33) “Gasoline tank truck” means a delivery tank truck used at bulk gasoline plants, bulk gasoline terminals, or gasoline dispensing facilities that is loading or unloading gasoline or that has loaded or unloaded gasoline on the immediately previous load.

(34) “Graphic arts” means an industry encompassing printing operations based on letterpress, offset lithography, screen, rotogravure, and flexography.

(35) “Heavy-duty truck” means any motor vehicle rated at more than 3,864 kg (8,500 lb) gross weight designed primarily to transport property.

(36) “Incinerator” means a combustion apparatus in which solid, semisolid, liquid, or gaseous combustible wastes are ignited and burned and from which the solid and gaseous residues contain little or no combustible material.

(37) “Ink” means a fluid composition consisting of colorant to provide optical contrast with a substrate, film formers to provide adhesion to the substrate, oils and/or solvents to provide fluidity and drying, and other functional additives.

(38) “Intermittent vapor control system” means a vapor control system that employs an intermediate vapor holder to accumulate vapors displaced from tanks during filling. The control device treats the accumulated vapors only during automatically controlled cycles.

(39) “Knife coating” means the application of a coating material to a substrate by means of drawing the substrate beneath a knife that spreads the coating evenly over the full width of the substrate.

(40) “Leak” means a VOC emission indicated by an instrument calibrated according to Method 21 using zero air (less than 10 parts per million [ppm] of hydrocarbon in air) and a mixture of methane or n-hexane and air at a concentration of about, but less than, 10,000 ppm methane or n-hexane; by dripping liquid; or by calibrated sensor.

(41) “Lease custody transfer” means the transfer of produced crude oil condensate, after processing and/or treating in the producing operations, from storage tanks or automatic transfer facilities to pipelines or any other forms of transportation.

(42) “Light-duty truck” means any motor vehicle rated at 3,864 kg (8,500 lb) gross weight or less designed primarily to transport property.

(43) “Loading rack” means an aggregation or combination of gasoline loading equipment arranged so that all loading outlets in the combination can be connected to a tank truck or trailer parked in a specified loading space.

(44) “Lower explosive limit” (also denoted as LEL) means the concentration of a compound in air below which a flame will not propagate if the mixture is ignited.

(45) “Maximum theoretical emissions” means the quantity of VOC that theoretically could be emitted by a source without control devices based on the design capacity or maximum production capacity of the source and 8,760 hours of operation per year. The design capacity or maximum production capacity includes use of materials with the highest VOC content used in practice by the source for the 2 years preceding April 22, 1993, and anytime after.

(46) “Maximum true vapor pressure” means the equilibrium partial pressure exerted by a stored volatile organic liquid at the temperature equal to: (1) for liquids stored above or below the ambient temperature, the highest calendar-month average of the liquid storage temperature, or (2) for liquids stored at the ambient temperature, the local maximum monthly average temperature as reported by the National Weather Service. This pressure shall be determined:

(a) In accordance with methods described in American Petroleum Institute Bulletin 2517, “Evaporation Loss From External Floating Roof Tanks”; (1962);

(b) By using standard reference texts;

(c) By ASTM D2879-83; or (d) By any other method approved as a revision to the State Implementation Plan.

(47) “Multicomponent coating” means a coating packaged in two or more parts, which parts are combined before application, and where a coreactant from one part of the coating chemically reacts, at ambient conditions, with a coreactant from another part of the coating.

(48) “Open-ended valve or line” means any valve, except safety relief valves, having one side of the valve seat in contact with process fluid and one side open to the atmosphere, either directly or through open piping.

(49) “Operation” means an activity. For example, a prime coat operation is the activity of applying a prime coat.

(50) “Organic compound” means a chemical compound of carbon excluding carbon monoxide, carbon dioxide, carbonic acid, metallic carbides or carbonates, and ammonium carbonate.

(51) “Oven” means a chamber which is used to bake, cure, polymerize, and/or dry a coating.

(52) “Overall emission reduction efficiency” means the weight per unit time of VOC removed or destroyed by a control device divided by the weight per unit time of VOC generated by a source, expressed as a percentage. The overall emission reduction efficiency can also be calculated as the product of the capture efficiency and the control device destruction or removal efficiency.

(53) “Owner or operator” means any person who owns, leases, controls, operates, or supervises a facility, existing source, new source, or control device.

(54) “Person” means any individual, partnership, copartnership, firm, company, corporation, association, joint stock company, trust, estate, state government, the federal government, political subdivision, or any other legal entity, or their legal representative, agent, or assigns.

(55) “Petroleum” means crude oil and the oils derived from tar sands, shale, and coal.

(56) “Petroleum liquid” means crude oil, condensate, and any finished or intermediate product manufactured or extracted at a petroleum refinery, but not including Nos. 2 through 6 fuel oils as specified in ASTM D396-78; gas turbine fuel oils Nos. 2-GT through 4-GT as specified in ASTM D2880-78; or diesel fuel oils Nos. 2-d and 4-D, as specified in ASTM D975-78.

(57) “Petroleum refinery” means any facility engaged in producing gasoline, kerosene, distillate fuel oils, residual fuel oils, lubricants, or other products through distillation of petroleum or through the redistillation, cracking, or reforming of unfinished petroleum derivatives.

(58) “Plastisol” means a coating made of a mixture of finely divided resin and a plasticizer.

Plastisol is applied as a thick gel that solidifies when heated.

(59) “Potential VOC emissions” means the maximum capacity to emit, without add-on emission controls, according to physical and operational design. Any physical or operational limitation, except concerning add-on emission controls, on the capacity to emit shall be treated as part of operational design for the purpose of determining potential emissions if the limitation is enforceable by the Administrator of the EPA and the Technical Secretary, including those under this Division 1200-03, the State Implementation Plan, and permit conditions established pursuant to Chapter 1200-03-09.

(60) “Pressure release” means the emission of materials resulting from system pressure being greater than set pressure of the pressure relief device.

(61) “Prime coat” means the first of two or more coatings applied to a surface.

(62) “Printing” means the mechanical process used to reproduce images, patterns, and text through the transfer of ink to a substrate.

(63) “Printing press” means equipment used to apply words, pictures, or graphic designs to either a continuous substrate or a sheet. A continuous substrate consists of paper, plastic, or other material that is unwound from a roll, passed through coating or ink applicators and any associated drying areas. The press includes all coating and ink applicators, including applicators which apply coatings uniformly across the substrate, and drying areas between unwind and final drying of the continuous substrate. A sheet consists of paper, plastic, or other material that is conveyed through the process. The press includes all coating and ink applicators and drying operations between the time that the sheet is put into the press until it is taken off.

(64) “Process unit” means equipment assembled for the extraction of natural gas liquids from field gas, the fractionation of the liquids into natural gas products, or other operations associated with the processing of natural gas products. A process unit can operate independently if supplied with sufficient feed or raw materials and sufficient storage facilities for the products.

(65) “Process unit shutdown” means a work practice or operational procedure that stops production from a process unit or part of a process unit. An unscheduled work practice or operational procedure that stops production from a process unit or part of a process unit for less than 24 hours is not a process unit shutdown. The use of spare equipment and technically feasible bypassing of equipment without stopping production are not process unit shutdowns.

(66) “Reference Method” means the method of sampling or analyzing described in Appendix A of 40 C.F.R. 60 as of July 1, 1991.

(67) “Reid vapor pressure” means the absolute vapor pressure of volatile crude oil and volatile non-viscous petroleum liquids, except liquified petroleum gases, as determined by ASTM D323-89.

(68) “Repaired” means that equipment is adjusted, or otherwise altered, in order to eliminate a leak as indicated by one of the following: a calibrated instrument reading of 10,000 parts per million (ppm) or greater, indication of liquids dripping, or indication by a calibrated sensor that a seal or barrier fluid system has failed.

(69) “Roll coating” means the application of a coating material to a moving substrate by means of hard rubber, elastomeric, or metal rolls.

(70) “Rotogravure coating” means the application of a coating material to a substrate by means of a roll coating technique in which the pattern to be applied is recessed relative to the nonimage area, and the coating material is picked up in these recessed areas and is transferred to the substrate.

(71) “Shutdown” means the cessation of operation of a facility or of its emission control or emission monitoring equipment.

(72) “Solvent” means a substance that is liquid at standard conditions and is used to dissolve or dilute another substance; this term includes, but is not limited to, organic materials used as dissolvers, viscosity reducers, degreasing agents, or cleaning agents.

(73) “Source” means any building, structure, equipment, or installation that releases or discharges, or has the potential to release or discharge, VOC’s into the ambient air.

(74) “Standard conditions” means a temperature of 20°C (68°F) and pressure of 760 mm Hg (29.92 in. Hg).

(75) “Startup” means the setting in operation of a source or of its emission control or emission monitoring equipment.

(76) “Submerged fill” means the method of filling a delivery vessel or storage vessel where product enters within 150 millimeters (mm) (5.9 inches [in]) of the bottom of the delivery or storage vessel. Bottom filling of delivery and storage vessels is included in this definition.

(77) “Substrate” means the surface onto which a coating is applied or into which a coating is impregnated.

(78) “Technical Secretary” means the Technical Secretary or his authorized representative.

(79) “Topcoat” means the final coating(s), as applied, in a multiple-coat operation.

(80) “Truck” means any motor vehicle designed primarily to transport property.

(81) “True vapor pressure” means the equilibrium partial pressure exerted by a volatile organic liquid as determined in accordance with methods described in American Petroleum Institute Bulletin 2517, “Evaporation Loss From Floating Roof Tanks,” second edition, February 1980.

(82) “Vapor balance system” means a closed system that causes, by displacement during transfer of gasoline, the transfer of gasoline vapors from a tank being loaded to the tank being unloaded.

(83) “Vapor collection system” means all piping, seals, hoses, connections, pressure-vacuum vents, and other equipment between a gasoline tank truck and a vapor processing unit and/or a storage tank and vapor holder.

(84) “Vapor control system” means a system that limits or prevents release to the ambient air of vapors displaced from a tank during the transfer of gasoline.

(85) “Vapor recovery system” means a vapor gathering system capable of collecting VOC vapors generated during the operation of any transfer, storage, or process equipment.

(86) “Vapor-tight” means equipment that allows no excessive loss of vapors. Compliance with vapor-tight requirements can be determined by checking to ensure that the concentration at a potential leak source is not equal to or greater than 100 percent of the lower explosive limit (LEL) when measured with a combustible gas detector, calibrated with propane, at a distance of 2.54 centimeters (cm) (1 inch [in]) from the source.

(87) “Vapor-tight gasoline tank truck” means a gasoline tank truck that has demonstrated within the 12 preceding months that its product delivery tank will sustain a pressure change of not more than 75 mm (3.0 in) of water within 5 minutes (min) after it is pressurized to 450 mm (18 in) of water; or when evacuated to 150 mm (5.9 in) of water, the same tank will sustain a pressure change of not more than 75 mm (3.0 in) of water within 5 min. This capability is to be demonstrated using the test procedures specified in Reference Method 27.

(88) Reserved.

(89) “Web coating line” means all of the coating applicator(s), drying area(s), or oven(s), located between an unwind station and a rewind station, that are used to apply coating onto a continuous strip of substrate (the web). A web coating line need not have a drying oven.

(90) “Weighted average VOC content” means the VOC content as calculated according to the specifications of Paragraph .82(1) of this chapter or according to the specifications of other rules of this chapter, as applicable.

NOTE: The definitions in Chapter 1200-03-02 apply for those terms not defined in Chapter 1200-03-18.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed April 23, 1981; effective December 14, 1981. Amendment filed September 22, 1988; effective November 6, 1988. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993. Amendment filed July 27, 1995; effective October 9, 1995. Amendment filed May 30, 1996; effective August 10, 1996. Amendment filed October 31, 1997; effective January 12, 1998. Amendment filed June 18, 1999; effective September 1, 1999. Amendments filed March 7, 2006; effective May 21, 2006. Amendments filed May 12, 2010; effective August 10, 2010. Amendments filed April 1, 2015; effective June 30, 2015.

Tenn. Comp. R. & Regs. 1200-03-18-.02 GENERAL PROVISIONS AND APPLICABILITY

(1) It is the purpose of this chapter to establish emission standards and requirements for certain sources of volatile organic compounds for which applicability is specified in this chapter and other chapters of this division. In determining whether the sources of a source category at a facility satisfy the applicability standard of a specific rule, the potential VOC emissions from all sources of the source category shall be totaled.

(2) Upon mutual agreement of any air contaminant source and the Technical Secretary, an emission limit more restrictive than that otherwise specified in this chapter may be established. Also, upon mutual agreement of any air contaminant source and the Technical Secretary, operating hours, process flow rates, or any other operating parameter may be established as a limit which the source must adhere to. Any items mutually agreed to shall be stated as special conditions for any permit or order concerning the source. Violation of this mutual agreement shall result in enforcement action.

(3) Nothing in this chapter shall be construed to exempt sources from satisfying other applicable rules in this division and standards and requirements derived from or according to rules of this division, including, but not limited to, new source review requirements, permit conditions, and standards and requirements mutually agreed to or included in the State Implementation Plan.

(4) These regulations do not apply to any equipment used exclusively for chemical or physical analysis or determination of product quality and commercial acceptance provided the operation of the equipment is not an integral part of a production process and the total actual emissions from all such equipment at the facility do not exceed 204 kilograms (kg) (450 pounds [lb]) in any calendar month. Any facility availing of this exemption shall maintain the following records for at least 3 years and shall make those records available to the Technical Secretary upon request:

(a) Records to document the purpose of the equipment for which the exemption is claimed, and (b) Records to document the amount of each volatile organic compound (VOC)-containing material used in the equipment each calendar month and the VOC content of each material such that emissions can be determined for each calendar month.

(5) At any facility which contains sources subject to volatile organic compound content standards of this chapter, there shall be allowed a nonrenewable exemption from these standards for the use in these sources of a facility-wide aggregate of 55 gallons, as applied, of coatings and inks which exceed these standards during any rolling 12-month period if the following conditions are satisfied:

(a) No more than 55 gallons of these coatings and inks is used during any rolling 12-month period;

(b) The owner or operator of the facility makes application to the Technical Secretary for such exemption identifying the composition or percentage of solid and liquid components for each coating and ink to be included in the exemption;

(c) The exemption has been made a condition on a permit;

(d) Monthly recordkeeping, consistent with the procedures published in Recordkeeping Guidance Document for Surface Coating Operations and the Graphic Arts Industry, EPA 340/1-88-003, July 1989, is maintained; and (e) After the exemption becomes effective, there is no instance of exceedance of the 55gallon per rolling 12-month period limit.

(6) No owner or operator subject to these regulations may build, erect, install, or use any article, machine, equipment, process, or other method the use of which conceals emissions that would otherwise constitute non-compliance with an applicable regulation. This includes, but is not limited to, the use of gaseous diluents to achieve compliance, and the piecemeal carrying out of an operation to avoid coverage by a regulation that applies only to operations larger than a specified size.

(7) Source-specific standards and requirements, such as reasonably available control technology standards and requirements, may be established which differ from the standards and requirements specified in this chapter. Source-specific standards and requirements must be incorporated as revisions to the State Implementation Plan, unless otherwise provided for in this chapter or in Chapter 21 of this division. The owner or operator of a source for which legal notice must be published to effect source - specific standards and requirements, shall be responsible for all costs associated with publishing the required legal notice.

(8) The owner or operator of any facility in Davidson, Rutherford, Shelby, Sumner, Knox, Blount, Anderson, Williamson, or Wilson County which has actual emissions from stationary sources of 25 tons or more of volatile organic compounds (VOC’s) and/or nitrogen oxides during a calendar year shall report to their permitting authority information and data concerning these emissions. This information and data shall be in the form prescribed by the Technical Secretary, and shall be submitted before March 31 of the year following the calendar year for which the information and data is reported. The first report shall be for the 1993 calendar year, and shall be submitted before March 31, 1994. Each report shall be signed by an official of the company, certifying that the information and data contained in the report is accurate to the best knowledge of the individual certifying the report.

(9) For any source subject to this chapter in a county other than Davidson, Knox, Rutherford, Shelby, Sumner, Williamson, or Wilson County, requirements in permit conditions specifying data to be collected, records to be maintained, the period of time over which compliance is to be demonstrated, and reports to be submitted to the Technical Secretary shall take precedence over corresponding requirements in rules of this chapter. However the period of time over which compliance is to be demonstrated shall not be in excess of 30 days unless otherwise specified in this chapter.

(10) Multiple lines or operations of a source category which are served by a common control system may be treated as a single line or operation for the purposes of determining compliance with the standards of this chapter. In this case, the most stringent standard applicable to any of the lines or operations shall be the applicable standard for the purpose of compliance determination.

(11) Records required to be maintained shall be maintained within the state. If such records are maintained at a site other than the facility for which the records are generated, the Technical Secretary shall be informed of this. The notice informing the Technical Secretary shall contain, at a minimum, the following:

(a) Facility name;

(b) Facility physical address;

(c) Physical address where the records are maintained; and (d) Name, phone number, and mailing address of the official responsible for maintenance of the records and from whom records may be obtained.

The Technical Secretary shall be informed of any change in the details listed above within 30 days following such change.

(12) Any facility that becomes or is currently subject to the provisions of a rule of this chapter by exceeding an applicability threshold will remain subject to these provisions even if its emissions, throughput, or capacity later fall below the applicability threshold.

(13) The owner or operator of any line or operation which achieves exemption from standards or requirements of this chapter shall maintain records that document the line or operation satisfies the applicable criteria for the exemption.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed December 8, 1981; effective January 22, 1982. Amendment filed January 31, 1983; effective March 2, 1983. Amendment filed May 17, 1990; effective July 1, 1990. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993. Amendment filed April 18, 1994; effective July 2, 1994. Amendment filed July 27, 1995; effective October 9, 1995. Amendment filed September 19, 2014; effective December 18, 2014.

Tenn. Comp. R. & Regs. 1200-03-18-.03 COMPLIANCE CERTIFICATION, RECORDKEEPING, AND REPORTING

REQUIREMENTS FOR COATING AND PRINTING SOURCES.

(1) Certification, recordkeeping, and/or reporting requirements specified in source - category specific rules of this chapter shall take precedence over the requirements of this rule. To establish the records required under this rule, the volatile organic compound (VOC) content of each coating or ink, as applied, and the efficiency of each capture system and control device shall be determined by the applicable test methods and procedures specified and referenced in this chapter.

(2) Any owner or operator of a coating or printing line or operation that is exempt from emission limitations of this chapter because combined VOC emissions from otherwise - subject lines and operations at the facility are below the 6.8-kilograms (kg) (15-pounds (lb))-per-day applicability threshold specified in the applicable rule of this chapter, before the application of capture systems and control devices, shall comply with the following for each rule from which the owner or operator claims an exemption:

(a) By April 22, 1994, the owner or operator shall certify to the Technical Secretary that the facility is exempt by providing the following:

1. Name and location of the facility;

2. Address and telephone number of the person responsible for the facility;

3. A declaration that the facility is exempt from emission limitations of this chapter because combined VOC emissions from otherwise - subject lines and operations are below the appropriate applicability threshold before the application of capture systems and control devices; and 4. Calculations that demonstrate that the combined VOC emissions from otherwise - subject lines and operations for a day representative of current maximum production levels are 6.8 kilograms (kg) (15 pounds [lb]) or less before the application of capture systems and control devices. The following equation shall be used to calculate total VOC emissions for that day: n T = Σ A i B i i = 1 where:

T = Total VOC emissions from otherwise - subject lines and operations at the facility, before the application of capture systems and control devices, in units of kg/day (lb/day); n = Number of different coatings or inks applied on each otherwise - subject line or operation at the facility; i = Subscript denoting an individual coating or ink;

A i = Mass of VOC per volume of coating or ink (i) (excluding water and/or exempt compounds), as applied, in units of kilograms VOC per liter (kg VOC/L) (pounds VOC per gallon [lb VOC/gal]); and B i = Volume of coating or ink (i) (excluding water and/or exempt compounds), as applied, in units of liters per day (L/day) (gallons per day [gal/day]). The instrument or method by which the owner or operator accurately measured or calculated the volume of each coating or ink, as applied, used shall be described in the certification to the Technical Secretary.

(b) On and after April 22, 1994, the owner or operator shall collect and record the following information each day or, for an alternate longer period which has been approved by the Technical Secretary and the EPA during which the applicable threshold is not exceeded and maintain the information at the facility for a period of 3 years:

1. The name and identification number of each coating or ink, as applied;

2. The mass of VOC per volume (excluding water and/or exempt compounds) and the volume of coating or ink (i) (excluding water and/or exempt compounds), as applied; and 3. The total VOC emissions as calculated using the equation in Part (a)4. of this paragraph.

(c) On and after April 22, 1994, the owner or operator shall notify the Technical Secretary of any record showing that combined VOC emissions exceed 6.8 kg (15 lb) on any day, before the application of capture systems and control devices. A copy of such record shall be sent to the Technical Secretary within 30 calendar days after the exceedance occurs.

(3) Any owner or operator of a coating line or operation subject to the limitations of this chapter and complying by means of the use of complying coatings or inks shall comply with the following:

(a) By April 22, 1994, or upon startup of a new line or operation, or upon changing the method of compliance for a subject line or operation from daily-weighted averaging or control devices to the use of complying coatings, the owner or operator shall certify to the Technical Secretary that the line or operation is in compliance with the requirements of the applicable rule. Such certification shall include:

1. The name and location of the facility;

2. The address and telephone number of the person responsible for the facility;

3. Identification of subject sources;

4. The name and identification number of each coating or ink in use, as applied; and 5. The mass of VOC per volume of each coating or ink in use (excluding water and/or exempt compounds), as applied.

(b) On and after April 22, 1994, or on and after the initial startup date, the owner or operator shall maintain for each subject line or operation for a period of 3 years information as follows:

1. The name and identification number of each coating or ink used, as applied, and 2. The mass of VOC per volume of each coating or ink (excluding water and/or exempt compounds), used, as applied.

(c) On and after April 22, 1994, the owner or operator shall notify the Technical Secretary in the following instances:

1. Any record showing use of any non-complying coatings and/or inks shall be reported by sending a copy of such record to the Technical Secretary within 30 calendar days following that use, and 2. At least 30 calendar days before changing the method of compliance from the use of complying coatings and/or inks to daily-weighted averaging or control devices, the owner or operator shall comply with all requirements of Subparagraph (4)(a) or (5)(a) of this rule, respectively.

(4) Any owner or operator of a coating or printing line or operation subject to the limitations of this chapter and complying by means of weighted averaging on that line or operation shall comply with the following:

(a) By April 22, 1994, or upon startup of a new line or operation, or upon changing the method of compliance for a subject line or operation from the use of complying coatings and/or inks or control devices to daily-weighted averaging, the owner or operator shall certify to the Technical Secretary that the line or operation is in compliance with the requirements of this paragraph. Such certification shall include:

1. The name and location of the facility;

2. The address and telephone number of the person responsible for the facility;

3. Identification of subject sources;

4. The name and identification number of each line or operation which will comply by means of weighted averaging;

5. The instrument or method by which the owner or operator will accurately measure or calculate the volume of each coating and/or ink (excluding water and/or exempt compounds), as applied, used each day on each line or operation;

6. The method by which the owner or operator will create and maintain records as required in Subparagraph (b) of this paragraph, with an example of the format in which these records will be kept;

7. Calculation of the weighted average for a day representative of current or projected maximum production levels; and 8. The time at which the facility’s “day” begins if a time other than midnight local time is used to define a “day.”

(b) On and after April 22, 1994, or on and after the initial startup date, the owner or operator shall collect and record all of the following information each day for each subject line or operation and maintain the information for a period of 3 years;

1. The name and identification number of each coating and/or ink, as applied;

2. The mass of VOC per volume (excluding water and/or exempt compounds) and the volume of each coating and/or ink (excluding water and/or exempt compounds), as applied, used; and 3. The weighted average VOC content of all coatings and/or inks, as applied, calculated according to the procedure in Paragraph .82(1) of this chapter.

(c) On and after April 22, 1994, the owner or operator shall notify the Technical Secretary in the following instances:

1. Any record showing noncompliance with the applicable daily-weighted average requirements shall be reported by sending a copy of the record to the Technical Secretary within 30 calendar days following the occurrence, and 2. At least 30 calendar days before changing the method of compliance from dailyweighted averaging to the use of complying coatings and/or inks or control devices, the owner or operator shall comply with all requirements of Subparagraph (3)(a) or (5)(a) of this rule, respectively.

(5) Any owner or operator of a coating or printing line or operation subject to the limitations of this chapter and complying by means of control devices shall comply with the following:

(a) By April 22, 1994, less otherwise specified in this chapter, or upon startup of a new line or operation, or upon changing the method of compliance for any existing line or operation from the use of complying coatings or inks or weighted averaging to control devices, the owner or operator of the subject line or operation shall have performed or shall perform, as applicable, a compliance test. Testing shall have been performed or shall be performed pursuant to the procedures specified and referenced in this chapter.

No later than 60 days after completion of the performance test, the owner or operator of the subject line or operation shall submit to the Technical Secretary results of all tests and calculations necessary to demonstrate that the subject line or operation is in compliance with the applicable rule of this chapter.

(b) On and after April 22, 1994, or on and after the initial startup date, the owner or operator shall collect and record the following information each day for each line or operation and maintain the information for a period of 3 years:

1. The name and identification number of each coating or ink used if necessary to calculate the required overall emission reduction efficiency;

2. The mass of VOC per unit volume of coating or ink solids, as applied, the volume solids content, as applied, and the volume, as applied, of each coating or ink used if necessary to calculate the required overall emission reduction efficiency;

3. The maximum VOC content (mass of VOC per unit volume of solids, as applied) or the weighted average VOC content (mass of VOC per unit volume of solids, as applied) of the coatings or inks used if necessary to calculate the required overall emission reduction efficiency;

4. The required overall emission reduction efficiency as determined in the applicable rule of this chapter;

5. The actual overall emission reduction efficiency achieved;

6. Control device monitoring data, e.g. incinerator temperature;

7. A log of operating time for the capture system, control device, monitoring equipment, and the associated line or operation;

8. A maintenance log for the capture system, control device, and monitoring equipment detailing all routine and non-routine maintenance performed including dates and duration of any outages;

9. For thermal incinerators, all 3-hour periods of operation in which the average combustion temperature was more than 28°C (50°F) below the average combustion temperature during the most recent performance test that demonstrated that the facility was in compliance;

10. For catalytic incinerators:

(i) Continuous records of the temperature of the gas stream both upstream and downstream of the incinerator;

(ii) Records of all 3-hour periods of operation for which the average temperature measured before the catalyst bed is more than 28°C (50°F) below the gas stream temperature measured before the catalyst bed during the most recent determination of destruction efficiency of the catalytic incinerator that demonstrated that the facility was in compliance; and (iii) Records of all 3-hour periods for which the average temperature difference across the catalyst bed is less than 80 percent of the temperature difference measured during the most recent determination of the destruction efficienct of the catalytic incinerator that demonstrated that the facility was in compliance.

11. For carbon adsorbers, all 3-hour periods of operation during which the average VOC concentration or reading of organics in the exhaust gases is more than 20 percent greater than the average exhaust gas concentration or reading measured by the organics monitoring device during the most recent determination of the removal efficiency of the carbon adsorber that demonstrated that the facility was in compliance. This specification applies only to carbon adsorbers for which stack emission testing is required to demonstrate compliance with a standard of this chapter.

(c) On and after April 22, 1994, the owner or operator shall notify the Technical Secretary of an instance of noncompliance with the applicable requirements for control devices, such instance of noncompliance including any period of operation during which the parameter boundaries established during the most recent performance test are exceeded as specified in Parts (b) 9., 10., and 11. of this paragraph, by sending a copy of that notice to the Technical Secretary within 30 calendar days following the occurrence.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed December 8, 1981; effective January 22, 1982. Amendment filed January 31, 1983; effective March 2, 1983. Amendment filed September 22, 1988; effective November 6, 1988. Amendment filed May 17, 1990; effective July 1, 1990. Repeal filed April 23, 1992; effective July 7, 1992. New rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.04 COMPLIANCE CERTIFICATION, RECORDKEEPING, AND REPORTING

REQUIREMENTS FOR NON-COATING AND NON-PRINTING SOURCES.

(1) The owner or operator of any facility containing sources subject to this rule shall submit to the Technical Secretary an initial compliance certification by April 22, 1994, or , for any facility in Shelby County, within 180 calendar days after the facility becomes subject to this rule, whichever is later. However, if another compliance date is specified for the source, initial compliance certification shall be submitted to the Technical Secretary within 30 days after that date, unless otherwise specified. The owner or operator of any facility containing new sources that become subject to this rule after April 22, 1994, shall submit an initial compliance certification within 180 days after the start-up of each source unless another time for such certification is specified on the construction permit for the source. Certification shall include the following:

(a) For initial compliance certification, as a minimum:

1. Name and location of the facility.

2. Address and telephone number of the person responsible for the facility.

3. Identification of subject sources.

(b) For each subject source, as a minimum:

1. The applicable emission limitation, equipment specification, or work practice;

2. The method of compliance;

3. For each source subject to numerical emission limitations, the estimated emissions without control;

4. The control system(s) in use;

5. The design performance efficiency of the control system;

6. For each source subject to numerical emission limitations, the estimated emissions after control;

7. Certification that each subject source at the facility is in compliance with the applicable emission limitation, equipment specification, or work practice; and 8. The time at which the facility’s “day” begins if a time other than midnight local time is used to define a “day.”

(2) The owner or operator of any facility containing sources subject to this rule shall, for each occurrence of excess emissions, within 30 calendar days of becoming aware of such occurrence, supply the Technical Secretary with the following information:

(a) The name and location of the facility;

(b) The subject sources that caused the excess emissions;

(c) The time and date of first observation of the excess emissions;

(d) The cause and expected duration of the excess emissions;

(e) For sources subject to numerical emission limitations, the estimated rate of emissions (expressed in the units of the applicable emission limitation) and the operating data and calculations used in determining the magnitude of the excess emissions; and (f) The proposed corrective actions and schedule to correct the conditions causing the excess emissions.

(3) The following requirements for sources using control devices apply:

(a) By April 22, 1994, or upon startup of a new source, or upon changing the method of compliance for an existing source, or, for any source in Shelby County, within 180 calendar days after the source becomes subject to this rule, whichever is later, the owner or operator of the subject source shall have performed or shall perform, as applicable, all tests. No later than 60 days after the completion of testing, the owner or operator of the subject source shall have submitted to the Technical Secretary the results of all tests and calculations necessary to demonstrate that the subject source is in compliance with the applicable rule of this chapter.

(b) Recordkeeping shall be as follows:

1. Each owner or operator of a source subject to this rule shall maintain up-to-date, continuous records of any equipment operating parameters specified to be monitored in the applicable rule of this chapter as well as up-to-date records of periods of operation during which the parameter boundaries established during the most recent performance test are exceeded. Exceedances as specified below shall constitute noncompliance. These records shall be maintained for at least 3 years, unless otherwise specified or provided for in this chapter. The Technical Secretary may at any time require a report of these data. Periods of operation during which the parameter boundaries established during the most recent performance test are exceeded are defined as follows:

(i) For thermal incinerators, all 3-hour periods of operation in which the average combustion temperature was more than 28°C (50°F) below the average combustion temperature during the most recent performance test that demonstrated that the facility was in compliance.

(ii) For catalytic incinerators:

(I) Continuous records of the temperature of the gas stream both upstream and downstream of the incinerator;

(II) Records of all 3-hour periods of operation for which the average temperature measured before the catalyst bed is more than 28°C (50°F) below the gas stream temperature measured before the catalyst bed during the most recent determination of destruction efficiency of the catalytic incinerator that demonstrated that the facility was in compliance; and (III) Records of all 3-hour periods for which the average temperature difference across the catalyst bed is less than 80 percent of the temperature difference measured during the most recent determination of the destruction efficienct of the catalytic incinerator that demonstrated that the facility was in compliance.

(iii) For carbon adsorbers, all 3-hour periods of operation during which the average VOC concentration or reading of organics in the exhaust gases is more than 20 percent greater than the average exhaust gas concentration or reading measured by the organics monitoring device during the most recent determination of the removal efficiency of the carbon adsorber that demonstrated that the facility was in compliance. This specification applies only to carbon adsorbers for which stack emission testing is required to demonstrate compliance with a standard of this chapter.

2. A log of operating time for the capture system, control device, monitoring equipment, and the associated source; and 3. A maintenance log for the capture system, control device, and monitoring equipment detailing all routine and non-routine maintenance performed including dates and duration of any outages.

(4) Provisions of this rule apply only to sources identified as subject to those specific provisions of this rule by other rules of this chapter.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed December 8, 1981; effective January 22, 1982. Amendment filed January 31, 1983; effective March 2, 1983. Amendment filed September 22, 1988; effective November 6, 1988. Amendment filed May 17, 1990; effective July 1, 1990. Repeal filed April 23, 1992; effective June 7, 1992. New rule filed March 8, 1993; effective April 22, 1993. Amendment filed July 27, 1995; effective October 9, 1995. Amendment filed May 16, 1997; effective July 30, 1997.

Tenn. Comp. R. & Regs. 1200-03-18-.05 RESERVED

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed December 8, 1981; effective January 22, 1982. Amendment filed January 31, 1983; effective March 2, 1983. Amendment filed May 17, 1990; effective July 1, 1990. Amendment filed April 23, 1992; effective June 7, 1992. Repeal filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.06 HANDLING, STORAGE, USE, AND DISPOSAL OF VOLATILE ORGANIC

COMPOUNDS (VOC’S).

(1) Applicability of this rule is as follows:

(a) This rule applies to all facilities in Davidson, Rutherford, Shelby, Sumner, Williamson, or Wilson County which contains any source which is subject to standards and requirements in Rules 1200-03-18-.11 through .21 and .24 through .79 of this chapter other than only those requirements for demonstration of exemption or for maintenance of records to document exemption is achieved, for example, a threshold of material use or VOC emission per unit of time has not been exceeded.

(b) This rule does not apply to:

1. Any VOC or material containing VOC emitted in compliance with any other VOC standard under this chapter;

2. Waste paint (sludge) handling systems, water treatment systems, and other similar operations at coating and printing facilities using complying coatings and/or inks; and 3. Sources for which the applicable requirements in Rules 1200-03-18-.11 through .21 and .24 through .79 are only for demonstration of exemption or for maintenance of records to document exemption is achieved, for example, a threshold of material use or VOC emission per unit of time has not been exceeded.

(2) “Minimum reasonably attainable emissions” is the minimum quantity of VOC’s which is emitted when utilizing all reasonable techniques for controlling evaporation during handling of materials for storage and disposal. Prevention of any evaporation of VOC’s from storage and disposal techniques is considered minimum reasonably attainable.

(3) Standards as follow apply:

(a) No owner or operator of a source subject to this rule may cause, allow, or permit the disposal of more than 5 kilograms (kg) (11 pounds [lb]) of any volatile organic compound (VOC), or of any materials containing more than 5 kg (11 lb) of any VOC’s, in any 1 day in a manner that would permit the evaporation from the facility of that VOC into the ambient air in excess of the minimum reasonably attainable.

(b) No owner or operator of a source subject to this rule shall use open containers for the storage or disposal of materials impregnated with VOC’s that are used for surface preparation, cleanup, coating removal, or facility or equipment cleaning or maintenance.

(c) No owner or operator of a source subject to this rule shall store in open containers spent or fresh VOC to be used for surface preparation, cleanup, coating removal, or facility or equipment cleaning or maintenance except as otherwise provided for in this

rule, such as in Subparagraph (d) of this paragraph.

(d) No owner or operator of a source subject to this rule shall use VOC for the cleanup of tools and process equipment, such as spray equipment, unless equipment is used to collect the cleaning compounds and to reasonably minimize their evaporation to the atmosphere.

(e) The owner or operator of a source subject to this rule and utilizing all reasonable techniques for controlling evaporation during handling, storage, use, and disposal of materials shall be considered to have achieved the minimum reasonably attainable VOC emissions required in Subparagraph (a) of this paragraph and to have reasonably minimized VOC emissions as required in Subparagraph (d) of this paragraph. Of course, prevention of any evaporation of VOC’s from handling, storage, use, and disposal shall be considered achievement of minimum reasonably attainable and to reasonably minimize emissions. Such prevention of any evaporation shall be accepted as a method of achieving compliance with the requirements of Subparagraph (a) and (d) of this paragraph.

(4) {Reserved} (5) {Reserved} (6) By July 1, 1996, the owner or operator of an existing source as of August 11, 1996, and subject to this rule shall submit to the Technical Secretary a plan acceptable to the Technical Secretary specifying the methods that will be implemented to achieve compliance with the requirements of Subparagraph (3)(a) and (d) of this rule, along with details of records to be kept demonstrating compliance is maintained.

(7) With respect to compliance certification, initiation of recordkeeping and reporting, and completion of control system compliance testing of a source, the owner or operator of that source shall comply with the requirements of Rule 1200-03-18-.04 of this chapter, except that the applicable date for initial compliance and certification and performance testing shall be November 15, 1996 rather than April 22, 1994. Records demonstrating compliance with the requirements of Paragraph (3) of this rule shall be maintained for a minimum of 3 years and shall be made available to the Technical Secretary upon request.

(8) With respect to petitioning for a source-specific compliance schedule according to and as provided for in Rule 1200-03-18-.07 of this chapter, the owner or operator of an existing source as of August 11, 1996, shall insure the petition is received by the Technical Secretary no later than July 1 1996, rather than October 22, 1993.

(9) For any source which is subject to any Rule 1200-03-18-.11 through .21 or .24 through .79 of this chapter and which handles, stores, uses, or disposes of volatile organic compounds, the standards and requirements of that rule with respect to handling, storage, use, or disposal shall take precedence over standards and requirements in this Rule 1200-03-18-.06 with respect to handling, storage, use, and disposal.

History

• Authority: T.C.A. §§ 4-5-202, et seq., and 68-201-105.
• Administrative History: Original rule certified July 10, 1979; effective July 10, 1979. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993. Amendment filed May 31, 1996; effective August 11, 1996. Amendment filed May 16, 1997; effective July 30, 1997.

Tenn. Comp. R. & Regs. 1200-03-18-.07 SOURCE-SPECIFIC COMPLIANCE SCHEDULES

(1) The owner or operator of an existing source or a source having a State or local agency’s construction permit before April 22, 1993, and subject to a standard in this chapter may petition for a source-specific compliance schedule differing from the schedules specified in other rules in this chapter according to the criteria as follow:

(a) One or more of the following conditions are satisfied:

1. The facility demonstrates that it is physically impossible for the source in question to comply with the dates in the categorical schedule;

2. That, by allowing additional time, innovative technology will be applied and the reductions to be achieved will be significantly greater than that from the applicable emission standard. That the facility agrees that this revised value will be contained on the permit as a condition of source operation;

3. (Reserved); or 4. The facility in question is a part of a statewide or multistate program to prioritize the sequence of installing controls at a number of similar sources owned or controlled by the same company, and the overall compliance program is as expeditious as practicable.

(b) Source-specific compliance schedules approved under this rule must propose to achieve final compliance with the specified emission standard as expenditiously as possible, and contain the increments of progress listed below:

1. Date control plan will be submitted, 2. Date contract will be awarded, 3. Date initial construction will commence, 4. Date construction will be completed, and 5. Date final compliance will be achieved.

(c) Source-specific compliance schedules approved under this rule will be subjected to a public hearing and incorporated as a revision to the State Implementation Plan. The facility requesting such source-specific compliance schedule shall be responsible for all costs associated with the required legal notices.

(d) No source-specific compliance schedule will be granted if such a revised schedule will interfere with reasonable further progress in nonattainment areas.

(e) The petition for the source-specific compliance schedule must be received by the Technical Secretary in the Nashville office prior to the first date contained in the compliance schedule specified for the source in other rules of this chapter or October 22, 1993, whichever is earlier.

(2) For any source, the provisions of this rule may be availed of only for achieving compliance with a standard or requirement specified in this chapter which the source was not subject to before April 22, 1993.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed July 21, 1980; effective September 8, 1980. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.08 THROUGH 1200-03-18-.10 RESERVED

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Repeal and new rule filed August 26, 1980; effective October 10, 1980. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.11 AUTOMOBILE AND LIGHT-DUTY TRUCK COATING OPERATIONS

(1) Applicability of this rule is as follows:

(a) This rule applies to operations in Davidson, Hamilton, Knox, Rutherford, Shelby, Sumner, Williamson, and Wilson Counties.

(b) This rule applies to the following coating operations in an automobile or light-duty truck assembly plant: each prime coat operation, each electrodeposition (EDP) prime coat operation, each primer surfacer operation, each topcoat operation, and each final repair operation.

(c) Antichip coatings, as applied to automobile and light-duty truck components such as, but not limited to, rocker panels, the bottom edge of doors and fenders, and the leading edge of the hood or roof, are considered primer surfacers.

(d) Application to metal parts of underbody antichip coatings (e.g., underbody plastisol) and coatings other than prime, primer surfacer, topcoat, and final repair shall be subject to the requirements of Rule .20 of this chapter (Coating of Miscellaneous Metal Parts).

(e) The requirements in Paragraph (3) of this rule do not apply to automobile and light-duty truck assembly plants whose plant-wide, actual emissions without control devices are less than 6.8 kilograms (kg) (15 pounds [lb]) of volatile organic compounds (VOC’s) per day.

(2) For the purpose of this rule, the following definitions apply:

(a) “Application area” means the area where a coating is applied by dipping or spraying.

(b) “Automobile and light-duty truck body” means the exterior and interior surfaces of an automobile or light-duty truck including, but not limited to, hoods, fenders, cargo boxes, doors, grill opening panels, engine compartment, all or portions of the passenger compartment, and trunk interior.

(c) “Electrodeposition (EDP)” means a method of applying a prime coat by which the automobile or light-duty truck body is submerged in a tank filled with coating material and an electrical field is used to effect the deposition of the coating material on the body.

(d) “Final repair operation” means the application area(s), flashoff area(s), and oven(s) used to apply and dry or cure coatings that are used to repair topcoat on fully assembled automobile or light-duty truck bodies from a single assembly line.

(e) “Prime coat operation” means the application area(s), flashoff area(s), and oven(s) that are used to apply and dry or cure the prime coat on components of automobile and light-duty truck bodies on a single assembly line.

(f) “Primer surfacer operation” means the application area(s), flashoff area(s), and oven(s) that are used to apply and dry or cure primer surfacer between the prime coat and the topcoat operations on components of automobile and light-duty truck bodies on a single assembly line. The primer surfacer coat is also referred to as the “guidecoat.”

(g) “Solids turnover ratio (R T )” means the ratio of total volume of coating solids that is added to the EDP system in a calendar month divided by the total volume design capacity of the EDP system.

(h) “Topcoat operation” means the application area(s), flashoff area(s), and oven(s) used to apply and dry or cure topcoat on components of automobile and light-duty truck bodies on a single assembly line.

(i) “Topcoat protocol” means the EPA document “Protocol for Determining the Daily VOC Emission Rate of Automobile and Light-Duty Truck Topcoat Operations,” EPA 450/3- 88-018, December 1988, and as revised to include procedures for testing VOC emissions from primer surfacer operations and a procedure for calculating credit for spray booth control.

(j) “Volume design capacity” means for the EDP system the total liquid volume that is contained in the EDP system (tanks, pumps, recirculating lines, filters, etc.) at the system’s designed liquid operating level. The EDP system volume design capacity is designated L E .

(3) Standards as follow apply:

(a) No owner or operator of an automobile or light-duty truck prime coat, EDP prime coat, or final repair operation subject to this rule shall cause or allow the application of any coating on that operation with VOC content, as applied, that exceeds the emission limits as follow:

1. 0.14 kilograms per liter (kg/L) (1.2 pounds per gallon [lb/gal]) of coating, excluding water and/or exempt compounds, as applied, from any prime coat operation.

2. 0.58 kg/L (4.8 lb/gal) of coating, excluding water and/or exempt compounds, as applied, from any final repair operation.

3. 0.17 kg/L (1.4 lb/gal) of coating solids from any EDP prime coat operation when the solids turnover ratio (R T ) is 0.16 or greater. R T shall be calculated as follows:

T V R

T = L

E where:

T V = total volume of coating solids that is added to the EDP system in a calendar month (liters); and L E = volume design capacity of the EDP system (liters).

4. 0.17 x 350 (0.160 - R T ) kg/L (1.4 x 350 (0.160 - R T ) lb/gal) of coating solids from any EDP prime coat operation when R T is greater than or equal to 0.040 and less than 0.160.

5. When R T is less than 0.040 for any EDP prime coat operation, there is no emission limit. When R T is less than 0.040, the owner or operator shall comply with the certification, recordkeeping, and reporting requirements in Subparagraph (8)(e) of this rule.

(b) For topcoat and primer surfacer operations:

1. No owner or operator of an automobile or light-duty truck topcoat operation or primer surfacer operation subject to this rule may cause or allow on any day emissions which exceed 1.8 kg/L (15.1 lb/gal) of solids deposited, or 2. In the alternative, no owner or operator of an automobile or light-duty truck topcoat or primer surfacer operation shall cause or allow the application of any topcoat or primer surfacer on that operation with VOC content in excess of 0.34 kilograms per liter (kg/L) (2.8 pounds per gallon [lb/gal]) of coating, excluding water and/or exempt compounds, as applied.

(c) As an alternative to compliance with the emission limits in Parts (3)(a)1. and 2. of this

rule for prime coat and final repair operations, respectively, and Subparagraph (3)(b) of this rule for primer surfacer operations, an owner or operator may meet the requirements of Paragraph (4) or (5) of this rule.

(4) No owner or operator subject to this rule shall apply coatings in any nonelectrodeposition prime coat, final repair or primer surfacer operation, during any day, whose weighted average VOC content exceeds the applicable emission limits in Parts (3)(a)1. and 2. and Subparagraph (3)(b) of this rule.

(5) Control device requirements as follow apply:

(a) An owner or operator subject to this rule shall comply with the applicable emission limits for any prime coat, final repair, or primer surfacer operation by:

1. Installing and operating a capture system and a control device on that operation;

2. Determining for each day the overall emission reduction efficiency needed to demonstrate compliance. The overall emission reduction needed is the lesser of the value calculated according to the procedure in this chapter or 95 percent; and 3. Demonstrating each day that the overall emission reduction efficiency achieved is greater than or equal to the overall emission reduction efficiency required.

(b) An owner or operator subject to this rule shall ensure that:

1. A capture system and control device are operated at all times the coating operation is in use, and the owner or operator demonstrates compliance with this

rule through the applicable coating analysis and capture system and control device efficiency test methods specified in this chapter; and 2. The control device is equipped with the applicable monitoring equipment specified in this chapter, and the monitoring equipment is installed, calibrated, operated, and maintained according to the vendor’s specifications at all times the control device is in use.

(6) The following compliance procedures for EDP prime coat operations apply:

(a) For any EDP prime coat operation that does not comply with the emission limit in Part (3)(a)3. or 4. of this rule by using a capture system and control device to reduce emissions, the owner or operator shall use the procedures in 40 C.F.R. 60.393(c)(1) as of July 1, 1991, to determine compliance.

(b) The owner or operator shall use the procedures in 40 C.F.R. 60.393(c)(2) as of July 1, 1991, to determine compliance if a capture system and a control device that destroys VOC are used to comply with the emission limit in Part (3)(a)3. or 4. of this rule.

(c) The owner or operator shall use the procedures in 40 C.F.R. 60.393(c)(3) as of July 1, 1991, to determine compliance if a capture system and a control device that recovers the VOC are used to comply with the emission limit in Part (3)(a)3. or 4. of this rule.

(7) (Reserved)

(8) The following recordkeeping and reporting requirements for prime coat and final repair operations apply:

(a) through (d) (Reserved)

(e) An owner or operator of an automobile or light-duty truck EDP prime coat operation subject to this rule and complying with the requirements in Part (3)(a)3. or 4. of this rule shall:

1. By April 22, 1994, or upon startup of a new EDP prime coat operation, certify to the Technical Secretary that the coating line or operation is in compliance with the requirements in Parts (3)(a)3. or 4. of this rule. Such certification shall include:

(i) The name and location of the facility;

(ii) The address and telephone number of the person responsible for the facility;

(iii) Identification of subject sources; and (iv) A copy of the calculations performed to determine R T and the calculations performed pursuant to Paragraph (6) of this rule to demonstrate compliance for the EDP prime coat operation for the month prior to submittal of the certification.

2. On and after April 22, 1994, or on and after the initial startup date of a new EDP prime coat operation, collect and record the following information for each EDP prime coat operation. These records shall be maintained at the facility for at least 3 years and shall be made available to the Technical Secretary upon request:

(i) For each month, the total volume of coating solids that is added to the EDP system;

(ii) For each month, calculation of R T using the equation in Part (3)(a)3. of this

rule; and (iii) For each month, the calculations used in the compliance determinations specified in Paragraph (6) of this rule.

3. On and after April 22, 1994, notify the Technical Secretary in the following instances:

(i) Any record showing noncompliance with the appropriate emission limit for the EDP prime coat operation; and (ii) At least 30 calendar days before changing the method of compliance from one of the procedures in Paragraph (6) of this rule to another of the procedures in Paragraph (6), the owner or operator shall comply with the certification requirements in Part (8)(e)1. of this rule.

(9) The following recordkeeping and reporting requirements for topcoat and primer surfacer operations apply:

(a) An owner or operator of an automobile or light-duty truck coating operation subject to this rule and complying with Subparagraph (3)(b) of this rule shall comply with the following requirements:

1. At least 180 days prior to the initial compliance date, the owner or operator of a coating operation subject to the topcoat and primer surfacer limit shall have submitted to the Technical Secretary a detailed proposal specifying the method of demonstrating how the compliance test will be conducted according to the topcoat protocol.

2. The proposal shall include a comprehensive plan (including a rationale) for determining the transfer efficiency at each booth through the use of in-plant or pilot testing; the selection of coatings to be tested (for the purpose of determining transfer efficiency) including the rationale for coating groupings; and a method for tracking coating usage during the transfer efficiency test.

3. Upon approval by the Technical Secretary, the owner or operator may proceed with the compliance demonstration.

(b) The owner or operator shall maintain at the source for a period of 3 years or until a new test is performed all test results, data, and calculations used to determine VOC emissions from each topcoat and each primer surfacer operation according to the topcoat protocol.

(c) If control devices are used to control emissions from an automobile or light-duty truck topcoat or primer surfacer operation, the owner or operator shall maintain records according to Parts .03(5)(b)6. through 11. of this chapter.

(d) Any instance of noncompliance with the emission limit in Subparagraph (3)(b) shall be reported to the Technical Secretary within 30 calendar days.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.12 CAN COATING

(1) Applicability of this rule is as follows:

(a) This rule applies to any can coating line used to apply the following coatings: sheet base coat, exterior base coat, interior body spray coat, overvarnish, side seam spray coat, exterior end coat, and end sealing compound coat.

(b) The emission limits of this rule do not apply to can coating lines within any facility:

1. In Davidson, Rutherford, Sumner, Williamson, or Wilson County whose actual emissions without control devices from all can coating lines within the facility are less than 6.8 kilograms (kg) (15 pounds [lb]) of volatile organic compounds (VOC’s) per day or whose maximum theoretical emissions from all can coating lines within the facility are less than 10 tons of volatile organic compounds (VOC’s) per year;

2. In Hamilton or Shelby County whose potential VOC emissions from all can coating lines within the facility are less than 25 tons of volatile organic compounds (VOC’s) per year; or 3. In any other county whose potential VOC emissions from all can coating lines within the facility are less than 100 tons of volatile organic compounds (VOC’s) per year.

(c) An owner or operator of a facility which achieves exemption by having emissions below the 6.8 kg (15 lb)-per-day applicability threshold in Part (b)1. of this paragraph shall comply with the certification, recordkeeping, and reporting requirements of Paragraph .03(2) of this chapter.

(2) For the purpose of this rule, the following definitions apply:

(a) “Can” means any cylindrical single walled container, with or without a top, cover, spout, and/or handle, that is manufactured from metal sheets thinner than 29 gauge (0.0141 inches [in]) and into which solid or liquid materials are packaged.

(b) “Can coating line” means a coating line in which any coating is applied onto the surface of cans or can components.

(c) “End sealing compound coat” means a compound applied onto can ends that functions as a gasket when the end is assembled onto the can.

(d) “Exterior base coat” means a coating applied to the exterior of a two-piece can body to provide protection to the metal or to provide background for any lithographic or printing operation.

(e) “Interior body spray coat” means a coating applied to the interior of the can body to provide a protective film between the product and the can.

(f) “Overvarnish” means a coating applied directly over a design coating or directly over ink to reduce the coefficient of friction, to provide gloss, and to protect the finish against abrasion and corrosion.

(g) “Sheet basecoat” means a coating applied to metal in sheet form to serve as either the exterior or interior of two-piece or three-piece can bodies or can ends.

(h) “Side-seam spray coat” means a coating applies to the seam of a three-piece can.

(i) “Three-piece can” means a can that is made by rolling a rectangular sheet of metal into a cylinder that is soldered, welded, or cemented at the seam and attaching two ends.

(j) “Two-piece can” means a can whose body and one end are formed from a shallow cup and to which the other end is later attached.

(k) “Two-piece can exterior end coat” means a coating applied by roller coating or spraying to the exterior end of a two-piece can to provide protection to the metal.

(3) Standards as follow apply:

(a) No owner or operator of a can coating line subject to this rule shall cause or allow the application of any coating on that line with VOC content, as applied, that exceeds the following limits: kg/L lb/gal a 1. Sheet basecoat and sheet overvarnish 0.34 2.8 2. Exterior basecoat and overvarnish (two-piece can) 0.34 2.8 3. Interior body spray coat 0.51 4.2 4. Two-piece can exterior end coat 0.51 4.2 5. Side seam spray coat 0.66 5.5 6. End sealing compound coat 0.44 3.7 a VOC content values are expressed in units of mass of VOC (kg, lb) per volume of coating (liter [L], gallon [gal]), excluding water and/or exempt compounds, as applied.

(b) As an alternative to compliance with the emission limits in Subparagraph (a) of this paragraph, an owner or operator of a can coating line may comply with the requirements of this rule by meeting the requirements of Paragraph (4) or (5) of this

rule.

(4) No owner or operator of a can coating line subject to this rule shall apply coatings on that line, during any day, whose weighted average VOC content exceeds the emission limits in Subparagraph (3)(a) of this rule.

(5) Control device requirements as follow apply:

(a) An owner or operator of a can coating line subject to this rule may comply with Subparagraph (3)(b) of this rule by:

1. Installing and operating a capture system and a control device on that line;

2. Determining for each day the overall emission reduction efficiency needed to demonstrate compliance. The overall emission reduction needed is the lesser of the value calculated according to the procedure in this chapter or 95 percent; and 3. Demonstrating each day that the overall emission reduction efficiency achieved is greater than or equal to the overall emission reduction efficiency required.

(b) An owner or operator of a can coating line subject to this rule shall ensure that:

1. A capture system and control device are operated at all times that the line is in operation, and the owner or operator demonstrates compliance with this rule through the applicable coating analysis and capture system and control device efficiency test methods specified in this chapter; and 2. The control device is equipped with the applicable monitoring equipment specified in this chapter, and the monitoring equipment is installed, calibrated, operated, and maintained according to the vendor’s specifications at all times the control device is in use.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed June 15, 1981; effective July 31, 1981. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.13 COIL COATING

(1) Applicability of this rule is as follows:

(a) This rule applies to any coil coating operation.

(b) This rule does not apply to any coil coating operation within a facility:

1. In Davidson, Rutherford, Sumner, Williamson, or Wilson County whose actual emissions without control devices from all coil coating operations within the facility are less than 6.8 kilograms (kg) (15 pounds [lb]) of volatile organic compounds (VOC’s) per day or whose maximum theoretical emissions from all coil coating operations within the facility are less than 10 tons of volatile organic compounds (VOC’s) per year;

2. In Hamilton or Shelby County whose potential VOC emissions from all coil coating operations within the facility are less than 25 tons of volatile organic compounds (VOC’s) per year; or 3. In any other county whose potential VOC emissions from all coil coating operations within the facility are less than 100 tons of volatile organic compounds (VOC’s) per year.

(2) For the purpose of this rule, the following definitions apply:

(a) “Coil” means any continuous metal strip with thickness of 0.15 millimeter (mm) (0.006 inch [in]) or more that is packaged in a roll or coil.

(b) “Coil coating line” means a web coating line where coating is applied to coil.

(c) “Coil coating operation” means a coating application station and its associated flashoff area, drying area, and/or drying oven wherein coating is applied and dried or cured on a coil coating line. A coil coating line may include more than one coil coating operation.

(3) Standards as follow apply:

(a) No owner or operator of a coil operation subject to this rule shall cause or allow the application of any coating on that operation with VOC content in excess of 0.31 kilograms per liter (kg/L) (2.6 pounds per gallon [lb/gal]) of coating, excluding water and/or exempt compounds, as applied.

(b) As an alternative to compliance with the emission limit in Subparagraph (a) of this paragraph, an owner or operator of a coil coating operation may meet the requirements of Paragraph (4) or (5) of this rule.

(4) No owner or operator of a coil coating operation subject to this rule shall apply coatings on that operation, during any day, whose weighted average VOC content exceeds the emission limit in Subparagraph (3)(a) of this rule.

(5) Control device requirements as follow apply:

(a) An owner or operator of a coil coating operation subject to this rule may comply with this rule by:

1. Installing and operating a capture system and a control device on that operation;

2. Determining for each day the overall emission reduction efficiency needed to demonstrate compliance. The overall emission reduction needed is the lesser of the value calculated according to the procedure in this chapter or 95 percent; and 3. Demonstrating each day that the overall emission reduction efficiency achieved is greater than or equal to the overall emission reduction efficiency required.

(b) An owner or operator of a coil coating operation subject to this rule shall ensure that:

1. A capture system and control device are operated at all times the coating operation is in use, and the owner or operator demonstrates compliance with this

rule through the applicable coating analysis and capture system and control device efficiency test methods specified in this chapter; and 2. The control device is equipped with the applicable monitoring equipment specified in this chapter, and the monitoring equipment is installed, calibrated, operated, and maintained according to the vendor’s specifications at all times the control device is in use.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.14 PAPER AND RELATED COATING

(1) Applicability of this rule is as follows:

(a) This rule applies to any paper coating operation which is not part of a printing press.

(b) This rule does not apply to any paper coating operation within a facility:

1. In Davidson, Rutherford, Sumner, Williamson, or Wilson County whose actual emissions without control devices from all paper coating operations within the facility are less than 6.8 kilograms (kg) (15 pounds [lb]) of volatile organic compounds (VOC’s) per day or whose maximum theoretical emissions from all paper coating operations within the facility are less than 10 tons of volatile organic compounds (VOC’s) per year;

2. In Hamilton or Shelby County whose potential VOC emissions from all paper coating operations within the facility are less than 25 tons of volatile organic compounds (VOC’s) per year; or 3. In any other county whose potential VOC emissions from all paper coating operations within the facility are less than 100 tons of volatile organic compounds (VOC’s) per year.

(2) For the purpose of this rule, the following definitions apply:

(a) “Paper coating line” means a web coating line where coating is applied to paper and pressure sensitive tapes regardless of the substrate. Printing presses are not considered paper coating lines. Products produced on a paper coating line include, but are not limited to, adhesive tapes and labels, book covers, post cards, office copier paper, drafting paper, and pressure sensitive tapes. Paper coating lines include, but are not limited to, application by impregnation or saturation or by the use of roll, knife, or rotogravure coating. A paper coating line may include more than one paper coating operation.

(b) “Paper coating operation” means a coating application station and its associated flashoff area, drying area, and/or oven wherein coating is applied uniformly across the web and dried or cured on a paper coating line.

(3) Standards as follow apply:

(a) No owner or operator of a paper coating operation subject to this rule shall cause, allow, or permit the application of any coating on that operation with VOC content in excess of 0.35 kilograms per liter (kg/L) (2.9 pounds per gallon [lb/gal]) of coating, excluding water and/or exempt compounds, as applied.

(b) As an alternative to compliance with the emission limit in Subparagraph (a) of this paragraph, an owner or operator of a paper coating operation subject to this rule may meet the requirements of Paragraph (4) or (5) of this rule.

(4) No owner or operator of a paper coating operation subject to this rule shall apply coatings on that operation, during any day, whose weighted average VOC content exceeds the emission limit in Subparagraph (3)(a) of this rule.

(5) Control device requirements as follow apply:

(a) An owner or operator of a paper coating operation subject to this rule may comply with this rule by:

1. Installing and operating a capture system and a control device on that operation;

2. Determining for each day the overall emission reduction efficiency needed to demonstrate compliance. The overall emission reduction needed is the lesser of the value calculated according to the procedure in this chapter or 95 percent; and 3. Demonstrating each day that the overall emission reduction efficiency achieved is greater than or equal to the overall emission reduction efficiency required.

(b) An owner or operator of a paper coating operation subject to this rule shall ensure that:

1. A capture system and control device are operated at all times the coating operation is in use, and the owner or operator demonstrates compliance with this

rule through the applicable coating analysis and capture system and control device efficiency test methods specified in this chapter; and 2. The control device is equipped with the applicable monitoring equipment specified in this chapter, and the monitoring equipment is installed, calibrated, operated, and maintained according to the vendor’s specifications at all times the control device is in use.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.15 FABRIC COATING

(1) Applicability of this rule is as follows:

(a) This rule applies to any fabric coating operation.

(b) This rule does not apply to any fabric coating operation within a facility:

1. In Davidson, Rutherford, Sumner, Williamson, or Wilson County whose actual emissions without control devices from all fabric coating operations within the facility are less than 6.8 kilograms (kg) (15 pounds [lb]) of volatile organic compounds (VOC’s) per day or whose maximum theoretical emissions from all fabric coating operations within the facility are less than 10 tons of volatile organic compounds (VOC’s) per year;

2. In Hamilton or Shelby County whose potential VOC emissions from all fabric coating operations within the facility are less than 25 tons of volatile organic compounds (VOC’s) per year; or 3. In any other county whose potential VOC emissions from all fabric coating operations within the facility are less than 100 tons of volatile organic compounds (VOC’s) per year.

(2) For the purpose of this rule, the following definitions apply:

(a) “Fabric coating line” means a web coating line where coating is applied to fabric. A fabric printing line is not considered a fabric coating line.

(b) “Fabric coating operation” means a coating application station and its associated flashoff area, drying area, and/or oven wherein coating is applied and dried or cured in a fabric coating line. A fabric coating line may include more than one fabric coating operation.

(3) Standards as follow apply:

(a) No owner or operator of a fabric coating operation subject to this rule shall cause or allow the application of any coating on that operation with VOC content in excess of 0.35 kilogram per liter (kg/L) (2.9 pounds per gallon [lb/gal]) of coating, excluding water and/or exempt compounds, as applied.

(b) As an alternative to compliance with the emission limit in Subparagraph (a) of this paragraph, an owner or operator of a fabric coating operation subject to this rule may meet the requirements of Paragraph (4) or (5) of this rule.

(4) No owner or operator of a fabric coating operation subject to this rule shall apply coatings on that operation, during any day, whose weighted average VOC content exceeds the emission limit in Subparagraph (3)(a) of this rule.

(5) Control device requirements as follow apply:

(a) An owner or operator of a fabric coating operation subject to this rule may comply with this rule by:

1. Installing and operating a capture system and a control device on that operation;

2. Determining for each day the overall emission reduction efficiency needed to demonstrate compliance. The overall emission reduction needed is the lesser of the value calculated according to the procedure in this chapter or 95 percent; and 3. Demonstrating each day that the overall emission reduction efficiency achieved is greater than or equal to the overall emission reduction efficiency required.

(b) An owner or operator of a fabric coating operation subject to this rule shall ensure that:

1. A capture system and control device are operated at all times the coating operation is in use, and the owner or operator demonstrates compliance with this

rule through the applicable coating analysis and capture system and control device efficiency test methods specified in this chapter; and 2. The control device is equipped with the applicable monitoring equipment specified in this chapter, and the monitoring equipment is installed, calibrated, operated, and maintained according to the vendor’s specifications at all times the control device is in use.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1992; effective July 10, 1979. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.16 VINYL COATING

(1) Applicability of this rule is as follows:

(a) This rule applies to any vinyl coating operation.

(b) This rule does not apply to:

1. Application of vinyl plastisol to fabric to form the substrate that is subsequently coated; and 2. Any vinyl coating line within a facility:

(i) In Davidson, Rutherford, Sumner, Williamson, or Wilson County whose actual emissions without control devices from all vinyl coating operations within the facility are less than 6.8 kilograms (kg) (15 pounds [lb]) of volatile organic compounds (VOC’s) per day or whose maximum theoretical emissions from all vinyl coating operations within the facility are less than 10 tons of volatile organic compounds (VOC’s) per year;

(ii) In Hamilton or Shelby County whose potential VOC emissions from all vinyl coating operations within the facility are less than 25 tons of volatile organic compounds (VOC’s) per year; or (iii) In any other county whose potential VOC emissions from all vinyl coating operations within the facility are less than 100 tons of volatile organic compounds (VOC’s) per year.

(2) For the purpose of this rule, “Vinyl coating line” means a web coating line where a decorative, functional, or protective coating is applied to a continuous web of vinyl or vinyl-coated fabric.

Lines used for coating and/or printing on vinyl and coating and/or printing on urethane are considered vinyl coating lines.

(3) Standards as follow apply:

(a) No owner or operator of a vinyl coating line subject to this rule shall cause or allow the application of any coating or ink on that line with VOC content in excess of 0.45 kilograms per liter (kg/L) (3.8 pounds per gallon [lb/gal]) of coating or ink, excluding water and/or exempt compounds, as applied.

(b) As an alternative to compliance with the emission limit in Subparagraph (a) of this paragraph, an owner or operator of a vinyl coating line subject to this rule may meet the requirements of Paragraph (4) or (5) of this rule.

(4) No owner or operator of a vinyl coating line subject to this rule shall apply coatings or inks on any such line, during any day, whose weighted average VOC content exceeds the emission limit in Subparagraph (3)(a) of this rule.

(5) Control device requirements as follow apply:

(a) An owner or operator of a vinyl coating line subject to this rule may comply with this

rule by:

1. Installing and operating a capture system and a control device on that line;

2. Determining for each day the overall emission reduction efficiency needed to demonstrate compliance. The overall emission reduction needed is the lesser of the value calculated according to the procedure in this chapter or 95 percent; and 3. Demonstrating each day that the overall emission reduction efficiency achieved is greater than or equal to the overall emission reduction efficiency required.

(b) An owner or operator of a vinyl coating line subject to this rule shall ensure that:

1. A capture system and control device are operated at all times that the line is in operation, and the owner or operator demonstrates compliance with this rule through the applicable coating analysis and capture system and control device efficiency test methods specified in this chapter; and 2. The control device is equipped with the applicable monitoring equipment specified in this chapter, and the monitoring equipment is installed, calibrated, operated, and maintained according to the vendor’s specifications at all times the control device is in use.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.17 COATING OF METAL FURNITURE

(1) Applicability of this rule is as follows:

(a) This rule applies to any metal furniture coating line.

(b) This rule does not apply to any metal furniture coating line within a facility:

1. In Davidson, Rutherford, Sumner, Williamson, or Wilson County whose actual emissions without control devices from all metal furniture coating lines within the facility are less than 6.8 kilograms (kg) (15 pounds [lb]) of volatile organic compounds (VOC’s) per day or whose maximum theoretical emissions from all metal furniture coating lines within the facility are less than 10 tons of volatile organic compounds (VOC’s) per year;

2. In Hamilton or Shelby County whose potential VOC emissions from all metal furniture coating lines within the facility are less than 25 tons of volatile organic compounds (VOC’s) per year; or 3. In any other county whose potential VOC emissions from all metal furniture coating lines within the facility are less than 100 tons of volatile organic compounds (VOC’s) per year.

(2) For the purpose of this rule, the following definitions apply:

(a) “Metal furniture” means any furniture piece made of metal or any metal part that will be assembled with other metal, wood, fabric, plastic, or glass parts to form a furniture piece including, but not limited to, tables, chairs, waste baskets, beds, desks, lockers, benches, shelving, file cabinets, and room dividers. This definition shall not apply to the coating of miscellaneous metal parts or products.

(b) “Metal furniture coating line” means a coating line in which a protective, decorative, or functional coating is applied onto the surface of metal furniture.

(3) Standards as follow apply:

(a) No owner or operator of a metal furniture coating operation line subject to this rule shall cause or allow the application of any coating on that line with VOC content in excess of 0.36 kilograms per liter (kg/L) (3.0 pounds per gallon [lb/gal]) of coating, excluding water and/or exempt compounds, as applied.

(b) As an alternative to compliance with the emission limit in Subparagraph (a) of this paragraph, an owner or operator of a metal furniture coating line may meet the requirements of Paragraph (4) or (5) of this rule.

(4) No owner or operator of a metal furniture coating line subject to this rule shall apply coatings on that operation, during any day, whose weighted average VOC content exceeds the emission limit in Subparagraph (3)(a) of this rule.

(5) Control device requirements as follow apply:

(a) An owner or operator of a metal furniture coating line subject to this rule may comply with this rule by:

1. Installing and operating a capture system and a control device on that line;

2. Determining for each day the overall emission reduction efficiency needed to demonstrate compliance. The overall emission reduction needed is the lesser of the value calculated according to the procedure in this chapter or 95 percent; and 3. Demonstrating each day that the overall emission reduction efficiency achieved is greater than or equal to the overall emission reduction efficiency required.

(b) An owner or operator of a metal furniture coating line subject to this rule shall ensure that:

1. A capture system and control device are operated at all times that the line is in operation, and the owner or operator demonstrates compliance with this rule through the applicable coating analysis and capture system and control device efficiency test methods specified in this chapter; and 2. The control device is equipped with the applicable monitoring equipment specified in this chapter, and the monitoring equipment is installed, calibrated, operated, and maintained according to the vendor’s specifications at all times the control device is in use.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.18 COATING OF LARGE APPLIANCES

(1) Applicability of this rule is as follows:

(a) This rule applies to any large appliance coating line.

(b) This rule does not apply to:

1. The use of quick-drying lacquers for repair of scratches and nicks that occur during assembly, provided the volume of coating does not exceed 0.95 liter (L)

(0.25 gallon [gal]) in any 8-hour period, and 2. Any large appliance coating line within a facility:

(i) In Davidson, Rutherford, Sumner, Williamson, or Wilson County whose actual emissions without control devices from all large appliance coating lines within the facility are less than 6.8 kilograms (kg) (15 pounds [lb]) of volatile organic compounds (VOC’s) per day or whose maximum theoretical emissions from all large applicance coating lines within the facility are less than 10 tons of volatile organic compounds (VOC’s) per year;

(ii) In Hamilton or Shelby County whose potential VOC emissions from all large appliance coating lines within the facility are less than 25 tons of volatile organic compounds (VOC’s) per year; or (iii) In any other county whose potential VOC emissions from all large appliance coating lines within the facility are less than 100 tons of volatile organic compounds (VOC’s) per year.

(2) For the purpose of this rule, the following definitions apply:

“Large appliance” means any residential or commercial washer, dryer, range, refrigerator, freezer, water heater, dishwasher, trash compactor, air conditioner, or other similar products under Standard Industrial Classification Code 363.

“Large appliance coating line” means a coating line in which any protective, decorative, or functional coating is put onto the surface of component metal parts (including, but not limited to, doors, cases, lids, panels, and interior parts) of large appliances.

(3) Standards as follow apply:

(a) No owner or operator of a large appliance coating line subject to this rule shall cause or allow the application of any coating on that line with VOC content in excess of 0.34 kilograms per liter (kg/L) (2.8 pounds per gallon [lb]) of coating, excluding water and/or exempt compounds, as applied.

(b) As an alternative to compliance with the emission limit in Subparagraph (a) of this paragraph, an owner or operator of a large appliance coating line, during any day, subject to this rule may meet the requirements of Paragraph (4) or (5) of this rule.

(4) No owner or operator of a large appliance coating line subject to this rule shall apply coatings on that line, during any day, whose weighted average VOC content exceeds the emission limit in Subparagraph (3)(a) of this rule.

(5) Control device requirements as follow apply:

(a) An owner or operator of a large appliance coating line subject to this rule may comply with this rule by:

1. Installing and operating a capture system and a control device on that line;

2. Determining for each day the overall emission reduction efficiency needed to demonstrate compliance. The overall emission reduction needed is the lesser of the value calculated according to the procedure in this chapter or 95 percent; and 3. Demonstrating each day that the overall emission reduction efficiency achieved is greater than or equal to the overall emission reduction efficiency required.

(b) An owner or operator of a large appliance coating line subject to this rule shall ensure that:

1. A capture system and control device are operated at all times that the line is in operation, and the owner or operator demonstrate compliance with this rule through the applicable coating analysis and capture system and control device efficiency test methods specified in this chapter; and 2. The control device is equipped with the applicable monitoring equipment specified in Subparagraph .83(2)(b) of this chapter, and the monitoring equipment is installed, calibrated, operated, and maintained according to the vendor’s specifications at all times the control device is in use.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed October 29, 1981; effective December 29, 1981. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.19 COATING OF MAGNET WIRE

(1) Applicability of this rule is as follows:

(a) This rule applies to any magnet wire coating line.

(b) This rule does not apply to any magnet wire coating line within a facility:

1. In Davidson, Rutherford, Sumner, Williamson, or Wilson County whose emissions without control devices from all magnet wire coating lines within the facility are less than 6.8 kilograms (kg) (15 pounds [lb]) of volatile organic compounds (VOC’s) per day or whose maximum theoretical emissions from all magnet wire coating lines within the facility are less than 10 tons of volatile organic compounds (VOC’s) per year;

2. In Hamilton or Shelby County whose potential VOC emissions from all magnet wire coating lines within the facility are less than 25 tons of volatile organic compounds (VOC’s) per year; or 3. In any other county whose potential VOC emissions from all magnet wire coating lines within the facility are less than 100 tons of volatile organic compounds (VOC’s) per year.

(2) For the purpose of this rule, “Magnet wire coating line” means a coating line in which an electrically insulating varnish or enamel is applied onto the surface of wire for use in electrical machinery.

(3) Standards as follow apply:

(a) No owner or operator of a magnet wire coating line subject to this rule shall cause or allow the use of any coating with VOC content in excess of 0.20 kilograms per liter (kg/L) (1.7 pounds per gallon [lb/gal]) of coating, excluding water and/or exempt compounds, as applied.

(b) As an alternative to compliance with the emission limit in Subparagraph (a) of this paragraph, an owner or operator of a magnet wire coating line subject to this rule may meet the requirements of Paragraph (4) or (5) of this rule.

(4) No owner or operator of a magnet wire coating line subject to this rule shall apply coatings on that line, during any day, whose weighted average VOC content exceeds the emission limit in Subparagraph (3)(a) of this rule.

(5) Control device requirements as follow apply:

(a) An owner or operator of a magnet wire coating line subject to this rule may comply with this rule by:

1. Installing and operating a capture system and a control device on that line;

2. Determining for each day the overall emission reduction efficiency needed to demonstrate compliance. The overall emission reduction needed is the lesser of the value calculated according to the procedure in this chapter or 95 percent; and 3. Demonstrating each day that the overall emission reduction efficiency achieved is greater than or equal to the overall emission reduction efficiency required.

(b) An owner or operator of a magnet wire coating line subject to this rule shall ensure that:

1. A capture system and control device are operated at all times that the line is in operation, and the owner or operator demonstrates compliance with this rule through the applicable coating analysis and capture system and control device efficiency determination methods specified in this chapter, and;

2. The control device is equipped with the applicable monitoring equipment specified in this chapter, and the monitoring equipment is installed, calibrated, operated, and maintained according to the vendor’s specifications at all times the control device is in use.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed October 29, 1981; effective December 14, 1981. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.20 COATING OF MISCELLANEOUS METAL PARTS

(1) Applicability of this rule is as follows:

(a) This rule applies to any miscellaneous metal parts and products coating line.

(b) This rule does not apply:

1. To the coating of the following metal parts and products that are covered by other rules of this chapter:

(i) Automobiles and light-duty trucks;

(ii) Metal cans;

(iii) Flat metal sheets and strips in the form of rolls or coils;

(iv) Magnet wire for use in electrical machinery;

(v) Metal furniture; and (vi) Large appliances.

2. To the coating operations in the following:

(i) Coating the exterior of completely assembled aircraft;

(ii) Coating the exterior of major aircraft subassemblies, if approved as revisions to the State Implementation Plan;

(iii) Automobile and truck refinishing;

(iv) Customized top coating of automobiles and trucks, if production is less than 35 vehicles per day;

(v) Coating the exterior of completely assembled marine vessels;

(vi) Coating the exterior of major marine vessel subassemblies if approved as revisions to the state implementation plan; and (vii) (Repealed)

3. With respect to the emission limits in this rule to any coating line within a facility:

(i) In Davidson, Rutherford, Sumner, Williamson, or Wilson County whose actual emissions without control devices from all miscellaneous metal parts and products coating lines within the facility are less than 6.8 kilograms (kg) (15 pounds [lb]) of volatile organic compounds (VOC’s) per day or whose maximum theoretical emissions from all miscellaneous metal parts and products coating lines within the facility are less than 10 tons of volatile organic compounds (VOC’s) per year;

(ii) In Hamilton or Shelby County whose potential VOC emissions from all miscellaneous metal parts and products coating lines within the facility are less than 25 tons of volatile organic compounds (VOC’s) per year; or (iii) In any other county whose potential VOC emissions from all miscellaneous metal parts and products coating lines within the facility are less than 100 tons of volatile organic compounds (VOC’s) per year.

(c) In lieu of satisfying the standards and requirements of this rule, the owner or operator of a heavy-duty truck electrodeposition prime coat operation shall satisfy the standards and requirements of Rule .11 of this chapter for that operation.

(2) For the purpose of this rule, the following definitions apply:

(a) “Air-dried coating” means a coating that is dried by the use of air or forced warm air at temperatures up to 90°C (194°F).

(b) “Clear coating” means a coating that:

1. Either lacks color and opacity or is transparent; and 2. Uses the surface to which it is applied as a reflective base or undertone color.

(c) “Drum” means any cylindrical metal shipping container of 13- to 110-gallon capacity.

(d) “Extreme environmental conditions” means any of the following: the weather all of the time, temperatures frequently above 95°C (203°F), detergents, abrasive and scouring agents, solvents, corrosive atmospheres, or similar environmental conditions.

(e) “Extreme performance coatings” means coatings intended for exposure to extreme environmental conditions.

(f) “Heavy-duty truck touch-up” means air-dried coatings used to repair scratches and/or blemishes in the coating of newly manufactured heavy-duty trucks.

(g) “High performance architectural coating” means a coating:

1. Applied to extruded aluminum architectural subsections intended for use on exteriors of buildings of more than one story;

2. Satisfying the Architectural Aluminum Manufacturer’s Association publication number AAMA 605.2-1980; and 3. (Repealed).

(h) “Miscellaneous metal parts and products coating line” means a coating line in which a coating is applied to any miscellaneous metal parts and products.

(i) “Miscellaneous metal parts and products” means any metal part or metal product, even if attached to or combined with a nonmetal part or product. Miscellaneous metal parts and products include, but are not limited to:

1. Large farm machinery (harvesting, fertilizing and planting machines, tractors, combines, etc);

2. Small farm machinery (lawn and garden tractors, lawn mowers, rototillers, etc.);

3. Small appliances (fans, mixers, blenders, crock pots, dehumidifiers, vacuum cleaners, etc.);

4. Commercial machinery (office equipment, computers and auxiliary equipment, typewriters, calculators, vending machines, etc.);

5. Industrial machinery (pumps, compressors, conveyor components, fans, blowers, transformers, etc.);

6. Fabricated metal products (metal covered doors, frames, etc.);

7. Any other industrial category that coats metal parts or products under the Standard Industrial Classification Codes of Major Group 33 (primary metal industries), Major Group 34 (fabricated metal products), Major Group 35 (nonelectric machinery), Major Group 36 (electrical machinery), Major Group 37 (transportation equipment), Major Group 38 (miscellaneous instruments), and Major Group 39 (miscellaneous manufacturing industries); and 8. Application of underbody antichip materials (e.g., underbody plastisol) and coating application operations other than prime, primer surface, topcoat, and final repair operations at automobile and light-duty truck assembly plants.

(j) “Pail” means any cylindrical metal shipping container of 1- to 12-gallon capacity and constructed of 29-gauge and heavier material.

(k) “Refinishing” means the repainting of used equipment.

(3) Standards as follow apply:

(a) No owner or operator of a miscellaneous metal parts and products coating line subject to this rule may cause or allow the application of any coating with VOC content in excess of the emission limits in Subparagraph (b) of this paragraph.

(b) If more than one emission limit in this subparagraph applies to a specific coating, then the least stringent emission limit shall be applied. kg/L a lb/gal a 1. High performance architectural coating 0.75 6.2 2. Heavy-duty truck touch-up 0.58 4.8 3. Clear coating 0.52 4.3 4. Steel pail and drum interior 0.52 4.3 5. Air-dried coating 0.42 3.5 6. Extreme performance coating 0.42 3.5 7 All other coatings 0.36 3.0 a VOC content values are expressed in units of mass of VOC (kg, lb) per volume of coating (liter [L], gallon [gal]), excluding water and/or exempt compounds, as applied.

(c) As an alternative to compliance with the emission limits in Subparagraph (b) of this paragraph, an owner or operator of a miscellaneous metal parts and products coating line may meet the requirements of Paragraphs (4) or (5) of this rule.

(4) No owner or operator of a miscellaneous metal parts and products coating line that applies multiple coatings during the same day shall apply coatings on that line during any day whose weighted average VOC content exceeds the weighted average VOC content limit calculated using VOC content factors from Subparagraph (3)(b) of this rule.

(5) Control device requirements as follow apply:

(a) An owner or operator of a miscellaneous metal parts and products coating line subject to this rule may comply with this rule by:

1. Installing and operating a capture system and a control device on that line;

2. Determining for each day the overall emission reduction efficiency needed to demonstrate compliance. The overall emission reduction needed is the lesser of the value calculated according to the procedure in this chapter or 95 percent; and 3. Demonstrating each day that the overall emission reduction efficiency achieved is greater than or equal to the overall emission reduction efficiency required.

(b) An owner or operator of a miscellaneous metal parts and products coating line subject to this rule shall ensure that:

1. A capture system and control device are operated at all times that the line is in operation, and the owner or operator demonstrates compliance with this rule through the applicable coating analysis and capture system and control device efficiency test methods specified in this chapter, and;

2. The control device is equipped with the applicable monitoring equipment specified in this chapter, and the monitoring equipment is installed, calibrated, operated, and maintained according to the vendor’s specifications at all times the control device is in use.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed March 23, 19891; effective May 7, 1981. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993. Amendment filed July 27, 1995; effective October 9, 1995. Amendment filed November 12, 1998; effective January 26, 1999.

Tenn. Comp. R. & Regs. 1200-03-18-.21 COATING OF FLAT WOOD PANELING

(1) Applicability of this rule is as follows:

(a) This rule applies to all flat wood paneling coating lines.

(b) This rule does not apply to:

1. Class I hardwood panels, particle board used in furniture, insulation board, exterior siding, tileboard, and softwood plywood coating lines; or 2. Any flat wood paneling coating line within any facility:

(i) In Davidson, Rutherford, Sumner, Williamson, or Wilson County whose actual emissions without control devices from all flat wood paneling coating lines within the facility are less than 6.8 kilograms (kg) (15 pounds [lb]) of volatile organic compounds (VOC’s) per day or whose maximum theoretical emissions from all flat wood paneling coating lines within the facility are less than 10 tons of volatile organic compounds (VOC’s) per year;

(ii) In Hamilton or Shelby County whose potential VOC emissions from all flat wood paneling coating lines within the facility are less than 25 tons of volatile organic compounds (VOC’s) per year; or (iii) In any other county whose potential VOC emissions from all flat wood paneling coating lines within the facility are less than 100 tons of volatile organic compounds (VOC’s) per year.

(2) For the purpose of this rule, the following definitions apply:

“Class II hardboard paneling finish” means finishes that meet the specifications of Voluntary Product Standard PS-59-73 as approved by the American National Standards Institute.

“Flat wood paneling coating line” means a coating line used in manufacturing to apply and dry or cure coatings applied to flat wood panels including: printed interior panels made of hardwood plywood and thin particle board (i.e., less than or equal to 0.64 centimeters (cm)

(0.25 inches [in]) in thickness); natural finish hardwood plywood panels; and hardwood paneling with Class II finishes.

“Hardboard” is a panel manufactured primarily from interfelted ligno-cellulosic fibers that are consolidated under heat and pressure in a hot press.

“Hardwood plywood” is plywood whose surface layer is a veneer of hardwood.

“Natural finish hardwood plywood panels” means panels whose original grain pattern is enhanced by essentially transparent finishes frequently supplemented by fillers and toners.

“Printed interior panels” means panels whose grain or natural surface is obscured by fillers and basecoats upon which a simulated grain or decorative pattern is printed.

“Thin particleboard” is a manufactured board that is 0.64 cm (0.25 in) or less in thickness made of individual wood particles that have been coated with a binder and formed into flat sheets by pressure.

“Tileboard” means paneling that has a colored, waterproof surface coating.

(3) Standards as follow apply:

(a) No owner or operator of a flat wood paneling coating line subject to this rule shall cause or allow VOC emissions from the coating of any flat wood paneling product in excess of the following emission limits: kg/100 lb/1,000 m 2a ft 2a 1. Printed interior panels 2.9 6.0 2. Natural finish hardwood plywood panels 5.8 12.0 3. Class II finish on hardwood panels 4.8 10.0 a VOC content values are expressed in units of mass of VOC (kg, lb) per volume of surface to which the coating is applied (100 square meters [m ], 1,000 square feet [ft ]).

(b) As an alternative to compliance with the emission limits in Subparagraph (a) of this paragraph, an owner or operator of a flat wood paneling coating line may meet the requirements of Paragraph (4) or (5) of this rule.

(4) No owner or operator of a flat wood paneling coating line subject to this rule shall apply coatings on that line, during any day, whose weighted average VOC content, calculated in accordance with the procedure in this rule, exceeds the emission limits in this rule.

(5) Control device requirements as follow apply:

(a) An owner or operator of a flat wood paneling coating line subject to this rule may comply with this rule by:

1. Installing and operating a capture system and a control device on that line;

2. Determining for each day the overall emission reduction efficiency needed to demonstrate compliance. The overall emission reduction needed is the lesser of the value calculated according to the procedure in this rule or 95 percent; and 3. Demonstrating each day that the overall emission reduction efficiency achieved is greater than or equal to the overall emission reduction efficiency required.

(b) An owner or operator of a flat wood paneling coating line subject to this rule shall ensure that:

1. A capture system and control device are operated at all times that the line is in operation, and the owner or operator demonstrates compliance with this rule through the applicable coating analysis and capture system and control device efficiency test methods specified in this chapter; and 2. The control device is equipped with the applicable monitoring equipment specified in this chapter, and the monitoring equipment is installed, calibrated, operated, and maintained according to the vendor’s specifications at all times the control device is in use.

(6) The test methods found in this chapter and in this paragraph as follow shall be used to determine compliance:

(a) The weighted average VOC content, in units of mass of VOC per area of surface coated, of the coatings used on a day on a flat wood paneling coating line shall be calculated using the following equation: n Σ VOC w = i - 1 ViCi a where VOC w = The weighted average VOC content of the coatings, as applied, used in units of kg VOC/100 m (lb VOC/1,000 ft ); n = The number of different coatings, as applied, each day;

V i = The volume of each coating applied in units of L (gal), each day; and C i = The VOC content of each coating, as applied, in units of kg VOC/L of coating (lb VOC/gal); a = Constant = 100 m if using metric units; and =1,000 ft if using english units.

(b) Calculate the required overall emission reduction efficiency of the control system for the day according to the following equation:

(VOCa - S) x 100 E = VOCa where:

E = The required overall emission reduction efficiency of the control system;

VOC a = The maximum VOC content of the coatings, as applied, used each day in units of kg VOC/100 m of surface area coated (lb VOC/1,000 ft ), as determined by the applicable test methods and procedures; or the weighted average VOC content, as applied, of the coatings used each day in units of kg VOC/100 m of surface area coated (lb VOC/1,000 ft ); and S = VOC emission limitation in terms of kg VOC/100 m of surface area coated (lb VOC/1,000 ft ).

(7) Recordkeeping and reporting requirements of this chapter and as follow apply:

(a) (Reserved)

(b) An owner or operator of a flat wood paneling coating line subject to this rule and complying with Paragraph (3) of this rule by means of the use of complying coatings shall comply with the following:

1. By April 22, 1994, or upon startup of a new coating line, or upon changing the method of compliance for a subject line from daily-weighted averaging or control devices to the use of complying coatings, the owner or operator shall certify to the Technical Secretary that the coating line is in compliance. Such certification shall include:

(i) The name and location of the facility;

(ii) The address and telephone number of the person responsible for the facility;

(iii) Identification of subject sources;

(iv) The name and identification number of each coating, as applied; and (v) The mass of VOC per area of surface to which the coating is applied in terms of kg VOC/100 m (lb VOC/1,000 ft ) and the surface area coated.

2. On and after April 22, 1994, or on and after the initial startup date, the owner or operator shall collect and record the following information each day and maintain the information for a period of 3 years:

(i) The name and identification number of each coating, as applied; and (ii) The mass of VOC per area of surface to which the coating is applied for each coating used each day in terms of kg VOC/100 m (lb VOC/1,000 ft ).

3. On and after April 22, 1994, the owner or operator shall notify the Technical Secretary in the following instances:

(i) Any record showing use of any non-complying coatings shall be reported by sending a copy of such record to the Technical Secretary within 30 calendar days following that use, and (ii) At least 30 calendar days before changing the method of compliance from the use of complying coatings to daily-weighted averaging or control devices, the owner or operator shall comply with all requirements of Part (c)1. or (d)1. of this paragraph, respectively.

(c) An owner or operator of a flat wood paneling coating line subject to this rule and complying with Paragraph (3) of this rule by means of weighted averaging on that line shall comply with the following:

1. By April 22, 1994, or upon startup of a new flat wood paneling coating line, or upon changing the method of compliance for a flat wood paneling coating line from the use of complying coatings or control devices to daily-weighted averaging, the owner or operator shall certify to the Technical Secretary that the coating line is in compliance with this subparagraph. Such certification shall include:

(i) The name and location of the facility.

(ii) The address and telephone number of the person responsible for the facility.

(iii) Identification of subject sources.

(iv) The name and identification number of each coating line which will comply by means of weighted averaging;

(v) The instrument or method by which the owner or operator will accurately measure or calculate the volume of each coating (excluding water and/or exempt compounds), as applied, used each day on each coating line;

(vi) The method by which the owner or operator will create and maintain records as required in Part 2. of this subparagraph, with an example of the format in which the records will be kept; and (vii) Calculation of the weighted average, using the procedure in Subparagraph (6)(a) of this rule, for a day representative of current or projected maximum production levels.

2. On and after April 22, 1994, or on and after the initial startup date, the owner or operator shall collect and record all of the following information each day for each subject coating line and maintain the information for a period of 3 years:

(i) The name and identification number of each coating, as applied;

(ii) The mass of VOC per volume (excluding water and/or exempt compounds) and the volume of each coating (excluding water and/or exempt compounds), as applied, used each day; and (iii) The weighted average VOC content of all coatings, as applied, calculated according to the procedure in Subparagraph (6)(a) of this rule.

3. On and after April 22, 1994, the owner or operator shall notify the Technical Secretary in the following instances:

(i) Any record showing noncompliance with the applicable daily-weighted average requirements shall be reported by sending a copy of the record to the Technical Secretary within 30 calendar days following the occurrence.

(ii) At least 30 calendar days before changing the method of compliance from daily-weighted averaging to the use of complying coatings or control devices, the owner or operator shall comply with all requirements of Part (b)1. or (d)1. of this paragraph, respectively.

(d) Any owner or operator of a flat wood paneling coating line subject to this rule and complying with Paragraph (3) of this rule by the use of control devices shall comply with the following:

1. By April 22, 1994, or upon startup of a new coating line, or upon changing the method of compliance for an existing coating line from the use of complying coatings or weighted averaging to control devices, the owner or operator of the subject coating line shall perform or shall have performed, as applicable, a compliance test. Testing shall be pursuant to the procedures in this chapter and Paragraph (6) of this rule. No later than 60 days after the completion of the performance testing, the owner or operator of the subject coating line shall submit to the Technical Secretary the results of all tests and calculations necessary to demonstrate that the subject coating line is in compliance.

2. On and after April 22, 1994, or on and after the initial startup date, the owner or operator shall collect and record all of the following information each day for each coating line and maintain the information for a period of 3 years:

(i) The name and identification number of each coating used;

(ii) The mass of VOC per area of surface to which the coating is applied in terms of kg VOC/100 m (lb VOC/1,000 ft ), and the surface area coated;

(iii) The maximum VOC content (mass of VOC per area of surface to which the coating is applied in terms of kg VOC/100 m [lb VOC/1,000 ft ] or the weighted average VOC content (mass of VOC per area of surface to which the coating is applied in terms of kg VOC/100 m [lb VOC/1,000 ft ]) of the coatings used;

(iv) The required overall emission reduction efficiency as determined in Subparagraph (6)(b) of this rule;

(v) The actual overall emission reduction efficiency achieved as determined in this chapter;

(vi) Control device monitoring data;

(vii) A log of operating time for the capture system, control device, monitoring equipment, and the associated coating line;

(viii) A maintenance log for the capture system, control device, and monitoring equipment detailing all routine and non-routine maintenance performed including dates and duration of any outages;

(ix) For thermal incinerators, all 3-hour periods of operation in which the average combustion temperature was more than 28°C (50°F) below the average combustion temperature during the most recent performance test that demonstrated that the facility was in compliance;

(x) For catalytic incinerators:

(I) Continuous records of the temperature of the gas stream both upstream and downstream of the incinerator;

(II) Records of all 3-hour periods of operation for which the average temperature measured befoe the catalyst bed is more than 28°C (50°F) below the gas stream temperature measured before the catalyst bed during the most recent determination of destruction efficiency of the catalytic incinerator that demonstrated that the facility was in compliance; and (III) Records of all 3-hour periods for which the average temperature across the catalyst bed is less than 80 percent of the temperature difference measured during the most recent determination of the destruction efficiency of the catalytic incinerator that demonstrated that the facility was in compliance.

(xi) For carbon adsorbers, all 3-hour periods of operation during which the average VOC concentration or reading of organics in the exhaust gases is more than 20 percent greater than the average exhaust gas concentration or reading measured by the organics monitoring device during the most recent determination of the recovery efficiency of the carbon adsorber that demonstrated that the facility was in compliance. This specification applies only to carbon adsorbers for which stack emission testing was required to demonstrate compliance with a standard of this chapter.

3. On and after April 22, 1994, the owner or operator shall notify the Technical Secretary of any instance of noncompliance with the applicable requirements for control devices, such instance of noncompliance including any period of operation during which the parameter boundaries established during the most recent performance test are exceeded as specified in Subparts 2.(ix), (x), and (xi) of this subparagraph, by sending a copy of that notice to the Technical Secretary within 30 calendar days following the occurrence.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1992; effective July 10, 1979. Amendment filed March 23, 1981; effective May 7, 1981. Amendment filed January 19, 1983; effective February 18, 1983. Amendment filed September 26, 1986; effective November 10, 1986. Amendment filed September 22, 1988; effective November 6, 1988. Amendment filed September 22, 1989; effective November 11, 1989. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993. Amendment filed July 27, 1995; effective October 9, 1995.

Tenn. Comp. R. & Regs. 1200-03-18-.22 through 1200-18-.24, 1200-03-18-.28 and 1200-03-18-.29, or;

2. This rule applies to any facility subject to rules 1200-03-18-.78 or .79.

(b) Any storage vessel with a capacity of 37.9 m3 (10,000 gal.) or less shall comply with the standard as prescribed in Subparagraph (3)(d) of this rule.

(c) Any storage vessel subject to rules 1200-03-18-.22 through 1200-18-.24, 1200-03-18- .28 and 1200-03-18-.29 shall not be subject to the standards of this rule.

(2) For the purpose of this rule, the following definitions, with precedence as listed below, apply:

(a) Any applicable definition in Subparagraph 1200-03-18-.01 of this chapter.

(b) Any applicable definition in rules 1200-03-18-.28 and 1200-03-18-.29, 1200-03-18-.22 through 1200-03-18-.24 of this chapter.

(c) Any definition in 40 C.F.R Part 60, subparts K, Ka, and Kb. The provisions of 40 C.F.R.

Part 60, subparts K, Ka, and Kb are hereby incorporated by reference as published in the July 1, 2022, edition of the Code of Federal Regulations.

(3) Standards for Volatile Organic Compounds:

(a) Each fixed roof tank with a design capacity greater than 37.9 m3 (10,000 gal.) shall be equipped with an internal floating roof meeting the following specifications or a vapor control system meeting the specification of Part 9. of this Subparagraph:

1. The internal floating roof shall rest or float on the liquid surface (but not necessarily in complete contact with it) inside a storage vessel that has a fixed roof, except during initial fill and during those intervals when the storage vessel is emptied or subsequently emptied and refilled.

2. Each internal floating roof shall be equipped with one of the following closure devices between the wall of the storage vessel and the edge of the internal floating roof:

(i) A foam-or liquid-filled seal mounted in contact with the liquid (liquidmounted seal). A liquid-mounted seal means a foam-or liquid-filled seal mounted in contact with the liquid between the wall of the storage vessel and the floating roof continuously around the circumference of the tank.

(ii) Two seals mounted one above the other so that each forms a continuous closure that completely covers the space between the wall of the storage vessel and the edge of the internal floating roof. The lower seal may be vapor-mounted, but both must be continuous.

(iii) A mechanical shoe seal. A mechanical shoe seal is a metal sheet held vertically against the wall of the storage vessel by springs or weighted levers and is connected by braces to the floating roof. A flexible coated fabric (envelope) spans the annular space between the metal sheet and the floating roof.

3. Each opening in a noncontact interval floating roof except for automatic bleeder vents (vacuum breaker vents) and the rim space vents is to provide a projection below the liquid surface.

4. Each opening in the internal floating roof except for leg sleeves, automatic bleeder vents, rim space vents, column wells, ladder wells, sample wells, and stub drains is to be equipped with a cover or lid which is to be maintained in a closed position at all times (i.e., no visible gap) except when the device is in actual use. The cover or lid shall be equipped with a gasket. Covers on each access hatch and automatic gauge float well shall be bolted except when they are in use.

5. Automatic bleeder vents shall be equipped with a gasket and are to be closed at all times when the roof is floating except when the roof is being floated off or is being landed on the roof leg supports.

6. Rim space vents shall be equipped with a gasket and are to be set to open only when the internal floating roof is not floating or at the manufacturer’s recommended setting.

7. Each penetration of the internal floating roof for the purpose of sampling shall be a sample well. The sample well shall have a slit fabric cover that covers at least 90 percent of the opening.

8. Each penetration of the internal floating roof that allows for passage of a ladder shall have a gasketed sliding cover.

9. A closed vent system and control device meeting the following specifications:

(i) The closed vent system shall be designed to collect all VOC vapors and gases discharged from the storage vessel and operated with no detectable emission as indicated by an instrument reading of less than 500 ppm above background, and;

(ii) The control device shall be designed and operated to reduce inlet VOC emissions by 95 percent or greater.

(b) Each external floating roof tank shall meet the following specifications:

1. Each external floating roof shall be equipped with a closure device between the wall of the storage vessel and the roof edge. The closure device is to consist of two seals, one above the other. The lower seal is referred to as the primary seal, and the upper seal is referred to as the secondary seal.

2. The primary seal shall completely cover the annular space between the edge of the floating roof and tank wall and shall be either a liquid mounted seal or a shoe seal.

3. The secondary seal shall completely cover the annular space between the external floating roof and the wall of the storage vessel in a continuous fashion.

4. The tank shall be equipped with the closure device after the effective date of this

rule.

5. Except for automatic bleeder vents and rim space vents, each opening in a noncontact external floating roof shall provide a projection below the liquid surface. Except for automatic bleeder vents, rim space vents, roof drains, and leg sleeves, each opening in the roof is to be equipped with a gasketed cover, seal, or lid that is to be maintained in a closed position at all times (i.e., no visible gap) except with the device is in actual use. Automatic bleeder vents are to be closed at all times when the roof is floating except when the roof is being floated off or is being landed on the roof leg supports. Rim vents are to be set to open when the roof is being floated off the roof leg supports or at the manufacturer’s recommended setting. Automatic bleeder vents and rim space vents are to be gasketed. Each emergency roof drain is to be provided with a slotted membrane fabric cover that covers at least 90 percent of the area of the opening.

6. The roof shall be floating on the liquid at all times (i.e., off the roof leg supports) except when the tank is completely emptied and subsequently refilled. The process of filling, emptying, or refilling when the roof is resting on the leg supports shall be continuous and shall be accomplished as rapidly as possible.

(c) The owner or operator of each storage vessel subject to the Parts (1)(a)1., and 2. of this rule shall equip each storage vessel with a closed vent system and control device as specified in Part 9. of Subparagraph (3)(a) of this rule.

(d) The owner or operator of each storage vessel subject to the Parts (1)(a)1., and 2. and Subparagraph (b) of this rule shall equip each storage vessel port with a cap which is consistent with the vessels manufacturer’s requirements, unless the port is used for pressure relief valve.

(4) The owner or operator of an affected source is subject to the following reporting and recordkeeping requirements:

(a) The owner or operator of an affected source subject to the emission standards in Paragraph (3) of this rule shall demonstrate compliance with those provisions and with the initial compliance certification requirements of Rule 1200-03-18-.04, except that the date for submittal of the initial compliance certification for each existing source as of August 2, 1996, is November 15, 1996, and for each new sources after August 2, 1996, is within 180 days after the start-up of that source.

(b) If a storage vessel has a potential VOC emissions of less than 100 tons per year , the owner or operator of such vessel shall maintain records which document that the potential VOC emissions from those vessels are less than the applicability threshold as specified in Subparagraph (1)(a) of this rule. An owner or operator of such vessel shall submit, upon request by the Technical Secretary, records that document that the vessel is exempt from these requirements. These records shall be submitted to the Technical Secretary within 30 calendar days from the date of request.

(c) The owner or operator of the subject VOC vessel shall perform all testing and maintain the results of all tests and calculations required under Paragraphs (1) and (3) of this

rule to demonstrate that the subject source is in compliance and shall maintain these records for a minimum of 5 years, and shall make these records available to the Technical Secretary upon request.

(5) With respect to petitioning for a source-specific compliance schedule according to and as provided for in Rule .07 of this chapter, insure the petition is received by the Technical Secretary no later than February 2, 1997, or October 1, 1996, whichever is earlier, rather than October 22, 1993. Under this paragraph, the applicable date on which a source must be an existing source or before which a state or local agency’s construction permit must have been issued for the source to be eligible to petition for a source-specific compliance schedule is August 2, 1996, rather than April 22, 1993, as specified in the first sentence of Paragraph .07(1) of this chapter.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed May 22, 1996; effective August 2, 1996. Amendments filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-18-.23 BULK GASOLINE TERMINALS

(1) Applicability of this rule is as follows:

(a) This rule applies to all loading racks at any bulk gasoline terminal which deliver liquid product into gasoline tank trucks and to gasoline tank trucks while loading at a terminal subject to this rule.

(b) Any facility that becomes or is currently subject to the provisions of this rule by exceeding the throughput specified in the definition of bulk gasoline terminal in Rule .01 of this chapter will remain subject to these provisions even if its throughput later falls below the applicability threshold.

(2) Standards as follow apply:

(a) Each loading rack at a bulk gasoline terminal subject to this rule shall be equipped with a vapor collection system designed to collect the total volatile organic compound (VOC) vapors displaced from tank trucks during product loading.

(b) Each vapor collection system shall be designed to prevent any VOC vapors collected at one loading rack from passing to another loading rack.

(c) In Davidson, Rutherford, Shelby, Sumner, Williamson, and Wilson Counties, loadings of liquid product into gasoline tank trucks shall be limited to vapor-tight gasoline tank trucks using the following procedures:

1. The owner or operator shall obtain the vapor-tightness documentation described in Subparagraphs (4)(a) and (b) of this rule for each gasoline tank truck that is to be loaded at the bulk gasoline terminal loading rack subject to this rule;

2. The owner or operator shall require the tank identification number, which allows for verification of vapor-tightness documentation, to be recorded as each gasoline tank truck is loaded at the terminal;

3. The owner or operator shall cross-check each tank identification number with the file of tank vapor-tightness documentation within 2 weeks after the corresponding tank is loaded;

4. The terminal owner or operator shall notify the owner or operator of each nonvapor-tight gasoline tank truck loaded at the bulk gasoline terminal loading rack that the truck is not vapor-tight subject to this rule within 3 weeks after the loading has occurred; and 5. The terminal owner or operator shall insure that the non-vapor-tight gasoline tank truck will not be reloaded at the bulk gasoline terminal loading rack subject to this

rule until vapor-tightness documentation for that tank is obtained.

(d) The terminal owner or operator or tank truck owner or operator shall ensure that loadings of any gasoline tank truck at the bulk gasoline terminal loading rack subject to this rule is made only into a tank equipped with vapor collection equipment that is compatible with the terminal’s vapor collection system.

(e) The terminal owner or operator or tank truck operator shall ensure that the terminal’s and the tank truck’s vapor collection systems are connected during each loading of a gasoline tank truck at the bulk gasoline terminal loading racks subject to this rule.

(f) The vapor collection and liquid loading equipment shall be designed and operated to prevent gauge pressure in the tank truck from exceeding 4,500 Pascals (Pa) (450 millimeters [mm] of water) during product loading. This level shall not be exceeded when measured by the procedures specified in Subparagraph (3)(a) of this rule.

(g) No pressure-vacuum vent in the bulk gasoline terminal’s vapor collection system shall begin to open at a system pressure less than 4,500 Pa (450 mm of water).

(h) Each calendar month, the vapor collection system, the vapor control system, and each loading rack handling gasoline shall be inspected during the loading of gasoline tank trucks for liquid or vapor leaks. For purposes of this subparagraph, detection methods incorporating sight, sound, or smell are acceptable. Each detection of a leak shall be recorded and the source of the leak repaired within 15 calendar days after it is detected. Dripping liquid resulting upon disconnect following gasoline transfer shall not constitute a leak.

(i) Emissions to the atmosphere from the vapor collection system due to the loading of gasoline tank trucks shall not exceed 80 milligrams per liter (mg/L) (4.7 grains per gallon [grain/ga]) of gasoline loaded.

(j) Loading of outgoing gasoline tank trucks shall be restricted to the use of submerged fill, with all hatches on the gasoline tank truck kept closed and securely fastened during loading.

(3) Test methods and procedures as follow apply:

(a) For the purpose of determining compliance with Subparagraph (2)(f) of this rule, the following procedures shall be used:

1. Calibrate and install a pressure measurement device (liquid manometer, magnehelic gauge, or equivalent instrument) capable of measuring up to 500 mm (20 inches [in]) of water gauge pressure with +_2.5 mm (0.098 in) of water precision.

2. Connect the pressure measurement device to a pressure tap in the terminal’s vapor collection system, located as close as possible to the connection with the gasoline tank truck.

3. During the performance test, record the pressure every 5 minutes (min) while a gasoline tank truck is being loaded, and record the highest instantaneous pressure that occurs during each loading. Every loading position shall be tested at least once during the performance test.

(b) For the purpose of determining compliance with the mass emission limitations of Subparagraph (2)(i) of this rule, the following reference methods shall be used:

1. For the determination of volume at the exhaust vent:

(i) Reference Method 2B for combustion vapor processing systems; and (ii) Reference Method 2A for all other vapor processing systems.

2. For the determination of total organic compounds concentration at the exhaust vent, Reference Method 25A or 25B. The calibration gas shall be either propane or butane.

(c) Immediately prior to a performance test required for determination of compliance with Subparagraphs (2)(f) and (i) of this rule, all potential sources of vapor leakage in the terminal’s vapor collection system equipment shall be monitored for leaks according to the procedures in Rule .85 of this chapter. The monitoring shall be conducted only while a gasoline tank truck is being loaded. A reading of 10,000 parts per million by volume (ppmv) or greater as methane shall be considered a leak. All leaks shall be repaired prior to conducting the performance test.

(d) The test procedure for determining compliance with Subparagraphs (2)(f) and (i) of this

rule is as follows:

1. All testing equipment shall be prepared and installed as specified in the appropriate test methods;

2. The time period for a performance test shall be not less than 6 hours, during which at least 300,000 liters (L) (80,000 gallons [gal]) of gasoline are loaded. If the throughput criterion is not met during the initial 6 hours, the test may be either continued until the throughput criterion is met, or resumed the next day with another complete 6 hours of testing. As much as possible, testing should be conducted during the 6-hour period in which the highest throughput normally occurs;

3. For intermittent vapor processing systems:

(i) The vapor holder level shall be recorded at the start of the performance test. The end of the performance test shall coincide with a time when the vapor holder is at its original level; and (ii) At least two startups and shutdowns of the vapor processor shall occur during the performance test. If this does not occur under automatically controlled operation, the system shall be manually controlled.

4. The volume of gasoline dispensed during the performance test period at all loading racks whose vapor emissions are controlled by the vapor processing system being tested shall be determined. This volume may be determined from terminal records or from gasoline dispensing meters at each loading rack;

5. An emission testing interval shall consist of each 5-minute period during the performance test. For each interval:

(i) The reading from each measurement instrument shall be recorded; and (ii) The volume exhausted and the average total organic compounds concentration in the exhaust vent shall be determined, as specified in the appropriate test method. The average total organic compounds concentration shall correspond to the volume measurement by taking into account the sampling system response time;

6. The mass emitted during each testing interval shall be calculated as follows:

M ei = 10 -6 KV es C e where:

M ei = Mass of total organic compounds (milligrams [mg]) emitted during testing interval i;

V es = Volume of air-vapor mixture exhausted (cubic meters [m ]), at standard conditions;

C e = Total organic compounds concentration (measured as carbon) at the exhaust vent (ppmv);

K = Density of calibration gas (milligrams/cubic meter [mg/m ]) at standard conditions; = 1.83 x 10 for propane; = 2.41 x 10 for butane; and s = Standard conditions, 20°C and 760 millimeters of mercury (mm Hg); and 7. The total organic compounds mass emissions shall be calibrated as follows: n Σ M ei E = i = 1 L where:

E = mass of total organic compounds emitted per volume of gasoline loaded, mg/L;

M ei = mass of total organic compounds emitted during testing interval i, mg;

L = total volume of gasoline loaded, L; and n = number of testing intervals.

(e) The owner or operator may adjust the emission results to exclude the methane and ethane content in the exhaust vent by any method approved by the Technical Secretary and the EPA.

(4) The owner or operator of a facility subject to the requirements of this rule shall maintain the following records for at least 3 years and shall make these records available to the Technical Secretary upon request:

(a) The tank truck vapor-tightness documentation required under Subparagraph (2)(c) of this rule shall be kept on file at the terminal in a permanent form available for inspection.

(b) The documentation file for each gasoline tank truck shall be updated at least once per year to reflect current test results as determined by Reference Method 27. This documentation shall include, as a minimum, the following information:

1. Test title: Gasoline Delivery Tank Pressure Test--Reference Method 27;

2. Tank owner and address;

3. Tank identification number;

4. Testing location;

5. Date of test;

6. Tester name and signature;

7. Witnessing inspector, if any: Name, signature, and affiliation; and 8. Test results: Actual pressure change in 5 min, mm of water (average for two runs).

(c) A record of each monthly leak inspection required under Subparagraph (2)(h) of this

rule shall be kept on file at the terminal. Inspection records shall include, as a minimum, the following information:

1. Date of inspection;

2. Findings (may indicate either no leaks discovered or the location, nature, and severity of each leak);

3. Leak determination method;

4. Corrective action (date each leak repaired, reasons for any repair interval in excess of 15 calendar days; and 5. Inspector name and signature.

(d) The terminal owner or operator shall keep documentation of all notifications required under Part (2)(c)4. of this rule on file at the terminal.

(e) Daily records shall be maintained of gasoline throughput.

(5) The owner or operator of any facility containing sources subject to this rule shall comply with the requirements in Paragraphs .04(1) and (2) of this chapter.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed March 23, 1981; effective May 7, 1981. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993. Amendment filed July 27, 1995; effective October 9, 1995.

Tenn. Comp. R. & Regs. 1200-03-18-.24 GASOLINE DISPENSING FACILITIES

(1) The provisions of 40 C.F.R. Part 63 Subpart CCCCCC (National Emission Standards for Hazardous Air Pollutants for Source Category: Gasoline Dispensing Facilities) are hereby adopted by reference as published in the July 1, 2023 edition of the Code of Federal Regulations (C.F.R.), except as provided in subparagraphs (a) through (d) of this paragraph.

(a) Any reference contained in 40 C.F.R. 63 Subpart CCCCCC to the:

1. Administrator shall instead be a reference to the Technical Secretary of the Tennessee Air Pollution Control Board, except for specific authorities that have not been delegated to the State of Tennessee;

2. Applicable EPA regional office for the State of Tennessee shall instead be a reference to the EPA Region IV office; and 3. Delegated State authority shall instead be a reference to the Technical Secretary.

(b) If your gasoline dispensing facility (GDF) has a monthly throughput of less than 10,000 gallons of gasoline, and is located in Anderson, Blount, Carter, Cheatham, Davidson, Dickson, Fayette, Hamilton, Hawkins, Haywood, Jefferson, Knox, Loudon, Marion, Meigs, Montgomery, Putnam, Robertson, Rutherford, Sevier, Shelby, Sullivan, Sumner, Tipton, Unicoi, Union, Washington, Williamson, or Wilson Counties, you must also comply with the requirements in 40 C.F.R. § 63.11117(b) and (c).

(c) If your GDF has a monthly throughput of 10,000 gallons of gasoline or more and is located in Anderson, Blount, Carter, Cheatham, Davidson, Dickson, Fayette, Hamilton, Hawkins, Haywood, Jefferson, Knox, Loudon, Marion, Meigs, Montgomery, Putnam, Robertson, Rutherford, Sevier, Shelby, Sullivan, Sumner, Tipton, Unicoi, Union, Washington, Williamson, or Wilson Counties, you must comply with the requirements in 40 C.F.R. § 63.11118.

(d) For any GDF otherwise exempt from Subparagraph (c) of this paragraph based on monthly throughput, if the GDF ever exceeds the applicability threshold specified in Subparagraph (c) of this paragraph, it shall be subject to the requirements of Subparagraph (c) of this paragraph and shall remain subject to those requirements even if its throughput later falls below the threshold. The owner or operator shall inform the Technical Secretary within 30 days following the exceedance.

(e) The owner or operator of any GDF in Davidson, Rutherford, Shelby, Sumner, Knox, Blount, Anderson, Williamson, or Wilson County which has actual emissions from stationary sources of 25 tons or more of volatile organic compounds (VOC) during a calendar year shall report to their permitting authority in accordance with Paragraph (8) of Rule 1200-03-18-.02.

(2) Stage II vapor recovery requirements for GDF in Davidson, Rutherford, Sumner, Williamson, and Wilson counties.

(a) This paragraph applies only to GDF located in Davidson, Rutherford, Sumner, Williamson, and Wilson counties.

(b) Any GDF with an existing Stage II vapor recovery system shall decommission and remove the system no later than July 14, 2019, and no GDF shall install a Stage II vapor recovery system on or after such date.

(c) On and after July 14, 2016, no GDF shall be required to install a Stage II vapor recovery system and a GDF may decommission and remove the GDF’s existing Stage II vapor recovery system.

(d) Any GDF that decommissions and removes a Stage II vapor recovery system shall conduct the decommissioning and removal in accordance with Petroleum Equipment Institute (PEI) guidance, “Recommended Practices for Installation and Testing of Vapor Recovery Systems at Vehicle Fueling Sites, PEI/RP300-09” for removal, notification, and certification.

(e) Any GDF that has a Stage II vapor recovery system must comply with all applicable provisions of Subparagraph (f) of this paragraph until the system is decommissioned and removed.

(f) Stage II vapor recovery.

1. Definitions.

(i) “Vacuum assist system” means the gasoline vapor recovery system that employs a vacuum generating device to effect transfer of gasoline vapor displaced in fueling a vehicle tank to a gasoline storage tank, vapor storage tank, or vapor processing unit.

(ii) “Motor vehicle” means any self-propelled vehicle used to carry people or property on a street or highway.

(iii) “Stage II vapor recovery system” means a system to recover gasoline vapors displaced during dispensing to motor vehicle fuel tanks.

(iv ) “Storage tank or storage vessel” means any stationary tank, reservoir or container used for the storage of a volatile organic liquid.

(v) “Volatile organic liquid” means any substance which is liquid at storage conditions and which contains volatile organic compounds.

2. The owner or operator of each GDF subject to this subparagraph shall comply with the following requirements:

(i) The Stage II vapor recovery system must be approved by the Technical Secretary; certified by the California Air Resources Board; designed, installed, operated, and maintained to recover gasoline vapors displaced during dispensing to motor vehicle fuel tanks; and accessible for inspection and testing.

(ii) The Stage II vapor recovery system shall include for any dispenser and system the following:

(I) Vapor-tight coaxial hose to conduct vapors captured during dispensing, except on new vehicle fueling lines at motor vehicle assembly plants where vapor-tight dual hose on vacuum assist systems may be employed in lieu of vapor-tight coaxial hose;

(II) For balance systems:

I. Installation of piping between the dispenser and the vapor collection tank which precludes liquid blockage in the piping; and II. No device which inhibits immediate testing for dynamic backpressure;

(III) For vacuum assist systems, sufficient vacuum to prevent escape of gasoline vapors during dispensing;

(IV) Vapor-tight piping, fittings, caps, couplers, and adapters; and (V) Maintenance of vapor tightness throughout the vapor recovery system, except during facility storage tank loading, gauging, and sampling and during maintenance and testing necessitating disruption in the integrity of the system.

(iii) Use of any aftermarket or rebuilt parts is restricted to parts approved by the California Air Resources Board.

(iv ) Gasoline shall not be dispensed from a dispensing unit served by or permitted to be served by a component which does not satisfy the following:

(I) Each component required for operation of the system is in place and, to the extent it can be confirmed by sensory inspection, is unimpaired and operational;

(II) Each nozzle boot is not torn in either of the following manners:

I. Triangular - shaped or similar tear 1/2 inch or more to a side, or hole 1/2 inch or more in length; or II. Slit 1 inch or more in length.

(III) Each faceplate or flexible cone is not damaged in the following manner:

I. For balance nozzles and nozzles for aspirator and eductor assist type systems, damage such that the capability to achieve a seal with a fillpipe interface is diminished for an accumulated total of 1/4 of the circumference of the faceplate; or II. For nozzles for vacuum assist systems, more than 1/4 of the flexible cone is missing;

(IV) Each nozzle shutoff mechanism is operational;

(V) Each vacuum producing unit is operational;

(VI) Each vapor processing unit is operational;

(VII) Each fitting, cap, coupler, and adapter is vapor-tight; and (VIII) Each pressure/vacuum relief valve, vapor check valve, and dry break is operational.

(v) The owner or operator shall conspicuously display fueling instructions and information in the gasoline dispensing area. These instructions and this information shall describe to customers clearly the proper procedure to be used for fueling vehicles from the dispenser. These instructions and this information shall include instruction about the proper method of reporting system defects first to facility management, and, then if defects are not corrected, to the Technical Secretary. The notice of the method of reporting to the Technical Secretary shall be displayed no earlier than 3 months after and no later than 6 months after the display of the other instructions and information listed above.

3. Test methods as follow apply:

(i) The test methods found in Appendix J, Technical Guidance - Stage II Vapor Recovery Systems for Control of Vehicle Refueling Emissions at Gasoline Dispensing Facilities, Volume II, EPA - 450/3-91-022b (November 1991), to determine compliance with applicable requirements specified in Part (2)(f)2. of this rule; or (ii) Other methods necessary for demonstration of compliance approved by the Technical Secretary and the EPA.

4. Notification requirements - Each owner or operator of any facility containing sources subject to this subparagraph shall provide the Technical Secretary written notice of any compliance demonstration testing. This notice shall be provided to the Technical Secretary such that the Technical Secretary is informed of the proposed testing at least 14 days before the proposed date of testing, thereby providing the Technical Secretary opportunity to observe the testing.

5. Recordkeeping requirements - Each owner or operator of any facility containing sources subject to this subparagraph shall, except as provided otherwise in this

chapter, maintain required permits and required logs of maintenance at the facility for which the permits are issued and the logs created for a minimum of 3 years. Such records shall be made available to the Technical Secretary upon request.

6. Excess Emissions Report - The owner or operator of any facility containing sources subject to this subparagraph shall comply with the requirements in Paragraph (2) of Rule 1200-03-18-.04.

7. Compliance Demonstration Testing - The owner or operator of any facility containing sources subject to the provisions of this subparagraph shall:

(i) Within 30 days following the occurrence of an incident which could reasonably be expected to have adversely affected the performance of the system, such as excavation near system piping or following replacement of the system, perform applicable testing to demonstrate compliance is maintained; and (ii) Within 5 years following any compliance demonstration for the complete system, demonstrate the system maintains compliance.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed March 8, 1993; effective April 22, 1993. Stay for rules 1200- 03-18-.24(1)(d), 1200-03-18-.24(2), 1200-03-18-.24(3)(c), 1200-03-18-.24(4)(b), 1200-03-18-.24(6)(c), 1200-03-18-.24(d) and 1200-03-18-.24(7) filed April 16, 1993; effective June 21, 1993. Amendment filed April 16, 1993; effective June 21, 1993. Amendment filed May 30, 1996; effective August 10, 1996. Amendment filed December 23, 2003; effective March 7, 2004. Amendments filed October 15, 2004; effective December 29, 2004. Repeal and new rule filed February 14, 2006; effective April 30, 2006. Amendments filed April 15, 2016; effective July 14, 2016. Amendments filed June 2, 2017; effective August 31, 2017. Amendments filed August 6, 2025; effective November 4, 2025.

Tenn. Comp. R. & Regs. 1200-03-18-.25 LEAKS FROM GASOLINE TANK TRUCKS

(1) This rule applies to any gasoline tank truck equipped for gasoline vapor collection. No exemptions are allowable based on number of gasoline tank trucks or total quantity of volatile organic compound (VOC) emissions.

(2) Each owner or operator of a gasoline tank truck subject to this rule shall ensure that the gasoline tank truck:

(a) Is a vapor-tight gasoline tank truck as demonstrated by Reference Method 27.

(b) Operates with hatches open only during measurement of product level or maintenance, with no product loading or unloading conducted during this measurement or maintenance.

(c) Retests for vapor-tightness documentation not more than 12 months from the month of the last vapor-tightness test.

(3) Monitoring for leaks from gasoline tank trucks shall be as follows:

(a) The Technical Secretary may, at any time, monitor a gasoline tank by the procedure referenced in Subparagraph (b) of this paragraph to confirm continuing compliance with this rule.

(b) Monitoring to confirm the continuing existence of leak-tight conditions shall be performed according to the procedures described in Appendix B of the OAQPS Guideline Series document, Control of Organic Compound Leaks from Gasoline Tank Trucks and Vapor Collection Systems, EPA-450/2-78-051.

(c) Within 30 days of detection of a leak, the owner or operator shall certify in writing to the Technical Secretary that repairs have been made.

(4) The test procedure to determine compliance with Subparagraph (2)(a) of this rule shall be Reference Method 27.

(5) Recordkeeping and reporting requirements as follow apply:

(a) The owner or operator of a gasoline tank truck subject to this rule shall maintain records of all certification, testing, and repairs concerning vapor-tightness and leaks.

The records shall identify the gasoline tank truck, the date of the tests or repair, and, if applicable, the type of repair and the date of retest. The records shall be maintained for at least 3 years after the date the testing or repair is completed. These records shall be made available to the Technical Secretary upon request.

(b) The records required by Subparagraph (a) of this paragraph with respect to vaportightness shall, as a minimum, contain:

1. The gasoline tank truck vessel tank identification number (serial number);

2. The initial test pressure;

3. The test pressure after 5 minutes;

4. The initial test vacuum;

5. The test vacuum after 5 minutes;

6. The testing company name and the date and location of the test; and 7. The signature of person conducting the test.

(c) The owner or operator of a gasoline tank truck subject to this rule shall certify and report to the Technical Secretary annually that the gasoline tank truck has been tested by Reference Method 27 as specified in Paragraph (4) of this rule. The certification shall include:

1. The name and address of the company and the name and telephone number of the responsible company representative under whose signature the certification is submitted; and 2. A copy of the information recorded to comply with Subparagraph (b) of this paragraph.

(d) Copies of all records and reports under this rule shall be made available to the Technical Secretary upon request.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed March 23, 1981; effective May 7, 1981. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.26 PETROLEUM REFINERY SOURCES

(1) Applicability of this rule is as follows:

(a) This rule applies to any vacuum-producing system, wastewater separator, and process unit turnaround at petroleum refinery sources. No exemptions are allowable based on size or throughput of a facility.

(b) This rule does not apply to segregated storm water run-off drain systems or to noncontact cooling water systems.

(2) For the purpose of this rule, the following definitions apply:

“Accumulator” means the reservoir of a condensing unit receiving the condensate from the condenser.

“Firebox” means the chamber or compartment of a boiler or furnace in which materials are burned but does not mean the combustion chamber of an incinerator.

“Forebays” means the primary sections of a wastewater separator.

“Hot well” means the reservoir of a condensing unit receiving the warm condensate from the condenser.

“Refinery fuel gas” means any gas that is generated by a petroleum refinery process unit and that is combusted, including any gaseous mixture of natural gas and fuel gas.

“Turnaround” means the procedure of shutting a refinery unit down after a run to perform necessary maintenance and repair work and returning the unit to operation.

“Vacuum producing system” means any reciprocating, rotary, or centrifugal blower or compressor, or any jet ejector or device that takes suction from a pressure below atmospheric and discharges against atmospheric pressure.

“Wastewater (oil/water) separator” means any device or piece of equipment that utilizes the difference in density between oil and water to remove oil and associated chemicals from water, or any device, such as a flocculation tank, clarifier, etc., that removes petroleumderived compounds from wastewater.

(3) Standards as follow apply:

(a) No person shall permit the emission of any uncondensed volatile organic compound (VOC) from the condensers, hot wells, or accumulators of any vacuum producing system at a petroleum refinery. The standard shall be achieved by:

1. Piping the uncondensed vapors to a firebox or incinerator, or 2. Compressing the vapors and adding them to the refinery fuel gas.

(b) The owner or operator of any wastewater (oil/water) separator at a petroleum refinery shall:

1. Provide covers and seals on all separators and forebays, and 2. Equip all openings in covers, separators, and forebays with lids or seals and keep the lids or seals in the closed position at all times except when in actual use.

(c) The owner or operator of a petroleum refinery shall provide for the following during process unit turnaround:

1. Depressurization venting of the process unit or vessel to a vapor recovery system, flare, or firebox;

2. No emission of VOC from a process unit or vessel until its internal pressure is 136 kiloPascals (kPa) (19.7 pounds per square inch atmospheric [psia]) or less; and, 3. Recordkeeping of the following items:

(i) Date of every process unit or vessel turnaround; and (ii) The internal pressure of the process unit or vessel immediately prior to venting to the atmosphere.

(4) The owner or operator of a petroleum refinery shall maintain the records required by Part (3)(c)3. of this rule for at least 3 years and shall make these records available to the Technical Secretary upon request.

(5) The owner or operator of any facility containing sources subject to this rule shall comply with the requirements in Paragraphs .04(1) and (2) of this chapter.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed March 23, 1981; effective May 7, 1981. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.27 LEAKS FROM PETROLEUM REFINERY EQUIPMENT

(1) Applicability of this rule is as follows:

(a) This rule applies to all equipment in volatile organic compound (VOC) service in any process unit at a petroleum refinery, regardless of size or throughput.

(b) The requirements of Paragraphs (4) through (8) of this rule do not apply to:

1. Any equipment in vacuum service;

2. Any pressure relief valve that is connected to an operating flare header or vapor recovery device;

3. Any liquid pump that has a dual mechanical pump seal with a barrier fluid system;

4. Any compressor with a degassing vent that is routed to an operating VOC control device; and 5. Pumps and valves in heavy liquid service except that if evidence of a leak is found by visual, audible, olfactory, or other detection method, the owner or operator shall confirm the presence of a leak using the methods specified in Rule .85 of this chapter. If a leak is confirmed, the owner or operator shall repair the leak as specified in Paragraph (7) of this rule.

(2) For the purpose of this rule, the following definitions apply:

(a) “[In] gas/vapor service” means that the piece of equipment in VOC service contains process fluid that is in the gaseous state at operating conditions.

(b) “[In] heavy liquid service” means that the piece of equipment in VOC service is not in gas/vapor service or in light liquid service.

(c) “[In] light liquid service” means that the piece of equipment in VOC service contains a liquid that meets the following conditions:

1. The vapor pressure of one or more of the components is greater than 0.3 kPa (0.044 in Hg) at 20°C (68°F) (standard reference texts or ASTM D2879 shall be used to determine the vapor pressures);

2. The total concentration of the pure components having a vapor pressure greater than 0.3 kPa (0.044 in. Hg) at 20°C (68°F) is equal to or greater than 20 percent by weight; and 3. The fluid is a liquid at operating conditions.

(d) “[In] vacuum service” means that the equipment in VOC service is operating at an interval pressure which is at least 5 kPa below ambient pressure.

(e) “[In] VOC service” means that the piece of equipment contains or contacts a process fluid that is at least 10 percent VOC by weight. The provisions of Subparagraph (9)(b) of this rule specify how to determine that a piece of equipment is not in VOC service.

(3) The owner or operator of a petroleum refinery complex subject to this regulation shall ensure that:

(a) Any open-ended line or valve is sealed with a second valve, blind flange, cap, or plug except during operations requiring process fluid flow through the open-ended line or valve;

(b) When a second valve is used, each open-ended line or valve equipped with a second valve is operated in such a manner that the valve on the process fluid end is closed before the second valve is closed; and (c) When a double block-and-bleed system is used, the bleed valve or line is open only during operations that require venting of the line between the block valves and is closed at all other times.

(4) Equipment inspection program standards as follow apply:

(a) The owner or operator of a petroleum refinery shall conduct quarterly monitoring of each:

1. Compressor;

2. Pump in light liquid service;

3. Valve in light liquid service, except as provided in Paragraphs (5) and (6) of this

rule;

4. Valve in gas/vapor service, except as provided in Paragraphs (5) and (6) of this

rule; and 5. Pressure relief valve in gas/vapor service, except as provided in Paragraphs (5) and (6) of this rule.

(b) The owner or operator of a petroleum refinery shall conduct a weekly visual inspection of each pump in light liquid service;

(c) The owner or operator of a petroleum refinery shall monitor each pressure relief valve after each overpressure relief to ensure that the valve has properly reseated and is not leaking;

(d) When an instrument reading of 10,000 parts per million (ppm) or greater is measured, it shall be determined that a leak has been detected;

(e) If there are indications of liquid dripping from the equipment, it shall be determined that a leak has been detected; and (f) When a leak is detected, the owner or operator shall affix a weatherproof, readily visible tag in a bright color such as red or yellow bearing the equipment identification number and the date on which the leak was detected. This tag shall remain in place until the leaking equipment is repaired. The requirements of this subparagraph apply to any leak detected by the equipment inspection program and to any leak from any equipment that is detected on the basis of sight, sound, or smell.

(5) Alternative standards for skip period leak detection and repair apply as follows:

(a) An owner or operator shall comply initially with the requirements for valves in gas/vapor service and valves in light liquid service, as described in Paragraph (4) of this rule.

(b) After two consecutive quarterly leak detection periods with the percent of valves leaking equal or less than 2.0, an owner or operator may begin to skip one of the quarterly leak detection periods for the valves in gas/vapor and light liquid service.

(c) After five consecutive quarterly leak detection periods with the percent of valves leaking equal to or less than 2.0, an owner or operator may begin to skip 3 of the quarterly leak detection periods for the valves in gas/vapor and light liquid service.

(d) If the percent of valves leaking is greater than 2.0, the owner or operator shall comply with the requirements as described in Paragraph (4) of this rule but can again elect to use the requirements in Paragraph (5) of this rule.

(e) The percent of valves leaking shall be determined by dividing the sum of valves found leaking during current monitoring and valves for which repair has been delayed by the total number of valves subject to the requirements of this rule.

(f) An owner or operator shall keep a record of the percent of valves found leaking during each leak detection period.

(6) Alternative standards for unsafe-to-monitor valves and difficult-to-monitor valves apply as follow:

(a) Any valve that is designated, as described in Part (10)(e)1. of this rule, as an unsafe-tomonitor valve is exempt from the requirements of Paragraph (4) if:

1. The owner or operator of the valve demonstrates that the valve is unsafe to monitor because monitoring personnel would be exposed to an immediate danger as a consequence of complying with Paragraph (4); and 2. The owner or operator of the valve adheres to a written plan that requires monitoring of the valve as frequently as practicable during safe-to-monitor times.

(b) Any valve that is designated, as described in Part (10)(e)2., as a difficult-to-monitor valve is exempt from the requirements of Paragraph (4) if:

1. The owner or operator of the valve demonstrates that the valve cannot be monitored without elevating the monitoring personnel more than 2 meters (m)

(6.6 feet [ft]) above a support surface; and 2. The owner or operator of the valve follows a written plan that requires monitoring of the valve at least once per calendar year.

(7) The owner or operator of a petroleum refinery shall:

(a) Make a first attempt at repair for any leak not later than 5 calendar days after the leak is detected; and (b) Repair any leak as soon as practicable, but not later than 15 calendar days after it is detected except as provided in Paragraph (8) of this rule.

(8) Delay of repair standards apply as follow:

(a) Delay of repair of equipment for which a leak has been detected will be allowed if the repair is technically infeasible without a process unit shutdown. Repair of such equipment shall occur before the end of the next process unit shutdown.

(b) Delay of repair of equipment will be allowed for equipment that is isolated from the process and that does not remain in VOC service.

(c) Delay of repair beyond a process unit shutdown will be allowed for a valve, if valve assembly replacement is necessary during the process unit shutdown, valve assembly supplies have been depleted, and valve assembly supplies had been sufficiently stocked before the supplies were depleted. Delay of repair beyond the next process unit shutdown will not be allowed unless the next process unit shutdown occurs sooner than 6 months after the first process unit shutdown.

(9) Test methods and procedures apply as follow:

(a) In conducting the tests required to comply with Paragraph (4) of this rule, the owner or operator shall use the test methods specified in Rule .85 of this chapter.

(b) The owner or operator shall test each piece of equipment as required under Paragraph (4) of this rule unless it is demonstrated that a process unit is not in VOC service, i.e., that the VOC content would never be reasonably expected to exceed 10 percent by weight. For purposes of this demonstration, the following methods and procedures shall be used:

1. Procedures that conform to the general methods in ASTM E260, E168, and E169 shall be used to determine the percent VOC content in the process fluid that is contained in or contacts a piece of equipment;

2. Where the test methods in Part 1. of this subparagraph also measure exempt compounds, these compounds may be excluded from the total quantity of organic compounds in determining the VOC content of the process fluid; and 3. Engineering judgment may be used to estimate the VOC content, if a piece of equipment had not been shown previously to be in VOC service. If the Technical Secretary disagrees with the judgment, Parts 1. and 2. of this subparagraph shall be used to resolve the disagreement.

(c) The owner or operator shall demonstrate that a piece of equipment is in light liquid service by showing that:

1. All of the following conditions apply:

(i) The vapor pressure of one or more of the components is greater than 0.3 kiloPascals (kPa) at 20°C (0.09 inches of Mercury [in Hg] at 68°F); standard reference texts or ASTM D2879 shall be used to determine the vapor pressures;

(ii) The total concentration of the pure components having a vapor pressure greater than 0.3 kPa at 20°C (0.09 in Hg at 68°F) is equal to or greater than 20 percent by weight; and (iii) The fluid is a liquid at operating conditions.

2. The percent VOC evaporated is greater than 10 percent at 150°C (302°F) as determined by ASTM D86.

(d) Samples used in conjunction with Subparagraphs (b) and (c) of this paragraph shall be representative of the process fluid that is contained in or contacts the equipment.

(10) Recordkeeping requirements apply as follow:

(a) Each owner or operator subject to the provisions of this rule shall comply with the recordkeeping requirements of this rule. Except as noted, these records will be maintained for a minimum of 3 years and shall be made available to the Technical Secretary upon request.

(b) An owner or operator of more than one affected facility subject to the provisions of this

rule may comply with the recordkeeping requirements for these facilities in one recordkeeping system if the system identifies each record by each facility.

(c) When each leak is detected as specified in Paragraph (4) of this rule, the following information shall be recorded in a log and shall be kept for 3 years:

1. The instrument and operator identification numbers and the equipment identification number;

2. The date the leak was detected and the dates of each attempt to repair the leak;

3. The repair methods employed in each attempt to repair the leak;

4. The notation “Above 10,000” if the maximum instrument reading measured by the methods specified in Rule .85 of this chapter after each repair attempt is equal to or greater than 10,000 ppm;

5. The notation “Repair delayed” and the reason for the delay if a leak is not repaired within 15 calendar days after discovery of the leak;

6. The signature of the owner or operator (or designate) whose decision it was that repair could not be effected without a process shutdown;

7. The expected date of successful repair of the leak if a leak is not repaired within 15 calendar days;

8. The dates of process unit shutdowns that occur while the equipment is unrepaired; and 9. The date of successful repair of the leak.

(d) A list of identification numbers of equipment in vacuum service shall be recorded in a log that is kept.

(e) The following information pertaining to all valves subject to the requirements of Paragraph (6) of this rule shall be recorded in a log that is kept for 3 years:

1. A list of identification numbers for valves that are designated as unsafe-tomonitor, an explanation for each valve stating why the valve is unsafe to monitor, and the plan for monitoring each valve; and 2. A list of identification numbers for valves that are designated as difficult-tomonitor, an explanation for each valve stating why the valve is difficult to monitor, and the schedule for monitoring each valve.

(f) The following information for valves complying with Paragraph (5) of this rule shall be recorded in a log that is kept for 3 years:

1. A schedule of monitoring; and 2. The percent of valves found leaking during each monitoring period as noted in Subparagraph (5)(f) of this rule.

(g) Information and data used to demonstrate that a piece of equipment is not in VOC service shall be recorded in a log that is kept 3 years in a readily accessible location for use in determining exemptions as provided in Paragraph (1) of this rule.

(11) The owner or operator of any facility containing sources subject to this rule shall comply with the requirements in Paragraphs .04(1) and (2) of this chapter.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed March 23, 1981; effective May 7, 1981. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.28 PETROLEUM LIQUID STORAGE IN EXTERNAL FLOATING ROOF TANKS

(1) Applicability of this rule is as follows:

(a) This rule applies to any petroleum liquid storage tank that is equipped with an external floating roof and that has a capacity greater than 150,000 liters (L) (40,000 gallons [gal]).

(b) This rule does not apply to any petroleum liquid storage tank that:

1. Is used to store waxy, heavy pour crude oil;

2. Has a capacity less than 1,600,000 L (420,000 gal) and is used to store produced crude oil and condensate prior to lease custody transfer;

3. Contains a petroleum liquid with a maximum true vapor pressure less than 10.5 kiloPascals (kPa) (1.5 pounds per square inch atmospheric [psia]) provided that records are kept consistent with Subparagraph (4)(b) of this rule;

4. Contains a petroleum liquid with a maximum true vapor pressure less than 27.6 kPa (4.0 psia); and (i) Is of welded construction, and (ii) Presently possesses a metallic-type shoe seal, a liquid-mounted foam seal, a liquid-mounted liquid-filled type seal, or other closure device of demonstrated equivalence approved as a revision to the State Implementation Plan; or 5. Is of welded construction, equipped with a metallic-type shoe primary seal and has a secondary seal from the top of the shoe seal to the tank wall (shoemounted secondary seal).

(2) For the purpose of this rule, the following definitions apply:

(a) “Liquid-mounted seal” means a primary seal mounted in continuous contact with the liquid between the tank wall and the floating roof around the circumference of the tank.

(b) “Vapor-mounted seal” means a primary seal mounted so there is an annular vapor space underneath the seal. The annual vapor space is bounded by the bottom of the primary seal, the tank wall, the liquid surface, and the floating roof.

(c) “Waxy, heavy-pour crude oil” means a crude oil with a pour point of 10°C (50°F) or higher as determined by the American Society for Testing and Materials Standard D97- 66, “Test for Pour Point of Petroleum Oils.”

(3) No owner of a petroleum liquid storage vessel subject to this rule shall store a petroleum liquid in that tank unless:

(a) The tank has been fitted with:

1. A continuous secondary seal extending from the floating roof to the tank wall (rim-mounted secondary seal); or 2. A closure or other device that controls VOC emissions with an effectiveness equal to or greater than a seal required under Part 1. of this subparagraph and is approved as a revision to the State Implementation Plan.

(b) All seal closure devices meet the following requirements:

1. There are no visible holes, tears, or other openings in the seal(s) or seal fabric;

2. The seal(s) are intact and uniformly in place around the circumference of the floating roof between the floating roof and the tank wall; and 3. For vapor-mounted primary seals, the accumulated area of gaps exceeding 0.32 centimeters (cm) (0.125 inches [in]) in width between the secondary seal and the tank wall shall not exceed 21.2 square centimeters per meter (cm /m) (1.0 square inches per foot [in /ft]) of tank diameter, as determined by the method in Paragraph (6) of this rule.

(c) All openings in the external floating roof, except for automatic bleeder vents, rim space vents, and leg sleeves, are:

1. Equipped with covers, seals, or lids in the closed position except when the openings are in actual use; and 2. Equipped with projections into the tank that remain below the liquid surface at all times.

(d) Automatic bleeder vents are closed at all times except when the roof is being floated off or being landed on the roof leg supports.

(e) Rim vents are set to open when the roof is being floated off the leg supports or at the manufacturer’s recommended setting.

(f) Emergency roof drains are provided with slotted membrane fabric covers or equivalent covers which cover at least 90 percent of the area of the opening.

(4) The owner or operator of a petroleum liquid storage tank with an external floating roof subject to this rule shall:

(a) Perform routine inspections semi-annually in order to ensure compliance with Paragraph (3) of this rule (the inspections shall include a visual inspection of the secondary seal gap); and (b) Measure the secondary seal gap annually in accordance with Paragraph (6) of this rule when the floating roof is equipped with a vapor-mounted primary seal.

(5) Recordkeeping requirements apply as follow:

(a) The owner or operator of any petroleum liquid storage tank with an external floating roof subject to this rule shall maintain the following records for at least 3 years and shall make copies of the records available to the Technical Secretary upon request:

1. Records of the types of volatile petroleum liquids stored;

2. Records of the maximum true vapor pressure of the liquid as stored; and 3. Records of the results of the inspections performed in accordance with Paragraph (4) of this rule.

(b) The owner or operator of a petroleum liquid storage vessel with an external floating roof exempted from this rule by Part (1)(b)3., but containing a petroleum liquid with a true vapor pressure greater than 7.0 kPa (1.0 psi), shall maintain the following records for at least 3 years and shall make copies of the records available to the Technical Secretary upon request:

1. Records of the average monthly storage temperature;

2. Records of the type of liquid stored; and 3. Records of the maximum true vapor pressure for all petroleum liquids with a true vapor pressure greater than 7.0 kPa (1.0 psia).

(c) The Technical Secretary may, upon written notice, require more frequent inspections or modify the monitoring and recordkeeping requirements, when necessary to accomplish the purposes of this regulation.

(6) Compliance with Part (3)(b)3. of this rule shall be determined by:

(a) Physically measuring the length and width of all gaps around the entire circumference of the secondary seal in each place where a 0.32 cm (0.125 in) uniform diameter probe passes freely (without forcing or binding against the seal) between the seal and tank wall; and (b) Summing the area of the individual gaps.

(7) The owner or operator of any facility containing sources subject to this rule shall comply with the requirements in Paragraphs .04(1) and (2) of this chapter.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed March 23, 1981; effective May 7, 1981. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.29 PETROLEUM LIQUID STORAGE IN FIXED ROOF TANKS

(1) Applicability of this rule is as follows:

(a) This rule applies to any fixed roof petroleum liquid storage tank with a capacity greater than 150,000 liters (L) (40,000 gallons [gal]).

(b) This rule does not apply to any petroleum liquid storage tank that:

1. Has a capacity of less than 1,600,000 L (420,000 gal) and is used to store produced crude oil and condensate prior to lease custody transfer;

2. Is a horizontal underground storage tank used to store JP-4 jet fuel; or, 3. Contains a petroleum liquid with a maximum true vapor pressure less than 10.5 kiloPascals (kPa) (1.5 pounds per square inch atmospheric [psia]), provided that records are maintained consistent with Subparagraph (5)(b) of this rule.

(2) For the purpose of this rule, “Internal floating roof” means a cover or roof in a fixed roof tank that rests upon or is floated upon the petroleum liquid being contained and is equipped with a closure seal or seals to close the space between the roof edge and tank shell.

(3) No owner or operator of a petroleum liquid storage tank subject to this rule shall store petroleum liquid in that tank unless:

(a) The tank is equipped with:

1. An internal floating roof equipped with a closure seal or seals to close the space between the roof edge and tank wall; or 2. An equally effective alternative control, approved as a revision to the State Implementation Plan.

(b) The tank is maintained such that there are no visible holes, tears, or other openings in the seal or any seal fabric or materials.

(c) All openings, except stub drains, are equipped with covers, lids, or seals such that:

1. The cover, lid, or seal is in the closed position at all times except when in actual use;

2. Automatic bleeder vents are closed at all times except when the roof is being floated off or being landed on the roof leg supports; and 3. Rim vents, if provided, are set to open when the roof is being floated off the roof leg supports or at the manufacturer’s recommended setting.

(4) The owner or operator of a petroleum liquid storage tank with a fixed roof subject to this rule shall:

(a) Perform routine, semi-annual, visual inspections of the internal floating roof and its closure seal or seals through roof hatches; and (b) Perform a complete inspection of the cover and seal whenever the tank is emptied and degassed or at least every 10 years, whichever is more frequent. To qualify for the 10 year inspection interval, the primary seal must be either a liquid-mounted or mechanical shoe primary seal. Otherwise if the above mentioned controls are not in place, a complete inspection of the cover and seal must be performed whenever the tank is emptied and degassed or at least every 5 years, whichever is more frequent.

(5) Recordkeeping requirements apply as follows:

(a) The owner or operator of a petroleum liquid storage tank with a fixed roof subject to this

rule shall maintain the following records for at least 3 years and shall make copies of the records available to the Technical Secretary upon request:

1. Records of the types of volatile petroleum liquids stored in that tank;

2. Records of the maximum true vapor pressure of the liquid as stored; and 3. Records of the results of the inspections required in Paragraph (4) of this rule.

(b) The owner or operator of a petroleum liquid storage tank with a fixed roof exempted from this rule by Subparagraph (1)(b), but containing a petroleum liquid with a true vapor pressure greater than 7.0 kPa (1.0 psia), shall maintain the following records for at least 3 years and shall make copies of the records available to the Technical Secretary upon request:

1. Records of the average monthly storage temperature;

2. Records of the type of liquid stored; and 3. Records of the maximum true vapor pressure for any petroleum liquid with a true vapor pressure greater than 7.0 kPa (1.0 psia).

(6) The owner or operator of any facility containing sources subject to this rule shall comply with the requirements in Paragraphs .04(1) and (2) of this chapter.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed March 23, 1981; effective May 1, 1981. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1993; effective April 22, 1993. Amendment filed May 25, 2011; effective August 23, 2011.

Tenn. Comp. R. & Regs. 1200-03-18-.30 LEAKS FROM NATURAL GAS/GASOLINE PROCESSING EQUIPMENT

(1) Applicability of this rule is as follows:

(a) This rule applies to all equipment in volatile organic compound (VOC) service in any process unit at any on-shore natural gas/gasoline processing facility in Davidson, Rutherford, Shelby, Sumner, Williamson, or Wilson County.

(b) This rule does not apply to:

1. Any equipment in vacuum service;

2. Any equipment in heavy liquid service; or 3. Wet gas reciprocating compressors in plants that do not have a VOC control device, such as a flare or a continuously burning process heater or boiler.

(c) The equipment inspection requirements in Paragraph (4) of this rule do not apply to:

1. Any natural gas/gasoline processing facility with a design field gas capacity of less than 2.8 x 10 standard cubic meters (10 x 10 standard cubic feet) per day that does not fractionate natural gas liquids;

2. Any pump with dual pump seals;

3. Any pressure relief valve that is connected to an operating flare header or vapor recovery device; or 4. Any compressor with a degreasing vent that is routed to an operating VOC control device.

(2) For the purpose of this rule, the following definitions apply:

(a) “Equipment” means each pump, compressor, pressure relief device, sampling connection system, open-ended valve or line, valve, and flange or other connector in VOC service or in wet gas service and any devices or systems required by this rule.

(b) “Field gas” means feedstock gas entering the natural gas processing plant.

(c) “[In] gas/vapor service” means that the piece of equipment in VOC service contains process fluid that is in the gaseous state at operating conditions.

(d) “[In] heavy liquid service” means that the piece of equipment in VOC service is not in gas/vapor service or in light liquid service.

(e) “[In] light liquid service” means that the piece of equipment in VOC service contains a liquid that meets the following conditions:

1. The vapor pressure of one or more of the components is greater than 0.3 kPa (0.044 in. Hg) at 20°C (68°C) (standard reference texts or ASTM D2879 shall be used to determine the vapor pressures);

2. The total concentration of the pure components having a vapor pressure greater than 0.3 kPa (0.044 in. Hg) at 20°C (68°F) is equal to or greater than 20 percent by weight; and 3. The fluid is a liquid at operating conditions.

(f) “Liquids dripping” means any visible leakage from a seal including spraying, misting, clouding, and ice formation.

(g) “Natural gas liquids” means the hydrocarbons, such as ethane, propane, butane, and pentane, that are extracted from field gas.

(h) “Natural gas processing plant” (gas plant) means any processing site engaged in the extraction of natural gas liquids from field gas, fractionation of mixed natural gas liquids to natural gas products, or both.

(i) “Nonfractionating plant” means any gas plant that does not fractionate mixed natural gas liquids into natural gas products.

(j) “On-shore” means all facilities except those that are located in the territorial seas or on the outer continental shelf.

(k) “Process unit” means equipment assembled for the extraction of natural gas liquids from field gas, the fractionation of the liquids into natural gas products, or other operations associated with the processing of natural gas products. A process unit can operate independently if supplied with sufficient feed or raw materials and sufficient storage facilities for the products.

(l) “Reciprocating compressor” means a piece of equipment that increases the pressure of a process gas by positive displacement, employing linear movement of the driveshaft.

(m) “[In] vacuum service” means that the equipment in VOC service is operating at an internal pressure which is at least 5 kPa below ambient pressure.

(n) “[In] VOC service” means that the piece of equipment contains or contacts a process fluid that is at least 1 percent VOC by weight. The provisions of Subparagraph (9)(b) of this rule specify how to determine that a piece of equipment is not in VOC service.

(o) “[In] wet gas service” means that a piece of equipment contains or contacts the field gas before the extraction step in the process.

(3) The owner or operator of a natural gas/gasoline processing facility subject to this rule shall ensure that:

(a) Any open-ended line or valve is sealed with a second valve, blind flange, cap, or plug except during operations requiring process fluid flow through the open-ended line or valve;

(b) When a second value is used, each open-ended line or valve equipped with a second valve is operated in such a manner that the valve on the process fluid end is closed before the second valve is closed; and (c) When a double block-and-bleed system is used, the bleed valve or line is open only during operations that require venting of the line between the block valves and is closed at all other times.

(4) Equipment inspection program standards as follow apply:

(a) The owner or operator of a natural gas/gasoline processing facility subject to this rule shall conduct quarterly monitoring of each:

1. Compressor;

2. Pump in light liquid service;

3. Valve in light liquid service, except as provided in Paragraphs (5) and (6) of this

rule;

4. Valve in gas/vapor service, except as provided in Paragraphs (5) and (6) of this

rule; and 5. Pressure relief valve in gas/vapor service, except as provided in Paragraphs (5) and (6) of this rule.

(b) The owner or operator of a natural gas/gasoline processing facility subject to this rule shall conduct a weekly visual inspection of each pump in light liquid service.

(c) The owner or operator of a natural gas/gasoline processing facility subject to this rule shall monitor each pressure relief valve within 5 days after each overpressure relief to ensure that the valve has properly reseated and is not leaking.

(d) Pressure relief device requirements apply as follow:

1. Any pressure relief device that is located in a nonfractionating plant that is monitored only by non-plant personnel may be monitored after a pressure release the next time the monitoring personnel are on-site, instead of within 5 days; but 2. No pressure relief device described in Part 1. of this subparagraph shall be allowed to operate for more than 30 days after a pressure release without monitoring.

(e) Leak provisions apply as follow:

1. When an instrument reading of 10,000 parts per million (ppm) or greater is measured, it shall be determined that a leak has been detected; or 2. If there are indications of liquid dripping from the equipment, it shall be determined that a leak has been detected.

(f) When a leak is detected, the owner or operator shall affix a weatherproof, readily visible tag in a bright color such as red or yellow, bearing the equipment identification number and the date on which the leak was detected. This tag shall remain in place until the leaking equipment is repaired. The requirements of this subparagraph apply to any leak detected by the equipment inspection program and to any leak from any equipment that is detected on the basis of sight, sound, or smell.

(5) Alternative standards for skip period leak detection and repair apply as follows:

(a) An owner or operator shall comply initially with the requirements for valves in gas/vapor service and valves in light liquid service, as described in Paragraph (4) of this rule.

(b) After two consecutive quarterly leak detection periods with the percent of valves leaking equal or less than 2.0, an owner or operator may skip one of the quarterly leak detection periods for the valves in gas/vapor and light liquid service.

(c) After five consecutive quarterly leak detection periods with the percent of valves leaking equal to or less than 2.0, an owner or operator may begin to skip three of the quarterly leak detection periods for the valves in gas/vapor and light liquid service.

(d) If the percent of valves leaking is greater than 2.0, the owner or operator shall comply with the requirements as described in Paragraph (4) of this rule but can again elect to use the requirements in Paragraph (5) of this rule.

(e) The percent of valves leaking shall be determined by dividing the sum of valves found leaking during current monitoring and valves for which repair has been delayed by the total number of valves subject to the requirements of this rule.

(f) An owner or operator shall keep a record of the percent of valves found leaking during each leak detection period.

(6) Alternative standards for valves that are unsafe or difficult to monitor apply as follow:

(a) Any valve that is designated, as described in Part (10)(e)1. of this rule, as an unsafe-tomonitor valve is exempt from the requirements of Paragraph (4) if:

1. The owner or operator of the valve demonstrates that the valve is unsafe to monitor because monitoring personnel would be exposed to an immediate danger as a consequence of complying with Paragraph (4); and 2. The owner or operator of the valve adheres to a written plan that requires monitoring of the valve as frequently as practicable during safe-to-monitor times.

(b) Any valve that is designated, as described in Part (10)(e)2., as a difficult-to-monitor valve is exempt from the requirements of Paragraph (4) if:

1. The owner or operator of the valve demonstrates that the valve cannot be monitored without elevating the monitoring personnel more than 2 meters (m)

(6.6 feet [ft]) above a support surface; and 2. The owner or operator of the valve follows a written plan that requires monitoring of the valve at least once per calendar year.

(7) The owner or operator of a natural gas/gasoline processing facility shall:

(a) Make a first attempt at repair for any leak not later than 5 calendar days after the leak is detected; and (b) Repair any leak as soon as practicable, but not later than 15 calendar days after it is detected except as provided in Paragraph (8) of this rule.

(8) Delay of repair standards apply as follow:

(a) Delay of repair of equipment for which a leak has been detected will be allowed if the repair is technically infeasible without a process unit shutdown. Repair of such equipment shall occur before the end of the next process unit shutdown.

(b) Delay of repair of equipment will be allowed for equipment that is isolated from the process and that does not remain in VOC service.

(c) Delay of repair beyond a process unit shutdown will be allowed for a valve, if valve assembly replacement is necessary during the process unit shutdown, valve assembly supplies have been depleted, and valve assembly supplies had been sufficiently stocked before the supplies were depleted. Delay of repair beyond the next process unit shutdown will not be allowed unless the next process unit shutdown occurs sooner than 6 months after the first process unit shutdown.

(9) Test methods and procedures apply as follow:

(a) In conducting the tests required to comply with Paragraph (4) of this rule, the owner or operator shall use the test methods specified in Rule .85 of this chapter.

(b) The owner or operator shall test each piece of equipment unless it is demonstrated that a process unit is not in VOC service, i.e., that the VOC content would never be reasonably expected to exceed 1 percent by weight. For purposes of this demonstration, the following methods and procedures shall be used:

1. Procedures that conform to the general methods in ASTM E260, E168 and E169 shall be used to determine the percent VOC content in the process fluid that is contained in or contacts a piece of equipment;

2. Where the test methods in Part 1. of this subparagraph also measure exempt compounds, these compounds may be excluded from the total quantity of organic compounds in determining the VOC content of the process fluid; and 3. Engineering judgment may be used to estimate the VOC content, if a piece of equipment had not been shown previously to be in VOC service. If the Technical Secretary disagrees with this judgment, Parts 1. and 2. of this subparagraph shall be used to resolve the disagreement.

(c) The owner or operator shall demonstrate that a piece of equipment is in light liquid service by showing that all of the following conditions apply:

1. The vapor pressure of one or more of the components is greater than 0.3 kilopascal (kPa) at 20°C (0.09 inches of mercury [in. Hg] at 68°F). Standard reference texts or ASTM D2879 shall be used to determine the vapor pressures;

2. The total concentration of the pure components having a vapor pressure greater than 0.3 kPa at 20°C (0.09 in. Hg at 68°F) is equal to or greater than 20 percent by weight; and 3. The fluid is a liquid at operating conditions.

(d) Samples used in conjunction with Subparagraphs (b) and (c) of this paragraph shall be representative of the process fluid that is contained in or contacts the equipment.

(10) Recordkeeping requirements apply as follow:

(a) Each owner or operator subject to the provisions of this rule shall comply with the recordkeeping requirements of this rule.

(b) An owner or operator of more than one facility subject to the provisions of this rule may comply with the recordkeeping requirements for these facilities in one recordkeeping system if the system identifies each record by facility.

(c) When each leak is detected as specified in Paragraph (4) of this rule, the following information shall be recorded in a log and shall be kept for 3 years in a readily accessible location:

1. The instrument and operator identification numbers and the equipment identification number;

2. The date the leak was detected and the dates of each attempt to repair the leak;

3. The repair methods employed in each attempt to repair the leak;

4. The notation “Above 10,000” if the maximum instrument reading measured by the methods specified in Rule .85 of this chapter after each attempt is equal to or greater than 10,000 ppm;

5. The notation “Repair delayed” and the reason for the delay if a leak is not repaired within 15 calendar days after discovery of the leak;

6. The signature of the owner or operator (or designate) whose decision it was that repair could not be effected without a process shutdown;

7. The expected date of successful repair of the leak if a leak is not repaired within 15 calendar days;

8. The dates of process unit shutdowns that occur while the equipment is unrepaired; and 9. The date of successful repair of the leak.

(d) A list of identification numbers of equipment in vacuum service shall be recorded in a log that is kept in a readily accessible location.

(e) The following information pertaining to all valves subject to the requirements of Paragraph (6) of this rule shall be recorded in a log that is kept for 3 years in a readily accessible location:

1. A list of identification numbers for valves that are designated as unsafe-tomonitor, an explanation for each valve stating why the valve is unsafe to monitor, and the plan for monitoring each valve; and 2. A list of identification numbers for valves that are designated as difficult-tomonitor, an explanation for each valve stating why the valve is difficult to monitor, and the schedule for monitoring each valve.

(f) The following information pertaining to all valves complying with Paragraph (5) of this

rule shall be recorded in a log that is kept for 3 years in a readily accessible location:

1. A schedule of monitoring; and 2. The percent of valves found leaking during each monitoring period.

(g) The following information shall be recorded in a log that is kept for 3 years in a readily accessible location for use in determining exemptions as provided in Paragraph (1) of this rule:

1. An analysis demonstrating the design capacity of the affected facility;

2. Information and data used to demonstrate that a piece of equipment is not in VOC service; and 3. Information and data used to demonstrate that a reciprocating compressor is in wet gas service.

(11) The owner or operator of any facility containing sources subject to this rule shall comply with the requirements in Rule 1200-03-18-.04(1) and (2) of this chapter.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule certified March 2, 1983. Repeal filed April 23, 1992; effective June 7, 1992. New rule filed March 8, 1993; effective April 22, 1993. Amendment filed May 16, 1997; effective July 30, 1997.

Tenn. Comp. R. & Regs. 1200-03-18-.31 SOLVENT METAL CLEANING

(1) This rule applies to all solvent metal cleaning sources with the following exemptions:

(a) Any open top vapor degreasing operation with an open area smaller than 1 square meter (m ) (10.8 square feet [ft ]) is exempt from Subparts (3)(b)3.(ii) and (iv) of this

rule;

(b) Any conveyorized degreaser with an air/solvent interface smaller than 2.0 m (21.5 ft ) is exempt from Part (3)(c)2. of this rule; and (c) Sources within a facility:

1. In Hamilton or Shelby County whose potential VOC emissions from all solvent metal cleaning within the facility are less than 25 tons of volatile organic compounds (VOC’s) per year; or 2. In any county other than Davidson, Hamilton, Rutherford, Shelby, Sumner, Williamson, or Wilson County whose potential VOC emissions from all solvent metal cleaning within the facility are less than 100 tons of volatile organic compounds (VOC’s) per year.

(2) For the purpose of this rule, the following definitions apply:

(a) “Air/solvent interface” means the surface area defined by points of contact between the solvent liquid or vapor in the cleaner/degreaser and the surrounding air.

(b) “Cold cleaning” means the batch process of cleaning and removing soils from a metal surface by spraying, brushing, flushing, or immersion while maintaining the solvent below its boiling point. Wipe cleaning is not included in this definition.

(c) “Conveyorized degreasing” means the process of cleaning and removing soils from a continuous stream of metal parts using either cold or vaporized solvents.

(d) “Freeboard height” means, for a cold cleaner, the distance from the liquid solvent level in the degreaser tank to the lip of the tank. For an open-top vapor degreaser, it is the distance from the vapor level in the tank during idling to the lip of the tank. For a vaporconveyorized degreaser, it is the distance from the vapor level to the bottom of the entrance or exit opening, whichever is lower. For a cold-conveyorized degreaser, it is the distance from the liquid solvent level to the bottom of the entrance or exit opening, whichever is lower.

(e) “Freeboard ratio” means the freeboard height divided by the smaller interior dimension (length, width, or diameter) of the degreaser tank.

(f) “Open-top vapor degreasing” means the process using condensation of hot solvent vapor to clean and remove soils from a batch of metal parts.

(g) “Refrigerated chiller” means a device mounted above both the water jacket and the primary condenser coils which carries a refrigerant that provides a chilled air blanket above the solvent vapor, thereby reducing emissions from the degreaser bath.

(h) “Solvent metal cleaning” means the process of cleaning soils from metal surfaces by cold cleaning, open-top vapor degreasing, or conveyorized degreasing.

(3) Standards as follow apply:

(a) The owner or operator of a cold cleaning facility shall:

1. Equip the cleaner with a cover that is easily operated with one hand, if:

(i) The solvent true vapor pressure is greater than 2 kiloPascals (kPa) (15 millimeters of Mercury [mm Hg] or 0.3 pounds per square inch [psi]) measured at 38C (100°F) by ASTM D323-89;

(ii) The solvent is agitated; or (iii) The solvent is heated;

2. Equip the cleaner with an internal drainage facility so that parts are enclosed under the cover while draining if the solvent true vapor pressure is greater than 4.3 kPa (32 mm Hg or 0.6 psi) measured at 38°C (100°F) by ASTM D323-89, except that the drainage facility may be external for applications where an internal type cannot fit into the cleaning system;

3. Implement one of the following control measures if the solvent true vapor pressure is greater than 4.3 kPa (32 mm of mercury or 0.6 psi) measured at 38°C (100°F) by ASTM D323-89, or if the solvent is heated above 50°C (120°F):

(i) Freeboard that gives a freeboard ratio greater than or equal to 0.7; or (ii) Water cover at least 2.54 centimeters (1 inch) in depth (solvent shall be insoluble in and heavier than water); or (iii) Another system of equivalent control, such as a refrigerated chiller or a arbon adsorber, approved as a revision to the State Implementation Plan;

4. Provide a permanent, legible, conspicuous label, summarizing the operating requirements;

5. Store waste solvent in covered containers;

6. Close the cover whenever parts are not being handled in the cleaner;

7. Drain the cleaned parts until dripping ceases;

8. If used, supply a solvent spray that is a solid fluid stream (not a fine, atomized, or shower-type spray) at a pressure that does not exceed 10 pounds per square inch gauge (psig); and 9. Degrease only materials that are neither porous nor absorbent.

(b) The owner or operator of an open top vapor degreaser shall:

1. Equip the vapor degreaser with a cover that can be opened and closed easily without disturbing the vapor zone;

2. Provide the following safety switches:

(i) A vapor level thermostat that shuts off the sump heat if the condenser coolant is either not circulating or too warm; and (ii) A spray safety switch that shuts off the spray pump if the vapor level drops more than 10 centimeters (cm) (4 inches [in]);

3. Implement one of the following control measures:

(i) Freeboard ratio greater than or equal to 0.75 and, if the degreaser opening is greater than 1 m (10.8 ft ), a powered cover;

(ii) Refrigerated chiller;

(iii) Enclosed design (cover or door opens only when the dry part is actually entering or exiting the degreaser);

(iv) Carbon adsorption system, with ventilation greater than or equal to 15 cubic meters per minute per square meter (m /min/m ) (50 cubic feet per minute per square foot [ft /min/ft ]) of air/solvent interface (when cover is open), and exhausting less than 25 parts per million (ppm) of solvent averaged over one complete adsorption cycle, or 24 hours, whichever is less; or (v) A control system, demonstrated to have a capture efficiency equivalent to or greater than any of the above and approved as a revision to the State Implementation Plan;

4. Keep the cover closed at all times except when processing work loads through the degreaser;

5. Minimize solvent carryout by:

(i) Racking parts so that solvent will drain freely and not be trapped;

(ii) Moving parts in and out of the degreaser at less than 3.3 meters per minute (m/min) (11 feet per minute [ft/min]);

(iii) Holding the parts in the vapor zone at least 30 seconds or until condensation ceases, whichever is longer;

(iv) Tipping out any pools of solvent on the cleaned parts before removal from the vapor zone; and (v) Allowing parts to dry within the degreaser for at least 15 seconds or until visually dry, whichever is longer.

6. Degrease only materials that are neither porous nor absorbent;

7. Occupy no more than one-half of the degreaser’s open top area with a workload;

8. Always spray within the vapor level;

9. Repair solvent leaks immediately, or shut down the degreaser;

10. Store waste solvent only in covered containers;

11. Operate the cleaner such that water cannot be visually detected in solvent exiting the water separator;

12. Use no ventilation fans near the degreaser opening;

13. When the cover is open, not expose the open top vapor degreaser to drafts greater than 40 m/min (131 ft/min), as measured between 1 and 2 m upwind and at the time elevation as the tank lip;

14. If a lip exhaust is used on the open top vapor degreaser, not use a ventilation rate that exceeds 20 m /min/m (65 ft /min/ft ) of degreaser open area, unless a higher rate is necessary to meet OSHA requirements; and 15. Provide a permanent, conspicuous label, summarizing the operating procedures of Parts 4. through 14. of this subparagraph.

(c) The owner or operator of a conveyorized degreaser shall:

1. Use no workplace fans near the degreaser opening, and ensure that exhaust ventilation does not exceed 20 m /min/m (65 ft /min/ft ) of degreaser opening, unless a higher rate is necessary to meet OSHA requirements;

2. Install one of the following control devices:

(i) Refrigerated chiller;

(ii) Carbon adsorption system, with ventilation greater than or equal to 15 m /min/m (50 ft /min/ft ) of air/solvent interface (when downtime covers are open), and exhausting less than 25 ppm of solvent by volume averaged over one complete adsorption cycle, or 24 hours, whichever is less; or (iii) A system demonstrated to have a capture efficiency equivalent to or greater than the device listed in Subpart 2.(i) or (ii) of this subparagraph and approved as a revision to the State Implementation Plan;

3. Equip the cleaner with equipment, such as a drying tunnel or rotating (tumbling) basket, sufficient to prevent cleaned parts from carrying out solvent liquid or vapor;

4. Provide the following safety switches:

(i) A condenser flow switch and thermostat that shut off the sump heat if the condenser coolant is either not circulating or too warm;

(ii) A spray safety switch which shuts off the spray pump or the conveyor if the vapor level drops more than 10 cm (4 in); and (iii) A vapor level control thermostat that shuts off the pump heat when the vapor level rises too high;

5. Minimize openings during operation so that entrances and exits will silhouette workloads with an average clearance between the parts and the edge of the degreaser opening of less than 10 cm (4 in) or less than 10 percent of the width of the opening;

6. Provide downtime covers for closing off the entrance and exit during shutdown hours;

7. Minimize carryout emissions by:

(i) Racking parts so that solvent will drain freely from parts and not be trapped; and (ii) Maintaining the vertical conveyor speed at less than 3.3 m/min (11 ft/min);

8. Store waste solvent only in covered containers;

9. Repair solvent leaks immediately, or shut down the degreaser;

10. Operate the cleaner such that water cannot be visually detected in solvent exiting the water separator;

11. Place downtime covers over entrances and exits of the conveyorized degreaser at all times, except during maintenance activities on the degreaser, when the conveyors and exhausts are not being operated; and 12. Degrease only materials that are neither porous nor absorbent.

(4) Compliance with Parts (3)(a)1. through 3., Subpart (3)(b)3.(iv), Parts (3)(b)7. through 14.,

Part (3)(c)1., and Subpart (3)(c)2.(ii) of this rule shall be determined by applying the following test methods, as appropriate:

(a) Reference Methods 1-4 for determining flow rates.

(b) Reference Method 18 for determining gaseous organic compound emissions by gas chromatography.

(c) Reference Method 25 for determining total gaseous non-methane organic emissions as carbon.

(d) Reference Method 25A or 25B for determining total gaseous organic concentrations using flame ionization or non-dispersive infrared analysis.

(e) ASTM D323-89 for measuring solvent true vapor pressure.

(5) Each owner or operator of a solvent metal cleaning source subject to this rule shall maintain the following records for at least 3 years and shall make these records available to the Technical Secretary upon request:

(a) A record of central equipment maintenance, such as replacement of the carbon in a carbon adsorption unit.

(b) The results of all tests conducted in accordance with the requirements in Paragraph (4) of this rule.

(6) The owner or operator of any facility containing sources subject to this rule shall:

(a) Comply with the initial compliance certification requirements of Paragraph .04(1) of this

chapter;

(b) Comply with the requirements of Paragraph .04(2) of this chapter regarding reports of excess emissions; and (c) Comply with the requirements of Paragraph .04(3) of this chapter for excess emissions related to any control devices used to comply with Subparts (3)(a)3.(iii), (3)(b)3.(iv) or (v), and (3)(c)1.(ii) or (iii) of this rule.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.32 CUTBACK AND EMULSIFIED ASPHALT

(1) This rule applies to the manufacture, mixing, storage, use, and application of cutback and emulsified asphalts. No exemptions are allowable based on the size or throughput of an operation.

(2) For the purpose of this rule, the following definitions apply:

(a) “Asphalt” means a dark-brown to black cementitious material (solid, semisolid, or liquid in consistency) of which the main constituents are bitumens that occur naturally or are a residue of petroleum refining.

(b) “Cutback asphalt” means asphalt cement that has been liquefied by blending with petroleum solvents (diluents). Upon exposure to atmospheric conditions, the diluents evaporate, leaving the asphalt cement to perform its function.

(c) “Emulsified asphalt” means an emulsion of asphalt cement and water that contains a small amount of an emulsifying agent; it is a heterogeneous system containing two normally immiscible phases (asphalt and water) in which the water forms the continuous phase of the emulsion, and minute globules of asphalt form the discontinuous phase.

(d) “Penetrating prime coat” means an application of low-viscosity liquid asphalt to an absorbent surface. It is used to prepare an untreated base for an asphalt surface. The prime coat penetrates the base, plugs the voids, and hardens and helps bind the top of the overlying asphalt course. The penetrating prime coat also reduces the necessity of maintaining an untreated base course prior to placing the asphalt pavement.

(3) Standards as follow apply:

(a) No person shall cause, allow, or permit the manufacture, mixing, storage, use, or application of cutback asphalts April 1 through October 31, except:

1. For long-life stockpile storage; and 2. When the cutback asphalt is to be used solely as a penetrating prime coat.

(b) April 1 through October 31, no person shall cause, allow, or permit the manufacturing, mixing, storage, or use of emulsified asphalt that contains more than 3 percent by volume of volatile organic compounds (VOC) which evaporate at 260 °C (500 °F) as determined by ASTM Method D244-92.

(4) The owner or operator of any facility subject to this rule shall maintain records of the manufacture, mixing, storage, use, or application of any asphalt containing VOC April 1 through October 31. These records shall be maintained for a minimum of 3 years and shall be made available to the Technical Secretary upon request.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed March 8, 1993; effective April 22, 1993. Amendment filed June 10, 2010; effective September 8, 2010.

Tenn. Comp. R. & Regs. 1200-03-18-.33 MANUFACTURING OF SYNTHESIZED PHARMACEUTICAL PRODUCTS

(1) Applicability of this rule is as follows:

(a) This rule applies to the following sources of volatile organic compounds (VOC) at synthesized pharmaceutical manufacturing facilities:

1. Reactors;

2. Distillation operations;

3. Crystallizers;

4. Centrifuges;

5. Vacuum dryers;

6. Air dryers;

7. Production equipment exhaust systems;

8. Rotary vacuum filters and other filters;

9. In-process tanks; and 10. Leaks.

(b) This rule does not apply to sources in a facility:

1. In Hamilton or Shelby County whose potential emissions from all sources listed in Subparagraph (a) of this paragraph within the facility are less than 25 tons of volatile organic compounds (VOC’s) per year; or 2. In any other county except Davidson, Hamilton, Rutherford, Shelby, Sumner, Williamson, and Wilson Counties whose potential VOC emissions from all sources listed in Subparagraph (a) of this paragraph within the facility are less than 100 tons on volatile organic compounds (VOC’s) per year.

(2) For the purpose of this rule, the following definitions apply:

“Production equipment exhaust system” means a device for collecting and directing out of the work area VOC fugitive emissions from reactor openings, centrifuge openings, and other vessel openings for the purpose of protecting workers from excessive VOC exposure.

“Reactor” means a vat or vessel, which may be jacketed to permit temperature control, designed to contain chemical reactions.

“Separation operation” means a process that separates a mixture of compounds and solvents into two or more components. Specific mechanisms include extraction, centrifugation, filtration, and crystallization.

“Synthesized pharmaceutical manufacturing” means manufacture of pharmaceutical products and intermediates by chemical synthesis. The production and recovery of materials produced via fermentation, extraction of organic chemical from vegetative materials or animal tissues, and formulation and packaging of the product are not considered synthesized pharmaceutical manufacturing.

(3) Standards as follow apply:

(a) The owner or operator of a synthesized pharmaceutical manufacturing facility subject to this regulation shall control the VOC emissions from all vents from reactors, distillation operations, crystallizers, centrifuges, and vacuum dryers at the facility that emit 6.8 kilograms per day (kg/day) (15 pounds per day [lb/day]) or more of VOC as determined by the procedure in “Control of Volatile Organic Emissions from Manufacture of Synthesized Pharmaceutical Products,” Appendix B, EPA-450/2-78- 029, December 1978. Surface condensers or equivalent controls shall be used, provided that:

1. If surface condensers are used, the condenser outlet gas temperature shall not exceed the allowable temperature limit described for each associated vapor pressure in the following table; or Allowable Condenser Outlet Gas Temperature °C VOC Vapor Pressure at 20°C, kPa (psi) -25 >40.01 (5.8) -15 >20.0 (2.9) 0 >10.0 (1.5) 10 > 7.0 (1.0) 25 > 3.5 (0.5)

2. If equivalent controls such as carbon adsorption or incineration are used, the VOC emissions shall be reduced by at least as much as they would be by using a surface condenser. The owner or operator shall calculate the efficiency equivalent to a condenser in accordance with the procedures specified on pages 4-2 through 4-6 in “Control of Volatile Organic Emissions from Manufacture of Synthesized Pharmaceutical Products,” Appendix B, EPA-450/2-78-029, December 1978.

(b) The owner or operator of a synthesized pharmaceutical manufacturing facility subject to this regulation shall reduce the VOC emissions from all air dryers and production equipment exhaust systems:

1. By at least 90 percent if emissions are 150 kg/day (330 lb/day) or more of VOC; or 2. To 15.0 kg/day (33 lb/day) or less if emissions are less than 150 kg/day (330 lb/day) of VOC.

(c) The owner or operator of a synthesized pharmaceutical manufacturing facility subject to this regulations shall reduce the VOC emissions from storage tanks by:

1. Providing a vapor balance system or equivalent control that is at least 90 percent effective in reducing emissions from truck or railcar deliveries to storage tanks with capacities greater than 7,500 liters (l) (2,000 gallons [gal]).

2. Installing pressure/vacuum conservation vents set at 0.2 kPa (0.03 pounds per square inch atmospheric [psia]) on all storage tanks that store VOC with vapor pressures greater than 10.0 kPa (1.5 psi) at 20°C (68°F).

(d) The owner or operator of a synthesized pharmaceutical facility subject to this regulation shall enclose all centrifuges, rotary vacuum filters, and other filters having an exposed liquid surface where the liquid contains VOC and exerts a total VOC vapor pressure of 3.50 kPa (0.5 psi) or more at 20°C (68°F).

(e) The owner or operator of a synthesized pharmaceutical facility subject to this regulation shall install covers on all in-process tanks that contain VOC at any time. These covers shall remain closed, unless production, sampling, maintenance, or inspection procedures require operator access.

(f) The owner or operator of a synthesized pharmaceutical manufacturing facility subject to this regulation shall repair all leaks from which a liquid containing VOC can be observed running or dripping. The repair shall be completed as soon as practicable but not later than 15 calendar days after the leak is found. If the leaking component cannot be repaired until the process is shut down, the leaking component shall then be repaired before the process is restarted.

(4) (Reserved).

(5) Monitoring for air pollution control equipment shall be as follows:

(a) At a minimum, continuous monitors for the following parameters shall be installed on air pollution control equipment used to control sources subject to this rule:

1. Destruction device combustion temperature;

2. Temperature rise across a catalytic incinerator bed;

3. VOC concentration on a carbon adsorption unit to determine breakthrough;

4. Outlet gas temperature of a refrigerated condenser; and 5. Temperature of a non-refrigerated condenser coolant supply system.

(b) Each monitor shall be equipped with a recording device.

(c) Each monitor shall be calibrated quarterly.

(d) Each monitor shall operate at all times while the associated control equipment is operating.

(6) Recordkeeping shall be as follows:

(a) The owner or operator of a pharmaceutical manufacturing facility subject to this rule shall maintain the following records:

1. Parameters listed in Paragraph (5) of this rule shall be recorded; and 2. For sources subject to this rule, the solvent true vapor pressure as determined by ASTM D323-89 shall be recorded for every process.

(b) For any leak subject to Subparagraph (3)(f) of this rule, which cannot be readily repaired within 1 hour after detection, the following records shall be kept:

1. The name of the leaking equipment;

2. The date and time the leak is detected;

3. The action taken to repair the leak; and 4. The date and time the leak is repaired.

(7) The owner or operator of any facility containing sources subject to this rule shall comply with the requirements in Paragraphs .04(1) and (2) of this chapter.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed March 8, 1993; effective April 22, 1993. Amendment filed September 7, 1993; effective November 21, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.34 PNEUMATIC RUBBER TIRE MANUFACTURING

(1) Applicability of this rule is as follows:

(a) This rule applies to the following operations in pneumatic rubber tire manufacturing facilities:

1. Undertread cementing;

2. Tread-end cementing;

3. Bead cementing; and 4. Green tire spraying.

(b) The provisions of this rule do not apply to the production of specialty tires for antique or other vehicles when produced on an irregular basis or with short production runs. This exemption applies only to tires produced on equipment separate from normal production lines for passenger-type tires.

(c) This rule does not apply to operations in a facility:

1. In Hamilton or Shelby County whose potential VOC emissions from all operations listed in Subparagraph (a) of this paragraph within the facility are less than 25 tons of volatile organic compounds (VOC’s) per year; or 2. In any other county except Davidson, Hamilton, Rutherford, Shelby, Sumner, Williamson, and Wilson Counties whose potential VOC emissions from all operations listed in Subparagraph (a) of this paragraph within the facility are less than 100 tons of volatile organic compounds (VOC’s) per year.

(2) For the purpose of this rule, the following definitions apply:

(a) “Bead cementing operation” means the system that is used to apply cement to the bead rubber before or after it is wound into its final, circular form. A bead cementing operation consists of a cement application station, such as a dip tank, spray booth and nozzles, cement trough and roller or swab applicator, and all other equipment necessary to apply cement to wound beads or bead rubber and to allow evaporation of solvent from cemented beads.

(b) “Green tire” means an assembled, uncured tire.

(c) “Green tire spraying operation” means the system used to apply a mold-release agent and lubricant to the inside and/or outside of green tires to facilitate the curing process and to prevent rubber from sticking to the curing press. A green tire spraying operation consists of a booth where spraying is performed, the spray application station, and related equipment, such as the lubricant supply system.

(d) “Passenger-type tire” means an agricultural, airplane, industrial, mobile home, light- or medium-duty truck, or passenger vehicle tire with a bead diameter up to 50.8 centimeters (cm) (20.0 inches [in.]) and cross-sectional dimension up to 32.5 cm (12.8 in.).

(e) “Pneumatic rubber tire manufacturing” means the production of pneumatic rubber passenger-type tires on a mass-production basis.

(f) “Sidewall cementing operation” means the system used to apply cement to a continuous strip of sidewall component or any other continuous strip component (except combined tread/sidewall component) that is incorporated into the sidewall of a finished tire. A sidewall cementing operation consists of a cement application station and all other equipment, such as the cement supply system and feed and takeaway conveyors, necessary to allow evaporation of solvent from the cemented rubber.

(g) “Tread-end cementing operation” means the system used to apply cement to one or both ends of the tread or combined tread/sidewall component. A tread and cementing operation consists of a cement application station and all other equipment, such as the cement supply system and feed and takeaway conveyors, necessary to apply cement to tread ends and to allow evaporation of solvent from the cemented tread ends.

(h) “Undertread cementing operation” means the system used to apply cement to a continuous strip of tread or combined tread/sidewall component. An undertread cementing operation consists of a cement application station and all other equipment, such as the cement system and feed and takeaway conveyors, necessary to apply cement to tread or combined tread/sidewall strips and to allow evaporation of solvent from the cemented tread or combined tread/sidewall.

(i) “Water-based green tire spray” means any mold release agent and lubricant applied to the inside or outside of green tires that contains 12 percent or less, by weight, of VOC as sprayed.

(3) Standards as follow apply:

(a) The owner or operator of an undertread cementing operation subject to this rule shall:

1. Install and operate a capture and control system for emissions from the undertread cementing operation that achieves an overall emission reduction of at least 75 percent calculated according to the procedures in this chapter, or 2. Meet the equipment design and performance specifications in the July 1, 1991, 40 C.F.R. 60.543(j)(1), (2), and (4) through (6), or under paragraphs (j)(1) and (3) through (6), and conduct a control device efficiency performance test to determine compliance as described under Paragraph (j)(7), or 3. Maintain total (uncontrolled) VOC use less than or equal to the levels specified in the July 1, 1991, 40 C.F.R. 60.542(a)(1)(ii)(A) through (E).

(b) The owner or operator of a sidewall cementing operation subject to this rule shall:

1. Install and operate a capture and control system for emissions from the sidewall cementing operation that achieves an overall emission reduction of at least 75 percent calculated according to the procedures in this chapter, or 2. Meet the equipment design and performance specifications in the July 1, 1991, 40 C.F.R. 60.543(j)(1), (2), and (4) through (6) or under paragraphs (j)(1) and (3) through (6), and conduct a control device efficiency performance test to determine compliance as described under Paragraph (j)(7), or 3. Maintain total (uncontrolled) VOC use less than or equal to the levels specified in the July 1, 1991, 40 C.F.R. 60.542(a)(2)(ii)(A) through (E).

(c) Alternate standards for undertread cementing and sidewall cementing as follow apply:

1. The owner or operator of each undertread cementing and sidewall cementing operation at a rubber tire manufacturing facility that meets the criteria in Subparts 2.(i) through (iii) of this subparagraph shall have the option of complying with the alternate standard in the July 1, 1991, 40 C.F.R. 60.542a in lieu of the standards in Subparagraphs (a) and (b) of this paragraph. The election of complying with this option shall be irreversible.

2. The owner or operator may elect to comply with the alternate standard in the July 1, 1991, 40 C.F.R. 60.542(a) provided that the undertread cementing and sidewall cementing operation meets all of the following criteria:

(i) Commenced construction, modification, or reconstruction after January 20, 1983, and before September 15, 1987;

(ii) Uses 25 g or less of VOC per tire per month; and (iii) Does not use a control device to control VOC emissions from these operations.

(d) The owner or operator of a green tire spraying operation subject to this rule:

1. Using only water-based sprays shall meet the g/tire limits in the July 1, 1991, 40 C.F.R. 60.542(a)(5)(i) and (ii).

2. Using only organic solvent-based sprays shall:

(i) Install and operate a capture and control system for emissions from the green tire spraying operation that achieves an overall emission reduction of at least 75 percent calculated according to the procedures in this chapter;

(ii) Meet the equipment design and performance specifications in the July 1, 1991, 40 C.F.R. 60.543(j)(1), (2), and (4) through (6), or under paragraphs (j)(1) and (3) through (6), and conduct a control device efficiency performance test to determine compliance as described under Paragraph (j)(7); or (iii) Meet the g/tire limits in the July 1, 1991, 40 C.F.R. 60.542(a)(6)(ii)(A) through (E).

3. Using both water-based and organic solvent-based sprays shall meet the emission limits in the July 1, 1991, 40 C.F.R. 60.542(a)(7).

(e) The owner or operator of a tread-end cementing operation subject to this rule shall:

1. Install and operate a capture and control system for emissions from these operations that achieves an overall emission reduction of at least 75 percent calculated according to the procedures in this chapter; or 2. Meet the g/tire limit in the July 1, 1991, 40 C.F.R. 60.542(a)(3).

(f) The owner or operator of a bead cementing operation subject to this rule shall:

1. Install and operate a capture and control system for emissions from these operations that achieves an overall emission reduction of at least 75 percent calculated according to the procedures in this chapter; or 2. Meet the g/bead limit in the July 1, 1991, 40 C.F.R. 60.542(a)(4).

(4) The compliance procedures as follow shall be used to determine compliance with the standards in Paragraph (3) of this rule:

(a) An owner or operator of a tread-end cementing operation who does not use a VOC control device and who is seeking to comply with the g/tire standards in Part (3)(e)2. shall:

1. Determine the density and weight fraction VOC (including dilution VOC) of each cement by analysis of the cement using Reference Method 24.

2. Calculate the total mass of VOC used at the tread-end cementing operation for the day (M d ) as follows:

(i) For each tread-end cementing operation subject to this rule for which cement is delivered in batch or via a distribution system that serves only that tread-end cementing operation, use the following equation to calculate the total mass of VOC used per day (M d ): a M d = Σ L ci D ci W oi i = 1 where: a = The number of different cements used during the day that are delivered in batch or via a distribution system that serves only a single operation subject to this rule.

L c = Volume of cement used for a day (liters).

D c = Density of cement (grams per liter).

W o = Weight fraction of VOC in a cement.

(ii) For each tread-end cementing operation subject to this rule for which cement is delivered via a common distribution system that also serves other operations that may or may not be subject to this rule:

(I) Calculate the total mass of VOC used for all operations served by the common distribution system for the day (M): b M = Σ L ci D ci W oi i = l where: b = The number of different cements used during the day that are delivered via a common distribution system that also serves other operations.

(II) Determine the fraction (F o ) of M used at the operation subject to this

rule by comparing the production records and process specifications for the material cemented at the subject operation for the day to the production records and process specifications for all the material cemented at all other operations served by the common distribution system for the day.

(III) Calculate the total mass of VOC used at the operation subject to this

rule for the day (M d ):

M d = MF o where:

M = Total mass of VOC used for a day by all operations served by a common cement distribution system (grams).

F o = Fraction of total mass of VOC used in a day by all operations served by a common cement distribution system that is used by a particular operation subject to this rule served by the common distribution system.

3. Determine the total number of tread or combined tread/sidewall components that receive an application of cement for the day at the tread-end cementing operation subject to this rule (T o ).

4. Calculate the mass of VOC used per tire cemented at the tread-end cementing operation subject to this rule for the day (G):

M d G = T o 5. Calculate the mass of VOC emitted per tire cemented at the tread-end cementing operation subject to this rule for the day (N):

N = G

(b) An owner or operator of a bead cementing operation who does not use a VOC control device and who is seeking to comply with the g/bead standard in Part (3)(f)2. shall:

1. Determine the density and weight fraction VOC of each cement as specified under Part (a)1. of this paragraph.

2. Calculate the total mass of VOC used at the bead cementing operation subject to this rule for the day (M d ) as specified under Part (a)2. of this rule.

3. Determine the number of beads cemented at the operation subject to this rule for the day (B d ) using production records; B d equals the number of beads that receive an application of cement for the day.

4. Calculate the mass of VOC used per bead cemented at the operation subject to this rule (G b ):

M d G b = B d 5. Calculate the mass of VOC emitted per bead cemented at the operation subject to this rule for the day (N b ):

N b = G b (c) For each tread-end cementing operation or each bead cementing operation that uses a VOC control device that destroys VOC (e.g., an incinerator), the owner or operator shall use the following procedure to determine compliance with the g/tire or g/bead standards in Parts (3)(e)2. and (f)2. of this rule:

1. Calculate the mass of VOC used per tire cemented (G) at the tread-end cementing operation subject to this rule as specified under Parts (a)1. through (a)4 of this paragraph, or calculate the mass of VOC used per bead cemented (G b ) at the bead cementing operation subject to this rule as specified in Parts (b)1. through (b)4. of this paragraph.

2. Calculate the mass of VOC emitted per tire cemented (N) or per bead cemented (N b ) at the operation subject to this rule:

N = G(1-R)

N b = G b (1-R) where:

R = Overall efficiency of an emission reduction system (fraction) as determined by the procedures specified in Subparts 3.(i) through 3.(iii) of this subparagraph.

3. For the initial compliance test, determine the overall reduction efficiency (R) as follows:

(i) The owner or operator shall construct a temporary total enclosure around the application and drying areas during the test for the purpose of capturing fugitive VOC emissions. The enclosure shall be maintained at a negative pressure to ensure that all evaporated VOC are measurable.

Determine the fraction (F c ) of total VOC used at the operation subject to this rule that enters the control device: m Σ C bi Q bi i = 1 F c = _____________________ m n Σ C bi Q bi + Σ C fi Q fi i = 1 i = 1 where:

C b = Concentration of VOC in the gas stream in the vents prior to a control device (parts per million by volume);

C f = Concentration of VOC in each gas stream vented directly to the atmosphere from an operation subject to this rule or from a temporary total enclosure around an operation subject to this rule (parts per million by volume); m = The number of vents from the operation subject to this rule to the control device; n = The number of vents from the operation subject to this rule to the atmosphere and from the temporary total enclosure;

Q b = Volumetric flow rate in the vents before a control device (dry standard cubic meters per hour); and Q f = Volumetric flow rate of each stream vented directly to the atmosphere from an operation subject to this rule or from a temporary total enclosure around an operation subject to this rule (dry standard cubic meters per hour).

(ii) Determine the destruction efficiency of the control device (E) by using values of the volumetric flow rate (Q) of each of the gas streams and the VOC concentration (as carbon) (C) of each of the gas streams in and out of the control device: m p Σ C bi Q bi - Σ C ai Q ai i = 1 i = 1 E = _________________________ m Σ C bi Q bi i = 1 where: p = Number of vents after the control device;

C a = Concentration of VOC in the gas stream in the vents after the control device (parts per million by volume); and Q a = Volumetric flow rate in vents after the control device (dry standard cubic meters per hour).

(iii) Determine the overall reduction efficiency (R):

R = EF c 4. If subsequent compliance tests are required, the owner or operator may use the most recently determined overall reduction efficiency (R) if the conditions under which the capture system and control device are being operated have not changed since R was most recently determined. If the conditions under which the capture system and control device are being operated are different from those in effect when R was determined, the owner or operator shall re-establish R as specified in Subparts 3.(i) through 3.(iii).

(d) For each tread-end cementing operation and each bead cementing operation subject to this rule that uses a VOC emission reduction system with a control device that recovers VOC (e.g., a carbon adsorber), the owner or operator shall use the following procedure to determine compliance with the g/tire or g/bead standards specified under Parts (3)(e)2. and (3)(f)2. of this rule:

1. Calculate the mass of VOC used per tire cemented at the operation subject to this rule for the day (G) as specified under Parts (a)1. through (a)4. of this paragraph or the mass of VOC used per bead cemented for the day (G b ) as specified in Parts (b)1. through (b)4. of this paragraph.

2. Calculate the total mass of VOC recovered from the operation subject to this rule for the day (M r ):

M r = L r D r where:

L r = Volume of VOC recovered by a control device for a day (liters); and D r = Density of VOC recovered by a control device (grams per liter).

3. Calculate the overall reduction efficiency for the VOC emission reduction system (R) for the day:

R = M r M o 4. Calculate the mass of VOC emitted per tire cemented at the operation subject to this rule for the day (N) or mass of VOC emitted per bead cemented at the operation subject to this rule for the day (N b ):

N = G(1-R)

N b = G b (1-R)

(e) An instance of operation of a control device outside of the parameter boundaries listed in Paragraph (6) of this rule shall be an instance of excess emission and noncompliance.

(5) Each owner or operator subject to the provisions of this rule shall install, calibrate, maintain, and operate according to the manufacturer’s specifications the following equipment:

(a) Where a thermal incinerator is used for VOC emission reduction, a temperature monitoring device equipped with a continuous recorder for the temperature of the gas stream in the combustion zone of the incinerator. The temperature monitoring device shall have an accuracy of +_1 percent of the combustion temperature being measured in °C or +_0.5 °C, whichever is greater.

(b) Where a catalytic incinerator is used for VOC emission reduction, temperature monitoring devices, each equipped with a continuous recorder, for the temperature in the gas stream immediately before and after the catalyst bed of the incinerator. The temperature monitoring devices shall have an accuracy of +_1 percent of the combustion temperature being measured in °C or +_0.5 °C, whichever is greater.

(c) Where a carbon adsorber is used for VOC emission reduction, and stack emission testing was required to demonstrate compliance with a standard in this rule, an organics monitoring device used to indicate the concentration level of organic compounds based on a detection principle such as infrared, photoionization, or thermal conductivity, equipped with a continuous recorder, for the outlet of the carbon bed.

(6) Recordkeeping requirements as follow apply:

(a) Each owner or operator of a facility subject to this rule that uses a thermal incinerator shall maintain the following records:

1. Continuous records of the temperature of the gas stream in the combustion zone of the incinerator; and 2. Records of all 3-hour periods of operation for which the average temperature of the gas stream in the combustion zone was more than 28°C (50°F) below the combustion zone temperature measured during the most recent determination of the destruction efficiency of the thermal incinerator that demonstrated that the facility was in compliance.

(b) Each owner or operator of a facility subject to this rule that uses a catalytic incinerator shall maintain the following records:

1. Continuous records of the temperature of the gas stream both upstream and downstream of the incinerator;

2. Records of all 3-hour periods of operation for which the average temperature measured before the catalyst bed is more than 28°C (50°F) below the gas stream temperature measured before the catalyst bed during the most recent determination of destruction efficiency of the catalytic incinerator that demonstrated that the facility was in compliance; and 3. Records of all 3-hour periods for which the average temperature difference across the catalyst bed is less than 80 percent of the temperature difference measured during the most recent determination of the destruction efficiency of the catalytic incinerator that demonstrated that the facility was in compliance.

(c) Each owner or operator of a facility subject to this rule that uses a carbon adsorber shall maintain continuous records of all 3-hour periods of operation during which the average VOC concentration level or reading of organics in the exhaust gases is more than 20 percent greater than the reading measured by the organics monitoring device during the most recent determination of the removal efficiency of the carbon adsorber that demonstrated that the facility was in compliance. This specification applies only to carbon adsorbers for which stack emission testing was required to demonstrate compliance with a standard of this rule.

(7) The owner or operator of any facility containing emission sources subject to this rule shall comply with the reporting requirements in Paragraphs .04(1) and (2) of this chapter.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.35 GRAPHIC ARTS SYSTEMS

(1) This rule applies to any packaging rotogravure, publication rotogravure, or flexographic printing press at any facility whose potential VOC emissions from all such printing presses is greater than or equal to 90.7 megagrams (Mg) (100 tons) per year.

(2) For the purpose of this rule, the following definitions apply:

(a) “Flexographic printing press” means a printing press that uses a roll printing technique in which the pattern to be applied is raised above the printing roll and the image carrier is made of rubber or other elastomeric materials.

(b) “Packaging rotogravure printing press” means a rotogravure printing press used to print on paper, paper board, metal foil, plastic film, and other substrates that are, in subsequent operations, formed into packaging products and labels, and other nonpublication products.

(c) “Publication rotogravure printing press” means a rotogravure printing press on which the paper products such as the following are printed:

1. Catalogues, including mail order and premium;

2. Direct mail advertisements, including circulars, letters, pamphlets, cards, and printed envelopes;

3. Display advertisements, including general posters, outdoor advertisements, car cards, window posters; counter and floor displays; point-of-purchase, and other printed display material;

4. Magazines, books;

5. Miscellaneous advertisements, including brochures, pamphlets, catalogue sheets, circular folders, announcements, package inserts, book jackets, market circulars, magazine inserts, and shopping news;

6. Newspapers, magazine and comic supplements for newspapers, and pre-printed newspaper inserts;

7. Periodicals; or 8. Telephone and other directories, including business reference services.

(d) “Rotogravure printing press” means any printing press designed to print on a substrate using a gravure cylinder.

(3) Standards as follow apply:

(a) No owner or operator of a packaging rotogravure or flexographic printing press subject to this rule shall apply any coating or ink unless the VOC content is equal to or less than one of the following:

1. 40 percent VOC by volume of the coating or ink, excluding water, as applied;

2. 25 percent VOC by volume of the volatile content in the coating or ink, as applied; or 3. 0.5 kilogram (kg) VOC per kg (0.5 pound [lb] VOC per lb) coating or ink solids, as applied.

(b) No owner or operator of a publication rotogravure printing press subject to this rule shall apply any coating or ink unless the VOC content is equal to or less than one of the following:

1. 40 percent VOC by volume of the coating or ink, excluding water, as applied; or 2. 25 percent VOC by volume of the volatile content in the coating or ink, as applied.

(c) As an alternative to compliance with the limits in Subparagraphs (a) or (b) of this paragraph, an owner or operator of a packaging rotogravure, publication rotogravure, or flexographic printing press may comply with the requirements of this rule by meeting the requirements of Paragraph (4) or (5) of this rule.

(4) Weighted average limitations as follow apply:

(a) No owner or operator of a packaging rotogravure, publication rotogravure, or flexographic printing press shall apply coatings and/or inks on the subject printing press unless the weighted average, by volume, VOC content of all coatings and/or inks, as applied, each day on the subject printing press is equal to or less than the limitation specified in either Part (3)(a)1. or (3)(b)1. [as determined by Subparagraph (4)(d)];

(3)(a)2. or (3)(b)2. [as determined by Subparagraph (4)(e)]; or, in the case of packaging rotogravure or flexographic printing, (3)(a)3. [as determined by Subparagraph (4)(f)] of this rule.

(b) An owner or operator may comply with the weighted average limitation by grouping coatings and/or inks used on a printing press into two categories that meet the conditions in Parts 1. and 2. of this subparagraph as follow. (Any use of averaging between the two categories of coatings and/ or inks used on a packaging rotogravure press or on a flexographic press requires compliance with the emission standard in

Part (3)(a)3., as determined by the equation in Subparagraph (f) of this paragraph.):

1. The weighted average VOC content for the first category shall comply with Part (3)(a)1. or (3)(b)1. of this rule, as determined by applying the equation in Subparagraph (d) of this paragraph to the coatings and/or inks in this first category.

2. The weighted average VOC content for the second category shall comply with

Part (3)(a)2. or (3)(b)2. of this rule, as determined by applying the equation in Subparagraph (e) of this paragraph to the coatings and/or inks in this second category.

(c) (Reserved)

(d) The following equation shall be used to determine if the weighted average VOC content of all coatings and/or inks, as applied, on the subject printing press exceeds the limitation specified in Part (3)(a)1. or (3)(b)1. of this rule: n Σ L i V VOCi i = 1 VOC (i)(A) = ___________ x 100 n Σ L i (V si + V VOCi ) i = 1 where:

VOC (i)(A) = The weighted average VOC content in units of percent VOC by volume of all coatings and/or inks (excluding water and/or exempt compounds) used each day; i = Subscript denoting a specific coating or ink, as applied; n = The number of different coatings and/or inks, as applied, each day on a printing press;

L i = The liquid volume of each coating or ink, as applied, used that day in units or liters (L) (gallons [gal]);

V si = The volume fraction of solids in each coating or ink, as applied; and V VOCi = The volume fraction of VOC in each coating or ink, as applied.

(e) The following equation shall be used to determine if the weighted average VOC content of all coatings and/or inks, as applied, on the subject printing press exceeds the limitation specified in Part (3)(a)2. or (3)(b)2. of this rule: n Σ L i V VOCi i = 1 VOC (i)(B) = ____________ x 100 n Σ L i V VCi i = 1 where:

VOC (i)(B) = The weighted average VOC content in units of percent VOC by volume of the volatile content of all coatings and/or inks used each day; i = Subscript denoting a specific coating or ink, as applied; n = The number of different coatings and/or inks, as applied, each day on a printing press;

L i = The liquid volume of each coating or ink, as applied, in units or L (gal);

V VOCi = The volume fraction of VOC in each coating or ink, as applied; and V VCi = The volume fraction of volatile matter in each coating or ink, as applied.

(f) The following equation shall be used to determine if the weighted average VOC content of all coatings and/or inks, as applied, on the subject printing press exceeds the limitation specified in Part (3)(a)3. of this rule: n Σ L i D i W VOCi i = 1 VOC (i)(C) = _______________ n Σ L i D i W si i = 1 where:

VOC (i)(C) = The weighted average VOC content in units of mass of VOC per mass of coating and/or ink solids; i = Subscript denoting a specific coating or ink, as applied; n = The number of different coatings and/or inks, as applied, each day on a printing press;

L i = The liquid volume of each coating or ink, as applied, used on the day in units of L (gal);

D i = The density of each coating or ink, as applied, in units of mass of coating or ink per unit volume of coating or ink;

W VOCi = The weight fraction of VOC in each coating or ink, as applied; and W si = The weight fraction of solids in each coating or ink, as applied.

(5) Control device requirements as follow apply:

(a) No owner or operator of a packaging rotogravure, publication rotogravure, or flexographic printing press equipped with a control system shall operate the printing press unless the owner or operator meets the following requirements:

1. A carbon adsorption, incineration, or other control device is used that reduces the VOC emissions delivered from the capture system to the control device by at least 90 percent by weight; and 2. The printing press is equipped with a capture system and control device that provides an overall emission reduction efficiency of at least:

(i) 75 percent for a publication rotogravure printing press;

(ii) 65 percent for a packaging rotogravure printing press; or (iii) 60 percent for a flexographic printing press.

(b) An owner or operator of a packaging rotogravure, publication rotogravure, or flexographic printing press equipped with a control system shall ensure that:

1. A capture system and control device are operated at all times that the printing press is in operation, and the owner or operator demonstrates compliance with this rule through the applicable coating analysis and capture system and control device efficiency test methods specified in this chapter; and 2. The control device is equipped with the applicable monitoring equipment specified in this chapter, and the monitoring equipment is installed, calibrated, operated, and maintained according to the vendor’s specifications at all times the control device is in use.

(6) The VOC content of each coating and ink and the efficiency of each capture system and control device shall be determined by the applicable test methods and procedures specified in this chapter to establish the records required under Paragraph (7) of this rule.

(7) Recordkeeping and reporting requirements as follow apply:

(a) By April 22, 1994, any owner or operator of a printing press that is exempt from the requirements of this rule because of the criteria in Paragraph (1) of this rule shall comply with the following:

1. The owner or operator of a facility in Davidson, Knox, Rutherford, Shelby, Sumner, Williamson, or Wilson County shall certify to the Technical Secretary that the facility is exempt under the provisions of Paragraph (1) of this rule. Such certification shall include:

(i) The name and location of the facility;

(ii) The address and telephone number of the person responsible for the facility;

(iii) A declaration that the facility is exempt from this rule because of the criteria in Paragraph (1) of this rule; and (iv) Calculations demonstrating that total potential VOC emissions of VOC from all flexographic and rotogravure printing presses at the facility are less than 90.7 Mg (100 tons) per calendar year.

2. The owner or operator shall collect and record all of the following information each year for each printing press and maintain the information for a period of 3 years:

(i) The name and identification number of each coating and ink, as applied each year;

(ii) The weight of VOC per volume of coating solids and the volume of solids of each coating and ink, as applied, each year; and (iii) The total emissions as calculated for that year.

3. Any record showing that total emissions of VOC from all flexographic and rotogravure printing presses exceeded 90.7 Mg (100 tons) in any calendar year, before the application of capture systems and control devices, shall be reported by sending a copy of such record to the Technical Secretary within 30 calendar days after the exceedance occurs.

(b) Any owner or operator of a printing press subject to this rule and complying by means of use of complying coatings and/or inks, shall comply with the following:

1. By April 22, 1994,or upon initial startup of a new printing press, the owner or operator of a subject printing press shall certify to the Technical Secretary that the printing press is in compliance with Subparagraph (3)(a) or (3)(b) of this rule.

Such certification shall include:

(i) The name and location of the facility;

(ii) The address and telephone number of the person responsible for the facility;

(iii) Identification of subject sources;

(iv) The name and identification number of each coating and ink, as applied; and (v) The VOC content of all coatings and inks, as applied, expressed in units of the applicable standard.

2. By April 22, 1994, or on and after the initial startup date, the owner or operator of a printing press subject to the limitations of this rule and complying with Subparagraph (3)(a) or (3)(b) shall collect and record all of the following information for each printing press and maintain the information for a period of 3 years:

(i) The name and identification number of each coating and ink used or, in the alternative, each coating and ink kept available for use on the press if only complying coatings and inks are used, as applied; and (ii) The VOC content of each coating and ink, as applied, expressed in units of the applicable standard.

3. Any record showing an exceedance of the VOC content standards of Subparagraph (3)(a) or (3)(b) of this rule shall be reported by the owner or operator of the subject printing press to the Technical Secretary within 30 calendar days following the exceedance; and (c) Any owner or operator of a printing press subject to the limitations of this rule and complying by means of weighted averaging shall comply with the following:

4. By April 22, 1994, or upon initial startup of a new printing press, the owner or operator of the subject printing press shall certify to the Technical Secretary that the printing press is in compliance with Paragraph (4) of this rule. Such certification shall include:

(i) The name and location of the facility;

(ii) The address and telephone number of the person responsible for the facility;

(iii) The name and identification of each printing press which will comply by means of Paragraph (4) of this rule;

(iv) The name and identification number of each coating and/or ink kept in inventory for use on each printing press;

(v) The VOC content of each coating and/or ink, as applied, each day on each printing press, expressed in units necessary to determine compliance;

(vi) The instrument or method by which the owner or operator will accurately measure or calculate the volume of each coating and/or ink, as applied, each day on each printing press;

(vii) The method by which the owner or operator will create and maintain records each day as required in Part 2. of this subparagraph; and (viii) An example of the format in which the records required in Part 2. of this subparagraph will be kept.

2. On and after April 22, 1994, or on and after the initial startup date, the owner or operator of a printing press subject to the limitations of this rule and complying by means of weighted averaging shall collect and record all of the following information each day for each printing press and maintain the information for a period of 3 years:

(i) The name and identification number of each coating and/or ink, as applied;

(ii) The VOC content and the volume of each coating and/or ink, as applied, expressed in units necessary to determine compliance; and (iii) The weighted average VOC content of all coatings and/or inks, as applied;

3. On and after April 22, 1994, the owner or operator of a subject printing press shall notify the Technical Secretary of any instance of noncompliance with Paragraph (4) by sending a copy of the calculation showing such noncompliance to the Technical Secretary within 30 calendar days following the occurrence.

(d) Any owner or operator of a printing press subject to this rule and complying by means of control devices shall comply with Paragraph .03(5) of this chapter.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.36 PETROLEUM SOLVENT DRY CLEANERS

(1) Applicability of this rule is as follows:

(a) This rule applies to petroleum solvent dry cleaning facilities in Davidson, Rutherford, Shelby, Sumner, Williamson, and Wilson Counties.

(b) Of the facilities referred to in Subparagraph (a) of the paragraph, any petroleum solvent dry cleaning facility that consumes less than 123,000 liters (L) (32,500 gallons [gal]) of petroleum solvent per year is subject only to the requirements of Subparagraph (5)(a) of this rule.

(c) This rule does not apply to facilities that use only petroleum-based solvents that contain chlorine.

(2) For the purpose of this rule, the following definitions apply:

(a) “Filter cartridge” means a replaceable filter unit containing filtration paper and carbon or carbon only.

(b) “Perceptible leaks” means any petroleum solvent vapor or liquid leaks that are conspicuous from visual observation or that bubble after application of a soap solution, such as pools or droplets of liquid, open containers of solvent, or solvent-laden waste standing open to the atmosphere.

(c) “Petroleum solvent cartridge filtration system” means a process in which soil-laden solvent is pumped under pressure from a washer through a sealed vessel containing filter cartridges that remove entrained solids and impurities from the solvent.

(d) “Petroleum solvent dry cleaning facility” means a facility engaged in the cleaning of fabrics, clothing, and other articles in a petroleum solvent by means of one or more washes in the solvent, extraction of excess solvent by spinning, and drying by tumbling in an airstream. Equipment at the facility includes, but is not limited to, any petroleum solvent washer, dryer, solvent filter system, settling tank, vacuum still, and any other container or conveyor of petroleum solvent.

(e) “Settling tank” means a container, and any associated piping and ductwork, that gravimetrically separates oils, grease, and dirt from petroleum solvent.

(f) “Solvent filter” means a discrete solvent filter unit containing a porous medium that traps and removes contaminants from petroleum solvent, together with the piping and ductwork used in the installation of this device.

(g) “Solvent recovery dryer” means a class of dry cleaning dryers that employs a condenser to condense and recover solvent vapors evaporated in a closed-loop stream of heated air, together with the piping and ductwork used in the installation of this device.

(h) “Standard dryer” means a device that dries dry-cleaned articles by tumbling in a heated airstream.

(i) “Still” means a device used to volatilize, separate, and recover petroleum solvent from contaminated solvent, together with the piping and ductwork used in the installation of this device.

(j) “Washer” means a machine which agitates fabric articles in a petroleum solvent bath and spins the articles to remove the solvent, together with the piping and ductwork used in the installation of this device.

(3) Standards as follow apply:

(a) The owner or operator of a petroleum solvent dry cleaning facility subject to this rule shall ensure that:

1. There are no perceptible leaks from any portion of the equipment; and 2. All washer lint traps, button traps, access doors, and other parts of the equipment where solvent may be exposed to the atmosphere are kept closed at all times except when opening is required for proper operation or maintenance.

(b) The owner or operator of a petroleum solvent dry cleaning facility subject to this rule shall repair any perceptible leaks in any portion of the dry cleaning equipment within 3 working days after the leak is detected. If necessary repair parts are not on hand, the owner or operator shall order these parts within 3 working days and repair the leaks no later than 3 working days after the parts arrive.

(c) The owner or operator of a petroleum solvent dry cleaning facility subject to this rule shall:

1. Limit the volatile organic compound (VOC) emissions from each standard dryer to 1.6 kilograms (kg) (3.5 pounds [lb]) VOC per 45 kg (100 lb) dry weight of articles dry cleaned, or 2. Install, maintain, and operate a solvent-recovery dryer such that the dryer remains closed and the recovery phase continues until a final recovered solvent flow rate of no greater than 50 milliliters per minute (ml/min) (0.013 gallons per minute [gal/min]) is attained.

(d) The owner or operator of a petroleum solvent filtration system subject to this rule shall:

1. Reduce the VOC content in filtration waste to 1 kg (2.2 lb) VOC per 100 kg (220 lb) dry weight of articles dry cleaned, or 2. As an alternative:

(i) Install, maintain, and operate a cartridge filtration system according to the manufacturer’s instructions, and (ii) Drain all filter cartridges in their sealed housings for 8 hours or more before their removal.

(4) Test methods and procedures as follow apply:

(a) To be in compliance with Part (3)(c)1. of this rule, each owner or operator of a petroleum solvent dry cleaning facility subject to this rule shall:

1. Calculate the weight of VOC’s vented from the dryer emission control device calculated by using Reference Methods 1, 2, and 25A with the following specifications:

(i) Field calibration of the flame ionization analyzer with propane standards;

(ii) Laboratory determination of the ratio of the flame ionization analyzer response to a given parts per million (ppm) by volume concentration of propane to the response to the same ppm concentration of the VOC’s to be measured; and (iii) Determination of the weight of VOC’s vented to the atmosphere by:

(I) Multiplying the ratio determined in Subpart (ii) of this part by the measured concentration of VOC gas (as propane) as indicated by the flame ionization analyzer response output record;

(II) Converting the ppm by volume value calculated in Item (I) of this

subpart into a mass concentration value for the VOC’s present; and (III) Multiplying the mass concentration value calculated in Item (II) of this

subpart by the exhaust flow rate determined by using Reference Methods 1 and 2.

2. Calculate the dry weight of articles dry cleaned; and 3. Repeat Parts 1. and 2. of this subparagraph for normal operating conditions that encompass at least 30 dryer loads, which total not less than 1,800 kg (4,000 lb) dry weight and represent a normal range of variations in fabrics, solvents, load weights, temperatures, flow rates, and process deviations.

(b) To determine initial compliance with Part (3)(c)2. of this rule, the owner or operator of a petroleum solvent dry cleaning facility shall:

1. Verify that the flow rate of recovered solvent from the solvent-recovery dryer at the termination of the recovery phase is no greater than 50 ml/min (0.013 gal/min) by using the following procedure:

(i) Determine the appropriate location for measuring the flow rate of recovered solvent; the suggested point is at the outlet of the solvent-water separator;

(ii) Near the end of the recovery cycle, divert the flow of recovered solvent to a graduated cylinder;

(iii) Continue the cycle until a flow rate of solvent no greater than 50 ml/min (0.013 gal/min) is reached; and (iv) Record the type of articles dry cleaned and the length of the cycle.

2. To determine initial compliance with Part (3)(c)2. of this rule, conduct the procedure in Part 1. of this subparagraph for at least 50 percent of the dryer loads over a period of no less than 2 consecutive weeks.

(c) To be in compliance with Subparagraph (3)(d) of this rule, the owner or operator of a petroleum solvent dry cleaning facility subject to this rule shall:

1. Calculate the weight of volatile organic compounds contained in each of at least five 1-kg (2.2-lb) samples of filtration waste material taken at intervals of at least 1 week, by employing ASTM D322-80 (Standard Test Method for Gasoline Diluent in Used Gasoline Engine Oils by Distillation);

2. Calculate the total dry weight of articles dry cleaned during the intervals between removal of filtration waste samples, as well as the total mass of filtration waste produced in the same period; and 3. Calculate the weight of VOC’s contained in filtration waste material per 100 kg (220 lb) dry weight of articles dry cleaned.

(d) Compliance with Paragraph (3) of this rule requires that each owner or operator of a petroleum solvent dry cleaning facility subject to this rule make weekly inspections of washers, dryers, solvent filters, settling tanks, vacuum stills, and all containers and conveyors of petroleum solvent to identify perceptible VOC vapor or liquid leaks.

(5) Recordkeeping requirements as follow apply:

(a) The owner or operator of a petroleum solvent dry cleaning facility claiming exemption from this regulation by the provisions of Subparagraph (1)(b) shall maintain records of annual solvent consumption for at least 3 years to document whether the applicability threshold in Subparagraph (1)(b) of this rule has been exceeded.

(b) The owner or operator of a petroleum solvent dry cleaning facility subject to this rule shall maintain the following records for at least 3 years:

1. Records of the weight of VOC’s vented from the dryer emission control device calculated according to Part (4)(a)1. of this rule;

2. Records of the dry weight of articles dry cleaned for use in the calculations required in Subparagraphs (4)(a), (4)(b), and (4)(c) of this rule;

3. Records of the weight of VOC’s contained in the filtration waste samples required by Part (4)(c)1. of this rule; and 4. Records of the weight of VOC’s in filtration waste material per 100 kg (220 lb) dry weight of articles dry cleaned.

(6) The owner or operator of any facility containing sources subject to this rule shall:

(a) Comply with the initial compliance certification requirements of Paragraph .04(1) of this

chapter; and (b) Comply with the requirements of Paragraph .04(2) of this chapter for excess emissions related to the control devices required to comply with Subparagraph (3)(b) and Parts (3)(c)2. and (3)(d)2. of this rule.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed March 8, 1993; effective April 22, 1993. Amendment filed July 27, 1995; effective October 9, 1995. Amendment filed May 16, 1997; effective July 30, 1997.

Tenn. Comp. R. & Regs. 1200-03-18-.38 LEAKS FROM SYNTHETIC ORGANIC CHEMICAL, POLYMER, AND RESIN

MANUFACTURING EQUIPMENT.

(1) Applicability of this rule is as follows:

(a) For general applicability:

1. This rule applies to all equipment in volatile organic compound (VOC) service in any process unit at a synthetic organic chemical, polymer, and resin manufacturing facility in Davidson, Rutherford, Shelby, Sumner, Williamson, or Wilson County.

2. A piece of equipment is not in VOC service if the VOC content of the process fluid can never be reasonably expected to exceed 10 percent by weight. For purposes of this demonstration, the following methods and procedures shall be used:

(i) Procedures that conform to the general methods in ASTM E260, E168, and E169 shall be used to determine the percent VOC content in the process fluid that is contained in or contacts a piece of equipment;

(ii) Organic compounds that are not volatile organic compounds, including exempt compounds, may be excluded from the total quantity of organic compounds in determining the VOC content of the process fluid; and (iii) Engineering judgment may be used to estimate the VOC content. If the Technical Secretary disagrees with the judgment, Parts (9)(b)1. and (9)(b)2. of this rule shall be used to resolve the disagreement.

(b) This rule does not apply to any synthetic organic chemical, polymer, or resin manufacturing facility whose annual design production capacity is less than 1,000 megegrams (Mg) (1,100 tons) of product.

(c) The requirements of Paragraph (4) of this rule do not apply to:

1. Any equipment in vacuum service;

2. Any pressure-relief valve that is connected to an operating flare header or vapor recovery device;

3. Any liquid pump that has a dual mechanical pump seal with a barrier fluid system; or 4. Any compressor with a degassing vent that is routed to an operating VOC control device.

(2) For the purpose of this rule, the following definitions apply:

(a) “[In] gas/vapor service” means that the piece of equipment in VOC service contains process fluid that is in the gaseous state at operating conditions.

(b) “[In] heavy liquid service” means that the piece of equipment in VOC service is not in gas/vapor service or in light liquid service.

(c) “[In] light liquid service” means that the piece of equipment in VOC service contains a liquid that meets the following conditions:

1. The vapor pressure of one or more of the components is greater than 0.3 kPa (0.044 in Hg) at 20°C (68°F) (standard reference texts or ASTM D2879 shall be used to determine the vapor pressures);

2. The total concentration of the pure components having a vapor pressure greater than 0.3 kPa (0.044 in Hg) at 20°C (68°F) is equal to or greater than 10 percent by weight; and 3. The fluid is a liquid at operating conditions.

(d) “Process unit” means components assembled to produce, as intermediate or final products, one or more of the chemicals listed in 40 C.F.R. 60.489 as of July 1, 1991. A process unit can operate independently if supplied with sufficient feed or raw materials and sufficient storage facilities for product.

(e) “[In] vacuum service” means that the equipment in VOC service is operating at an internal pressure which is at least 5 kPa below ambient pressure.

(f) “[In] VOC service” means that the piece of equipment contains or contacts a process fluid that is at least 10 percent VOC by weight. The provisions of Part (1)(a)2. of this

rule specify how to determine that a piece of equipment is not in VOC service.

(3) The owner or operator of a synthetic organic chemical, polymer, or resin manufacturing facility subject to this rule shall ensure that:

(a) Any open-ended line or valve is sealed with a second valve, blind flange, cap, or plug except:

1. During operations requiring process fluid flow through the open-ended line or valve; or 2. For an open-ended valve or line containing materials which would autocatalytically polymerize or would present an explosion, serious overpressure, or other safety hazard if capped, plugged, or sealed by a second valve or blind flange;

(b) When a second valve is used, each open-ended line or valve equipped with a second valve is operated in such a manner that the valve on the process fluid end is closed before the second valve is closed; and (c) When a double block-and-bleed system is used, the bleed valve or line is open only during operations that require venting of the line between the block valves and is closed at all other times.

(4) The owner or operator of a synthetic organic chemical, polymer, or resin manufacturing facility shall conduct the equipment inspection program described in Subparagraphs (a) through (c) of this paragraph using the test methods specified in this chapter, leak determination, and tagging procedure as follow:

(a) The owner or operator of a synthetic organic chemical, polymer, or resin manufacturing facility shall conduct quarterly monitoring of each:

1. Compressor;

2. Pump in light liquid service;

3. Valve in light liquid service, except as provided in Paragraphs (5) and (6) of this

rule;

4. Valve in gas/vapor service, except as provided in Paragraphs (5) and (6) of this

rule; and 5. Pressure relief valve in gas/vapor service, except as provided in Paragraphs (5) and (6) of this rule.

(b) The owner or operator of a synthetic organic chemical or resin manufacturing facility shall conduct a weekly visual inspection of each pump in light liquid service.

(c) The owner or operator of a synthetic organic chemical, polymer, or resin manufacturing facility shall inspect each pressure relief valve immediately after each overpressure relief to ensure that the valve has properly reseated and is not leaking.

(d) Leak determination is as follows:

1. When an instrument reading of 10,000 parts per million (ppm) or greater is measured, it shall be determined that a leak has been detected.

2. If there is liquid dripping from the equipment, it shall be determined that a leak has been detected.

(e) When a leak is detected, the owner or operator shall affix a weatherproof, readily visible tag in a bright color such as red or yellow, bearing the equipment identification number and the date on which the leak was detected. This tag shall remain in place until the leaking equipment is repaired. The requirements of this subparagraph apply to any leak detected by the equipment inspection program and to any leak from any equipment that is detected on the basis of sight, sound, or smell.

(f) Following any attempt to repair a leak which it is believed has been successfully repaired, testing by the methods listed in Subparagraph (d) of this paragraph shall be conducted.

(5) An owner or operator shall comply with the requirements for valves in gas/vapor service and valves in light liquid service as described in Paragraph (4) of this rule except as follows:

(a) If the percent of valves leaking is equal or less than 2.0 for two consecutive quarters, an owner or operator may skip alternate quarterly leak detection periods for the valves in gas/vapor and light liquid service;

(b) If the percent of valves leaking is equal to or less than 2.0 for five consecutive quarters, an owner or operator may skip three of the quarterly leak detection periods per year for the valves in gas/vapor and light liquid service, provided that each valve shall be monitored once year year;

(c) If at any time the percent of valves leaking is greater than 2.0, the owner or operator shall resume compliance with the requirements in Paragraph (4) of this rule but may again elect to comply with the alternative standards in this paragraph.

(d) The percent of valves leaking shall be determined by dividing the sum of valves found leaking during current monitoring and previously leaking valves for which repair has been delayed by the total number of valves subject to the requirements of this rule.

(e) An owner or operator shall keep a record of the percent of valves found leaking during each leak detection period.

(6) Alternative standards for unsafe-to-monitor valves and difficult-to-monitor valves apply as follow:

(a) Any valve is exempt from the requirements of Paragraph (4) as an unsafe-to-monitor valve if:

1. The owner or operator of the valve demonstrates that the valve is unsafe-tomonitor because monitoring personnel would be exposed to an immediate danger as a consequence of complying with Paragraph (4); and 2. The owner or operator of the valve adheres to a written plan that requires monitoring of the valve as frequently as practicable during safe-to-monitor times.

(b) Any valve is exempt from the requirements of Paragraph (4) as a difficult-to-monitor valve if:

1. The owner or operator of the valve demonstrates that the valve cannot be monitored without elevating the monitoring personnel more than 2 meters (m)

(6.6 feet [ft]) above a support surface; and 2. The owner or operator of the valve follows a written plan that requires monitoring of the valve at least once per calendar year.

(c) The alternative standards of Paragraph (5) are not available to valves subject to the requirements of this paragraph.

(7) The owner or operator of a synthetic organic chemical, polymer, or resin manufacturing facility refinery shall:

(a) Make a first attempt at repair for any leak not later than 5 calendar days after the leak is detected; and (b) Repair any leak as soon as practicable, but not later than 15 calendar days after it is detected except as provided in Paragraph (8) of this rule.

(8) Delay of repair standards apply as follow:

(a) Delay of repair of equipment for which a leak has been detected will be allowed if repair is technically infeasible without a process unit shutdown. Repair of such equipment shall occur before the end of the first process unit shutdown after detection of the leak.

(b) Delay of repair of equipment will also be allowed for equipment that is isolated from the process and that does not remain in VOC service after detection of the leak.

(c) Delay of repair beyond a process unit shutdown will be allowed for a valve, if valve assembly replacement is necessary during the process unit shutdown, and if valve assembly supplies have been depleted, where valve assembly supplies had been sufficiently stocked before the supplies were depleted. Delay of repair beyond the first process unit shutdown will not be allowed unless the next process unit shutdown occurs sooner than 6 months after the first process unit shutdown.

(9) Test methods and procedures apply as follow:

(a) In conducting the monitoring required to comply with Paragraph (4) of this rule, the owner or operator shall use the test methods specified in this chapter.

(b) The owner or operator shall demonstrate that a piece of equipment is in light liquid service by showing that all of the following conditions apply:

1. The vapor pressure of one or more of the components is greater than 0.3 kiloPascal (kPa) (0.044 inches of mercury [in Hg]) at 20°C (68°F) with standard reference texts or ASTM D2879 used to determine the vapor pressures;

2. The total concentration of the pure components having a vapor pressure greater than 0.3 kPa (0.044 in Hg) at 20°C (68°F) is equal to or greater than 20 percent by weight; and 3. The fluid is a liquid at operating conditions.

(c) Samples shall be representative of the process fluid that is contained in or contacts the equipment.

(10) Recordkeeping requirements apply as follow:

(a) Each owner or operator subject to the provisions of this rule shall comply with the recordkeeping requirements of this rule.

(b) An owner or operator of more than one facility subject to the provisions of this rule may comply with the recordkeeping requirements for these facilities in one recordkeeping system if the system identifies each record by each facility.

(c) When each leak is detected as specified in Paragraph (4) of this rule, the following information shall be recorded in a log and shall be kept for 3 years:

1. The instrument and operator identification numbers and the equipment identification number;

2. The date the leak was detected and the dates of each attempt to repair the leak;

3. The repair methods employed in each attempt to repair the leak;

4. The notation of and the reason for the delay if a leak is not repaired within 15 calendar days after discovery of the leak;

5. The signature of the owner or operator (or designate) whose decision it was that repair could not be effected without a process shutdown;

6. The dates of process unit shutdowns that occur while the equipment is unrepaired; and 7. The date of successful repair of the leak.

(d) A list of identification numbers of equipment in vacuum service shall be recorded in a log that is kept for 3 years.

(e) The following information for valves complying with Paragraph (5) of this rule shall be recorded in a log that is kept for 3 years.

1. A schedule of monitoring, and 2. The percent of valves found leaking during each monitoring period.

(f) The following information pertaining to all valves subject to the requirements of Paragraph (6) of this rule shall be recorded in a log that is kept for 3 years:

1. A list of identification numbers for valves that are designated as unsafe to monitor, an explanation for each valve stating why the valve is unsafe to monitor, and the plan for monitoring each valve, and 2. A list of identification numbers for valves that are designated as difficult to monitor, an explanation for each valve stating why the valve is difficult to monitor, and the schedule for monitoring each valve.

(g) The following information shall be recorded in a log that is kept for 3 years for use in determining exemptions as provided in Paragraph (1) of this rule:

1. An analysis demonstrating the design capacity of the affected facility; and 2. Information and data used to demonstrate that a piece of equipment is not in VOC service.

(11) The owner or operator of any facility containing sources subject to this rule shall comply with the requirements in Paragraphs .04(1) and (2) of this chapter.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed March 8, 1993; effective April 22, 1993. Amendment filed July 27, 1995; effective October 9, 1995. Amendment filed May 16, 1997; effective July 30, 1997.

Tenn. Comp. R. & Regs. 1200-03-18-.39 MANUFACTURE OF HIGH-DENSITY POLYETHYLENE, POLYPROPYLENE, AND

POLYSTYRENE RESINS.

(1) Applicability of this rule is as follows:

(a) This rule applies to the following process sections at facilities in Davidson, Rutherford, Shelby, Sumner, Williamson, and Wilson Counties engaged in the manufacture of highdensity polyethylene, polypropylene, and polystyrene:

1. For the manufacture of high-density polyethylene using a liquid-phase slurry process: each material recovery section and each product finishing section;

2. For the manufacture of polypropylene using a liquid-phase process: each polymerization reaction section, each material recovery section, and each product finishing section; and 3. For the manufacture of polystyrene using a continuous process: each material recovery section.

(b) Facilities having all process sections with uncontrolled emission rates at or below those identified as follow are exempt from the requirements of this rule except that owners or operators seeking to comply with this rule by complying with the uncontrolled emission rates in this subparagraph are still required to comply with the initial certification requirements at Paragraph .04(1) of this chapter:

Uncontrolled emission rate, megagram of product per Production Process Process Section year (Mg/yr)

1. High density material recovery 7 polyethylene, liquid- section phase slurry process.

2. High density product finishing 19 polyethylene, liquid- section phase slurry process 3. Polypropylene, liquid- polymerization reaction 7 phase process section 4. Polypropylene, liquid- material recovery 8 phase process section 5. Polypropylene, liquid- product finishing 36 phase process section 6. Polystyrene, continuous material recovery 7 process section (2) For the purpose of this rule, the following definitions apply:

(a) “Continuous process” means a polymerization process in which reactants are introduced in a continuous manner and products are removed either continuously or intermittently at regular intervals so that the process can be operated and polymers produced essentially continuously.

(b) “Flame zone” means that portion of the combustion chamber in a boiler occupied by the flame envelope.

(c) “High-density polyethylene” means a linear, thermoplastic polymer comprised of at least 50 percent ethylene by weight and having a density greater than 0.94 grams per cubic centimeter (g/cm ) (59 pounds per cubic foot [lb/ft ]).

(d) “Liquid-phase process” means a polymerization process in which the polymerization reaction is carried out in the liquid phase; i.e.,the monomer(s) and any catalyst are dissolved or suspended in a liquid solvent.

(e) “Liquid-phase slurry process” means a liquid-phase polymerization process in which the monomer(s) are in solution (completely dissolved) in a liquid solvent, but the polymer is in the form of solid particles suspended in the liquid reaction mixture during the polymerization reaction, sometimes called a particle-form process.

(f) “Polypropylene” means a polymer comprised of at least 50 percent propylene by weight.

(g) “Polystyrene” means a thermoplastic polymer comprised of at least 80 percent stryene or para-methylstyrene by weight.

(h) “Process line” means a group of equipment assembled that can operate independently if supplied with sufficient raw materials to produce polypropylene, high-density polyethylene, polystyrene. A process line consists of the equipment in the following process sections (to the extent that these process sections are present at a plant): raw materials preparation, polymerization reaction, product finishing, product storage, and material recovery.

(i) “Process section” means the equipment designed to accomplish a general but welldefined task in polymer production. Process sections include raw materials preparation, polymerization reaction, material recovery, product finishing, and product storage and may be dedicated to a single process line or common to more than one process line.

(j) “Product finishing section” means the equipment that treats, shapes, or modifies the polymer or resin to produce the finished end product of the particular facility. Product finishing equipment may accomplish extruding and pelletizing, cooling and drying, blending, additives introduction, curing, or annealing. Product finishing does not include polymerization or shaping such as fiber spinning, molding, or fabricating or modification such as fiber stretching and crimping.

(3) The owner or operator of a high-density polyethylene or polypropylene process line containing a process section subject to this rule shall comply with the following:

(a) Reduce emissions of total volatile organic compounds (VOC’s) by 98 weight percent, determined according to the procedure specified in Subparagraph (5)(a) of this rule, or to a VOC concentration of 20 parts per million volumetric (ppmv), as determined by the procedure specified in Subparagraph (5)(b) of this rule, on a dry basis, whichever is less stringent. Total VOC is expressed as the sum of the actual compounds, not carbon equivalents. If an owner or operator elects to comply with the 20 ppmv concentration standard, the concentration shall include a correction to 3 percent oxygen only when supplemental combustion air is used to combust the vent stream.

The procedure in Subparagraph (5)(c) shall be used to correct the concentration to 3 percent oxygen;

(b) Combust the emissions in a boiler or process heater with a design heat input capacity of 150 million British thermal units per hour (Btu/hr) or greater by introducing the vent stream into the flame zone of the boiler or process heater; or (c) Combust the emissions in a flare as follows:

1. Flares shall be designed for and operated with no visible emissions as determined by the method specified in Part (5)(d)1. of this rule, except for periods not to exceed a total of 5 minutes during any 2 consecutive hours;

2. Flares shall be operated with a flame present at all times, as determined by the method specified in Part (5)(d)2. of this rule;

3. Flares used to comply with provisions of this rule shall be steam-assisted, airassisted, or non-assisted;

4. Flares shall be used only with the net heating value of the gas being combusted being 11.2 megaJoules per standard cubic meter (MJ/scm) (300 Btu per standard cubic foot [Btu/scf]) or greater if the flare is steam-assisted or airassisted; or with the net heating value of the gas being combusted being 7.45 MJ/scm (200 Btu/scf) or greater if the flare is non-assisted. The net heating value of the gas being combusted shall be determined by the method specified in

Part (5)(e)7. of this rule.

5. Consistent with exit velocity requirements as follow:

(i) Steam-assisted and non-assisted flares shall be designed for and operated with an exit velocity, as determined by the method specified in Part (5)(e)4. of this rule, less than 18.3 meters per second (m/s) (60 feet per second [ft/s]), except as provided in Subparts (ii) and (iii) of this part;

(ii) Steam-assisted and non-assisted flares designed for and operated with an exit velocity, as determined by the methods specified in Part (5)(e)4. of this

rule, equal to or greater than 18.3 m/s (60 ft/s) but less than 122 m/s (400 ft/s) are allowed if the net heating value of the gas being combusted is greater than 37.3 MJ/scm (1,000 Btu/scf); and (iii) Steam-assisted and non-assisted flares designed for and operated with an exit velocity, as determined by the methods specified in Part (5)(e)4. of this

rule, less than the velocity, V max , as determined by the method specified in

Part (5)(e)5. of this rule and less than 122 m/s (400 ft/s) are allowed.

6. Air-assisted flares shall be designed and operated with an exit velocity less than the velocity, V max , as determined by the method specified in Part (5)(e)6. of this

rule.

(4) The owner or operator of a polystyrene process line containing process sections subject to this rule shall comply with the following:

(a) Not allow continuous VOC emissions from the material recovery section to be greater than 0.12 kg (kilograms) VOC per 1,000 kg of product (0.12 pounds [lb] VOC per 1,000 lb of product); or (b) Not allow the outlet gas stream from each final condenser in the material recovery

section to exceed -25°C (-13°F).

(5) Test methods and procedures as follow apply:

(a) The owner or operator shall determine compliance with the percent emission reduction standard in Subparagraph (3)(a) of this rule as follows:

1. The emission reduction of total VOC shall be determined using the following equation:

E inlet - E outlet P = ____________ x 100 E inlet where:

P = Percent emission reduction, by weight.

E inlet = Mass rate of total VOC entering the control device, kg VOC/hr.

E outlet = Mass rate of total VOC discharged to the atmosphere, kg VOC/hr.

2. The mass rates of total VOC (E i , E o ) shall be computed using the following equations: n E i = K ( Σ C ij M ij ) Q i j = 1 n E o = K ( Σ C oj M oj ) Q o j = 1 where:

C ij , C oj = Concentration of sample component “j” of the gas stream at the inlet and outlet of the control device, respectively, dry basis, ppmv.

M ij , M oj = Molecular weight of sample component “j” of the gas stream at the inlet and outlet of the control device respectively, g/gmole (lb/lbmole).

Q i , Q o = Flow rate of the gas stream at the inlet and outlet of the control device, respectively, dscm/hr (dscf/hr).

K = 4.157 x 10 -8 [(kg)/(g-mole)]/[(g)(ppm)(dscm)] or {2.595 x 10 -9 [(lb)(/(lbmole)]/[(lb)(ppm)(dscf)]}.

3. Reference Method 18 shall be used to determine the concentration of each individual organic component (C ij , C oj ) in the gas stream. Reference Method 1 or 1A, as appropriate, shall be used to determine the inlet and outlet sampling sites. The inlet site shall be before the inlet of the control device and after all product recovery units.

4. Reference Method 2, 2A, 2C, or 2D, as appropriate, shall be used to determine the volumetric flow rates (Q i , Q o ). If necessary, Method 4 shall be used to determine the moisture content. Both determinations shall be compatible with the Reference Method 18 determinations.

5. Inlet and outlet samples shall be taken simultaneously. The sampling time for each run shall be 1 hour in which either an integrated sample or four grab samples shall be taken. If grab sampling is used, then the samples shall be taken at 15 minute intervals.

(b) The owner or operator shall determine compliance with the emission concentration standard in Subparagraph (3)(a) of this rule as follows:

1. The total VOC concentration is the sum of the individual components and shall be computed for each run using the following equation: n C voc = Σ C j j = 1 where:

C voc = Concentration of total VOC, dry basis, ppmv;

C j = Concentration of sample component j, ppm; and n = Number of components in the sample.

2. Reference Method 18 shall be used to determine the concentration of each individual inorganic component (C j ) in the gas stream. Reference Method 1 or 1A as appropriate, shall be used to determine the sampling site at the outlet of the control device. Reference Method 4 shall be used to determine the moisture content, if necessary.

3. The sampling time for each run shall be 1 hour in which either an integrated sample or four grab samples shall be taken. If grab sampling is used, then the samples shall be taken at 15 minute intervals.

(c) Correction for supplemental combustion air shall be as follows:

1. If supplemental combustion air is used, the total VOC concentration shall be corrected to 3 percent oxygen and shall be computed using the following equation: 17.9 C CORR = C meas 20.9 - %0 2d C CORR = Concentration of total VOC corrected to 3 percent oxygen, dry

basis, ppmv;

C MEAS = Concentration of total VOC, dry basis, ppmv, as calculated in Part (5)(b)1. above; and %O 2d = Concentration of O , dry basis, percent by volume.

2. The emission rate correction factor, integrated sampling and analysis procedure of Reference Method 3 shall be used to determine the oxygen concentration (%O 2d ). The sampling site shall be the same as that of the total VOC sample and the samples shall be taken during the same time that the total VOC samples are taken.

(d) When a flare is used to comply with Subparagraph (3)(c) of this rule:

1. Reference Method 22 shall be used to determine the compliance of flares with the visible emission requirement in Part (3)(c)1. of this rule. The observation period is 2 hours and shall be used according to Reference Method 22; and 2. The presence of a flare pilot flame shall be monitored using a thermocouple or other equivalent monitoring device to detect the presence of a flame.

(e) The test methods shall be used for determining the VOC emission rate in terms of kg emission per megagram (Mg) of product, exit velocities, or net heating value of the gas combusted to determine compliance under Paragraphs (3) and (4) of this rule as follows:

1. Reference Method 1 or 1A, as appropriate, for selection of the sampling site.

The sampling site for the molar composition and vent stream flow rate determination prescribed in Parts 2. and 3. of this subparagraph shall be prior to the inlet of any combustion device and prior to any dilution of the stream with air.

2. The composition of the process vent stream shall be determined as follows:

(i) Reference Method 18 and ASTM D2504-67 (reapproved 1977) to measure the concentration of VOC and the concentration of all other compounds present except water vapor and carbon monoxide, and (ii) Reference Method 4 to measure the content of water vapor.

3. The volumetric flow rate shall be determined using Reference Method 2, 2A, 2C, or 2D, as appropriate;

4. The actual exit velocity of a flare shall be determined by dividing the volumetric flow rate (in units of standard temperature and pressure), as determined by Reference Method 2, 2A, 2C, or 2D as appropriate, by the unobstructed (free) cross-sectional area of the flare tip;

5. The maximum permitted velocity, V max , for flares complying with Subpart (3)(c)5.(i) of this rule shall be determined using the following equation:

H T + 28.8

Log (V max ) = 31.7 where:

V max = Maximum permitted velocity, m/s; 28.8 = Constant; 31.7 = Constant; and H T = The net heating value as determined in Part 7. of this subparagraph.

6. The Vmax for air-assisted flares shall be determined by the following equation:

Vmax = 8.706 + 0.7084 (HT) where:

Vmax = Maximum permitted velocity, m/s; 8.706 = Constant; 0.7084 = Constant; and HT = The net heating value as determined in Part 7. of this subparagraph.

7. The net heating value of the process vent stream being combusted in a flare shall be calculated using the following equation: n HT = K SUM CiHi i = 1 where:

HT = Net heating value of the sample, MJ/scm, where the net enthalpy per mole of offgas is based on combustion at 25 C and 760 millimeters of Mercury (mm Hg) (77 F and 29.92 inches of Mercury [in Hg]), but the standard temperature for determining the volume corresponding to one mole is 20 C (68 F);

K = Constant:

(1) (g mole) (MJ)

K = 1.740 x 10 -7 ___________________________________ ppm scm kcal where standard temperature for (g mole)/scm is 200C.

Ci = Concentration of sample components i in ppm on a wet basis, as measured for organics by Reference Method 18 and measured for hydrogen and carbon monoxide by ASTM D1946-82; and Hi = Net heat of combustion of sample component i, kcal/g-mole at 25 C (77 F) and 760 mm Hg (29.92 in Hg). The heats of combustion of process vent stream components may be determined using ASTM D2382-76 (reapproved 1977) if published values are not available or cannot be calculated;8.The emission rate of VOC in the process vent stream shall be calculated using the following equation:

8. The emission rate of VOC in the process vent stream shall be calculated using the following equation: n E voc = K ( Σ C i M i ) Q s i = 1 where:

E voc = Emission rate of total organic compounds in the sample, kilogram per hour (kg/h);

K = Constant, 2.494 x 10 -6 (1/ppm)(g-mole/scm)(kg/g)(min/h), where standard temperature for (g-mole/scm) is 20°C (68°F);

C i = Concentration of sample component i, ppm;

M i = Molecular weight of sample component i, g/g-mole; and Q s = Vent stream flow rate (scm/min), at a standard temperature of 20°C (68°F).

9. The rate of polymer produced, P p (kg/h), shall be determined by dividing the weight of polymer pulled in kg from the process line during the performance test by the number of hours (h) taken to perform the performance test. The polymer pulled, in kg, shall be determined by direct measurement or, if approved by the Technical Secretary and approved as a revision to the State Implementation Plant, computed from materials balance by good engineering practice; and 10. The emission rate of VOC in terms of kilograms of emissions per megagram of production shall be calculated using the following equation:

ER voc = E VOC P p x 1Mg 1,000 kg where:

ER voc = Emission rate of VOC, kg VOC/Mg product;

E voc = Emission rate of VOC in the sample, kg/h; and P p = The rate of polymer produced, kg/h.

(6) The owner or operator of a facility subject to this rule shall maintain the following records for at least 3 years and shall make these records available to the Technical Secretary upon request:

(a) For facilities complying with the standards listed in Subparagraph (3)(a), parameters listed in Subparagraphs (5)(a), (5)(b), and, where applicable, (5)(e);

(b) For facilities complying with the standards listed in Subparagraph (3)(b), parameters listed in Subparagraphs (5)(c), and, where applicable, (5)(e);

(c) For facilities complying with the standards listed in Subparagraph (3)(c), parameters listed in Subparagraphs (5)(d), and, where applicable, (5)(e);

(d) For facilities complying with the standards listed in Paragraph (4), parameters listed in Subparagraph (5)(e) where applicable; and (e) For all facilities containing sources subject to this rule, the following records shall be kept:

1. The time, date, and duration of any excess emissions;

2. The subject source of any excess emissions;

3. The cause of any excess emissions;

4. The estimated rate of emissions (expressed in the units of the applicable emission limitation) and the operating data and the calculations used in determining the magnitude of any excess emissions; and 5. Any corrective actions and schedules utilized to correct the conditions causing any excess emissions.

(7) The owner or operator of any facility containing sources subject to this rule shall:

(a) Comply with the initial compliance certification requirements of Paragraph .04(1) of this

chapter; and (b) Comply with the requirements of Paragraph .04(2) of this chapter for excess emissions related to the control devices required to comply with Subparagraph (3)(b), (3)(c), or (4)(b) of this rule.

History

• Authority: T.C.A. §§ 4-5-202, et seq., and 68-201-105.
• Administrative History: Original rule filed March 8, 1993; effective April 22, 1993. Amendment filed January 31, 1997; effective April 16, 1997.

Tenn. Comp. R. & Regs. 1200-03-18-.40 AIR OXIDATION PROCESSES IN THE SYNTHETIC ORGANIC CHEMICAL

MANUFACTURING INDUSTRY.

(1) Applicability of this rule is as follows:

(a) This rule applies to the following air oxidation facilities in Davidson, Rutherford, Shelby, Sumner, Williamson, and Wilson Counties in the synthetic organic chemical manufacturing industry:

1. Each air oxidation reactor not discharging its vent stream into a recovery system;

2. Each combination of an air oxidation reactor and the recovery system into which its vent stream is discharged; and 3. Each combination of two or more air oxidation reactors and the common recovery system into which their vent streams are discharged.

(b) Any air oxidation reactor vent stream that has a total resource effectiveness (TRE) index value greater than 1.0 is exempt from all provisions of this rule except the requirements in Paragraph (3) and Subparagraphs (5)(b) and (6)(j) of this rule.

(2) For the purpose of this rule, the following definitions apply:

“Air oxidation facility” means a product recovery system and all associated air oxidation process reactors discharging directly into that system or any such reactors discharging directly into the atmosphere.

“Air oxidation process” means a reactor in which air is used as an oxidizing agent to produce an organic chemical.

“Air oxidation reactor” means any device or process vessel in which one or more organic reactants are combined with air or a combination of air and oxygen to produce one or more organic compounds. Ammoxidation and oxychlorination are included in this definition.

“Air oxidation reactor recovery train” means an individual recovery system receiving the vent stream from at least one air oxidation reactor, along with all air oxidation reactors feeding vent streams into this system.

“Product recovery system” means any equipment used to collect volatile organic compounds (VOC’s) for use, reuse, or sale. Such equipment includes, but is not limited to, absorbers, adsorbers, condensers, and devices that recover non-VOC’s such as ammonia and HCl.

“Synthetic organic chemical manufacturing industry” means the industry that produces, as intermediates or final products, one or more of the chemicals listed at 40 C.F.R. 60.489, as of July 1, 1991.

“Total resource effectiveness index value,” or TRE index value, means a measure of the supplemental total resource requirement per unit of VOC emission reduction associated with an individual air oxidation vent stream, based on vent stream flow rate, emission rate of VOC, net heating value, and corrosive properties, as quantified by the equation given under Subparagraph (4)(a) of this rule.

“Vent stream” means any gas stream containing nitrogen that was introduced as air to the air oxidation reactor, released to the atmosphere directly from any air oxidation reactor recovery train or indirectly, after diversion through other process equipment.

(3) For each vent stream from an air oxidation reactor or combination air oxidation reactor and recovery train subject to this rule, the owner or operator shall comply with Subparagraph (a), (b), or (c) as follows:

(a) Reduce total VOC emissions by 98 weight percent or to 20 parts per million volumetric (ppmv) on a dry basis corrected to 3 percent oxygen, whichever is less stringent. If a boiler or process heater is used to comply with this subparagraph, the vent stream shall be introduced into the flame zone of the boiler or process heater;

(b) Combust the emissions in a flare that meets the requirements of 40 C.F.R. 60.18, as of July 1, 1991, except that, for a hydrogen fueled flare serving a hydrogen cyanide process at a facility in Shelby County, the Technical Secretary, upon demonstration that stable-flame conditions are maintained, may waive the net heating value and exit velocity requirements of the C.F.R. section; or (c) Maintain a TRE index value greater than 1.0 without the use of VOC emission control devices.

(4) Monitoring requirements as follow apply:

(a) The owner or operator of an air oxidation facility that uses an incinerator to seek to comply with the VOC emission limit specified under Subparagraph (3)(a) of this rule, shall install, calibrate, maintain, and operate according to manufacturer’s specifications the following equipment:

1. A temperature monitoring device equipped with a continuous recorder and having an accuracy of +_1 percent of the temperature being monitored expressed in degrees Celsius or +_0.5°C, whichever is greater.

(i) Where an incinerator other than a catalytic incinerator is used, a temperature monitoring device shall be installed in the firebox.

(ii) Where a catalytic incinerator is used, temperature monitoring devices shall be installed in the gas stream immediately before and after the catalyst bed.

2. A flow indicator that provides a record of vent stream flow to the incinerator at least once every hour for each air oxidation facility. The flow indicator shall be installed in the vent stream from each air oxidation facility at a point closest to the inlet of each incinerator and before being joined with any other vent stream.

(b) The owner or operator of an air oxidation facility that uses a flare to seek to comply with Subparagraph (3)(b) of this rule shall install, calibrate, maintain, and operate according to manufacturer’s specifications the following equipment:

1. A heat sensing device, such as an ultra-violet sensor or thermocouple, at the pilot light to indicate the continuous presence of a flame.

2. A flow indicator that provides a record of vent stream flow to the flare at least once every hour for each air oxidation facility. The flow indicator shall be installed in the vent stream from each air oxidation facility at a point closest to the flare and before being joined with any other vent stream.

(c) The owner or operator of an air oxidation facility that uses a boiler or process heater to seek to comply with Subparagraph (3)(a) of this rule shall install, calibrate, maintain, and operate according to the manufacturer’s specifications the following equipment:

1. A flow indicator that provides a record of vent stream flow to the boiler or process heater at least once every hour for each air oxidation facility. The flow indicator shall be installed in the vent stream from each air oxidation reactor within a facility at a point closest to the inlet of each boiler or process heater and before being joined with any other vent stream.

2. A temperature monitoring device in the firebox equipped with a continuous recorder and having an accuracy of +_1 percent of the temperature being measured expressed in degrees Celsius or +_0.5°C, whichever is greater, for boilers or process heaters of less than 44 MW (150 million Btu/hr) heat input design capacity.

3. Monitor and record the periods of operation of the boiler or process heater if the design input capacity of the boiler or process heater is 44 MW (150 million Btu/hr) or greater. The records shall be readily available for inspection.

(d) The owner or operator of an air oxidation facility that seeks to demonstrate compliance with the TRE index value limit specified under Subparagraph (3)(c) of this rule shall install, calibrate, maintain, and operate according to manufacturer’s specifications the following equipment:

1. Where an absorber is the final recovery device in a recovery system:

(i) A scrubbing liquid temperature monitoring device having an accuracy of +_1 percent of the temperature being monitored, expressed in degrees Celsius or +_0.5°C, whichever is greater, and a specific gravity monitoring device having an accuracy of +_0.02 specific gravity unit, each equipped with a continuous recorder; and (ii) An organic monitoring device used to indicate the concentration level of organic compounds exiting the recovery device based on a detection principle such as infrared, photoionization, or thermal conductivity, each equipped with a continuous recorder.

2. Where a condenser is the final recovery device in a recovery system:

(i) A condenser exit (product site) temperature monitoring device equipped with a continuous recorder and having an accuracy of +_1 percent of the temperature being monitored expressed in degrees Celsius or +_0.5°C, whichever is greater; and (ii) An organic monitoring device used to indicate the concentration level of organic compounds exiting the recovery device based on a detection principle such as infrared, photoionization, or thermal conductivity, each equipped with a continuous recorder.

3. Where a carbon adsorber is the final recovery device in a recovery system:

(i) An integrating steam flow monitoring device having an accuracy of +_10 percent, and a carbon bed temperature monitoring device having an accuracy of +_1 percent of the temperature being monitored expressed in degrees Celsius or +_0.5°C, whichever is greater, both equipped with a continuous recorder; and (ii) An organic monitoring device used to indicate the concentration level of organic compounds exiting the recovery device based on a detection principle such as infrared, photoionization, or thermal conductivity, each equipped with a continuous recorder.

(5) The following methods shall be used to demonstrate compliance with Paragraph (3) of this

rule:

(a) The following equation shall be used to calculate the TRE index for a given vent stream:

TRE = 1_ [a+b (FL) 0.88 + C(FL) + d(FL)H T + e(FL) 0.88 (H T ) 0.88 + f(FL) 0.5 ]

E where:

TRE = The total resource effectiveness index value.

E = The measured hourly emissions in units of kilograms/hour (kg/h).

FL = The vent stream flow rate in scm/min, at a standard temperature of 20°C.

For a Category E stream (see Table 1), the factor f(FL) 0.5 should be replaced with (H T ) 0.5 f [(FL 3.6 ] where:

H T = Vent stream net heating value in units of MJ/scm, where the net enthalpy per mole of offgas is based on combustion at 25°C (68°F) and 760 millimeters of Mercury (mm Hg), but the standard temperature for determining the volume corresponding to one mole is 20°c, as in the definition of FL. a, b, c, d, e, and f = Specific coefficients for six different general categories of process vent streams. The set of coefficients that apply to a given air oxidation process vent stream are specified in Table 1.

TABLE 1. COEFFICIENTS OF THE TOTAL RESOURCE EFFECTIVENESS (TRE)

INDEX EQUATION

A1. For Chlorinated Process Vent Streams, if 0 <_ Net Heating Value (MJ/scm) <_ 3.5:

FL - Vent Stream Flow Rate (scm/min) a b c d e f FL <_ 13.5 48.73 0 0.404 -0.1632 0 0 13.5 < FL <_ 700 42.35 0.624 0.404 -0.1632 0 0.0245 700 < FL <_ 1,400 84.38 0.678 0.404 -0.1632 0 0.0346 1,400 < FL <_ 2,100 126.41 0.712 0.404 -0.1632 0 0.0424 2,100 < FL <_ 2,800 168.44 0.747 0.404 -0.1632 0 0.0490 2,800 < FL <_ 3,500 210.47 0.758 0.404 -0.1632 0 0.0548 A2. For Chlorindated Process Vent Streams, if 3.5 < Net Heating Value (MJ/scm):

FL - Vent Stream Flow Rate (scm/min) a b c d e f FL <_ 13.5 47.76 0 0.292 0 0 0 13.5 < FL <_ 700 41.58 0.605 0.292 0 0 0.0245 700 < FL <_ 1,400 82.84 0.658 0.292 0 0 0.0346 1,400 < FL <_ 2,100 123.10 0.691 0.292 0 0 0.0424 2,100 < FL <_ 2,800 165.36 0.715 0.292 0 0 0.0490 2,800 < FL <_ 3,500 206.62 0.734 0.292 0 0 0.0548 B. For Nonchlorinated Process Vent Streams, if 0 <_ Net Heating Value (MJ/scm) <_ 0.48:

FL - Vent Stream Flow Rate (scm/min) a b c d e f FL <_ 13.5 19.05 0 0.113 -0.214 0 0 13.5 < FL <_ 1,350 16.61 0.239 0.113 -0.214 0 0.0245 1,350 < FL <_ 2,700 32.91 0.260 0.113 -0.214 0 0.0346 2,700 < FL <_ 3,500 49.21 0.273 0.113 -0.214 0 0.0424 C. For Nonchlorindated Process Vent Streams, if 0.48 < Net Heating Value (MJ/scm) <_ 1.9:

FL - Vent Stream Flow Rate (scm/min) a b c d e f FL <_ 13.5 19.74 0 0.400 -0.202 0 0 13.5 < FL <_ 1,350 18.30 0.138 0.400 -0.202 0 0.0245 1,350 < FL <_ 2,700 36.28 0.150 0.400 -0.202 0 0.0346 2,700 < FL <_ 4,050 54.26 0.158 0.400 -0.202 0 0.0424 D. For Nonchlorinated Process Vent Streams, if 1.9 < Net Heating Value (MJ/scm) <_ 3.6:

FL - Vent Stream Flow Rate (scm/min) a b c d e f FL <_ 13.5 15.24 0 0.033 0 0 0 13.5 < FL <_ 1,190 13.63 0.157 0.033 0 0 0.0245 1,190 < FL <_ 2,380 26.95 0.171 0.033 0 0 0.0346 2,380 < FL <_ 3,570 40.27 0.179 0.033 0 0 0.0424 E. For Nonchlorinated Process Vent Streams, if 3.6 < Net Heating Value (MJ/scm):

FL - Vent Stream Flow Rate (scm/min) a b c d e f FL <_ 13.5 15.24 0 0 0.0090 0 0 13.5 < FL <_ 1,190 13.63 0 0 0.0090 0.0503 0.0245 1,190 < FL <_ 2,380 26.95 0 0 0.0090 0.0546 0.0346 2,380 < FL <_ 3,570 40.27 0 0 0.0090 0.0573 0.0424 (b) Each owner or operator of an air oxidation facility seeking to comply with Subparagraph (1)(b) or (3)(c) of this rule shall recalculate the TRE index value for that air oxidation facility whenever process changes are made. Some examples of process changes are changes in production capacity, feedstock type, or catalyst type, or whenever there is replacement, removal, or addition of recovery equipment. The TRE index value shall be recalculated based on test data, or on best engineering estimates of the effects of the change to the recovery system.

(c) Reference Method 1 or 1A, as appropriate, for selection of the sampling sites. The control device inlet sampling site for determination of vent stream molar composition or VOC reduction efficiency shall be prior to the inlet of the control device and after the recovery system.

(d) Reference Method 2, 2A, 2C, or 2D, as appropriate, for determination of the volumetric flow rates.

(e) The emission rate correction factor, integrated sampling and analysis procedure of Method 3 shall be used to determine the oxygen concentration (%0 2d ) for the purposes of determining compliance with the 20 ppmv limit. The sampling site shall be the same as that of the VOC samples and the samples shall be taken during the same time that the VOC samples are taken. The VOC concentration corrected to 3 percent O (C ) shall be computed using the following equation: 17.9 C c = C voc __________ 20.9 - %0 2d where:

C c = Concentration of VOC corrected to 3 percent 0 , dry basis, ppm by volume.

C voc = Concentration of VOC, dry basis, ppm by volume. %0 2d = Concentration of 0 , dry basis, percent by volume.

(f) Reference Method 18 to determine concentration of VOC in the control device outlet and the concentration of VOC in the inlet when the reduction efficiency of the control device is to be determined, according to the following:

1. The sampling time for each run shall be 1 hour in which either an integrated sample or four grab samples shall be taken. If grab sampling is used, then the samples shall be taken at 15-minute intervals.

2. The emission reduction (R) of VOC shall be determined using the following equation:

E i - E o R = _____ x 100 E i where:

R = Emission reduction, percent by weight.

E i = Mass rate of VOC entering the control device, kg VOC/hr.

E o = Mass rate of VOC discharged to the atmosphere, kg VOC/hr.

3. The mass rates of VOC (E i , E o ) shall be computed using the following equations: n E i = K ( Σ C ij M ij ) Q i j = 1 n E o = K ( Σ C oj M oj ) Q o j = 1 where:

C ij , C oj = Concentration of sample component “j” of the gas stream at the inlet and outlet of the control device, respectively.

M ij , M oj = Molecular weight of sample component “j” of the gas stream at the inlet and outlet of the control device, respectively, g/g-mole (lb/lb-mole).

Q i , Q o = Flow rate of gas stream at the inlet and outlet of the control device, respectively, dscm/min (dscf/hr).

K = Constant, 2.494 x 10 -6 (1/ppm) (g-mole/scm) (kg/g) (min/h), where standard temperature for (g-mole/scm) is 20 C.

4. The VOC concentration (C voc ) is the sum of the individual components and shall be computed for each run using the following equation: n C voc = Σ C j j = 1 where:

C voc = Concentration of VOC, dry basis, ppm by volume.

C j = Concentration of sample components in the sample. n = Number of components in the sample.

(g) When a flare is used to seek to comply with Subparagraph (3)(b) of this rule, the flare shall comply with the requirements of 40 C.F.R. 60.18, as of July 1, 1991.

(h) The following test methods shall be used for determining the net heating value of the gas combusted to determine compliance under Subparagraph (3)(b) of this rule, and for determining the process vent stream TRE index value to determine compliance under Subparagraph (3)(c) of this rule:

1. For selection of sampling site:

(i) Reference Method 1 or 1A, as appropriate, for selection of the sampling site. The sampling site for the vent stream flow rate and molar composition determination prescribed in Parts 2. and 3. of this subparagraph shall be, except for the situations outlined in Subpart (ii) of this part, prior to the inlet of any control device, prior to any post-reactor dilution of the stream with air, and prior to any post-reactor introduction of halogenated compounds into the vent stream. No transverse site selection method is needed for vents smaller than 4 inches in diameter.

(ii) If any gas stream other than the air oxidation vent stream is normally conducted through the final recovery device:

(I) The sampling site for vent stream flow rate and molar composition shall be prior to the final recovery device and prior to the point at which the nonair oxidation stream is introduced.

(II) The efficiency of the final recovery device is determined by measuring the VOC concentration using Method 18 at the inlet to the final recovery device after the introduction of any nonair oxidation vent stream and at the outlet of the final recovery device.

(III) This efficiency is applied to the VOC concentration measured prior to the final recovery device and prior to the introduction of the nonair oxidation stream to determine the concentration of VOC in the air oxidation stream from the final recovery device. This concentration of VOC is then used to perform the calculations outlined in Parts 4. and 5. of this subparagraph.

2. For determining molar composition of the process vent stream:

(i) Reference Method 18 to measure the concentration of VOC including those containing halogens.

(ii) ASTM D1946-77 to measure the concentration of carbon monoxide and hydrogen.

(iii) Reference Method 4 to measure the content of water vapor.

3. For volumetric flow rate Reference Method 2, 2A, 2C, or 2D, as appropriate.

4. For net heating value of the vent stream, the following equation: n H T = K Σ C j H j j = 1 where:

H T = Net heating value of the sample, MJ/scm, where the net enthalpy per mole of offgas is based on combustion at 25°C and 760 mm Hg, but the standard temperature for determining the volume corresponding to one mole is 20°C, as in the definition of Q s (offgas flow rate).

K = Constant, 1.740 x 10 -7 (1) (g-mole) (MJ) ppm scm kcal where standard temperature for (g-mole) scm is 20°C.

C j = Concentration of compound j in ppm, as measured for organics by Reference Method 18 and measured for hydrogen and carbon monoxide by ASTM D1946-77 as indicated in Part 2. of this subparagraph.

H j = Net heat of combustion of compound j, kcal/g-mole, based on combustion at 25°C and 760 mm Hg. The heats of combustion of vent stream components would be required to be determined using ASTM D2382-76 if published values are not available or cannot be calculated.

5. For emission rate of VOC in the process vent stream, the following equation: n E voc = K ( Σ C j M j ) Q s j = 1 where:

E voc = Emission rate of VOC in the sample, kg/hr.

K = Constant, 2.494 x 10 -6 (1/ppm) (g-mole/scm) (kg/g) (min/hr), where standard temperature for (g-mole/scm) is 20°C.

C j = Concentration on a dry basis of compound j in ppm as measured by Reference Method 18 as indicated in Part 2. of this subparagraph.

M j = Molecular weight of sample j, g/g-mole.

Q s = Vent stream flow rate (scm/min) at a standard temperature of 20°C.

(6) The owner or operator of a facility subject to this rule shall keep the records specified in this paragraph for at least 3 years. These records, as follow, shall be made available to the Technical Secretary immediately upon request:

(a) Where an owner or operator subject to this rule seeks to demonstrate compliance with Subparagraph (3)(a) of this rule through the use of either a thermal or catalytic incinerator:

1. The average firebox temperature of the incinerator (or the average temperature upstream and downstream of the catalyst bed for a catalytic incinerator), measured at least every 15 minutes and averaged over the same time period as the compliance test, and 2. The percent reduction of VOC determined as specified in Subparagraph (3)(a) of this rule that is achieved by the incinerator, or the concentration of VOC determined as specified in Subparagraph (3)(a) of this rule at the outlet of the control device on a dry basis corrected to 3 percent oxygen.

(b) Where an owner or operator subject to the provisions of this rule seeks to demonstrate compliance with Subparagraph (3)(a) of this rule through the use of a boiler or process heater:

1. A description of the location at which the vent stream is introduced into the boiler or process heater, and 2. The average combustion temperature of the boiler or process heater with a design heat input capacity of less than 44 MW (150 million Btu/hr) measured at least every 15 minutes and averaged over the same time period of the compliance testing.

(c) Where an owner or operator subject to the provisions of this rule seeks to comply with Subparagraph (3)(b) of this rule through the use of a smokeless flare, flare design (i.e., steam-assisted, air-assisted, or non-assisted), all visible emission readings, heat content determinations, flow rate measurements, and exit velocity determinations made during the compliance test, continuous records of the flare pilot flame monitoring, and records of all periods of operation during which the pilot flame is absent.

(d) Where an owner or operator seeks to demonstrate compliance with Subparagraph (3)(c) of this rule:

1. Where an absorber is the final recovery device in a recovery system, the exit specific gravity and average exit temperature of the absorbing liquid, measured at least every 15 minutes and averaged over the same time period of the compliance testing (both measured while the vent stream is normally routed and constituted), or 2. Where a condenser is the final recovery device in a recovery system, the average exit (product side) temperature, measured at least every 15 minutes and averaged over the same time period of the compliance testing while the vent stream is normally routed and constituted, or 3. Where a carbon adsorber is the final recovery device in a recovery system, the total steam mass flow measured at least every 15 minutes and averaged over the same time period of the compliance test (full carbon bed cycle), temperature of the carbon bed after regeneration (and within 15 minutes of completion of any cooling cycle(s)), and duration of the carbon bed steaming cycle (all measured while the vent stream is normally routed and constituted), or 4. As an alternative to Part 1., 2., or 3. of this subparagraph, the concentration level or reading indicated by the organic monitoring device at the outlet of the absorber, condenser, or carbon adsorber measured at least every 15 minutes and averaged over the same time period of the compliance testing while the vent stream is normally routed and constituted.

2. All measurements and calculations performed to determine the TRE index value of the vent stream.

(e) Each owner or operator subject to the provisions of this rule shall keep up-to-date continuous records of the equipment operating parameters specified to be monitored under Subparagraphs (4)(a) and (4)(c) of this rule as well as up-to-date records of periods of operation during which the parameter boundaries established during the most recent compliance test are exceeded. The Technical Secretary may at any time require a report of these data. Where a combustion device is used by an owner or operator seeking to demonstrate compliance with Subparagraph (3)(a) or (3)(c) of this

rule, periods of operation during which the parameter boundaries established during the most recent performance tests are exceeded and therefore an instance of noncompliance has occurred are defined as follows:

1. For thermal incinerators, all 3-hour periods of operation during which the average combustion temperature was more than 28°C (50°F) below the average combustion temperature during the most recent test at which compliance with Subparagraph (3)(a) of this rule was determined.

2. For catalytic incinerators, all 3-hour periods of operation during which the average temperature of the vent stream immediately before the catalyst bed is more than 28°C (50°F) below the average temperature of the vent stream during the most recent test at which compliance with Subparagraph (3)(a) of this rule was determined. The owner or operator also shall record all 3-hour periods of operation during which the average temperature difference across the catalyst bed is less than 80 percent of the average temperature difference of the device during the most recent test at which compliance with Subparagraph (3)(a) of this

rule was determined.

3. All 3-hour periods of operation during which the average combustion temperature was more than 28°C (50°F) below the average combustion temperature during the most recent test at which compliance with Subparagraph (3)(a) of this rule was determined for boilers or process heaters with a design heat input capacity of less than 44 MW (150 million Btu/hr).

4. For boilers or process heaters, whenever there is a change in the location at which the vent stream is introduced into the flame zone as required under Subparagraph (3)(a) of this rule.

(f) Each owner or operator subject to the provisions of this rule shall keep up-to-date continuous records of the flow indication specified under Parts (4)(a)2., (4)(b)2., and (4)(c)1. of this rule, as well as up-to-date records of all periods when the vent stream is diverted from the control device or has no flow rate.

(g) Each owner or operator subject to the provisions of this rule who uses a boiler or process heater with a design heat input capacity of 44 MW or greater to comply with Subparagraph (3)(a) of this rule shall keep an up-to-date record of all periods of operation of the boiler or process heater. (Examples of such records could include records of steam use, fuel use, or monitoring data collected pursuant to other regulatory requirements.)

(h) Each owner or operator subject to the provisions of this rule shall keep up-to-date continuous records of the flare pilot flame monitoring specified in Subparagraph (4)(b) of this rule as well as up-to-date records of all periods of operations in which the pilot flame is absent.

(i) Each owner or operator subject to the provisions of this rule shall keep up-to-date continuous records of the equipment operating parameters specified to be monitored under Subparagraph (4)(c) of this rule as well as up-to-date records of periods of operation during which the parameter boundaries established during the most recent compliance test are exceeded. The Technical Secretary may at any time require a report of these data. Where the owner or operator seeks to demonstrate compliance with Subparagraph (3)(c) of this rule, periods of operation during which the parameter boundaries established during the most recent compliance tests are exceeded and therefore an instance of noncompliance has occurred are defined as follows:

1. Where an absorber is the final recovery device in a recovery system, and where an organic monitoring device is not used:

(i) All 3-hour periods of operation during which the average absorbing liquid temperature was more than 11°C (20°F) above the average absorbing liquid temperature during the most recent compliance test that demonstrated that the facility was in compliance, or (ii) All 3-hour periods of operation during which the average absorbing liquid specific gravity was more than 0.1 unit above, or more than 0.1 unit below, the average absorbing liquid specific gravity during the most recent compliance test that demonstrated that the facility was in compliance.

2. Where a condenser is the final recovery device in a recovery system, and where an organic monitoring device is not used, all 3-hour periods of operation during which the average exit (product site) condenser operating temperature was more than 6°C (11°C) above the average exit (product site) operating temperature during the most recent compliance test that demonstrated that the facility was in compliance.

3. Where a carbon adsorber is the final recovery device in a recovery system and where an organic monitoring device is not used:

(i) All carbon bed regeneration cycles during which the total mass steam flow was more than 10 percent below the total mass steam flow during the most recent compliance test that demonstrated that the facility was in compliance, or (ii) All carbon bed regeneration cycles during which the temperature of the carbon bed after regeneration [and after completion of any cooling cycle(s)] was more than 10 percent greater than the carbon bed temperature (in degrees Celsius) during the most recent compliance test that demonstrated that the facility was in compliance.

4. Where an absorber, condenser, or carbon adsorber is the final recovery device in the recovery system and an organic monitoring device approved by the Technical Secretary is used, all 3-hour periods of operation during which the average concentration level or reading of organic compounds in the exhaust gases is more than 20 percent greater than the exhaust gas organic compound concentration level or reading measured by the monitoring device during the most recent compliance test that demonstrated that the facility was in compliance.

(j) Each owner or operator subject to the provisions of this rule and seeking to demonstrate compliance with Subparagraph (3)(c) of this rule shall keep up-to-date records of:

1. Any changes in production capacity, feedstock type, or catalyst type, or of any replacement, removal, or addition of recovery equipment or air oxidation reactors;

2. Any calculation of the TRE index value performed pursuant to Subparagraph (5)(b) of this rule.

3. The results of any test performed pursuant to the methods and procedures required by Subparagraph (4)(d) of this rule.

(7) The owner or operator of any facility containing sources subject to this rule shall:

(a) Comply with the initial compliance certification requirements of Paragraph .04(1) of this

chapter; and (b) Comply with the requirements of Paragraph .04(2) of this chapter for excess emissions related to the control devices required to comply with this rule.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed October 2, 1979; effective November 16, 1979. Amendment filed April 23, 1992; effective June 7, 1992. Repeal and new rule filed March 8, 1983; effective April 22, 1993. Amendment filed May 16, 1997; effective July 30, 1997.

Tenn. Comp. R. & Regs. 1200-03-18-.41 RESERVED

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed May 15, 1979; effective July 10, 1979. Amendment filed December 14, 1981; effective January 28, 1982. Amendment filed April 23, 1992; effective June 7, 1992. Repeal filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.42 WOOD FURNITURE FINISHING AND CLEANING OPERATION

(1) Applicability of this Rule is as follows:

This Rule applies to any wood furniture coating line within a facility located in Davidson, Rutherford, Shelby, Sumner, Williamson or Wilson County whose maximum potential emissions from all wood furniture coating lines within the facility are 100 tons or more of volatile organic compounds (VOC’s) per year.

(2) For the purpose of this Rule, the following definitions apply:

(a) “Adhesive” means any chemical substance that is applied for the purpose of bonding two surfaces together other than by mechanical means.

(b) “Administrator” means the Administrator of the United States Environmental Protection Agency or his or her authorized representative.

(c) “Affected Source” means a wood furniture manufacturing facility that meets the criteria listed in Subparagraph (1).

(d) “Alternative method” means any method of sampling and analyzing for an air pollutant that is not a reference or equivalent method but that has been demonstrated to the Technical Secretary and the Administrator’s satisfaction to, in specific cases, produce results adequate for a determination of compliance.

(e) “Basecoat” means a coat of colored material, usually opaque, that is applied before graining inks, glazing coats, or other opaque finishing materials and is usually topcoated for protection.

(f) “Baseline conditions” means the conditions that exist prior to an affected source implementing controls, such as a control system.

(g) “Cleaning operations” means operations in which organic solvent is used to remove coating materials from equipment used in the coating operation.

(h) “Coating Solids (or solids)” mean the part of the coating that remains after the coating is dried or cured.

(i) “Continuous coater” means a finishing system that continuously applies finishing materials onto furniture parts moving along a conveyor system. Finishing materials that are not transferred to the part are recycled to the finishing material reservoir.

Several types of application methods can be used with a continuous coater including spraying, curtain coating, roll coating, dip coating, and flow coating.

(j) “Continuous compliance” means that the affected source is meeting the emission limitations and other requirements of the Rule at all times and is fulfilling all monitoring and recordkeeping provisions of the Rule in order to demonstrate compliance.

(k) “Conventional air spray” means a spray coating method in which the coating is atomized by mixing it with compressed air at an air pressure greater than 10 pounds per square inch (gauge) at the point of atomization. Airless and air assisted airless spray technology are not conventional air spray because the coating is not atomized by mixing it with compressed air.

(l) “Disposed offsite” means sending used organic solvent or finishing material outside of the facility for disposal.

(m) “Enamel” means the coat of colored material, usually opaque, that is applied as a protective topcoat over a basecoat, primer, or a previously applied enamel coat. In some cases, another finishing material may be applied as a topcoat over enamel.

(n) “Equivalent method” means any method of sampling and analyzing for an air pollutant that has been demonstrated to the Technical Secretary and the Administrator’s satisfaction to have a consistent and quantitatively known relationship to the reference method under specific conditions.

(o) “Final touch-up and repair” means the application of finishing materials after completion of the finishing operation to cover minor imperfections.

(p) “Finishing application station” means the part of a finishing operation where the finishing material is applied, e.g., a spray booth.

(q) “Finishing material” means a coating other than an adhesive. For the wood furniture manufacturing industry, such materials include, but are not limited to, basecoats, stains, washcoats, sealers, topcoats, and enamels.

(r) “Finishing operation” means those activities in which a finishing material is applied to a substrate and is subsequently air-dried, cured in an oven, or cured by radiation.

(s) “Incinerator” means, for the purposes of this industry, an enclosed combustion device that thermally oxidizes volatile organic compounds to CO and CO . This term does not include devices that burn municipal or hazardous waste material.

(t) “Material safety data sheet (MSDS)” means the documentation required by the Occupational Safety and Health Administration (OSHA) Hazard Communication Standard for a solvent, cleaning material, finishing material, or other material that identifies select reportable hazardous ingredients of the material, safety and health considerations, and handling procedures.

(u) “Normally closed container” means a container that is closed unless an operator is actively engaged in activities such as emptying or filling the container.

(v) “Operating parameter value” means a minimum or maximum value established for a control device or process parameter that, if achieved by itself or in combination with one or more other operating parameter values, determines that an owner or operator has complied with an applicable emission limit.

(w) “Organic solvent” means a liquid containing volatile organic compounds that is used for dissolving or dispersing constituents in a coating, adjusting the viscosity of a coating, or cleaning equipment. When used in a coating the organic solvent evaporates during drying and does not become a part of the dried film.

(x) “Permanent total enclosure” means a permanently installed enclosure that completely surrounds a source of emissions such that all emissions are captured and contained for discharge through a control device.

(y) “Recycled onsite” means the reuse of an organic solvent in a process other than cleaning or washoff.

(z) “Sealer” means a finishing material used to seal the pores of a wood substrate before additional coats of finishing material are applied. Special purpose finishing materials that are used in some finishing systems to optimize aesthetics are not sealers.

(aa) “Stain” means any color coat having a solids content by weight of no more than 8.0 percent that is applied in single or multiple coats directly to the substrate. This includes, but is not limited to, nongrain raising stains, equalizer stains, sap stains, body stains, no-wipe stains, penetrating stains, and toners.

(bb) “Storage containers” means vessels or tanks, including mix equipment, used to hold finishing or cleaning materials.

(cc) “Strippable booth coating” means a coating that:

1. Is applied to a booth wall to provide a protective film to receive overspray during finishing operations;

2. That is subsequently peeled off and disposed of; and;

3. By achieving 1. and 2., reduces or eliminates the need to use organic solvents to clean booth walls.

(dd) “Temporary total enclosure” means an enclosure that meets the requirements of (7)(e)1.(i) through (iv) and is not permanent, but constructed only to measure the capture efficiency of the capture system of a given source. In addition to meeting the requirements of (7)(e)1.(i) through (iv), any exhaust point from the enclosure shall be at least 4 equivalent duct or hood diameters from each natural draft opening.

(ee) “Topcoat” means the last film-building finishing material applied in a finishing system.

(ff) “Washcoat” means a transparent special purpose coating having a solids content by weight of 12.0 percent or less. Washcoats are applied over initial stains to protect and control color and to stiffen the wood fibers in order to aid sanding.

(gg) “Washoff” operations means those operations in which organic solvent is used to remove coating from a substrate.

(hh) “Waterborne” coating means a coating that contains more than five percent water by weight in its volatile fraction.

(ii) “Wood furniture” facility means all of the pollutant-emitting activities that belong to the same wood furniture industrial grouping, are located on one or more contiguous or adjacent properties, and are under the control of the same person (or persons under common control). The wood furniture industrial grouping includes the following SIC codes: 2434, 2511, 2512, 2517, 2519, 2521, 2531, 2541, and 2599.

(jj) “Wood furniture manufacturing operations” means the finishing and cleaning operations conducted at a wood furniture facility.

(kk) “Working day” means a day, or any part of a day, in which a facility is engaged in manufacturing.

(3) The nomenclature used in this Rule has the following meaning:

(a) A k = the area of each natural draft opening (k) in a total enclosure, in square meters.

(b) C = the VOC content of a coating (c), in kilograms of VOC per kilogram of coating solids (kg VOC/kg solids), as applied. Also given in pounds of VOC per pound of coating solids (lb VOC/lb solids), as applied.

(c) C aj = the concentration of VOC in gas stream (j) exiting the emission control device, in parts per million by volume.

(d) C bi = the concentration of VOC in gas stream (i) entering the emission control device, in parts per million by volume.

(e) C di = the concentration of VOC in gas stream (i) entering the emission control device from the affected emission point(s), in parts per million by volume.

(f) C fk = the concentration of VOC in each uncontrolled gas stream (k) emitted directly to the atmosphere from the affected emission point(s), in parts per million by volume.

(g) E = the emission limit to be achieved by the affected emission point(s), in kg VOC/kg solids.

(h) F = the control device efficiency, expressed as a fraction.

(i) FV = the average inward face velocity across all natural draft openings in a total enclosure, in meters per hour.

(j) N = the capture efficiency, expressed as a fraction.

(k) Q aj = the volumetric flow rate of gas stream (j) exiting the emission control device, in dry standard cubic meters per hour.

(l) Q bi = the volumetric flow rate of gas stream (i) entering the emission control device, in dry standard cubic meters per hour.

(m) Q di = the volumetric flow rate of gas stream (i) entering the emission control device from the affected emission point(s), in dry standard cubic meters per hour.

(n) Q fk = the volumetric flow rate of each uncontrolled gas stream (k) emitted directly to the atmosphere from the affected emission point(s), in dry standard cubic meters per hour.

(o) Q in i = the volumetric flow rate of gas stream (i) entering the total enclosure through a forced makeup air duct, in standard cubic meters per hour (wet basis).

(p) Q out j = the volumetric flow rate of gas stream (j) exiting the total enclosure through an exhaust duct or hood, in standard cubic meters per hour (wet basis).

(q) R = the overall efficiency of the control system, expressed as a percentage.

(4) Emission Standards (a) Each owner or operator of an affected source subject to this Rule shall limit VOC emissions from finishing operations by:

1. Using topcoats with a VOC content no greater than 0.8 kg VOC/kg solids (0.8 lb VOC/lb solids), as applied; or 2. Using a finishing system of sealers with a VOC content no greater than 1.9 kg VOC/kg solids (1.9 lb VOC/lb solids), as applied and topcoats with a VOC content no greater than 1.8 kg VOC/kg solids (1.8 lb VOC/lb solids), as applied; or 3. For affected sources using acid-cured alkyd amino vinyl sealers or acid-cured alkyd amino conversion varnish topcoats, using sealers and topcoats based on the following criteria:

(i) If the affected source is using acid-cured alkyd amino vinyl sealers and acid-cured alkyd amino conversion varnish topcoats, the sealer shall contain no more than 2.3 kg VOC/kg solids (2.3 lb VOC/lb solids), as applied, and the topcoat shall contain no more than 2.0 kg VOC/kg solids (2.0 lb VOC/lb solids), as applied; or (ii) If the affected source is using a sealer other than an acid-cured alkyd amino vinyl sealer and acid-cured alkyd amino conversion varnish topcoats, the sealer shall contain no more than 1.9 kg VOC/kg solids (1.9 lb VOC/lb solids), as applied, and the topcoat shall contain no more than 2.0 kg VOC/kg solids (2.0 lb VOC/lb solids), as applied; or (iii) If the affected source is using an acid-cured alkyd amino vinyl sealer and a topcoat other than an acid-cured alkyd amino conversion varnish topcoat, the sealer shall contain no more than 2.3 kg VOC/kg solids (2.3 lb VOC/lb solids), as applied, and the topcoat shall contain no more than 1.8 kg VOC/kg solids (1.8 lb VOC/lb solids), as applied; or 4. Meeting the provisions established in Paragraph (10) for sources using an averaging approach and demonstrating that actual emissions from the affected source are less than or equal to allowable emissions using one of the following equations:

(1)

(2) where:

N = number of finishing materials participating in averaging;

TC i = kilograms of solids of topcoat “i” used;

SE i = kilograms of solids of sealer “i” used;

WC i = kilograms of solids of washcoat “i” used;

BC i = kilograms of solids of basecoat “i” used;

ST i = liters of stain “i” used;

ER TCi = VOC content of topcoat “i” in kg VOC/kg solids, as applied;

ER SEi = VOC content of sealer “i” in kg VOC/kg solids, as applied;

ER WCi = VOC content of washcoat “i” in kg VOC/kg solids, as applied;

ER BCi = VOC content of basecoat “i” in kg VOC/kg solids, as applied; and ER STi = VOC content of stain “i” in kg VOC/liter (kg/l),as applied.

5. Using a control system that will achieve an equivalent reduction in emissions as the requirements of Part (a)1. or 2. of this Paragraph, as calculated using the compliance provisions in Part (6)(a)2. of this Rule, as appropriate; or 6. Using a combination of the methods presented in Parts (4)(a)1., 2., 3., 4., and 5. of this Rule.

(b) Each owner or operator of an affected source subject to this Rule shall limit VOC emissions from cleaning operations when using a strippable booth coating. A strippable booth coating shall contain no more than 0.8 kg VOC/kg solids, as applied (0.8 lb VOC/lb solids).

(5) Work Practice Standards (a) Work practice implementation plan.

1. Each owner or operator of an affected source subject to this Rule shall prepare and maintain a written work practice implementation plan that defines environmentally desirable work practices for each wood furniture manufacturing operation and addresses each of the topics specified in Subparagraphs (b) through (j) of this paragraph. The plan shall be developed no more than 60 days after the compliance date. The written work practice implementation plan shall be available for inspection by the Technical Secretary, upon request. If the 0.9 ( 0.8( TC ))

ER (

TC ) i=1N i i=1N TCii →→ ∑ ≥ ∑ 0.9( 1.8( TC ) + 1.9( SE ) + 9.0( WC ) + 1.2( BC ) + 0.791( ST ))

ER (

TC ) +

ER (

SE ) +

ER (

WC ) +

ER (

BC ) +

ER (

ST ) i = 1N ii ii i i = 1N TCi iSEii WCi iBCi iSTi i → → ∑ ≥ ∑ Technical Secretary determines that the work practice implementation plan does not adequately address each of the topics specified in Subparagraphs (b) through (j) of this Paragraph, the Technical Secretary shall require the affected source to modify the plan.

(b) Operator training course.

Each owner or operator of an affected source shall train all new and existing personnel, including contract personnel, who are involved in finishing or cleaning operations or implementation of the requirements of this Rule. All personnel shall be given refresher training annually. The affected source shall maintain a copy of the training program with the work practice implementation plan. The training program shall include, at a minimum, the following:

1. A list of all personnel by name and job description that are required to be trained;

2. An outline of the subjects to be covered in the initial and refresher training for each person, or group of personnel;

3. Lesson plans for courses to be given at the initial and the annual refresher training that include, at a minimum, appropriate application techniques, appropriate cleaning procedures, appropriate equipment setup and adjustment to minimize finishing material usage and overspray, and appropriate management of cleanup wastes; and 4. A description of the methods to be used at the completion of initial or refresher training to demonstrate and document successful completion.

(c) Leak inspection and maintenance plan.

Each owner or operator of an affected source shall prepare and maintain with the work practice implementation plan a written leak inspection and maintenance plan that specifies:

1. A minimum visual inspection frequency of once per month for all equipment used to transfer or apply finishing materials or organic solvents;

2. An inspection schedule;

3. Methods for documenting the date and results of each inspection and any repairs that were made;

4. The time frame between identifying a leak and making the repair, which adheres to the following schedule:

(i) A first attempt at repair (e.g., tightening of packing glands) shall be made no later than 5 working days after the leak is detected; and (ii) Final repairs shall be made within 15 working days, unless the leaking equipment is to be replaced by a new purchase, in which case repairs shall be completed within 3 months.

(d) Cleaning solvent accounting system.

Each owner or operator of an affected source shall develop an organic solvent accounting form to record:

1. The quantity and type of organic solvent used each month for washoff and cleaning;

2. The number of pieces washed off, and the reason for the washoff; and 3. The quantity of spent organic solvent generated from each activity, and the quantity that is recycled onsite or disposed offsite each month.

(e) Each owner or operator of an affected source shall not use organic solvents containing more than 8.0 percent by weight of VOC for cleaning spray booth components other than conveyors, continuous coaters and their enclosures, and/or metal filters, unless the spray booth is being refurbished. If the spray booth is being refurbished, that is, the spray booth coating or other material used to cover the booth is being replaced, the affected source shall use no more than 1.0 gallon of organic solvent to clean the booth.

(f) Each owner or operator of an affected source shall use normally closed containers for storing finishing and cleaning materials.

(g) Each owner or operator of an affected source shall not use conventional air spray guns for applying finishing materials except under the following circumstances:

1. To apply finishing materials that have a VOC content no greater than 1.0 kg VOC/kg solids (1.0 lb VOC/lb solids), as applied;

2. For final touch-up and repair;

3. If spray is automated, that is, the spray gun is aimed and triggered automatically, not manually;

4. If emissions from the finishing application station are directed to a control device;

5. The conventional air gun is used to apply finishing materials and the cumulative total usage of that finishing material is less than 5 percent of the total gallons of finishing material used during that semiannual reporting period; or 6. The conventional air gun is used to apply coating on a part for which it is technically or economically infeasible to use any other spray application technology. The affected source shall demonstrate technical or economic infeasibility by submitting to the Technical Secretary a videotape, a technical report, or other documentation that supports the affected source’s claim of technical or economic infeasibility. The following criteria shall be used, either independently or in combination, to support the affected source’s claim of technical or economic infeasibility:

(i) The production speed is too high or the part shape is too complex for one operator to coat the part and the application station is not large enough to accommodate an additional operator; or (ii) The excessively large vertical spray area of the part makes it difficult to avoid sagging or runs in the stain.

(h) Each owner or operator of an affected source shall pump or drain all organic solvent used for line cleaning into a normally closed container.

(i) Each owner or operator of an affected source shall collect all organic solvent used to clean spray guns into a normally closed container.

(j) Each owner or operator of an affected source shall control emissions from washoff operations by:

1. Using normally closed tanks for washoff; and 2. Minimizing dripping by tilting or rotating the part to drain as much organic solvent as possible.

(6) Compliance Procedures and Monitoring Requirements (a) The owner or operator of an affected source subject to the emission standards in Paragraph (4) of this Rule shall demonstrate compliance with those provisions and with the initial compliance certification requirements of Paragraph .03(1) of this chapter, except that the date for submittal of the initial compliance certification for each existing source as of August 15, 1995 is November 15, 1996, and for each new sources (after August 15, 1995) is within 180 days after the start-up of that source; and by using any of the following methods:

1. To support that each sealer, topcoat, and strippable booth coating meets the requirements of Parts (4)(a)1., 2., or 3. or Subparagraph (4)(b) of this Rule, maintain documentation in accordance with Rule .81 of this chapter, or data from an alternative or equivalent method, to determine the VOC and solids content of the as supplied finishing material. If solvent or other VOC is added to the finishing material before application, the affected source shall maintain documentation showing the VOC content of the finishing material as applied, in kg VOC/kg solids.

2. To comply through the use of a control system as discussed in (4)(a)5.:

(i) Determine the overall control efficiency needed to demonstrate compliance using Equation 3;

R = ((C - E)/C)(100) (3)

(ii) Document that the value of C in Equation 3 is obtained from the VOC and solids content of the as-applied finishing material;

(iii) Calculate the overall efficiency of the control device, using the procedures in Subparagraphs (7)(d) or (e), and demonstrate that the value of R calculated by Equation 6 is equal to or greater than the value of R calculated by Equation 3.

(b) Initial compliance.

1. Owners or operators of an affected source subject to the provisions of Parts (4)(a)1., 2., or 3. or Subparagraph (4)(b) that are complying through the procedures established in Part (6)(a)1. shall submit an initial compliance status report, as required by Subparagraph (9)(b), stating that compliant sealers and/or topcoats and strippable booth coatings are being used by the affected source.

2. Owners or operators of an affected source subject to the provisions of Parts (4)(a)1., 2., or 3. that are complying through the procedures established in Part (6)(a)1. and are applying sealers and/or topcoats using continuous coaters shall demonstrate initial compliance by:

(i) Submitting an initial compliance status report stating that compliant sealers and/or topcoats, as determined by the VOC content of the finishing material in the reservoir and the VOC content as calculated from records, are being used; or (ii) Submitting an initial compliance status report stating that compliant sealers and/or topcoats, as determined by the VOC content of the finishing material in the reservoir, are being used and the viscosity of the finishing material in the reservoir is being monitored. The affected source shall also provide data that demonstrates the correlation between the viscosity of the finishing material and the VOC content of the finishing material in the reservoir.

3. Owners or operators of an affected source using a control system (capture device/control device) to comply with the requirements of this Rule, as allowed by Parts (4)(a)5. and (6)(a)2. shall demonstrate initial compliance by:

(i) Submitting a monitoring plan that identifies the operating parameter to be monitored for the capture device and discusses why the parameter is appropriate for demonstrating ongoing compliance;

(ii) Conducting an initial performance test using the procedures and test methods listed in Subparagraphs (7)(c) and (d) or (e);

(iii) Calculating the overall control efficiency (R) using Equation 6; and (iv) Determining those operating conditions critical to determining compliance and establishing operating parameters that will ensure compliance with the standard.

(I) For compliance with a thermal incinerator, minimum combustion temperature shall be the operating parameter.

(II) For compliance with a catalytic incinerator equipped with a fixed catalyst bed, the minimum gas temperature both upstream and downstream of the catalyst bed shall be the operating parameter.

(III) For compliance with a catalytic incinerator equipped with a fluidized catalyst bed, the minimum gas temperature upstream of the catalyst bed and the pressure drop across the catalyst bed shall be the operating parameters.

(IV) For compliance with a carbon adsorber, the operating parameters shall be either the total regeneration mass stream flow for each regeneration cycle and the carbon bed temperature after each regeneration, or the concentration level of organic compounds exiting the adsorber, unless the owner or operator requests and receives approval from the Technical Secretary and the Administrator to establish other operating parameters.

(V) For compliance with a control device not listed in this section, the operating parameter shall be established using the procedures identified in Subpart (6)(c)3.(vi).

(v) Owners or operators complying with Part (b)3. of this Paragraph shall calculate the site-specific operating parameter value as the arithmetic average of the maximum or minimum operating parameter values, as appropriate, that demonstrate compliance with the standards, during the test runs required by Rule .84 of this chapter 4. Owners or operators of an affected source subject to the work practice standards in Paragraph (5) shall submit an initial compliance status report, as required by (9)(b), stating that the work practice implementation plan has been developed and procedures have been established for implementing the provisions of the plan.

(c) Continuous compliance demonstrations.

1. Owners or operators of an affected source subject to the provisions of Paragraph (4) that are complying through the procedures established in Part (6)(a)1. shall demonstrate continuous compliance by using compliant materials, maintaining records that demonstrate the finishing materials are compliant materials.

(i) The compliance certification shall state that compliant sealers and/or topcoats and strippable booth coatings have been used each day, or should otherwise identify the days of noncompliance and the reasons for noncompliance. An affected source is in violation of the standard whenever a noncompliant material, as determined by records or by a sample of the finishing material, is used. Use of a noncompliant material is a separate violation for each day the noncompliant material is used.

(ii) The compliance certification shall be signed by a responsible official of the company that owns or operates the affected source.

2. Owners or operators of an affected source subject to the provisions of Paragraph (4) that are complying through the procedures established in Part (6)(a)1. and are applying sealers and/or topcoats using continuous coaters shall demonstrate continuous compliance by following the procedures in (i) or (ii) of this Part.

(i) Using compliant materials, as determined by the VOC content of the finishing material in the reservoir and the VOC content as calculated from records.

(I) The compliance certification shall state that compliant sealers and/or topcoats have been used each day, or should otherwise identify the days of noncompliance and the reasons for noncompliance. An affected source is in violation of the standard whenever a noncompliant material, as determined by records or by a sample of the finishing material, is used. Use of a noncompliant material is a separate violation for each day the noncompliant material is used.

(II) The compliance certification shall be signed by a responsible official of the company that owns or operates the affected source.

(ii) Using compliant materials, as determined by the VOC content of the finishing material in the reservoir, maintaining a viscosity of the finishing material in the reservoir that is no less than the viscosity of the initial finishing material by monitoring the viscosity with a viscosity meter or by testing the viscosity of the initial finishing material and retesting the material in the reservoir each time solvent is added, and maintaining records of solvent additions.

(I) The compliance certification shall state that compliant sealers and/or topcoats, as determined by the VOC content of the finishing material in the reservoir, have been used each day. Additionally, the certification shall state that the viscosity of the finishing material in the reservoir has not been less than the viscosity of the initial finishing material, that is, the material that is initially mixed and placed in the reservoir.

(II) The compliance certification shall be signed by a responsible official of the company that owns or operates the affected source.

(III) An affected source is in violation of the standard when a sample of the as-applied finishing material exceeds the applicable limit established in 4(a)(1), (2), or (3), as determined according to and as provided for in Rule .81 of this chapter, or an alternative or equivalent method, or the viscosity of the finishing material in the reservoir is less than the viscosity of the initial finishing material.

3. Owners or operators of an affected source subject to the provisions of Paragraph (4) that are complying through the use of a control system (capture/ control device) shall demonstrate continuous compliance by installing, calibrating, maintaining, and operating the appropriate monitoring equipment according to manufacturers specifications.

(i) Where a capture/control device is used, a device to monitor the sitespecific operating parameter established in accordance with (6)(b)3.(iv) is required.

(ii) Where an incinerator is used, a temperature monitoring device equipped with a continuous recorder is required.

(I) Where a thermal incinerator is used, a temperature monitoring device shall be installed in the firebox or in the ductwork immediately downstream of the firebox in a position before any substantial heat exchange occurs.

(II) Where a catalytic incinerator equipped with a fixed catalyst bed is used, temperature monitoring devices shall be installed in the gas stream immediately before and after the catalyst bed.

(III) Where a catalytic incinerator equipped with a fluidized catalyst bed is used, a temperature monitoring device shall be installed in the gas stream immediately before the bed. In addition, a pressure monitoring device shall be installed to determine the pressure drop across the catalyst bed. The pressure drop shall be measured monthly at a constant flow rate.

(iii) Where a carbon adsorber is used:

(I) An integrating regeneration stream flow monitoring device having an accuracy of + 10 percent, capable of recording the total regeneration stream mass flow for each regeneration cycle; and a carbon bed temperature monitoring device having an accuracy of +1 percent of the temperature being monitored expressed in degrees Celsius or +0.5°C, whichever is greater, capable of recording the carbon bed temperature after each regeneration and within 15 minutes of completing any cooling cycle;

(II) An organic monitoring device, equipped with a continuous recorder, to indicate the concentration level of organic compounds exiting the carbon adsorber; or (III) Any other monitoring device that has been approved by the Technical Secretary and the Administrator as allowed under (6)(c)3.(iv).

(iv) Owners or operators of an affected source shall not operate the capture or control device at a daily average value greater than or less than (as appropriate) the operating parameter value. The daily average value shall be calculated as the average of all values for a monitored parameter recorded during the operating day.

(v) Owners or operators of an affected source that are complying through the use of a catalytic incinerator equipped with a fixed catalyst bed shall maintain a constant pressure drop, measured monthly, across the catalyst bed.

(vi) An owner or operator using a control device not listed in this Paragraph shall submit to the Technical Secretary and the Administrator a description of the device, test data verifying the performance of the device, and appropriate operating parameter values that will be monitored to demonstrate continuous compliance with the standard. Compliance using this device is subject to both the Technical Secretary and the Administrator’s approval.

4. Owners or operators of an affected source subject to the work practice standards in Paragraph (5) shall demonstrate continuous compliance by following the work practice implementation plan and submitting a compliance certification required by Rule .03 of this chapter.

(i) The compliance certification shall state that the work practice implementation plan is being followed, or should otherwise identify the periods of noncompliance with the work practice standards. Each failure to implement an obligation under the plan during any particular day is a separate violation.

(ii) The compliance certification shall be signed by a responsible official of the company that owns or operates the affected source.

5. The owner or operator of an existing source or of a source having a state or local agency’s construction permit before August 15, 1995 (instead of April 22,1993) and subject to this Rule may petition for a source-specific compliance schedule according to and as provided for in Rule .07 of this chapter. The petition for the source-specific compliance schedule must be received by Technical Secretary by February 11, 1996 (instead of October 22, 1993).

(7) Performance Test Methods (a) The VOC content and the solids content by weight of the as supplied finishing materials shall be determined according to and as provided for in Rule .81 of this chapter. The owner or operator of the affected source may request approval from the Technical Secretary and the Administrator to use an alternative or equivalent method for determining the VOC content of the finishing material. If it is demonstrated to the satisfaction of the Technical Secretary and the Administrator that a finishing material does not release VOC byproducts during the cure, for example, all VOC is organic solvent, then batch formulation information shall be accepted. In the event of any inconsistency between the procedures described in Rule .81 of this chapter and a facility’s formulation data, that is, if the procedures described in Rule .81 of this chapter result in higher values, these procedures (Rule .81) shall govern.

(b) Owners or operators demonstrating compliance with the provisions of this Rule via a control system shall determine the overall control efficiency of the control system (R) as the product of the capture and control device efficiencies, using the test methods cited in Subparagraph (7)(c) and the procedures in Subparagraphs (7)(d) or (e).

(c) Owners or operators using a control system shall demonstrate initial compliance using the procedures in Rule .84 of this chapter.

(d) Owners or operators using a control system to demonstrate compliance with this Rule shall use the following procedures:

1. Construct the overall VOC control system so that volumetric flow rates and VOC concentrations can be determined by the test methods specified in Rule .84 of this chapter;

2. Measure the capture efficiency from the affected emission point(s) by capturing, venting, and measuring all VOC emissions from the affected emission point(s).

To measure the capture efficiency of a capture device located in an area with non-affected VOC emission point(s), the affected emission point(s) shall be isolated from all other VOC sources by one of the following methods:

(i) Build a temporary total enclosure (see Subparagraph (2)(dd) of this Rule) around the affected emission point(s);

(ii) Shut down all non-affected VOC emission point(s) and continue to exhaust fugitive emissions from the affected emission point(s) through any building ventilation system and other room exhausts such as drying ovens. All exhaust air must be vented through stacks suitable for testing; or (iii) Use another methodology approved by the Technical Secretary and the Administrator provided that it is constructed and operated in accordance with the guidelines of the latest edition of the Industrial Ventilation Manual, of the American Conference of Governmental Industrial Hygienists.

3. Operate the control system with all affected emission point(s) connected and operating at maximum production rate;

4. Determine the efficiency (F) of the control device using Equation 4; and (4)

5. Determine the efficiency (N) of the capture system using Equation 5;

F = Q

C - Q

C Q C i=1 n bi bi j=1 P aj aj i=1 n bi bi ∑∑ ∑ 6. Compliance is demonstrated if the value of (R) in Equation 6 is greater than or equal to the value of R calculated by Equation 3 in accordance with Subpart (6)(a)2.(i).

R = (F x N)(100) (6)

(e) An alternative to the compliance method presented in Subparagraph (7)(d) is the installation of a permanent total enclosure. A permanent total enclosure presents prima facia evidence that all VOC emissions from the affected emission point(s) are directed to the control device. Each affected source that complies using a permanent total enclosure shall:

1. Demonstrate that the total enclosure meets the following requirements:

(i) The total area of all natural draft openings shall not exceed 5 percent of the total surface area of the total enclosure’s walls, floor, and ceiling;

(ii) All sources of emissions within the enclosure shall be a minimum of four equivalent diameters away from each natural draft opening;

(iii) Average inward face velocity (FV) across all natural draft openings shall be a minimum of 3,600 meters per hour as determined by the following procedures:

(I) All forced makeup air ducts and all exhaust ducts are constructed so that the volumetric flow rate in each can be accurately determined by the test methods and procedures specified in Rule .83 of this

chapter. Volumetric flow rates shall be calculated without the adjustment normally made for moisture content; and (II) Determine FV by the following equation:

(iv) All access doors and windows whose areas are not included as natural draft openings and are not included in the calculation of FV shall be closed during routine operation of the process.

2. Determine the control device efficiency using Equation 4, and the test methods and procedures specified in Subparagraph (7)(c).

3. If the permanent enclosure is demonstrated to be total, the value of N in Equation 5 is equal to 1.

4. For owners or operators using a control system to comply with the provisions of this Rule, compliance is demonstrated if:

N = Q

C Q C +

Q C i=1 n di di i=1 n di di k=1 P fk fk ∑ ∑∑ (5)

FV =

Q - Q

A j=1 n out j i=1 p i k=1 q k ∑∑ ∑ ∈ (i) The installation of a permanent total enclosure is demonstrated (N=1); and (ii) The value of (R) calculated by Equation 6 in accordance with Paragraph (7)(d) is greater than or equal to the value of R calculated by Equation 3 in accordance with Part (6)(a)2.

(8) Recordkeeping Requirements (a) The owner or operator of an affected source subject to the emission limits in Paragraph (4) of this Rule shall maintain records of the following:

1. A list of each finishing material and strippable booth coating subject to the emission limits in Paragraph (4);

2. The VOC and solids content, as applied, of each finishing material and strippable booth coating subject to the emission limits in Paragraph (4), and copies of data sheets documenting how the as applied values were determined.

(b) The owner or operator of an affected source following the compliance procedures of Paragraph (6)(c)2. shall maintain the records required by Paragraph (8)(a) and records of the following:

1. Solvent and finishing material additions to the continuous coater reservoir; and 2. Viscosity measurements.

(c) The owner or operator of an affected source following the compliance method of Paragraph (6)(a)2. shall maintain the following records:

1. Copies of the calculations to support the equivalency of using a control system, as well as the data that are necessary to support the calculation of E in Equation 3 and the calculation of R in Equation 6;

2. Records of the daily average value of each continuously monitored parameter for each operating day. If all recorded values for a monitored parameter are within the range established during the initial performance test, the owner or operator may record that all values were within the range rather than calculating and recording an average for that day; and 3. Records of the pressure drop across the catalyst bed for facilities complying with the emission limitations using a catalytic incinerator with a fluidized catalyst bed.

(d) The owner or operator of an affected source subject to the work practice standards in Paragraph (5) of this Rule shall maintain onsite the work practice implementation plan and all records associated with fulfilling the requirements of that plan, including, but not limited to:

1. Records demonstrating that the operator training program is in place;

2. Records maintained in accordance with the inspection and maintenance plan;

3. Records associated with the cleaning solvent accounting system;

4. Records associated with the limitation on the use of conventional air spray guns showing total finishing material usage and the percentage of finishing materials applied with conventional air spray guns; and;

5. Records showing the VOC content of solvent used for cleaning booth components, except for solvent used to clean conveyors, continuous coaters and their enclosures, and/or metal filters; and 6. Copies of logs and other documentation developed to demonstrate that the other provisions of the work practice implementation plan are followed.

(e) The owner or operator of an affected source shall maintain a copy of all other information submitted with the initial status report required by Subparagraph (9)(b).

(f) The owner or operator of an affected source shall maintain all records for a minimum of 5 years.

(g) Failure to maintain the records required by (a) through (f) of this Paragraph shall constitute a violation of the Rule for each day records are not maintained.

(9) Reporting Requirements (a) The owner or operator of an affected source using a control system to fulfill the requirements of this Rule are subject to the following reporting requirements:

1. The owner or operator of an affected source subject to this Rule shall submit an initial compliance report by the compliance date. The report shall include the items required by Subparagraph (6)(b) of this Rule.

2. The owner or operator of an affected source subject to this Rule and demonstrating compliance in accordance with Parts (6)(a)1. or 2. shall comply with Rule .03 of this chapter, except that the date for compliance for an existing source as of August 15, 1995 is November 15, 1996, and for each new source (after August 15, 1995) is within 180 days after the start-up of that source.

(10) Special Provisions for Sources Using an Averaging Approach The owner or operator of an affected source complying with the emission limitations established in Paragraph (4) through the procedures established in (4)(a)4. shall also meet the provisions established in (a) through (i) of this Paragraph.

(a) Program goals and rationale. The owner or operator of the affected source shall provide a summary of the reasons why the affected source would like to comply with the emission limitations through the procedures established in (4)(a)4. and a summary of how averaging can be used to meet the emission limitations. The affected source shall also document that the additional environmental benefit requirement is being met through the use of the equations in (4)(a)4. These equations ensure that the affected source is achieving an additional 10 percent reduction in emissions when compared to affected sources using a compliant coatings approach to meet the requirements of the

Rule.

(b) Program scope. The owner or operator of the affected source shall describe the types of finishing materials that will be included in the affected source’s averaging program.

Stains, basecoats, washcoats, sealers, and topcoats may all be used in the averaging program. Finishing materials that are applied using continuous coaters may only be used in an averaging program if the affected source can determine the amount of finishing material used each day.

(c) Program baseline. The baseline for each finishing material included in the averaging program shall be the lower of the actual or allowable emission rate as of the effective date of this rule, August 15, 1995. In no case shall the facility baseline emission rate be higher than what was presumed in the 1990 emissions inventory for the facility unless the State has accounted for the increase in emissions as growth.

(d) Quantification procedures. The owner or operator of the affected source shall describe how emissions and changes in emissions will be quantified, including methods for quantifying usage of each finishing material. Quantification procedures for VOC content are included in Paragraph (7). The quantification methods used shall be accurate enough to ensure that the affected source’s actual emissions are less than the allowable emissions, as calculated using Equation 1 or 2 in Part (4)(a)4., on a daily

basis.

(e) Monitoring, recordkeeping, and reporting. The owner or operator of an affected source shall provide a summary of the monitoring, recordkeeping, and reporting procedures that will be used to demonstrate daily compliance with the equations presented in (4)(a)4. The monitoring, recordkeeping, and reporting procedures shall be structured in such a way that inspectors and facility owners can determine an affected source’s compliance status for any day.

(f) Implementation schedule. The owner or operator of an affected source shall submit an averaging proposal for Technical Secretary and the Administrator’s approval for each existing source as of 180 days after August 15, 1995, and for each new source (after August 15, 1995) which is within 180 days after the start-up of that source. This must ensure that all sources are in compliance with the State’s Rule by the November 15, 1996. Submittal of the averaging proposal does not provide an exemption from this

Rule. The source must submit the averaging proposal by a date that allows sufficient time for the Administrator’s approval.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed June 2, 1995; effective August 15, 1995. Amendment filed March 13, 1997; effective May 27, 1997. Amendment filed June 13, 1997; effective August 28, 1997.

Tenn. Comp. R. & Regs. 1200-03-18-.43 OFFSET LITHOGRAPHIC PRINTING OPERATIONS

(1) Applicability of this rule is as follows:

(a) This rule applies to offset lithographic printing operations in Davidson, Rutherford, Shelby, Sumner, Williamson, and Wilson Counties.

(b) The emission limits of this rule do not apply to offset lithographic printing operations within any facility whose potential VOC emissions from all offset lithographic printing operations within the facility are less than 100 tons of volatile organic compounds (VOC’s) per year.

(2) For the purpose of this rule, the following definitions apply:

(a) “Alcohol substitute” means nonalcohol additives that contain VOC’s and are used in the fountain solution. Some additives are used to reduce the surface tension of water; others (especially in the newspaper industry) are added to prevent piling (ink build up).

(b) “Batch” means a supply of fountain solution that is prepared and used without alteration until completely used or removed from the printing process.

(c) “Cleaning Solution” means liquids to remove ink and debris from the operating surfaces of the printing press and its parts.

(d) “Fountain Solution” means a mixture of water, nonvolatile printing chemicals, and an additive (liquid) that reduces the surface tension of the water so that it spreads easily across the printing plate surface. The fountain solution wets the nonimage areas so that the ink is maintained within the image area. Isopropyl alcohol, a VOC, is the most common additive used to reduce the surface tension of the fountain solution.

(e) “Heatset” means any operation where heat is required to evaporate ink oil from the printing ink. Hot air dryers are used to deliver the heat.

(f) “Lithography” means a printing process where the image and nonimage area are chemically differentiated; the image area is oil receptive and the nonimage area is water receptive. This method differs from other printing methods, where the image is a raised or recessed surface.

(g) “Non-heatset” means any operation where the printing inks are set without the use of heat.

(h) “Offset” means a printing process that transfers the ink film from the lithographic plate to an intermediary surface (blanket), which, in turn, transfer the ink film to the substrate.

(i) “Press” means a printing production assembly composed of one or many units to produce a printed sheet or web.

(j) “Sheet-fed” means a printing operation where individual sheets of substrate are fed to the press.

(k) “Unit” means the smallest complete printing component of a printing press.

(l) “Web” means a continuous roll of paper used as the printing substrate.

(3) Standard as follow apply:

(a) No owner or operator of a heatset web offset lithographic printing press subject to this

rule shall apply any fountain solution unless the VOC content is equal to or less than one of the following:

1. 1.6 percent VOC by volume of the fountain solution containing alcohol, as applied;

2. 3 percent VOC by volume of the fountain solution containing alcohol, as applied, if the fountain solution is refrigerated to less than 60°F.

3. 4.6 percent VOC by volume of the fountain solution, as applied, and use no alcohol in the fountain solution .

4. 6 percent VOC by volume of the fountain solution, as applied, if the fountain solution is refrigerated to less than 60°F and use no alcohol in the fountain solution.

(b) No owner or operator of a non-heatset web offset printing press subject to this rule shall apply any fountain solution that contains alcohol, nor shall any fountain solution be applied unless the VOC content is equal to or less than 5 percent by weight of the fountain solution, as applied.

(c) Reserved.

(d) No owner or operator of a sheet-fed offset lithographic printing press subject to this rule shall apply any fountain solution unless the VOC content is equal to or less than one of the following:

1. 5 percent VOC by volume of the fountain solution, as applied;

2. 8.5 percent VOC by volume of the fountain solution, as applied, if the fountain solution is refrigerated to less than 60°F.

(e) No owner or operator of an offset lithographic printing press subject to this rule shall apply any cleaning solutions unless:

1. The VOC composite partial vapor pressure of the cleaning solutions is less than 10mm Hg at 20°C, as applied; or 2. The VOC content of the cleaning solutions are less than or equal to 30 percent by weight, as applied.

(f) Reserved.

(g) Any person who owns or operates a heatset offset lithographic printing press subject to this rule shall reduce VOC emissions from the press dryer exhaust vent by 90 percent by weight of total organic (minus methane and ethane), or maintain a maximum control device outlet concentration of 50 ppmv whichever is less stringent when the press is in operation.

(h) As an alternative to compliance with the limits in Subparagraphs (3)(a), (d), (e), or (f) of this paragraph, an owner or operator of an offset lithographic printing press may comply with the requirements of Paragraph (4) of this rule.

(i) As an alternative to compliance with the limits in Subparagraphs (3)(g) of this paragraph, an owner or operator of an offset lithographic printing press may comply with the requirements of Paragraph (5) of this rule.

(4) Weighted average limitations as follow apply:

(a) No owner or operator of an offset lithographic printing press subject to this rule shall apply fountain solutions on the printing press unless the weighted average, by volume, VOC content of all fountain solutions, as applied, each day on the printing press is equal to or less than the limitation specified in either Part (3)(a) or (3)(d) [as determined by Subparagraph (4)(d)]; or, in the case of nonalcohol additives or alcohol substitute addition to fountain solution, (3)(c) [as determined by Subparagraph (4)(e)].

(b) Reserved.

(c) No owner or operator of an offset lithographic printing press subject to this rule shall apply cleaning solutions on the printing press unless VOC composite vapor pressure, as applied, each day on the printing press is equal to or less than the limitation specified in Subparagraph (3)(e)1. [as determined by Subparagraph (4)(f)] of this rule.

(d) The following equation shall be used to determine if the weighted average VOC content, by volume, of all fountain solutions, as applied, on the subject printing press exceeds the limitation specified in Part (3)(a) or (3)(d) of this rule:

( )( )i A i i n VOCi i i l n VOCi VOC L V L V x= = = ∑ ∑ where:

VOC (i)(A) = The weighted average VOC content in units of percent VOC by volume of the volatile content of all fountain solutions used each day; i = Subscript denoting a specific fountain solution, as applied; n = The number of different fountain solutions, as applied, each day on a printing press;

L i = The liquid volume of each fountain solution, as applied, used that day in units of liters (L)

(gallons [gal]);

V VOCi = The volume fraction of VOC in each fountain solution, as applied; and V VCi = The volume fraction of volatile matter in each fountain solution, as applied.

(e) The following equation shall be used to determine if the weighted average VOC content, by weight, of all fountain solutions, as applied, on the subject printing press exceeds the limitations specified in Part (4)(a) in case of fountain solution :

( )( )i B i i n iVOCi i i n ini VOC L D W L D W x= = = ∑ ∑ where:

VOC (i)(B) = The weighted average VOC content in units of percent VOC by weight of the volatile content of all fountain solutions used each day; i = Subscript denoting a specific fountain solution as applied; n = The number of different fountain solutions, as applied, each day on a printing press;

L i = The liquid volume of each fountain solution, as applied, used on the day in units of L (gal);

D i = The density of each fountain solution, as applied, in units of mass of fountain solution per unit volume of fountain solution;

W VOCi = The weight fraction of VOC in each fountain solution, as applied; and W si = The weight fraction of solids in each fountain solution, as applied.

(f) The following equation shall be used to determine if the VOC composite partial pressure of cleaning solutions, as applied, exceeds the limitation specified in Part (3)(e) of this rule:

( )

( ) c i i i W W e e i i i n i n PP W VP MW W MW W MW W MW = ++ = = ∑ ∑ where:

PP c = VOC composite partial pressure at 20°C, in mm Hg.

VP i = Vapor pressure of the “i”th VOC compound at o , in mm Hg.

W i = Weight of the “i”th cleaning solution, in grams;

W w = Weight of the water, in grams;

W e = Weight of exempt compound, in grams;

MW i = Molecular weight of the “i”th cleaning solution, in grams;

MW w = Molecular weight of the water, in grams;

MW e = Molecular weight of exempt compound, in grams; i = Subscript denoting a specific cleaning solution, as applied; n = The number of different cleaning solutions, as applied, each day on a printing press.

(5) Reserved.

(6) Test methods and procedures as follow apply:

(a) The affected facility shall be run at typical operating conditions and flow rates during any emission testing.

(b) Emission tests shall include an initial test, within 90 days of initial startup, when the control device is installed and operating that demonstrates compliance with either the 90 percent (by weight) reduction or the 50 ppmv emission limit.

(c) In conducting the tests required to comply with Paragraph (3)(a), (b), (d), or (e)(2) of this rule, the owner or operator shall use the test methods specified in Rule 1200-03- 18-.81 of this chapter.

(d) In conducting the tests required to comply with Subparagraph (3)(g) of this rule, the owner or operator shall use the test methods specified in Rule 1200-03-18-.84 of this

chapter.

(e) To be in compliance with the fountain solution refrigeration requirements of this rule, the affected facility shall use a thermometer or other temperature detection device capable of reading to 0.5°F to ensure that a refrigerated fountain solution containing alcohol is below 60°F at all times.

(f) To be in compliance with the Subparagraph (3)(e)1. of this rule, if applicable, each owner or operator of an offset lithographic printing press subject to this rule shall determine VOC composite partial pressure as given in Subparagraph (4)(f).

(7) Monitoring requirement apply as follow:

(a) To be in compliance with the emission control requirements of this rule, the affected facility shall monitor any add-on dryer exhaust control device as follow:

1. The owner or operator of a subject heatset offset lithographic printing press shall install, calibrate, maintain, and operate a temperature monitoring device, according to the manufacturer’s instructions, at the inlet or outlet of the control device. The monitoring temperature shall be set during testing required to demonstrate compliance with the emission standard. Monitoring shall be required only when the unit is operational.

2. The temperature monitoring device shall be equipped with a continuous recorder and shall have an accuracy of 0.5°F.

3. The dryer pressure shall be maintained lower than the press room air pressure such that air flows into the dryer at all times when the press is operating. A 100 percent emissions capture efficiency for the dryer shall be established using an air flow direction indicator, such as a smoke stick or aluminum ribbons.

(b) To be in compliance with the Subparagraph (3)(a), (b), or (d) of this rule, each owner or operator of an offset lithographic printing facility subject to this rule shall monitor the fountain solution as follow:

1. The purpose of monitoring the VOC concentration in the fountain solution is to provide data that can be correlated to the amount of material used when the fountain solution contains alcohol and complies with the limits listed in Subparagraph (3)(a) or (d). The following methods may be used to determine the concentration of alcohol in the fountain solution frequently. Alternatively, calculation of the alcohol concentration using the protocol of Subparagraph (7)(c) or (d) may be used to demonstrate compliance with Subparagraph (3)(a) or (d).

The monitoring requirements of Subparagraph (7)(b) shall only be required if noncompliance is suspected.

(i) The owner or operator of any subject offset lithographic printing press shall monitor the alcohol concentration of the fountain solution with a refractometer, that is corrected for temperature, at least once per 8-hour shift or once per batch, whichever is longer. The refractometer shall have a visual, analog, or digital readout with an accuracy of 0.5 percent. A standard solution shall be used to calibrated the refractometer for the type of alcohol used in the fountain. Alternatively, the refractometer shall be standardized against measurements or calculations performed to determine compliance, according to the procedures described in Subparagraph 7(c) or (d).

(ii) Alternatively, the owner or operator of any subject offset lithographic printing press shall monitor the alcohol concentration of the fountain solution with a hydrometer, that is corrected for temperature, at least once per 8-hour shift or once per batch, whichever is longer. The hydrometer shall have a visual, analog, or digital readout with an accuracy of 0.5 percent. A standard solution shall be used to calibrate the refractometer for the type of alcohol used in the fountain. Alternatively, the refractometer shall be standardized against measurements or calculations performed to determine compliance, according to the procedures described in Subparagraph 7(c) or (d).

(iii) The VOC content of the fountain solution may be monitored with a conductivity meter if it is determined that a refractometer or hydrometer cannot be used for monitoring the type of VOC’s in the fountain solution.

The conductivity meter reading for the fountain solution shall be referenced to the conductivity of the incoming water. A standard solution shall be used to calibrate the conductivity meter for the type of alcohol used in the fountain. Alternatively, the conductivity shall be standardized against measurements or calculations performed to determine compliance, according to the procedures described in Subparagraph (7)(c) or (d).

2. If, through recordkeeping for a period of 6 months or more, the printing process is shown to consistently meet the requirements in (3)(a) or (d), the monitoring requirement may be waived or extended by the Technical Secretary to a longer period of time.

3. The owner or operator of any subject offset lithographic printing press using refrigeration equipment on the fountain to comply with the requirements of Subparagraph (3)(a)2. Or (d)2., shall maintain, and operate a temperature monitor of the fountain solution reservoir.

4. The temperature monitor shall be read and noted at least once per operation day to verify that the refrigeration system is operating properly.

(c) The VOC content of fountain solution shall be determined by using the test methods specified in Rule 1200-03-18-.81.

(d) Alternatively, a sample of the fountain solution (as used) may be taken from the fountain tray or reservoir of fountain solution during use and measured with a hydrometer or refractometer that has been standardized with tests or calculations performed in accordance with Subparagraph (7)(b). The unit shall be considered in compliance with Section 6(c) if the refractometer or hydrometer measurement is less than of equal to the value determined according to section 7(c), plus ten percent.

(8) Compliance Certification, recordkeeping and reporting requirements as follow apply:

(a) By November 15, 1996, any owner or operator of an offset lithographic printing press that is exempt from the requirements of this rule because of the criteria in Subparagraph (1)(b) of this rule shall comply with the following:

1. The owner or operator of a facility in Davidson, Rutherford, Sumner, Wilson and Williamson County shall certify to the Technical Secretary that the facility is exempt under the provisions of Subparagraph (1)(b) of this rule. Such certification shall include:

(i) The name and location of the facility;

(ii) The address and telephone number of the person responsible for the facility;

(iii) A declaration that the facility is exempt from emission limitations of this

chapter because total VOC emissions from the facility are below 25 tons per year; and (iv) Calculations demonstrating the combined VOC emissions from the facility are below 25 tons per year before the application of capture systems and control devices. The following equations shall be used to calculate the VOC emissions:

A. Ink VOC Content and Emissions:

Ink VOC Content:

C = M x W or C = L x G Ink VOC Emissions:

E = C x R −       Total Ink VOC emissions;

T = 11121

EEE n +++.... where, C = VOC content in Ink M = Weight of ink used: (amount purchased amount discarded or recycled).

W = %VOC (by weight) in ink from either supplier (MSDS) or method specified in Subparagraph (2)(a) of Rule 1200-03-18-.81.

G = Volume (gallons) used; (volume purchased volume discarded or recycled)

R = % VOC (by weight) retained by paper:

Non-heatset - 95% as per Nov. 1993 draft Control Techniques Guideline for Offset Lithography.

Heatset - 20% as per Nov. 1993 draft Control Techniques Guideline for Offset Lithography.

UV - Amount from method specified in Subparagraph (2)(a) of Rule 1200-03-18-.81 after curing (assume 100%).

T = Total VOC emissions from all inks, 1 + 2 + .. + n.

B. Fountain solution VOC Content and emissions:

Fountain solution VOC content:

FC C

A A S

S CM

W M W

M W xxx=       +       +       100100100 Fountain solution VOC emissions:

FFF ECD =−

Total fountain solution VOC emissions:

FFFFn TEEE =+++ ... where, F C = VOC content of fountain solution F D = VOC content of press-ready fountain solution discarded or recycled.

C M =

Fountain solution concntrate weight.

C W = % VOC (by weight) in fountain solution from supplier (MSDS) or method specified in Subparagraph (2)(a) in Rule 1200-03-18- .81.

A M =

Isopropanol weight.

A W = % Isopropanol (by weight) from supplier (MSDS).

S M =

Weight of alcohol substitute.

S W = % VOC (by weight) in alcohol substitute from supplier (MSDS) or method specified in Subparagraph (2)(a) in Rule 1200-03-18- .81.

F T =

Total emissions from all fountain solutions, 1 + 2 + ... + n. weight of material:

M = V x D M = Weight of material V = Volume (gallon) of material used: (volume purchased - volume discarded or recycled).

D = Density in lb/gal from MSDS or (specific gravity x 8.33 lbs/gal).

C. Cleaning solution VOC content and emissions:

Cleaning solution VOC content:

LL L

CM W x= or LLL CLG x= Cleaning solution VOC emissions from Automatic Blanket Wash System:

LL EC =

Cleaning solution VOC emissions from hand washing:

LL EC x R =−       Total cleaning solution VOC emissions:

LLLLn TEEE =+++ .....

Key:

L C = VOC content in cleaning solution L M = Weight of cleaning solution (see above for calculation).

L w = % VOC (by weight) in cleaners from supplier (MSDS) or method specified in Subparagraph (2)(a) in

Rule 1200-03-18-.81.

L L = Pounds VOC per gallon from supplier (MSDS) or method specified in Subparagraph(2)(a) in Rule 1200- 03-18-.81.

L G = volume (gallon) used: (volume purchased volume discarded or recycled).

L E = Clenaing solution VOC emissions.

R = % VOC (by weight) retained by wipes: 50% per June 1994 ACT for Offset lithography and cleaning solutions with VOC partial vapor pressure of 10mm Hg or less at 20 degree C.

L T = Total VOC emissions from all cleaners, 1 + 2 + .. +n 2. On or after November 15, 1996, the owner or operator shall collect and record all of the following information and maintain the information at the facility for a period of 3 years:

(i) The name and identification of each ink, fountain solution and cleaning solvent;

(ii) The weight of VOC per unit weight of ink and the weight of ink used;

(iii) The weight of VOC per unit weight of cleaning solvent and fountain solution and the weight of cleaning solvent and fountain solution used; and (iv) The average VOC emissions as calculated using the equation in Subparagraph (8)(a)1.(iv) of this paragraph.

3. Any record showing that total emissions of VOC from all offset lithographic printing operations exceeded 25 tons in any calendar year, before the application of capture systems and control devices, shall be reported by sending a copy to the Technical Secretary within 30 calendar days after the exceedences occurs.

(b) Any owner or operator of a printing press subject to this rule and complying by means of use of complying inks, fountain solution, and cleaning solution, shall comply with the following:

1. By November 15, 1996, or upon initial startup of a new printing press (i) The name and identification number of each ink, fountain solution, and cleaning solution as applied; and (ii) The VOC content of all inks, fountain solutions and cleaning solutions, as applied, expressed in units of the applicable standard.

(c) Any owner or operator of a printing press subject to this rule and complying by means of weighted averaging shall comply with the following:

1. By November 15, 1996, or upon initial startup of a new printing press, or change method of compliance, the owner or operator of a subject printing press shall certify to the Technical Secretary that the printing press is in compliance with Paragraph (4) of this rule. Such certification shall include:

(i) The name and location of the facility;

(ii) The address and telephone number of the person responsible for the facility;

(iii) The name and identification of each printing press which will comply by means of Paragraph (4) of this rule;

(iv) The name and identification of each ink, fountain solution, or cleaning solution as applied;

(v) The VOC content of all inks, fountain solutions or cleaning solutions, as applied, expressed in units of the applicable standard;

(vi) The instrument or method by which the owner or operator will accurately measure or calculate the volume of each solution, as applied, each day on each printing press;

(vii) The methods by which the owner or operator will create and maintain records each day as required in Part 2. of this subparagraph; and (viii) An example of the format in which the records required in Part 2. of this Subparagraph will be kept.

2. On or after November 15, 1996, or on and after the initial startup date, or change method of compliance, the owner or operator of a printing press subject to the limitations of this rule and complying by means of weighted averaging shall collect and record all of the following information each day for each printing press and maintain the information for a period of 3 years:

(i) The name and identification number of each coating, fountain solution, or cleaning solution, as applied;

(ii) The VOC content and the volume of each solution, as applied, expressed in units necessary to determine compliance; and (iii) The weighted average VOC content of all solutions, as applied.

3. On or after November 15, 1996, the owner or operator of a printing press subject to the limitations of this rule shall notify the Technical Secretary of any instance of noncompliance with Paragraph (4) be sending a copy of the calculation showing such noncompliance to the Technical Secretary within 30 calendar days following the occurrence.

(d) Any owner or operator of a printing press subject to this rule and complying by means of control devices shall comply with Rule 1200-03-18-.03(5) of this chapter, except that the applicable date for certification, recordkeeping and reporting shall be November 15, 1996 rather than April 22, 1994.

(9) With respect to petitioning for a source-specific compliance schedule according to and as provided for in Rule 1200-03-18-.07 of this chapter, the owner or operator shall insure the petition is received by the Technical Secretary no later than October 1, 1995 rather than October 22, 1993.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed August 11, 1995; effective October 26, 1995. Amendment filed March 13, 1997; effective May 27, 1997. Amendment filed January 15, 2009; effective March 31, 2009.

Tenn. Comp. R. & Regs. 1200-03-18-.44 SURFACE COATING OF PLASTIC PARTS

(1) APPLICABILITY. This rule applies as follows:

(a) This rule applies to any plastic parts coating line within a facility located in Davidson, Rutherford, Sumner, Williamson or Wilson County whose potential VOC emissions from all plastic parts coating lines within the facility are greater than 25 tons of volatile organic compounds (VOC’s) per year and coats plastic components for any of the following uses:

1. Automotive or other transportation equipment including interior and/or exterior parts for automobiles, trucks, tractors, lawn mowers, and other mobile equipment;

2. Business machines and office machines, including computers, copy machines, and typewriters;

3. Medical equipment housing;

4. Entertainment equipment housing;

5. Miscellaneous plastic parts, including toys, musical equipment housing, sporting goods, outdoor signs, and architectural structures such as doors, floors, and window frames.

(b) This rule does not apply to topcoating of automotive exterior panels, which must comply with Rule 1200-03-18-.11 of this chapter.

(2) DEFINITIONS. For the purpose of this rule, the following definitions apply:

(a) Basecoat/clear coat: a two step topcoat system in which a highly pigmented, often metallic, basecoat is followed by a clearcoat. It results in a finished with high-gloss characteristics and often used on automotive parts.

(b) Clearcoat: a transparent coating usually applied over a colored, opaque coat to improve gloss and protection to the basecoat below.

(c) Colorcoat: a coating that contains pigment and provides color to a part; may constitute the topcoat or serve as the base coat portion of the basecoat//clearcoat system.

(d) Electromagnetic interference/radio frequency interference (EMI/RFI) coatings: coating used in plastic business machine housing to attenuate electromagnetic and radio frequency interference signals that would otherwise pass through the plastic housings.

The EMI/RFI shielding substance used in coating include copper or nickel. Zinc-arc spraying, electroless plating, conductive plastics, metal inserts, and vacuum-metallizing and sputtering are other mean of EMI/RFI shielding.

(e) Flexible coating: a coating with ability to withstand dimensional changes; flexible substrates utilizing flexible coatings include thermoplastic olefin (TPO), vinyl, acrylonitrile-butadiene (ABS) alloy, reaction injection molded (RIM) and thermoplastic urethane (TPU).

(f) Non-flexible coating: a coating which lacks the ability to withstand dimensional changes; non-flexible substrates utilizing non-flexible coatings include sheet molding compound (SMC), nylon, polyester, ABS, Xenoy polycarbonate, and acrylic.

(g) Plastic part: a piece made from a substance that has been formed from a resin through the application of pressure or heat or both.

(h) Waterborne coating: a coating which contains more than fifty percent by weight water in its volatile fraction.

(3) EMISSION STANDARDS. Each owner or operator of a source subject to this rule shall limit VOC emissions from finishing operations by one of the following methods:

(a) Each owner or operator of a source subject to this rule shall not cause or allow the application of any coating with VOC content in excess of these amounts:

1. Business machines, Medical equipment housing, Entertainment equipment housing and Miscellaneous plastic parts:

COATING VOC (lb/gal)

Primer 1.20 Color 2.30 Color/texture 2.30 EMI/RFI 2.50 2. Automotive Coating:

COATING VOC (lb/gal)

(i) Auto Interior:

High Bake Colorcoat 4.1 High Bake Primer 3.8 Low Bake Colorcoat 3.2 Low Bake Primer 3.5 (ii) Auto Exterior Flexible/Nonflexible (unless otherwise noted)

High Bake Colorcoat 4.7 High Bake Clearcoat 4.3 High Bake Primer 5.0 (Flexible)

High Bake Primer 4.5 (Nonflexible)

Low Bake Colorcoat 5.6 (Red & Black)

Low Bake Colorcoat 5.1 Low Bake Primer 5.5 Low Bake Clear 4.5 3. Automotive Specialty COATINGS VOC (lb/gal)

(i) Group A-1 Coatings: 5.5 Vacuum Metallizing Basecoats Texture Basecoats (ii) Group A-2 Coatings: 5.9 Black and Reflective Argent Air Bag Cover Coatings Soft Coatings (iii) Group B Coatings: 6.4 Golss Reducers Vacuum Metallizing Topcoats Texture Topcoats (iv) Group C Coatings: 6.8 Stencil Adhesion Primer/Promoter Ink Pad Electrostatic Prep Resist (v) Headlight Lens Coating 7.4 (b) Each owner or operator of a plastic parts coating line subject to this rule shall not:

1. Apply coatings on that line, during any one day, whose weighted average VOC content for any category exceeds the emission limits in Subparagraph (3)(a) of this rule.

2. Apply coatings on that line, during any one day, whose weighted average VOC content exceeds the emission limits in Subparagraph (3)(a) of this rule by performing the calculation in paragraph .82(1) of this chapter. The calculation shall be for the daily total of all coatings of the appropriate coating category in Subparagraph (3)(a) above used in all lines subject to this rule, if such calculation is consistent with all approved lowest achievable emission rate determinations for the lines involved.

(c) Each owner or operator shall apply control device requirements as follows:

1. An owner or operator of a plastic coating line subject to this rule may comply with this rule by:

(i) Installing and operating a capture system and a control device on that line;

(ii) Determining for each day the overall emission reduction efficiency needed to demonstrate compliance. The overall emission reduction needed is the lesser of the value calculated according to the procedure in this chapter or 95 percent; and (iii) Demonstrating each day that the overall emission reduction efficiency achieved is greater than or equal to the overall emission reduction efficiency required.

2. An owner or operator of a plastic coating line subject to this rule electing to comply with the requirements of Part 1. of this subparagraph shall ensure that:

(i) A capture system and control device are operated at all times that the line is in operation, and the owner or operator demonstrates compliance with this rule through the applicable coating analysis and capture system and control device efficiency test methods in this chapter, and (ii) The control device is equipped with the applicable monitoring equipment specified in this chapter, and the monitoring equipment is installed, calibrated, operated, and maintained according to the vendor’s specifications at all times the control device is in use.

(4) COMPLIANCE CERTIFICATION, RECORDKEEPING AND REPORTING REQUIREMENTS.

The owner or operator of an affected source subject to this rule shall:

(a) Demonstrate compliance with this rule by using the applicable test methods specified in this chapter;

(b) Except the for waterborne coatings the methods for determining VOC content may be batch formulation data certified as accurate by the coating supplier.

With respect to compliance certification, initiation of recordkeeping and reporting, and completion of control system compliance testing of a source, the owner or operator of that source shall comply with the requirements of rule .03 of this chapter, except that the applicable date for initial compliance and certification and performance testing shall be November 15, 1996, rather than April 22, 1994.

With respect to petitioning for a source-specific compliance schedule according to and as provided for in rule .07 of this chapter, the owner or operator shall insure the petition is reviewed by the Technical Secretary no later than October 1, 1995, rather than October 22, 1993.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed May 30, 1996; effective August 10, 1996.

Tenn. Comp. R. & Regs. 1200-03-18-.45 STANDARDS OF PERFORMANCE FOR COMMERCIAL MOTOR VEHICLE AND

MOBILE EQUIPMENT REFINISHING OPERATIONS.

(1) APPLICABILITY: This regulations is applicable to those commercial facilities making spot repairs, panel repairs, refinishing of parts and/or the refinishing of the entire motor vehicle or mobile equipment. This rule applies to any facility located in Davidson, Rutherford, Sumner, Williamson or Wilson County whose potential emissions fro the facility is greater than 15 pounds of volatile organic compounds (VOC’s) per day.

(2) DEFINITIONS: Terms used in this regulations not defined herein shall have the meaning given then in Regulations .01 of this chapter.

(a) “Adhesion promoter” means a coating used to promote adhesion of a topcoat on surfaces such as trim moldings, door locks, door spills, or any coating which provides adhesion to plastic substrates, where sanding is not practical.

(b) “Aerosol coating products” means a mixture of resins, pigments, liquid solvents and gaseous propellants, packaged in a disposable can for small, hand-held spraying applications. or change method of compliance, the owner or operator of a subject printing press shall certify to the Technical Secretary that the printing press is in compliance with Paragraph (3)(a) through (f) of this rule. Such certification shall include:

1. (i) The name and location of the facility;

(ii) The address and telephone number of the person responsible for the facility;

(iii) Identification of subject sources;

(iv) The name and identification of each ink, fountain solution, and cleaning solution as applied; and (v) The VOC content of all inks, fountain solutions and cleaning solutions, as applied, expressed in units of the applicable standard.

2. By November 15, 1996, or on and after the initial startup date, or after changing method of compliance, the owner or operator of a printing press subject to this

rule and complying with Subparagraph (3)(a) through (f) shall collect and record all of the following information for each printing press and maintain the information for a period of 3 years:

(c) “Basecoat” means a pigmented topcoat which is the first topcoat applied as part of a multiple stage topcoat system.

(d) “Basecoat/clearcoat system” means a topcoat system composed of a pigmented basecoat portion and a transparent and clear overcoat portion.

(e) “Capture system” means the equipment including, but not limited to, booths, ducts, dryers or ovens, fans, and hoods that contains, collects, and transports an air pollutant to a control device.

(f) “Catalyst” means a substance whose presence enhances the reaction between chemical compounds.

(g) “Chemical Abstract Service (CAS) registration number” means that unique identification number, usually three parts, given to each chemical product or component by the Chemical Abstract Service.

(h) “Clearcoat” means a topcoat which contains no pigments or only transparent pigments and which is the final topcoat applied as a part of a multiple stage topcoat system.

(i) “Coating” means coating or surface cleaning.

(j) “Color match” means the ability of a repair coating to blend into an existing coating so that color difference is not visible.

(k) “Exempt VOC” means any of the compounds expressly excluded from the definition of volatile organic compound in Rule .01 of this chapter.

(l) “Elastomeric materials” means topcoats and primers that are specifically formulated for application over flexible parts such as filler panels and elastomeric bumpers.

(m) “Electrostatic application” means the application of charged atomized paint droplets which are deposited by electrostatic attraction.

(n) “Extreme performance coating” means any coating used on the surface of a motor vehicle, mobile equipment or their parts or components which, during intended use, is exposed to either of the following conditions:

1. Industrial grade detergents, cleaners or abrasive scouring agents, or 2. Extreme environmental conditions during the vehicle’s principle use, which is use in extremely hot or cold, extremely high or low humidity and etc.

(o) “Graphic design application” means the application of logos, letters lines, stripes numbers and/or other graphics to a painted surface, with or without the use of a template.

(p) “Ground support vehicles” means vehicles used in support of aircraft activities at airports.

(q) “Group I vehicles and equipment” means passenger cars, large-sized trucks cabs and chassis, light and medium duty trucks and vans, motor homes, recreational vehicles and motorcycles.

(r) “Group II vehicles” means buses and mobile equipment.

(s) “High-volume, low pressure (HVLP) spray” means equipment used to apply coatings by means of a spray gun which typically operates at less than 10 psig applied air pressure.

(t) “Material Safety Data Sheet” (MSDS) means the documentation required by the Occupational Safety and Health Administration (OSHA) Hazard Communication Standard for a solvent, cleaning material, finishing material, or other material that identifies select reportable hazardous ingredients of the material, safety and health considerations, and handling procedures.

(u) “Metallic/iridescent topcoat” means any coating which contains more than 5 g/l (0.042 lb/gal) of metal or iridescent particles, as applied, where such particles are visible in the dried coating.

(v) “Midcoat” means a semi-transparent topcoat which is a middle topcoat applied as part of a multiple topcoat system.

(w) “Mobile equipment” means any equipment which may be drawn or is capable of being driven on a roadway, including but not limited to: trucks bodies, truck trailers, cargo vaults, utility bodies, camper shells, construction equipment (mobile cranes, bulldozers, concrete mixers), farming equipment (tractor, plows, pesticide sprayers), and miscellaneous equipment (street cleaners, golf carts, ground support vehicles, tow motors, fork lifts).

(x) “Multiple stage topcoat system” means any basecoat/clearcoat topcoat system or any three-stage or more topcoat system manufactured as a system, and used as specified by the manufacturer.

(y) “Panel” means a complete section (e.g., hood, door), which typically is approximately 9 square feet.

(z) “Precoat” mans any coating which is applied to bare metal primarily to deactivate the metal surface for corrosion resistance to a subsequent water-base primer.

(aa) “Pretreatment wash primer” means any coating which contains a minimum of 0.5% acid by weight, as necessary to provide surface etching and is applied directly to bare metal surfaces to provide etching and is applied directly to bare, metal surfaces to provide corrosion resistance and adhesion.

(bb) “Primer” means any coating applied prior to the application of a topcoat for the purpose of corrosion resistance and adhesion of the topcoat (cc) “Primer sealer” means any coating applied prior to the application of a topcoat for the

purpose of corrosion resistance, adhesion of the topcoat, color uniformity and to promote the ability of an undercoat to resist penetration by the topcoat.

(dd) “Primer surface” means any coating applied prior to the application of a topcoat for the

purpose of corrosion resistance, adhesion of the topcoat, and which promotes a uniform surface by filling in surface imperfections.

(ee) “Reducer” means the solvent used to thin enamel.

(ff) “Refinishing” means any coating of vehicles, their parts and components, or mobile equipment, including partial body collision repairs, for the purpose of protection or beautification and which is subsequent to the original coating applied at a manufacturing plant coating line.

(gg) “Specialty coating” means any coating which is necessary due to unusual job performance requirements. The coating includes, but is not limited to: weld-through primer, adhesion promoter, uniform finish blender, elastomeric material, gloss flattener, bright metal trim repair, antiglare coating, and safety related coating.

(hh) “Spot/panel repair” means the non assembly line process of repairing and restoring a portion of a motor vehicle or mobile equipment to predamaged condition.

(ii) “Three-stages coating system” means a topcoat system composed of a pigmented basecoat portion, a semi-transparent midcoat portion, and a transparent clearcoat portion.

(jj) “Topcoat” means any coating applied over a primer or an original finish for the purpose of protection or appearance. For the purpose of this regulation, basecoat/clearcoat and multiple-stage coating systems shall be considered topcoats.

(kk) “Touch-up coating” means any coating applied by brush and, in some limited cases, by aerosol spray to repair minor surface damage or imperfections.

(ll) “Transfer efficiency” means the ratio of the amount of coating solids adhering to the object being coated to the total amount of coating solids used in the application process, expressed as a percentage.

(mm) “Trucks” means a motor vehicle designed, used, or maintained primarily for the transportation of property.

(nn) “Large-sized truck” means a truck having a manufacturer’s gross vehicle weight rating of more than 8500 pounds.

(oo) “Small-sized truck” means any motor vehicle having a manufacturer’s gross vehicle weight rating at 8500 pounds or less and which is designed primarily for the purposes of transportation of property or is a derivative of such vehicle, or is available with special features enabling on-street or off-highway operation and use.

(pp) “Van” means a closed truck for carrying property or persons.

(qq) “Waterborne primer” means any primer using waste as the primary solids suspension agent, usually containing 5% or more water in its volatile fraction.

(3) EXEMPTIONS: The following activities are exempted from this regulation:

(a) Application of aerosol coating products;

(b) Graphic designs such as the application of letter, lines, logos, numbers, striping, etc. covering less than 10% of the total painted surface of the vehicle;

(c) Original Equipment Manufacturer (OEM) coatings applied at manufacturing or assembly plants.

(d) Touch-up operations involving the application of very small quantities of coatings, usually by brush;

(e) Application of waterborne coatings of less than 2 lbs VOC/gal of coating as applied; and (f) Small facilities that perform minimal coating operations and meet all of the following limitations. These limitations must be met on a weekly basis, where a time period is shown:

1. Not more than one complete motor vehicle or mobile equipment per week shall be refinished;

2. Not more than five panel or spot repair jobs per week shall be performed; and 3. No visible emissions shall leave the applicator’s property.

(g) An exemption under this Paragraph does not constitute an exemption from any other regulations.

(4) STANDARDS AS FOLLOW APPLY: Effective on the dates specified, a person applying coatings to Group I or Group II vehicles and equipment, including parts and components, repairing of partial collision damage or refinishing entire motor vehicles or mobile equipment, shall not apply materials that have a VOC content which exceeds the limits in Subparagraphs (4)(a) and(4)(b). Compliance with the VOC limits shall be based on VOC content, including any VOC material added to the original coating supplied by the manufacturer, less water and exempt solvent, as applied to the coated surface.

(a) Group I Vehicles: Group I vehicles, their parts and components, whether existing or replacement parts, shall not be refinished with a coating which has a VOC content in excess of the limits in Part (4)(a)1.;

1. After November 15, 1996, no coatings shall be used which have a VOC content in excess of the following limits, expressed as pounds of VOC per gallon of coating, as applied, less water and exempt compounds unless the condition of Subparagraph (4)(c) are met.

Coating VOC lb/gal Surface cleaner 1.7 Pretreatment wash primer 6.5 Precoat 5.5 Prime sealer 4.6 Primer/primer surface 4.8 Topcoat 5.2 Metallic/iridescent topcoat 5.2 Extreme performance 6.2 (b) Group II Vehicles: Group II vehicles, or their existing parts and components, or replacement parts or components, shall not be refinished with a coating which has a VOC content in excess of the limits in Part (4)(b)1.;

1. After November 15, 1996, no coatings shall be used which have a VOC content in excess of the following limits, expressed as pounds of VOC per gallon of coating, as applied, less water and exempt compounds unless the conditions of Paragraph (4)(c) are met:

Coating VOC lb/gal Surface cleaner 1.7 Pretreatment wash primer 6.5 Precoat 5.5 Primer/primer surface 2.8 Primer sealer 3.5 Topcoat 3.5 Metallic/iridescent topcoat 3.5 Extreme performance 6.2 (c) The limitations of VOC content in Subparagraph (4)(a) and (4)(b) shall not exceed unless:

1. Emissions are controlled to an equivalent level by air pollutant control equipment.

2. The efficiency of the control equipment is a minimum of 85%, and 3. The control equipment has been approved by the Technical Secretary.

3. A determination is made of the overall emission reduction efficiency needed to demonstrate compliance.

4. A determination is made each day that the overall emission reduction efficiency achieved is greater than or equal to the overall emission reduction efficiency required.

5. A capture system and control device are operated at all times that the line is in operation, and the owner or operator demonstrates compliance with this rule through the applicable coating analysis and capture system and control device efficiency test methods specified in this chapter, and;

6. The control device is equipped with the applicable monitoring equipment specified in this chapter, and the monitoring equipment is installed, calibrated,, operated, and maintained according to the vendor’s specifications at all times the control device is in use.

(d) In lieu of satisfying the standards above for specialty coating, specialty coatings shall not be applied unless;

1. The VOC content is equal to or less than 7 pounds of VOC per gallon of coating, as applied, less water and exempt compounds and;

2. The application of all such coatings, except safety related coatings, shall not exceed 10% of all coatings applied, on a weekly basis.

(e) VOC content shall be given and/or calculated in lbs/gal as follows.

Calculation 1:

The VOC content of a basecoat/topcoat system shall be calculated according to the following equation:

VOC ms = VOC bc + 2VOC ee where VOC ms = the composite VOC content, less water and less exempt compounds, to be used for compliance determination under the multistage topcoat system coating category.

VOC bc = the VOC content, less water and less exempt compounds as applied, of any given basecoat.

VOC cc = the VOC content, less water and less exempt compounds as applied, of any given clearcoat.

Calculation 2:

The VOC content per gallon of any coating, less water and less exempt compounds, shall be calculated by the following equation:

Content = W s - W w - W es V m - V w - V es where Pounds of VOC per gallon of coating, less water and less exempt compounds is the weight of VOC per combined volume of VOC and coating solids.

W s = weight of volatile compounds in pounds.

W w = weight of water in pounds.

W es = weight of exempt compounds in pounds.

V m = volume of material in gallons.

V w = volume of water in gallons.

V es = volume of exempt compounds in gallons.

Calculation 3:

The VOC content of any coating shall be calculated by the following equation:

Content = W s - W w - W es Vm where W s = weight of volatile compounds in pounds.

W w = weight of water in pounds.

W es = weight of exempt compounds in pounds.

V m = volume of material in gallons.

Calculation 4:

The VOC content of a three-stage topcoat system shall be calculated according to the equation:

VOC ms = VOC bc +VOC mc + 2VOC cc where A three-stage topcoat system is a topcoat system composed of a basecoat portion, a midcoat portion, and a transparent clearcoat portion.

VOC ms = the composite VOC content, less water and less exempt compounds, to be used for compliance determination under the multistage topcoat system coating category.

VOC bc = the VOC content, less water and less exempt compounds as applied, of any give basecoat.

VOC mc = the VOC content, less water and less exempt compounds as applied, of any give midcoat.

VOC cc = the VOC content, less water and less exempt compounds as applied, of any given clearcoat.

(5) EQUIPMENT STANDARDS: All spray coating operators that coat more than one complete motor vehicle or mobile equipment per week or perform more than five panel or spot repairs per week shall perform those operations using the following equipment:

(a) Spraying operations shall be performed in a totally enclosed spray booth or a totally enclosed spray area which provides, at a minimum, proper maintenance of the equipment in accordance with the manufacturer’s recommendations.

(b) Effective November 15, 1996, spraying equipment shall have a minimum transfer efficiency of 65% at 8 inches from the work surface. Compliance may be achieved by any of the following:

1. Electrostatic application equipment operated and maintained in accordance with the manufacturer’s recommendations;

2. High Volume Low Pressure (HVLP) spray equipment operated and maintained in accordance with the manufacturer’s recommendations; or 3. Any other coating application equipment which has been satisfactorily demonstrated to be capable of achieving a minimum of 65% efficiency and approved by the Technical Secretary.

(c) VOC pollution control equipment, if required for compliance with Section (4), shall be appropriately installed, maintained and operated in accordance with the manufacturer’s recommendations. The minimum efficiency of the control device shall be 85%.

(d) Spray and other equipment cleanup shall be accomplished in a totally enclosed apparatus specifically designed to minimize evaporation of VOC materials to the atmosphere. Non-enclosed gun cleaners, etc. may be used provided that the vapor pressure of the cleaning solvent is less than 100 mmHg at 68 degrees F and the used solvent is contained for subsequent disposal by means which minimize emission of the used solvent (6) PROHIBITIONS:

(a) No person shall specify or require for use the application of any coating if such use results in a violation of this regulations. This prohibition is applicable to all contracts wherein a coating is to be applied at any location within Davidson, Rutherford, Sumner, Wilson and Williamson counties. This prohibition shall not apply if the coating is to be utilized at surface coating facilities where control equipment has been installed to meet the requirements of paragraph (5)(c).

(b) Cleaning of equipment by spraying solvent through the spray gun without measures being employed to collect the sprayed solvent and minimize emissions of the solvent is prohibited.

(7) OPERATING REQUIREMENTS: The owner/operator shall implement good housekeeping practices which include, but are not limited to, the following:

(a) All equipment shall be maintained in accordance with the manufacturer’s recommendations;

(b) All fresh or used solvents shall be stored in closed containers;

(c) All waste coatings, and surface cleaners, waste solvents, and uncured spray booth filters, etc. shall be stored in closed containers prior to disposal by means which minimize emissions of volatile organic compounds; and (d) Storage of cloth or paper products used for solvents surface preparation and cleanup shall be stored in closed containers prior to disposal by means which minimize emissions of volatile organic compounds.

(e) A person using pressure pots shall use either;

1. Bag-type liners to aid cleanup and minimize cleaning solvent use;

2. Insert containers to aid cleanup and minimize cleaning solvent use; or 3. Other reasonable practices to reduce the amount of cleaning solvent used.

(f) Equipment cleanup shall be performed with appropriate methods to minimize the use of solvents. Reasonable effort must be made to reclaim the bulk of the used solvents.

Absolutely no cleaning shall be effected by the direct spraying of solvent such that it is emitted to the atmosphere.

(g) Personnel performing spraying operations must be trained to properly position a spray gun to minimize overspray.

(h) Reasonable effort shall be employed to schedule operations of a similar nature to significantly reduce overall VOC material consumption.

(8) REPORTING AND RECORDKEEPING REQUIREMENTS: Any person subject to this

regulation shall comply with the following requirements as a minimum:

(a) A current list of all coatings, solvents, reducers, additives, and any other VOC containing material in use at the facility shall be maintained and readily available upon request. This list shall include, but is not limited to, the following information:

1. Name and appropriate identification of coating, catalyst, hardener, reducer, etc. used;

2. Mix ratio of components used; and 3. VOC content of coatings, as applied, less water and exempt solvents, in pounds per gallon.

(b) Daily records shall be maintained which shall include:

1. Identification of applied coatings pursuant to Part (8)(a)1. and 2. Quantity of each coating applied.

(c) Monthly records shall be maintained which shall include:

1. Type of solvent used for cleanup and/or surface preparation, and 2. Quantity of each solvent, cleaner, etc. used.

(d) MSDS or other data sheets provided by the material manufacturer and/or its agent shall be maintained and readily retrievable for each item listed pursuant to Part (8)(a)1. and shall include as a minimum the designation of VOC content as supplied, expressed in lbs/gal, less water and exempt compounds;

(e) Records specified in this section shall be retained and readily available for inspection by EPA; Tennessee Department of Environment and Conservation, Division of Air Pollution Control; Nashville and Davidson County Metropolitan Health Department, Air Pollution Division; and each record shall be maintained for 5 years.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed November 3, 1995; effective January 17, 1996.

Tenn. Comp. R. & Regs. 1200-03-18-.48 VOLATILE ORGANIC LIQUID STORAGE TANKS

(1) Applicability of this rule is as follows:

(a) This rule applies to Volatile Organic Liquid Storage Tanks at:

1. Any facility in Davidson, Rutherford, Sumner, Williamson, or Wilson County having potential Volatile Organic Compounds (VOC) emission of 100 tons per year or greater from Volatile Organic Liquid Storage Tanks. In calculation to determine whether this applicability threshold is exceeded, potential VOC emissions are not included from any storage vessel subject to standards in rules

Tenn. Comp. R. & Regs. 1200-03-18-.78 OTHER FACILITIES THAT EMIT VOLATILE ORGANIC COMPOUNDS (VOC’S) OF

FIFTY TONS PER YEAR.

(1) Applicability of this rule is as follows:

(a) This rule applies to the sources at any facility in Davidson, Rutherford, Sumner, Williamson, or Wilson County for which the aggregate potential VOC emissions from the sources at the facility total 45.4 megagrams (Mg) (50 tons) or more per calendar year on or after November 15, 1996. In calculation to determine whether this applicability threshold is exceeded, potential VOC emissions from the following sources are not included:

1. Any sources subject to standards in Rules .11 through .77 of this chapter;

2. Any sources subject to source-specific standards (Division Rule 1200-03-18- .02(7) approved in lieu of standards in Rules .11 through .77 of this chapter; and 3. Any sources which are within the source categories listed in Subparagraph (c) of this paragraph.

(b) After publication of the notice specified in Paragraph (7) of this rule, the owner or operator of a facility which has potential VOC emissions which are below the applicability threshold of Subparagraph (a) of this paragraph, but which otherwise would be subject to this rule, shall comply with the certification, recordkeeping, and reporting requirements of Paragraph (4) of this rule.

(c) This rule will not apply to:

Barge loading facilities;

Coke ovens (including by-product recovery plants);

Fuel combustion sources;

Iron and steel production;

Jet engine test cells;

Vegetable oil processing facilities; and Wastewater treatment facilities;

(d) (Reserved)

(e) The standards and requirements of this rule shall not apply to the following sources:

1. Sources subject to standards in Rules .11 through .77 and in Rule .79 of this

chapter;

2. Sources subject to source-specific standards approved in lieu of standards in Rules .11 through .77 and in Rule .79 of this chapter; and 3. Sources which are within the source categories listed in Subparagraph (c) of this paragraph.

(2) After publication of the notice specified in Paragraph (7) of this rule, the owner or operator of any source subject to this rule shall:

(a) Install and operate:

1. An emission capture system which:

(i) Achieves 90 percent capture, or (ii) Is constructed and operated in accordance with the guidelines of the Industrial Ventilation Manual, 20th Edition, of the American Conference of Governmental Industrial Hygienists, and 2. An emission control device which achieves 90 percent destruction or removal.

(b) For any coating or printing line, limit the weighted average VOC content to 0.40 kilograms VOC per liter (kg VOC/L) 3.5 pounds VOC per gallon (lbvoc/gal) or less of coating or ink, as applied, (excluding water and/or exempt compounds) as calculated in this chapter; or (c) Comply with a control plan that employs reasonably available control technology and has been approved as a state implementation plan revision. The control plan shall;

1. Be submitted by May 15, 1997; and 2. Be accompanied by a demonstration of the technical or economic infeasibility of complying with the requirements in Subparagraph (a) or (b) of this paragraph.

(3) After publication of the notice specified in Paragraph (7) of this rule, the owner or operator of any source subject to this rule shall demonstrate compliance with this paragraph by using the applicable test methods specified in this chapter.

(4) After publication of the notice specified in Paragraph (7) of this rule, reporting and recordkeeping requirements for sources referenced in Subparagraph (1)(b) of this rule apply as follow:

(a) An owner or operator shall maintain records which document potential VOC emissions are less than the applicability threshold specified in Subparagraph (1)(a) of this rule.

(b) An owner or operator shall submit, upon request by the Technical Secretary, records that document that the source is exempt from these requirements. These records shall be submitted to the Technical Secretary within 30 calendar days from the date of request.

(5) After publication of the notice specified in Paragraph (7) of this rule, compliance certification, reporting and recordkeeping, and testing requirements for sources other than those referenced in Subparagraph (1)(b) of this rule apply as follows:

(a) The owner or operator of the subject VOC source shall perform all testing and maintain the results of all test and calculations required under Paragraphs (2) and (3) of this rule to demonstrate that the subject source is in compliance.

(b) This owner or operator of the subject VOC source shall maintain these records for a minimum of 3 years, and shall make these records available to the Technical Secretary upon request.

(c) The owner or operator of any subject source shall comply with the requirements in Rule .03 or .04 of this chapter, as appropriate for such source, except that the date for compliance certification, initiation of recordkeeping and reporting, and completion of control system compliance testing shall be by November 15, 1997, rather than by April 22, 1994, as specified in Rules .03 and .04.

(6) After publication of the notice specified in Paragraph (7) of this rule, the owner or operator of a source which is an existing source as of November 15, 1996, or of a source which has a state or local agency’s construction permit before November 15, 1996, and is subject to this

rule may petition for a source-specific compliance schedule according to and as provided for in Rule .07 of this chapter. The April 22, 1993, date of Rule .07 shall not be pertinent for sources subject to Rule .78 of this chapter. For sources subject to Rule .78 of this chapter, the petition for the source-specific schedule must be received by the Technical Secretary no later than May 15, 1997.

(7) The standards and requirements of this rule shall apply only after the failure to attain by November 15, 1996, the ambient air quality standard for ozone in the counties listed in Subparagraph (1)(a) of this rule and after the Technical Secretary publishes legal notice of this failure in a major Nashville newspaper which has distribution throughout the five counties listed in Subparagraph (1)(a) of this rule.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed August 11, 1995; effective October 25, 1995.

Tenn. Comp. R. & Regs. 1200-03-18-.79 OTHER FACILITIES THAT EMIT VOLATILE ORGANIC COMPOUNDS (VOC’S) OF

ONE HUNDRED TONS PER YEAR.

(1) Applicability of this rule is as follows:

(a) This rule applies to any facility in Davidson, Rutherford, Shelby, Sumner, Williamson, or Wilson County having sources that in the aggregate have potential VOC emissions of 90.7 megagrams (Mg) (100 tons) or more per calendar year. In calculation to determine whether this applicability threshold is exceeded, potential VOC emissions are not included from handling, storage, use and disposal of VOC’s subject to the requirements of Rule .06 of this chapter and from the sources as follow:

1. Any sources subject to standards in Rules .11 through .77 of this chapter;

2. Any sources subject to source-specific standards approved in lieu of standards in Rules .11 through .77 of this chapter; and 3. Any sources which are within the sources categories listed in Subparagraph (c) of this paragraph.

(b) The owner or operator of a facility which has potential VOC emissions which are below the applicability threshold of Subparagraph (a) of this paragraph, but which otherwise would be subject to this rule, shall comply with the certification, recordkeeping, and reporting requirements of Paragraph (4) of this rule.

(c) This rule will not apply to:

Barge loading facilities;

Coke ovens (including by-product recovery plants);

Fuel combustion sources;

Iron and steel production;

Jet engine test cells;

Vegetable oil processing facilities;

Wastewater treatment facilities; and (d) (Reserved)

(e) The standards and requirements of this rule shall not apply to handling, storage, use, and disposal of VOC’s subject to the requirements of Rule .06 of this chapter and to sources as follows:

1. Sources subject to standards in Rules 1200-03-18-.11 through 1200-03-18-.77 of this chapter;

2. Sources subject to source-specific standards approved in lieu of standards in Rules 1200-03-18-.11 through 1200-03-18-.77 of this chapter; and 3. Sources which are within the source categories listed in Subparagraph (c) of this paragraph.

(2) The owner or operator of any source subject to this rule shall:

(a) Install and operate:

1. An emission capture system which:

(i) Achieves 90 percent capture, or (ii) Is constructed and operated in accordance with the guidelines of the Industrial Ventilation Manual, 20th Edition, of the American Conference of Governmental Industrial Hygienists, and 2. An emission control device which achieves 90 percent destruction or removal.

(b) For any coating or printing line, limit the weighted average VOC content to 0.40 kilograms VOC per liter (kg VOC/L) (3.5 pounds VOC per gallon [lb VOC/gal]) or less of coating or ink, as applied, (excluding water and/or exempt compounds) as calculated in this chapter; or (c) Comply with a control plan that employs reasonably available control technology and has been approved as a State Implementation Plan revision. The control plan shall:

1. Be submitted by October 22, 1993, and 2. Be accompanied by a demonstration of the technical or economic infeasibility of complying with the requirements in Subparagraph (a) or (b) of this paragraph.

2. “The standards and requirements of Rule .06 and Rules .11 through .77 for source categories and types of operations shall be accepted, if proposed for the control plan by the owner or operator, as reasonably available control technology for any operation which fulfills the source category or type operation criteria specified in those rules. For example, the standards and requirements specified in Rule .35 for flexographic printing presses may be proposed for a control plan by the owner or operator of a flexographic printing press subject to this Rule .79, and these standards and requirements shall be accepted as reasonably available control technology for that press even if the facility’s printing presses do not have total potential VOC emissions of 100 tons per year. In addition, if the control plan includes only standards and requirements of Rule .06 and Rules .11 through .77 as proposed reasonably available control technology, the requirement for approval of this plan as a state implementation plan revision shall not apply.

Also, for those operations for which reasonably available control technology is as specified in Rule .06 and Rules .11 through .77, the requirement in Part 2. of this subparagraph for demonstration of infeasibility shall not apply. However, the control plan shall be submitted as specified in Part 1. of this subparagraph, and the compliance certification, reporting, and recordkeeping, and testing requirements of this Rule .79 shall be satisfied.”

(3) The owner or operator of any source subject to this rule shall demonstrate compliance with this paragraph by using the applicable test methods specified in this chapter.

(4) Reporting and recordkeeping requirements for sources referenced in Subparagraph (1)(b) of this rule apply as follow:

(a) An owner or operator shall maintain records which document potential VOC emissions are less than the applicability threshold specified in Subparagraph (1)(a) of this rule.

(b) An owner or operator shall submit, upon request by the Technical Secretary, records that document that the source is exempt from these requirements. These records shall be submitted to the Technical Secretary within 30 calendar days from the date of request.

(5) Reporting and recordkeeping requirements for subject non-coating and non-printing sources apply as follow:

(a) The owner or operator of the subject VOC sources shall perform all testing and maintain the results of all tests and calculations required under Paragraphs (2) and (3) of this rule to demonstrate that the subject source is in compliance.

(b) This owner or operator of the subject VOC source shall maintain these records for a minimum of 3 years, and shall make these records available to the Technical Secretary upon request.

(c) The owner or operator of any facility containing subject sources shall comply with the requirements in Rule 1200-03-18-.04 of this chapter.

(6) The owner or operator of any source which on October 25, 1995, became, but before this date was not subject to the standards and requirements of Paragraph (2) of this rule shall:

(a) With respect to compliance certification, initiation of recordkeeping and reporting, and completion of control system compliance testing for that source, comply with the requirements of Rule .03 or .04 of this chapter, as appropriate for such source, except the applicable date for compliance is October 25, 1996, rather than April 22, 1994;

(b) With respect to submitting a control plan for the source, as provided for in Subparagraph (2)(c)of this rule, submit the plan by April 25, 1996, rather than October 22, 1993; and (c) With respect to petitioning for a source-specific compliance schedule according to and as provided for in Rule .07 of this chapter, insure the petition is received by the Technical Secretary no later than April 25, 1996, rather than October 22, 1993. The applicable date on which a source must be an existing source or before which a state or local agency’s construction permit must have been issued for the source to be eligible to petition for a source specific compliance schedule is October 25, 1995, rather than April 22, 1993, as specified in the first sentence of Paragraph .07(1) of this

chapter.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed March 8, 1993; effective April 22, 1993. Amendment filed August 11, 1995; effective October 25, 1995. Amendment filed May 16, 1997; effective July 30, 1997. Amendment filed May 21, 1997; effective August 4, 1997.

Tenn. Comp. R. & Regs. 1200-03-18-.80 TEST METHODS AND COMPLIANCE PROCEDURES: GENERAL PROVISIONS

(1) The owner or operator of any volatile organic compound (VOC) source required to comply with Rules 1200-03-18-.11 through 1200-03-18-.79 of this chapter shall demonstrate or have demonstrated compliance by using the applicable methods of Rules 1200-03-18-.80 through

Tenn. Comp. R. & Regs. 1200-03-18-.85 TEST METHODS AND COMPLIANCE PROCEDURES: LEAK DETECTION

METHODS FOR VOLATILE ORGANIC COMPOUNDS (VOC’S).

(1) Owners or operators required to carry out a leak detection monitoring program shall comply with the following requirements:

(a) Monitoring shall be performed in accordance with Reference Method 21.

(b) The detection instrument shall meet the performance criteria of Reference Method 21.

(c) The detection instrument shall be calibrated before and after use on each day of its use by the methods specified in Reference Method 21. Failure to achieve a post-use calibration precision of less than 10 percent shall constitute grounds for rejecting all tests performed since the last pre-use calibration. In such cases, required leak tests must be reperformed.

(d) Calibration gases shall be:

1. Zero air (less than 10 parts per million [ppm] of hydrocarbon in air); and 2. A mixture of methane or n-hexane and air at a concentration of approximately, but less than, 10,000 ppm methane or n-hexane.

(e) The detection instrument probe shall be traversed around all potential leak interfaces as close to the interface as possible as described in Reference Method 21.

(2) When equipment is tested for compliance with the requirement that there be no detectable emissions, the test shall comply with the following:

(a) The requirements of Paragraph (1) of this rule shall apply and shall be met, and (b) The background level shall be determined as set forth in Reference Method 21.

(3) Leak detection tests shall be performed consistent with:

(a) “APTI Course SI 417-Controlling Volatile Organic Compound Emissions from Leaking Process Equipment,” EPA-450/2-82-015;

(b) “Portable Instrument User’s Manual for Monitoring VOC Sources,” EPA-340/1-86-015;

(c) “Protocols for Generating Unit--Specific Emission Estimates for Equipment Leaks of VOC and VHAP,” EPA-450/3-88-010; and (d) “Petroleum Refinery Enforcement Manual,” EPA-340/1-90-008.

(4) Use of an adaptation to any of the analytical methods specified in this rule shall be approved by the Technical Secretary and EPA on a case-by-case basis. An owner or operator shall submit sufficient documentation for the Technical Secretary and EPA to find that the analytical methods specified will yield inaccurate results and that the proposed adaptation is appropriate, or that the proposed adaptation will yield results as accurate as will the specified analytical methods.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.81 TEST METHODS AND COMPLIANCE PROCEDURES: DETERMINING THE

VOLATILE ORGANIC COMPOUND (VOC) CONTENT OF COATINGS AND INKS.

(1) Sampling procedures shall follow the guidelines presented in:

(a) ASTM D3925: Standard practice for sampling liquid paints and related pigment coatings; or (b) ASTM E300: Standard practice for sampling industrial chemicals.

(2) The analytical methods and procedures specified as follow shall be used to determine VOC content:

(a) For coatings and for inks other than solvent - borne (solvent reducible) publication rotogravure inks (See Subparagraph (b) of this paragraph for explanation of solvent borne (solvent reducible) publication rotogravure inks.):

1. Reference Method 24 shall be used in the determination of total volatile organic content, water content, and density.

2. To determine the total volatile organic content, water content, and density of multicomponent coatings, the following procedures shall be used in addition to Reference Method 24:

(i) The components shall be mixed in a storage container in proportions the same as those in the coating, as applied. The mixing shall be accomplished by weighing the components in the proper proportion into a container which is closed between additions and during mixing. About 100 ml of coating shall be prepared in a container just large enough to hold the mixture prior to withdrawing a sample.

(ii) For determination of volatile content, a sample shall be withdrawn from the mixed coating, and then transferred to a dish where the sample shall stand for at least 1 hour, but no more than 24 hours prior to being oven dried.

(iii) For determination of the water content and density of multicomponent coatings, samples shall be taken from the same 100 ml mixture of coating and shall be analyzed by the appropriate ASTM methods referenced in Reference Method 24.

(b) Reference Method 24A shall be used in the determination of total volatile organic compound (VOC) content and density of solvent - borne (solvent reducible) publication rotogravure inks. A solvent - borne publication rotogravure ink is an ink used in publication rotogravure printing, as defined in Paragraph .35(2) of this chapter, whose volatile portion consists essentially of VOC solvent with not more than five weight percent water, as applied to the gravure cylinder.

(c) The following ASTM method may be used as an additional procedure related to determining VOC:

1. ASTM D4457-85: Standard test method for determination of dichloromethane and 1,1,1 trichloroethane in paints and coatings by direct injection into a gas chromatograph (the procedure delineated above may be used to develop protocols for any compounds specifically exempted from the definition of VOC).

(3) Use of an adaptation or alternative to any of the analytical methods and procedures specified in Paragraph (2) of this rule shall be approved by the Technical Secretary and the EPA on a case-by-case basis. An owner or operator shall submit sufficient documentation to verify that the analytical methods specified in Subparagraphs (2)(a), (2)(b), and (2)(c) will yield inaccurate results and that the proposed adaptation is appropriate, or that the proposed adaptation will yield results as accurate as will the specified analytical methods.

(4) Each sample collected for analysis shall meet the following criteria:

(a) Each sample shall be at least 1 pint taken into a 1 pint container at a location and time such that the sample will be representative of the coating or ink, as applied (i.e., the sample shall include any dilution solvent or VOC added during the manufacturing process);

(b) If a sample larger than 1 pint is obtained, the sample container shall be of a size such that the sample completely fills the container;

(c) The container shall be tightly sealed immediately after the sample is taken;

(d) Any solvent or other VOC added after the sample is taken shall be measured and accounted for in the calculations in Paragraph (3) of this rule; and (e) For multiple-component coatings, separate samples of each component shall be obtained.

(5) Calculations for determining the VOC content of coatings and inks from data as determined by Reference Method 24 or 24A shall follow the guidance provided in the following documents:

(a) “A Guideline for Surface Coating Calculations” EPA-340/1-86-016; and (b) “Procedures for Certifying Quantity of Volatile Organic Compounds Emitted by Paint, Ink and Other Coatings.” (Revised June 1986) EPA-450/3-84-019.

(6) In lieu of determining VOC content by the methods and procedures specified in the other paragraphs of this rule, formulation data shall be used if approved by the EPA and the Technical Secretary.

History

• Authority: T.C.A. §§ 4-5-202, et seq., and 68-201-105.
• Administrative History: Original rule filed March 8, 1993 effective April 22, 1993. Amendment filed January 31, 1997; effective April 16, 1997.

Tenn. Comp. R. & Regs. 1200-03-18-.82 TEST METHODS AND COMPLIANCE PROCEDURES: ALTERNATIVE

COMPLIANCE METHODS FOR SURFACE COATING.

(1) The weighted average VOC content, in units of mass of VOC per volume of coating and/or ink, excluding water and/or exempt compounds, as applied, of the coatings and/or inks used on a day on a coating line or operation shall be calculated using the following equation: n Σ Vi Ci i = 1 VOCw = _________________ VT where:

VOCw = The weighted average VOC content of the coatings and/or inks, as applied, used on a line or operation in units of kilograms of VOC per liter of coating and/or ink (kg VOC/L) (pounds of VOC per gallon of coating and/or ink [lb VOC/gal]), excluding water and/or exempt compounds; n = The number of different coatings and/or inks, as applied, each day on a line or operation;

Vi = The volume of each coating or ink, as applied, each day on a line or operation in units of L (gal), excluding water and/or exempt compounds; and Ci = The VOC content of each coating or ink, as applied, each day on a line or operation in units of kg VOC/L of coating or ink (lb VOC/gal), excluding water and/or exempt compounds; and VT = The total volume of all coating and/or ink, as applied, each day on a line or operation in units of L (gal), excluding water and/or exempt compounds.

(2) [Reserved]

(3) The overall emission reduction efficiency needed to demonstrate compliance is determined each day as follows:

(a) Obtain the emission limitation from the applicable rule of this chapter.

(b) Calculate the emission limitation on a solids basis according to the following equation:

C S =

1 - C d where:

S = The VOC emission limitation in terms of kg VOC/L of coating or ink solids (lb VOC/gal);

C = The VOC emissions limitation in terms of kg VOC/L of coating or ink (lb/gal), excluding water and/or exempt compounds; and d = The density of VOC for converting emission limitation to a solids basis.

The density equals 0.882 kg/L (7.36 lb/gal).

(c) Calculate the required overall emission reduction efficiency of the control system for the day according to the following equation:

(VOCa - S)

E = _________ x 100 VOCa where:

E = The required overall emission reduction efficiency of the control system;

VOCa = 1. The maximum VOC content of the coatings and/or inks, as applied, used each day on the subject line or operation, in units of kg VOC/L of solids (lb/gal), as determined by the applicable test methods and procedures specified in this chapter; or 2. The weighted average VOC content, as applied, of the coatings and/or inks used each day on the subject line or operation, in units of kg VOC/L of solids (lb/gal), as determined by the applicable test methods and procedures specified in this chapter and the procedure in Subparagraph (d) of this paragraph; and S = VOC emission limitation in terms of kg VOC/L of solids (lb VOC/gal).

(d) The weighted average VOC content, as applied, of the coatings and/or inks used on a coating line or operation in units of mass of VOC per unit volume of coating and/or ink solids shall be calculated by the following equation: n Σ Wvoci Di Vi i = 1 ______________ VOCws = n Σ Vi VS1 i = 1 where:

VOCws = The weighted average VOC content, as applied, of the coatings and/or inks used on the line or operation in units of mass of VOC per unit volume of coating and/or ink solids; n = The number of different coatings and/or inks, as applied, used in a day on the line or operation;

Vi = The volume of each coating or ink (i), as applied, used in a day on the line or operation in units of liters (L) (gallons[gal]);

Wvoci = The weight fraction of VOC in each coating or ink (i), as applied, used in a day on the line or operation in units of kg VOC/kg coating or ink (lb/lb);

Di = The density of each coating or ink (i) as applied, used in a day on the line or operation in units of kg/L of coating or ink (lb/gal);

VSi = The volume fraction solids content of each coating or ink (i), as applied, used in a day on the line or operation in units of L solids/L coating or ink (gal/gal).

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed March 8, 1993; effective April 22, 1993. Amendment filed January 20, 1997; effective April 15, 1997.

Tenn. Comp. R. & Regs. 1200-03-18-.83 TEST METHODS AND COMPLIANCE PROCEDURES: EMISSION CAPTURE AND

DESTRUCTION OR REMOVAL EFFICIENCY AND MONITORING REQUIREMENTS.

(1) The methods and procedures for determining the efficiency of volatile organic compound (VOC) capture systems shall be as specified in the EPA’s Capture Efficiency Testing Guidance, dated January 9, 1995, unless an alternate method or procedure has been approved by the EPA and the Technical Secretary. This EPA guidance document can be obtained from the Technology Transfer Network (TTN) bulletin board, located in the Emission Measurement Technical Information (EMTIC) section, document number GD - 035.

(2) The methods and procedures for determining the destruction or removal efficiency and monitoring parameters of incinerators and carbon adsorbers shall be according to the following, unless an alternate method or procedure has been approved by the EPA and the Technical Secretary:

(a) Testing shall be as follows:

1. The control device destruction or removal efficiency shall be determined from data obtained by simultaneously measuring the inlet and outlet gas-phase VOC concentrations and gas volumetric flow rates in accordance with the gas-phase test methods specified in this chapter. The control device destruction or removal efficiency shall be calculated using the following equation: n m Σ Qi Ci - Σ Qj Cj i = 1 j = 1 E = ___________________ N Σ Qi Ci i = 1 where:

E = VOC destruction efficiency of the control device;

Qi = Volumetric flow rate of the effluent gas flowing through stack i entering the control device, dry standard cubic meters per hour (dscmh);

Ci = Concentration of VOC (as carbon) in the effluent gas flowing through stack i entering the control device, ppmv;

Qj = Volumetric flow rate of the effluent gas flowing through stack j leaving the control device, dscmh;

Cj = Concentration of VOC (as carbon) in the effluent gas flowing through stack j leaving the control device, ppmv; n = The number of vents to the control device; and m = The number of vents after the control device.

2. and 3. (Reserved)

(b) Monitoring shall be as follows:

1. Any owner or operator who uses an incinerator or carbon adsorber for which stack emission testing is required to demonstrate compliance with any standard of this chapter shall install, calibrate, certify to the Technical Secretary, operate, and maintain continuous monitoring equipment. The continuous monitoring equipment shall monitor the following parameters:

(i) Combustion chamber temperature of each thermal incinerator or afterburner;

(ii) Temperature immediately before the catalytic incinerator and temperature rise across each catalytic incinerator bed; and (iii) The VOC concentration of the outlet from each carbon adsorption bed.

2. The continuous temperature monitoring equipment must be equipped with a continuous recorder and have an accuracy of +_1 percent of the combustion temperature being measured expressed in degrees Celsius (°C) or +_0.5°C, whichever is greater.

(3) The overall emission reduction efficiency of the emission control system shall be determined as the product of the capture efficiency and the control device destruction or removal efficiency; or for each emission control system in which solvent is recovered, by a method approved by the EPA and Technical Secretary. The results of a capture efficiency test and control device destruction or removal efficiency test remain valid until a subsequent test is performed. The results of any valid test may be used until superseded by the results of a valid test subsequently performed.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.84 TEST METHODS AND COMPLIANCE PROCEDURES: DETERMINING THE

DESTRUCTION OR REMOVAL EFFICIENCY OF A CONTROL DEVICE.

(1) One of the following test methods must be used to determine volatile organic compound (VOC) concentrations of a gas stream:

(a) Reference Method 18;

(b) Reference Method 25; or (c) Reference Method 25A.

(2) Reference Method 25 or 25A shall be used for determining destruction efficiency of incinerators and catalytic incinerators, unless an alternate method is approved by the Technical Secretary and the EPA.

(3) Except as indicated in Subparagraphs (a) and (b) of this paragraph, a test shall consist of three separate runs, each lasting a minimum of 60 minutes (min):

(a) When the method is to be used to determine the efficiency of a fixed-bed carbon adsorption system with a common exhaust stack for all of the individual adsorber vessels, the test shall consist of three separate runs, each coinciding with one or more complete sequences through the adsorption cycles of all the individual adsorber vessels.

(b) When the method is to be used to determine the efficiency of a fixed-bed carbon adsorption system with individual exhaust stacks for each adsorber vessel, each adsorber vessel shall be tested individually. The test for each adsorber vessel shall consist of three separate runs. Each run shall coincide with one or more complete adsorption cycles.

(4) Reference Method 1 or 1A shall be used for velocity traverses.

(5) Reference Method 2, 2A, 2C, or 2D shall be used for velocity and volumetric flow rates.

(6) Reference Method 3 or 3A shall be used for O2 or CO2 analysis.

(7) Reference Method 4 shall be used for stack gas moisture.

(8) Reference Methods 2, 2A, 2C, 2D, 3, 3A, and 4 shall be performed, as applicable, at least twice during each test run.

(9) Use of an adaptation or alternative to any of the methods specified in this rule shall be approved by the Technical Secretary and EPA on a case-by-case basis. An owner or operator shall submit sufficient documentation for the Technical Secretary and EPA to find that the analytical methods specified will yield inaccurate results and that the proposed adaptation or alternative is appropriate, or that the proposed adaptation or alternative will yield results as accurate as will the specified analytical methods.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed March 8, 1993; effective April 22, 1993.

Tenn. Comp. R. & Regs. 1200-03-18-.86 PERFORMANCE SPECIFICATIONS FOR CONTINUOUS EMISSIONS MONITORING

OF TOTAL HYDROCARBONS.

(1) Applicability of this rule is as follows:

(a) This method applies to the measurement of total hydrocarbons as a surrogate measure for the total gaseous organic concentration of the combustion gas stream. The concentration is expressed in terms of propane.

(b) The use of gas conditioning, including cooling to between 4.4 and 18°C (40 and 64°F), and condensate traps to reduce the moisture content of the sample gas may be approved if the owner/operator:

1. Successfully demonstrates to the Technical Secretary and the EPA that the use of such system is necessary for the specific application; and 2. Includes in the demonstration a quantification of the total hydrocarbon concentration (THC) lost to the gas conditioning system.

(2) Monitoring is by the principle that a gas sample is extracted from the source through a heated sample line and heated glass fiber filter to a flame ionization detector (FID). Results are reported as volume concentration equivalents of the propane.

(3) For the purpose of this rule, the following definitions apply:

(a) “Calibration drift” means the difference in the measurement system response to a midlevel calibration gas before and after a stated period of operation during which no unscheduled maintenance, repair, or adjustment took place.

(b) “Calibration error” means the difference between the gas concentration indicated by the measurement system and the known concentration of the calibration system.

(c) “Calibration gas” means a known concentration of a gas in an appropriate diluent gas.

(d) “Measurement system” means the total equipment required for the determination of the inlet and outlet gas concentrations, percent capture efficiency, and gas outlet emission rate. The system consists of the following major subsystems:

1. Sample interface--the portion of the system that is used for one or more of the following:

(i) Sample acquisition;

(ii) Sample transportation;

(iii) Sample conditioning; or (iv) Protection of the analyzer from the effects of the stack effluent;

2. Organic analyzer--the portion of the system that senses organic concentration and generates an output proportional to the gas concentration;

3. Data recorder--the portion of the system that records a permanent record of the measurement values; and 4. Flow rate system--a gas volume meter meeting the requirements of Reference Method 2A, Section 2.1.

(e) “Response time” means the time interval from a step change in pollutant concentration at the inlet to the emission measurement system to the time at which 95 percent of the corresponding final value is reached as displayed on the recorder.

(f) “Span value” means, for most incinerators, a 50 parts per million (ppm) propane span.

Higher span values may be necessary if propane emissions are significant. For convenience, the span value should correspond to 100 percent of the recorder scale.

(g) “Zero drift” means the difference in the measurement system response to a zero level calibration gas before and after a stated period of operation during which no unscheduled maintenance, repair, or adjustment took place.

(4) An acceptable measurement system includes a sample interface system, a calibration valve, gas filter and a pump preceding the analyzer. THC measurement systems are designated HOT or COLD systems based on the operating temperatures of the system. In HOT systems, all components in contact with the sample gas (probe, calibration valve, filter, and sample lines) as well as all parts of the flame ionization analyzer between the sample inlet and the FID must be maintained between 1500 to 1750C. This includes the sample pump if it is located on the inlet side of the FID. A condensate trap may be installed, if necessary, to prevent any condensate entering the FID. The essential components of the measurement system are as follows:

(a) An FID capable of meeting or exceeding the specifications in this method.

(b) A sample probe as follows:

1. Stainless steel, or equivalent, three-hole rake type. Sample holes shall be 4 millimeters (mm) (0.2 inches [in.] in diameter or smaller and located at 16.7, 50, and 83.3 percent of the equivalent stack diameter; or 2. A single opening probe so that a gas sample is collected from the centrally located 10 percent area of the stack cross section.

(c) Stainless steel or Teflon tubing to transport the sample gas to the analyzer. The sample line from the heated probe shall be heated to between 150° and 175°C (302° and 347°F).

(d) A calibration valve assembly as follows:

1. A heated three-way valve assembly to direct the zero and calibration gases to the analyzers; or 2. Other methods, such as quick-connect lines, to route calibration gas to the analyzers.

(e) An in-stack or an out-of-stack glass fiber filter if exhaust gas particulate loading is significant. An out-of-stack filter must be heated.

(f) A strip-chart recorder, analog computer, or digital recorder for recording measurement data. The minimum data recording shall be one measurement value per minute.

(5) Calibration gases and other gases shall be as follows:

(a) Gases used for calibration, fuel, and combustion air shall be contained in compressed gas cylinders.

(b) Preparation of calibration gases shall be done according to the procedure in Protocol No. 1, listed in the reference in Subparagraph (12)(b) of this rule.

(c) The recommended shelf life for each calibration gas cylinder over which the concentration does not change more than +_2 percent from the certified value shall be obtained from the cylinder manufacturer.

(d) The following calibration and other gases shall be used:

1. As fuel, a 40 percent hydrogen and 60 percent helium or 40 percent hydrogen and 60 percent nitrogen gas mixture to avoid an oxygen synergism effect that reportedly occurs when oxygen concentration varies significantly from a mean value.

2. As zero gas, high purity air with less than 0.1 parts per million by volume (ppmv) of organic material methane or carbon equivalent or less than 0.1 percent of the span value, whichever is greater.

3. As low-level calibration gas, propane calibration gas (in air or nitrogen) with a concentration equivalent to 20 to 30 percent of the applicable span value.

4. As mid-level calibration gas, propane calibration gas with a concentration equivalent to 45 to 55 percent of the applicable span value.

5. As high-level calibration gas, propane calibration gas with a concentration equivalent to 80 to 90 percent of the applicable span value.

(6) Measurement system performance specifications as follow apply:

(a) Zero drift shall be less than +_3 percent of the span value.

(b) Calibration drift shall be less than +_3 percent of the span value.

(c) Calibration error shall be less than +_5 percent of the calibration gas value.

(7) Pretest preparations include the following:

(a) Sampling site selection as follows:

1. The location of the sampling site shall be determined from the applicable

regulation or purpose of the test (i.e., exhaust stack, inlet line, etc).

2. The sample port shall be located at least 1.5 meters (4.9 feet) or 2 equivalent diameters upstream of the gas discharge to the atmosphere.

(b) The sample probe must be installed so that the probe is centrally located in the stack, pipe or duct and is sealed tightly at the stack port connection.

(c) Prior to the emission test, the measurement system must be assembled following the manufacturer’s written instructions in preparing the sample interface and the organic analyzer. The system must be operable.

(d) Calibration error test as follows:

1. Immediately prior to the test series (within 2 hours of the start of the test), zero gas and high-level calibration gas shall be introduced at the calibration valve assembly.

2. The analyzer output shall be adjusted to the appropriate levels, if necessary.

3. The predicted response for the low-level and mid-level gases shall be calculated based on a linear response line between the zero and high-level responses.

4. Low-level and mid-level calibration gases shall be introduced successively to the measurement system.

5. The analyzer responses for low-level and mid-level calibration gases shall be recorded, and the differences between the measurement system responses and the predicted responses shall be determined. These differences must be less than +_5 percent of the respective calibration gas value. If not, the measurement system shall be deemed not acceptable and must be replaced or repaired prior to testing. No adjustments to the measurement system shall be conducted after the calibration and before the drift determination found in Paragraph (8)(b) of this

section.

6. If adjustments are necessary before the completion of the test series, the drift checks shall be performed prior to the required adjustments, and the calibration following the adjustments shall be repeated.

7. If multiple electronic ranges are to be used, each additional range must be checked with a mid-level calibration gas to verify the multiplication factor.

(e) Response time test as follows:

1. Zero gas shall be introduced into the measurement system at the calibration valve assembly.

2. When the system output has stabilized, the owner or operator shall switch quickly to the high-level calibration gas.

3. The time shall be recorded from the concentration change to the measurement system response equivalent to 95 percent of the step change.

4. The test shall be repeated three times and the results averaged.

(8) Emission measurement test procedure includes the following:

(a) Organic measurement as follows:

1. Sampling shall begin at the start of the test period.

2. Time and any required process information shall be recorded, as appropriate.

3. Periods of process interruption or cyclic operation shall be noted on the recording chart.

(b) Drift determination as follows:

1. Immediately following the completion of the test period and hourly during the test period, the zero and mid-level calibration gases shall be introduced, one at a time, to the measurement system at the calibration valve assembly. No adjustments to the measurement system shall be made until after both the zero and calibration drift checks are made.

2. The analyzer response shall be recorded.

3. If the drift values exceed the specified limits, the test results shall be invalidated preceding the check, and the test shall be repeated following corrections to the measurement system.

4. Alternatively, the test measurement system may be recalibrated as in Subparagraph (7)(d) of this rule and the results reported using both sets of calibration data (i.e., data determined prior to the test period and data determined following the test period).

(9) The average organic concentration shall be determined in terms of ppmv propane by the integration of the output recording over the period specified in the applicable regulation.

(10) Quality assurance includes the following:

(a) The owner or operator shall assure proper calibration, maintenance, and operation of the continuous emissions monitoring system on a continual basis.

(b) The owner or operator shall establish a quality assurance program to evaluate and monitor performance on a continual basis. The following checks shall routinely be done:

1. A daily calibration check for each monitor. The calibration shall be adjusted if the check indicates the instrument’s calibration drift exceeds the specification established in Paragraph (6) of this rule;

2. A daily system audit which includes the following:

(i) A review of the calibration check data;

(ii) An inspection of the recording system;

(iii) An inspection of the control panel warning lights; and (iv) An inspection of the sample transport/interface system (e.g., flowmeters, filters), as appropriate.

3. A quarterly calibration error test at the span midpoint; and 4. The entire performance specification test repeated every second year.

(11) Reporting of total hydrocarbon levels shall be as follows:

(a) The total hydrocarbon concentration (THC) levels from the initial compliance certification test shall be reported as ppm propane for inlet and outlet concentrations and as a percent reduction across the control device.

(b) THC levels shall be expressed in milligrams per second (mg/sec) (pounds per second [lb/sec]).

(c) This conversion shall be accomplished using the following equation:

THC, mg/sec = (THC ppm propane) x (stack gas flow) x 5.183 x 10-2 where:

THC ppm propane = The total hydrocarbon concentration as actually measured by this method in ppm propane at the inlet or outlet.

Stack gas flow = Measured in dry standard cubic feet per second as determined by the flowmeter system or Reference Methods 2 and 4. 5.183 x 10-2 = Constant to account for the conversion of units.

(12) References as follow are applicable for this rule:

(a) Measurement of Volatile Organic Compounds--Guideline Series. U.S. Environmental Protection Agency, Research Triangle Park, North Carolina. Publication No. EPA- 450/2-78-041. June 1978. p. 46-54.

(b) Traceability Protocol for Establishing True Concentrations of Gases Used for Calibration and Audits of Continuous Source Emission Monitors (Protocol No. 1). U.S.

Environmental Protection Agency, Environmental Monitoring and Support Laboratory.

Research Triangle Park, North Carolina. June 1973.

(c) Gasoline Vapor Emission Laboratory Evaluation--Part 2. U.S. Environmental Protection Agency. Office of Air Quality Planning and Standards. Research Triangle Park, North Carolina. EMB Report No. 75-GAS-6. August 1975.

(d) Appendix D: Performance Specifications for Continuous Emissions Monitoring of Total Hydrocarbons in Hazardous Waste Incinerators, Boilers and Industrial Furnaces.

Federal Register. 54:206 pp. 43743-43745. October 26, 1989.

(13) Use of an adaptation to any of the requirements specified in this rule shall be approved by the Technical Secretary and EPA case-by-case. An owner or operator shall submit sufficient documentation for the Technical Secretary and EPA to find that the specified requirements will yield inaccurate results and that the proposed adaptation is appropriate, or that the proposed adaptation will yield results as accurate as will the specified requirements.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed March 8, 1993; effective April 22, 1993. Amendment filed May 30, 1996; effective August 10, 1996.

Tenn. Comp. R. & Regs. 1200-03-18-.87 QUALITY CONTROL PROCEDURES FOR CONTINUOUS EMISSION MONITORING

SYSTEMS (CEMS).

(1) Each owner or operator of a CEMS shall develop and implement a CEMS QC program. At a minimum, each QC program shall include written procedures that describe in detail step-bystep procedures and operations for each of the following:

(a) Initial and routine periodic calibration of the CEMS.

(b) Calibration drift (CD) determination and adjustment of the CEMS.

(c) Preventative maintenance of the CEMS (including spare parts inventory).

(d) Data recording, calculations, and reporting.

(e) Accuracy audit procedures including sampling and analysis methods.

(f) Program of corrective action for malfunctioning CEMS.

(2) Out-of-control conditions are as follows:

(a) If either the zero (or low-level) or high-level CD exceeds twice the applicable drift specification in 40 C.F.R. Part 60, Appendix B, as of July 1, 1991, for five consecutive daily periods, the CEMS is out-of-control.

(b) If either the zero (or low-level) or high-level CD exceeds four times the applicable drift specification in 40 C.F.R. Part 60, Appendix B, as of July 1, 1991, during any CD check, the CEMS is out-of-control.

(c) If the CEMS fails a performance audit (PA), the CEMS is out-of-control, and the owner or operator shall take necessary corrective action to eliminate the problem. Following the corrective action, the source owner or operator shall reconduct the appropriate failed portion of the audit and other applicable portions to determine whether the monitoring system is operating properly and within specifications. Monitoring data obtained during any out-of-control period may not be used for compliance determination or to meet any data capture requirements; however, the data can be used for identifying periods when there has been a failure to meet quality assurance/quality control criteria.

(3) Out-of-control time periods determination shall be as follows:

(a) The beginning of the out-of-control period is:

1. The time corresponding to the completion of the fifth consecutive daily CD check with CD in excess of two times the allowable limit, or 2. The time corresponding to completion of the daily CD check preceding the daily CD check that results in a CD in excess of four times the allowable limit.

(b) The end of the out-of-control period is the time corresponding to the completion of the CD check following corrective action that results in the CD’s at both the zero (or lowlevel) and high-level measurement points being within the corresponding allowable CD limit (i.e., either two times or four times the allowable limit in 40 C.F.R. Part 60,

Appendix B, as of July 1, 1991).

(c) If the CEMS failed a PA, the beginning of the out-of-control period is the time corresponding to the completion of the failed audit test. The end of the out-of-control period is the time corresponding to a successful retest of the PA sample.

(4) The owner or operator shall keep the QC procedure described in Paragraph (1) of this rule in a readily accessible location for at least 3 years and shall make the procedure available to the Technical Secretary upon request.

(5) Upon request, the owner or operator shall submit to the Technical Secretary a copy of all information and records documenting out-of-control periods including beginning and end dates and descriptions of corrective actions taken.

(6) Use of an adaptation to any of the requirements specified in this rule shall be approved by the Technical Secretary and EPA case-by-case. An owner or operator shall submit sufficient documentation for the Technical Secretary and EPA to find that the specified requirements are inappropriate and that the proposed adaptation is appropriate.

History

• Authority: T.C.A. §§ 4-5-202 and 68-201-105.
• Administrative History: Original rule filed March 8, 1993; effective April 22, 1993.

Chapter 1200-03-19 Emission Standards and Monitoring Requirements for Additional Control Areas

Tenn. Comp. R. & Regs. 1200-03-19-.01 PURPOSE

It is the purpose of this chapter to establish specific emission standards for existing air contaminant sources located in or significantly impacting upon an additional control area with the state of Tennessee.

The emissions standards established in this chapter will apply to those air contaminant sources specifically identified in addition to the standards contained in other chapters of division 1200-03 of the Tennessee Air Pollution Control Regulations and any local regulations. An additional control area as used in this chapter is an area which was identified at sometime by the Tennessee Air Pollution Control Board as not meeting an ambient air quality standard. This area by design will eventually meet the ambient air quality standards because of the additional controls required in this chapter.

History

• Authority: T.C.A. §§ 4-5-202, et seq. and 68-25-105.
• Administrative History: Original rule filed March 8, 1979; effective April 23, 1979. Amendment filed September 22, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-19-.02 GENERAL REQUIREMENTS

No person shall cause, suffer, allow or permit emissions in excess of the standards set for each company, emission point, and/or source specified in the remaining rules of this chapter 1200-03-19.

History

• Authority: T.C.A. §§ 4-5-202, et seq. and 68-25-105.
• Administrative History: Original rule filed March 8, 1979; effective April 23, 1979. Amendment filed September 22, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-19-.03 PARTICULATE AND SULFUR DIOXIDE ADDITIONAL CONTROL AREAS WITHIN

TENNESSEE.

(1) Particulate Additional Control Areas (a) Bristol Additional Control Areas - (Sullivan County) bounded by Virginia Avenue on the west, Lakeview on the north, Georgia Avenue on the east and Beachwood on the south.

(b) La Follette Additional Control Area - (Campbell County) - Area bounded on the north by Prospect Street, on the south by Elm Street, the west by West Street and South Avenue and on the east by Cumberland Avenue.

(c) (RESERVED).

(d) (RESERVED).

(e) Jacksboro Additional Control Area - (Campbell County) - Area bounded by the fence along the property line of the Carborundum Company.

(f) Kingsport Additional Control Area - (Sullivan County) - Area bounded by the South Fork of the Holston River on the south side, Wilcox Drive on the eastern side, East Sullivan Street on the northeast and West Sullivan Street on the northwest.

(g) (RESERVED).

(h) Nashville Additional Control Areas - (Davidson County)

1. Area bounded by I-65 on the north, I-40 on the west and I-40/I-65 on the south.

2. Area bounded by 44th Avenue North extended to the Cumberland River on the east, I-40 on the south, Morrow Road to 63rd Avenue extended to the Cumberland River on the west, and the Cumberland River on the north.

(i) (RESERVED).

(j) Chattanooga Additional Control Area - (Hamilton County) - Area beginning at a point, said point being the original beginning point of the composite description of the corporate limits of the City of Chattanooga, Hamilton County, Tennessee, as of September 28, 1967, described thus; proceed from a point on the line between Townships 2 and 3, Range 4, west of the Basis Line, Ocoee District, where said line crosses the low water mark on the east side of the Tennessee River at this point, thence proceed down the said river on said low water mark to a point one hundred feet (100’) westwardly from the low water mark of Chattanooga Creek. This last designated point in the low water mark of the existing south side of the Tennessee River, being designated as the point of beginning of the above-name corporate limits description and the beginning point of the additional control area. Thence, proceed south following the corporate city limits of Chattanooga as defined in the composite description of September 28, 1967, to the State Line between Tennessee and Georgia; thence eastwardly with said State Line to a point of intersection with the center line of Waheela Street, from said point in a generally north direction to South Crest Road, thence in a generally north, northeast direction to North Crest Road, thence in a generally north, northeast direction to a point of intersection, said point of intersection being North Crest Road and Campbell Street, thence in a generally northwest direction to Glass Street, thence in a generally west, and then southwest direction to the intersection of Glass Street with Roanoke Avenue, thence in a generally south direction along Roanoke Avenue to the intersection of Roanoke Avenue with the intersection of Sherman Street, thence in a generally west direction to the intersection of Sherman Street with Hawthorne, thence in a generally north direction along Hawthorne to its intersection with Sholar Avenue, thence follow the Sholar Avenue loop north and then west through the Boone Hysinger Homes subdivision, proceed along the center line of Sholar Avenue to its nearest point to the southernmost corner of the apartment at 2001 Sholar Avenue, Boone Hysinger Homes subdivision (near the railroad tracks); from said point at 2001 Sholar Avenue, Boone Hysinger Homes subdivision, proceed generally in a northwest direction as if a line were extended from said point across the Southern Railroad tracks to a point, said point being the intersection of the center lines of Riverside Drive and Elena Drive, thence proceed in a generally northwest and then north direction along the center line of Elena Drive to Queen’s Drive, thence in a generally west and then north direction along Queen’s Drive to its intersection with Crutchfield Street, thence in a generally west direction continue along Crutchfield Street to its intersection with Amnicola Highway, thence in a generally west direction as if a line were extended from said point across the Tennessee River to the intersection of the center lines of Hillcrest Road and Lexington Street, thence in a generally northwest direction along Lexington Street to Falmouth Street, thence in a generally south, southwest direction along Falmouth Street to Hixson Pike, thence in a generally south direction along Hixson Pike to Tremont Street, thence in a generally northwest direction and then a southwest direction along Tremont street to Mississippi Avenue, thence in a generally northwest and then southwest direction along Mississippi Avenue to Forrest Street, thence in a generally south direction along Forrest Street to Sylvan Street, thence in a generally northwest direction along Sylvan Street to Dallas Road, thence in a generally southwest direction along Dallas Road to North Market Street, thence in a southward direction along North Market Street to Chambliss Street, thence in a generally west direction along Chambliss Street to Pine Ridge Trail, thence in a generally west direction along Pine Ridge Trail to Gurley Street, thence in a generally southward direction along Gurley Street to Cherokee Boulevard, thence in a generally northwest direction to East Elmwood Drive with Beason Drive crossing the railroad tracks to West Elmwood Drive, thence in a generally south direction along West Elmwood Drive to Pineville Road, thence in a generally south direction along West Elmwood Drive to Pineville Road, thence in a generally south direction along Pineville Road to Moccasin Bend Road to its end at the Hospital Loop, thence in a generally south direction as if a line were extended across the Hospital property and the Tennessee River to the original point of beginning, which is at the low water mark of the existing south side of the Tennessee River as described above.

(k) Memphis Additional Control Areas - (Shelby County)

1. Area bounded by I-55 on the north, eastern boundary proceeding south along I- 55 where the axis of I-55 (if extended) would intersect Nonconnah Creek. The southern boundary being Nonconnah Creek to where Nonconnah Creek enters McKellar Lake then west to where the axis of Wharf Street would intersect Harbor Channel, west on Wharf Street to Harbor Avenue. The western boundary being Harbor Avenue north to Jack Carley Causeway then due north to the Mississippi River, then along the Mississippi River to I-55.

2. (RESERVED).

(2) Sulfur Dioxide - Additional Control Area (a) Copper Basin Additional Control Areas - (Polk County) - Area is bounded on the south by the Georgia state line and on the east by the North Carolina state line. The northern boundary consists of Brush Creek and a line extending between the origin of Brush Creek and the North Carolina state line. The western boundary consists of the portion of Brush Creek which runs southward into the Ocoee River, a portion of the Ocoee River between the mouths of Brush and Grassy Creeks, and Grassy Creek southward to the Georgia state line.

(b) New Johnsonville Additional Control Area - (Humphreys and Benton Counties) - Area bounded by I-40 on the south, from I-40 north on Highway 69 bounding the west to the intersection with Highway 69A to the town of Big Sandy where 69A becomes Main Street, north on Main Street until it intersects the L & N Railroad, the railroad on the north to the Tennessee River, south on the river to Richland Creek, east on Richland Creek to Highway 13 which bounds the east and then south back to I-40.

History

• Authority: T.C.A. §§ 4-5-202, et seq. and 68-25-105.
• Administrative History: Original rule filed March 8, 1979; effective April 23, 1979. Amendment filed July 13, 1979; effective October 10, 1979. Amendment filed July 21, 1980; effective September 4, 1980. Amendment filed June 9, 1981; effective July 24, 1981. Amendment filed December 8, 1981; effective January 22, 1982. Amendment filed May 25, 1982; effective July 9, 1982. Amendment filed January 19, 1983; effective February 18, 1983. Amendment filed January 31, 1983; effective March 2, 1983. Amendment filed September 22, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-19-.05 OPERATING PERMITS AND EMISSION LIMITING CONDITIONS

(1) All operating permits for sources in or significantly impacting on particulate matter additional control areas except Bristol, Bull Run, Odom’s Bend, Jacksboro, LaFollette, and Columbia shall expire three months after February 14, 1980. For sources within local government jurisdictions presently regulating the sources under a certificate of exemption any operating permit of the local government shall be deemed to have expired three months after the suspension of the certificate of exemption.

(2) The Technical Secretary shall specify on the operating permits for all sources whose permits are affected by paragraph (1) above as permit conditions the emission level that is reasonably available control technology (RACT) and reasonable limitations on operating hours as necessary to achieve and maintain ambient air quality standards as specified in

Chapter 1200-03-03. It is for purposes of this rule to be considered necessary that there be some room for growth. The RACT specifications will include specific emissions limits (one hour average basis or shorter time interval basis if so specified).

(3) Any source may operate more than the hours that would be specified under paragraph (2) above or any other rule of this chapter by agreeing to reduce emissions proportionally from the RACT allowable emission rate such that no increase in emissions occur on either a twenty-four hour basis or an annual basis. This may only be done after the owner or operator has applied for and obtained a new operating permit with revised operating hour specifications and emission rates for each emission point.

(4) To increase the operating hours or make other modifications without a proportional decrease in emissions, a source which has enforceable limitations on a RACT permit must apply for a construction permit. Upon issuance of said construction permit the RACT permit will be deleted from the State Implementation Plan.

History

• Authority: T.C.A. §§ 4-5-202, et seq. and 68-25-105.
• Administrative History: Original rule filed December 31, 1979; effective February 14, 1980. Amendment filed April 30, 1987; effective June 4, 1987. Amendment filed September 22, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-19-.06 LOGS FOR OPERATING HOURS

The owner or operator of any air contaminant sources with operative hours limited by a rule of this

chapter must keep a running log, showing the hours of operation of each such source with time of each startup and shutdown indicated. This log must be available for inspection by the Technical Secretary or his representative at all times and a copy must be maintained for at least two full calendar years. The total operating hours for each such source for each calendar year must be reported to the Technical Secretary on or before January 31 of the following year. This report shall also include most hours operated in any one day during the calendar year if there is an hours per day restriction.

History

• Authority: T.C.A. §§ 4-5-202, et seq. and 68-25-105.
• Administrative History: Original rule filed December 31, 1979; effective February 14, 1980. Amendment filed September 22, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-19-.11 PARTICULATE MATTER EMISSION REGULATIONS FOR THE BRISTOL

ADDITIONAL CONTROL AREA.

(1) Visible Emission Standards for Air Contaminants Sources in Operation Prior to January 1, (a) No person shall cause, suffer, allow or permit discharge of a visible emission from any stack with an opacity in excess of ten (10) percent for an aggregate of more than five (5) minutes in any one (1) hour or more than twenty (20) minutes in any twenty-four (24) hour period.

(b) No person shall cause, suffer, allow or permit discharge of a visible emission from any fugitive dust source with an opacity in excess of ten (10) percent on a 15 minute average except as provided in 1200-03-19-.11(3).

(c) Specific Visible Emission Standards for Air Contaminant Sources in Operation Prior to January 1, 1978.

1. Wood Fired Boilers (i) This part applies to units with a heat input greater than one (1) million Btu per hour.

(ii) The units shall not discharge visible emissions with an opacity in excess of twenty (20) percent for an aggregate of more than five (5) minutes in any one (1) hour or more than twenty (20) minutes in any twenty-four (24) hour period.

2. Wood Working Cyclones Cyclone exhausts shall not discharge any gases with an opacity in excess of fifteen (15) percent for an aggregate of more than five (5) minutes in any one (1) hour or more than twenty (20) minutes in any twenty-four (24) hour period.

3. Traffic and Wind Emissions from Roadways and General Grounds of Plants No person shall cause, suffer, allow or permit discharge of a visible emission with an opacity in excess of five (5) percent on a fifteen (15) minute average except as provided in 1200-03-19-.11(3).

(2) Particulate Emission Standards for Air Contaminant Sources in Operation Prior to January 1, 1978.

(a) Wood Fired Boilers 1. This subparagraph applies to units with a heat input greater than one (1) million Btu per hour.

2. No owner or operator subject to the provisions of this subparagraph shall discharge or cause the discharge into the atmosphere from any affected facility particulate matter in excess of 0.55 pounds per million Btu of heat input not to exceed 7.7 pounds per hour.

(b) Cyclones on Wood Working Operations No owner or operator shall discharge or cause the discharge into the atmosphere from cyclone exhausts any gases which contain particulate matter in excess of 0.02 gr/dscf not to exceed 5.0 pounds per hour.

(c) Fabric Filter Collectors (Baghouses) on Wood Working Operations No owner or operator shall discharge or cause the discharge into the atmosphere from baghouse exhausts particulate emissions in excess of 0.1 pounds per hour.

(3) Compliance Schedules for Particulate Matter Air Contaminant Sources in or Significantly Impacting the Bristol Additional Control Area (a) The owner or operator of an air contaminant source of particulate fugitive dust emissions subject to the standards in this rule proposing utilization of new and/or additional control techniques shall achieve final compliance by December 31, 1979.

Final compliance shall be determined in accordance with the method(s) specified by the Technical Secretary.

(b) (RESERVED).

History

• Authority: T. C.A. §§ 4-5-202, et seq. and 68-25-105.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Amendment filed April 15, 1987; effective May 30, 1987. Amendment filed September 22, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-19-.12 PARTICULATE MATTER EMISSION REGULATIONS FOR AIR CONTAMINANT

SOURCES IN OR SIGNIFICANTLY IMPACTING THE PARTICULATE ADDITIONAL CONTROL

AREAS IN CAMPBELL COUNTY.

(1) Visible Emission Standards for Air Contaminant Sources in Operation Prior to January 1, 1978.

(a) No person shall cause, suffer, allow or permit discharge of a visible emission from any stack with an opacity in excess of ten (10) percent for an aggregate of more than five (5) minutes in any one (1) hour or more than twenty (20) minutes in any twenty-four (24) hour period except as provided in 1200-03-19-.12(4).

(b) No person shall cause, suffer, allow or permit discharge of a visible emission from any fugitive dust source with an opacity in excess of ten (10) percent on an 15 minute average except as provided in 1200-03-19-.12(4).

(c) Specific Visible Emission Standards for Air Contaminant Sources in Operation Prior to January 1, 1978.

1. Limestone Aggregate Plants.

Primary and secondary crushing, screening, and conveying of limestone shall not exceed 15% on a 15 minute average.

2. Coal Fired Boiler Units.

(i) This part applies to units with a heat input greater than one (1) million Btu per hour.

(ii) The units shall not discharge visible emissions with an opacity in excess of twenty (20) percent for an aggregate of more than five (5) minutes in any one (1) hour or more than twenty (20) minutes in any twenty-four (24) hour period.

3. Hot Mix Asphalt Plants.

These plants shall not discharge visible emissions with an opacity in excess of twenty (20) percent for an aggregate of more than five (5) minutes in any one (1) hour or more than twenty (20) minutes in any twenty-four (24) hour period.

4. Traffic and Wind Emissions from Roadways and General Ground of Plants.

No person shall cause, suffer, allow or permit discharge of a visible emission with an opacity in excess of five (5) percent on a fifteen (15) minute average except as provided in 1200-03-19-.12(4).

(2) Particulate Emission Standards for Air Contaminant Sources in Operation Prior to January 1, 1978.

(a) Hot Mix Asphalt Plant No owner or operator shall discharge or cause the discharge into the atmosphere from any affected plant any gases which contain particulate matter in excess of 0.06 gr/dscf except as provided in 1200-03-19-.12(4).

(b) Limestone Aggregate Plants No owner or operator shall discharge or cause the discharge into the atmosphere from limestone rock tertiary crushing and screening, and agriculture lime crushing and screening any gases which contain particulate matter in excess of 0.16 gr/dscf.

(c) Feed and Grain Mills No owner or operator shall discharge or cause the discharge from any stack any gases which contain particulate matter in excess of 0.02 gr/dscf.

(d) Concrete Block Plants No owner or operator shall discharge into the atmosphere from any stack any gases which contain particulate matter in excess of 0.03 gr/dscf except as provided in 1200- 03-19-.12(4).

(e) Coal Fired Boiler Units 1. No owner or operator subject to the provisions of this subparagraph shall discharge or cause the discharge into the atmosphere from any affected facility particulate matter in excess of 0.4 pounds per million Btu of heat input.

2. This subparagraph applies to units with a heat input greater than one (1) million Btu per hour.

(f) Oil Fired Boiler Units 1. No owner or operator subject to the provisions of this subparagraph shall discharge or cause the discharge into the atmosphere from any affected facility particulate matter in excess of 0.015 pounds per million Btu of heat input.

2. This subparagraph applies to units with a heat input greater than one (1) million Btu per hour.

(g) (RESERVED).

(3) Limitation of Operating Hours (a) No owner or operators shall operate any particulate matter air contaminant source subject to the regulations set forth in paragraph 1200-03-19-.12(1) and (2) in excess of the specified limit on operating hours contained in Table I.

Table I Limitation of Operating Hours Air Contaminant Source Operating Schedule Grain Crushing and Feed Mixing 3000 HRS./YR.

Boilers at Dry Cleaners and Laundries 3000 HRS./YR.

Boilers at Schools 2000 HRS./YR.

Boilers at Churches 7000 HRS./YR.

Hot Mix Asphalt Plants 2500 HRS./YR.

Concrete Block Plants 3000 HRS./YR.

Limestone crushing, screening, conveying and handling facilities with a design 2500 HRS./YR. capacity greater than 750 tons per hour 16 HRS./DAY Limestone crushing, screening, conveying, and handling facilities with a design capacity less than 250 tons per hour. 2100 HRS./YR.

Limestone crushing, screening, conveying and handling facilities with a design capacity less than or equal to 750 tons per hour and greater than or equal 10 HRS./DAY to 250 tons per hour 3210 HRS./YR.

(b) The owner or operator of an air contaminant source with restricted operating hours must maintain a daily log of operating hours and keep it available for inspection by Division personnel on request for at least one year after the end of any calendar year included in the log. The owner or operator shall submit by letter on or before January 31 of each year the total hours of operation for the previous calendar year and/or the maximum daily operation for said calendar year.

(4) Compliance Schedules for Particulate Matter Air Contaminant Sources in or Significantly Impacting the Particulate Additional Control Area in Campbell County (a) The owner or operator of an air contaminant source of particulate fugitive dust emissions subject to the standards in this rule proposing utilization of new and/or additional control techniques shall achieve final compliance by December 31, 1979.

Final compliance shall be determined in accordance with the method(s) specified by the Technical Secretary.

(b) No owner or operator shall cause, suffer, allow, or permit discharge of particulate matter emissions from any stack in excess of the standards in this rule after December 31, 1979. Final compliance shall be determined in accordance with the method(s) specified by the Technical Secretary.

(c) Specific Compliance Schedules 1. Owners or operators of hot mix asphalt plants are required to have air contaminant sources achieve final compliance with the standards in this rule by July 1, 1979.

2. Owners or operators of concrete block manufacturing plants are required to have air contaminant sources achieve final compliance with the standards in this rule by July 1, 1979.

History

• Authority: T.C.A. §§ 4-5-202, et seq. and 68-25-105.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Amendment filed April 15, 1987; effective May 30, 1987. Amendment filed September 22, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-19-.13 PARTICULATE MATTER EMISSION REGULATIONS FOR THE BULL RUN

ADDITIONAL CONTROL AREA AND ODOMS BEND ADDITIONAL CONTROL AREA.

(1) All particulate matter emission sources in operation prior to January 1, 1978 which are in and significantly impact on these additional control areas are subject to the general requirements as found in the Air Pollution Control Rules and Regulations of the State of Tennessee for sources in unclassified and attainment areas.

History

• Authority: T.C.A. §§ 4-5-202, et seq. and 68-25-105.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Amendment filed September 22, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-19-.14 SULFUR DIOXIDE EMISSION REGULATIONS FOR THE NEW JOHNSONVILLE

ADDITIONAL CONTROL AREA.

(1) Sulfur Dioxide Emission Standards for Air Contaminant Sources in operation prior to January 1, 1981.

(a) Definitions 1. Titanium dioxide manufacturing plant is a pigment manufacturing plant.

2. Neutral sulfite semi-chemical corrugating medium mill is a paper plant making a corrugating medium using a pulping process.

3. Electrolytic manganese production plant is a plant producing manganese by electrolysis.

4. Hot mix asphalt plant is a plant producing a paving material consisting of a combination of aggregate that has been dried, heated, and then evenly coated with hot mix asphalt.

5. Sand or clay dryer is a kiln used to dry sand or clay.

6. Wood refuse boiler means a furnace or a boiler used in the process of burning wood refuse for the purpose of producing steam by heat transfer.

(b) Fuel burning installations Fuel burning sources located in or significantly impacting on the New Johnsonville additional control area shall be regulated in the following manner.

1. Coal fired fuel burning installations with a heat input less than 1000 million btu per hour, shall not discharge sulfur dioxide in excess of 5.0 pounds per million btu of heat input.

2. Coal fired fuel burning installations with a heat input more than or equal to 1000 million btu per hour, shall not discharge sulfur dioxide in excess of 3.4 pounds per million btu of heat input, 24 hour average as covered in Chapter 1200-03-14- .02(1)(d).

3. Electric generating turbines shall not discharge sulfur dioxide in excess of 0.8 pound per million btu of heat input.

4. The sulfur dioxide emissions from wood refuse boilers shall be 90% controlled and less than 0.8 pounds per million btu of heat input.

5. The fuel burning installations using natural gas or propane or fuel oil as fuel shall not discharge sulfur dioxide in excess of 0.51 pounds per million btu of heat input.

(c) Process emission sources Process emission sources located in or significantly impacting on the New Johnsonville additional control area shall emit no emission in excess of the following:

1. Hot Mix Asphalt Plants - 800ppm 2. Sand or clay dryers - 300ppm 3. Titanium dioxide manufacturing plants (i) Reaction stacks - 800ppm (ii) Spray dryers - 300ppm (iii) Ore roasters - 300ppm (iv) Screen dryers - 300ppm (v) Scrubs kiln - 300ppm (vi) Gas fired heaters - 300ppm (vii) Slurry filter vents - 100ppm (viii) TiC1 purification process 100ppm (viiii) Wet treatment operation 10ppm 4. Pathological incinerators - 1 pound/hour 5. Gray iron foundries Induction furnaces - 100ppm Preheaters - 100ppm Heat treat ovens - 100ppm 6. Electrolytic manganese production plants (i) Reduction furnaces - 350ppm for manganese ores (ii) All other process - 100ppm emission sources 7. Neutral sulfite semi-chemical corrugating medium mills (i) Cooking liquor system 300ppm (ii) Blowtank exhaust 300ppm (iii) Digester vent 300ppm (iv) The process emissions sources not given a specific standard above shall emit no emissions in excess of 100ppm.

2. Primary aluminum reduction plants (i) All operating permits for primary aluminum reduction potlines shall expire on the rule certified date of 1200-03-19-.14(1)(c)8.

(ii) The Technical Secretary shall specify on the operating permit for the sources affected by subpart 8 (i) above as a permit condition the maximum sulfur content of the carbon electrodes which may be used. This percent by weight of sulfur shall not exceed 6.0 and shall be less than that value necessary to assure compliance with the primary SO ambient standards after December 31, 1982 and the secondary SO ambient standard after December 31, 1987.

(iii) The Technical Secretary shall specify as a condition of the operating permit for the sources affected by subpart 8 (i) above a compliance schedule assuring attainment of the secondary standard by December 31, 1987 and the primary standard by December 31, 1982.

(iv) The sulfur dioxide emissions from melting and holding furnaces shall not exceed 0.51 pounds per million btu of heat input.

History

• Authority: T.C.A. §§ 4-5-202, et seq. and 68-25-105.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Repealed and new rule filed November 17, 1982; effective December 17, 1982. Amendment filed September 22, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-19-.15 (RESERVED)

History

• Authority: T.C.A. §§ 4-5-202, et seq. and 68-25-105.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Repealed and new rule filed November 17, 1982; effective December 17, 1982. Amendment filed September 22, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-19-.19 SULFUR DIOXIDE REGULATIONS FOR THE COPPER BASIN ADDITIONAL

CONTROL AREA.

(1) Process emission sources located in or significantly impacting on the Copper Basin Additional Control Area shall emit no emissions in excess of the following where each value is a three hour average on a dry basis of parts per million sulfur dioxide by volume:

(a) Reserved (b) Liquid Sulfur Dioxide Plants 375 PPM (c) Organic Chemical Plants 50 PPM (d) Reserved (e) Reserved Where the general test methods specified in other chapters of these regulations cannot physically be applied to determine emissions from a particulate source, then it shall be tested in accordance with the method specified by the Technical Secretary, considering testing cost and achieving a reliable measure of the true emissions.

(2) (a) During startup and shutdown of process emission sources as indicated in this paragraph, the sources indicated may operate in excess of the standards in paragraph (1). Maximum allowable emissions for these processes at these times are as indicated in Table 1. Where malfunctions occur which are beyond the control of the source operator and the emission levels exceed the allowable standards as stipulated in Table 1 of this paragraph, then these cases will be considered under Chapter 1200-03-20 of these regulations.

Table 1 Startup/Shutdown Allowable SO Levels Process Emission Source Allowable for Startup/Shutdown 24 hour average Allowable for Concurrent Startup/Shutdown 3 hour average Allowable for Non-Concurrent Startup/Shutdown 3 hour average Sulfuric Acid Plants 800 PPM 1200 PPM 1400 PPM Liquid Sulfur Dioxide Plants 600 PPM 900 PPM 1000 PPM (b) Reserved (c) All concentrations are parts per million by volume, dry basis.

(d) All other sources must meet the general emission standards in other paragraphs of this

rule or Chapter 1200-03-14 even during startups and shutdowns.

(3) All liquid sulfur dioxide plants in existence prior to January 1, 1978, must exhaust any emissions through a stack at least 126 feet in vertical distance above grade directly below the tip of the stack.

(4) (Reserved)

(5) (a) No owner or operator shall burn in any non-process fuel burning equipment located in or significantly impacting on the Copper Basin additional control area a #1 or #2 fuel oil with a sulfur weight content exceeding 0.500 percent nor shall such owner or operator burn in any non-process fuel burning equipment a #4, #5, or #6 fuel oil with a sulfur weight content exceeding 1.25 percent.

(b) For any process emission source or incinerator located in or significantly impacting on the Copper Basin additional control area for which there is no sulfur dioxide stack standard (PPM) contained within Rule 1200-03-19-.19 of these regulations, the owner or operator shall not burn a #1 or #2 fuel oil with a sulfur weight content exceeding 0.500 percent nor shall such owner or operator burn in the process emission source or incinerator a #4, #5, or #6 fuel oil with a sulfur weight content exceeding 1.25 percent.

(c) A higher sulfur content fuel may be utilized, but only where air pollution controls limit sulfur dioxide emissions to the amount that the specified fuels alone would result in and only after this has been specifically allowed and detailed as conditions on the operating permits. A stack test must be submitted to verify the effectiveness of the controls.

(d) For any process emission source in which fuel is burned and a standard is presently stipulated in paragraph 1200-03-19-.19(1) of these regulations then such source shall not be limited in the sulfur content of fuel provided such source meets process standards contained in Rule 1200-03-19-.19.

(e) (Reserved)

(f) The owner or operator of an air contaminant source with restricted operating hours must maintain a daily log of operating hours and keep it available for inspection by Division personnel on request for at least one year after the end of any calendar year included in the log. The owner or operator shall submit by letter on or before January 31 of each year the total hours or operation for the previous calendar year and/or the maximum daily operation for said calendar year.

History

• Authority: T.C.A. §§ 4-5-202, et seq. and 68-25-105.
• Administrative History: Original rule filed May 7, 1979; effective June 21, 1979. Amendment filed June 16, 1981; effective July 31, 1981. Amendment filed September 22, 1988; effective November 6, 1988. Amendment filed November 30, 1996.

Chapter 1200-03-20 Limits on Emissions Due to Malfunctions, Startups, and Shutdowns

Tenn. Comp. R. & Regs. 1200-03-20-.01 PURPOSE

(1) The purpose of this chapter is to place reasonable limits on the amount of emissions an air contaminant source can emit due to a malfunction or during startup or shutdown of said source. Without such limits in many parts of the state and specifically in nonattainment areas, air quality standards will not be met and public health and welfare will be endangered.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed February 5, 1979; effective March 21, 1979. Repeal and new rule filed July 13, 1994; effective September 26, 1994.

Tenn. Comp. R. & Regs. 1200-03-20-.02 REASONABLE MEASURES REQUIRED

(1) Air contaminant sources must take all reasonable measures to keep emissions to a minimum during startups, shutdowns, and malfunctions. These measures may include installation and use of alternate control systems, changes in operating methods or procedures, cessation of operation until the process equipment and/or air pollution control equipment is repaired, maintaining sufficient spare parts, use of overtime labor, use of outside consultants and contractors, and other appropriate means. Failures that are caused by poor maintenance, careless operation or any other preventable upset condition or preventable equipment breakdown shall not be considered malfunctions.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed February 5, 1979; effective March 21, 1979. Amendment filed September 22, 1988; effective November 6, 1988. Repeal and new rule filed July 13, 1994; effective September 26, 1994. Amendment filed August 28, 1997; effective November 11, 1997.

Tenn. Comp. R. & Regs. 1200-03-20-.03 NOTICE REQUIRED WHEN MALFUNCTION OCCURS

(1) When any air contaminant source malfunctions in such a manner as to cause the emission of air contaminants in excess of the applicable emission standards contained in Division 1200- 03, Division 0400-30, or any permit issued thereto, or of sufficient duration to cause damage to property or public health, the owner or operator of the air contaminant source shall promptly notify the Technical Secretary of such malfunction and provide a statement giving all pertinent facts, including the estimated duration of the malfunction. Violations of the visible emission standard (excluding visible emissions caused by hazardous air pollutants named in

Chapter 0400-30-38) which occur for less than 20 minutes in one day (midnight to midnight) need not be reported. Prompt notification will be within 24 hours of the malfunction and shall be provided by telephone to the Division’s Nashville office. The Technical Secretary shall be notified when the malfunction has been corrected. In attainment and unclassified areas, if emissions other than from sources designated as significantly impacting on a nonattainment area in excess of the standards will not and do not occur over more than a 24-hour period (or will not recur over more than a 24-hour period) and no damage to property and or public health is anticipated, notification is not required. Any malfunction that creates an imminent hazard to health must be reported by telephone immediately to the Division’s Nashville office and to the State Civil Defense.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed February 5, 1979; effective March 21, 1979. Amendment filed September 4, 1981; effective October 19, 1981. Repeal and new rule filed July 13, 1994; effective September 26, 1994. Amendments filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-20-.04 LOGS AND REPORTS

(1) (a) A log of all malfunctions, startups, and shutdowns resulting in emissions excess of the standards in Division 1200-03 or any permit issued thereto must be kept at the plant.

This log must record at least the following:

1. Stack or emission point involved.

2. Time malfunction, startup, or shutdown began and/or when first noticed.

3. Type of malfunction and/or reason for shutdown.

4. Time startup or shutdown was complete or time the air contaminant source returned to normal operation.

5. The company employee making entry on the log must sign, date, and indicate the time of each log entry.

(b) The information under parts (a)1. and 2. of this paragraph must be entered into the log by the end of the shift during which the malfunction or startup began.

(c) All information shall be entered in the log no later than twenty-four (24) hours after the startup or shutdown is complete, or the malfunction has ceased or has been corrected.

(d) Any later discovered corrections can be added in the log as footnotes with the reason given for the change.

(2) Reserved.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed February 5, 1979; effective March 21, 1979. Amendment filed September 22, 1988; effective November 6, 1988. Repeal and new rule filed July 13, 1994; effective September 26, 1994. Amendment filed March 21, 2013; effective June 19, 2013.

Tenn. Comp. R. & Regs. 1200-03-20-.05 COPIES OF LOG REQUIRED

The Technical Secretary may require the owner or operator of any air contaminant source to submit a copy of the upset log required under rule .04 of this chapter to him ten (10) days after the request is received. The Technical Secretary can require submission of copies of the entire log.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed February 5, 1979; effective March 21, 1979. Repeal and new rule filed July 13, 1994; effective September 26, 1994.

Tenn. Comp. R. & Regs. 1200-03-20-.06 REPORT REQUIRED UPON THE ISSUANCE OF A NOTICE OF VIOLATION

(1) In the event excess emissions are emitted from any air contaminant source, a notice of violation shall automatically be issued except for visible emission levels included as a startup and/or shutdown permit condition under Paragraph 1200-03-05-.02(1) or determined to be de minimis under Rule 1200-03-20-.06.

(2) The owner or operator of the violating air contaminant source shall submit within twenty (20) days after receipt of the notice of violation, the data required in paragraph (3) of this rule. If the data required in paragraph (3) of this rule has previously been available to the Technical Secretary or the Technical Secretary’s representative prior to the issuance of the notice of violation no further action is required of the violating source. However, if the owner or operator of the source desires to submit additional information, then the additional information must be submitted within the twenty (20) day time period.

(3) Each report required in paragraph 1200-03-20-.06(2) shall include as a minimum:

(a) The identity of the stack and/or other emission point where the excess emission(s) occurred;

(b) The magnitude of the excess emissions expressed in pounds per hour and the units of the applicable emission limitation and the operating data and calculations used in determining the magnitude of the excess emissions;

(c) The time and duration of the emissions;

(d) The nature and cause of such emissions;

(e) For malfunctions. The steps taken to correct the situation and the action taken or planned to prevent the recurrence of such malfunctions;

(f) The steps taken to limit the excess emissions during the occurrence reported, and (g) If applicable, documentation that the air pollution control equipment, process equipment, or processes were at all times maintained and operated in a manner consistent with good operating practices for minimizing emissions.

(4) Failure to submit the report required in paragraph (3) of this rule within the twenty (20) day period specified in paragraph (2) of this rule shall preclude the admissibility of the data for determination of potential enforcement actions.

(5) Where the violations are determined from properly certified and operated continuous emission monitors, no notice of violation(s) will be automatically issued unless the specified de minimis levels are exceeded:

Source Type De Minimis Pollutant Monitored De Minimis Level (a) Fuel Burning Installations subject to

Rule 1200-03-05-.01 or

Rule 1200-03-05-.05 and having fuel burning equipment of input capacity greater than Opacity Two percent of the time during calendar quarter (Excluding periods of permitted startup or shutdown and excused malfunctions) so long as no more than one 24-hour exceedance per calendar year takes place. 600 x 106 Btu/hr.

Sulfur Dioxide One 24-hour exceedance per calendar year.

(b) Fuel Burning Installations subject to

Rule 1200-03-05-.05,

Rule 1200-03-05-.10, or Rule 1200-30-06- .05.

Opacity One percent of the time during a calendar quarter (Excluding period of permitted startup or shutdown and excused malfunctions) as long as no more than one 24-hour exceedance per calendar year takes place.

(c) Fuel Burning Equipment subject to

part (1)(b)11. of Rule

Tenn. Comp. R. & Regs. 0400-30-39-.01 .

Opacity One half percent of the time during a calendar quarter (Excluding time periods of startup, shutdown, or excused malfunction).

(l) Any source type utilizing a thirty day rolling average.

Nitrogen Oxides None. (Excluding periods of startup, shutdown, or excused malfunction.)

For purposes of this paragraph, the term 24-hour exceedance means a continuous exceedance of an emission standard having a total duration of greater than 24 hours (midnight to midnight).

(6) No emission during periods of malfunction, start-up, or shutdown that is in excess of the standards in Division 1200-03 or any permit issued thereto shall be allowed which can be proved to cause or contribute to any violations of the Ambient Air Quality Standards contained in Chapter 1200-03-03 or the National Ambient Air Quality Standards.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed February 5, 1979; effective March 21, 1979. Amendment filed October 28, 1981; effective December 14, 1981. Repeal and new rule filed July 13, 1994; effective September 26, 1994. Amendments filed August 18, 2016; effective November 16, 2016. Amendments filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-07-.07 .

Total Reduced Sulfur Two percent of the time during a calendar quarter (Excluding periods of permitted startup or shutdown and excused malfunctions).

(g) Sulfuric Acid Plants subject to part (1)(b)22. of Rule 0400-30-39-.01 and Liquid Sulfur Dioxide Plants subject to Rule 1200-03-19- .19.

Sulfur Dioxide One exceedance greater than three hours duration per year (Excluding periods of excused malfunctions).

(h) Primary Zinc Smelters subject to part (1)(b)35. of Rule 0400-30-39- Sulfur Dioxide One exceedance of greater than three hours duration but less than 24-hour duration per calendar year .01. and/or one 24-hour exceedance per year (Excluding periods of startup, shutdown, or excused malfunction).

(i) Electric Arc Furnaces subject to part (1)(b)45. of Rule 0400-30-39-.01 or part (1)(b)46. of Rule

Tenn. Comp. R. & Regs. 1200-03-20-.07 SPECIAL REPORTS REQUIRED

(1) The Technical Secretary may require any air contaminant source to submit a report within thirty (30) days after the end of each calendar quarter in a format he specifies containing as a minimum the following information:

(a) The dates on which malfunctions, startups, and shutdowns resulted in emissions greater than those allowed by the emission standards in this Division 1200-03.

(b) The estimated amount of air contaminants emitted in excess of the emission standards in units of pounds of air contaminant per hour and pounds of air contaminant per day.

(c) Other emission characteristics such as stack exit temperature, stack height and diameter, stack exit velocities, and other similar information.

(d) Information needed to evaluate the possibility of instituting measures to eliminate or reduce the number of malfunctions and/or the amount of emissions from malfunctions, startups, and shut downs.

(e) Information to determine if the excess emissions truly result from a malfunction.

(f) Information to evaluate the impact of the emissions on the surrounding area.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed February 5, 1979; effective March 21, 1979. Amendment filed October 28, 1981; effective December 14, 1981. Amendment filed September 22, 1988; effective November 6, 1988. Repeal and new rule filed July 13, 1994; effective September 26, 1994.

Tenn. Comp. R. & Regs. 1200-03-20-.08 RIGHTS RESERVED

(1) Nothing in this chapter shall be construed to limit the obligation of the air contaminant source to attain and maintain the ambient air quality standards nor the authority of the Technical Secretary and/or Board to institute actions under other Chapters of these rules and the Tennessee Air Quality Act.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed February 5, 1979; effective March 21, 1979. Repeal and new rule filed July 13, 1994; effective September 26, 1994.

Tenn. Comp. R. & Regs. 1200-03-20-.09 ADDITIONAL SOURCES COVERED

(1) The Technical Secretary may order the owner or operator of other air contaminant sources to report in accordance with the requirement of this chapter for those sources in nonattainment areas or significantly impacting on nonattainment areas when he has reason to believe that an ambient air quality standard may be violated in the general vicinity where the source is located. There is sufficient reason (for purposes of this rule) to believe a standard may be violated if a value not to be exceeded more than once in a year is equalled or exceeded once and/or if individual readings have a mean excess of ninety percent of a standard set for any given averaging interval regardless of the acceptability of the monitoring site, calibration of the monitor, and other similar matters. Even if there are no monitors in an area, if mathematical modelling and/or physical damage in the area indicate the standards may be violated, he may order such reporting.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed February 5, 1979; effective March 21, 1979. Repeal and new rule filed July 13, 1994; effective September 26, 1994.

Chapter 1200-03-21 General Alternate Emission Standards

Tenn. Comp. R. & Regs. 1200-03-21-.01 GENERAL ALTERNATE EMISSION STANDARD

(1) In lieu of satisfying the standards and requirements of other chapters of this division, air contaminant sources with a certificate of alternate control shall not emit particulate matter, sulfur dioxide, carbon monoxide, nitrogen dioxide or volatile organic compounds in excess of the respective limits on said certificate. Air contaminant sources applying for a certificate of alternate control shall not be considered a modification under Rule 1200-03-02-.01(aa) provided the rated capacity in terms of heat input, charging rate, or process weight does not change for any fuel burning installation, incinerator, or process emission source respectively.

(2) The owner or operator of any air contaminant source that discharges particulate matter, sulfur dioxide, carbon monoxide, nitrogen dioxide, or volatile organic compounds regulated by other rules in these regulations can apply to the Technical Secretary for a Certificate of Alternate Control for an air contaminant source(s) or a portion of an air contaminant source(s), and he may grant the request if the following conditions are met:

(a) The air contaminant source or portion thereof is reducing or will be after a specific date taking actions to reduce emissions of particulate matter, sulfur dioxide, carbon monoxide, nitrogen dioxide or volatile organic compounds at least as much as required under other rules of these regulations even though affected specific source(s) (i.e. permit unit) at the air contaminant source may not be meeting the mass emission standard(s) specified in the other rules of these regulations. Calculations to determine equivalence to standards limiting the pounds of volatile organic compounds per gallon of material shall be on the basis of equivalent solids applied. Under the conditions of the certificate, the total final emission limits of each given pollutant must be equivalent or less for each pollutant than under otherwise applicable rules. These limits shall include limits applied in pounds per hour, or if hourly emissions cannot be determined, per as short a period over which emissions can be determined, and in tons per year for the entire air contaminant source.

(b) If a schedule of compliance is required, it must be included as a condition on the certificate. In no case shall the final compliance data be beyond a date that would cause interference with the attainment of the Reasonable Further Progress line specified for a specific nonattainment area.

(c) The air contaminant source shall verify through modeling, consistent with the requirements specified in 40 CFR Part 51 Appendix W, that this alternate emission standard will yield equivalent or improved air quality for the pollutant involved. The provisions of 40 CFR Part 51 Appendix W are hereby adopted by reference as published in the July 1, 2019 edition of the Code of Federal Regulations (CFR). For volatile organic compound emissions, modeling for ozone impacts may be required. Air quality need not improve or stay the same at every location affected by the alternate emission standard, but on balance, the air quality of the affected area must not be adversely affected. This will be demonstrated by modeling all included emission points at the proposed alternative levels and at the allowable emission level for sources subject to emissions standards in Chapter 1200-03-19 for the pollutant involved. The lower of either the allowable emission under other chapters in Division 1200-03 or actual emissions shall be used in all other modeling. In addition, the source shall demonstrate that the use of the alternate emission standard will not interfere with the attainment or maintenance of any ambient air quality standard nor violate any applicable ambient air quality standard nor violate any applicable ambient air increment.

(d) The pollutants involved in the alternate emission standard must be comparable emissions, and no interpollutant trades are allowed. Air contaminant sources subject to the standards in Chapter 0400-30-38 cannot apply the alternate emission standard to hazardous air contaminants. Air contaminant sources subject to emission standards in

Chapter 0400-30-39 or paragraph (4) of Rule 1200-03-09-.01 or subparagraph (5)(b) of

Rule 1200-03-09-.01 cannot use an alternate emission standard, except for reductions in actual emissions below the level required in these rules. Such reduction may be used as credit for existing source. However, all applicable standards and requirements established under paragraph (4) of Rule 1200-03-09-.01, under Chapters 0400-30-38 and 0400-30-39, and according to a lowest-achievement-emission-rate (LAER) determination under paragraph (5) of Rule 1200-03-09-.01 must be complied with and are not superseded or replaced by the alternate emission standard.

(e) A fee of one thousand dollars ($1,000.00) for each pollutant for each source to be covered by a certificate has been paid to the Department at the time the application is made to cover the cost of review of the request for the certificate of alternate control.

(f) Air contaminant sources utilizing the alternate emission standards: (1) must be in compliance with all applicable emission limits; (2) if not in compliance, must be meeting the requirements in an approved compliance schedule; or (3) if not in compliance, must be subject to a court order which includes a compliance schedule and allows for timely modification of the decree without delaying the final compliance date. Under no circumstances can the alternate emission standard delay or defer a specified compliance date nor shall the certificate insulate the source from any penalties or sanctions for noncompliance or affect the source’s liability to comply with any regulations, order, or compliance plan.

(g) The provisions of the Emission Trading Policy Statement, Federal Register, Vol. 51, No. 233, December 4, 1986, are being satisfied.

(3) The alternate emission standards and certificate conditions must be subjected to a public hearing and submitted to the EPA for approval as a revision to the State Implementation Plan. The owner or operator requesting this alternate emission control emission standard shall be responsible for all costs associated with publishing the required legal notices.

(4) Good engineering practice stack heights shall be utilized on all stack changes associated with the alternate control standards for particulate matter, sulfur dioxide, carbon monoxide, and nitrogen dioxide.

(5) The owner or operator of the facility must:

(a) Post or file on the operating premises a copy of the certificate of alternative control.

(b) Keep all pollution control equipment in good operating condition and utilize said equipment at all times.

(6) The certificate of alternate control will be revoked after administrative hearing by the Technical Secretary or the Board if it is found that any of the requirements of paragraph (2) have been violated and/or if any of the requirements of paragraph (5) have been frequently and flagrantly violated after the certificate was issued and/or if violation of the requirements of paragraph (4) and/or conditions placed on their certificate under paragraph (9) are not corrected promptly on written notice.

(7) The certificate of alternate control does not relieve the owner or operator of the duty of meeting all emission requirements in other rules for sources commenced after the effective date of the rule.

(8) Upon revocation of the certificate of alternative control, the sources at the facility must comply with other rules in these regulations that would have been applicable had the certificate not been issued.

(9) The Technical Secretary shall specify the new emission limits as conditions on the certificate and if other than reference test methods are to be used to determine compliance, these should be specified on the certificate or the operating permit. Other conditions needed to insure and verify compliance may be placed on the certificate as conditions.

(10) The owner and operator is hereby placed on notice that the certificate shall become void should the Board find it proper to amend the regulations covering any source listed on the certificate if the effect is to reduce the allowable emission of the source. The certificate in this instance shall be deemed void ninety (90) days after receipt of notice from the Technical Secretary of the effective date of the revised regulations.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed July 25, 1980; effective September 8, 1980. Amendment filed February 4, 1993; effective March 18, 1993. Amendments filed January 22, 2021; effective April 22, 2021. Amendments filed September 29, 2022; effective December 28, 2022. Amendments filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-21-.02 APPLICABILITY

This chapter applies only to those air contaminant sources which apply for a certificate of alternate control or a revision to a certificate of alternate control after March 18, 1993.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed February 4, 1993; effective March 18, 1993.

Chapter 1200-03-22 Lead Emission Standards

Tenn. Comp. R. & Regs. 1200-03-22-.01 DEFINITIONS

Unless specifically defined in this Chapter, the definitions from Chapter 1200-03-02 will apply:

(1) “Significant source of lead” means:

(a) Any one permit unit, or combination of permit units as determined by the Technical Secretary, at any of the following stationary sources that emit lead or lead compounds (measured as elemental lead) of at least 1.25 tons per calendar quarter or at least five (5) tons per year whichever is the more restrictive: primary lead smelters, secondary lead smelters, primary copper smelters, lead gasoline additive plants, lead-acid storage battery manufacturing plants that produce 2000 or more batteries per day.

(b) Notwithstanding the source sizes specified in subparagraph (a) of this paragraph, any other stationary source that emits 25 or more tons per year of lead or lead compounds measured as elemental lead.

(2) “Source” means any structure, building, facility, equipment, installation, or operation (or combination thereof) which is located on one or more contiguous or adjacent properties and which is owned or operated by the same person (or by persons under common control). If a portion(s) of a source is rented to or leased to another person(s) for the purpose of a totally separate business venture, the Technical Secretary may designate that (those) portion(s) as a separate source(s).

(3) “Permit unit” means any part of a source required to obtain an operating permit as determined by the Technical Secretary.

(4) “Lead point source” means:

(a) Any source the actual emissions of which are in excess of 5.0 tons per year of lead or lead compounds measured as elemental lead.

(b) Any physical change that would occur at a source not otherwise qualifying under subparagraph (4)(a) as a lead point source if the increase in lead emissions due to a change is in excess of 5.0 tons per year of lead or lead compounds measured as elemental lead.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-25-105.
• Administrative History: Original rule filed November 5, 1984; effective December 5, 1984. Amendment filed September 22, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-22-.02 GENERAL LEAD EMISSION STANDARDS

(1) No person shall cause, suffer, allow, or permit lead emissions in excess of the standards in this Chapter.

(2) Upon mutual agreement of the owner or operator of a significant source of lead and the Technical Secretary, an emission limit more restrictive than that otherwise specified in this

Chapter may be established. Also, upon mutual agreement of the owner or operator of any source and the Technical Secretary, operating hours, process flow rates, or any other operating parameters may be established as a binding limit(s). The mutually acceptable limits shall be stated as a special condition(s) for any permit or order concerning the source.

Violation of any accepted special limitations is grounds for revocation of the issued permit and/or other enforcement measures provided for in the Tennessee Air Quality Act.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-25-105.
• Administrative History: Original rule filed November 5, 1984; effective December 5, 1984.

Tenn. Comp. R. & Regs. 1200-03-22-.03 SPECIFIC EMISSION STANDARDS FOR EXISTING SOURCES OF LEAD

(1) For an existing source that is a significant source of lead, the Technical Secretary shall specify on the operating permit(s) as permit conditions the emission level that is reasonably available control technology (RACT). The RACT emission level specified as permit conditions on the operating permit (s) must be submitted, reviewed and approved by the Administrator of the Environmental Protection Agency or his designee.

(2) The possession of a valid permit shall not protect the source from enforcement actions if permit condition(s) are not met.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-25-105.
• Administrative History: Original rule filed November 5, 1984; effective December 5, 1984. Amendment filed November 12, 1999; effective January 26, 2000.

Tenn. Comp. R. & Regs. 1200-03-22-.04 STANDARDS FOR NEW OR MODIFIED SOURCES OF LEAD

(1) A new source the actual emissions of which are in excess of 5.0 tons per year of lead or lead compounds measured as elemental lead shall utilize best available control technology (BACT).

(2) Any modification of a lead point source which results in an increase in excess of 0.6 tons per year of lead or lead compounds measured as elemental lead shall utilize BACT.

(3) The owner or operator of a proposed new or modified source of lead shall perform a source impact analysis to demonstrate that the allowable emission increases from the proposed source or modification would not cause or contribute to a violation of the lead ambient air quality standard in the source impact area including background concentrations. Source impact analysis shall be based on the applicable air quality models and data bases acceptable to the Technical Secretary.

(4) Additional requirements for certain new or modified sources of lead are given in paragraph (4) of Rule 1200-03-09-.01 and in Chapter 0400-30-39.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed November 5, 1984; effective December 5, 1984. Amendment filed September 22, 1988; effective November 6, 1988. Amendments filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-22-.05 SOURCE SAMPLING AND ANALYSIS

Source sampling and analysis for lead shall be conducted in the manner prescribed in Subparagraph 1200-03-12-.03(1)(j) of these regulations.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-25-105.
• Administrative History: Original rule filed November 5, 1984; effective December 5, 1984.

Tenn. Comp. R. & Regs. 1200-03-22-.06 LEAD AMBIENT MONITORING REQUIREMENTS

The Technical Secretary may require ambient lead monitoring in the vicinity of a source regulated by this

Chapter 1200-03-22. This monitoring shall be done in accordance with the requirements of Rule 1200-03- 12-.02 of these regulations.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-25-105.
• Administrative History: Original rule filed November 5, 1984; effective December 5, 1984.

Chapter 1200-03-23 Visibility Protection

Tenn. Comp. R. & Regs. 1200-03-23-.01 PURPOSE

The purpose of this Chapter is to assure reasonable progress toward meeting the goal of preventing any future, and remedying any existing impairment of visibility in mandatory Class I Federal areas in which impairment results from man-made air pollution.

History

• Authority: T.C.A. §§ 4-5-201, et seq. and 68-25-105.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-23-.02 DEFINITIONS

Unless specifically defined in this Chapter, the definitions from Chapter 1200-03-02 and Paragraph 1200- 03-09-.01(4) shall apply:

(1) “Best Available Retrofit Technology (BART)” means an emission limitation based on the degree of reduction achievable through the application of the best system of continuous emission reduction for each pollutant which is emitted by an existing stationary facility. The emission limitation must be established, on a case-by-case basis, taking into consideration the technology available, the costs of compliance, the energy and nonair quality environmental impacts of compliance, any pollution control equipment in use or in existence at the source, the remaining useful life of the source, and the degree of improvement in visibility which may reasonably be anticipated to result from the use of such technology.

(2) “Existing Stationary Facility” means any of the following stationary sources of air pollutants, including any reconstructed source, which was not in operation prior to August 7, 1962, and was in existence on August 7, 1977, and has the potential to emit 250 tons per year or more of any air pollutant. In determining the potential to emit, fugitive emissions must be counted, to the extent quantifiable.

(a) Fossil fuel fired steam electric plants of more than 250 million British thermal units per hour heat input.

(b) Coal cleaning plants (thermal dryers), (c) Kraft pulp mills, (d) Portland cement plants, (e) Primary zinc smelters, (f) Iron and steel mill plants, (g) Primary aluminum ore reduction plants, (h) Primary copper smelters, (i) Municipal incinerators capable of charging more than 250 tons of refuse per day, (j) Hydrofluoric, sulfuric, and nitric acid plants, (k) Petroleum refineries, (l) Lime plants, (m) Phosphate rock processing plants, (n) Coke oven batteries, (o) Sulfur recovery plants, (p) Carbon black plants (furnace process), (q) Primary lead smelters, (r) Fuel conversion plants, (s) Sintering plants, (t) Secondary metal production facilities, (u) Chemical process plants, (v) Fossil-fuel boilers of more than 250 million British thermal units per hour heat input, (w) Petroleum storage and transfer facilities with a capacity exceeding 300,000 barrels, (x) Taconite ore processing facilities, (y) Glass fiber processing plants, and (z) Charcoal production facilities.

(3) “Federal Class I area” means any Federal land that is classified or reclassified “Class I”.

(4) “Fixed Capital Cost” means the capital needed to provide all of the depreciable components.

(5) “In existence’ means that the owner or operator has obtained all necessary preconstruction approvals or permits required by this Division and either has (1) begun, or caused to begin, a continuous program of physical on-site construction of the facility or (2) entered into binding agreements or contractual obligations, which cannot be canceled or modified without substantial loss to the owner or operator, to undertake a program of construction of the facility to be completed in a reasonable time.

(6) “In operation” means engaged in activity related to the primary design function of the source.

(7) “Mandatory Class I Federal area” means any area identified by the Administrator of the EPA, including the Great Smoky Mountains National Park, the Joyce Kilmer - Slickrock National Wilderness Area, the Linville Gorge Wilderness Area, Cohutta Wilderness Area, Shining Rock Wilderness Area, Sipsey Wilderness Area, the Mingo National Wilderness Area, and the Mammoth Cave National Park including any integral vista associated with these areas.

(8) “Natural Conditions” includes naturally occurring phenomena that reduce visibility as measured in terms of visual range, contrast, or coloration.

(9) “Reconstruction” will be presumed to have taken place where the fixed “capital cost of the new component exceeds 50 percent of the taxed capital cost of a comparable entirely new source. Any final decision as to whether reconstruction has occurred must be made in accordance with the requirements of 40 CFR Part 60.15, Standards of Performance for New Stationary Sources” (dated July 1, 1993.)

(10) “Visibility Impairment” means any humanly perceptible change in visibility (visual range, contrast, coloration) from that which would have existed under natural conditions.

(11) “Significant Impairment” means visibility impairment which, in the judgment of the Technical Secretary, interferes with the management, protection, preservation, or enjoyment of the visitor’s visual experience of the mandatory Class I Federal area. This determination must be made on a case-by-case basis taking into account the geographic extent, intensity, duration, frequency, and time of the visibility impairment, and how these factors correlate with times of visitor use of the mandatory Class I Federal area, and the frequency and timing of natural conditions that reduce visibility.

(12) “Integral vista” means a view perceived from within the mandatory Class I Federal area of a specific landmark or panorama located outside the boundary of the mandatory Class I Federal area.

(13) “Continuous program of physical on-site construction” means significant and continuous site preparation work such as major clearing or excavation followed by placement of footings, pilings, and other materials of construction, assembly, or installation of unique facilities or equipment at the site of the source.

(14) “Substantial loss” generally means a loss which would equal or exceed 10 percent of the total project cost.

(15) “Adverse impact on visibility” means, for purposes of 1200-03-23, visibility impairment which interferes with management, protection, preservation, or enjoyment of the visitor’s visual experience of the Federal Class I area. This determination must be made on a case-by-case

basis taking into account the geographic extent, intensity, duration, frequency and time of visibility impairments, and how these factors correlate with:

(a) Times of visitor use of the Federal Class I area, and (b) The frequency and timing of natural conditions that reduce visibility. This term does not include integral vistas.

(16) “Pollutant” means, for this Rule, for particulate matter, the standards expressed in 1200-03- 03, Table I which are attained when the expected number of days per calendar year with a 24-hour average concentration above 150 mg/m as determined in accordance with 40 CFR 50 Appendix K (July 1, 1993), is equal to or less than one.

(17) “Reasonably attributable” means attributable by visual observation or any other technique the Technical Secretary deems appropriate.

History

• Authority: T.C.A. §§ 4-5-201, et seq. and 68-25-105.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Amendment filed May 10, 1994; effective July 24, 1994.

Tenn. Comp. R. & Regs. 1200-03-23-.03 GENERAL VISIBILITY PROTECTION STANDARDS

(1) No person shall cause, suffer, allow, or permit emissions in excess of the standards in this

Chapter.

(2) Upon mutual agreement of the owner or operator of a source and the Technical Secretary, an emission limitation more restrictive than that otherwise specified in this Chapter may be established. Also, upon mutual agreement of the owner or operator of any source and the Technical Secretary, operating hours, process flow rates, or any other operating parameters may be established as a binding limit(s). The mutually acceptable limits shall be stated as a special condition(s) for any permit or order concerning the source. Violation of any accepted special limitations is grounds for revocation of the issued permit and/or other enforcement measures provided for in the Tennessee” Air Quality Act.

(3) The possession of a valid permit shall not protect the source from enforcement actions if permit conditions are not met.

History

• Authority: T.C.A. §§ 4-5-201, et seq. and 68-25-103.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-23-.04 SPECIFIC EMISSION STANDARDS FOR EXISTING STATIONARY FACILITIES

For an existing stationary facility that causes visibility impairment in any mandatory Class I Federal area, the Technical Secretary shall specify on the operating permit(s) as permit conditions the emission limitation that is “best available retrofit technology (BART)”, subject to the following provisions:

(1) Best available retrofit technology (BART) must be determined for fossil-fuel fired generating lants having a total generating capacity in excess of 750 megawatts pursuant to “Guidelines for Determining Best Available Retrofit Technology for Coal-fired Power Plants and Other Stationary Facilities” (1980).

(2) Each existing stationary facility is required to install and operate BART as expeditiously as practicable but in no case later than five years after July 24, 1994.

(3) A BART analysis will be provided for any existing stationary facility that might cause or contribute to impairment of visibility in any mandatory Class I Federal area at such times, as determined by the EPA, as new technology for control of the pollutant becomes reasonably available and if:

(a) The pollutant is emitted by that existing stationary facility:

(b) Controls representing BART for the pollutant have not previously been required under this rules; and (c) The impairment of visibility in any mandatory Class I Federal area is reasonably attributable to the emissions of that pollutant.

History

• Authority: T.C.A. §§ 4-5-201, et seq. and 68-25-105.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Amendment filed May 10, 1994; effective July 24, 1994.

Tenn. Comp. R. & Regs. 1200-03-23-.05 SPECIFIC EMISSION STANDARDS FOR EXISTING SOURCES

For any existing source that causes visibility impairment in any mandatory Class I Federal area, the Technical Secretary may specify on the construction and/or operating permit(s) as permit conditions an emission limitation that is equivalent to “BART”. Existing sources subject to the provisions of rule .04 are not subject to the provisions of this Rule ( 1200-03-23-.05).

History

• Authority: T.C.A. §§ 4-5-201, et seq. and 68-25-105.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Amendment filed May 10, 1994; effective July 24, 1994.

Tenn. Comp. R. & Regs. 1200-03-23-.06 VISIBILITY STANDARDS FOR NEW AND MODIFIED SOURCES

(1) A new “major stationary source” or a “major modification” constructing in an attainment area or unclassifiable area must meet the requirements in Paragraph 1200-03-09-.01(4), Prevention of Significant Deterioration.

(2) A new “major stationary source” or a “major modification” constructing in a nonattainment area must meet the requirements in Parts 1200-03-09-.01(5)(b)3. and 4.

(3) For any new source or modification whose air contaminant emissions may cause visibility impairment in a mandatory Class I Federal area, the Technical Secretary may require “best available control technology (BACT)”.

History

• Authority: T.C.A. §§ 4-5-201, et seq. and 68-25-105.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-23-.07 VISIBILITY MONITORING REQUIREMENTS

The Technical Secretary may require visibility monitoring in the vicinity of a source regulated by this

Chapter 1200-03-23. This monitoring shall be done in accordance with the requirements as specified by the Technical Secretary.

History

• Authority: T.C.A. §§68-25-103 and 4-5-201 et. seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988.

Tenn. Comp. R. & Regs. 1200-03-23-.08 EXEMPTIONS FROM BART REQUIREMENTS

(1) Any existing stationary facility subject to the requirement of this chapter to install, operate, and maintain BART may apply to the Administrator of the EPA through the Technical Secretary for an exemption from that requirement.

(2) An application under this rule must include all available documentation relevant to the impact of the source’s emissions on visibility in any mandatory Class I Federal area and a demonstration by the existing stationary facility that it does not or will not, by itself or in combination with other sources, emit any air pollutant which may be reasonably anticipated to cause or contribute to a significant impairment of visibility in any mandatory Class I Federal area.

(3) Any fossil-fuel fired power plant with a total generating capacity of 750 megawatts or more may receive an exemption from BART only if the owner or operator of such power plant demonstrates to the satisfaction of the Technical Secretary that such power plant is located at such a distance from all mandatory Class I Federal areas that such power plant does not or will not, by itself or in combination with other sources, emit any air pollutant which may reasonably be anticipated to cause or contribute to significant impairment of visibility in any such mandatory Class I Federal area.

(4) The existing stationary facility must give prior written notice to all affected Federal Land Managers of any application for exemption under this rule.

(5) The Federal Land Manager may provide an initial recommendation or comment on the disposition of such application. Such recommendation, where provided, must be part of the exemption application. This recommendation is not to be construed as the concurrence required under Paragraph (6) below.

(6) The Technical Secretary within 90 days of receipt of an application for exemption from control, will provide notice of receipt of an exemption application and notice of opportunity for public hearing on the application. After notice and opportunity for public hearing, the Technical Secretary may concur with the application for exemption. If the Technical Secretary concurs, the application for exemption accompanied by the Technical Secretary’s written concurrence will be forwarded to the Administrator of the EPA who will grant or deny the exemption. An exemption granted by the Administrator of the EPA will be effective only upon concurrence by all affected Federal Land Managers with the Administrator of the EPA’s determination.

History

• Authority: T.C.A. §§ 4-5-201, et seq. and 68-25-105.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Amendment filed May 10, 1994; effective July 24, 1994.

Chapter 1200-03-24 Good Engineering Practice Stack Height Regulations

Tenn. Comp. R. & Regs. 1200-03-24-.01 GENERAL PROVISIONS

(1)This chapter provides that the degree of emission limitation required of any source for control of any air pollutant must not be affected by that portion of any source’s stack height that exceeds good engineering practice (GEP) or by any other dispersion technique, except as provided in (a) and (b) of paragraph (2) of this rule. A source may want to establish an emission limitation based on the good engineering practice stack height demonstrated by a fluid model or field study. If the source demonstrates the good engineering practice stack height by a fluid model or a field study, the Technical Secretary must notify the public of the availability of the demonstration study and must provide opportunity for a public hearing on it. This chapter does not restrict in any manner the actual stack height of any source.

(2)The provisions of this chapter shall not apply to:

(a)Stack heights in existence, or dispersion techniques implemented on or before December 31, 1970, except where pollutants are being emitted from such stacks or using such dispersion techniques by stationary sources which were constructed, or reconstructed, or for which major modifications, as defined in 1200-3-9-.01(4)(b)2. and; 1200-3-9-.01(4)(b)2.(i)(I) and were carried out after December 31, 1970; or (b)Coal-fired steam electric generating units which commenced operation before July 1, 1957, and whose stacks were constructed under a construction contract awarded before February 8, 1974.

History

• Authority: T.C.A. §§4-5-202 and 68-25-101 et. seq.
• Administrative History: Original rule filed October 8, 1987; effective November 22, 1987.

Tenn. Comp. R. & Regs. 1200-03-24-.02 DEFINITIONS

(1)Within the context of this chapter the following definitions apply:

(a)Dispersion Technique means any technique which attempts to affect the concentration of a pollutant in the ambient air by: 1.Using that portion of a stack which exceeds good engineering practice stack height; 2.Varying the rate of emission of a pollutant according to atmospheric conditions or ambient concentrations of that pollutant; or 3.Increasing final exhaust gas plume rise by manipulating source process parameters, exhaust gas parameters, stack parameters, or combining exhaust gases from several existing stacks into one stack; or other selective handling of exhaust gas streams so as to increase the exhaust gas plume rise.

(i)The preceding sentence does not include:

(I)The reheating of a gas stream, following use of a pollution control system, for the purpose of returning the gas to the temperature at which it was originally discharged from the facility generating the gas stream;

(II)The merging of exhaust gas streams where:

I.The source owner or operator demonstrates that the facility was originally designed and constructed with such merged gas streams;

II.After July 8, 1985, such merging is part of a change in operation at the facility that includes the installation of pollution controls and is accompanied by a net reduction in the allowable emissions of a pollutant. This exclusion from the definition of dispersion techniques shall apply only to the emission limitation for the pollutant affected by such change in operation; or III.Before July 8, 1985, such merging was part of a change in operation at the facility that included the installation of emissions control equipment or was carried out for sound economic or engineering reasons. Where there was an increase in the emissions limitation or, in the event that no emission limitation was in existence prior to the merging, an increase in the quantity of pollutants actually emitted prior to the merging, the Technical Secretary shall presume that merging was significantly motivated by an intent to gain emissions credit for greater dispersion. Absent a demonstration by the source owner or operator that merging was not significantly motivated by such intent, the Technical Secretary shall deny credit for the effects of such merging in calculating the allowable emissions for the source;

(III)Smoke management in agricultural of silvicultural prescribed burning programs;

(IV)Episodic restrictions on residential woodburning and open burning; or (V)Techniques under 1200-3-24-.02(1)(a)3., which increase final exhaust gas plume rise where the resulting plant wide allowable emissions of sulfur dioxide do not exceed 5,000 tons per year.

(b)Emission limitation and emission standard mean a requirement established by the Technical Secretary, which limits the quantity rate or concentration of emissions of air pollutants on a continuous basis, including any requirements which limit the level of opacity, prescribe equipment, set fuel specifications, or prescribe operation or maintenance procedures for a source to assure continuous emission reduction.

(c)Good engineering practice (GEP) stack height means the greater of: 1.65 meters (213 feet), measured from the ground-level elevation at the base of the stack; 2.Considering other stack criteria the following formulae apply:

(i)For stacks in existence on January 12, 1979, and for which the owner or operator had obtained all applicable permits or approvals required, Hg = 2.5H provided the owner or operator produces evidence that this equation was actually relied on in establishing an emission limitation;

(ii)For all other stacks, Hg = H + 1.5L, where Hg = good engineering practice stack height, measured from the ground-level elevation at the base of the stack, H = height of nearby structure(s) measured from ground-level elevation atthe base of the stack, L =lesser dimension, height (H) or projected width, of nearby structure(s),provided that the Technical Secretary may require the use of a field study or fluid model to verify GEP stack height for the source; or 3.The height demonstrated by a fluid model or a field study approved by the Technical Secretary, which ensures that the emissions from a stack do not result in excessive concentrations of any air pollutant as a result of atmospheric downwash, wakes, or eddy effects created by the source itself, nearby structures or nearby terrain features.

(d)Nearby as used in 1200-3-24-.02(1)(c) is defined for a specific structure or terrain feature and 1.For the purposes of applying the formulae provided in rule 1200-3-24-.02(1)(c)2., means that distance up to five times the lesser of the height or the width dimension of a structure, but not greater than 0.8 km (½ mile), and 2.For conducting demonstrations under rule 1200-3-24-.02(1)(c)3., means not greater than 0.8 km (½ mile), except that the portion of a terrain feature may be considered to be nearby which falls within a distance of up to 10 times the maximum height (H t ) of the feature, not to exceed 2 miles if such feature achieves a height (h t ) 0.8 km from the stack that is at least 40 percent of the GEP stack height determined by the formulae provided in 1200-3-24-.02(1)(c)2.(ii) or 26 meters (85 feet), whichever is greater, as measured from the ground level elevation at the base of the stack. The height of the structure or terrain feature is measured from the ground-level elevation at the base of the stack.

(e)Excessive Concentration is defined for the purposes of determining good engineering practice stack height under 1200-3-24-.02(1)(c)3. and means: 1.For sources seeking credit for stack height exceeding that established under 1200-3-24- .02(1)(c)2., a maximum ground-level concentration due to emissions from a stack due in

part to a downwash, wakes, and eddy effects produced by nearby structures or nearby terrain features which individually is at least 40 percent in excess of the maximum concentration experienced in the absence of such downwash, wakes, or eddy effects and which contributes to a total concentration due to emissions from all sources that is greater than an ambient air quality standard. For sources subject to the prevention of significant deterioration program, an excessive concentration alternatively means a maximum ground-level concentration due to emissions from a stack due in whole or part to downwash, wakes, or eddy effects produced by nearby structures or nearby terrain features which individually is at least 40 percent in excess of the maximum concentration experienced in the absence of such downwash, wakes, or eddy effects and greater than a prevention of significant deterioration increment. The allowable emission rate to be used in making demonstrations under this rule shall be prescribed by the new source performance standard (NSPS) that is applicable to the source category unless the owner or operator demonstrates that this emission rate is infeasible. Where such demonstrations are approved by the Technical Secretary, an alternative emission rate shall be established in consultation with the source owner or operator; 2.For sources seeking credit after October 11, 1983, for increases in existing stack heights established under 1200-3-24-.02(1)(c)2., either:

(i)a maximum ground-level concentration due in whole or part to downwash, wakes, or eddy effects as provided in 1200-3-24-.02(1)(e)1., except that the emission rate specified by the State Implementation Plan (or, in absence of such a limit, the actual emission rate) shall be used, or (ii)the actual presence of a local nuisance caused by the existing stack, as determined by the Technical Secretary; and 3.For sources seeking credit after January 12, 1979, for a stack height determined under 1200-3-24-.02(1)(c)2., where the Technical Secretary requires the use of a field study or fluid model to verify GEP stack height, for sources seeking stack height credit after November 9, 1984, based on the aerodynamic influence of cooling towers, and for sources seeking stack height credit after December 31, 1970, based on the aerodynamic influence of structures and adequately represented by the equations in rule 1200-3-24- .02(1)(c)2., a maximum ground-level concentration due in whole or part to downwash, wakes, or eddy effects that is at least 40 percent in excess of the maximum concentration experienced in the absence of such downwash, wakes, or eddy effects.

(f)Stack for the purpose of good engineering practice means any point in a source designed to emit solids, liquids, or gases into the air, including a pipe or duct but not including flares.

(g)A Stack in Existence means that the owner or operator had (1) begun, or caused to begin, a continuous program of physical on-site construction of the stack; or (2) entered into binding agreements or contractual obligations, which could not be canceled or modified without substantial loss to the operator, to undertake a program of construction of the stack to be completed in a reasonable time.

(h)Coal-Fired Steam Electric Generating Unit means any furnace, boiler, or other device used for combusting coal for the purpose of producing steam and is constructed for the purpose of supplying more than one-third of its potential electric outlet capacity and more than 25 megawatts electrical output to any utility power distribution system for sale.

History

• Authority: T.C.A. §§68-25-105 and 4-5-201 et. seq.
• Administrative History: Original rule filed October 8, 1987; effective November 22, 1987.

Tenn. Comp. R. & Regs. 1200-03-24-.03 GOOD ENGINEERING PRACTICE STACK HEIGHT REGULATIONS STANDARDS

(1)No person shall cause, suffer, allow, or permit emissions in excess of the standards of this chapter.

(2)Upon mutual agreement of the owner or operator of a source and the Technical Secretary, an emission limitation more restrictive than that otherwise specified in this chapter may be established. Violation of any accepted special limitations is grounds for revocation of the issued permit and/or other enforcement measures provided for in the Tennessee Air Quality Act.

(3)The possession of a valid permit shall not protect the source from enforcement actions if permit conditions are not met.

History

• Authority: T.C.A. §§68-25-105 and 4-5-201 et. seq.
• Administrative History: Original rule filed October 8, 1987; effective November 22, 1987.

Tenn. Comp. R. & Regs. 1200-03-24-.04 SPECIFIC EMISSION STANDARDS

For any affected air contaminant source(s) at a facility, the Technical Secretary shall specify on the construction and/or operating permit(s) as permit conditions the emission limitation that is determined to be necessary under the provisions of this chapter. The permit(s) must be subjected to a public hearing and incorporated as a revision to the State Implementation Plan.

History

• Authority: T.C.A. §§68-25-105 and 4-5-201 et. seq.
• Administrative History: Original rule filed October 8, 1987; effective November 22, 1987.

Chapter 1200-03-25 Repealed

Tenn. Comp. R. & Regs. 1200-03-25-.01 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 8, 2025; effective December 7, 2025.

Tenn. Comp. R. & Regs. 1200-03-25-.10 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 8, 2025; effective December 7, 2025.

Tenn. Comp. R. & Regs. 1200-03-25-.02 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 8, 2025; effective December 7, 2025.

Tenn. Comp. R. & Regs. 1200-03-25-.03 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 8, 2025; effective December 7, 2025.

Tenn. Comp. R. & Regs. 1200-03-25-.04 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Amendment filed May 17, 1990; effective July 1, 1990. Repeal filed September 8, 2025; effective December 7, 2025.

Tenn. Comp. R. & Regs. 1200-03-25-.05 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Amendments filed September 16, 2024; effective December 15, 2024. Repeal filed September 8, 2025; effective December 7, 2025.

Tenn. Comp. R. & Regs. 1200-03-25-.06 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 8, 2025; effective December 7, 2025.

Tenn. Comp. R. & Regs. 1200-03-25-.07 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 8, 2025; effective December 7, 2025.

Tenn. Comp. R. & Regs. 1200-03-25-.08 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 8, 2025; effective December 7, 2025.

Tenn. Comp. R. & Regs. 1200-03-25-.09 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202; 68-25-105; and 68-201-101, et seq.
• Administrative History: Original rule filed September 22, 1988; effective November 6, 1988. Repeal filed September 8, 2025; effective December 7, 2025.

Chapter 1200-03-26 Administrative Fees Schedule

Tenn. Comp. R. & Regs. 1200-03-26-.01 TENNESSEE VISIBLE EMISSIONS EVALUATION COURSE FEES

(1) The effective date of the fee schedule in subparagraph (2)(b) of this rule shall be July 1, 2020. The fee schedule in subparagraph (2)(a) of this rule continues to apply until June 30, 2020.

(2) Fee schedules.

(a) Until June 30, 2020, the following course fees apply:

Initial Certification Tennessee Applicant $125.00 Recertification Tennessee Applicant $95.00 Initial Certification Out-of-State Applicant $175.00 Recertification Out-of-State Applicant $125.00 (b) Beginning July 1, 2020, the following course fees apply:

Initial Certification $180.00 Recertification $150.00

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed June 1, 1990; effective July 16, 1990. Repeal and new rule filed July 5, 1994; effective September 18, 1994. Amendments filed January 15, 2020; effective April 14, 2020.

Tenn. Comp. R. & Regs. 1200-03-26-.02 CONSTRUCTION AND ANNUAL FEES

(1) Purpose.

(a) It is the purpose of this rule to establish fees for sources subject to permitting pursuant to Division 1200-03 sufficient to supplement existing state and federal funding that covers reasonable costs (direct and indirect) associated with the development, processing, and administration of the air pollution control program. This will provide for better quality evaluation of the impact of air emissions on the citizens of Tennessee, and timely permitting services for sources subject to permitting requirements.

(b) Such costs shall include, but not be limited to, costs associated with review of applications and reports, issuance of required permits and associated inspections of sources, unit observation, review and evaluation of monitoring results (stack and/or ambient), modeling, and costs associated with any necessary enforcement actions (excluding penalties assessed).

(c) Annual emission fees collected from major sources and all sources subject to paragraph (11) of Rule 1200-03-09-.02 shall be used to pay for the direct and indirect costs of:

1. Preparing generally applicable regulations or guidance regarding the permit program or its implementation or enforcement;

2. Reviewing and acting on any application for a permit, permit revision, or permit renewal, including the development of an applicable requirement as part of the processing of a permit, or permit revision or renewal;

3. General administrative costs of running the permit program, including the supporting and tracking of permit applications, compliance certification and related data entry;

4. Implementing and enforcing the terms of any 40 C.F.R. Part 70 permit (not including any court costs or other costs associated with an enforcement action), including adequate resources to determine which sources are subject to the program;

5. Emissions and ambient monitoring;

6. Modeling, analyses, or demonstrations;

7. Preparing inventories and tracking emissions; and 8. Providing direct and indirect support to sources under the Small Business Environmental Assistance Program.

(2) Definitions.

Unless specifically defined in this chapter, the definitions from Chapter 1200-03-02 will apply.

All terms defined in this chapter apply only to the provisions of this chapter.

(a) “Air contaminant” is particulate matter, dust, fumes, gas, mist, smoke, or vapor, or any combinations thereof.

(b) “A source subject to fees (source)” is any and all sources of emission of air contaminants, whether privately or publicly owned or operated, that is required to obtain a permit.

(c) “Annual accounting period” is a twelve (12) consecutive month period. For sources subject to paragraph (11) of Rule 1200-03-09-.02, the annual accounting period shall be either of the following: the calendar year (January 1 to December 31) or the state fiscal year (July 1 to June 30). For sources not subject to paragraph (11) of Rule 1200- 03-09-.02, the annual accounting period is the twelve consecutive month period as specified in paragraph (6) of this rule.

(d) “Allowable emissions” mean the emissions rate of a source calculated at full design capacity operating twenty-four (24) hours per day, every day of the annual accounting period or calculated at the operating time and/or other operating conditions specified in a legally enforceable permit, and the most stringent of the following:

1. The applicable standards under Division 1200-03;

2. The emission rate specified in a legally enforceable permit condition established pursuant to Rule 1200-03-09-.01 including those with a future compliance date; or pursuant to Rule 1200-03-09-.02; or 3. If no allowable emission rate is specified pursuant to part 1. or part 2. above, the actual emissions will equal the allowable emission rate solely for the purposes of fee computation. In no way is this item to be considered the setting of a binding emission limitation pursuant to the provisions of Chapter 1200-03-09. The actual emission rate will be calculated as the maximum actual emissions expected of full design capacity operating twenty-four (24) hours per day, every day of the annual accounting period, or expected at the operating time specified in a legally enforceable permit.

(e) “Division” means the Tennessee Division of Air Pollution Control.

(f) “Legally enforceable” means all limitations and conditions which are enforceable by the Technical Secretary, including those under this Division 1200-03, Division 0400-30, the State Implementation Plan, and any permit requirements established pursuant to

Chapter 1200-03-09. For major sources and sources subject to paragraph (11) of Rule

Tenn. Comp. R. & Regs. 1200-03-09-.02 , legally enforceable also includes a limitation or condition that is enforceable by the United States Environmental Protection Agency or its administrator.

(g) “Major source” means any source or group of sources located within a contiguous area, and under common control which is regulated by one of the following:

1. A source subject to the Prevention of Significant Deterioration (PSD) requirements, paragraph 1200-03-09-.01(4).

2. A source subject to the requirements for nonattainment areas, subparagraph 1200-03-09-.01(5)(b) which must meet a lowest achievable emission rate (LAER) limitation.

3. “Major source” means any stationary source (or any group of stationary sources that are located on one or more contiguous or adjacent properties, and are under common control of the same person [or persons under common control]) belonging to a single major industrial grouping and that are described in subparts (i), (ii), or (iii) of this definition. For the purposes of defining “major source,” a stationary source or group of stationary sources shall be considered part of a single industrial grouping if all of the pollutant emitting activities at such source or group of sources on contiguous or adjacent properties belong to the same Major Group (i.e., all have the same two-digit code) as described in the Standard Industrial Classification Manual, 1987.

(i) A major source under section 112 of the Federal Act which is defined as:

(I) For pollutants other than radionuclides, any stationary source or group of stationary sources located within a contiguous area and under common control that emits or has the potential to emit, in the aggregate, 10 tons per year (tpy) or more of any hazardous air pollutant which has been listed pursuant to section 112(b) of the Federal Act, 25 tpy or more of any combination of such hazardous air pollutants, or such lesser quantity as the Administrator may establish by rule. Notwithstanding the preceding sentence, emissions from any oil or gas exploration or production well (with its associated equipment) and emissions from any pipeline compressor or pump station shall not be aggregated with emissions from other similar units, whether or not such units are in a contiguous area or under common control, to determine whether such units or stations are major sources; or (II) For radionuclides, “major source” shall have the meaning specified by the Administrator by rule.

(ii) A major stationary source of air pollutants, as defined in section 302 of the Federal Act, that directly emits or has the potential to emit, 100 tpy or more of any air pollutant (including any major source of fugitive emissions of any such pollutant, as determined by rule by the Administrator). The fugitive emissions of a stationary source shall not be considered in determining whether it is a major stationary source for the purposes of section 302(j) of the Federal Act, unless the source belongs to one of the following categories of stationary sources:

(I) Coal cleaning plants (with thermal dryers);

(II) Kraft pulp mills;

(III) Portland cement plants;

(IV) Primary zinc smelters;

(V) Iron and steel mills;

(VI) Primary aluminum ore reduction plants;

(VII) Primary copper smelters;

(VIII) Municipal incinerators capable of charging more than 250 tons of refuse per day;

(IX) Hydrofluoric, sulfuric, or nitric acid plants;

(X) Petroleum refineries;

(XI) Lime plants;

(XII) Phosphate rock processing plants;

(XIII) Coke oven batteries;

(XIV) Sulfur recovery plants;

(XV) Carbon black plants (furnace process);

(XVI) Primary lead smelters;

(XVII) Fuel conversion plant;

(XVIII) Sintering plants;

(XIX) Secondary metal production plants;

(XX) Chemical process plants;

(XXI) Fossil-fuel boilers (or combination thereof) totaling more than 250 million British thermal units per hour heat input;

(XXII) Petroleum storage and transfer units with a total storage capacity exceeding 300,000 barrels;

(XXIII) Taconite ore processing plants;

(XXIV) Glass fiber processing plants;

(XXV) Charcoal production plants;

(XXVI) Fossil-fuel-fired steam electric plants of more than 250 million British thermal units per hour heat input; or (XXVII) All other stationary source categories regulated by a standard promulgated under section 111 or 112 of the Federal Act, but only with respect to those air pollutants that have been regulated for that category;

(iii) A major stationary source as defined in part D of Title I of the Federal Act, including:

(I) For ozone nonattainment areas, sources with the potential to emit 100 tpy or more of volatile organic compounds or oxides of nitrogen in areas classified as “marginal” or “moderate,” 50 tpy or more in areas classified as “serious,” 25 tpy or more in areas classified as “severe,” and 10 tpy or more in areas classified as “extreme”; except that the references in this paragraph to 100, 50, 25, and 10 tpy of nitrogen oxides shall not apply with respect to any source for which the Administrator has made a finding, under section 182(f)(1) or (2) of the Federal Act, that requirements under section 182(f) of the Federal Act do not apply;

(II) For ozone transport regions established pursuant to section 184 of the Federal Act, sources with the potential to emit 50 tpy or more of volatile organic compounds;

(III) For carbon monoxide nonattainment areas (1) that are classified as “serious,” and (2) in which stationary sources contribute significantly to carbon monoxide levels as determined under rules issued by the Administrator, sources with the potential to emit 50 tpy or more of carbon monoxide; and (IV) For particulate matter (PM-10) nonattainment areas classified as “serious,” sources with the potential to emit 70 tpy or more of PM-10.

(h) “Minor source” means any source or group of sources located within a contiguous area, and under common control which is not a major or conditional major source for the purposes of this rule. However, for the sole purpose of emission fee calculation, affected sources subject to the acidic precipitation requirements of Title IV of the Federal Clean Air Act embodied at 42 U.S.C. §§ 7401 et seq. shall be considered minor sources subject to the provisions of paragraph 1200-03-26-.02(6) until the year 2000. At that time, the affected sources will become major sources subject to paragraph 1200-03-26-.02(9).

(i) “Regulated pollutant” means allowable emissions (and/or actual emissions for major sources) of 4,000 tons per year or less from a source for each of the following compounds or substances:

1. Each pollutant regulated under Chapter 0400-30-38 Emission Standards for Hazardous Air Pollutants (excluding transitory asbestos from construction, demolition, and renovation).

2. Each regulated pollutant from a source subject to the provisions of Chapter 0400- 30-39 Standards of Performance for New Stationary Sources.

3. Volatile Organic Compounds (VOC)

4. Particulates 5. For major sources, the following pollutants:

(i) Nitrogen oxides or any volatile organic compounds;

(ii) Any pollutant for which a national ambient air quality standard has been promulgated;

(iii) Any pollutant that is subject to any standard promulgated under section 111 of the Federal Act; provided, however, that any such pollutant shall not be a regulated pollutant solely because the pollutant is a constituent of greenhouse gases;

(iv) Deleted.

(v) Any pollutant subject to a standard promulgated under section 112 or other requirements established under section 112 of the Federal Act, including sections 112(g), and (j), of the Act, including the following:

(I) Any pollutant subject to requirements under section 112(j) of the Federal Act. If the Administrator fails to promulgate a standard by the date established pursuant to section 112(e) of the Federal Act, any pollutant for which a subject source would be major shall be considered to be regulated on the date 18 months after the applicable date established pursuant to section 112(e) of the Federal Act; and (II) Any pollutant for which the requirements of section 112(g)(2) of the Federal Act have been met, but only with respect to the individual source subject to section 112(g)(2) requirement except that carbon monoxide, any pollutant regulated as a Class I or Class II substance subject to a standard promulgated under Title VI of the Federal Clean Air Act or any pollutant regulated solely because it is subject to the provision of Section 112(r) of the Federal Clean Air Act shall not be included in the compilation of pollutants at part 1200-03-09- 02(11)(b)19.

6. Sulfur Dioxide (SO2)

7. Nitrogen Oxides (NOx)

8. Lead (Pb)

9. Gaseous Fluorides expressed as Hydrogen Fluoride (HF)

10. Carbon Monoxide (no charge)

11. Hydrogen Chloride (HCl)

12. Each hazardous air pollutant actually emitted or allowed to be emitted from a source subject to paragraph (11) of Rule 1200-03-09-.02.

(j) “Construction” means for the purpose of this rule, any activities that require a source to obtain a construction permit under the provisions of Rule 1200-03-02-.01 and Rule

Tenn. Comp. R. & Regs. 1200-03-09-.01 located within the boundary of a nonattainment area so designated by the Board and/or the United States Environmental Protection Agency.

1. If an application for a construction permit is determined to be incomplete, the Division must notify the applicant in writing via certified mail of the finding with a brief explanation of the deficiencies. The application filing/processing fee shall be retained by the Division.

2. After receiving notice from the Division that the application was incomplete, the applicant shall have 180 calendar days to correct the deficiencies. If properly corrected, the application will be processed and no additional fee is required. The permit will then be granted or denied in accordance with this chapter and

Chapter 1200-03-09. If the deficiencies are not corrected within the 180-day correction period, the fee will be forfeited in its entirety to the Division and the Division will officially deny the permit based on the incomplete permit application.

If the applicant re-applies, a new application/processing fee must be paid in full along with the re-application.

3. It is the express intent of the Board that the 180-day permit application correction period is not to be construed by an applicant as permission to construct or modify a source without the permit required by Chapter 1200-03-09.

4. Upon receipt of a corrected application revised pursuant to part 1., 2., or 3. of this subparagraph, the Division shall re-evaluate the application and notify the applicant of its finding as to whether or not the application is considered to be complete. If the application is still deemed incomplete the applicant has the remainder of the initial 180-day period to correct the deficiencies or forfeit the fee in its entirety. Unless a determination that a corrected application is not complete is made by the Division and communicated to the applicant via certified mail within 30 days of receipt, the corrected application shall be deemed to be complete for the purpose of starting the Division’s permit processing deadline schedule. However, if additional information is still needed to process the permit, the applicant has a duty to furnish said information or face denial of the permit.

(e) Revisions to a construction permit application to reflect changes in the design of the source or the materials to be processed therein will be accepted by the Division during the permit processing period. However, the deadline for evaluation as to issuance of a permit or denial of the request will restart upon each and every significant revision as though it were an entirely new permit.

(5) Construction Fees.

(a) Construction Permit and Opt-Out Permit Application Filing/Processing Fees 1. The fee rates of this subparagraph effective on July 1, 2022, continue to apply until July 1, 2024.

2. On and after July 1, 2024, a responsible official applying for the construction permit (i.e., construction as defined in subparagraph (2)(j) of this rule) required by Rule 1200-03-09-.01, or an opt-out permit, must pay a construction permit application filing/processing fee as follows:

(i) A responsible official of a minor source or a conditional major source must pay construction permit application fees as set forth in subparagraph (g), Schedule A of this paragraph. The fee determined from subparagraph (g), Schedule A of this paragraph shall be calculated based on the definitions of AMER and anticipated maximum increase in emissions, as defined in subparagraphs (2)(u) and (v) of this rule.

(ii) A responsible official of a major source or a source subject to paragraph (11) of this rule (hereinafter, “Paragraph 11 source”) must pay a construction permit application fee of $7,000.

(iii) Except as specified in subpart (v) of this part, a responsible official applying for a Prevention of Significant Air Quality Deterioration permit as required by paragraph (4) of Rule 1200-03-09-.01 must pay a construction application fee of $70,000.

(iv) Except as specified in subpart (v) of this part, a responsible official applying for a permit under the provisions of paragraph (5) of Rule 1200- 03-09-.01, Growth Policy, must pay a construction application fee of $70,000.

(v) A responsible official applying for a plantwide applicability limit (PAL) under the provisions of subparagraph (4)(s) of Rule 1200-03-09-.01 or part (5)(b)10. of Rule 1200-03-09-.01 must pay an application fee of $10,000 per pollutant.

(vi) A responsible official of an existing Paragraph 11 source applying for an operating permit to opt out of being a Paragraph 11 source, as described in subparagraph (11)(a) of Rule 1200-03-09-.02, by limiting the potential to emit such that the potential emissions of all pollutants are below the major source applicability thresholds, as defined in part (11)(b)14. of Rule 1200- 03-09-.02, must pay an application fee of $18,000.

3. On and after July 1, 2024, an applicant for a minor source or a conditional major source applying to make a change to an existing source or permit such that a new construction permit is required must pay a permit application fee as set forth in subparagraph (g), Schedule A of this paragraph. This fee is determined by the anticipated maximum increase in emissions, as defined in subparagraph (2)(v) of this rule, from the AMER of the previous construction permit for the source. The fee rates in this part in effect on July 1, 2022, continue to apply until July 1, 2024.

4. On and after July 1, 2024, an owner or operator of a source that submits notice of intent for coverage under a general permit serving as a construction permit shall pay a permit application fee equal to that determined in accordance with the subparagraph (g) of this paragraph, Schedule A fee corresponding to the applicant’s AMER, unless an alternate construction permit application fee is stipulated in the table below. If Schedule A from subparagraph (g) of this paragraph is used to determine the fee, it shall be determined by the anticipated maximum increase in emissions, as defined in subparagraph (2)(v) of this rule, from the AMER of the previous construction permit for the source.

General Permit Category Construction and Modification Permit Application Fee Perchloroethylene and Petroleum Solvent Dry Cleaners $100 Concrete batch plants $100 Portable rock crushers $100 Asphalt plants $250 Air Curtain Incinerators $500 5. All application filing/processing fees required by this subparagraph are due upon submission of the permit application.

(b) 1. The fee rates required by this subparagraph effective July 1, 2022, continue until July 1, 2024.

2. With the exception of changes received during the initial construction permit evaluation period (i.e., prior to the Division letter or email denoting application completeness), all revisions under subparagraph (4)(e) of this rule that result in an increase in allowable emissions sought by the applicant or an increase in actual emissions declared in the original application for a permit shall be subject to a fee equal to the following:

(i) For minor sources and conditional major sources, one-half of the Schedule A fee corresponding to the applicant’s anticipated maximum emission rate, not to exceed $500.

(ii) For Paragraph 11 sources, $3,500.

3. The fee required by subparts 2(i) and (ii) of this subparagraph is determined by the anticipated maximum increase in emissions from the anticipated maximum emission rate of the previous construction permit for the source.

(c) Reserved.

(d) The Division must consider all applications for construction that are received from a source in the Division’s Nashville office on the same date as a source submittal. The source submittal is subject to the applicable permit filing/processing fee.

(e) The Division must make a decision to issue or deny a request for a permit in one of the categories listed in parts 1. through 4. of this subparagraph and notify the applicant of that decision in accordance with the following time-lines:

1. Major source or Paragraph 11 source construction permit reviews must be completed in 180 days, from receipt of a complete application unless a longer period is agreed to in writing by the applicant.

2. Minor and conditional major source construction permit reviews must be completed within 115 days from receipt of a complete application.

3. PAL reviews must be completed within 365 days from receipt of a complete application unless a longer period is agreed to in writing by the applicant.

4. Operating permit reviews for an existing major source or Paragraph 11 source applying for an operating permit to opt out of being a major source or Paragraph 11 source by limiting the potential to emit such that they are below the major source applicability thresholds must be completed within 365 days from receipt of a complete application unless a longer period is agreed to in writing by the applicant.

5. If a mutual agreement letter required by part (6)(b)1. of this rule or subparagraph (11)(a) of Rule 1200-03-09-.02 has been requested by the Division at least seven days prior to a deadline specified in part 1., 2., 3., or 4. of this subparagraph, but is not received by that deadline, the applicable deadline specified in part 1., 2., 3., or 4. of this subparagraph shall be seven days after receipt of the agreement letter.

6. If a source is required to have a compliance schedule in their permit in accordance with paragraph (4) of Rule 1200-03-09-.02 arises after an application was deemed complete, the deadlines specified in part 1., 2., 3., or 4. of this subparagraph shall be extended as follows:

(i) 21 days after receipt of a compliance schedule from the applicant that is acceptable to the Technical Secretary if the draft permit is not required to have a public comment period.

(ii) 60 days after receipt of a compliance schedule from the applicant that is acceptable to the Technical Secretary if the draft permit is subject to an opportunity for public comment, and no public hearing is held.

(iii) 60 days after receipt of a compliance schedule from the application that is acceptable to the Technical Secretary if the draft permit is subject to an opportunity for public comment and a public hearing is announced along with the opportunity for public comment on the draft permit.

(iv) 90 days after receipt of a compliance schedule from the applicant that is acceptable to the Technical Secretary if the draft permit is subject to an opportunity for public comment, if a public hearing is requested during the public comment period, and the public hearing is held after the close of the public comment period.

(f) In the event that the Division fails to process the construction permit application within the time lines established in subparagraph (e) of this paragraph, the Division will refund the permit filing/processing fee to the applicant in full. The refund will be made within 30 days following the date that the deadline for a decision on that particular permit application was established. For refunds in excess of $1,000, additional time to allow review and approval of the refund by the Office of the Attorney General shall be allowed.

(g) The appropriate permit filing/processing fee shall be determined by the applicant from the following schedules:

SCHEDULE A –

CONSTRUCTION PERMIT FEES FOR MINOR AND CONDITIONAL MAJOR SOURCES

Anticipated Maximum (Filing/Processing)

Emission Rate Permit Fee Less Than 10 Tons/Year $100 10 to < 100 Tons/Year $500 100 to < 250 Tons/Year $1,000 250 to < 500 Tons/Year $2,000 500 to < 1,000 Tons/Year $3,000 1,000 to < 5,000 Tons/Year $4,000 5,000 and Greater Tons/Year $5,000 (6) Annual Fees for Minor and Conditional Major Sources.

(a) A responsible official of a minor source and/or a conditional major source must pay an annual fee to the State of Tennessee. The annual fee shall be based on the source’s allowable emissions as defined in subparagraph (2)(d) of this rule.

(b) 1. The minor source and conditional major source annual emission fee must be calculated using the sum of the allowable emissions of all regulated pollutants at a source. Upon mutual agreement of the responsible official and the Technical Secretary, a more restrictive regulatory requirement may be established to minimize the allowable emissions and thus the annual emission fee. The more restrictive requirement must be specified in the permit, and must include the method(s) used to determine compliance with the limitation(s). The documentation procedure to be followed by the source owner or operator must also be included to ensure that the limit is not exceeded. Exceedances of the mutual agreement limit will be considered by the Board as circumvention of the required annual emissions fee and a matter in which enforcement action must be pursued.

2. To reduce the amount of the fee as provided in part 1. of this subparagraph, the responsible official must submit a letter to the Technical Secretary requesting reduced allowable emissions and providing the method or methods that will be used to ensure compliance with the requested limit or limits. This request must be received at least 90 days prior to the applicable due date of the annual fee.

Any request received after that deadline may only apply to the fee for the following year and not for the year being invoiced.

(c) All minor and conditional major source annual fees are due and payable to the State of Tennessee in full according to Schedule I of this subparagraph. The county in which a source is located determines when the source’s annual fee is due. If a source is located on contiguous property in more than one county, the county appearing earliest in the calendar year shall be used to determine the due date of the annual fee. Due to seasonal operations, cotton gin source annual fees are due and payable annually to the State of Tennessee by December 1 of each year regardless of the county in which the source is located. The fee must be paid to the State of Tennessee in full by the first day of the month that the fee is due. The Technical Secretary extends this due date by an appropriate period not to exceed 90 days where the source owner or operator’s fee notice was mailed by the Department to an incorrect mailing address.

SCHEDULE I

Month the Annual Fee Is Due (Accounting Period)

Counties in the Monthly Grouping January Anderson, Bedford, Benton, Bledsoe, Blount, Bradley, and Campbell February Cannon, Carroll, Carter, Cheatham, Chester, Claiborne, Clay, and Cocke March Coffee, Crockett, Cumberland, Davidson, Decatur, DeKalb, Dickson, Dyer, and Fayette April Fentress, Franklin, Gibson, Giles, Grainger, Greene, and Grundy May Hamblen, Hamilton, Hancock, Hardeman, Hardin, Hawkins, Haywood, and Henderson June Henry, Hickman, Houston, Humphreys, Jackson, Jefferson, Johnson, Knox, Lake, Lauderdale, Lawrence, and Lewis July Lincoln, Loudon, McMinn, McNairy, Macon, and Madison August Marion, Marshall, Maury, Meigs, Monroe, Montgomery, Moore, and Morgan September Obion, Overton, Perry, Pickett, Polk, Putnam, and Rhea October Roane, Robertson, Rutherford, Scott, Sequatchie, Sevier, and Shelby November Smith, Stewart, Sullivan, Sumner, Tipton, Trousdale, Unicoi, and Union December Van Buren, Warren, Washington, Wayne, Weakley, White, Williamson, and Wilson (d) 1. A newly constructed minor or conditional major source beginning operation subsequent to the annual accounting period for the county in which it is located shall not be required to pay an annual fee for the remainder of the annual accounting period. A minor or conditional major source ceasing operations during the annual accounting period will not receive a refund for annual fees paid.

2. Sources issued a combination construction and operating permit in accordance with paragraph (12) of Rule 1200-03-09-.02 shall pay annual fees as if operation of the new or modified source began on the date of permit issuance. This part does not apply to sources for which construction and operation of the new source or modification began prior to receipt of a construction permit.

(e) Except for sources that are covered under a general permit issued in accordance with

Rule 1200-03-09-.06, the appropriate annual emissions fee for minor and conditional major sources in operation on or after July 1, 1993, shall be calculated at an emission fee rate of $18.75 per ton of allowable emissions of regulated pollutants at the time of the fee assessment by the Division based on the current active permit(s). Sources with allowable emissions less than 10 tons will not be subject to this fee, provided that such source has not taken a limitation on their permit that would render them a conditional major source.

(f) A responsible official of a source operating under a general permit shall pay an annual emissions fee as stipulated in subparagraph (e) of this paragraph based on the allowable emissions specified in the general permit unless different fee rates are stipulated in the following table. These fees are due and payable by the date established in subparagraph (c) of this paragraph:

General Permit Category Combined Annual Emission Fee and Base Fee Permit Review Fee Perchloroethylene and Petroleum Solvent Dry Cleaners $0 $0 Concrete Batch Plants with emissions less than 10 tons per calendar year $0 $0 Concrete Batch Plants with emissions greater than or equal to 10 tons per calendar year $400 $0 Portable rock crushers at True Minor Facilities $1,000 $0 Portable rock crushers at Conditional Major Facilities $1,000 $500 Asphalt Plants $1,000 $500 (g) Deleted.

(h) Deleted.

(i) The annual emission fee will be calculated on no more than 4,000 tons per year of each regulated pollutant. An annual emission fee will not be charged for carbon monoxide or for emissions of a pollutant solely because the pollutant is a constituent of greenhouse gases.

(j) Deleted.

(k) Conditional major sources must pay an annual permit review fee in accordance with the table below in addition to the annual emission fees specified in subparagraph (e) of this paragraph. This fee is due and payable to the State of Tennessee according to Schedule I found in subparagraph (c) of this paragraph. When determining the permit review fee, the allowable tons per year shall be calculated in accordance with subparagraph (b) of this paragraph except that carbon monoxide emissions shall be included.

Allowable Tons Per Year Review Fee 0-50 $250 50.1-100 TPY $500 100.1-250 TPY $1,000 250.1 and up $2,000 (7) Payment of Fees.

(a) All fees regulated by this chapter shall be payable to the State of Tennessee.

(b) Fees not paid, late fees, and returned checks are subject to the provisions of paragraph (8) of this rule.

(c) Returned checks for any reason (i.e. insufficient funds, account closed, etc.) are considered failure to pay until such time collected funds are forwarded to the State of Tennessee. Returned checks are subjected to additional handling charges.

(d) Annual fee payments and permit review fee payments shall be clearly identified with the “Emission Source Reference Number” or “Facility ID” specified in the source’s permit(s) and the invoice number, if available, or by an alternative method proposed by the source and agreed to by the Technical Secretary. Major sources paying fees on more than one SIC code at their facility shall denote the SIC code on their check for the account upon which they are paying. Delivery of the payment shall be to the location prescribed by the Technical Secretary.

(e) When a fee overpayment has been made as a result of an error by the source, an owner or operator may seek a credit or refund for such fee overpayment within one year from the date on which the State of Tennessee received payment of the fee.

(f) Online payment can be made to the State of Tennessee for annual fees by following the established State of Tennessee online payment process. Online payments require the inclusion of the customer identification number and the invoice number, if available, to ensure proper crediting of payment.

(8) Late Fees – Failure to Pay.

(a) The Technical Secretary will not issue any permit or renewal of a permit to an applicant until all fees required by this chapter have been paid in full to the State of Tennessee.

(b) If any part of any fee imposed under this rule is not paid within 15 days of the due date, a late payment penalty of five percent of the amount due shall at once accrue and be added thereto. Thereafter, on the first day of each month during which any part of any fee or any prior accrued late payment penalty remains unpaid, an additional late payment penalty of five percent of the then unpaid balance shall accrue and be added thereto. In addition, the fees not paid within 15 days after the due date, shall bear interest at the maximum lawful rate from the due date to the date paid, compounded monthly; however, the total of the penalties and interest that accrue pursuant to this subparagraph shall not exceed three times the amount of the original fee.

(c) It is the express intent of the Tennessee Air Pollution Control Board that late payment fees or interest accrued on an unpaid fee are not to be viewed by the Technical Secretary as a mitigating factor in calculating a civil penalty for construction or operating without the permits required by Rule 1200-03-09-.01 and/or Rule 1200-03- 09-.02.

(9) Annual Fees for Major Sources and Sources Subject to Paragraph (11) of Rule 1200-03-09- .02.

(a) 1. A responsible official of a major source or a source subject to paragraph (11) of

Rule 1200-03-09-.02 (hereinafter, “Paragraph 11 source”) must pay an annual fee to the State of Tennessee. A major source or Paragraph 11 source is not subject to the minor and conditional major source annual fees of paragraph (6) of this rule on or after July 1, 1994. Prior to July 1, 2022, a major source or Paragraph 11 source paying major source annual fees pursuant to this paragraph (9) will not be subject to the construction permit fees of paragraph (5) of this rule for any additional construction occurring at the source as long as the source remains a major source or Paragraph 11 source. On or after July 1, 2022, all major sources and Paragraph 11 sources are subject to the construction permit fees of paragraph (5) of this rule.

2. Effective January 1, 2018, the following shall apply:

(i) Sources choosing to pay annual fees on an allowable emissions basis pursuant to subparagraph (b) of this paragraph shall pay 100% of the fee due pursuant to subparagraph (d) of this paragraph:

(I) No later than April 1 of the year immediately following the annual accounting period for which the fee is due for sources paying on a calendar year basis pursuant to subparagraph (b) of this paragraph; or (II) No later than April 1 of the current fiscal year for sources paying on a fiscal year basis pursuant to subparagraph (b) of this paragraph.

(ii) Sources choosing to pay annual fees on an actual emissions basis or a combination of actual and allowable emissions basis and on a calendar year basis pursuant to subparagraph (b) of this paragraph shall pay 100% of the fee due pursuant to subparagraph (d) of this paragraph no later than April 1 of the year immediately following the annual accounting period for which the fee is due, except as allowed by part (g)3. of this paragraph.

(iii) Sources choosing to pay annual fees on an actual emissions basis or a combination of actual and allowable emissions basis and on a fiscal year

basis pursuant to subparagraph (b) of this paragraph shall pay an estimated 65% of the fee due pursuant to subparagraph (d) of this paragraph no later than April 1 of the current fiscal year. The remainder of the annual fee is due August 1 of each year, except as allowed by part (g)3. of this paragraph.

(b) 1. On or before December 31 of the annual accounting period, the responsible official must submit to the Division in writing the responsible official’s determination to pay the annual fee based on:

(i) Either a calendar year or state fiscal year; and (ii) Actual emissions, allowable emissions, or a mixture of actual and allowable emissions of regulated pollutants.

2. If the responsible official does not declare a fee payment choice as provided in subparts 1.(i) or (ii) of this subparagraph, then the basis of the annual fee payment shall be the same as the responsible official’s most recent choice of fee payment, or, if no such previous choice was made, the basis of the annual fee payment shall be that specified in the source’s current major source operating permit.

3. If the responsible official wishes to restructure allowable emissions for a major source or Paragraph 11 source for the purpose of lowering the annual fee, then an application must be filed at least 90 days prior to December 31 of the annual accounting period as provided in subparagraph (g) of this paragraph.

4. The responsible official of a newly constructed major source, Paragraph 11 source, or minor source modifying its operation such that the source becomes a major source or Paragraph 11 source shall pay an initial annual fee based on a calendar year and allowable emissions for the fractional remainder of the calendar year commencing upon the source’s start-up. However, in no case shall the annual fee be less than the annual base fee established in part (d)1 of this paragraph. Prior to July 1, 2024, in no case shall the annual fee be less than the minimum fee established in subpart (d)2.(ii) of this paragraph effective on July 1, 2022.

5. For purposes of the payment of annual fees due July 1, 2016, parts 1. and 2. of this subparagraph shall not apply. Annual fees due July 1, 2016, shall be based on the state fiscal year and the annual fee basis (actual emissions, allowable emissions, or a mixture) specified in a source’s current major source operating permit. If a source does not have an effective major source operating permit on July 1, 2016, then the source’s responsible official shall pay the annual fee based on the state fiscal year and allowable emissions.

(c) Reserved.

(d) 1. Notwithstanding the fee rates established by parts 2. and 4. of this subparagraph, a responsible official of any source subject to this paragraph shall pay an annual base fee which shall be calculated in accordance with subparts (i) through (iii) of this part. This base fee shall be paid in addition to the annual emission fee established by subpart 2.(iii) of this subparagraph. The fee rates required by this

part effective July 1, 2022, continue to apply until July 1, 2024.

(i) The base fee shall be determined by the number of federal air quality standards to which a major source or Paragraph 11 source is subject. The following federal air quality standards shall be considered if the standards have been incorporated into a permit issued to the facility under the provisions of Chapter 1200-03-09 or have been incorporated into Chapter 0400-30-38 or Chapter 0400-30-39:

(I) Standards of Performance for New Stationary Sources as codified in 40 C.F.R. part 60, excluding subparts A, B, Ba, C, Cb, Cc, Cd, Ce, Cf, AAA, DDDD, FFFF, MMMM, and UUUUa.

(II) National Emission Standards for Hazardous Air Pollutants as codified in 40 C.F.R. part 61, excluding subpart A.

(III) National Emissions Standards for Hazardous Air Pollutants as codified in 40 C.F.R. part 63, excluding subparts A, B, C, D, E, OO, PP, QQ, RR, SS, TT, UU, VV, and XX.

(ii) If a facility is subject to 40 C.F.R. part 60 subpart IIII or JJJJ, or 40 C.F.R.

part 63 subpart ZZZZ or CCCCCC and is only subject to that subpart for air contaminate sources that are not required to be included in a permit in accordance with paragraph (4) of Rule 1200-03-09-.04, then such subpart shall not be included when determining the number of federal air quality standards that a source is subject.

(iii) The base fee is determined in accordance with the following table:

Number of federal air quality standards Base Fee 0 $10,000 1 $15,000 2 to 3 $20,000 4 to 5 $30,000 6 to 10 $40,000 11 to 20 $50,000 21 and up $75,000 2. (i) For purposes of this part, an electric utility generating unit (EGU) means any steam electric generating unit or stationary combustion turbine that is constructed for the purpose of supplying more than one-third of its potential electric output capacity and more than 25 MW net-electrical output to any utility power distribution system for sale. Also, any steam supplied to a steam distribution system for the purpose of providing steam to a steam electric generator that would produce electrical energy for sale is considered in determining the electrical energy output capacity of the affected EGU.

(ii) Notwithstanding the annual emission fee rates established by subpart (iii) of this part, the annual fee required to be paid by a responsible official of any source subject to this paragraph shall be no less than:

(I) $5,500 for sources (Once in/Always in sources) subject to this paragraph solely due to the May 16, 1995 EPA memorandum entitled, “Potential to Emit for MACT Standards—Guidance on Timing Issues,” from John Seitz, Director, Office of Air Quality Planning and Standards (OAQPS), to EPA Regional Air Division Directors, provided that the source has permitted allowable emissions below the major source thresholds found in part (11)(b)14. of Rule 1200-03-09-.02. If the source’s permitted allowable emissions are not below those major source thresholds as of October 31 of the annual accounting period for which fees are due under this part, then item (II) of this subpart applies; and (II) $10,000 for all other sources subject to this paragraph for fees due on and after January 1, 2023.

(iii) The emission fee rates applied to calculate the annual fee assessed pursuant to subparagraph (a) of this paragraph shall be as follows:

(I) Fee based on actual emissions: $70.50 per ton for non-EGU sources and $98.50 per ton for EGU sources; and (II) Fee based on allowable emissions: $48.50 per ton for non-EGU sources and $68.00 per ton for EGU sources.

(iv) The fees and fee rates enumerated in this subparagraph must be supported by the Division’s annual workload analysis that is approved by the Board.

(v) When subparts 1.(i) through (iii) of this subparagraph become effective,

subpart (ii) of this part will no longer be applicable.

3. The fees and fee rates specified in this subparagraph shall remain in effect until the effective date of an amendment to this subparagraph. Any revision to the fees and fee rates must result in the collection of sufficient fee revenue to fund the activities identified in subparagraph (1)(c) of this rule and must be supported by the Division’s annual workload analysis that is approved by the Board.

4. Notwithstanding the fee rates established by part 1. or 2. of this subparagraph, a responsible official of any source subject to this paragraph shall pay a Title V modification fee calculated as follows:

(i) For each minor permit modification issued in accordance with subpart (11)(f)5.(ii) of Rule 1200-03-09-.02 during the calendar year preceding the year in which the annual fee is due, the responsible official shall pay $2,800.

(ii) For each significant modification issued in accordance with subpart (11)(f)5.(iv) of Rule 1200-03-09-.02 during the calendar year preceding the year in which the annual fee is due, the responsible official shall pay $5,000.

5. The Title V modification fee required by part 4. of this subparagraph shall be paid in addition to the annual emission fee established by subpart 2.(iii) of this subparagraph. The Title V modification fee is not required for complete minor permit modification and significant modification applications received prior to July 1, 2024.

(e) 1. An emission cap of 4,000 tons per year per regulated pollutant per major source SIC code shall apply to actual or allowable based emission fees. A major source annual emission fee will not be charged for emissions in excess of the cap(s) or for carbon monoxide.

2. No annual fee under this paragraph (9) will be charged for emissions of a pollutant solely because the pollutant is a constituent of greenhouse gases.

(f) In the case where a source is shut down such that it has operated only during a portion of the annual accounting period and the source’s permits are forfeited to the Technical Secretary, the appropriate fee shall be calculated on a prorated basis over the period of time that the source was operated in the annual accounting period. The responsible official of a major source or Paragraph 11 source that is shut down, but wishes to retain its permits, shall pay a maintenance fee equivalent to 40% of the fee that would be charged had the responsible official determined to base the annual fee on allowable emissions. If the responsible official chooses this option in the midst of an annual accounting period, then the fee will be prorated according to the number of months that the source was in the maintenance fee status. However, in no case shall the annual fee be less than the minimum annual fee established in subpart (d)2.(ii) of this paragraph.

The responsible official shall notify the Division no later than December 31 of the annual accounting period so that the Division will have sufficient time to adjust billing records for the maintenance fee status.

(g) Responsible officials required to pay the major source or Paragraph 11 source annual fee pursuant to subparagraph (a) of this paragraph must conform to the following requirements with respect to fee payments:

1. (i) If a responsible official paying the annual fee based on allowable emissions wishes to restructure the allowable emissions of a major source or Paragraph 11 source for the purpose of lowering the annual fee, then upon mutual agreement of the responsible official and the Technical Secretary, a more restrictive regulatory requirement may be established to minimize the allowable emissions and thus the annual fee. The more restrictive regulatory requirement, the method used to determine compliance with the limitation, and the documentation procedure to be followed by the major source or Paragraph 11 source to ensure that the limit is not exceeded must be included in the application and specified in a permit through either the permit modification processes of paragraph (11) of Rule 1200-03-09- .02, or the construction permit processes of Rule 1200-03-09-.01, or both.

The more restrictive requirement shall be effective for purposes of lowering the annual fee upon agreement by both the responsible official and the Technical Secretary and for all other purposes shall be effective upon issuance of the permit, modification, or both.

(ii) To reduce the amount of the fee as provided in subpart (i) of this part, the responsible official must file a complete permit modification or construction permit application with the Division at least 90 days prior to December 31 of the annual accounting period.

2. The responsible official shall file an analysis of actual emissions, allowable emissions, or both actual and allowable emissions, whichever is appropriate due to the basis of the annual fee payment, with the Technical Secretary on or before the date the fee is due pursuant to subparagraph (a) of this paragraph. The analysis shall summarize the emissions of all regulated pollutants at the air contaminant sources of the major source or Paragraph 11 source facility and shall be used to calculate the amount of the annual fee owed pursuant to subparagraph (a) of this paragraph.

(i) An annual fee based on both actual emissions and allowable emissions shall be calculated utilizing the 4,000 ton per year cap specified in subparagraph (2)(i) of this rule. In determining the tonnages to be applied toward the regulated pollutant 4,000 ton cap in a mixed base fee, the responsible official shall first calculate the actual emission-based fees for a regulated pollutant and apply that tonnage toward the regulated pollutant’s cap. The remaining tonnage available in the 4,000 ton category of a regulated pollutant shall be subject to allowable emission-based fee calculations. Once the 4,000 ton per year cap has been reached for a regulated pollutant, no additional fee for that pollutant shall be required.

(ii) If the responsible official chooses to base the annual fee on actual emissions, then the responsible official must prove the magnitude of the source’s emissions to the satisfaction of the Technical Secretary.

3. (i) Responsible officials choosing to pay the annual fee based on actual emissions or a mixture of actual and allowable emissions may request an extension of time for filing the emissions analysis with the Technical Secretary. The extension may, for facilities paying fees on a calendar year

basis, be granted by the Technical Secretary for up to 90 days after the fee is due pursuant to subparagraph (a) of this paragraph. The extension may, for facilities paying fees on a fiscal year basis, be granted by the Technical Secretary for up to 60 days after the fee is due pursuant to subparagraph (a) of this paragraph. The request for extension must be received by the Division no later than 4:30 p.m. on April 1 or the request for extension shall be denied. The request for extension to file must state the reason for the request and provide an adequate explanation. An estimated annual fee payment of no less than 65% of the annual fee must accompany the request for extension to avoid penalties and interest on the underpayment of the annual fee. The remaining balance due must accompany the emission analysis. If there has been an overpayment, the responsible official may request a refund in writing to the Division or the amount of the overpayment may be applied as a credit toward the next annual fee.

(ii) A responsible official choosing to pay the annual fee based on allowable emissions is not eligible for the extension of time authorized by subpart (i) of this part.

(h) Reserved.

(i) Reserved.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 4-5-202, et seq.; 68-201-101, et seq.; 68-201-105, et seq.; and 68- 203-103, et seq.
• Administrative History: Original rule filed June 1, 1990; effective July 16, 1990. Repeal and new rule filed July 5, 1994; effective September 18, 1994. Amendment filed March 13, 1997; effective May 27, 1997. Amendment filed March 23, 1998; effective June 6, 1998. Amendment filed March 26, 1999; effective June 9, 1999. Amendment filed April 17, 2000; effective July 1, 2000. Amendment filed December 21, 2000; effective March 6, 2001. Amendment filed January 14, 2002; effective March 30, 2002. Amendment filed May 23, 2003; effective August 6, 2003. Amendment filed May 17, 2004; effective July 31, 2004. Amendment filed March 29, 2005; effective June 12, 2005. Amendment filed April 13, 2006; effective June 27, 2006. Amendment filed June 30, 2006; effective October 27, 2006. Amendment filed October 17, 2006; effective December 31, 2006. Amendment filed April 16, 2007; effective June 30, 2007. Amendment filed April 16, 2008; effective June 30, 2008. Amendment filed February 25, 2009; effective May 11, 2009. Amendment filed July 13, 2009; effective October 11, 2009. Amendment filed March 30, 2010; effective June 28, 2010. Amendments filed November 1, 2010; to have become effective January 30, 2011. On January 24, 2011, the Government Operations Committee voted to stay the amendments for 60 days; new effective date March 31, 2011. Amendment filed November 30, 2010; to have become effective February 28, 2011. On January 24, 2011, the Government Operations Committee voted to stay the amendment for 60 days; new effective date April 30, 2011. Amendment filed March 16, 2011; effective June 14, 2011. Amendments filed February 22, 2012; effective May 22, 2012. Amendment filed January 8, 2013; to have become effective April 8, 2013. However, the Government Operations Committee filed a 25-day stay of the rule’s effective date; new effective date May 3, 2013. Amendment filed January 8, 2014; effective April 8, 2014. Amendments filed January 6, 2016; effective April 5, 2016. Amendments filed March 7, 2016; effective June 5, 2016. Amendments filed May 17, 2017; effective August 15, 2017. Amendments filed October 10, 2017; effective January 8, 2018. Amendments filed January 11, 2018; effective April 11, 2018. Amendments filed January 15, 2020; effective April 14, 2020. Amendments filed December 20, 2021; effective March 20, 2022. Amendments filed September 29, 2022; effective December 28, 2022. Amendments filed December 4, 2023; effective March 3, 2024. Amendments filed September 16, 2024; effective December 15, 2024.

Tenn. Comp. R. & Regs. 1200-03-26-.03 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-1-1301; and 68-25-105.
• Administrative History: Original rule filed March 5, 1993; effective April 19, 1993. Amendment filed March 18, 1994; effective June 1, 1994. Amendment filed November 4, 1996; effective January 18, 1997. Repeal filed June 26, 2001; effective September 7, 2001.

Chapter 1200-03-27 Nitrogen Oxides

Tenn. Comp. R. & Regs. 1200-03-27-.01 DEFINITIONS

(1) For the purpose of this rule, the following definitions apply:

(a) “Facility” means any source or group of sources located within a contiguous area, and under common control.

(b) “Nitrogen Oxides” means all oxides of nitrogen except nitrous oxide.

(2) The definitions in Chapter 1200-03-02 apply for those terms not defined in Chapter 1200-03- 27.

History

• Authority: T.C.A. §§ 4-5-201, et seq. and 68-201-105.
• Administrative History: Original rule filed March 5, 1993; effective April 19, 1993.

Tenn. Comp. R. & Regs. 1200-03-27-.02 GENERAL PROVISIONS AND APPLICABILITY

(1) It is the purpose of this chapter to establish emission standards and requirements for certain sources of nitrogen oxides.

(2) Upon mutual agreement of any air contaminant source and the Technical Secretary, an emission limit more restrictive than that otherwise specified in this chapter may be established. Also, upon mutual agreement of any air contaminant source and the Technical Secretary, operating hours, process flow rates, or any other operating parameter may be established as a binding limit which the source must adhere to. Any items mutually agreed to shall be stated as a special condition for any permit or order concerning the source. Violation of this mutual agreement shall result in enforcement action.

(3) Nothing in this chapter shall be construed to exempt sources from meeting other applicable rules in this division and standards and requirement derived from or according to rules of this division, including, but not limited to, new source review requirements, permit conditions, and standards and requirements mutually agreed to or included in the State Implementation Plan.

(4) No owner or operator subject to these regulations may build, erect, install, or use any article, machine, equipment, process, or other method the use of which conceals emissions that would otherwise constitute non-compliance with an applicable regulation. This includes, but is not limited to, the use of gaseous diluents to achieve compliance, and the piecemeal carrying out of an operating to avoid coverage by a regulation that applies only to operations larger than a specified size.

(5) The owner or operator of a source for which legal notice must be published to effect a source-specific compliance method, compliance demonstration method, record keeping record, reporting record, etc., shall be responsible for all costs associated with publishing the required legal notice.

(6) The owner or operator of any facility in Anderson, Blount, Davidson, Knox, Rutherford, Shelby, Sumner, Williamson, or Wilson County which has actual emissions from stationary sources of 25 tons or more of volatile organic compounds (VOCs) and/or nitrogen oxides during a calendar year shall report to their permitting authority information and data concerning these emissions. This information and data shall be in the form prescribed by the Technical Secretary, and shall be submitted before March 31 of the year following the calendar year for which the information and data is reported. The first report shall be for the 1993 calendar year, and shall be submitted before March 31, 1994. Each report shall be signed by an official of the company, certifying that the information and data contained in the report is accurate to the best knowledge of the individual certifying the report.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed March 5, 1993; effective, April 19, 1993. Amendment filed April 18, 1994; effective July 2, 1994. Amendment filed May 10, 1994; effective July 24, 1994. Amendment filed August 14, 1995; effective October 28, 1995. Amendment filed September 9, 1996; effective November 23, 1996. Amendments filed June 6, 2018; effective September 4, 2018.

Tenn. Comp. R. & Regs. 1200-03-27-.03 STANDARDS AND REQUIREMENTS

(1) Emission standards for sources of nitrogen oxides apply as follows:

(a) Any owner or operator of a stationary source in Davidson, Rutherford, Sumner, Williamson, or Wilson County which emits or has the potential to emit 100 tons per year or more of nitrogen oxides (NOx) before control shall apply reasonably available control technology (RACT) to control NOx emissions from that source; and (b) Specifically, the owner or operator of a tangentially fired coal burning boiler having heat input capacity in excess of 600 million BTU per hour in Davidson, Rutherford, Sumner, Williamson, or Wilson County shall not allow emissions of nitrogen oxides from that boiler in excess of 0.45 pound per million BTU (30-day rolling average) (RACT).

(2) In calculation to determine whether the 100-ton-per-year threshold specified in subparagraph (1)(a) of this rule is met, the nitrogen oxides contribution from all process emissions sources and fuel burning equipment, including those sources and that equipment listed for exemption in paragraph (4) of this rule, shall be totaled.

(3) Compliance schedules apply as follows:

(a) The owner or operator of a boiler subject to the requirements of subparagraph (1)(b) of this rule shall:

1. Submit a final control plan, acceptable to the Technical Secretary, for the installation of nitrogen oxides emission control systems and/or modifications of fuel burning equipment to the Technical Secretary by April 26, 1994;

2. Complete construction or installation of equipment by May 31, 1995; and 3. Demonstrate full compliance with nitrogen oxides reasonably available control technology by July 31, 1995, using approved test methods and procedures; and (b) The owner or operator of any process emission source or fuel burning equipment subject to the requirements of subparagraph (1)(a) but not subparagraph (1)(b) of this

rule shall either:

1. Satisfy the schedule as follows:

(i) Submit a demonstration of appropriate reasonably available control technology by February 25, 1994;

(ii) Submit a final control plan, acceptable to the Technical Secretary, for the installation of nitrogen oxides emission control systems and/or modifications of the source or equipment to the Technical Secretary by April 26, 1994;

(iii) Complete construction or installation of equipment by May 31, 1995; and (iv) Demonstrate full compliance with nitrogen oxides reasonably available control technology by July 31, 1995, using approved test methods and procedures; or 2. In lieu of satisfying the schedule specified in part 1. of this subparagraph, satisfy the schedule as follows:

(i) By February 25, 1994, submit a demonstration, acceptable to the Technical Secretary, that reasonably available control technology for nitrogen oxides from the process emission source or fuel burning equipment according to the schedule specified in part 1. of this subparagraph is not practicable, for example, due to equipment unavailability or system unreliability;

(ii) Within 60 days after approval by the Technical Secretary of this demonstration, submit a schedule, acceptable to the Technical Secretary, containing dates for accomplishment on the process emission source or fuel burning equipment of the steps listed in the schedule specified in part 1. of this subparagraph; and (iii) Satisfy the schedule approved by the Technical Secretary.

(4) The reasonably available control technology requirements of this rule shall not apply to any of the following:

(a) A process emission source or fuel burning installation which neither emits nor has the potential to emit one ton or more per year of nitrogen oxides before control;

(b) Fuel burning equipment or a component of a process emission source which does not operate between April 1 and October 31; or (c) An air pollution control device which is installed to effect compliance with a requirement of other chapters of Division 1200-03.

History

• Authority: T.C.A. §§ 4-5-201, et seq. and 68-201-105.
• Administrative History: Original rule filed September 7, 1993; effective November 27, 1993.

Tenn. Comp. R. & Regs. 1200-03-27-.04 STANDARDS FOR CEMENT KILNS

(1) The requirements of this rule apply only to kilns with process rates of at least the following:

(a) Long dry kilns------------12 tons per hour (TPH);

(b) Long wet kilns------------10 TPH;

(c) Preheater kilns------------16 TPH; and (d) Precalciner and preheater/precalciner kilns--------22 TPH.

(2) For the purpose of this rule, definitions apply as follows:

(a) “Clinker” means the product of a Portland cement kiln from which finished cement is manufactured by milling and grinding.

(b) “Long dry kiln” means a kiln 14 feet or larger in diameter, 400 feet or greater in length, which employs no preheating of the feed. The inlet feed to the kiln is dry.

(c) “Long wet kiln” means a kiln 14 feet or larger in diameter, 400 feet or greater in length, which employs no preheating of the feed. The inlet feed to the kiln is a slurry.

(d) “Low-NOx burners” means combustion equipment designed to reduce flame turbulence, delay fuel/air mixing, and establish fuel-rich zones for initial combustion.

(e) “Mid-kiln system firing” means secondary firing in kiln systems by injecting fuel at an intermediate point in the kiln system using a specially designed fuel injection mechanism for the purpose of decreasing nitrogen oxide (NOx) emissions through:

1. Burning part of the fuel at a lower temperature; and 2. Reducing conditions at the fuel injection point that may destroy some of the NOx formed upstream in the kiln burning zone.

(f) “Portland cement” means a hydraulic cement produced by ssentially of hydraulic calcium silicates, usually containing one or more of the forms of calcium sulfate as an interground addition.

(g) “Portland cement kiln” means a system, including any solid, gaseous or liquid fuel combustion equipment, used to calcine and fuse raw materials, including limestone and clay, to produce Portland cement clinker.

(h) “Precalciner kiln” means a kiln system where the feed to the kiln is preheated in cyclone chambers and utilizes a second burner to calcine material in a separate vessel attached to the preheater prior to the final fusion in a kiln which forms clinker.

(i) “Preheater kiln” means a kiln system where the feed to the kiln is preheated in cyclone chambers prior to the final fusion in a kiln which forms clinker.

(3) After May 31, 2004, the owner or operator of any Portland cement kiln subject to this rule shall not operate the kiln during May 1 through September 30 unless the kiln has installed and operates during May 1 to September 30 with at least one of the following:

(a) Low-NOx burners;

(b) Mid-kiln system firing;

(c) Alternative control techniques approved by the Technical Secretary and the EPA as achieving at least the same emissions decreases as with low-NOx burners or mid-kiln system firing; or (d) Reasonably available control technology approved by the Technical Secretary and the EPA.

(4) The owner or operator subject to the requirements of paragraph (3) of this rule shall comply with the requirements as follows:

(a) By May 31, 2004, submit to the Technical Secretary the identification number and type of each kiln subject to this rule, the name and address of the facility where the kiln is located, and the name and telephone number of the person responsible for demonstrating compliance with paragraph (3); and (b) By October 31, 2004, submit to the Technical Secretary a report documenting for that kiln the total NO x emissions from May 31, 2004, through September 30, 2004, and beginning in 2005 submit by October 31 of each year to the Technical Secretary a report documenting NOx emissions from May 1 through September 30 of that year.

(5) By May 31, 2004, the owner or operator of a kiln subject to this rule shall submit to the Technical Secretary a demonstration of compliance with the requirements of paragraph (3). If compliance is being achieved by use of prescribed equipment, for example low-NOx burners or mid-kiln system firing, the demonstration of compliance shall be written certification to the Technical Secretary that this equipment is installed and is in use. If compliance is being achieved by use of alternative control techniques approved by the Technical Secretary and the EPA, demonstration of compliance shall as specified by the Technical Secretary and the EPA. In the case of compliance proposed to be achieved by use of alternative control techniques, a plan for compliance demonstration shall be submitted to the Technical Secretary by May 1, 2003. Upon receipt the Technical Secretary shall immediately forward a copy of the plan to the EPA. By November 1, 2003, the Technical Secretary shall specify in writing to the owner or operator of the kiln how compliance shall be demonstrated, this specification consistent with methods and requirements specified by the EPA following its review of the submitted plan.

(6) By December 31 of each year, beginning in 2004, the owner or operator of a kiln subject to this rule shall submit to the Technical Secretary a written certification that compliance with the requirements of paragraph (3) has been maintained during that year’s five-month period May 1 through September 30, except for 2004 when compliance is to be maintained from May 31 through September 30. The methods of determining that this compliance has been maintained shall be as specified on the major source operating permit issued for the facility at which the kiln is operated.

(7) Beginning May 31, 2004, the owner or operator of a kiln subject to this rule shall maintain records for May 31 through September 30 of that year, and in subsequent years for May 1 through September 30, that include the data as follows:

(a) The date, time, and duration of any startup, shutdown, or malfunction in the operation of the cement kiln or its emissions monitoring equipment or of any scheduled maintenance activity that affects NOx emissions or emissions monitoring;

(b) The results of any compliance testing; and (c) Other data required by permit to be maintained.

(8) The records listed in paragraph (7) of this rule shall be retained on-site for a minimum of 2 years following the calendar year for which they are made and shall be made available to the Technical Secretary for his review upon request.

(9) The requirements of this rule shall not apply to periods of scheduled maintenance activities that affect NOx emissions.

(10) The requirements of this rule shall not apply to periods of malfunctions, startups, and shutdowns. These periods are subject to the requirements of Chapter 1200-03-20.

History

• Authority: T.C.A. §§ 4-5-201, et seq. and 68-201-105.
• Administrative History: Original rule filed July 9, 2001; effective September 22, 2001.

Tenn. Comp. R. & Regs. 1200-03-27-.05 RESERVED

History

• Authority: T.C.A. §§ 4-5-201, et seq. and 68-201-105.
• Administrative History: Original rule filed July 9, 2001; effective September 22, 2001.

Tenn. Comp. R. & Regs. 1200-03-27-.06 RESERVED

History

• Authority: T.C.A. §§ 4-5-201, et seq. and 68-201-101, et seq.
• Administrative History: Original rule filed July 9, 2001; effective September 22, 2001. Amendment filed May 13, 2003; effective July 27, 2003. Amendment filed August 5, 2003; effective October 19, 2003. Amendment filed October 10, 2012; effective January 8, 2013.

Tenn. Comp. R. & Regs. 1200-03-27-.07 REPEALED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed September 11, 2003; effective November 25, 2003. Repeal filed September 8, 2025; effective December 7, 2025.

Tenn. Comp. R. & Regs. 1200-03-27-.09 COMPLIANCE PLANS FOR NO

X EMMISSIONS FROM STATIONARY INTERNAL

COMBUSTION (IC) ENGINES.

(1) For the purposes of this rule, the following definitions shall apply:

(a) “Affected Engine” means any stationary IC engine that is a Large NOx SIP Call Engine, or other stationary IC engine that is subject to NOx control under a compliance plan established pursuant to paragraph (3) of this rule.

(b) “Engine Seasonal NOx 2007 Tonnage Reduction” means the year 2007 seasonal NOx emissions reductions value (tons) for a Large NOx SIP Call Engine which is calculated as the difference between the 2007 Ozone Season Base NOx Emissions and the 2007 Ozone Season Budget NOx Emissions contained in the NOx SIP Call Engine Inventory.

(c) “Facility Seasonal NOx 2007 Tonnage Reduction” means the total of the Engine Seasonal NOx 2007 Tonnage Reductions attributable to all of an owner/operator’s Large NOx SIP Call Engines.

(d) “Large NOx SIP Call Engine” means a stationary IC engine identified and designated as “large” in the NOx SIP Call Engine Inventory as emitting more than one ton of NOx per average ozone season day in 1995.

(e) “NOx SIP Call Engine Inventory” means the inventory of IC engines compiled by EPA as part of the NOx SIP Call Rule, including the Technical Amendments (Federal Register/Vol. 65, No. 42/March 2, 2000, Technical Amendment to the Finding of Significant Contribution and Rulemaking for Certain States for Purposes of Reducing Regional Transport of Ozone), and the adjustment of the 2007 Budget NOx Control Efficiency to 82 percent for large gas-fired engines (Federal Register/Vol. 69, No. 77/April 21, 2004, Interstate Ozone Transport: Response to Court Decisions on the NOx SIP Call, NOx SIP Call Technical Amendments, and Section 126 Rules).

(f) “Past NOx Emission Rate” means the emission rate of an Affected Engine in grams per brake horsepower-hour (g/bhp-hr) as determined by performance testing consistent with the requirements of 40 CFR part 60, Appendix A. Where such performance test data are not available, the Past NOx Emission Rate may be determined by the Technical Secretary on a case-by-case basis using, for example, appropriate emission factors or data from the NOx SIP Call Engine Inventory. For Large NOx SIP Call Engines, the Past NOx Emission Rate is the uncontrolled emission rate.

(g) “Projected Operating Hours” means the projected actual number of hours of operation per ozone season for an Affected Engine.

(h) “Projected NOx Emission Rate” means the projected emission rate in g/bhp-hr after installation of controls on an Affected Engine.

(i) “Stationary internal combustion engine” means any internal combustion engine of the reciprocating type that is either attached to a foundation at a facility or is designed to be capable of being carried or moved from one location to another and remains at a single site at a building, structure, facility, or installation for more than 12 consecutive months.

Any engine (or engines) that replaces an engine at a site that is intended to perform the same or similar function as the engine replaced is included in calculating the consecutive time period.

(j) “Ozone season” means the period from May 1 through September 30.

(2) The requirements of this rule apply to the owner or operator of any Large NOx SIP Call Engine.

(3) (a) After May 1, 2007, an owner or operator of a Large NOx SIP Call Engine shall not operate the engine in the period May 1 through September 30 of 2007 and any subsequent year unless the owner or operator complies with the requirements of a compliance plan which meets the provisions listed below.

1. The compliance plan must be approved by the Technical Secretary.

2. The compliance plan must demonstrate enforceable emission reductions from one or more stationary internal combustion engines equal to or higher than the Facility Seasonal NOx 2007 Tonnage Reduction.

3. The compliance plan may cover some or all engines at an individual facility or at several facilities or at all facilities in Tennessee that are in control of the same owner/operator.

4. The compliance plan must be submitted to the Technical Secretary by May 1, 2006.

5. The compliance plan may include credit for decreases in NOx emissions from Large NOx SIP Call Engines in Tennessee due to NOx control equipment. Credit may also be included for decreases in NOx emissions from other engines in Tennessee due to NOx control equipment not reflected in the 2007 Ozone Season Base NOx Emissions in the NOx SIP Call Engine Inventory.

6. The compliance plan must include the following items:

(i) List of engines subject to the plan, including the engine’s manufacturer, model, facility location address, and facility identification number.

(ii) The projected ozone season hours of operation for each engine and supporting documentation.

(iii) A description of the NOx emissions control installed, or to be installed, on each engine and documentation to support the Projected NOx Emission Rates.

(iv) The Past and Projected NOx Emission Rates for each Affected Engine in g/bhp-hr.

(v) A numerical demonstration that the emission reductions obtained from all engines included under the plan will be equivalent to or greater than the owner/operator’s Facility Seasonal NOx 2007 Tonnage Reduction, based on the difference between the Past NOx Emission Rate and the Projected NOx Emission Rate multiplied by the Projected Operating Hours for each Affected Engine, and taking into account any credit under part (3)(a)5. of this paragraph.

(vi) Provisions for monitoring, reporting and recordkeeping for each Affected Engine.

(b) The Projected NOx Emission Rate in g/bhp-hr or lb/hr for each Affected Engine must be included in a federally enforceable permit.

(4) Any owner or operator subject to the requirements of paragraph (3) shall comply with the following reporting, monitoring, and recordkeeping requirements:

(a) Monitoring requirements. Each Affected Engine subject to this rule shall comply with the following requirements.

1. Complete an initial performance test consistent with the requirements of 40 CFR

part 60, Appendix A, following installation of emission controls required to achieve the emission rate limit specified in subparagraph (3)(b) of this rule.

2. Perform periodic monitoring sufficient to yield reliable data from the relevant time period that is representative of a source’s compliance with the emission rate limit specified in subparagraph (3)(b) of this rule. Such periodic monitoring may include either:

(i) Performance tests consistent with the requirements of 40 CFR part 60,

Appendix A, or portable monitors using ASTM D6522-00;

(ii) A parametric monitoring program that specifies operating parameters, and their ranges, that will provide reasonable assurance that each engine’s emissions are consistent with the requirements of paragraph (3) of this

rule;

(iii) A predictive emissions measurement system that relies on automated data collection from instruments; or (iv) A continuous emission monitoring system that complies with 40 CFR parts 60 or 75.

(b) Recordkeeping requirements.

1. Maintain all records necessary to demonstrate compliance with the requirements of this rule for a period of 2 calendar years at the plant at which the subject engine is located. The records shall be made available to the Technical Secretary and EPA upon request.

2. For each engine subject to the requirements of this rule, the owner or operator shall maintain records of:

(i) Identification and location of each engine subject to the requirements of this rule.

(ii) Calendar date of record.

(iii) The number of hours the unit is operated during each ozone season compared to the Projected Operating Hours.

(iv) Type and quantity of fuel used.

(v) The results of all compliance tests.

(c) Reporting requirements. Any owner or operator subject to the requirements of this rule shall submit results of all compliance tests to the Technical Secretary.

History

• Authority: T.C.A. §§ 4-5-201, et seq. and 68-201-105.
• Administrative History: Original rule filed August 31, 2005; effective November 14, 2005.

Tenn. Comp. R. & Regs. 1200-03-27-.10 RESERVED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: New rule filed August 10, 2006; effective October 24, 2006. Amendments filed November 21, 2016; effective February 19, 2017.

Tenn. Comp. R. & Regs. 1200-03-27-.11 RESERVED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: New rule filed August 10, 2006; effective October 24, 2006. Amendment filed July 6, 2009; effective October 4, 2009. Amendments filed November 21, 2016; effective February 19, 2017.

Tenn. Comp. R. & Regs. 1200-03-27-.12 NO

X SIP CALL REQUIREMENTS FOR STATIONARY BOILERS AND COMBUSTION

TURBINES.

(1) Definitions. The terms used in this rule shall have the meanings set forth in this paragraph as follows:

(a) “Administrator” means the Administrator of the United States Environmental Protection Agency or the Administrator’s duly authorized representative.

(b) “Affected facility” means the group of all affected units at a facility.

(c) 1. “Affected unit” means any unit identified as an existing affected unit in subparagraph (n) of this paragraph and any unit that has the following characteristics:

(i) The unit’s maximum design heat input is greater than 250 MMBtu/hr;

(ii) The unit combusts, or will combust during any year, fossil fuel in the following amounts:

(I) Alone or in combination with any other fuel, where fossil fuel actually combusted comprises more than 50 percent of the annual heat input on a Btu basis during any year starting in 1995 or, if a unit had no heat input starting in 1995, during the last year of operation of the unit prior to 1995; or (II) Alone or in combination with any other fuel, where fossil fuel is projected to comprise more than 50 percent of the annual heat input on a Btu basis during any year; and (iii) The unit:

(I) Does not serve a generator producing electricity for sale at any time; or (II) Serves a generator producing electricity for sale at any time and qualifies under 40 CFR § 72.6(b)(4) as an unaffected unit under the Acid Rain Program.

2. Notwithstanding part 1. of this subparagraph, any unit subject to 40 CFR 97

subpart EEEEE (CSAPR NO X Ozone Season Group 2 Trading Program) shall not be an affected unit.

(d) “Allocate” or “allocation” means the determination by the Technical Secretary of the amount of allowances to be credited to an affected facility.

(e) “Allowance” (or “NO X allowance”) means a limited authorization issued by the Technical Secretary to emit one ton of nitrogen oxides (“NOx”) during a control period of a specified calendar year or of any calendar year thereafter.

(f) “Boiler” means an enclosed fossil- or other-fuel-fired combustion device used to produce heat and to transfer heat to recirculating water, steam, or other medium.

(g) “Clean Air Act” or “CAA” means the Clean Air Act, 42 U.S.C. § 7401, et seq.

(h) “Combustion turbine” means:

1. An enclosed device comprising a compressor, a combustor, and a turbine and in which the flue gas resulting from the combustion of fuel in the combustor passes through the turbine, rotating the turbine; and 2. If the enclosed device under part 1. of this subparagraph is combined cycle, any associated duct burner, heat recovery steam generator, and steam turbine.

(i) “Commence operation” means the later of November 15, 1990, or the date the unit begins any mechanical, chemical, or electronic process, including, with regard to a unit, start-up of a unit’s combustion chamber.

1. For a unit that commences operation as defined in this subparagraph, and that subsequently undergoes a physical change (other than replacement of the unit by a unit at the same source), such date shall remain the date of commencement of operation of the unit, which shall continue to be treated as the same unit.

2. For a unit that commences operation as defined in this subparagraph, and that is subsequently replaced by a unit at the same source (e.g., repowered), such date shall remain the replaced unit’s date of commencement of operation, and the replacement unit shall be treated as a separate unit with a separate date for commencement of operation.

(j) “Compliance deadline” means, for a control period, midnight of December 1 (if it is a business day), or midnight of the first business day thereafter (if December 1 is not a business day) immediately following the control period.

(k) “Control period” or “ozone season” means the period beginning May 1 of a calendar year and ending on September 30 of the same year, inclusive.

(l) “Emissions” means air pollutants exhausted from a unit or source into the atmosphere, as measured, recorded, and reported to the Technical Secretary by the Responsible Official in accordance with paragraph (11) of this rule.

(m) “Excess emissions” means any ton of nitrogen oxides emitted by an affected facility during a control period that exceeds the total number of allowances allocated to an affected facility for a control period.

(n) “Existing affected unit” means the following units:

Packaging Corporation of America Unit 17 Tate & Lyle, Loudon Units 34 and 35 Resolute FP US, Inc. Units 11 and 12 Eastman Chemical Company Units 83-23 and 83-24; Units 253-25, Units 253-26, Units 253-27, Units 253-28, and Units 253-29; Units 325-30 and 325- The Valero Refining Company - Tennessee, LLC Unit P049 TVA Cumberland Startup Boilers A1 and A2 (o) “Fossil-fuel-fired” means, with regard to an affected unit, combusting any amount of fossil fuel (coal, natural gas, petroleum, or any form of solid, liquid, or gaseous fuel derived from such material) in any calendar year.

(p) “Heat input” means, with regard to a specified period of time, the product of the gross calorific value of the fuel (in Btu/lb) divided by 1,000,000 Btu/MMBtu and multiplied by the fuel feed rate into a combustion device (in pounds of fuel per unit of time), as measured and recorded in accordance with paragraph (11) of this rule. Heat input does not include the heat derived from preheated combustion air, recirculated flue gases, or exhaust from other sources.

(q) “Maximum design heat input” means the maximum amount of fuel per hour (in MMBtu/hr) that a unit is capable of combusting on a steady state basis as of the initial installation of the unit as specified by the manufacturer of the unit.

(r) “Most stringent state or federal NO X emissions limitation” means, with regard to a unit, the lowest NO X emissions limitation (in terms of lb/MMBtu) that is applicable to the unit under state or federal law, regardless of the averaging period to which the emissions limitation applies.

(s) “New affected unit” means any affected unit that is not an existing affected unit.

(t) “Operator” means any person who operates, controls, or supervises an affected unit or an affected facility and shall include, but not be limited to, any holding company, utility system, or plant manager of such a unit or source.

(u) “Owner” means any of the following persons:

1. Any holder of any portion of the legal or equitable title in an affected facility or an affected unit; or 2. Any holder of a leasehold interest in an affected facility or an affected unit.

(v) “Receive” or “receipt of” means, when referring to the Technical Secretary or the Administrator, to come into possession of a document, information, or correspondence (whether sent in hard copy or by authorized electronic transmission), as indicated in an official log, or by a notation made on the document, information, or correspondence, by the Technical Secretary or the Administrator in the regular course of business.

(w) “Replacement”, “replace”, or “replaced” means, with regard to a unit, the demolishing of a unit, or the permanent shutdown and permanent disabling of a unit, and the construction of another unit (the replacement unit) to be used instead of the demolished or shutdown unit (the replaced unit).

(x) “Responsible Official” has the same meaning as defined by Rule 1200-03-09-.02(11); however, a designated representative as defined by 40 CFR part 72, relative to actions, standards, requirements, or prohibitions under Title IV of the Clean Air Act or the regulations promulgated thereunder, including 40 CFR part 75, may also serve as the Responsible Official for any purposes under this rule.

(y) “Source” means all buildings, structures, or installations located in one or more contiguous or adjacent properties under common control of the same person or persons. For purposes of section 502(c) of the Clean Air Act, a “source,” including a “source” with multiple units, shall be considered a single “facility.”

(z) 1. “Submit” or “serve” means to send or transmit a document, information, or correspondence to the person specified in accordance with the applicable rule:

(i) In person;

(ii) By United States Postal Service; or (iii) By other means of dispatch or transmission and delivery.

2. Compliance with any “submission” or “service” deadline shall be determined by the date of dispatch, transmission, or mailing and not the date of receipt.

(aa) “Technical Secretary” means the Technical Secretary of the Tennessee Air Pollution Control Board or a duly authorized representative.

(bb) “Ton” means 2,000 pounds. For the purpose of determining compliance with the ozone season NO X emissions limitation, total tons of nitrogen oxides emissions for a control period shall be calculated as the sum of all recorded hourly emissions (or the mass equivalent of the recorded hourly emission rates) in accordance with paragraph (11) of this rule, but with any remaining fraction of a ton equal to or greater than 0.50 tons deemed to equal one ton and any remaining fraction of a ton less than 0.50 tons deemed to equal zero tons.

(cc) “Unit” means a stationary, fossil-fuel fired boiler or combustion turbine or other stationary, fossil-fuel-fired combustion device.

(2) Measurements, abbreviations, and acronyms. Measurements, abbreviations, and acronyms used in this rule are defined as follows:

Btu - British thermal unit CO - carbon dioxide H O - water hr - hour lb - pound MMBtu - million Btu NO X - nitrogen oxides O - oxygen ppm - parts per million scfh - standard cubic feet per hour SO - sulfur dioxide (3) Applicability. Except as otherwise exempted by this rule, the provisions of this rule shall apply to each affected unit and each affected facility.

(4) Retired unit exemption.

(a) 1. Any affected unit that is permanently retired shall be exempt from this rule, except for the provisions of this paragraph and paragraphs (1), (2), (3), (6), subparagraphs (7)(c) through (f), and paragraphs (8) and (9) of this rule.

2. The exemption under part 1. of this subparagraph shall become effective the day on which the affected unit is permanently retired. Within 30 days of the unit’s permanent retirement, the Responsible Official shall submit a report to the Technical Secretary and shall submit a copy of the statement to the Administrator. The report shall state, in a format prescribed by the Technical Secretary, that the unit was permanently retired on a specific date and that the unit will comply with the requirements of subparagraph (b) of this paragraph. The report shall include a signed statement by the Responsible Official certifying the truth, accuracy, and completeness of the information provided in the report.

(b) Special provisions.

1. An affected unit exempt under subparagraph (a) of this paragraph shall not emit any nitrogen oxides during a control period, starting on the date that the exemption takes effect.

2. For a period of 5 years from the date the records are created, the owners and operators of a unit exempt under subparagraph (a) of this paragraph shall retain, at the source that includes the unit, records demonstrating that the unit is permanently retired. The 5-year period for keeping records may be extended for cause, at any time before the end of the period, in writing by the Technical Secretary or the Administrator. The owners and operators of the unit bear the burden of proof that the unit is permanently retired.

3. Owners and operators shall comply with the requirements of this rule during all periods for which the exemption is not in effect.

(c) An exempt unit shall lose its exemption on the date on which the unit resumes operation.

(d) For the purpose of applying the monitoring, recordkeeping, and reporting requirements of paragraph (11) of this rule, a unit that loses its exemption under subparagraph (a) of this paragraph shall be treated as a unit that commences operation on the first date on which the unit resumes operation.

(5) State emissions budget. The state emissions budget for allowance allocations to affected units is 5,666 tons per control period for the control period in 2017 and thereafter.

(6) Allowance allocations for affected units:

(a) For each control period in 2017 and thereafter, the Technical Secretary will allocate NOx allowances in the amounts specified in the State Implementation Plan to all existing affected units.

(b) For new affected units, the heat input (in MMBtu) used for calculating NO X allowance allocations shall be determined in accordance with 40 CFR part 75, to the extent that the unit was subject to the requirements of 40 CFR part 75 for the year, or based on the best available data reported to the Technical Secretary for the unit.

(c) For each control period in 2017 and thereafter, the Technical Secretary will allocate allowances to new affected units in accordance with the following procedures:

1. The Technical Secretary will establish a new unit set-aside for each control period. For each control period, the new unit set-aside is established as the State emission budget established in paragraph (5) of this rule minus the number of NO X allowances allocated in subparagraph (a) of this paragraph.

2. The Responsible Official of a new affected unit may request NO X allowances from the Technical Secretary starting with the later of the control period in 2017 or the first control period in which the affected unit commences operation as provided in this part.

(i) The Responsible Official may request allowances for a control period in an amount not exceeding any of the following emission rates:

(I) The allowable NOx emission rate under any applicable provision of 40 CFR part 60;

(II) The allowable NO X emission rate under any state or federal construction or operating permit; and (III) The allowable NO X emission rate under any provision in Tennessee’s State Implementation Plan.

(ii) The emission rates indicated in items (i)(I) through (III) of this part shall be converted to tons as follows:

(I) For units with four years of heat input data, the emission rate shall be multiplied by the average of the three highest years of heat input (of the most recent four-year period) as indicated in subparagraph (b) of this paragraph divided by 2,000, and rounded to the nearest whole number as appropriate.

(II) For units with less than four years of heat input data, the emission rate shall be multiplied by the unit’s maximum design heat input in MMBtu/hr, multiplied by 3,672 hours per control period, divided by 2,000, and rounded to the nearest whole number as appropriate.

3. The Technical Secretary will review each allowance allocation request and allocate NO X allowances for each control period as follows:

(i) The Technical Secretary will accept an allowance allocation request only if the request meets, or is adjusted by the Technical Secretary as necessary to meet, the requirements of part 2. of this subparagraph.

(ii) On or after February 1 before the control period, the Technical Secretary will determine the sum of NO X allowances requested under subpart (i) of this part for the control period.

(iii) If the amount of NO X allowances in the new unit set-aside for the control period is greater than or equal to the sum of NO X allowances requested, then the Technical Secretary will allocate the amount of NO X allowances requested to each new affected unit.

(iv) If the amount of NO X allowances in the new unit set-aside for the control period is less than the sum of NO X allowances requested, then the Technical Secretary will allocate to each new affected unit the amount of allowances requested, multiplied by the amount of allowances in the new unit set-aside for the control period, divided by the sum of NO X allowances requested, and rounded to the nearest whole allowance as appropriate.

(v) The Technical Secretary will notify each Responsible Official that submitted an allowance allocation request of the amount of allowances (if any) allocated for the control period to the affected unit covered by the request.

(vi) After completion of the procedures specified in subparts (i) through (v) of this part, the Technical Secretary will allocate NOx allowances remaining in the new unit set-aside to existing affected units, using the following formula and rounding to the nearest whole NOx allowance as appropriate:

Unit’s share of NOx allowances = (Total NOx allowances remaining in new unit set-aside) x (Unit’s NOx allowance allocation) ÷ (State trading program budget excluding new unit set-aside).

(d) Adjustment of allowance allocations for new and existing affected units. The Technical Secretary may, after appropriate notice and comment, adjust the allowance allocations for new and existing affected units as necessary to comply with applicable requirements promulgated by the Administrator or to provide additional allowances for new construction.

(7) NO

X emission requirements.

(a) As of the compliance deadline for a control period, the tons of total nitrogen oxides emissions for the control period from all affected units at an affected facility, as determined in accordance with paragraph (11) of this rule, shall not exceed the number of allowances allocated to the affected facility.

1. Allowances are available to an affected facility for a given control period only if the allowances were allocated to the affected facility for the same control period.

2. An affected unit shall be subject to the requirements of this paragraph for the control period starting on the later of May 1, 2017, or the deadline for meeting the unit’s monitor certification requirements under paragraph (11) of this rule, and for each control period thereafter.

(b) Recordkeeping and reporting requirements.

1. The owners, operators, and Responsible Official of each affected facility and each affected unit shall comply with the recordkeeping and reporting requirements of this subparagraph.

2. The emissions measurements recorded and reported in accordance with paragraph (11) of this rule shall be used to determine compliance of each affected facility with the requirements of this paragraph.

3. Unless otherwise provided, the owners and operators of the affected facility shall maintain the following documents at the affected facility location for a period of 5 years from the date the document is created. This period may be extended for cause, at any time before the end of 5 years, in writing by the Technical Secretary or the Administrator.

(i) All emissions monitoring information, in accordance with paragraph (11) of this rule, provided that to the extent that paragraph (11) of this rule provides for a 3-year period for recordkeeping, the 3-year period shall apply.

(ii) Copies of all reports, compliance certifications, and other submissions and all records made or required under this paragraph.

(iii) Copies of any other submission used to demonstrate compliance with this paragraph.

4. Reserved.

(c) Excess emissions requirements. If an affected facility emits nitrogen oxides during any control period in excess of the number of allowances allocated to the affected facility, then:

1. The Technical Secretary may deduct allowances from the affected facility’s allocation for the following control period, in an amount up to 3 times the number of tons of the facility’s excess emissions;

2. The affected facility shall pay any fine, penalty, or assessment, or comply with any other remedy imposed, for the same violations, under the Clean Air Act or applicable state law; and 3. Each ton of such excess emissions and each day of such control period shall constitute a separate violation of this rule, the Clean Air Act, and applicable state law.

(d) Liability.

1. Each affected facility and each affected unit shall meet the requirements of this

rule.

2. Any provision of this rule that applies to an affected facility, an affected unit, or a Responsible Official shall also apply to the owners and operators of such affected facility or affected unit.

3. Any person who knowingly violates any requirement or prohibition of this rule shall be subject to enforcement pursuant to applicable state or federal law.

4. Any person who knowingly makes a false material statement in any record, submission, or report required by this rule shall be subject to criminal enforcement pursuant to the applicable state or federal law.

(e) Effect on other authorities. No provision of this rule shall be construed as exempting or excluding the owners and operators and the Responsible Official of an affected facility or an affected unit from compliance with any other provision of the applicable, approved State Implementation Plan, a federally enforceable permit, or the Clean Air Act.

(f) An allowance does not constitute a property right.

(8) Computation of time.

(a) Unless otherwise stated, any time period scheduled under this rule to begin on the occurrence of an act or event shall begin on the day the act or event occurs.

(b) Unless otherwise stated, any time period scheduled under this rule to begin before the occurrence of an act or event shall be computed so that the period ends the day before the act or event occurs.

(c) Unless otherwise stated, if the final day of any time period under this rule falls on a weekend or a state or federal holiday, the time period shall be extended to the next business day.

(9) Technical Secretary’s action on submissions.

(a) The Technical Secretary may review and conduct independent audits concerning any submission under this rule and make appropriate adjustments of the information in the submissions.

(b) The Technical Secretary may deduct allowances from or transfer allowances to an affected facility based on the information in the submissions.

(10) The Technical Secretary may, at his or her sole discretion and on his or her own motion, correct any error in the allocation of any affected facility. Within 10 business days of making such correction, the Technical Secretary will notify the Responsible Official for the affected facility.

(11) Monitoring and reporting.

(a) Owners, operators, and Responsible Officials of affected units shall implement a monitoring and reporting system sufficient to attribute ozone season NO X mass emissions to each unit. The applicable monitoring, recordkeeping, and reporting requirements set out in 40 CFR Part 75 Subpart H, shall be the required monitoring method for all affected units unless and until an approved alternative monitoring method is incorporated into a federally enforceable construction or operating permit issued for the affected unit, at which time that approved monitoring method shall be the required monitoring method for the unit. NO X mass emissions measurements recorded and reported in accordance with an approved monitoring method implemented pursuant to this subparagraph shall be used to determine compliance with the NO X budgets allocated in accordance with paragraph (6) of this rule. For sources that monitor in accordance with 40 CFR Part 75 Subpart H, or a monitoring alternative for which EPA authorizes direct reporting to EPA pursuant to 40 CFR Part 75, the Responsible Official shall be authorized as provided in, and shall certify each submission and may delegate the Responsible Official’s authority in accordance with, 40 CFR 72 subpart B. The approved alternative monitoring methods are:

1. 40 CFR 60 Subpart D to determine NOx emission rate in lb/MMBtu, multiplied by measured fuel consumption in MMBtu to determine NOx mass emissions;

2. 40 CFR 60 Subpart Db to determine NOx emission rate in lb/MMBtu, multiplied by measured fuel consumption in MMBtu to determine NOx mass emissions; or 3. An alternative monitoring method approved by EPA in a revision to the State Implementation Plan. Alternative methodologies must address monitoring, recordkeeping, and reporting procedures, including direct reporting of NO X emissions to the Technical Secretary for each control period.

(b) Reserved.

(c) An application submitted to the Technical Secretary for a construction or operating permit requesting to use an alternative monitoring method listed in part (a)1. or (a)2. of this paragraph shall include a description of the overall monitoring program for conducting continuous in-stack monitoring for NOx mass emissions. To be approvable, the program must address the following:

1. Specifications demonstrating that the proposed monitoring instruments will meet the requirements of 40 CFR 60, Appendix B;

2. Specifications for the proposed fuel flow meter and a discussion of how the fuel Btu content will be determined;

3. Proposed location(s) of the monitoring instruments in the effluent gas stream;

4. Proposed procedures for conducting performance specification testing of the monitoring instruments in units of the applicable standard;

5. Proposed ongoing monitoring instrument quality assurance procedures;

6. Procedures for addressing missing data; and 7. Proposed format for the reporting of data.

(d) An affected facility or affected unit monitoring in accordance with parts (a)1., (a)2., or (a)3. of this paragraph must directly report NO X emissions to the Technical Secretary for each control period and may not report directly to EPA under 40 CFR Part 75 unless EPA expressly authorizes such reporting when approving a source-specific SIP revision.

(e) For each control period, the approved monitoring method in effect at midnight on the first day (May 1) of a control period shall be used for the entire control period.

(f) No later than January 31 following the end of each control period, the Technical Secretary will report to the Administrator the total NOx mass emissions (in tons) from affected units subject to this rule and certify compliance with the NOx budget established by paragraph (5) of this rule and the allowances allocated to each affected unit as specified in paragraph (6) of this rule.

(g) References to the Code of Federal Regulations in this paragraph (11) are to be regulations as published in the July 1, 2021, edition of the Code of Federal Regulations.

History

• Authority: T.C.A. §§ 4-5-201, et seq. and 68-201-101, et seq.
• Administrative History: New rule filed November 21, 2016; effective February 19, 2017. Amendments filed September 13, 2019; effective December 12, 2019. Amendments filed August 26, 2022; effective November 24, 2022.

Chapter 1200-03-28 Reserved

Tenn. Comp. R. & Regs. 1200-03-28 Reserved

RULES

OF TENNESSEE DEPARTMENT OF ENVIRONMENT AND CONSERVATION

BUREAU OF ENVIRONMENT

DIVISION OF AIR POLLUTION CONTROL

Chapter 1200-03-29 Light-Duty Motor Vehicle Inspection and Maintenance

Tenn. Comp. R. & Regs. 1200-03-29-.01 PURPOSE AND APPLICABILITY

(1) The purpose of this chapter is to reduce the air pollution produced by the operation of lightduty motor vehicles.

(2) This chapter shall apply in the following areas of Tennessee as designated by the Tennessee Air Pollution Control Board:

(a) Davidson County (b) Hamilton County (c) Rutherford County (d) Sumner County (e) Williamson County (f) Wilson County (3) For the counties specified in paragraph (2) of this rule, the requirements of this chapter shall become effective as follows:

(a) For EPA designated nonattainment counties classified as Basic, the effective date is April 1, 2006.

(b) For EPA designated nonattainment counties with an EPA approved Early Action Compact classified as Basic, the effective date is April 1, 2005.

(c) For EPA designated nonattainment areas classified as Marginal, the effective date is July 1, 2005.

(d) For EPA designated nonattainment areas classified as Moderate, the effective date is April 1, 2007.

(4) For the counties specified in paragraph (2) of this rule, the requirements of this chapter shall remain in effect until 120 days following EPA final approval of State Implementation Plan revisions eliminating the requirement for Light-Duty Motor Vehicle Inspection programs in the State of Tennessee; provided, however, that if on this date a contract exists between the department and a contractor providing inspection and maintenance services, the requirements of this chapter shall continue to apply until the contract’s termination or expiration.

(5) If the requirement for a Light-Duty Motor Vehicle Inspection Program is eliminated from the State Implementation Plan, Davidson County having had a local air pollution control program and implemented its own inspection and maintenance program before May 15, 2018, and having been authorized by the governing body within 30 days of May 15, 2018, can continue its own inspection and maintenance program. The dates of applicability, technical guidelines, enforcement, and fees for county- or municipality-specific vehicle inspection programs that are not required by the State or EPA will be determined by Davidson County.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 55-4-130; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed February 14, 1994; effective April 30, 1994. Stay of effective date filed April 15, 1994; effective June 14, 1994. Repeal and new rule filed September 28, 2004; effective December 12, 2004. Amendments filed January 11, 2021; effective April 11, 2021.

Tenn. Comp. R. & Regs. 1200-03-29-.02 DEFINITIONS

As used in this Chapter, all terms not defined herein shall have the meaning given them in Chapter 1200- 03-02:

(1) Air Pollution is any particulate matter or any gas or vapor other than water or any combination thereof including any physical, chemical, biological, radioactive substance or matter which is emitted into or otherwise enters the ambient air.

(2) Antique motor vehicle is any motor vehicle over twenty-five years old which is owned solely as a collectors’ item and is used for participation in club activities, exhibits, tours, parades and similar uses, but in no event for general transportation.

(3) Carbon dioxide is a compound consisting of the chemical formula (CO ).

(4) Carbon monoxide is a compound consisting of the chemical formula (CO).

(5) Catalytic converter is a pollution control device containing a catalyst for converting automobile exhaust into mostly harmless products.

(6) Centralized Network means that motor vehicle inspections are conducted by the State and/or a single contractor in an area.

(7) Certificate of Compliance is a certification issued by a Department vehicle inspector or a fleet vehicle inspector that the motor vehicle identified on the certificate complies with the emission performance and anti-tampering criteria appropriate to the vehicle as specified in this regulation.

(8) Check Engine Light: for the definition see Malfunction Indicator Light (MIL).

(9) Contractor is a person (as defined in 1200-03-02) with whom the Department has a contract that provides for the operation of one or more Official Inspection Stations.

(10) Department means the Tennessee Department of Environment and Conservation, Division of Air Pollution Control.

(11) Department Vehicle Inspector is any person employed by the Tennessee Division of Air Pollution Control and/or contractor who is designated by the Technical Secretary as qualified to perform vehicle emissions performance and anti-tampering inspections.

(12) Diagnostic Trouble Codes (DTCs) is an alphanumeric code which is set in a vehicle’s onboard computer when a monitor detects a condition likely to lead to (or has already produced) a component or system failure or otherwise contribute to exceeding emissions standards by 1.5 times the certification FTP standard.

(13) Diesel powered motor vehicle is a motor vehicle powered by a compression-ignition internal combustion engine.

(14) Electric powered motor vehicle is a motor vehicle which uses a propulsive unit powered exclusively by electricity.

(15) Exhaust emissions are substances emitted into the atmosphere from any opening downstream from the exhaust ports of a motor vehicle engine.

(16) Exhaust gas analyzer is a device for sensing the amount of air pollutants, including carbon monoxide and hydrocarbons, in the exhaust emissions of a motor vehicle. For the purpose of this regulation, this shall mean analyzing devices of the nondispersive infrared type or any other analyzing devices that provide equal or greater accuracy as approved by the Technical Secretary.

(17) Factory-Installed Motor Vehicle Pollutant Control System is a motor vehicle pollution control system installed by the vehicle or engine manufacturer to comply with the United States government motor vehicles emission control laws and regulations.

(18) Federal Test Procedure (FTP) is the test procedure used to determine the compliance of vehicles with federal emission standards.

(19) Fleet means 50 or more light-duty motor vehicles owned by the same person or business entity which are in-use, registered in any county that has been designated by the Board to have a motor vehicle inspection and maintenance program in order to attain and maintain compliance with national ambient air quality standards within any area of Tennessee or an adjoining state and not owned or held primarily for the purpose of resale.

(20) Fleet Inspection Location is any motor vehicle inspection facility operated by a fleet operator holding a valid fleet inspection permit.

(21) Fleet Inspection Permit is a certificate issued by the Technical Secretary authorizing a fleet operator to conduct motor vehicle inspections in accordance with this regulation and other requirements as determined by the Department.

(22) Fleet Operator is the person owning a group of motor vehicles which constitute a fleet as defined in this regulation.

(23) Fleet Vehicle Inspector is any person retained by a fleet operator holding a valid fleet inspection permit and who is certified by the Technical Secretary as qualified to perform vehicle emissions performance and anti-tampering inspections.

(24) Fuel inlet restrictor is the leaded fuel nozzle restrictor installed on motor vehicles which was designed for the use of unleaded gasoline only.

(25) Gasoline powered motor vehicle is any motor vehicle powered by spark-ignition internal combustion engine.

(26) Gross Vehicle Weight Rating (GVWR) is a term defining the gross vehicle weight as determined from the combined manufacturer vehicle and maximum load rating.

(27) Heavy-duty motor vehicle is any motor vehicle having a combined manufacturer vehicle and maximum load rating (GVWR) to be carried thereon in excess of 10,500 pounds (4,773 kilograms).

(28) Hydrocarbon is any organic compound consisting predominantly of carbon and hydrogen.

(29) Idle speed means the unloaded engine speed of a motor vehicle when the accelerator pedal is fully released. In a vehicle equipped with an automatic transmission, this is with the drive selector in neutral or park. In a vehicle equipped with a manual transmission, this is with the gear selector in neutral and the clutch fully engaged. In all vehicles, the engine operated accessories shall be turned off.

(30) Internal combustion engine is any engine in which the combustion of gaseous, liquid or pulverized solid fuel takes place within one or more cylinders, or any engine with one or more combustion chambers.

(31) Light-duty motor vehicle is any motor vehicle having a combined manufacturer vehicle and maximum load rating (GVWR) to be carried thereon of 10,500 pounds (4,773 kilograms) or less.

(32) Malfunction Indicator Light (MIL) is known as the Check Engine light. The Malfunction Indicator Light is illuminated on the dashboard when conditions exist likely to result in emissions exceeding FTP standards by 1.5 time or worse. Alternatives include “Service Engine Soon,” as well as an unlabeled icon of an engine.

(33) Manufacturers Idle-speed Specification is the engine idle speed specified for a particular motor vehicle as printed on the engine compartment emissions system data plate or in the owners manual.

(34) Model Year means the annual production period of new motor vehicles or new motor vehicle engines designated by the calendar year in which such production ends. If the manufacturer does not designate a production period, the year with respect to such vehicle or engines shall mean the twelve (12) month period beginning January of the year in which production thereof begins. The model year for a motor vehicle constructed by other than the original manufacturer shall be assigned by the Technical Secretary.

(35) Motor vehicle is any self-propelled vehicle used for transporting persons or commodities on public roads.

(36) Motor Vehicle Regulatory License is the annual motor vehicle license required as a condition for legal operation of certain classes of motor vehicles.

(37) Motorcycle is any motor vehicle having a seat or saddle for the use of the rider and designed to travel on not more than three wheels in contact with the ground, and having a curb weight of 2000 pounds (907 kilograms) or less.

(38) New motor vehicle is any motor vehicle that has never been previously titled or registered in this or any other jurisdiction and whose ownership document remains as a manufacturer’s certificate of origin.

(39) Official Inspection Station means a facility operated by the Department and/or contractor to conduct test only vehicle inspections pursuant to this regulation, in a Centralized Network.

(40) Onboard Diagnostics (OBD) is a system of vehicle component and condition monitors controlled by a central, onboard computer designed to signal the motorist when conditions exist which could lead to a vehicle’s exceeding its certification standards by 1.5 times the FTP standard.

(41) OBD Data Link Connector (DLC) serves as an interface between a vehicle’s OBD computer and the OBD scanner and is usually located under the dashboard on the driver’s side.

Connecting an OBD scanner to the DLC allows inspectors and vehicle repair technicians to read the readiness status of vehicle’s onboard monitors as well as any diagnostic trouble codes.

(42) Pollution Control Device is the equipment designed by the manufacturer for installation on a motor vehicle for the purpose of reducing pollutants emitted from the vehicle, or a system or engine modification on a motor vehicle which causes a reduction of pollutants emitted from the motor vehicle.

(43) Readiness codes are status flags stored by a vehicle’s onboard computer which is different from the DTC in that it does not indicate a vehicle fault, but rather whether or not a given monitor has been run (i.e. whether or not the component or system in question has been checked to determine if it is functioning properly).

(44) RPM is a term describing the engine crankshaft revolutions per minute.

(45) Tampering means to remove, render inoperative, cause to be removed, or make less operative any emission control device, unless such removal or act to render inoperative or less operative is for the purpose of motor vehicle disposal or salvage operation.

(46) Technical Secretary is the Technical Secretary of the Air Pollution Control Board of the State of Tennessee or his designated representative.

(47) Vehicle Exhaust System means all devices, equipment and systems which transport exhaust emissions from the exhaust ports of the motor vehicle engine to the atmosphere.

(48) Wheel Tax is the annual commercial vehicle tax required as a condition for the legal operation of certain classes of motor vehicles.

(49) Opacity is the degree to which emissions reduce the transmission of light and obscure the view of an object in the background.

(50) Low-speed vehicle means a four-wheeled vehicle manufactured as a non-road vehicle with a gross vehicle weight of less than 3,000 pounds, capable of twenty miles per hour (20 mph) but not capable of exceeding twenty-five miles per hour (25 mph) on a paved level surface.

(51) Medium-speed vehicle means any four-wheeled vehicle manufactured as a non-road vehicle with a gross vehicle weight of less than 3,000 pounds, capable of thirty miles per hour (30 mph) but not capable of exceeding thirty-five miles per hour (35 mph) on a paved level surface.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed February 14, 1994; effective April 30, 1994. Stay of effective date filed April 15, 1994; effective June 14, 1994. Amendment filed July 18, 2001; effective October 1, 2001. Amendment filed September 19, 2001; effective December 3, 2001. Repeal and new rule filed September 28, 2004; effective December 12, 2004. Amendment filed November 9, 2010; effective February 7, 2011.

Tenn. Comp. R. & Regs. 1200-03-29-.03 MOTOR VEHICLE INSPECTION REQUIREMENTS

(1) All of the light-duty motor vehicles registered in any county that has been designated by the Board to have a motor vehicle inspection and maintenance program or directly with the motor vehicle division of the Tennessee Department of Revenue pursuant to T.C.A. § 55-4-207 and used within or assigned to a user within that county, except those exempted by Rule 1200- 03-29-.04, are required to be inspected annually for compliance with emissions performance and anti-tampering test criteria in Rules 1200-03-29-.05 and 1200-03-29-.06. Owners of vehicles so inspected are required to obtain a Certificate of Compliance. A Certificate of Compliance shall be valid for 90 days following the date of issuance, except for those registered pursuant to T.C.A. § 55-4-207, which shall be valid for one year.

(2) Any light-duty vehicle which is owned or operated by an agency of the federal government and which is operated on a federal installation located in any county that has been designated by the Board to have a motor vehicle inspection and maintenance program is required to be inspected annually for compliance with emissions performance and antitampering criteria in Rules 1200-03-29-.05 and 1200-03-29-.06. This requirement shall not apply to a vehicle which is on the facility for less than a total of 60 days during the calendar year.

(3) A Certificate of Compliance shall be issued only by the Department and/or contractor vehicle inspector or a licensed fleet vehicle inspector and only after the vehicle demonstrates compliance with the test criteria established in Rules 1200-03-29-.05 and 1200-03-29-.06.

(4) All light-duty motor vehicles required to obtain a Certificate of Compliance except those vehicles contained in a fleet which has a valid fleet inspection permit and those vehicles registered in any county that has been designated by the Board to have a motor vehicle inspection and maintenance program but not subject to either the Wheel Tax or the Motor Vehicle Regulatory License requirements shall obtain a valid Certificate of Compliance within 90 days prior to the required date for payment of the wheel tax or the motor vehicle regulatory license fee as appropriate to the class of motor vehicle. .

(5) All light-duty motor vehicles required to obtain a Certificate of Compliance that are contained in a fleet having a valid fleet inspection permit, operated on a Federal installation registered in any county that has been designated by the Board to have a motor vehicle inspection and maintenance program or vehicles registered in any county that has been designated by the Board to have a motor vehicle inspection and maintenance program in order to attain and maintain compliance with national ambient air quality standards within any area of Tennessee or an adjoining state but exempt from the Wheel Tax and Motor Vehicle Regulatory License requirements shall obtain a valid Certificate of Compliance within 90 days prior to a compliance date for that particular motor vehicle. The Technical Secretary shall establish a schedule of compliance dates for such vehicles. A copy of the Certificate of Compliance for each fleet vehicle shall be submitted to the Technical Secretary within 90 days of the compliance date. A list of all subject vehicles shall be submitted to the Technical Secretary or his designee on an annual basis as directed by the division. Additionally, notification of any changes to the list of subject vehicles shall be made to the division within 30 days of such changes.

(6) The Certificate of Compliance must be presented to the County Clerks’ office prior to the issuance of the Wheel Tax or the Vehicle Regulatory License.

(7) The requirements contained in this Chapter shall become effective July 1, 1994. The provisions concerning OBD testing shall become effective July 1, 2002.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed February 14, 1994; effective April 30, 1994. Stay of effective date filed April 15, 1994; effective June 14, 1994. Amendment filed October 12, 1998; effective December 26, 1998. Amendment filed July 18, 2001; effective October 1, 2001. Repeal and new rule filed September 28, 2004; effective December 12, 2004.

Tenn. Comp. R. & Regs. 1200-03-29-.04 EXEMPTION FROM MOTOR VEHICLE INSPECTION REQUIREMENTS

(1) The following classes of motor vehicles are exempt from the requirements established in

Rule 1200-03-29-.03 of this Chapter:

(a) Antique motor vehicles (b) Electric powered light-duty vehicles (c) Light-duty motor vehicles with a designated model year prior to 1975 (d) Motorcycles (e) Heavy-duty motor vehicles (f) New motor vehicles being registered for the first time or one year from initial registration (g) Tactical military vehicles (h) Low-speed and medium-speed vehicles

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed February 14, 1994; effective April 30, 1994. Stay of effective date filed April 15, 1994; effective June 14, 1994. Amendment filed September 19, 2001; effective December 3, 2001. Repeal and new rule filed September 28, 2004; effective December 12, 2004. Amendment filed November 9, 2010; effective February 7, 2011.

Tenn. Comp. R. & Regs. 1200-03-29-.05 MOTOR VEHICLE EMISSION PERFORMANCE TEST CRITERIA

(1) Vehicles shall not be allowed to complete emission performance testing if one or more of the following conditions exist when the vehicle is presented for testing:

(a) For 1975 through 1995 model gasoline powered motor vehicles, if the vehicle exhaust system leaks in such a way as to dilute the exhaust emissions being sampled by the exhaust gas analyzer, the sum of carbon monoxide and carbon dioxide concentrations recorded for idle speed reading from an exhaust outlet must not be less than 6%.

(b) For 1975 through 2001 model diesel powered motor vehicles, if the vehicle’s exhaust system leaks in such a way as to dilute the exhaust emissions being sampled.

(c) The visible emissions from the motor vehicle are such that it would interfere with operation of the testing equipment.

(2) Gasoline powered motor vehicle models 1975 through 1995 which have idle speed emission values that exceed the test standards specified in Table I shall fail the emission performance test.

TABLE I

MAXIMUM IDLE SPEED EMISSIONS ALLOWABLE

DURING IDLE SPEED EMISSIONS TEST

CO (%) HC (PPM)

VEHICLE

MODEL

YEAR

LIGHT-DUTY

VEHICLES LESS

THAN OR EQUAL

TO 6000 LBS GVWR

LIGHT-DUTY

VEHICLES

GREATER THAN

6000 LBS GVWR

LIGHT-DUTY

VEHICLES LESS

THAN OR EQUAL

TO 6000 LBS GVWR

LIGHT-DUTY

VEHICLES

GREATER THAN

6000 LBS GVWR 1975 5.0 6.5 500 750 1976 5.0 6.5 500 750 1977 5.0 6.5 500 750 1978 4.0 6.0 400 600 1979 4.0 6.0 400 600 1980 3.0 4.5 300 400 1981- 1.2 4.0 220 400 (3) Light-duty diesel powered motor vehicle models 1975 through 2001 shall be subject to the curb idle test as follows:

(a) A diesel vehicle shall not emit visible emissions in excess of ten (10) percent opacity for ten (10) or more consecutive seconds, as measured at idle engine speed.

(4) All 1996 and newer gasoline powered motor vehicles and all 2002 and newer diesel powered motor vehicles shall be subject to an OBD inspection. An OBD check shall consist of two parts: a visual check of the MIL and an electronic examination of the OBD computer. The vehicle is required to pass a MIL command on test and a bulb check test. After the vehicle has passed the MIL command on test and the bulb check test, it must not have any DTCs set and all of the required readiness codes must be set in order to pass an OBD inspection.

(5) When a motor vehicle is equipped with other than the original engine or when a motor vehicle has been constructed, modified, customized or altered in such a way so that the model year cannot be clearly determined, the vehicle shall be classified for purposes of the emission performance test by the model year of the chassis.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed February 14, 1994; effective April 30, 1994. Stay of effective date filed April 15, 1994; effective June 14, 1994. Amendment filed September 19, 2001; effective December 3, 2001. Repeal and new rule filed September 28, 2004; effective December 12, 2004.

Tenn. Comp. R. & Regs. 1200-03-29-.06 MOTOR VEHICLE ANTI-TAMPERING TEST CRITERIA

(1) Each gasoline powered motor vehicle subject to an emission performance test is also subject to a visual anti-tampering inspection under this rule and shall comply with the following minimum anti-tampering requirements:

(a) At a minimum, the emissions control devices subject to an inspection are the catalytic converter, and fuel filler cap. If emission control devices are found in a tampered condition, such devices shall be repaired or replaced prior to any retesting or reinspection as provided for in Rule 1200-03-29-.10.

(b) Nothing in this Rule shall be construed as to relieve a motor vehicle owner from complying with the provisions of Rule 1200-03-29-.05.

(2) Each gasoline powered motor vehicle subject to an OBD inspection is also subject to an antitampering test, and shall comply with a DLC check, and a fuel cap pressure test.

(3) Each diesel powered motor vehicle subject to an emission performance test is also subject to an anti-tampering test and shall comply at a minimum with a catalytic converter check, if applicable, and a fuel capcheck.

(4) Each diesel powered motor vehicle subject to an OBD inspection is also subject to an antitampering test, and shall comply with a DLC check and a fuel capcheck.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed February 14, 1994; effective April 30, 1994. Stay of effective date filed April 15, 1994; effective June 14, 1994. Amendment filed September 19, 2001; effective December 3, 2001. Repeal and new rule filed September 28, 2004; effective December 12, 2004.

Tenn. Comp. R. & Regs. 1200-03-29-.07 MOTOR VEHICLE EMISSIONS PERFORMANCE TEST METHODS

(1) For gasoline powered motor vehicles, the motor vehicle emissions performance test shall consist of the sampling of exhaust emissions at idle speed and measurement of CO dilution, CO concentration and HC concentration.

(2) For gasoline powered motor vehicles, sampling of exhaust emissions shall consist of measurement of CO dilution, CO concentration and HC concentration during idle operation using an approved exhaust gas analyzer. Measurements taken during the initial idle phase may be succeeded by measurements taken during a second idle phase which has followed an engine conditioning phase consisting of engine operation at approximately 2500 RPM for approximately 20 seconds. The lowest emission readings from either of these idle speed test phases shall be used to determine pass or failure of the emissions performance test.

(3) For diesel powered motor vehicles, the motor vehicle emissions performance test shall consist of the Curb Idle test procedures for diesel vehicles:

(a) Diesel-powered vehicles shall be inspected with an opacity meter that is a full-flow, direct reading, continuous reading light extinction type using a collimated light source and photo-electric cell, accurate to within plus or minus five (5) percent.

(b) Separate measurements shall be made on each exhaust outlet on diesel vehicles equipped with multiple exhaust outlets. The reading taken from the outlet giving the highest reading shall be used for comparison with the standard for the vehicle being tested.

(4) For gasoline powered motor vehicles with a model year of 1996 and newer and for diesel powered motor vehicles with a model year of 2002 and newer, an onboard diagnostic test shall be performed. All vehicles that have a readily accessible OBD system shall be tested.

The results of the test shall be used to determine pass or failure of the vehicle.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed February 14, 1994; effective April 30, 1994. Stay of effective date filed April 15, 1994; effective June 14, 1994. Amendment filed September 19, 2001; effective December 3, 2001. Repeal and new rule filed September 28, 2004; effective December 12, 2004.

Tenn. Comp. R. & Regs. 1200-03-29-.08 MOTOR VEHICLE ANTI-TAMPERING TEST METHODS

(1) For vehicles 1975 to 1995, the motor vehicle anti-tampering test shall be verified by the Department vehicle inspector and consist of the following elements:

(a) The vehicle shall be checked by the vehicle inspector to see that the appropriate fuel cap is securely in place. If the appropriate fuel cap is not in place, it shall result in the failure of the anti-tampering test.

(b) The vehicle shall be checked visually (with a mirror or otherwise) to see if the catalytic converter is the correct type for the certified vehicle configuration and is properly connected. If the catalytic converter has been tampered with, removed or is the incorrect configuration, it shall result in the failure of the anti-tampering test.

(2) Each gasoline powered motor vehicle with a model year of 1996 and newer is subject to an anti-tampering test, and shall comply with the DLC and a fuel cap pressure test. The antitampering test shall consist of the following elements:

(a) Vehicle shall be visually checked to see if the appropriate fuel cap is securely in place.

(b) If the fuel cap is present, it shall be removed and a fuel cap pressure test shall be performed to assure the cap is working properly. (F.T.P. 26-21 Pass/Fail Standard). If the fuel cap fails the pressure test, it shall result in a failure of the anti-tampering test.

(c) If the DLC has been tampered with or is missing, it must be repaired or replaced prior to any retesting or reinspection. If the vehicle is incompatible with the OBD test equipment or if the DLC is readily unavailable, then the vehicle is required to pass the idle speed emission values as specified in Paragraph 1200-03-29-.05.

(3) Each diesel powered motor vehicle with a model year of 2002 and newer is subject to an antitampering test, and shall comply at a minimum with a DLC check and a fuel cap pressure test. The anti-tampering test shall consist of the following elements:

(a) Vehicle shall be visually checked to see if the appropriate fuel cap is securely in place.

(b) If the DLC has been tampered with or is missing, it must be repaired or replaced prior to any retesting or reinspection. If the vehicle is incompatible with the OBD test equipment or if the DLC is readily unavailable, then the vehicle is subject to the Curb Idle test as specified in Paragraph 1200-03-29-.05.

(4) Pass/fail determination. A pass or fail determination shall be made for each of the test elements in Paragraph 1200-03-29-.08(1), (2), or (3). If a vehicle fails any of the antitampering elements in Paragraph 1200-03-29-.08(1), (2), or (3), it shall result in the failure of the motor vehicle inspection test and a Certificate of Compliance shall not be issued until the repairs have been made to the vehicle.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed February 14, 1994; effective April 30, 1994. Stay of effective date filed April 15, 1994; effective June 14, 1994. Amendment filed September 19, 2001; effective December 3, 2001. Repeal and new rule filed September 28, 2004; effective December 12, 2004.

Tenn. Comp. R. & Regs. 1200-03-29-.09 MOTOR VEHICLE INSPECTION PROGRAM

(1) The motor vehicle inspection program shall be operated by the Tennessee Department of Environment and Conservation, Division of Air Pollution Control, the State approved local government and/or the State approved contractor.

(2) All motor vehicle inspections shall be conducted at official or mobile inspection stations operated by the Department, local government and/or contractor except those fleet inspections provided for in Paragraph 1200-03-29-.09(3) of this regulation.

(3) In lieu of the requirement in Paragraph 1200-03-29-.09(2) of this regulation, vehicles owned or operated by a fleet operator to whom a fleet inspection permit has been issued may be inspected by a licensed fleet vehicle inspector at a site other than an official inspection station.

(4) A light-duty fleet vehicle operator may make application to the Technical Secretary for a fleet inspection permit. Minimum requirements for issuance of a permit shall be:

(a) Possession of an approved analyzer, tools and testing equipment determined by the Technical Secretary to be adequate for conducting the required emissions inspections;

(b) Demonstration of knowledge of methods and procedures for conducting the required emissions performance and anti-tampering inspections according to criteria developed by the Technical Secretary;

(c) Provisions of appropriate facility for vehicle testing and appropriate secure storage facility for storage of Certificates of Compliance and records of inspections;

(d) Agreement to supply inspection and Certificate of Compliance issuance information as requested by the Technical Secretary and to allow access to testing facility, testing equipment, testing personnel, testing data, Certificate of Compliance inventory and fleet vehicles as requested by the Technical Secretary;

(e) Retention of licensed fleet vehicle inspector to conduct fleet vehicle inspections.

(5) A fleet inspection permit shall be valid for one year from the date of issuance and may be renewed through application to the Technical Secretary within 30 days prior to the date of expiration. A fleet inspection permit is not transferable and may be denied, suspended or revoked by the Technical Secretary for failure to comply with this regulation and other requirements as determined by the Department.

(6) A person employed or retained by a fleet operator holding a valid fleet inspection permit may make application to the Technical Secretary for a fleet vehicle inspector’s license. Minimum requirements for issuance of this license shall be:

(a) Successful completion of a vehicle inspector training course prepared and offered by the Department;

(b) Successful completion of the mechanics training course approved by the Technical Secretary;

(c) Agreement to participate in additional training activities from time to time as specified by the Technical Secretary;

(d) Provision of written evidence that applicant is employed or retained by the fleet operator.

(7) A fleet inspector’s license shall be valid for one year from the date of issuance and may be renewed through application to the Technical Secretary within thirty (30) days prior to the date of expiration. A fleet vehicle inspector’s license is not transferable and may be denied, suspended or revoked by the Technical Secretary for failure to comply with this regulation and other requirements as determined by the Department.

(8) All vehicles issued a Certificate of Compliance under the provision of Paragraph 1200-03-29- .09(3) of this regulation shall be subject to retesting at either the fleet inspection location or an official inspection station as deemed necessary by the Technical Secretary in order to maintain compliance with the intent of this regulation.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed February 14, 1994; effective April 30, 1994. Stay of effective date filed April 15, 1994; effective June 14, 1994. Repeal and new rule filed September 28, 2004; effective December 12, 2004.

Tenn. Comp. R. & Regs. 1200-03-29-.10 MOTOR VEHICLE INSPECTION FEE

(1) There shall be a fee set by the Tennessee Air Pollution Control Board for the Inspection & Maintenance program. The fee shall be for each emission test and payable at the time of inspection by the operator of the vehicle subject to the testing.

(2) There shall be a fee of five dollars ($5.00) for each Certificate of Compliance generated by licensed fleet inspectors for issuance to motor vehicles which comply with the testing provisions of this regulation.

(3) Each vehicle which fails its initial inspection is entitled to one (1) reinspection at no charge if the vehicle is accompanied by the entire initial inspection report.

(4) Motor vehicle owners or operator shall be given in writing the results of all inspection procedures carried out at any official inspection station.

(5) There shall be a fee of One Hundred Dollars ($100.00) for each annual Fleet Inspection Permit issued to fleet vehicle operators.

(6) There shall be a fee of One Hundred Dollars ($100.00) for each initial annual Fleet Vehicle Inspector’s License issued to a fleet vehicle inspector; there shall be a fee of Twenty-Five Dollars ($25.00) for each annual renewal of a Fleet Vehicle Inspector’s License.

History

• Authority: T.C.A. §§ 4-5-201, et seq., and 68-201-105.
• Administrative History: Original rule filed February 14, 1994; effective April 30, 1994. Stay of effective date filed April 15, 1994; effective June 14, 1994. Amendment filed July 18, 2001; effective October 1, 2001. Amendment filed September 19, 2001; effective December 3, 2001. Repeal and new rule filed September 28, 2004; effective December 12, 2004.

Tenn. Comp. R. & Regs. 1200-03-29-.11 WAIVER PROVISIONS

(1) The purpose of this rule is to allow a person to operate a motor vehicle that fails to meet the applicable motor vehicle emission performance test criteria as specified in Rule 1200-03-29- .05, provided the department has issued to the owner of the motor vehicle a waiver.

(2) A waiver issued pursuant to this rule shall relieve the owner of a motor vehicle from responsibility for taking any further action to reduce exhaust emissions from the motor vehicle until the motor vehicle is next due for inspection, pursuant to Rule 1200-03-29-.03.

(3) Any owner of a motor vehicle may be eligible and may apply to the department for a waiver pursuant to this rule if:

(a) An application for a waiver is submitted to a representative at an inspection site designated by the department;

(b) The vehicle passed the tampering portion of the vehicle inspection;

(c) All of the exhaust emissions components appropriate to make, model, year, series, and engine size are in place and visually operating;

(d) The vehicle failed the first initial emissions test and subsequent retest after repairs;

(e) The owner of the vehicle has spent the required amount, pursuant to part 1., 2., or 3. of this subparagraph, in parts and/or labor as an attempt to bring the vehicle into compliance with the motor vehicle emission performance test criteria as specified in

Rule 1200-03-29-.05.

1. For 1975 through 1980 model year vehicles – the minimum expenditure requirement is $75.00. All repairs must be appropriate and/or related to the cause of the test failure. This expenditure includes parts and labor, as specified in part 4.

2. For 1981 through 1995 model year vehicles – the minimum expenditure requirement is $200.00. All repairs must be appropriate and/or related to the cause of the test failure. This expenditure includes parts and labor, as specified in part 4.

3. For 1996 and newer model year vehicles – the minimum expenditure requirement is $650.00. All repairs must be appropriate and/or related to the cause of the test failure. This expenditure includes parts and labor, as specified in part 4.

4. The cost of labor can be applied towards the expenditure amount only if the repairs were performed by a certified repair technician (National Institute for Automotive Service Excellence [ASE] certified in engine repair and engine performance). Repairs performed by non-technicians (e.g., owners) may only apply the cost of parts towards the expenditure.

(f) Documentation of repairs must be provided to the department. Documentation shall include dated receipts itemized with the name of each part, part number, and manufacturer.

(g) Emission related repairs were performed on the vehicle sixty (60) days before or after the initial failed exhaust emissions inspection; and (h) Proof of county residence is provided to the department. (Example: Driver’s License and/or vehicle registration).

(4) The owner of a motor vehicle still within the failed vehicle’s warranty period shall use all available warranty coverage to have repairs made that are directed toward correcting the cause of the motor vehicle’s inspection failure prior to applying for a waiver and provide support documentation pursuant to subparagraph (a) or (b) of this paragraph.

(a) Documentation indicating that any available warranty coverage has been used to have the repairs made that are directed toward correcting the cause of the motor vehicle’s failure to pass the motor vehicle inspection shall be provided to the Department; or (b) A written denial of warranty coverage for the needed repairs from the manufacturer or authorized dealer shall be provided to the Department.

(5) Prior to the issuance of a waiver, Division staff shall perform a visual (underhood) inspection of the motor vehicle. This inspection will be performed to determine that emission related repairs have been completed and verify that the minimum expenditure has been met. If during the visual inspection any motor vehicle tampering, as defined in Division Rule 1200- 03-36, is discovered, a waiver cannot be granted.

(6) The waiver shall be valid for one year or until the next registration expiration date, whichever is sooner.

(7) A waiver shall be granted to the owner of a motor vehicle provided the requirements of this

rule have been fulfilled.

(8) Upon receiving a waiver from the department, the motor vehicle owner shall be exempt from the requirements of paragraph (6) in rule 1200-03-29-.03 within the time period prescribed in paragraph (6) of rule 1200-03-29-.11.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 55-4-128; and 68-201-105.
• Administrative History: Original rule filed August 30, 2001; effective November 13, 2001. Repeal and new rule filed September 28, 2004; effective December 12, 2004.

Tenn. Comp. R. & Regs. 1200-03-29-.12 RESERVED

History

• Authority: T.C.A. §§ 4-5-201 through 4-5-231, 55-4-128, 55-4-130, and 68-201-101 through 68-201-121.
• Administrative History: Original rule filed September 28, 2004; effective date December 12, 2004. Amendments filed January 11, 2021; effective April 11, 2021.

Chapter 1200-03-30 Acidic Precipitation Control

Tenn. Comp. R. & Regs. 1200-03-30-.01 through Rule 1200-3-30-.10, 40 CFR parts 72, 73, 75, 77, and 78, and regulations implementing sections 407 and 410 of the Act.

(f)“Act” means the Clean Air Act, 42 U.S.C. 7401, et seq. as amended by Public Law No. 101-549 (November 15, 1990).

(g)“Actual SO2 emissions rate” means the annual average sulfur dioxide emissions rate for the unit (expressed in lb/mmBtu), for the specified calendar year; provided that, if the unit is listed in the NADB, the "1985 actual SO2 emissions rate" for the unit shall be the rate specified by the Administrator in the NADB under the data field "SO2RTE."

(h)“Administrator” means the Administrator of the United States Environmental Protection Agency or the Administrator's duly authorized representative.

(i)“Affected source” means a source that includes one or more affected units.

(j)“Affected unit” means a unit that is subject to any Acid Rain emissions reduction requirement or Acid Rain emissions limitation.

(k)“Affiliate” shall have the meaning set forth in section 2(a)(11) of the Public Utility Holding Company Act of 1935, 15 U.S.C. 79b(a)(11), as of November 15, 1990.

(l)“Allocate or allocation” means the initial crediting of an allowance by the Administrator to an Allowance Tracking System unit account or general account.

(m)“Allowance” means an authorization by the Administrator under the Acid Rain Program to emit up to one ton of sulfur dioxide during or after a specified calendar year.

(n)“Allowance deduction, or deduct when referring to allowances”, means the permanent withdrawal of allowances by the Administrator from an Allowance Tracking System compliance subaccount to account for the number of the tons of SO2 emissions from an affected unit for the calendar year, for tonnage emissions estimates calculated for periods of missing data as provided in 40 CFR part 75, or for any other allowance surrender obligations of the Acid Rain Program.

(o)“Allowances held or hold allowances” means the allowances recorded by the Administrator, or submitted to the Administrator for recordation in accordance with 40 CFR 73.50, in an Allowance Tracking System account.

(p)“Allowance Tracking System or ATS” means the Acid Rain Program system by which the Administrator allocates, records, deducts, and tracks allowances.

(q)“Allowance Tracking System account” means an account in the Allowance Tracking System established by the Administrator for purposes of allocating, holding, transferring, and using allowances.

(r)“Allowance transfer deadline” means midnight of January 30 or, if January 30 is not a business day, midnight of the first business day thereafter and is the deadline by which allowances may be submitted for recordation in an affected unit's compliance subaccount for the purposes of meeting the unit's Acid Rain emissions limitation requirements for sulfur dioxide for the previous calendar year.

(s)“Authorized account representative” means a responsible natural person who is authorized, in accordance with 40 CFR part 73, to transfer and otherwise dispose of allowances held in an Allowance Tracking System general account; or, in the case of a unit account, the designated representative of the owners and operators of the affected unit.

(t)“Basic Phase II allowance allocations” means: (1) For calendar years 2000 through 2009 inclusive, allocations of allowances made by the Administrator pursuant to section 403 and

section 405 (b)(1), (3), and (4); (c)(1), (2), (3), and (5); (d)(1), (2), (4), and (5); (e); (f); (g)(1), (2), (3), (4), and (5); (h)(1); (i); and (j). (2) For each calendar year beginning in 2010, allocations of allowances made by the Administrator pursuant to section 403 and section 405 (b)(1), (3), and (4); (c)(1), (2), (3), and (5); (d)(1), (2), (4), and (5); (e); (f); (g)(1), (2), (3), (4), and (5); (h)(1) and (3); (i); and (j).

(u)“Boiler” means an enclosed fossil or other fuel-fired combustion device used to produce heat and to transfer heat to recirculating water, steam, or any other medium.

(v)“Certificate of representation” means the completed and signed submission required by 40 CFR 72.20, for certifying the appointment of a designated representative for an affected source or a group of identified affected sources authorized to represent the owners and operators of such source(s) and of the affected units at such source(s) with regard to matters under the Acid Rain Program.

(w)“Certifying Official” means: 1.For a corporation, a president, secretary, treasurer, or vice-president of the corporation in charge of a principal business function, or any other person who performs similar policy or decision-making functions for the corporation; 2.For partnership or sole proprietorship, a general partner or the proprietor, respectively; and 3.For a local government entity or State, federal, or other public agency, either a principal executive officer or ranking elected official.

(x)“Coal” means all solid fuels classified as anthracite, bituminous, subituminous, or lignite by the American Society for Testing and Materials Designation ASTM D388-92 “Standard Classification of Coals by Rank.”

(y)“Coal-derived fuel” means any fuel, whether in a solid, liquid, or gaseous state, produced by the mechanical, thermal, or chemical processing of coal (e.g., pulverized coal, coal refuse, liquified or gasified coal, washed coal, chemically cleaned coal, coal-oil mixtures, and coke).

(z)“Coal-fired” means the combustion of fuel consisting of coal or any coal-derived fuel (except a coal-derived gaseous fuel with a sulfur content no greater than natural gas), alone or in combination with any other fuel, where a unit is “coal-fired” if it uses coal or coal-derived fuel as its primary fuel (expressed in mmBtu); provided that, if the unit is listed in the NADB, the primary fuel is the fuel listed in the NADB under the data field “PRIMEFUEL”.

(aa)“Cogeneration unit” means a unit that has equipment used to produce electric energy and forms of useful thermal energy (such as heat or steam) for industrial, commercial, heating or cooling purposes, through the sequential use of energy.

(bb)“Commence commercial operation” means to have begun to generate electricity for sale, including the sale of test generation.

(cc)“Commence construction” means that an owner or operator has either undertaken a continuous program of construction or has entered into a contractual obligation to undertake and complete, within a reasonable time, a continuous program of construction.

(dd)“Commence operation” means to have begun any mechanical, chemical, or electronic process, including start-up of an emissions control technology or emissions monitor or of a unit's combustion chamber.

(ee)“Common stack” means the exhaust of emissions from two or more units through a single flue.

(ff)“Compliance certification” means a submission to the Administrator or Technical Secretary that is required by Rule 1200-3-30-.01 through Rule 1200-3-30-.10, by 40 CFR part 72, 73, 75, 77, or 78, or by regulations implementing sections 407 or 410 of the Act to report an affected source or an affected unit's compliance or non-compliance with a provision of the Acid Rain Program and that is signed and verified by the designated representative in accordance with subpart B of 40 CFR part 72, Rule 1200-3-30.08, and the Acid Rain Program regulations generally.

(gg)“Compliance plan,” for purposes of the Acid Rain Program, means the document submitted for an affected source in accordance with Paragraph 1200-3-30-.03(1) and Paragraph 1200-3-30-.03(2) specifying the method(s) (including one or more Acid Rain compliance options under Paragraph 1200-3-30-.04(2) or regulations implementing section 407 of the Act) by which each affected unit at the source will meet the applicable Acid Rain emissions limitation and Acid Rain emissions reduction requirements.

(hh)“Compliance subaccount” means the subaccount in an affected unit's Allowance Tracking System account, established pursuant to 40 CFR 73.31 (a) or (b), in which are held, from the date that allowances for the current calendar year are recorded under 40 CFR 73.34(a) until December 31, allowances available for use by the unit in the current calendar year and, after December 31 until the date that deductions are made under 40 CFR 73.35(b), allowances available for use by the unit in the preceding calendar year, for the purpose of meeting the unit's Acid Rain emissions limitation for sulfur dioxide.

(ii)“Compliance use date” means the first calendar year for which an allowance may be used for purposes of meeting a unit's Acid Rain emissions limitation for sulfur dioxide.

(jj)“Construction” means fabrication, erection, or installation of a unit or any portion of a unit.

(kk)“Designated” representative means a responsible natural person authorized by the owners and operators of an affected source and of all affected units at the source, as evidenced by a certificate of representation submitted in accordance with subpart B of 40 CFR part 72, to represent and legally bind each owner and operator, as a matter of federal law, in matters pertaining to the Acid Rain Program. Whenever the term "responsible official" is used in 40 CFR part 70 or in any other regulations implementing title V of the Act, it shall be deemed to refer to the "designated representative" with regard to all matters under the Acid Rain Program.

(ll)“Diesel fuel” means a low sulfur fuel oil of grades 1-D or 2-D, as defined by the American Society for Testing and Materials ASTM D975-91, “Standard Specification for Diesel Fuel Oils.”

(mm)“Direct public utility ownership” means direct ownership of equipment and facilities by one or more corporations, the principal business of which is sale of electricity to the public at retail.

Percentage ownership of such equipment and facilities shall be measured on the basis of book value.

(nn)“Draft Acid Rain permit or draft permit” means the version of the Acid Rain permit, or the Acid Rain portion of an operating permit, that the Technical Secretary offers for public comment.

(oo)“Emissions” means air pollutants exhausted from a unit or source into the atmosphere, as measured, recorded, and reported to the Administrator by the designated representative and as determined by the Administrator, in accordance with the emissions monitoring requirements of 40 CFR part 75.

(pp)“EPA” means the United States Environmental Protection Agency.

(qq)“Excess emissions” means: 1.Any tonnage of sulfur dioxide emitted by an affected unit during a calendar year that exceeds the Acid Rain emissions limitation for sulfur dioxide for the unit; and 2.Any tonnage of nitrogen oxide emitted by an affected unit during a calendar year that exceeds the annual tonnage equivalent of the Acid Rain emissions limitation for nitrogen oxides applicable to the affected unit taking into account the unit's heat input for the year.

(rr)“Existing unit” means a unit (including a unit subject to section 111 of the Act) that commenced commercial operation before November 15, 1990 and that on or after November 15, 1990 served a generator with a nameplate capacity of greater than 25 MWe. "Existing unit" does not include simple combustion turbines or any unit that on or after November 15, 1990 served only generators with a nameplate capacity of 25 MWe or less. Any “existing unit” that is modified, reconstructed, or repowered after November 15, 1990 shall continue to be an “existing unit.”

(ss)“Facility” means any institutional, commercial, or industrial structure, installation, plant, source, or building.

(tt)“Fossil fuel” means natural gas, petroleum, coal, or any form of solid, liquid, or gaseous fuel derived from such material.

(uu)“Fossil fuel-fired” means the combustion of fossil fuel or any derivative of fossil fuel, alone or in combination with any other fuel, independent of the percentage of fossil fuel consumed in any calendar year.

(vv)“Fuel oil” means any petroleum-based fuel (including diesel fuel or petroleum derivatives such as oil tar) as defined by the American Society for Testing and Materials in ASTM D396-90a, “Standard Specification for Fuel Oils,” and any recycled or blended petroleum products or petroleum by-products used as a fuel whether in a liquid, solid or gaseous state.

(ww)“Gas-fired” means the combustion of natural gas, or a coal-derived gaseous fuel with a sulfur content no greater than natural gas, for at least 90 percent of the average annual heat input during the previous three calendar years and for at least 85 percent of the annual heat input in each of those calendar years; and any fuel other than coal or any other coal-derived fuel for the remaining heat input, if any.

(xx)“General Account” means an Allowance Tracking System account that is not a unit account.

(yy)“Generator” means a device that produces electricity and was or would have been required to be reported as a generating unit pursuant to the United States Department of Energy Form 860 (1990 edition).

(zz)“Generator output capacity” means the full-load continuous rating of a generator under specific conditions as designed by the manufacturer.

(aaa)“Heat input” means the product (expressed in mmBtu/time) of the gross calorific value of the fuel (expressed in Btu/lb) and the fuel feed rate into the combustion device (expressed in mass of fuel/time) and does not include the heat derived from preheated combustion air, recirculated flue gases, or exhaust from other sources.

(bbb)“Independent power production facility (IPP)” means a source that: 1.Is nonrecourse project financed, as defined by the Secretary of Energy at 10 CFR part 715; 2.Is used for the generation of electricity, eighty percent or more of which is sold at wholesale; and 3.Is a new unit required to hold allowances under title IV of the Act; 4.Provided that direct public utility ownership of the equipment comprising the facility does not exceed 50 percent.

(ccc)“Life-of-the-unit, firm power contractual arrangement” means a unit participation power sales agreement under which a utility or industrial customer reserves, or is entitled to receive, a specified amount or percentage of nameplate capacity and associated energy generated by any specified generating unit and pays its proportional amount of such unit's total costs, pursuant to a contract: 1.For the life of the unit; 2.For a cumulative term of no less than 30 years, including contracts that permit an election for early termination; or 3.For a period equal to or greater than 25 years or 70 percent of the economic useful life of the unit determined as of the time the unit was built, with option rights to purchase or release some portion of the nameplate capacity and associated energy generated by the unit at the end of the period.

(ddd)“Nameplate capacity” means the maximum electrical generating output (expressed in MWe) that a generator can sustain over a specified period of time when not restricted by seasonal or other deratings, as listed in the NADB under the data field "NAMECAP" if the generator is listed in the NADB or as measured in accordance with the United States Department of Energy standards if the generator is not listed in the NADB.

(eee)“National Allowance Data Base or NADB” means the data base established by the Administrator under section 402(4)(C) of the Act.

(fff)“Natural gas” means a naturally occurring fluid mixture of hydrocarbons containing little or no sulfur (e.g., methane, ethane, or propane), produced in geological formations beneath the Earth's surface, and maintaining a gaseous state at standard atmospheric temperature and pressure conditions under ordinary conditions.

(ggg)“New unit” means a unit that commences commercial operation on or after November 15, 1990, including any such unit that serves a generator with a nameplate capacity of 25 MWe or less or that is a simple combustion turbine.

(hhh)“Offset plan” means a plan pursuant to 40 CFR part 77 for offsetting excess emissions of sulfur dioxide that have occurred at an affected unit in any calendar year.

(iii)“Oil-fired” means the combustion of: fuel oil for more than 10 percent of the average annual heat input during the previous three calendar years or for more than 15 percent of the annual heat input in any one of those calendar years; and any solid, liquid, or gaseous fuel, other than coal or any other coal-derived fuel (except a coal-derived gaseous fuel with a sulfur content no greater than natural gas), for the remaining heat input, if any.

(jjj)“Operating permit” means a permit issued under 40 CFR part 70, Paragraph 1200-3-9-.02(11), and any other regulations implementing title V of the Act.

(kkk)“Owner” means any of the following persons: 1.Any holder of any portion of the legal or equitable title in an affected unit; or 2.Any holder of a leasehold interest in an affected unit; or 3.Any purchaser of power from an affected unit under a life-of-the-unit, firm power contractual arrangement. However, unless expressly provided for in a leasehold agreement, owner shall not include a passive lessor, or a person who has an equitable interest through such lessor, whose rental payments are not based, either directly or indirectly, upon the revenues or income from the affected unit; or 4.With respect to any Allowance Tracking System general account, any person identified in the submission required by 40 CFR 73.31(c) that is subject to the binding agreement for the authorized account representative to represent that person's ownership interest with respect to allowances.

(lll)“Owner or operator” means any person who is an owner or who operates, controls, or supervises an affected unit or affected source and shall include, but not be limited to, any holding company, utility system, or plant manager of an affected unit or affected source.

(mmm)“Permit revision” means a permit modification, fast track modification, administrative permit amendment, or automatic permit amendment, as provided in Rule 1200-3-30-.07 of this

regulation.

(nnn)“Phase II” means the Acid Rain Program period beginning January 1, 2000, and continuing into the future thereafter.

(ooo)“Potential electrical output capacity” means the MWe capacity rating for the units which shall be equal to 33 percent of the maximum design heat input capacity of the steam generating unit, as calculated according to appendix D of 40 CFR part 72.

(ppp)“ower distribution system” means the portion of an electricity grid owned or operated by a utility that is dedicated to delivering electric energy to customers.

(qqq)“Power purchase commitment” means a commitment or obligation of a utility to purchase electric power from a facility pursuant to: 1.A power sales agreement; 2.A State regulatory authority order requiring a utility to:

(i)Enter into a power sales agreement with the facility;

(ii)Purchase from the facility; or (iii)Enter into arbitration concerning the facility for the purpose of establishing terms and conditions of the utility's purchase of power; 3.A letter of intent or similar instrument committing to purchase power (actual electrical output or generator output capacity) from the source at a previously offered or lower price and a power sales agreement applicable to the source is executed within the time frame established by the terms of the letter of intent but no later than November 15, 1992 or, where the letter of intent does not specify a time frame, a power sales agreement applicable to the source is executed on or before November 15, 1992; or 4.A utility competitive bid solicitation that has resulted in the selection of the qualifying facility of independent power production facility as the winning bidder.

(rrr)“Power sales agreement” is a legally binding agreement between a QF, IPP, or firm associated with such facility and a regulated electric utility that establishes the terms and conditions for the sale of power from the facility to the utility.

(sss)“Primary fuel or primary fuel supply” means the main fuel type (expressed in mmBtu) consumed by an affected unit for the applicable calendar year.

(ttt)“Proposed Acid Rain permit or proposed permit” means the version of an Acid Rain permit that the Technical Secretary submits to the Administrator after the public comment period, but prior to completion of the EPA permit review period under 40 CFR 70.8(c).

(uuu)“Qualifying facility (QF)” means a "qualifying small power production facility" within the meaning of section 3(17)(C) of the Federal Power Act or a "qualifying cogeneration facility" within the meaning of section 3(18)(B) of the Federal Power Act.

(vvv)“Qualifying power purchase commitment” means a power purchase commitment in effect as of November 15, 1990 without regard to changes to that commitment so long as: 1.The identity of the electric output purchaser, the identity of the steam purchaser and the location of the facility, remain unchanged as of the date the facility commences commercial operation; and 2.The terms and conditions of the power purchase commitment are not changed in such a way as to allow the costs of compliance with the Acid Rain Program to be shifted to the purchaser.

(www)“Qualifying repowering technology” means: 1.Replacement of an existing coal-fired boiler with one of the following clean coal technologies: atmospheric or pressurized fluidized bed combustion, integrated gasification combined cycle, magnetohydrodynamics, direct and indirect coal-fired turbines, integrated gasification fuel cells, or as determined by the Administrator, in consultation with the Secretary of Energy, a derivative of one or more of these technologies, and any other technology capable of controlling multiple combustion emissions simultaneously with improved boiler or generation efficiency and with significantly greater waste reduction relative to the performance of technology in widespread commercial use as of November 15, 1990; or 2.Any oil-or gas-fired unit that has been awarded clean coal technology demonstration funding as of January 1, 19911, by the Department of Energy.

(xxx)“Receive or receipt of” means the date the Administrator or Technical Secretary comes into possession of information or correspondence (whether sent in writing or by authorized electronic transmission), as indicated in an official correspondence log, or by a notation made on the information or correspondence, by the Administrator or Technical Secretary in the regular course of business.

(yyy)“Recordation, record, or recorded” means, with regard to allowances, the transfer of allowances by the Administrator from one Allowance Tracking System account or subaccount to another.

(zzz)“Schedule of compliance” means an enforceable sequence of actions, measures, or operations designed to achieve or maintain compliance, or correct non-compliance, with an applicable requirement of the Acid Rain Program, including any applicable Acid Rain permit requirement.

(aaaa)“Secretary of Energy” means the Secretary of the United States Department of Energy or the Secretary's duly authorized representative.

(bbbb)“Simple combustion turbine” means a unit that is a rotary engine driven by a gas under pressure that is created by the combustion of any fuel. This term includes combined cycle units without auxiliary firing. This term excludes combined cycle units with auxiliary firing, unless the unit did not use the auxiliary firing from 1985 through 1987 and does not use auxiliary firing at any time after November 15, 1990.

(cccc)“Solid waste incinerator” means a source as defined in section 129(g)(1) of the Act.

(dddd)“Source” means any governmental, institutional, commercial, or industrial structure, installation, plant, building, or facility that emits or has the potential to emit any regulated air pollutant under the Act. For purposes of section 502(c) of the Act, a “source”, including a “source” with multiple units, shall be considered a single “facility.”

(eeee)“Stack” means a structure that includes one or more flues and the housing for the flues.

(ffff)“State” means one of the 48 contiguous States and the District of Columbia and includes any non-federal authorities, including local agencies, interstate associations, and State-wide agencies with approved State operating permit programs. The term "State" shall have its conventional meaning where such meaning is clear from the context.

(gggg)“State operating permit program” means an operating permit program that the Administrator has approved as meeting the requirements of titles IV and V of the Act and 40 CFR parts 70 and 72.

(hhhh)“Submit or serve” means to send or transmit a document, information, or correspondence to the person specified in accordance with the applicable regulation: 1.In person; 2.By United States Postal Service certified mail with the official postmark or, if service is by the Administrator or the Technical Secretary, by any other mail service by the United States Postal Service; or 3.By other means with an equivalent time and date mark used in the regular course of business to indicate the date of dispatch or transmission and a record of prompt delivery.

Compliance with any "submission", "service", or "mailing" deadline shall be determined by the date of dispatch, transmission, or mailing and not the date of receipt.

(iiii)“Ton or tonnage” means any "short ton" (i.e., 2,000 pounds). For the purpose of determining compliance with the Acid Rain emissions limitations and reduction requirements, total tons for a year shall be calculated as the sum of all recorded hourly emissions (or the tonnage equivalent of the recorded hourly emissions rates) in accordance with 40 CFR part 75, with any remaining fraction of a ton equal to or greater than 0.50 ton deemed to equal one ton and any fraction of a ton less than 0.50 ton deemed not to equal any ton.

(jjjj)“Total planned net output capacity” means the planned generator output capacity, excluding that portion of the electrical power which is designed to be used at the power production facility, as specified under one or more qualifying power purchase commitments or contemporaneous documents as of November 15, 1990. "Total installed net output capacity" shall be the generator output capacity, excluding that portion of the electrical power actually used at the power production facility, as installed.

(kkkk) “Unit” means a fossil fuel-fired combustion device.

(llll)“Unit account” means an Allowance Tracking System account, established by the Administrator for an affected unit pursuant to 40 CFR 73.31 (a) or (b).

(mmmm)“Utility” means any person that sells electricity.

(nnnn)“Utility competitive bid solicitation” is a public request from a regulated utility for offers to the utility for meeting future generating needs. A qualifying facility, independent power production facility may be regarded as having been “selected” in such solicitation if the utility has named the facility as a project with which the utility intends to negotiate a power sales agreement.

(oooo)“Utility regulatory authority” means an authority, board, commission, or other entity (limited to the local-, State-, or federal-level, whenever so specified) responsible for overseeing the business operations of utilities located within its jurisdiction, including, but not limited to, utility rates and charges to customers.

(pppp)“Utility unit” means a unit owned or operated by a utility: 1.That serves a generator that produces electricity for sale, or 2.That during 1985, served a generator that produced electricity for sale. 3.Notwithstanding part 1 and 2 of this definition, a unit that was in operation during 1985, but did not serve a generator that produced electricity for sale during 1985, and did not commence commercial operation on or after November 15, 1990 is not a utility unit for purposes of the Acid Rain Program. 4.Notwithstanding parts 1 and 2 of this definition, a unit that cogenerates steam and electricity is not a utility unit for purposes of the Acid Rain Program, unless the unit is constructed for the purpose of supplying, or commences construction after November 15, 1990 and supplies, more than one-third of its potential electrical output capacity and more than 25 MWe output to any power distribution system for sale.

(2)MEASUREMENTS, ABBREVIATIONS, AND ACRONYMS. (40 CFR 72.3)

Measurements, abbreviations, and acronyms used in this regulation are defined as follows:

ASTM- American Society for Testing and Materials Btu-British thermal unit.

CFR-Code of Federal Regulations DOE-Department of Energy. mmBtu-million Btu.

MWe-megawatt electrical.

SO2-sulfur dioxide.

(3)APPLICABILITY. (40 CFR 72.6)

(a)Each of the following units shall be an affected unit, and any source that includes such a unit shall be an affected source, subject to the requirements of the Acid Rain Program: 1.A unit listed in Table 1 of 40 CFR 73.10(a). 2.An existing unit that is identified in Table 2 or 3 of 40 CFR 73.10 and any other existing utility unit, except a unit under paragraph (b) of this section. 3.A utility unit, except a unit under subparagraph (b) of this paragraph, that:

(i)Is a new unit;

(ii)Did not serve a generator with a nameplate capacity greater than 25 MWe on November 15, 1990 but serves such a generator after November 15, 1990.

(iii)Was a simple combustion turbine on November 15, 1990 but adds or uses auxiliary firing after November 15, 1990;

(iv)Was an exempt cogeneration facility under part (b)4 of this paragraph but during any three calendar year period after November 15, 1990 sold, to a utility power distribution system, an annual average of more than one-third of its potential electrical out-put capacity and more than 219,000 MWe-hrs electric output, on a gross basis;

(v)Was an exempt qualifying facility under part (b)5 of this paragraph but, at any time after the later of November 15, 1990 or the date the facility commences commercial operation, fails to meet the definition of qualifying facility;

(vi)Was an exempt independent power production facility under part (b)6 but, at any time after the later of November 15, 1990 or the date the facility commences commercial operation, fails to meet the definition of independent power production facility; or (vii)Was an exempt solid waste incinerator under part (b)7 of this paragraph but during any three calendar year period after November 15, 1990 consumes 20 percent or more (on a Btu basis) fossil fuel.

(b)The following types of units are not affected units subject to the requirements of the Acid Rain Program: 1.A simple combustion turbine that commenced operation before November 15, 1990. 2.Any unit that commenced commercial operation before November 15, 1990 and that did not, as of November 15, 1990, and does not currently, serve a generator with a nameplate capacity of greater than 25 MWe. 3.Any unit that, during 1985, did not serve a generator that produced electricity for sale and that did not, as of November 15, 1990, and does not currently, serve a generator that produces electricity for sale. 4.A cogeneration facility which:

(i)For a unit that commenced construction on or prior to November 15, 1990, was constructed for the purpose of supplying equal to or less than one-third its potential electrical output capacity or equal to or less than 219,000 MWe-hrs actual electric output on an annual basis to any utility power distribution system for sale (on a gross basis). If the purpose of construction is not known, it will be presumed to be consistent with the actual operation from 1985 through 1987.

However, if in any three calendar year period after November 15, 1990, such unit sells to a utility power distribution system an annual average of more than one-third of its potential electrical output capacity and more than 219,000 MWe-hrs actual electric output (on a gross basis), that unit shall be an affected unit, subject to the requirements of the Acid Rain Program; or (ii)For units that commenced construction after November 15, 1990, supplies equal to or less than one-third its potential electrical output capacity or equal to or less than 219,000 MWe-hrs actual electric output on an annual basis to any utility power distribution system for sale (on a gross basis). However, if in any three calendar year period after November 15, 1990, such unit sells to a utility power distribution system an annual average of more than one-third of its potential electrical output capacity and more than 219,000 MWe-hrs actual electric output (on a gross basis), that unit shall be an affected unit, subject to the requirements of the Acid Rain Program. 5.A qualifying facility that:

(i)Has, as of November 15, 1990, one or more qualifying power purchase commitments to sell at least 15 percent of its total planned net output capacity; and (ii)Consists of one or more units designated by the owner or operator with total installed net output capacity not exceeding 130 percent of the total planned net output capacity. If the emissions rates of the units are not the same, the Administrator may exercise discretion to designate which units are exempt. 6.An independent power production facility that:

(i)Has, as of November 15, 1990, one or more qualifying power purchase commitments to sell at least 15 percent of its total planned net output capacity; and (ii)Consists of one or more units designated by the owner or operator with total installed net output capacity not exceeding 130 percent of its total planned net output capacity. If the emissions rates of the units are not the same, the Administrator may exercise discretion to designate which units are exempt. 7.A solid waste incinerator, if more than 80 percent (on a Btu basis) of the annual fuel consumed at such incinerator is other than fossil fuels. For a solid waste incinerator which began operation before January 1, 1985, the average annual fuel consumption of non-fossil fuels for calendar years 1985 through 1987 must be greater than 80 percent for such an incinerator to be exempt. For a solid waste incinerator which began operation after January 1, 1985, the average annual fuel consumption of non-fossil fuels for the first three years of operation must be greater than 80 percent for such an incinerator to be exempt. If, during any three calendar year period after November 15, 1990, such incinerator consumes 20 percent or more (on a Btu basis) fossil fuel, such incinerator will be an affected source under the Acid Rain Program. 8.A non-utility unit.

(c)A certifying official of any unit may petition the Administrator for a determination of applicability under 40 CFR 72.6(c). The Administrator's determination of applicability shall be binding upon the Technical Secretary, unless the petition is found to have contained significant errors or omissions.

(4)New units exemption. (40 CFR 72.7)

(a)Applicability. This paragraph applies to any new utility unit that serves one or more generators with total nameplate capacity of 25 MWe or less and burns only fuels with a sulfur content of 0.05 percent or less by weight, as determined in accordance with part (d)1 of this paragraph.

(b)Petition for Written Exemption. The designated representative, authorized in accordance with

subpart B of 40 CFR part 72, of a source that includes a unit under subparagraph (a) of this paragraph may petition the Technical Secretary for a written exemption, or to renew a written exemption, for the unit from certain requirements of the Acid Rain Program. The petition shall be submitted on a form approved by the Technical Secretary which includes the following elements: 1.Identification of the unit. 2.The nameplate capacity of each generator served by the unit. 3.A list of all fuels currently burned by the unit and their percentage sulfur content by weight, determined in accordance with subparagraph (a) of this paragraph. 4.A list of all fuels that are expected to be burned by the unit and their sulfur content by weight. 5.The special provisions in subparagraph (d) of this paragraph.

(c)Technical Secretary's Action. 1.(i)The Technical Secretary will issue, for any unit meeting the requirements of subparagraphs (a) and (b) of this paragraph, a written exemption from the requirements of the Acid Rain Program except for the requirements specified in this section, 40 CFR 72.2 through 72.7, and 40 CFR 72.10 through 72.13; provided that no unit shall be exempted unless the designated representative of the unit surrenders, and the Administrator deducts from the unit's Allowances Tracking System account, allowances pursuant to 40 CFR 72.7(c)(1)(i) and (d)(1).

(ii)The exemption shall take effect on January 1 of the year immediately following the date on which the written exemption is issued as a final agency action subject to judicial review, in accordance with part (c)2 of this paragraph; provided that the owners and operators, and, to the extent applicable, the designated representative, shall comply with the requirements of the Acid Rain Program concerning all years for which the unit was not exempted, even if such requirements arise, or must be complied with, after the exemption takes effect. The exemption shall not be a defense against any violation of such requirements of the Acid Rain Program whether the violation occurs before or after the exemption takes effect. 2.In considering and issuing or denying a written exemption under part (c)1 of this paragraph, the Technical Secretary will apply the permitting procedures in Rule

Tenn. Comp. R. & Regs. 1200-03-30-.02 DESIGNATED REPRESENTATIVE

(40 CFR PART 72, SUBPART B)

(1)Submissions. (40 CFR 72.21)

(a)The designated representative shall submit a certificate of representation, and any superseding certificate of representation, to the Administrator in accordance with subpart B of 40 CFR part 72 and, concurrently, shall submit a copy to the Technical Secretary. Whenever the term “designated representative” is used in this regulation, the term shall be construed to include the alternate designated representative.

(b)Each submission under the Acid Rain Program shall be submitted, signed, and certified by the designated representative for all sources on behalf of which the submission is made.

(c)In each submission under the Acid Rain Program, the designated representative shall certify, by his or her signature: 1.The following statement, which shall be included verbatim in such submission: ''I am authorized to make this submission on behalf of the owners and operators of the affected source or affected units for which the submission is made.'' 2.The following statement, which shall be included verbatim in such submission: “I certify under penalty of law that I have personally examined, and am familiar with, the statements and information submitted in this document and all its attachments. Based on my inquiry of those individuals with primary responsibility for obtaining the information, I certify that the statements and information are to the best of my knowledge and belief true, accurate, and complete. I am aware that there are significant penalties for submitting false statements and information or omitting required statements and information, including the possibility of fine or imprisonment.”

(d)The Technical Secretary will accept or act on a submission made on behalf of owners or operators of an affected source and an affected unit only if the submission has been made, signed, and certified in accordance with subparagraphs (b) and (c) of this paragraph.

(e)1.The designated representative of a source shall serve notice on each owner and operator of the source and of an affected unit at the source:

(i)By the date of submission, of any Acid Rain Program submissions by the designated representative;

(ii)Within 10 business days of receipt of a determination, of any written determination by the Administrator or the Technical Secretary; and (iii)Provided that the submission or determination covers the source or the unit. 2.The designated representative of a source shall provide each owner and operator of an affected unit at the source a copy of any submission or determination under part (e)1 of this paragraph, unless the owner or operator expressly waives the right to receive such a copy.

(2)Objections. (40 CFR 72.25)

(a)Except as provided in 40 CFR 72.23, no objection or other communication submitted to the Administrator or the Technical Secretary concerning the authorization, or any submission, action or inaction, of the designated representative shall affect any submission, action, or inaction of the designated representative, or the finality of any decision by the Technical Secretary, under the Acid Rain Program. In the event of such communication, the Technical Secretary is not required to stay any submission or the effect of any action or inaction under the Acid Rain Program.

(b)The Technical Secretary will not adjudicate any private legal dispute concerning the authorization or any submission, action, or inaction of any designated representative, including private legal disputes concerning the proceeds of allowance transfers.

History

• Authority: T.C.A. §§668-201-105 and 4-5-202.
• Administrative History: Original rule filed June 30, 1994; effective September 15, 1994.

Tenn. Comp. R. & Regs. 1200-03-30-.03 ACID RAIN PERMIT APPLICATIONS

(40 CFR PART 72, SUBPART C)

(1)Requirement to apply. (40 CFR 72.30)

(a)Duty to apply. The designated representative of any source with an affected unit shall submit a complete Acid Rain permit application by the applicable deadline in subparagraphs (b) and (c) of this paragraph, and the owners and operators of such source and any affected unit at the source shall not operate the source or unit without a permit that states its Acid Rain Program requirements.

(b)Deadlines. 1.For any source with an existing unit described under part 1200-3-30-.01(3)(a)2, the designated representative shall submit a complete Acid Rain permit application governing such unit to the Technical Secretary on or before January 1, 1996. 2.For any source with a new unit described under subpart 1200-3-30-.01(3)(a)3(i), the designated representative shall submit a complete Acid Rain permit application governing such unit to the Technical Secretary at least 24 months before the later of January 1, 2000 or the date on which the unit commences operation. 3.For any source with a unit described under subpart 1200-3-30-.01(3)(a)3(ii), the designated representative shall submit a complete Acid Rain permit application governing such unit to the Technical Secretary at least 24 months before the later of January 1, 2000 or the date on which the unit begins to serve a generator with a nameplate capacity greater than 25 MWe. 4.For any source with a unit described under subpart 1200-3-30-.01(3)(a)3(iii), the designated representative shall submit a complete Acid Rain permit application governing such unit to the Technical Secretary at least 24 months before the later of January 1, 2000 or the date on which the auxiliary firing commences operation. 5.For any source with a unit described under subpart 1200-3-30-.01(3)(a)3(iv), the designated representative shall submit a complete Acid Rain permit application governing such unit to the Technical Secretary before the later of January 1, 1998 or March 1 of the year following the three calendar year period in which the unit sold to a utility power distribution system an annual average of more than one-third of its potential electrical output capacity and more than 219,000 MWe-hrs actual electric output (on a gross basis). 6.For any source with a unit described under subpart 1200-3-30-.01(3)(a)3(v), the designated representative shall submit a complete Acid Rain permit application governing such unit to the Technical Secretary before the later of January 1, 1998 or March 1 of the year following the calendar year in which the facility fails to meet the definition of qualifying facility. 7.For any source with a unit described under subpart 1200-3-30-.01(3)(a)3(vi), the designated representative shall submit a complete Acid Rain permit application governing such unit to the Technical Secretary before the later of January 1, 1998 or March 1 of the year following the calendar year in which the facility fails to meet the definition of an independent power production facility. 8.For any source with a unit described under subpart 1200-3-30-.01(3)(a)3(vii), the designated representative shall submit a complete Acid Rain permit application governing such unit to the Technical Secretary before the later of January 1, 1998 or March 1 of the year following the three calendar year period in which the incinerator consumed 20 percent or more fossil fuel (on a Btu basis).

(c)Duty to Reapply. The designated representative shall submit a complete Acid Rain permit application for each source with an affected unit at least 6 months or such longer time as may be approved under 40 CFR part 70 prior to the expiration of an existing Acid Rain permit governing the unit.]

(d)The original and three copies of all permit applications shall be submitted to the Technical Secretary.

(2)Information requirements for Acid Rain permit applications. (40 CFR 72.31) A complete Acid Rain permit application shall be submitted on a form approved by the Technical Secretary, which includes the following elements:

(a)Identification of the affected source for which the permit application is submitted;

(b)Identification of each affected unit at the source for which the permit application is submitted;

(c)A complete compliance plan for each unit, in accordance with Rule 1200-3-30-.04.

(d)The standard requirements under paragraph 1200-3-30-.01(6); and (e)If the unit is a new unit, the date that the unit has commenced or will commence operation and the deadline for monitor certification.

(3)Permit application shield and binding effect of permit application. (40 CFR 72.32)

(a)Once a designated representative submits a timely and complete Acid Rain permit application, the owners and operators of the affected source and the affected units covered by the permit application shall be deemed in compliance with the requirement to have an Acid Rain permit under part 1200-3-30-.01(6)(a)2 and subparagraph 1200-3-30-.03(1)(a); provided that any delay in issuing an Acid Rain permit is not caused by the failure of the designated representative to submit in a complete and timely fashion supplemental information, as required by the Technical Secretary, necessary to issue a permit.

(b)Prior to the earlier of the date on which an Acid Rain permit is issued as a final agency action subject to judicial review, an affected unit governed by and operated in accordance with the terms and requirements of a timely and complete Acid Rain permit application shall be deemed to be operating in compliance with the Acid Rain Program.

(c)A complete Acid Rain permit application shall be binding on the owners and operators and the designated representative of the affected source and the affected units covered by the permit application and shall be enforceable as an Acid Rain permit from the date of submission of the permit application until the issuance or denial of such permit as a final agency action subject to judicial review.

History

• Authority: T.C.A. §§668-201-105 and 4-5-202.
• Administrative History: Original rule filed June 30, 1994; effective September 15, 1994.

Tenn. Comp. R. & Regs. 1200-03-30-.04 ACID RAIN COMPLIANCE PLAN AND COMPLIANCE OPTIONS (40 CFR PART 72,

SUBPART D)

(1)General. (40 CFR 72.4)

(a)For each affected unit included in an Acid Rain permit application, a complete compliance plan shall include: 1.For sulfur dioxide emissions, a certification that, as of the allowance transfer deadline, the designated representative will hold allowances in the unit's compliance subaccount (after deductions under 40 CFR 73.34(c)) not less than the total annual emissions of sulfur dioxide from the unit. The compliance plan may also specify, in accordance with

Rule 1200-3-30-.04, one or more of the Acid Rain compliance options. 2.For nitrogen oxides emissions, a certification that the unit will comply with the applicable limitation established by regulations implementing section 407 of the Act or shall specify one or more Acid Rain compliance options, in accordance with section 407 of the Act and regulations implementing section 407.

(b)The compliance plan may include a multi-unit compliance option under paragraph 1200-3-30-.04(2) or section 407 of the Act or regulations implementing section 407. 1.A plan for a compliance option that includes units at more than one affected source shall be complete only if:

(i)Such plan is signed and certified by the designated representative for each source with an affected unit governed by such plan; and (ii)A complete permit application is submitted covering each unit governed by such plan. 2.Technical Secretary's approval of a plan under part (b)1 of this paragraph that includes units in more than one State shall be final only after every permitting authority with jurisdiction over any such unit has approved the plan with the same modifications or conditions, if any.

(c)Conditional Approval. In the compliance plan, the designated representative of an affected unit may propose, in accordance with Rule 1200-3-30-.04, any Acid Rain compliance option for conditional approval; provided that an Acid Rain compliance option under section 407 of the Act may be conditionally proposed only to the extent provided in regulations implementing

section 407 of the Act. 1.To activate a conditionally-approved Acid Rain compliance option, the designated representative shall notify the Technical Secretary in writing that the conditionally-approved compliance option will actually be pursued beginning January 1 of a specified year. Such notification shall be subject to the limitations on activation under paragraph 1200-3-30-.04(2) and regulations implementing section 407 of the Act.

If the conditionally approved compliance option includes a plan described in part (b)1 of this paragraph, the designated representative of each source governed by the plan shall sign and certify the notification. 2.The notification under part (c)1 of this paragraph shall specify the first calendar year and the last calendar year for which the conditionally approved Acid Rain compliance option is to be activated. A conditionally approved compliance option shall be activated, if at all, before the date of any enforceable milestone applicable to the compliance option. The date of activation of the compliance option shall not be a defense against failure to meet the requirements applicable to that compliance option during each calendar year for which the compliance option is activated. 3.Upon submission of a notification meeting the requirements of parts (c)1 and 2 of this paragraph, the conditionally-approved Acid Rain compliance option becomes binding on the owners and operators and the designated representative of any unit governed by the conditionally-approved compliance option. 4.A notification meeting the requirements of parts (c)1 and 2 of this paragraph will revise the unit's permit in accordance with paragraph 1200-3-30-.07(4) (administrative permit amendment).

(d)Termination of Compliance Option. 1.The designated representative for a unit may terminate an Acid Rain compliance option by notifying the Technical Secretary in writing that an approved compliance option will be terminated beginning January 1 of a specified year. Such notification shall be subject to the limitations on termination under paragraph 1200-3-30-.04(2) and regulations implementing section 407 of the Act.If the compliance option includes a plan described in part (b)1 of this paragraph, the designated representative for each source governed by the plan shall sign and certify the notification. 2.The notification under part (d)1 of this paragraph shall specify the calendar year for which the termination will take effect. 3.Upon submission of a notification meeting the requirements of parts (d)1 and 2 of this paragraph, the termination becomes binding on the owners and operators and the designated representative of any unit governed by the Acid Rain compliance option to be terminated. 4.A notification meeting the requirements of parts (d)1 and 2 of this paragraph will revise the unit's permit in accordance with paragraph 1200-3-30-.07(4) (administrative permit amendment).

(2)Repowering extensions. (40 CFR 72.44)

(a)Applicability. 1.This paragraph shall apply to the designated representative of:

(i)Any existing affected unit that is a coal-fired unit and has a 1985 actual SO2 emissions rate equal to or greater than 1.2 lbs/mmBtu; or (ii)Any new unit that will be a replacement unit, as provided in part (b)2 of this paragraph, for a unit meeting the requirements of subpart (a)1(i) of this paragraph; or (iii)Any oil and/or gas-fired unit that has been awarded clean coal technology demonstration funding as of January 1, 1991 by the Secretary of Energy. 2.A repowering extension does not exempt the owner or operator for any unit governed by the repowering plan from the requirement to comply with such unit's Acid Rain emissions limitations for sulfur dioxide.

(b)The designated representative of any unit meeting the requirements of subpart (a)1(i) of this paragraph may include in the unit’s Acid Rain permit application a repowering extension plan that includes a demonstration that: 1.The unit will be repowered with a qualifying repowering technology in order to comply with the emissions limitations for sulfur dioxide; or 2.The unit will be replaced by a new utility unit that has the same designated representative and that is located at a different site using a qualified repowering technology and the existing unit will be permanently retired from service on or before the date on which the new utility unit commences commercial operation.

(c)In order to apply for a repowering extension, the designated representative of a unit under subparagraph (a) of this paragraph shall: 1.Submit to the Technical Secretary, by January 1, 1996, a complete repowering extension plan; 2.Submit to the Administrator before June 1, 1997, a complete petition for approval of repowering technology in accordance with 40 CFR 72.44(d) and submit a copy to the Technical Secretary; and 3.If the repowering extension plan is submitted for conditional approval, submit to the Technical Secretary by December 31, 1997, a notification to activate the plan in accordance with subparagraph 1200-3-30-.04(1)(c).

(d)Contents of Repowering Extension Plan. A complete repowering extension plan shall include the following elements: 1.Identification of the existing unit governed by the plan. 2.The unit's federally-approved State Implementation Plan sulfur dioxide emissions limitation. 3.The unit's 1995 actual SO2 emissions rate, or best estimate of the actual emissions rate; provided that the actual emissions rate is submitted to the Technical Secretary by January 30, 1996. 4.A schedule for construction, installation, and commencement of operation of the repowering technology approved or submitted for approval under 40 CFR 72.44(d) with dates for the following milestones:

(i)Completion of design engineering;

(ii)For a plan under part (b)1 of this paragraph, removal of the existing unit from operation to install the qualified repowering technology;

(iii)Commencement of construction;

(iv)Completion of construction;

(v)Start-up testing;

(vi)For a plan under part (b)2 of this paragraphn, shutdown of the existing unit; and (vii)Commencement of commercial operation of the repowering technology. 5.For a plan under part (b)2 of this paragraph;

(i)Identification of the new unit. A new unit shall not be included in more than one repowering extension plan.

(ii)Certification that the new unit will replace the existing unit.

(iii)Certification that the new unit has the same designated representative as the existing unit.

(iv)Certification that the existing unit will be permanently retired from service on or before the date the new unit commences commercial operation. 6.The special provisions of subparagraph (g) of this paragraph.

(e)Technical Secretary's Action on Repowering Extension Plan. 1.The Technical Secretary will not approve a repowering extension plan until the Administrator makes a conditional determination that the technology is a qualified repowering technology, unless the Technical Secretary approves such plan subject to the conditional determination of the Administrator. 2.Permit Issuance.

(i)Upon a conditional determination by the Administrator that the technology to be used in the repowering extension plan is a qualified repowering technology and a determination by the Technical Secretary that such plan meets the requirements of this section, the Technical Secretary will issue the Acid Rain portion of the operating permit including:

(I)The approved repowering extension plan; and (II)A schedule of compliance with enforceable milestones for construction, installation, and commencement of operation of the repowering technology and other requirements necessary to ensure that emission reduction requirements under this paragraph will be met.

(ii)Except as otherwise provided in subparagraph (f) of this paragraph, the repowering extension shall be in effect starting January 1, 2000 and ending on the day before the date (specified in the Acid Rain permit) on which the existing unit will be removed from operation to install the qualifying repowering technology or will be permanently removed from service for replacement by a new unit with such technology; provided that the repowering extension shall end no later than December 31, 2003.

(iii)The portion of the operating permit specifying the repowering extension and other requirements under subpart (e)2(i) of this paragraph shall be subject to the Administrator's final determination, under 40 CFR 72.44(d)(4), that the technology to be used in the repowering extension plan is a qualifying repowering technology. 3.Allowance Allocation. Allowances will be allocated in accordance with 40 CFR 72.44(f)(3) and (g).

(f)Failed Repowering Projects. 1.(i)If, at any time before the end of the repowering extension under subpart (e)2(ii) of this paragraph, the designated representative of a unit governed by an approved repowering extension plan submits the notification under subparagraph 1200-3-30-.08(2)(d) that the owners and operators have decided to terminate efforts to properly design, construct, and test the repowering technology specified in the plan before completion of construction or start-up testing, the designated representative may submit to the Technical Secretary a proposed permit modification demonstrating that such efforts were in good faith. If such demonstration is to the satisfaction of the Administrator, the unit shall not be deemed in violation of the Act because of such a termination and the Technical Secretary will revise the operating permit in accordance with subpart (f)1(ii) of this paragraph.

(ii)Regardless of whether notification under subpart (f)(1)(i) of this paragraph is given, the repowering extension will end beginning on the earlier of the date of such notification or the date by which the designated representative was required to give such notification under subparagraph 1200-3-30-.08(2)(d). 2.The designated representative of a unit governed by an approved repowering extension plan may submit to the Technical Secretary a proposed permit modification demonstrating that the repowering technology specified in the plan was properly constructed and tested on such unit but was unable to achieve the emissions reduction limitations specified in the plan and that it is economically or technologically infeasible to modify the technology to achieve such limits, the unit shall not be deemed in violation of the Act because of such failure to achieve the emissions reduction limitations. In order to be properly constructed and tested, the repowering technology shall be constructed at least to the extent necessary for direct testing of the multiple combustion emissions (including sulfur dioxide and nitrogen oxides) from such unit while operating the technology at nameplate capacity. If such demonstration is to the satisfaction of the Administrator, (i)The unit shall not be deemed in violation of the Act because of such failure to achieve the emissions reduction limitations;

(ii)The Technical Secretary will revise the Acid Rain portion of the operating permit in accordance with subparts (f)2 (ii) and (iii) of this paragraph.

(iii)The existing unit may be retrofitted or repowered with another clean coal or other available control technology; and (iv)The repowering extension will continue in effect until the earlier of the date the existing unit commences commercial operation with such control technology or December 31, 2003.

(g)Special Provisions. 1.Emissions Limitations.

(i)Sulfur Dioxide. Allowances allocated during the repowering extension under part (e)2 and subparagraph (f) of this paragraph to a unit governed by an approved repowering extension plan shall not be transferred to any Allowance Tracking System account other than the unit accounts of other units at the same source as that unit.

(ii)Nitrogen Oxides. Any existing unit governed by an approved repowering extension plan shall be subject to the Acid Rain emissions limitations for nitrogen oxides in accordance with section 407 of the Act and regulations implementing

section 407 of the Act beginning on the date that the unit is removed from operation to install the repowering technology or is permanently removed from service.

(iii)No existing unit governed by an approved repowering extension plan shall be eligible for a waiver under section 111(j) of the Act.

(iv)No new unit governed by an approved repowering extension plan shall receive an exemption from the requirements imposed under section 111 of the Act. 2.Reporting Requirements. Each unit governed by an approved repowering extension plan shall comply with the special reporting requirements of paragraph 1200-3-30-.08(2). 3.Liability.

(i)The owners and operators of a unit governed by an approved repowering plan shall be liable for any violation of the plan or this section at that or any other unit governed by the plan, (ii)The units governed by the plan under part (b)2 of this paragraph shall continue to have a common designated representative until the existing unit is permanently retired under the plan. 4.Terminations. Except as provided in subparagraph (f) of this paragraph, a repowering extension plan shall not be terminated after December 31, 1999.

History

• Authority: T.C.A. §§668-201-105 and 4-5-202.
• Administrative History: Original rule filed June 30, 1994; effective September 15, 1994.

Tenn. Comp. R. & Regs. 1200-03-30-.05 ACID RAIN PERMIT

(40 CFR PART 72, SUBPART E)

(1)Contents. (40 CFR 72.50)

(a)Each Acid Rain permit (including any draft or proposed Acid Rain permit) will contain the following elements: 1.All elements required for a complete Acid Rain permit application under paragraph 1200-3-30-.03(2), as approved or adjusted by the Technical Secretary; 2.The applicable Acid Rain emissions limitation for sulfur dioxide; and 3.The applicable Acid Rain emissions limitation for nitrogen oxides.

(b)Each Acid Rain permit is deemed to incorporate the definitions of terms under paragraph 1200-3-30-.01(1).

(2)Permit shield. (40 CFR 72.51)

Each affected unit operated in accordance with the Acid Rain permit that governs the unit and that was issued in compliance with title IV of the Act, as provided in Rule 1200-3-30-.01 through Rule

Tenn. Comp. R. & Regs. 1200-03-30-.06 .

(c)Any reopening of an Acid Rain permit shall not affect the term of the permit.

History

• Authority: T.C.A. §§668-201-105 and 4-5-202.
• Administrative History: Original rule filed June 30, 1994; effective September 15, 1994.

Tenn. Comp. R. & Regs. 1200-03-30-.08 COMPLIANCE CERTIFICATION (40 CFR PART 72, SUBPART I)

(1)Annual compliance certification report. (40 CFR 72.90)

(a)Applicability and Deadline. For each calendar year in which a unit is subject to the Acid Rain emissions limitations, the designated representative of the source at which the unit is located shall submit to the Administrator and to the Technical Secretary, within 60 days after the end of the calendar year, an annual compliance certification report for the unit in compliance with 40 CFR 72.90.

(b)The submission of complete compliance certifications in accordance with subparagraph (a) of this paragraph and 40 CFR part 75 shall be deemed to satisfy the requirement to submit compliance certifications under item 1200-3-9-.02(11)(e)3(v)(III) with regard to the Acid Rain portion of the source's operating permit.

(2)Units with repowering extension plans. (40 CFR 72.94)

(a)Design and Engineering and Contract Requirements. No later than January 1, 2000, the designated representative of a unit governed by an approved repowering plan shall submit to the Administrator and the Technical Secretary: 1.Satisfactory documentation of a preliminary design and engineering effort. 2.A binding letter agreement for the executed and binding contract (or for each in a series of executed and binding contracts) for the majority of the equipment to repower the unit using the technology conditionally approved by the Administrator under 40 CFR 72.44(d)(3). 3.The letter agreement under part (a)2 of this paragraph shall be signed and dated by each party and specify:

(i)The parties to the contract;

(ii)The date each party executed the contract;

(iii)The unit to which the contract applies;

(iv)A brief list identifying each provision of the contract;

(v)Any dates to which the parties agree, including construction completion date;

(vi)The total dollar amount of the contract; and (vii)A statement that a copy of the contract is on site at the source and will be submitted upon written request of the Administrator or the Technical Secretary.

(b)Removal From Operation to Repower. The designated representative of a unit governed by an approved repowering plan shall notify the Administrator and the Technical Secretary in writing at least 60 days in advance of the date on which the existing unit is to be removed from operation so that the qualified repowering technology can be installed, or is to be replaced by another unit with the qualified repowering technology, in accordance with the plan.

(c)Commencement of Operation. Not later than 60 days after the units repowered under an approved repowering plan commences operation at full load, the designated representative of the unit shall submit a report to the Administrator and the and the Technical Secretary comparing the actual hourly emissions and percent removal of each pollutant controlled at the unit to the actual hourly emissions and percent removal at the existing unit under the plan prior to repowering, determined in accordance with 40 CFR part 75.

(d)Decision to Terminate. If at any time before the end of the repowering extension and before completion of construction and start-up testing, the owners and operators decide to terminate good faith efforts to design, construct, and test the qualified repowering technology on the unit to be repowered under an approved repowering plan, then the designated representative shall submit a notice to the Administrator and the Technical Secretary by the earlier of the end of the repowering extension or a date within 30 days of such decision, stating the date on which the decision was made.

Tenn. Comp. R. & Regs. 1200-03-30-.07 .

(b)The following permit revisions are permit modifications: 1.Relaxation of an excess emission offset requirement after approval of the offset plan by the Administrator; 2.Incorporation of a final nitrogen oxides alternative emission limitation following a demonstration period; 3.Determinations concerning failed repowering projects under subpart 1200-3-30-.04 (2)(f)1(i) and part 1200-3-30-.04(2)(f)2; and 4.At the option of the designated representative submitting the permit revision, the permit revisions listed in subparagraph 1200-3-30-.07(3)(b).

(3)Fast-track modifications. (40 CFR 72.82)

(a)Fast-track modifications shall follow the following procedures: 1.The designated representative shall serve a copy of the fast-track modification on the Administrator, the Technical Secretary, and any person entitled to a written notice under

part 1200-3-9-.02(11)(f)8 and part 1200-3-9-.02(11)(g)2. Within 5 business days of serving such copies, the designated representative shall also give public notice by publication in a newspaper of general circulation in the area where the source is located or in a State publication designed to give general public notice. 2.The public shall have a period of 30 days, commencing on the date of publication of the notice, to comment on the fast-track modification. Comments shall be submitted in writing to the Technical Secretary and to the designated representative. 3.The designated representative shall submit the fast-track modification to the Technical Secretary on or before commencement of the public comment period. 4.Within 30 days of the close of the public comment period, the Technical Secretary will consider the fast-track modification and the comments received and approve, in whole or in part or with changes or conditions as appropriate, or disapprove the modification. A fast-track modification shall be effective immediately upon issuance, in accordance with item 1200-3-9-.02(11)(f)1(i)(V) as applied to significant modifications.

(b)The following permit revisions are, at the option of the designated representative submitting the permit revision, either fast-track modifications under this section or permit modifications under paragraph 1200-3-30-.07(2): 1.Incorporation of a compliance option that the designated representative did not submit for approval and comment during the permit issuance process; 2.Addition of a nitrogen oxides averaging plan to a permit; and 3.Changes in a repowering plan, nitrogen oxides averaging plan, or nitrogen oxides compliance deadline extension.

(4)Administrative permit amendment. (40 CFR 72.83)

(a)Administrative amendments shall follow the procedures set forth at subpart 1200-3-9-.02(11)(f)4(iii). The Technical Secretary will submit the revised portion of the permit to the Administrator within 10 working days after the date of final action on the request for an administrative amendment.

(b)The following permit revisions are administrative amendments: 1.Activation of a compliance option conditionally approved by the Technical Secretary; provided that all requirements for activation under subparagraph 1200-3-30-.04(1)(c) and paragraph 1200-3-30-.04(2) are met; 2.Changes in the designated representative or alternative designated representative; provided that a new certificate of representation is submitted to the Administrator in accordance with subpart B of 40 CFR part 72; 3.Correction of typographical errors; 4.Changes in names, addresses, or telephone or facsimile numbers; 5.Changes in the owners or operators; provided that a new certificate of representation is submitted within 30 days to the Administrator in accordance with subpart B of 40 CFR

part 72; 6.Termination of a compliance option in the permit; provided that all requirements for termination under subparagraph 1200-3-30-.04(1)(d) shall be met and this procedure shall not be used to terminate a repowering plan after December 31, 1999; 7.Changes in the date, specified in a new unit's Acid Rain permit, of commencement of operation or the deadline for monitor certification, provided that they are in accordance with paragraph 1200-3-30-.01(6). 8.The addition of or change in a nitrogen oxides alternative emissions limitation demonstration period, provided that the requirements of regulations implementing

section 407 of the Act are met; and 9.Incorporation of changes that the Administrator has determined to be similar to those in parts (a)1 through (8) of this paragraph.

(5)Automatic permit amendment. (40 CFR 72.84)

The following permit revisions shall be deemed to amend automatically, and become a part of the affected unit's Acid Rain permit by operation of law without any further review:

(a)Upon recordation by the Administrator under 40 CFR part 73, all allowance allocations to, transfers to, and deductions from an affected unit's Allowance Tracking System account; and (b)Incorporation of an offset plan that has been approved by the Administrator under 40 CFR part 77.

(6)Permit reopenings. (40 CFR 72.85)

(a)As provided in part 1200-3-9-.02(11)(f)6, the Technical Secretary will reopen an Acid Rain permit for cause, including whenever additional requirements become applicable to any affected unit governed by the permit.

(b)In reopening an Acid Rain permit for cause, the Technical Secretary will issue a draft permit changing the provisions, or adding the requirements, for which the reopening was necessary.

The draft permit shall be subject to the requirements of Rule 1200-3-30-.05 and Rule

Tenn. Comp. R. & Regs. 1200-03-30-.10 SULFUR DIOXIDE OPT-INS [RESERVED]

History

• Authority: T.C.A. 68-201-105 and 4-5-202.
• Administrative History: Original rule filed June 30, 1994; effective September 13, 1994.

Chapter 1200-03-31 Case-By-Case Determinations of Hazardous Air Pollutant Control Requirements

Tenn. Comp. R. & Regs. 1200-03-31-.01 RESERVED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed July 5, 1994; effective September 18, 1994. Amendments filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-31-.02 DEFINITIONS - The following definitions are applicable to this chapter:

(1) “Major Source” means any stationary source or group of stationary sources located within a contiguous area and under common control that emits or has the potential to emit considering controls, in the aggregate, 10 tons per year or more of any hazardous air pollutant or 25 tons per year of any combination of hazardous air pollutants. In addition, the provisions of subpart (11)(b)14.(i) of Rule 1200-03-09-.02 are recognized as to the grouping or aggregation of emissions for the purpose of calculating emission potential as it relates to the applicability thresholds of this definition. Additionally, electric utility steam generating units will not be regulated as major sources until the United States Environmental Protection Agency decides that they should be so regulated pursuant to Section 112(n) of the Federal Clean Air Act.

(2) “Area Source” means any stationary source of hazardous air pollutants that is not a major source. Mobile sources such as vehicles, trains, planes, ships, et cetera are not area sources.

(3) “New Source” means a stationary source that emits hazardous air pollutants as they are defined in this paragraph and is constructed or reconstructed on or after the date that the United States Environmental Protection Agency approves the major source operating permit program submitted by the State of Tennessee in accordance with Section 502(d) of the Federal Clean Air Act.

(4) “Stationary Source” shall have the meaning given to it in subparagraph (1)(ddd) of Rule 1200- 03-02-.01.

(5) “Existing Source” is any stationary source that emits hazardous air pollutants as they are defined in paragraph (6) of this rule and is not a new source.

(6) “Hazardous Air Pollutant” - means any of the following air contaminants:

CAS No. Chemical name 75070 Acetaldehyde 60355 Acetamide 75058 Acetonitrile 98862 Acetophenone 53963 2-Acetylaminofluorene 107028 Acrolein 79061 Acrylamide 79107 Acrylic acid 107131 Acrylonitrile 107051 Allyl chloride 92671 4-Aminobiphenyl 62533 Aniline 90040 o-Anisidine 1332214 Asbestos 71432 Benzene (including benzene from gasoline) 92875 Benzidine 98077 Benzotrichloride 100447 Benzyl chloride 92524 Biphenyl 117817 Bis(2-ethylhexyl)phthalate(DEHP) 542881 Bis(chloromethyl) ether 75252 Bromoform 106990 1,3-Butadiene 156627 Calcium cyanamide 133062 Captan 63252 Carbaryl 75150 Carbon disulfide 56235 Carbon tetrachloride 463581 Carbonyl sulfide 120809 Catechol 133904 Chloramben 57749 Chlordane 7782505 Chlorine 79118 Chloroacetic acid 532274 2-Chloroacetophenone 108907 Chlorobenzene 510156 Chlorobenzilate 67663 Chloroform 107302 Chloromethyl methyl ether 126998 Chloroprene 1319773 Cresols/Cresylic acid (is omers and mixture) 95487 o-Cresol 108394 m-Cresol 106445 p-Cresol 98828 Cumene 94757 2,4-D, salts and esters 3547044 DDE 334883 Diazomethane 132649 Dibenzofurans 96128 1,2-Dibromo-3-chloropropane 84742 Dibutylphthalate 106467 1,4-Dichlorobenzene(p) 91941 3,3-Dichloro benzidene 111444 Dichloroethyl ether (Bis(2-chloroethyl)ether) 542756 1,3-Dichloropropene 62737 Dichlorvos 111422 Diethanolamine 121697 N,N-Diethyl aniline (N,N-Dimethylaniline) 64675 Diethyl sulfate 119904 3,3-Dimethoxybenzidine 60117 Dimethyl aminoazobenzene 119937 3,3'-Dimethyl benzidine 79447 Dimethyl carbamoyl chloride 68122 Dimethyl formamide 57147 1,1-Dimethyl hydrazine 131113 Dimethyl phthalate 77781 Dimethyl sulfate 534521 4,6-Dinitro-o-cresol, and salts 51285 2,4-Dinitrophenol 121142 2,4-Dinitrotoluene 123911 1,4-Dioxane (1,4-Diethyleneoxide) 122667 1,2-Diphenylhydrazine 106898 Epichlorohydrin (1-Chloro-2,3-epoxypropane) 106887 1,2-Epoxybutane 140885 Ethyl acrylate 100414 Ethyl benzene 51796 Ethyl carbamate (Urethane) 75003 Ethyl Chloride (Chloroethane) 106934 Ethylene dibromide (Dibromoethane) 107062 Ethylene dichloride (1,2-Dichlorethane) 107211 Ethylene glycol 151564 Ethylene imine (Aziridine) 75218 Ethylene oxide 96457 Ethylene thiourea 75343 Ethylidene dichloride (1,1-Dichloroethane) 50000 Formaldehyde 76448 Heptachlor 118741 Hexachlorobenzene 87683 Hexachlorobutadiene 77474 Hexachlorocyclopentadiene 67721 Hexachloroethane 822060 Hexamethylene-1,6-diisocyanate 680319 Hexamethylphosphoramide 110543 Hexane 302012 Hydrazine 7647010 Hydrochloric acid 7664393 Hydrogen fluoride (Hydrofluoric acid) 123319 Hydroquinone 78591 Isophorone 58899 Lindane (all isomers) 108316 Maleic anhydride 67561 Methanol 72435 Methoxychlor 74839 Methyl bromide (Bromomethane) 74873 Methyl chloride (Chloromethane) 71556 Methyl chloroform (1,1,1-Trichloroethane) 60344 Methyl hydrazine 74884 Methyl iodide (Iodomethane) 108101 Methyl isobutyl ketone (Hexone) 624839 Methyl isocyanate 80626 Methyl methacrylate 1634044 Methyl tert butyl ether 101144 4,4-Methylene bis(2-chloronaniline) 75092 Methylene chloride (Dichloromethane) 101688 Methylene diphenyl diisocyanate (MDI) 101779 4,4'-Methylenedianiline 91203 Naphthalene 98953 Nitrobenzene 92933 4-Nitrobiphenyl 100027 4-Nitrophenol 79469 2-Nitropropane 684935 N-Nitroso-N-methylurea 62759 N-Nitrosodimethylamine 59892 N-Nitrosomorpholine 56382 Parathion 82688 Pentachloronitrobenzene (Quintobenzene) 87865 Pentachlorophenol 108952 Phenol 106503 p-Phenylenediamine 75445 Phosgene 7803512 Phosphine 7723140 Phosphorus 85449 Phthalic anhydride 1336363 Polychlorinated biphenyls (Arochlors) 1120714 1,3-Propane sultone 57578 beta-Propiolactone 123386 Propionaldehyde 114261 Propoxur (Baygon) 78875 Propylene dichloride (1,2-Dichloropropane) 75569 Propylene oxide 75558 1,2-Propylenimine (2-Methyl aziridine) 91225 Quinoline 106514 Quinone 100425 Styrene 96093 Styrene oxide 1746016 2,3,7,8-Tetrachlorodibenzo-p-dioxin 79345 1,1,2,2-Tetrachloroethane 127184 Tetrachoroethylene (Perchloroethylene) 7550450 Ti tanium tetrachloride 108883 Toluene 95807 2,4-Toluene diamine 584849 2,4-Toluene diisocyanate 95534 o-Toluidine 8001352 Toxaphene (chlorinated camphene) 120821 1,2,4-Trichlorobenzene 79005 1,1,2-Trichloroethane 79016 Trichloroethylene 95954 2,4,5-Trichlorophenol 88062 2,4,6-Trichlorophenol 121448 Triethylamine 1582098 Trifluralin 540841 2,2,4-Trimethylpentane 108054 Vinyl acetate 593602 Vinyl bromide 75014 Vinyl chloride 75354 Vinylidene chloride (1,1-Dichloroethylene) 1330207 Xylenes (isomers and mixture) 95476 o-Xylenes 108383 m-Xylenes 106423 p-Xylenes 0 Antimony Compounds 0 Arsenic Compounds (inorganic including arsine) 0 Beryllium Compounds 0 Cadmium Compounds 0 Chromium Compounds 0 Cobalt Compounds 0 Coke Oven Emissions 0 Cyanide compounds 0 Glycol ethers 2, 0 Lead Compounds 0 Manganese Compounds 0 Mercury Compounds 0 Fine mineral fibers 0 Nickel Compounds 0 Polycyclic Organic Matter 0 Radionuclides (including radon) 0 Selenium Compounds (7) “Federal Clean Air Act” means the federal statutes found at 42 U.S.C. 7401 et seq. as amended by Public Law No. 101-549 (November 15, 1990).

(8) “MACT” means maximum achievable control technology. It is a case-by-case determination of what constitutes a maximum achievable reduction of hazardous air pollutants considering the costs of achieving the emission reduction and any non-air quality health and environmental impacts and energy requirements. MACT may include but is not limited to: control equipment, work practice standards, emission standards, process modifications, or raw materials substitution and/or reformulation.

X'CN where X = H' or any other group where a formal dissoci ation may occur. For example KCN or Ca(CN)

Include mono- and di-ethers of ethylene glycol, diethylene glycol, and triethylene glycol R-(OCH CH ) n -OR’.

Where: n = 1, 2, or 3:

R = alkyl C7 or less; or R = phenyl or alkyl substituted phenyl;

R’ = H or alkyl C7 or less; or OR’ co nsist ing of carboxylic acid ester, sulfate, phosphate, nitrate, or sulfonate.

This action deletes each individual compound in a group called the surfactant alcohol ethoxy lates and their derivatives (SAED) from the glycol ethers category in the list of hazardous air poll utants (HAP) established by section 112(b)(1) of the Clean Air Act (CAA).

Includes mineral fiber emissions from facilities manufacturing or processing glass, rock, or slag fibers (or other mineral derived fibers) of average diameter 1 micrometer or less.

Includes organic compounds with than one benzene ring, and which have a boiling point greater than or equal to 100 C. a type of atom which spontaneously undergoes radioactive decay.

The substance ethylene glycol monobutyl ether (EGBE, 2-Butoxyethanol) (Chemical Abstract Service (CAS) Number 111-76-2) is deleted from the list of hazardous air pollutants established by 42 U.S.C. 7412(b)(1).

(9) “GACT” means generally available control technology. It is a case-by-case determination of what constitutes reasonable and proper control for hazardous air pollutants from area sources. GACT may include, but is not limited to: control equipment, work practice standards, emission standards, process modification, or raw materials substitution and/or reformulation.

(10) Reserved.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed July 5, 1994; effective September 18, 1994. Amendment filed November 12, 1998; effective January 26, 1999. Amendment filed June 30, 2006; effective October 27, 2006. Amendment filed October 17, 2006; effective December 31, 2006. Amendments filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-31-.03 INTENT OF THE BOARD

(1) The role of the United States Environmental Protection Agency is recognized by the Board as being essential in the setting of case-by-case determinations of hazardous air pollutant control requirements. The federal Agency is in the unique position to conduct research and compile national data bases as to the source-by-source control levels that are being achieved or proposed in the regulation of hazardous air pollutants. As the State of Tennessee does not fully possess these abilities, the Technical Secretary shall utilize the federal Agency's resources prior to setting a case-by-case hazardous air pollutant requirement. In addition, the Technical Secretary shall recognize any federal law, federal regulation, or lawfully promulgated policy of the United States Environmental Protection Agency pertaining to caseby-case determinations of hazardous air pollutant requirements as the minimum acceptable criteria prior to the setting of a case-by-case hazardous air pollutant requirement under the provisions of this rule.

(2) The Technical Secretary may consider other applicable criteria in the absence of any data or requirement of the United States Environmental Protection Agency. In such case, the Technical Secretary shall rely upon generally accepted engineering principles and any unique aspects of a source category as a whole that would be a prohibitory factor in the imposition of a requirement for industries in that source category.

(3) To the extent possible, it is the Board's intent to impose MACT and GACT limitations equivalent to that required by the United States Environmental Protection Agency at the time of the case-by-case determination. Should there be a prudent reason to be more stringent than the federal equivalent, the Technical Secretary may issue a more stringent MACT or GACT requirement. In exercise of the authority to issue a more stringent requirement, the Technical Secretary shall issue a determination specifying the rationale employed in the setting of a more stringent requirement. The determination shall accompany the permit in which the case-by-case determination is declared. As the declaration of a case-by-case requirement will be specified on a permit, disputes regarding the imposition of MACT or GACT are to be resolved in the manner prescribed by Rule 1200-03-09-.05. If GACT is done on a permit-by-rule basis, the Board will view the public hearing process as the permittee's opportunity to object to the requirements of GACT. However, the permittee may appeal the applicability of GACT to their operations as to commenced date or emission/production magnitude applicability thresholds present at their source.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed July 5, 1994; effective September 18, 1994. Amendments filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-31-.04 STANDARD FOR EXISTING SOURCES

(1) Major sources will be issued an operating permit pursuant to the provisions of paragraph (11) of Rule 1200-03-09-.02 listing their current hazardous air pollutant emission rate on a pollutant-by-pollutant basis. These “hollow permits” will remain in effect until one or more of the following activities occur:

(a) When the United States Environmental Protection Agency promulgates MACT for a source-specific category pursuant to Sections 112(d) or (h) of the Federal Clean Air Act, the Technical Secretary shall specify MACT for all existing major sources in that category as a revision to their “hollow permit”. Upon written notification from the Technical Secretary, the source shall have 180 days to prepare their application for a MACT permit revision and submit it to the Technical Secretary. The Technical Secretary shall process the application by issuing a permit within 9 months of receipt of a complete application. MACT revisions to hollow permits shall be issued within 18 months of promulgation. A compliance schedule to attain MACT by a date certain shall be made part of the permit. The length of the schedule to attain compliance shall be determined by the complexities of coming into compliance and the Board's intent to be equivalent to the federal MACT. The Technical Secretary shall provide that the source's compliance schedule is at least as long as the federal rules allow. In most areas, thi s should not exceed three years. The Technical Secretary is authorized to grant up to a one-year extension to comply as long as it does not conflict with the federal requirements and there is sufficient justification to grant the additional time.

(b) If the United States Environmental Protection Agency fails to meet the Federal Clean Air Act schedules prescribed in Section 112(e)(1) and/or (3) for timely promulgation of MACT requirements thereby invoking the “MACT hammer” provisions at Section 112(j) of the Federal Clean Air Act, the Technical Secretary shall specify MACT for all sources in the source category in question as a permit revision to their “hollow permit”.

Sources subject to the missed MACT standard shall file a complete MACT permit revision application with the Technical Secretary no later than 18 months after the federally missed deadline for the source category. The Technical Secretary shall process the MACT permit revision application by issuing a permit within 18 months of his receipt of a complete application.

(2) Area sources that are not exempt from the requirement to obtain a permit pursuant to Rule

Tenn. Comp. R. & Regs. 1200-03-31-.05 STANDARD FOR NEW SOURCES

(1) Major sources shall utilize MACT as prescribed by the Technical Secretary upon start up regardless of whether or not the United States Environmental Protection Agency has established MACT under Section 112(d) or (h) of the Federal Clean Air Act. MACT shall be prescribed on the source's construction permit and transferred to the source's operating permit upon start up of the facility.

(2) Area sources that are not exempt from the requirement to obtain a permit in accordance with

Rule 1200-03-09-.04 shall utilize GACT as prescribed by the Technical Secretary upon start up if the United States Environmental Protection Agency has established GACT under

Section 112(d)(5) of the Federal Clean Air Act. GACT shall be prescribed on the source's construction permit and transferred to the source's operating permit upon start up of the facility.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed July 5, 1994; effective September 18, 1994. Amendment filed December 12, 1997; effective February 25, 1998. Amendments filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-31-.06 OPPORTUNITY FOR EARLY REDUCTIONS SCHEDULE

(1) The owner or operator of an existing source of hazardous air pollutants may be issued an operating permit allowing six additional years to comply with a future MACT commencing on the compliance date of that MACT limit if each of the following criteria are satisfied:

(a) The source will utilize control and/or work practices that will result in a 90 per centum or more reduction in emissions of hazardous air pollutants (95 per centum in the case of hazardous air pollutants which are particulates).

1. The reduction shall be determined with respect to verifiable and actual emissions in a base year not earlier than calendar year 1987.

2. If there is evidence that emissions in the base year 1987, or any subsequent base year, are artificially or substantially greater than emissions in other years prior to the implementation of the early emission reductions, the Technical Secretary shall require the use of an arithmetic average of the years commencing upon the suspect year and ending upon the period of time when the person seeking the early reductions schedule files their plan for the purpose of determining base year emission levels.

3. The Technical Secretary may allow a source to use 1985 or 1986 emission data for the purpose of determining base year emissions if the source has submitted such data to the Technical Secretary in a form that can be used to make the baseline calculations and further that such information was in the Technical Secretary’s possession prior to November 15, 1990.

(2) The early emission reduction must occur prior to the federal proposal of a source categoryspecific MACT standard to which the source will be subject. Federal proposal will be considered effective when the United States Environmental Protection Agency publishes the standard in the Federal Register. The reduction need not actually occur prior to the federal proposal if the source owner or operator has committed to an enforceable schedule that extends no further than January 1, 1994.

(3) A major source operating permit must be issued to the source owner or operator pursuant to the provisions of paragraph (11) of Rule 1200-03-09-.02 detailing the schedule to attain the early emission reductions and the enforceable emission limit that is to be attained. For the purposes of this paragraph, the Technical Secretary shall issue the permit within nine months of a complete application.

(4) The early reductions of less toxic hazardous air pollutants shall not be credited toward the reduction of highly toxic hazardous air pollutants (such as, but not limited to chlorinated dioxins and furans) that pose high risks of adverse public health effects associated with exposure to small quantities of such highly toxic hazardous air pollutants. The Technical Secretary shall use the relative risks of chlorinated dioxins and furans as a qualitative benchmark in determining whether or not a hazardous air pollutant is highly toxic.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed July 5, 1994; effective September 18, 1994. Amendments filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-31-.07 RESIDUAL RISK AND REVISIONS TO MACT

(1) MACT standards are subject to revision if the United States Environmental Protection Agency determines that the existing MACT standards are insufficient to protect the public pursuant to the residual risk provisions of Section 112(f) of the Federal Clean Air Act. Upon such finding, the Technical Secretary shall modify previously set MACT limitations in that source category to conform to the federally promulgated revised MACT standards within 18 months of such federal promulgation. The modification will be a permit revision to the source's operating permit consistent with the provisions of paragraph (11) of Rule 1200-03-09-.02. The Technical Secretary shall prescribe a compliance schedule on the permit amendment that will specify an expeditious date to attain compliance with the revised MACT standards. The length of the schedule will be determined by the complexities of coming into compliance and the Board's desire to be equivalent to any federally revised MACT requirements.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed July 5, 1994; effective September 18, 1994. Amendments filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-31-.08 THROUGH 1200-03-31-.12 RESERVED

History

• Authority: T.C.A. §§ 4-5-201, et seq. and 68-201-101, et seq.
• Administrative History: Amendments filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-31-.13 RESERVED

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed May 10, 1994; effective July 24, 1994. Amendment filed August 28, 1997; effective November 11, 1997. Amendments filed September 29, 2022; effective December 28, 2022.

Tenn. Comp. R. & Regs. 1200-03-09-.04 will be issued an operating permit specifying GACT with an appropriate compliance schedule to achieve that requirement by a date certain within 18 months of the United States Environmental Protection Agency's promulgation of a source-specific GACT standard if they are in that source-specific category. The date to achieve compliance shall be no less than that allowed by the federal rule which promulgated GACT for that source category. If a source is not exempted from the requirement to obtain a permit pursuant to

Rule 1200-03-09-.04, it shall be the duty of such area source owner or operator to register their annual emissions of hazardous air pollutants with the Technical Secretary utilizing the forms prescribed by the Technical Secretary. In the interest of efficiency, the Technical Secretary may bring proposed regulations to the Board that would permit area sources by

rule on a source category-specific basis. It is the intent of the Board that such rule would be effective within 18 months of the federal GACT promulgation. The rule will also provide that compliance with GACT shall be attained no later than that specified by the equivalent federal

rule.

History

• Authority: T.C.A. §§ 4-5-201, et seq.; 68-201-101, et seq.; and 68-201-105.
• Administrative History: Original rule filed July 5, 1994; effective September 18, 1994. Amendment filed December 15, 1997; effective February 28, 1998. Amendments filed September 29, 2022; effective December 28, 2022.

Chapter 1200-03-32 Prevention of Accidental Releases

Tenn. Comp. R. & Regs. 1200-03-32-.01 PURPOSE AND INTENT

It is the objective of this chapter to prevent the accidental release and to minimize the consequences of any such release of any substance listed pursuant to this chapter. These substances have been determined by the Board to be potentially hazardous to the public if accidentally released into the ambient air. The general intent of these rules is to correspond to the federal regulations promulgated under Section 112(r) of the Clean Air Act (42 U.S.C. 7401 et seq.)

History

• Authority: T.C.A. §§68-201-105 and 4-5-201 et.seq.
• Administrative History: Original rule filed July 7, 1994; effective September 20, 1994.

Tenn. Comp. R. & Regs. 1200-03-32-.02 DEFINITIONS

“Federal Clean Air Act” means the Clean Air Act, as amended, 42 U.S.C. 7401, et seq. as amended by Public Law No. 101-549 (November 15, 1990).

History

• Authority: T.C.A. §§68-201-105 and 4-5-201 et.seq.
• Administrative History: Original rule filed July 7, 1994; effective September 20, 1994.

Tenn. Comp. R. & Regs. 1200-03-32-.03 DUTY TO FILE ACCIDENTAL RELEASE PLANS

(1)Sources which are subject to the provisions of Section 112(r) of the federal Clean Air Act or any federal regulations promulgated thereunder, must file a copy of any plan or submittal required therein with the Technical Secretary. If such a source is subject to the permitting requirements of Paragraph 1200-3-9-.02(11) and has failed to timely file their plan with the United States Environmental Protection Agency, the Technical Secretary shall place them on a schedule of compliance to develop and file the plan. The schedule of compliance shall be placed on the source's operating permit consistent with the provisions of Subpart 1200-3-9-.02(11)(e)3(iii).

(2)The Technical Secretary is specifically authorized to request information from sources for the purpose of determining whether or not they are subject to Section 112(r) of the federal Clean Air Act or any federal regulations promulgated thereunder.

(3)Sources that have filed an accidental release plan shall annually certify in writing to the Technical Secretary that they are properly following their accidental release plan. The annual certification is due in the office of the Technical Secretary no later than January 31 of each year. Said certification will be for the preceding calendar year.

History

• Authority: T.C.A. §§68-201-105 and 4-5-201 et.seq.
• Administrative History: Original rule filed July 7, 1994; effective September 20, 1994

Chapter 1200-03-33 Repealed

Tenn. Comp. R. & Regs. 1200-03-33 Repealed

RULES

OF TENNESSEE DEPARTMENT OF ENVIRONMENT AND CONSERVATION

BUREAU OF ENVIRONMENT

DIVISION OF AIR POLLUTION CONTROL

Authority: T.C.A. §§2-41-101 et seq. and 4-5-201 et seq. Administrative History: Original rule filed March 29, 1995; effective June 14, 1995. Repealed May 5, 1997.

Chapter 1200-03-34 Conformity

Tenn. Comp. R. & Regs. 1200-03-34-.01 TRANSPORTATION CONFORMITY INTERAGENCY CONSULTATIONAND

GENERAL PROVISIONS.

(1) Interagency Consultation Procedures (a) General.

1. Pursuant to 40 CFR §51.390, this document provides for interagency consultation (federal, state, and local), resolution of conflicts, public consultation procedures (per 40 CFR §93.105) and written commitments to control measures (40 CFR §93.122(a)(4)(ii)) and mitigation measures (40 CFR §93.125(c)). Such consultation procedures shall be undertaken by Metropolitan Planning Organizations (MPOs), the State department of transportation, and the Federal Highway Administration (FHWA) and the Federal Transit Administration (FTA) with State and local air quality agencies and the Environmental Protection Agency (EPA) prior to making conformity determinations, and by State and local air agencies and EPA with MPOs, the State department of transportation, and FHWA and FTA in developing applicable implementation plans.

2. The provisions of this rule shall apply in all nonattainment and maintenance areas for transportation related criteria pollutants or precursor pollutants for which the area is designated nonattainment or has a maintenance plan, and with respect to all actions outside any nonattainment area that in the judgment of the Tennessee Air Pollution Control Division (TAPCD) may cause or contribute to a new violation or increase the frequency or severity of any existing violation of any standard in any nonattainment area, or delay the timely attainment of any standard or any required interim emissions reduction or other milestone in any nonattainment area. Exhibit A illustrates stakeholders currently subject to this

rule. Exhibit A is for illustrative purposes only; stakeholders need not be listed to be subject to this rule.

3. Definitions:

Terms used but not defined in this rule shall have the meaning given them by the Clean Air Act, titles 23 and 49 U.S.C., other Environmental Protection Agency (EPA) regulations, or other United States Department of Transportation (DOT) regulations, in that order of priority.

(i) Local air agencies are those agencies which are charged under law with the control of air pollution existing within the geographic boundaries of the political subdivisions, as defined by the Tennessee Air Quality Act, T.C.A. §§ 68-201-101, et seq., organized and existing under the laws of the State of Tennessee.

(ii) Local transportation agencies are publicly owned transportation agencies which provide mass transportation by bus or rail which provides general service to the public on a fixed route on a regular and continuing basis. It does not include school buses or charter or sightseeing services, van pools, or small trolley fleets.

(iii) Project means a highway project or transit project.

(iv) TAPCD means the Tennessee Air Pollution Control Division.

(v) TDOT means the Tennessee Department of Transportation.

(b) Interagency consultation procedures: General factors.

1. Representatives of the MPOs, State and local air quality planning agencies, State department of transportation, and local publicly-owned transportation agencies not represented by an MPO, shall undertake an interagency consultation process in accordance with this rule with each other and with the EPA, FHWA, and FTA on the development of the implementation plan, the transportation plan (Plan), the Transportation Improvement Program (TIP), any revisions to the preceding documents, and all conformity determinations required by this rule.

2. The TAPCD, also referred to as the State air agency, shall be the lead agency responsible for preparing the final document or decision and for assuring the adequacy of the interagency consultation process with respect to the development of applicable transportation related implementation plans and control strategy implementation plan revisions.

3. MPOs subject to conformity shall be the lead agencies responsible for preparing the final document or decision and for assuring the adequacy of the interagency consultation process with respect to the development of the long range transportation plan, the Transportation Improvement Program (TIP), and any amendments or revisions thereto, and for providing assistance for technical analyses by employing travel-demand modeling techniques and acquiring all necessary data in the metropolitan area(s) under their jurisdiction. In the case of non-metropolitan areas, the TDOT shall be the lead agency responsible for preparing the final document or decision and for assuring the adequacy of the interagency consultation process with respect to the development of the Statewide long range transportation plan, the Statewide Transportation Improvement Program (STIP), and any amendments or revisions thereto and for providing assistance for technical analyses by employing travel-demand modeling techniques and acquiring all necessary data in non-metropolitan areas.

4. In addition to the lead agencies identified in parts 2 and 3 of this subparagraph, other agencies entitled to actively participate in the interagency consultation process under this rule include: the FHWA, the FTA, EPA, and local air agencies.

5. It shall be the role and responsibility of each lead agency in an interagency consultation process, as specified in parts 2 and 3 of this subparagraph, to confer with all other agencies identified in parts 1 through 4 of this subparagraph, provide all appropriate information to those agencies needed for meaningful input, solicit early and continuing input from those agencies, conduct the consultation process described in 40 CFR §93.105, assure policy-level contact with those agencies, consider the views of each agency and respond to those views in a period not to exceed thirty (30) days from the date received, prior to any final decision on such document, and assure that such views and written response are made part of the record of any decision or action. Each lead agency shall provide all necessary documentation for review at the initiation, or prior to, the review and comment period. Information for scheduled meetings will be distributed to participants at least seven (7) days before the scheduled meeting. It shall be the role and responsibility of each agency specified in parts 1 through 4 of this subparagraph, when not fulfilling the role and responsibilities of a lead agency, to confer with the lead agency and other participants in the consultation process, review and comment as appropriate (including comments in writing) on all proposed documents and decisions in a period not to exceed thirty (30) days, attend consultation and decision meetings, assure policy-level contact with other participants, provide input on any area of substantive expertise or responsibility, and provide technical assistance to the lead agency or consultation process in accordance with 40 CFR §93.105 when requested.

6. It shall be the responsibility of the MPOs, the State and local air agencies, and the State and local transportation agencies identified in parts 1 through 4 of this subparagraph to schedule and convene meetings for their own agencies, and to notify all other agencies involved in the conformity process of these scheduled meetings at least fourteen (14) days in advance, unless such meetings are of an internal nature and not immediately related to the conformity process. However, the participants may waive the fourteen (14) day advance notice requirement if all participants agree that an earlier scheduled meeting is in the best interest of the parties. Scheduling changes shall be coordinated in a timely manner. The lead agency will develop draft documents, record notes and distribute agendas prior to meetings (in person or by conference calls or other practical electronic means). The lead agency shall provide all appropriate information to those agencies needed for meaningful input and provide all draft and supportive documentation (hard copy or electronic format) in a timely manner to participating agencies. The lead agency responsible for preparing the final document subject to interagency consultation shall assure that all relevant documents and information are supplied to all participants in the consultation process prior to the release for public review.

7. Consultation on specific issues, other than the continual process of keeping all the agencies informed on all conformity and State Implementation Plan (SIP) actions, may be initiated at any time during the document development process by any of the agencies specified in parts 1 through 4 of this subparagraph. It shall be the responsibility of the initiator to ensure that all other agencies identified in parts 1 through 4 of this subparagraph are notified of any such action. All agencies so notified must respond to the issue(s) raised within fourteen (14) days, unless an alternate schedule is agreed upon by all participants.

8. It shall be the responsibility of the MPOs subject to this rule, and TDOT, to provide the State and local air agencies specified in this rule with the latest version of the TIP or STIP and the transportation plan.

9. It shall be the responsibility of the State and local air agencies to provide the MPOs, TDOT, FHWA, FTA and EPA with the latest version of the SIP as it applies to transportation conformity, in particular, attainment and maintenance plans.

10. It shall also be the responsibility of each of the agencies specified in parts 1 through 4 of this subparagraph to keep their own superiors and constituents properly informed of conformity determinations, as well as making this information available for the general public.

11. The agencies specified in parts 1 through 4 of this subparagraph may employ consultation services at their own discretion.

(c) Specific roles and responsibilities of various participants in the interagency consultation process shall be as follows:

1. TAPCD and the local air agencies shall be responsible for, in relation to SIP development, the following:

(i) Developing emissions inventories;

(ii) Developing emissions budgets;

(iii) Conducting air quality modeling;

(iv) Developing attainment and maintenance demonstrations;

(v) Revising control strategy implementation plans;

(vi) Regulatory Transportation Control Measures (TCMs) intended to provide enforceable emission reductions;

(vii) Compiling motor vehicle emissions factors;

(viii) Meeting all EPA reporting requirements related to air quality; and (ix) Responding to all comments concerning the SIP.

The local air agencies shall be responsible for their areas of jurisdiction, with the State air agency being responsible for all remaining counties, as well as being responsible for ensuring that the local air agencies fulfill these tasks. Local air agencies may request assistance from the State air agency in any of the responsibilities listed here.

2. The MPOs subject to the conformity rule shall be responsible for, in their area(s) of jurisdiction, the following:

(i) Developing and monitoring transportation plans and TIPs;

(ii) Evaluating the transportation impacts and feasibility of TCMs;

(iii) Developing transportation and socioeconomic data and latest planning assumptions and providing such data and planning assumptions to TAPCD for use in air quality analysis;

(iv) Developing system- or facility-based or other programmatic (nonregulatory) TCMs;

(v) Providing technical and policy input on emissions budgets;

(vi) Performing transportation modeling, including:

(I) Selecting and evaluating such models;

(II) Documenting their use in conformity determinations; and (III) Alerting, for comment, the agencies identified in parts (b)1 through 4 of this paragraph when any new model is being tested or employed, and;

(vii) Developing draft and final conformity determination documents for all transportation plans, TIPs and projects;

(viii) Monitoring and coding regionally significant projects into the transportation networks;

(ix) Developing statistical information such as vehicle miles travelled (VMT), vehicle mix and vehicle speeds for use in on-road mobile emissions analysis;

(x) Making elections regarding the timeframe of the conformity determination under 40 CFR §93.106(d); and (xi) Identifying planning assumptions and evaluating those assumptions for consistency with SIP assumptions.

3. The Tennessee Department of Transportation shall be responsible for:

(i) Developing the Statewide transportation plan and STIP;

(ii) Providing technical input on new and proposed revisions to motor vehicle emission budgets;

(iii) Distributing draft and final environmental documents to other agencies;

(iv) Providing the transportation related information needed for mobile emissions analysis;

(v) Developing the statistical information, such as VMT, vehicle mix, and vehicle speeds, for use in on-road mobile emission analysis for areas outside the MPO boundary;

(vi) Developing the draft document(s) related to the NEPA process, providing it for review, responding to comments and preparing the final document(s);

(vii) Performing transportation modeling, including:

(I) Selecting and evaluating such models;

(II) Documenting their use in conformity determinations; and (III) Alerting, for comment, the agencies identified in parts (b)1 through 4 of this paragraph when any new model is being tested or employed, and;

(viii) Making conformity determinations for areas outside of the MPO boundary;

(ix) Convening consultation to cooperatively choose the appropriate conformity test(s) and methodologies for use in isolated rural nonattainment and maintenance areas, as required by 40 CFR §93.109(l)(2)(iii); and (x) Convening air quality technical review meetings on specific projects when requested by other agencies or as needed.

4. FHWA and FTA shall be responsible for:

(i) Ensuring timely action on final determinations of conformity within thirty (30) days of receiving a formal conformity determination, after consultation with other agencies as provided in this rule and 40 CFR §93.105;

(ii) Providing guidance on conformity and the transportation planning process to participating agencies in interagency consultation; and (iii) Reviewing and commenting on conformity determinations.

5. EPA shall be responsible for:

(i) Reviewing motor vehicle emissions budgets in submitted SIPs and finding them adequate or inadequate based on adequacy criteria and procedures;

(ii) Providing guidance on conformity criteria and procedures to agencies in interagency consultation;

(iii) Approving or disapproving submitted SIP revisions (including TCMs);

(iv) Providing modeling and emissions inventory development assistance to TAPCD, TDOT and MPOs; and (v) Providing comments on the regional emissions analyses and conformity determination of transportation plans, TIPs and projects.

(d) Conformity determinations:

1. All conformity determinations shall be initiated by the sponsor of the transportation plan, program or project subject to the conformity rule:

(i) MPOs shall be responsible for initiating conformity determinations for plans, programs or projects within the specific MPO boundary;

(ii) TDOT shall be responsible for initiating conformity determination for plans, programs or projects external to an MPO boundary, including isolated rural nonattainment and maintenance areas as required by §93.109(l)(2)(iii); and (iii) MPOs and TDOT shall employ interagency consultation procedures to ensure compatibility of conformity determinations for the same or overlapping nonattainment or maintenance area(s).

2. It shall be the responsibility of the MPOs subject to conformity and TDOT to submit any conformity determinations to the FHWA, FTA, EPA, TACPD, local air agencies, TDOT, if not the sponsor, and local publicly-owned transportation agencies not represented by an MPO for review and approval before the plan, program or project subject to the conformity rule may be found to conform, or found to be exempt.

3. All conformity determinations with all supporting documentation and data shall be made available for review and comment to the TAPCD, local air agencies, FHWA, FTA and the EPA no less than thirty (30) days prior to presentation to a policy making body (electronic copy acceptable). Shorter review periods may be allowed occasionally in emergency situations with participant concurrence.

4. All conformity determinations shall also be made available to the general public, as defined in subparagraph (h) of this paragraph.

5. Conformity determinations, at a minimum, should include written documentation of the following:

(i) All the input run streams for the latest mobile emissions model and latest planning assumptions on the date that the conformity analysis began (with the beginning date and the criteria used to identify this date specified), and attestation that the latest mobile emissions model is being used;

(ii) Transportation related information and assumptions used for input into the mobile model, such as, vehicle miles traveled, vehicle speeds, and vehicle mix, along with a brief description of the source of this information, including documentation of any transportation related models used;

(iii) A description of the project, plan or program that is the subject of the conformity or exemption status determination(s); and (iv) TAPCD may request further documentation; however, the agency making the conformity demonstration may appeal to the Technical Secretary if the request seems unreasonable.

6. TAPCD (and/or local air agencies, where applicable) shall review and provide written comment on final conformity determinations within fourteen (14) days of the date received. This process shall consist of:

(i) Review of mobile emissions model inputs and outputs;

(ii) Verification that the latest mobile emissions model and planning assumptions are being used;

(iii) Review of the reasonableness of transportation related data; and (iv) Ensuring consistency with the emissions budget and/or the interim emission tests, as applicable.

7. It shall be the responsibility of the MPO (or the TDOT, where applicable) making a conformity determination, to provide TAPCD and the applicable local air agencies, FTA, FHWA and the EPA with documentation of the conformity determination.

8. It shall be the responsibility of TAPCD to provide affected MPOs, FHWA, FTA, EPA, local air agencies and TDOT with appropriate information regarding any SIP changes that could impact the conformity process.

9. It shall be the responsibility of the EPA to provide TAPCD and local air agencies and FTA, FHWA, TDOT, and the affected MPOs information regarding changes to the Conformity Rule that could impact conformity determinations.

10. Emissions reduction credit from control measures that are not included in the transportation plan and TIP and that do not require a regulatory action in order to be implemented may not be included in the emissions analysis unless written commitments to implementation are obtained by the MPO (or TDOT, where applicable) prior to the conformity determination and such commitments must be fulfilled by the implementing entities. This rule satisfies the requirement of 40 CFR §93.122(a)(4)(ii).

11. Written commitments to mitigation measures for project-level mitigation and control measures must be obtained by FHWA (or FTA for transit related projects), from project sponsors, prior to a positive project-level conformity determination, and that project sponsors must comply with such commitments.

This rule satisfies the requirement of 40 CFR §93.125(c).

12. In order to assure the most recent planning assumptions are in place at the time the conformity analysis begins, the “time the conformity analysis begins” is to be determined by interagency consultation. This point in time should occur at the point at which the MPO (or TDOT, when applicable) or other designated agency begins to model the impact of the transportation plan or TIP on travel and/or emissions. New data that becomes available after an analysis begins is required to be used in the conformity determination only if a significant delay in the analysis has occurred, as determined through interagency consultation.

13. Consultation shall be undertaken, and conducted in accordance with this rule, to evaluate events which will trigger new conformity determinations in addition to those triggering events established in 40 CFR §93.104, including any changes in planning assumptions, that may trigger a new conformity determination. The consultation process pursuant to this rule shall be initiated by FHWA, EPA, TAPCD, TDOT, or the MPO where one exists.

(e) Implementation Plans:

1. Any proposed revisions to the SIP, which may have a direct or indirect effect upon the motor vehicle emissions budget for an area subject to conformity, shall be made available to the MPOs specified in this rule, as well as TDOT, FHWA, FTA, and EPA in written or electronic form for their review and comment at least thirty (30) days before presentation to the Tennessee Air Pollution Control Board.

Shorter review periods may be allowed occasionally in emergency situations with participant concurrence.

2. TAPCD shall also provide the public a period from the date of announcement to comment on any proposed SIP revisions which may have a direct or indirect effect upon the motor vehicle emissions budget for an area subject to conformity, as defined in subparagraph (h) of this paragraph.

3. Any proposed revisions to the SIP shall include documentation on methods of analysis, models employed and purpose of the revision.

(f) Other processes:

1. TAPCD shall be responsible for the process whereby MPOs, local air agencies, TDOT, FHWA, FTA and EPA shall study and develop supplementary consultation procedures to identify, evaluate and address, as needed, the following issues. In the absence of supplementary consultation procedures, TAPCD will include the following items for discussion during interagency consultation meetings in advance of a conformity determination:

(i) Hot spot analysis methods, models and assumptions;

(ii) Determination of regionally significant projects and projects considered to have a significant change in design concept and scope;

(iii) Evaluating when exempt projects should be treated as non-exempt;

(iv) Timely implementation of TCMs and processing of TCM substitutions;

(v) Identifying conformity determination triggers other than those established in 40 CFR §93.104; and (vi) Methods, models and assumptions for regional emissions analysis.

2. These supplementary procedures (in part 1 of this subparagraph) may be specific for each metropolitan area or each nonattainment or maintenance area subject to the conformity rule.

3. TAPCD shall conduct meetings to discuss any supplementary consultation procedures as needed.

4. Final document distribution for conformity determinations associated with Plans, TIPs and STIPs (occasionally, alternate schedules may be used with concurrence by participants):

(i) The final air quality conformity determination, necessary supporting documentation and the Plan and TIP will be submitted to the FHWA Division Office, the FTA Regional Office, the EPA Regional Office, TDOT, TAPCD and any applicable local air agencies. EPA will respond in writing, to the FTA Regional Office and FHWA Division Office, as soon as possible but not later than thirty (30) days from the date received;

(ii) Comments will be resolved by FHWA and FTA, in concert with EPA, with the MPO or TDOT, in their respective areas, as necessary;

(iii) FHWA and FTA will jointly prepare correspondence to make the conformity finding. Joint conformity findings will be addressed to the MPO (or TDOT where no MPO exists), with a copy to TDOT, EPA, TAPCD and any applicable local air agencies. The findings of FTA and FHWA together constitute the DOT conformity findings;

(iv) In the event that the MPO or TDOT in their respective areas, wishes to amend the TIP to add projects that are exempt from the conformity analysis requirement, FHWA or FTA or both, if necessary, will concur in the amendment and re-affirm the original DOT conformity finding by letter.

This re-affirmation letter will reference the date(s) of the original FHWA and FTA findings. In cases where the amendment involves projects that are not exempt, a new conformity analysis and determination will be required, and will, in turn, require a new DOT conformity finding.

Within fifteen (15) days subsequent to approval and adoption of final documents, including transportation plans, TIPs, conformity determinations, applicable implementation plans and implementation plan revisions, the lead agency shall provide copies (electronic copies acceptable) of such documents and supporting information to all affected agencies.

5. Generalized hot-spot determination process:

Interagency consultation shall be undertaken to evaluate and choose a model(s), associated methods and planning assumptions to be used in hot-spot analyses.

Generalized hot-spot determination process (occasionally, alternate schedules may be used with concurrence by participants):

(i) The project sponsor (or TDOT or the MPO), will seek consensus if the project is believed to be exempt from hot-spot analysis. This can be accomplished through electronic transmittal, providing for a minimum of fourteen (14) days for review. If requested, an additional fourteen (14) days will be provided for review, as well as any additional information needed to make the determination;

(ii) If the project is not exempt, the project sponsor (or TDOT or the MPO) will collect and organize and distribute specific data needed to determine whether nonexempt projects are or are not of air quality concern. This can be accomplished through electronic transmittal, providing for a minimum of fourteen (14) days for review. If requested, an additional fourteen (14) days will be provided for review, as well as any additional information needed to make the determination;

(iii) If it is determined the project is a project of air quality concern, the project sponsor (or TDOT or the MPO) will then engage and begin a consultation process to evaluate and choose a model (or models) and associated methods and assumptions to be used in hot-spot analysis. The project sponsor (or TDOT or the MPO) will make a PM2.5 hot-spot determination (i.e., project-level conformity determination) and request that other stakeholder agencies comment on the conclusions through formal interagency consultation as provided in this rule.

6. Regionally significant projects:

For purposes of regional emissions analysis, the MPO (TDOT where no MPO exists) shall actively consult with the affected agencies to determine which minor arterials and other transportation projects should be considered “regionally significant” projects (in addition to those functionally classified as principal arterial or higher or fixed guideway systems or extensions that offer an alternative to regional highway travel) and which projects should be considered to have a significant change in design concept and scope from the transportation plan or TIP. Prior to initiating any final action on these issues, the MPO (or TDOT, if applicable) shall consider the views of each agency that comments and respond in writing.

7. Transportation Control Measures (TCMs):

(i) For each Plan or TIP update, the agencies specified in this rule to participate in consultation shall review whether past obstacles to implementation of Transportation Control Measures (TCMs) which are behind the schedule established in the applicable implementation plan are being overcome, and whether State and local agencies with influence over approval or funding for TCMs are giving maximum priority to approval or funding for TCMs. If necessary, consideration will be given as to whether delays in TCM implementation necessitate revisions to the applicable implementation plan to remove TCMs or substitute TCMs or other emission reduction measures.

(ii) Where TCMs are to be included in an applicable implementation plan, a list of TCMs shall be developed by TDEC (and local air agencies, if applicable) in cooperation with the MPO, TDOT, or both.

8. Exempt projects which may be non-exempt:

The MPO (or TDOT where applicable) shall commence consultation regarding potentially exempt projects to (occasionally, alternate schedules may be used with concurrence by participants):

(i) Identify exempt project as defined by 40 CFR §93.126 Table 2, and 40 CFR §93.127 Table 3;

(ii) Identify exempt projects and categories of exempt projects which should be treated as non-exempt because they may have adverse air quality impacts and determine appropriate air quality analysis methodologies for analyzing such projects; and (iii) Identify transportation Plan and TIP/STIP revisions which add or delete exempt projects, as defined in 40 CFR §93.126 Table 2 and 40 CFR §93.127 Table 3.

The MPO (or TDOT where applicable), will seek consensus from the consultation participants if the project is believed to be exempt. This can be accomplished through electronic transmittal, providing for a minimum of fourteen (14) days for review. If requested, an additional fourteen (14) days will be provided for review, as well as any additional information needed to make the determination.

9. Multi-jurisdictional consultation:

Agencies specified in this rule will consult on emissions analysis for transportation activities which cross the borders of MPOs or nonattainment areas or air basins. Where the nonattainment area crosses the boundaries of multiple MPOs, the MPOs shall share cooperatively the responsibilities of conducting conformity determinations on transportation activities. The MPOs will enter into a memorandum of agreement which will define the effective boundaries and the respective responsibilities for each MPO for regional emissions analysis.

Adjacent MPOs of nonattainment or maintenance areas shall share information concerning air quality modeling assumptions and emissions rates that affect both areas. This provision also applies to MPOs and TDOT where the nonattainment area extends beyond the MPO’s boundary. TAPCD and/or local air agencies (where applicable) will initiate consultation with other states when nonattainment areas extend beyond Tennessee’s borders.

10. Project disclosure:

(i) The sponsor of any potentially regionally significant project, and any agency that is responsible for taking action(s) on any such project, shall disclose such project to TDOT or the MPO (whichever is appropriate) in a timely manner. Such disclosure shall be made not later than the first occasion on which any of the following actions is sought: any policy board action necessary for the project to proceed, the issuance of administrative permits for the facility or for construction of the facility, the execution of a contract to design or construct the facility, the execution of any indebtedness for the facility, any final action of a board, commission or administrator authorizing or directing employees to proceed with design, permitting or construction of the project, or the execution of any contract to design or construct or any approval needed for any facility that is dependent on the completion of the regionally significant project. To help assure timely disclosure, the sponsor of any potential regionally significant project shall disclose to TDOT or the MPO (whichever is appropriate) on a schedule prescribed by TDOT or the MPO (whichever is appropriate), but no less than annually, each project for which alternatives have been identified through the NEPA process, and any preferred alternative that may be a regionally significant project. The consultation process shall include assuming the location, design concept and scope of the project, where the sponsor has not yet decided these features, in sufficient detail to allow the MPO (or TDOT) to perform a regional emissions analysis. This consultation process pursuant to this rule shall be initiated by TDOT, or the MPO, where one exists;

(ii) In the case of any such regionally significant project that has not been disclosed to the MPO and other interested agencies participating in the consultation process in a timely manner, such regionally significant project shall not be considered to be included in the regional emissions analysis supporting the current conformity determination and not to be consistent with the motor vehicle emissions budget in the applicable implementation plan or interim budget.

11. Transportation model development:

An interagency consultation process in accordance with the interagency consultation procedures outlined in this rule shall be undertaken for the design, schedule, and funding of research and data collection efforts related to regional transportation model development (such as household/ travel transportation surveys), to be initiated by MPOs (or TDOT, if applicable).

12. Responding to significant comments:

If the written response to a significant comment does not adequately address the commenting agency’s concerns, further consultation is to be conducted. If a regularly scheduled meeting is to be held within a reasonable time frame of the receipt of the significant comment, it should be made a part of that meeting’s agenda and information on the issue will be forwarded to all involved agencies.

If necessary, discussion and resolution of the significant comment will be considered a reason to convene a special meeting with the commenting agency as the requester and the agenda consisting of the significant comment.

(g) Resolving conflicts:

Any conflict among State agencies or between State agencies and the MPO shall be escalated to the Governor if the conflict cannot be resolved by the heads of the involved agencies. All agencies involved shall make every effort to resolve any differences, including personal meetings between the heads of such agencies or their policy-level representatives, to the extent possible. The appeal process described herein shall apply only to MPO (or TDOT) approved conformity determinations on the transportation plan, TIP, or projects (including project-level determinations), including any documents directly related to determinations of conformity and conflicts between state agencies or between one or more state agency(ies) and the MPO.

Conflicts regarding SIPs should be appealed to the State or Local Air Pollution Control Board as appropriate.

1. In the event that the MPO or TDOT determines that every effort has been made to address TAPCD concerns and no further progress is possible, the MPO or TDOT shall notify the Director of TAPCD in writing to this effect. The memorandum shall delineate each unresolved issue to be appealed, and shall include, at a minimum:

(i) The legal basis of the issue/conflict and steps taken to resolve the conflict;

(ii) Relevant reference material needed to facilitate review and mediation of the conflict, including all relevant portions of state and federal law and regulations, conformity requirements, and any other relevant documents;

(iii) A description of all reasonable alternatives and supporting data and justification for each alternative. This includes quantifying and documenting the need for the recommended alternative consistent with the Clean Air Act of 1990 and the applicable state and federal laws and regulations; and (iv) An explanation of the consequences of not reaching a resolution.

2. If conflicts concerning conformity determinations cannot be resolved by the interagency consultation procedures, then the State air agency shall notify the agency or agencies involved in the conflict of its intent to escalate the conflict resolution to the Office of the Governor.

3. The fourteen (14) calendar day window shall commence:

(i) On the date that the Technical Secretary of TAPCD and head of the agency or agencies involved in the conflict officially agree that the conflict cannot be resolved; or (ii) When one or more agencies other than TAPCD request the start of the fourteen (14) day clock on a specified date, after notifying all other agencies involved of their intent, and TAPCD agrees.

4. If TAPCD does not contact the Office of the Governor within the fourteen (14) calendar day window, then the issue in conflict is considered to be resolved in favor of the agency in conflict with TAPCD.

5. The Governor may delegate his or her role, but not to the head or staff of TAPCD, TDOT, a state transportation commission or board, or an MPO.

6. TAPCD shall notify involved parties of the final decision by the Office of the Governor.

7. In the case of interstate nonattainment areas, if the conflict involves agencies outside of Tennessee, and the conflict cannot be resolved by the affected agency heads, the conflicts may be resolved in a manner mutually agreed to by the parties involved.

(h) Public participation:

1. Each agency subject to conformity shall provide the general public a window of opportunity no less than thirty (30) days to review and comment on new conformity determinations before formal action (approval or endorsement by an executive committee of the MPO, or where no MPO exists, TDOT management, for submission to FTA/FHWA for their finding) is taken on all transportation plans, TIPs and STIPs, consistent with these requirements and those of 23 CFR §450.316(a). A comment period of no less than fourteen (14) days will be made available to the public on amendments to conformity determinations and associated documents. TAPCD and local air agencies shall offer the public the same opportunity to comment before final action on SIPs which may have a direct or indirect effect upon the motor vehicle emissions budget for an area subject to conformity. The notification process shall include, at a minimum, public notices and submittals to public depositories. In addition, all public comments that specifically address known plans for a regionally significant project, which is not receiving FHWA or FTA funding or approval, and have not been properly reflected in the emissions analysis supporting a proposed conformity determination for a transportation plan or TIP, must be responded to, in writing, within thirty (30) days of the end of the comment period.

2. The public participation procedure defined in part 1 of this subparagraph shall not be construed as superseding public involvement procedures already in effect for agencies subject to the conformity consultation process, such as the MPOs' citizen involvement process, the Uniform Administrative Procedures Act (T.C.A. §§ 4-5-101 et seq.), the Tennessee Sunshine Law (T.C.A. §§ 8-44-101 et seq.), or any other established process which already meets or exceeds these standards. In addition, this subparagraph does not apply to project-level conformity determinations subject to NEPA where a NEPA public participation process exists.

3. The public or any interested party may also inspect any of the documents related to the conformity process upon request; any charges imposed on the public for inspection or copying documents related to the conformity process shall be consistent with (or no greater than) the fee schedule contained in 49 CFR §7.43.

Exhibit A: Illustrative list of stakeholders subject to consultation as per this rule:

Federal Agencies:

United State Environmental Protection Agency (EPA)

Federal Transit Administration (FTA)

Federal Highway Administration (FHWA)

State Agencies:

Tennessee Air Pollution Control Division (TAPCD)

Tennessee Department of Transportation (TDOT)

Local Air Agencies:

Air Pollution Control Program, Memphis/Shelby County Health Department Division of Pollution Control, Metropolitan Health Department for Davidson County Department of Air Quality Management, Knox County Health Department Air Pollution Control Bureau, Chattanooga/Hamilton County Metropolitan Planning Organizations:

Chattanooga-Hamilton County Regional Planning Agency Clarksville-Montgomery County Regional Planning Commission Knoxville Regional Transportation Planning Organization Memphis-Shelby County Department of Regional Services Nashville Metropolitan Planning Organization

History

• Authority: T.C.A. §§ 68-201-105.
• Administrative History: Original rule filed March 29, 1995; effective June 14, 1995. Amendment filed August 31, 2001; effective November 14, 2001. Repeal and new rule filed January 18, 2012; effective April 17, 2012.

Tenn. Comp. R. & Regs. 1200-03-34-.02 CONFORMITY OF GENERAL FEDERAL ACTIONS

(1) Adopted herein by reference are the federal regulations in Paragraph (2) of this rule as published in the Code of Federal Regulations (CFR ) as Subpart W of 40 CFR § 51.850 et seq., Federal Register November 30, 1993 (2) SUBPART W -- DETERMINING CONFORMITY OF GENERAL FEDERAL ACTIONS TO STATE OR FEDERAL IMPLEMENTATION PLANS §51.850 Prohibition.

(a) No department, agency or instrumentality of the Federal Government shall engage in, support in any way or provide financial assistance for, license or permit, or approve any activity which does not conform to an applicable implementation plan.

(b) A Federal agency must make a determination that a Federal action conforms to the applicable implementation plan in accordance with the requirements of this rule before the action is taken.

(c) The preceding sentence does not include Federal actions where either:

(1) A National Environmental Policy Act (NEPA) analysis was completed as evidenced by a final environmental assessment (EA), environmental impact statement (EIS), or finding of no significant impact (FONSI) that was prepared prior to January 31, 1994, or (2) (i) Prior to January 31, 1994, an EA was commenced or a contract was awarded to develop the specific environmental analysis;

(ii) Sufficient environmental analysis is completed by March 15,1994 so that the Federal agency may determine that the Federal action is in conformity with the specific requirements and the purposes of the applicable SIP pursuant to the agency's affirmative obligation under section 176(c) of the Clean Air Act (Act); and (iii) A written determination of conformity under section 176(c) of the Act has been made by the Federal agency responsible for the Federal action by March 15, 1994.

(d) Notwithstanding any provision of this subpart, a determination that an action is in conformance with the applicable implementation plan does not exempt the action from any other requirements of the applicable implementation plan, the NEPA, or the Act. §51.851 State implementation plan (SIP) revision.

(a) Each State must submit to the Environmental Protection Agency (EPA) a revision to its applicable implementation plan which contains criteria and procedures for assessing the conformity of Federal actions to the applicable implementation plan, consistent with this subpart. The State must submit the conformity provisions within 12 months after November 30, 1993, or within 12 months of an area's designation to nonattainment, whichever date is later.

(b) The Federal conformity rules under this subpart and 40 CFR part 93, in addition to any existing applicable State requirements, establish the conformity criteria and procedures necessary to meet the Act requirements until such time as the required conformity SIP revision is approved by EPA. A State's conformity provisions must contain criteria and procedures that are no less stringent than the requirements described in this subpart.

A State may establish more stringent conformity criteria and procedures only if they apply equally to non-Federal as well as Federal entities. Following EPA approval of the State conformity provisions (or a portion thereof) in a revision to the applicable SIP, the approved (or approved portion of the) State criteria and procedures would govern conformity determinations and the Federal conformity regulations contained in 40 CFR

part 93 would apply only for the portion, if any, of the State's conformity provisions that is not approved by EPA. In addition, any previously applicable SIP requirements relating to conformity remain enforceable until the State revises its SIP to specifically remove them from the SIP and that revision is approved by EPA. §51.852 Definitions.

Terms used but not defined in this part shall have the meaning given them by the Act and EPA's regulations (40 CFR chapter 1), in that order of priority.

Affected Federal land manager means the Federal agency or the Federal official charged with direct responsibility for management of an area designated as Class I under 42 U.S.C. 7472 of the Act that is located within 100 km of the proposed Federal action.

Applicable implementation plan or applicable SIP means the portion (or portions) of the SIP or most recent revision thereof, which has been approved under section 110 of the Act, or promulgated under section 110(c) of the Act (Federal implementation plan), or promulgated or approved pursuant to regulations promulgated under section 301(d) of the Act and which implements the relevant requirements of the Act.

Areawide air quality modeling analysis means an assessment on a scale that includes the entire nonattainment or maintenance area which uses an air quality dispersion model to determine the effects of emissions on air quality.

Cause or contribute to a new violation means a Federal action that:

(1) Causes a new violation of a national ambient air quality standard (NAAQS) at a location in a nonattainment or maintenance area which would otherwise not be in violation of the standard during the future period in question if the Federal action were not taken, or (2) Contributes, in conjunction with other reasonably foreseeable actions, to a new violation of a NAAQS at a location in a nonattainment or maintenance area in a manner that would increase the frequency or severity of the new violation.

Caused by, as used in the terms "direct emissions" and "indirect emissions," means emissions that would not otherwise occur in the absence of the Federal action.

Criteria pollutant or standard means any pollutant for which there is established a NAAQS at 40 CFR part 50.

Direct emissions means those emissions of a criteria pollutant or its precursors that are caused or initiated by the Federal action and occur at the same time and place as the action.

Emergency means a situation where extremely quick action on the part of the Federal agencies involved is needed and where the timing of such Federal activities makes it impractical to meet the requirements of this rule, such as natural disasters like hurricanes or earthquakes, civil disturbances such as terrorist acts, and military mobilizations.

Emissions budgets are those portions of the applicable SIP's projected emissions inventories that describe the levels of emissions (mobile, stationary, area, etc.) that provide for meeting reasonable further progress milestones, attainment, and/or maintenance for any criteria pollutant or its precursors.

Emission offsets, for purposes of section 51.858, are emissions reductions which are quantifiable, consistent with the applicable SIP attainment and reasonable further progress demonstrations, surplus to reductions required by, and credited to, other applicable SIP provisions, enforceable at both the State and Federal levels, and permanent within the time frame specified by the program.

Emissions that a Federal agency has a continuing program responsibility for means emissions that are specifically caused by an agency carrying out its authorities, and does not include emissions that occur due to subsequent activities, unless such activities are required by the Federal agency. Where an agency, in performing its normal program responsibilities, takes actions itself or imposes conditions that result in air pollutant emissions by a non-Federal entity taking subsequent actions, such emissions are covered by the meaning of a continuing program responsibility.

EPA means the Environmental Protection Agency.

Federal action means any activity engaged in by a department, agency, or instrumentality of the Federal government, or any activity that a department, agency or instrumentality of the Federal government supports in any way, provides financial assistance for, licenses, permits, or approves, other than activities related to transportation plans, programs, and projects developed, funded, or approved under title 23 U.S.C. or the Federal Transit Act (49 U.S.C. 1601 et seq.). Where the Federal action is a permit, license, or other approval for some aspect of a non-Federal undertaking, the relevant activity is the part, portion, or phase or the non-Federal undertaking that requires the Federal permit, license, or approval.

Federal agency means, for purposes of this rule, a Federal department, agency, or instrumentality of the Federal government.

Increase the frequency or severity of any existing violation of any standard in any area means to cause a nonattainment area to exceed a standard more often or to cause a violation at a greater concentration than previously existed and/or would otherwise exist during the future period in question, if the project were not implemented.

Indirect emissions means those emissions of a criteria pollutant or its precursors that:

(1) Are caused by the Federal action, but may occur later in time and/or may be farther removed in distance from the action itself but are still reasonably foreseeable; and (2) The Federal agency can practicably control and will maintain control over due to a continuing program responsibility of the Federal agency.

Local air quality modeling analysis means an assessment of localized impacts on a scale smaller than the entire nonattainment or maintenance area, including, for example, congested roadway intersections and highways or transit terminals, which uses an air quality dispersion model to determine the effects of emissions on air quality.

Maintenance area means an area with a maintenance plan approved under section 175A of the Act.

Maintenance plan means a revision to the applicable SIP, meeting the requirements of

section 175A of the Act.

Metropolitan Planning Organization (MPO) is that organization designated as being responsible, together with the State, for conducting the continuing, cooperative, and comprehensive planning process under 23 U.S.C. 134 and 49 U.S.C. 1607.

Milestone has the meaning given in sections 182(g)(1) and 189(c)(1) of the Act.

National ambient air quality standards (NAAQS) are those standards established pursuant to section 109 of the Act and include standards for carbon monoxide (CO), lead (Pb), nitrogen dioxide (NO ), ozone, particulate matter (PM-10), and sulfur dioxide (SO ).

NEPA is the National Environmental Policy Act of 1969, as amended (42 U.S.C. 4321 et seq.).

Nonattainment Area (NAA) means an area designated as nonattainment under section 107 of the Act and described in 40 CFR part 81.

Precursors of a criteria pollutant are:

(1) For ozone, nitrogen oxides (NOx), unless an area is exempted from NOx requirements under section 182(f) of the Act, and volatile organic compounds (VOC); and (2) For PM-10, those pollutants described in the PM-10 nonattainment area applicable SIP as significant contributors to the PM-10 levels.

Reasonably foreseeable emissions are projected future indirect emissions that are identified at the time the conformity determination is made; the location of such emissions is known and the emissions are quantifiable, as described and documented by the Federal agency based on its own information and after reviewing any information presented to the Federal agency.

Regional water and/or wastewater projects include construction, operation, and maintenance of water or wastewater conveyances, water or wastewater treatment facilities, and water storage reservoirs which affect a large portion of a nonattainment or maintenance area.

Regionally significant action means a Federal action for which the direct and indirect emissions of any pollutant represent 10 percent or more of a nonattainment or maintenance area's emissions inventory for that pollutant.

Total of direct and indirect emissions means the sum of direct and indirect emissions increases and decreases caused by the Federal action; i.e., the "net" emissions considering all direct and indirect emissions. The portion of emissions which are exempt or presumed to conform under section 51.853, paragraphs (c), (d), (e), or (f) are not included in the "total of direct and indirect emissions." The "total of direct and indirect emissions" includes emissions of criteria pollutants and emissions of precursors of criteria pollutants. §51.853 Applicability.

(a) Conformity determinations for Federal actions related to transportation plans, programs, and projects developed, funded, or approved under title 23 U.S.C. or the Federal Transit Act (49 U.S.C. 1601 et seq.) must meet the procedures and criteria of 40 CFR part 51, subpart T, in lieu of the procedures set forth in this subpart.

(b) For Federal actions not covered by paragraph (a) of this section, a conformity determination is required for each pollutant where the total of direct and indirect emissions in a nonattainment or maintenance area caused by a Federal action would equal or exceed any of the rates in paragraphs (b)(1) or (2) of this section.

(1) For purposes of paragraph (b) of this section, the following rates apply in nonattainment areas (NAAs):

Tons/Year Ozone (VOC's or NOx)

Serious NAA's 50 Severe NAA's 25 Extreme NAA's 10 Other ozone NAA's outside an ozone transport region 100 Marginal and moderate NAA's inside an ozone transport region VOC 50 NOx 100 Carbon monoxide All NAA's 100 SO or NO All NAA's 100 PM-10 Moderate NAA's 100 Serious NAA's 70 Pb All NAA's 25 (2) For purposes of paragraph (b) of this section, the following rates apply in maintenance areas:

Tons/Year Ozone (NOx), SO or NO All Maintenance Areas 100 Ozone (VOC's)

Maintenance areas inside an ozone transport region 50 Maintenance areas outside an ozone transport region 100 Carbon monoxide All maintenance areas 100 PM-10 All maintenance areas 100 Pb All maintenance areas 25 (c) The requirements of this subpart shall not apply to:

(1) Actions where the total of direct and indirect emissions are below the emissions levels specified in paragraph (b) of this section.

(2) The following actions which would result in no emissions increase or an increase in emissions that is clearly de minimus:

(i) Judicial and legislative proceedings.

(ii) Continuing and recurring activities such as permit renewals where activities conducted will be similar in scope and operation to activities currently being conducted.

(iii) Rulemaking and policy development and issuance.

(iv) Routine maintenance and repair activities, including repair and maintenance of administrative sites, roads, trails, and facilities.

(v) Civil and criminal enforcement activities, such as investigations, audits, inspections, examinations, prosecutions, and the training of law enforcement personnel.

(vi) Administrative actions such as personnel actions, organizational changes, debt management or collection, cash management, internal agency audits, program budget proposals, and matters relating to the administration and collection of taxes, duties and fees.

(vii) The routine, recurring transportation of material and personnel.

(viii) Routine movement of mobile assets, such as ships and aircraft, in home port reassignments and stations (when no new support facilities or personnel are required) to perform as operational groups and/or for repair or overhaul.

(ix) Maintenance dredging and debris disposal where no new depths are required, applicable permits are secured, and disposal will be at an approved disposal site.

(x) Actions, such as the following, with respect to existing structures, properties, facilities and lands where future activities conducted will be similar in scope and operation to activities currently being conducted at the existing structures, properties, facilities, and lands; for example, relocation of personnel, disposition of federally-owned existing structures, properties, facilities, and lands, rent subsidies, operation and maintenance cost subsidies, the exercise of receivership or conservatorship authority, assistance in purchasing structures, and the production of coins and currency.

(xi) The granting of leases, licenses such as for exports and trade, permits, and easements where activities conducted will be similar in scope and operation to activities currently being conducted.

(xii) Planning, studies, and provision of technical assistance.

(xiii) Routine operation of facilities, mobile assets and equipment.

(xiv) Transfers of ownership, interests, and titles in land, facilities, and real and personal properties, regardless of the form or method of the transfer.

(xv) The designation of empowerment zones, enterprise communities, or viticultural areas.

(xvi) Actions by any of the Federal banking agencies or the Federal Reserve Banks, including actions regarding charters, applications, notices, licenses, the supervision or examination of depository institutions or depository institution holding companies, access to the discount window, or the provision of financial services to banking organizations or to any department, agency or instrumentality of the United States.

(xvii) Actions by the Board of Governors of the Federal Reserve System or any Federal Reserve Bank to effect monetary or exchange rate policy.

(xviii) Actions that implement a foreign affairs function of the United States.

(xix) Actions (or portions thereof) associated with transfers of land, facilities, title, and real properties through an enforceable contract or lease agreement where the delivery of the deed is required to occur promptly after a specific, reasonable condition is met, such as promptly after the land is certified as meeting the requirements of the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), and where the Federal agency does not retain continuing authority to control emissions associated with the lands, facilities, title, or real properties.

(xx) Transfers of real property, including land, facilities, and related personal property from a Federal entity to another Federal entity and assignments of real property, including land, facilities, and related personal property from a Federal entity to another Federal entity for subsequent deeding to eligible applicants.

(xxi) Actions by the Department of the Treasury to effect fiscal policy and to exercise the borrowing authority of the United States.

(3) The following actions where the emissions are not reasonably foreseeable:

(i) Initial Outer Continental Shelf lease sales which are made on a broad scale and are followed by exploration and development plans on a project level.

(ii) Electric power marketing activities that involve the acquisition, sale and transmission of electric energy.

(4) Actions which implement a decision to conduct or carry out a conforming program such as prescribed burning actions which are consistent with a conforming land management plan.

(d) Notwithstanding the other requirements of this subpart, a conformity determination is not required for the following Federal actions (or portion thereof):

(1) The portion of an action that includes major new or modified stationary sources that require a permit under the new source review (NSR) program (section 173 of the Act) or the prevention of significant deterioration (PSD) program (title I, part C of the Act).

(2) Actions in response to emergencies or natural disasters such as hurricanes, earthquakes, etc., which are commenced on the order of hours or days after the emergency or disaster and, if applicable, which meet the requirements of paragraph (e) of this section;

(3) Research, investigations, studies, demonstrations, or training [other than those exempted under section 51.853(c)(2)], where no environmental detriment is incurred and/or, the particular action furthers air quality research, as determined by the State agency primarily responsible for the applicable SIP;

(4) Alteration and additions of existing structures as specifically required by new or existing applicable environmental legislation or environmental regulations (e.g., hush houses for aircraft engines and scrubbers for air emissions).

(5) Direct emissions from remedial and removal actions carried out under the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) and associated regulations to the extent such emissions either comply with the substantive requirements of the PSD/NSR permitting program or are exempted from other environmental regulation under the provisions of CERCLA and applicable regulations issued under CERCLA.

(e) Federal actions which are part of a continuing response to an emergency or disaster under section 51.853(d)(2) and which are to be taken more than 6 months after the commencement of the response to the emergency or disaster under section 51.853(d)(2) are exempt from the requirements of this subpart only if:

(1) The Federal agency taking the actions makes a written determination that, for a specified period not to exceed an additional 6 months, it is impractical to prepare the conformity analyses which would otherwise be required and the actions cannot be delayed due to overriding concerns for public health and welfare, national security interests and foreign policy commitments; or (2) For actions which are to be taken after those actions covered by paragraph (e)(1) of this section, the Federal agency makes a new determination as provided in paragraph (e)(1) of this section.

(f) Notwithstanding other requirements of this subpart, actions specified by individual Federal agencies that have met the criteria set forth in either paragraph (g)(1) or (g)(2) and the procedures set forth in paragraph (h) of this section are presumed to conform, except as provided in paragraph (j) of this section.

(g) The Federal agency must meet the criteria for establishing activities that are presumed to conform by fulfilling the requirements set forth in either paragraph (g)(1) or (g)(2) of this section:

(1) The Federal agency must clearly demonstrate using methods consistent with this

rule that the total of direct and indirect emissions from the type of activities which would be presumed to conform would not:

(i) Cause or contribute to any new violation of any standard in any area;

(ii) Interfere with provisions in the applicable SIP for maintenance of any standard;

(iii) Increase the frequency or severity of any existing violation of any standard in any area; or (iv) Delay timely attainment of any standard or any required interim emission reductions or other milestones in any area including, where applicable, emission levels specified in the applicable SIP for purposes of:

(A) A demonstration of reasonable further progress;

(B) A demonstration of attainment; or (C) A maintenance plan; or (2) The Federal agency must provide documentation that the total of direct and indirect emissions from such future actions would be below the emission rates for a conformity determination that are established in paragraph (b) of this section, based, for example, on similar actions taken over recent years.

(h) In addition to meeting the criteria for establishing exemptions set forth in paragraphs (g)(1) or (g)(2) of this section, the following procedures must also be complied with to presume that activities will conform:

(1) The Federal agency must identify through publication in the Federal Register its list of proposed activities that are presumed to conform and the basis for the presumptions;

(2) The Federal agency must notify the appropriate EPA Regional Office(s), State and local air quality agencies and, where applicable, the agency designated under section 174 of the Act and the MPO and provide at least 30 days for the public to comment on the list of proposed activities presumed to conform;

(3) The Federal agency must document its response to all the comments received and make the comments, response, and final list of activities available to the public upon request; and (4) The Federal agency must publish the final list of such activities in the Federal Register.

(i) Notwithstanding the other requirements of this subpart, when the total of direct and indirect emissions of any pollutant from a Federal action does not equal or exceed the rates specified in paragraph (b) of this section, but represents 10 percent or more of a nonattainment or maintenance area's total emissions of that pollutant, the action is defined as a regionally significant action and the requirements of section 51.850 and sections 51.855-860 shall apply for the Federal action.

(j) Where an action otherwise presumed to conform under paragraph (f) of this section is a regionally significant action or does not in fact meet one of the criteria in paragraph (g)(1) of this section, that action shall not be presumed to conform and the requirements of section 51.850 and sections 51.855-860 shall apply for the Federal action.

(k) The provisions of this subpart shall apply in all nonattainment and maintenance areas. §51.854 Conformity analysis.

Any Federal department, agency, or instrumentality of the Federal government taking an action subject to this subpart must make its own conformity determination consistent with the requirements of this subpart. In making its conformity determination, a Federal agency must consider comments from any interested parties. Where multiple Federal agencies have jurisdiction for various aspects of a project, a Federal agency may choose to adopt the analysis of another Federal agency or develop its own analysis in order to make its conformity determination. §51.855 Reporting requirements.

(a) A Federal agency making a conformity determination under section 51.858 must provide to the appropriate EPA Regional Office(s), State and local air quality agencies and, where applicable, affected Federal land managers, the agency designated under

section 174 of the Act and the MPO a 30 day notice which describes the proposed action and the Federal agency's draft conformity determination on the action.

(b) A Federal agency must notify the appropriate EPA Regional Office(s), State and local air quality agencies and, where applicable, affected Federal land managers, the agency designated under section 174 of the Clean Air Act and the MPO within 30 days after making a final conformity determination under section 51.858. §51.856 Public participation.

(a) Upon request by any person regarding a specific Federal action, a Federal agency must make available for review its draft conformity determination under section 51.858 with supporting materials which describe the analytical methods and conclusions relied upon in making the applicability analysis and draft conformity determination.

(b) A Federal agency must make public its draft conformity determination under section 51.858 by placing a notice by prominent advertisement in a daily newspaper of general circulation in the area affected by the action and by providing 30 days for written public comment prior to taking any formal action on the draft determination. This comment period may be concurrent with any other public involvement, such as occurs in the NEPA process.

(c) A Federal agency must document its response to all the comments received on its draft conformity determination under section 51.858 and make the comments and responses available, upon request by any person regarding a specific Federal action, within 30 days of the final conformity determination.

(d) A Federal agency must make public its final conformity determination under section 51.858 for a Federal action by placing a notice by prominent advertisement in a daily newspaper of general circulation in the area affected by the action within 30 days of the final conformity determination. §51.857 Frequency of conformity determinations.

(a) The conformity status of a Federal action automatically lapses 5 years from the date a final conformity determination is reported under section 51.855, unless the Federal action has been completed or a continuous program has been commenced to implement that Federal action within a reasonable time.

(b) Ongoing Federal activities at a given site showing continuous progress are not new actions and do not require periodic redeterminations so long as such activities are within the scope of the final conformity determination reported under section 51.855.

(c) If, after the conformity determination is made, the Federal action is changed so that there is an increase in the total of direct and indirect emissions above the levels in

section 51.853(b), a new conformity determination is required. §51.858 Criteria for determining conformity of general Federal actions.

(a) An action required under section 51.853 to have a conformity determination for a specific pollutant, will be determined to conform to the applicable SIP if, for each pollutant that exceeds the rates in section 51.853, paragraph (b), or otherwise requires a conformity determination due to the total of direct and indirect emissions from the action, the action meets the requirements of paragraph (c) of this section, and meets any of the following requirements:

(1) For any criteria pollutant, the total of direct and indirect emissions from the action are specifically identified and accounted for in the applicable SIP's attainment or maintenance demonstration;

(2) For ozone or nitrogen dioxide, the total of direct and indirect emissions from the action are fully offset within the same nonattainment or maintenance area through a revision to the applicable SIP or a similarly enforceable measure that effects emission reductions so that there is no net increase in emissions of that pollutant;

(3) For any criteria pollutant, except ozone and nitrogen dioxide, the total of direct and indirect emissions from the action meet the requirements:

(i) Specified in paragraph (b) of this section, based on areawide air quality modeling analysis and local air quality modeling analysis; or (ii) Meet the requirements of paragraph (a)(5) and, for local air quality modeling analysis, the requirement of paragraph (b) of this section;

(4) For CO or PM-10, (i) Where the State agency primarily responsible for the applicable SIP determines that an areawide air quality modeling analysis is not needed, the total of direct and indirect emissions from the action meet the requirements specified in paragraph (b) of this section, based on local air quality modeling analysis; or (ii) Where the State agency primarily responsible for the applicable SIP determines that an areawide air quality modeling analysis is appropriate and that a local air quality modeling analysis is not needed, the total of direct and indirect emissions from the action meet the requirements specified in paragraph (b) of this section, based on areawide modeling, or meet the requirements of paragraph (a)(5) of this section; or (5) For ozone or nitrogen dioxide, and for purposes of paragraphs (a)(3)(ii) and (a)(4)(ii) of this section, each portion of the action or the action as a whole meets any of the following requirements:

(i) Where EPA has approved a revision to an area's attainment or maintenance demonstration after 1990 and the State makes a determination as provided in paragraph (2)(5)(i)(A) of this section; or where the State makes a commitment as provided in paragraph (2)(5)(i)(B) of this section;

(A) The total of direct and indirect emissions from the action (or portion thereof) is determined and documented by the State agency primarily responsible for the applicable SIP to result in a level of emissions which, together with all other emissions in the nonattainment (or maintenance) area, would not exceed the emissions budgets specified in the applicable SIP;

(B) The total of direct and indirect emissions from the action (or portion thereof) is determined by the State agency responsible for the applicable SIP to result in a level of emissions which, together with all other emissions in the nonattainment (or maintenance) area, would exceed an emissions budget specified in the applicable SIP and the State Governor or the Governor's designee for SIP actions makes a written commitment to EPA which includes the following:

(1) A specific schedule for adoption and submittal of a revision to the SIP which would achieve the needed emission reductions prior to the time emissions from the Federal action would occur;

(2) Identification of specific measures for incorporation into the SIP which would result in a level of emissions which, together with all other emissions in the nonattainment or maintenance area, would not exceed any emissions budget specified in the applicable SIP;

(3) A demonstration that all existing applicable SIP requirements are being implemented in the area for the pollutants affected by the Federal action, and that local authority to implement additional requirements has been fully pursued;

(4) A determination that the responsible Federal agencies have required all reasonable mitigation measures associated with their action; and (5) Written documentation including all air quality analyses supporting the conformity determination.

(C) Where a Federal agency made a conformity determination based on a State commitment under paragraph (a)(5)(i)(B) of this section, such a State commitment is automatically deemed a call for a SIP revision by EPA under section 110(k)(5) of the Act, effective on the date of the Federal conformity determination and requiring response within 18 months or any shorter time within which the State commits to revise the applicable SIP;

(ii) The action (or portion thereof), as determined by the MPO, is specifically included in a current transportation plan and transportation improvement program which have been found to conform to the applicable SIP under 40 CFR part 51, subpart T, or 40 CFR part 93, subpart A;

(iii) The action (or portion thereof) fully offsets its emissions within the same nonattainment or maintenance area through a revision to the applicable SIP or an equally enforceable measure that effects emission reductions equal to or greater than the total of direct and indirect emissions from the action so that there is no net increase in emissions of that pollutant;

(iv) Where EPA has not approved a revision to the relevant SIP attainment or maintenance demonstration since 1990, the total of direct and indirect emissions from the action for the future years [described in paragraph (d) of section 51.859] do not increase emissions with respect to the baseline emissions;

(A) The baseline emissions reflect the historical activity levels that occurred in the geographic area affected by the proposed Federal action during:

(1) Calendar year 1990;

(2) The calendar year that is the basis for the classification (or, where the classification is based on multiple years, the most representative year), if a classification is promulgated in 40 CFR part 81; or (3) The year of the baseline inventory in the PM-10 applicable SIP;

(B) The baseline emissions are the total of direct and indirect emissions calculated for the future years [described in paragraph (d) of section 51.859] using the historic activity levels [described in paragraph (a)(5)(iv)(A) of this section] and appropriate emission factors for the future years; or (v) Where the action involves regional water and/or wastewater projects, such projects are sized to meet only the needs of population projections that are in the applicable SIP.

(b) The areawide and/or local air quality modeling analyses must:

(1) Meet the requirements in section 51.859; and (2) Show that the action does not:

(i) Cause or contribute to any new violation of any standard in any area; or (ii) Increase the frequency or severity of any existing violation of any standard in any area.

(c) Notwithstanding any other requirements of this section, an action subject to this

subpart may not be determined to conform to the applicable SIP unless the total of direct and indirect emissions from the action is in compliance or consistent with all relevant requirements and milestones contained in the applicable SIP, such as elements identified as part of the reasonable further progress schedules, assumptions specified in the attainment or maintenance demonstration, prohibitions, numerical emission limits, and work practice requirements.

(d) Any analyses required under this section must be completed, and any mitigation requirements necessary for a finding of conformity must be identified before the determination of conformity is made. §51.859 Procedures for conformity determinations of general Federal actions.

(a) The analyses required under this subpart must be based on the latest planning assumptions.

(1) All planning assumptions must be derived from the estimates of population, employment, travel, and congestion most recently approved by the MPO, or other agency authorized to make such estimates, where available.

(2) Any revisions to these estimates used as part of the conformity determination, including projected shifts in geographic location or level of population, employment, travel, and congestion, must be approved by the MPO or other agency authorized to make such estimates for the urban area.

(b) The analyses required under this subpart must be based on the latest and most accurate emission estimation techniques available as described below, unless such techniques are inappropriate. If such techniques are inappropriate and written approval of the EPA Regional Administrator is obtained for any modification or substitution, they may be modified or another technique substituted on a case-by-case

basis or, where appropriate, on a generic basis for a specific Federal agency program.

(1) For motor vehicle emissions, the most current version of the motor vehicle emissions model specified by EPA and available for use in the preparation or revision of SIPs in that State must be used for the conformity analysis as specified below:

(i) The EPA must publish in the Federal Register a notice of availability of any new motor vehicle emissions model; and (ii) A grace period of three months shall apply during which the motor vehicle emissions model previously specified by EPA as the most current version may be used. Conformity analyses for which the analysis was begun during the grace period or no more than 3 years before the Federal Register notice of availability of the latest emission model may continue to use the previous version of the model specified by EPA.

(2) For non-motor vehicle sources, including stationary and area source emissions, the latest emission factors specified by EPA in the "Compilation of Air Pollutant Emission Factors (AP-42)" must be used for the conformity analysis unless more accurate emission data are available, such as actual stack test data from stationary sources which are part of the conformity analysis.

(c) The air quality modeling analyses required under this subpart must be based on the applicable air quality models, data bases, and other requirements specified in the most recent version of the "Guideline on Air Quality Models (Revised)" (1986), including supplements (EPA publication no. 450/2-78-027R), unless:

(1) The guideline techniques are inappropriate, in which case the model may be modified or another model substituted on a case-by-case basis or, where appropriate, on a generic basis for a specific Federal agency program; and (2) Written approval of the EPA Regional Administrator is obtained for any modification or substitution.

(d) The analyses required under this subpart, except section 51.858(a)(1), must be based on the total of direct and indirect emissions from the action and must reflect emission scenarios that are expected to occur under each of the following cases:

(1) The Act mandated attainment year or, if applicable, the farthest year for which emissions are projected in the maintenance plan;

(2) The year during which the total of direct and indirect emissions from the action is expected to be the greatest on an annual basis; and (3) Any year for which the applicable SIP specifies an emissions budget. §51.860 Mitigation of air quality impacts.

(a) Any measures that are intended to mitigate air quality impacts must be identified and the process for implementation and enforcement of such measures must be described, including an implementation schedule containing explicit timelines for implementation.

(b) Prior to determining that a Federal action is in conformity, the Federal agency making the conformity determination must obtain written commitments from the appropriate persons or agencies to implement any mitigation measures which are identified as conditions for making conformity determinations.

(c) Persons or agencies voluntarily committing to mitigation measures to facilitate positive conformity determinations must comply with the obligations of such commitments.

(d) In instances where the Federal agency is licensing, permitting or otherwise approving the action of another governmental or private entity, approval by the Federal agency must be conditioned on the other entity meeting the mitigation measures set forth in the conformity determination.

(e) When necessary because of changed circumstances, mitigation measures may be modified so long as the new mitigation measures continue to support the conformity determination. Any proposed change in the mitigation measures is subject to the reporting requirements of section 51.856 and the public participation requirements of

section 51.857.

(f) The implementation plan revision required in section 51.851 of this subpart shall provide that written commitments to mitigation measures must be obtained prior to a positive conformity determination and that such commitments must be fulfilled.

(g) After a State revises its SIP to adopt its general conformity rules and EPA approves that SIP revision, any agreements, including mitigation measures, necessary for a conformity determination will be both State and federally enforceable. Enforceability through the applicable SIP will apply to all persons who agree to mitigate direct and indirect emissions associated with a Federal action for a conformity determination.

History

• Authority: T.C.A. §§ 4-5-201 et. seq. and 68-201-105.
• Administrative History: Original rule filed March 29, 1995; effective June 14, 1995.

Chapter 1200-03-35 Reserved

Tenn. Comp. R. & Regs. 1200-03-35 Reserved

RULES

OF TENNESSEE DEPARTMENT OF ENVIRONMENT AND CONSERVATION

BUREAU OF ENVIRONMENT

DIVISION OF AIR POLLUTION CONTROL

Chapter 1200-03-36 Motor Vehicle Tampering

Tenn. Comp. R. & Regs. 1200-03-36-.01 PURPOSE

The purpose of this chapter is to reduce the air pollution caused by tampering with a motor vehicle emissions system.

History

• Authority: TCA 68-201-105, 68-201-120, and 4-5-202.
• Administrative History: Original rule filed October 15, 2004; effective December 29, 2004.

Tenn. Comp. R. & Regs. 1200-03-36-.02 DEFINITIONS

Unless specifically defined in this chapter, the definitions from Chapters 1200-3- 2 and 1200-3-29 shall apply:

(1) Aftermarket part means any part offered for sale for installation in or on a motor vehicle after such vehicle has left the vehicle manufacturer's production line.

(2) Air pollution emission control device is a mechanism or equipment installed on a motor vehicle by the manufacturer that controls and reduces generated emissions that would otherwise be released into the atmosphere.

(3) Antique motor vehicle is any motor vehicle over twenty-five years old which is owned solely as a collectors’ item and is used for participation in club activities, exhibits, tours, parades and similar uses, but in no event for general transportation.

(4) Catalytic converter is an air pollution emission control device containing a catalyst for converting automobile exhaust into mostly harmless products.

(5) Department means the Tennessee Department of Environment and Conservation, Division of Air Pollution Control.

(6) EGR valve means an exhaust gas recirculation valve.

(7) Federal Motor Vehicle Standards are the required emission standards as defined in Title 40, Code of Federal Regulations, Parts 86 and 88.

(8) Individual is a private citizen who may or may not be the owner or operator of the motor vehicle that performs engine, transmission, and/or exhaust system repairs without obtaining the services of a repair technician provided that all repairs are in accordance with Rule 1200-3-36-.03.

(9) Kit Car means a motor vehicle which does not utilize a chassis from a vehicle certified to meet emissions control standards or for which the original manufacturer’s identification has been eliminated due to the replacement of the vehicle’s body with one of a different make and/or style.

(10) Leaded gasoline means gasoline containing greater than five hundredths (0.050) gram of lead per gallon of gasoline.

(11) Motor vehicle is any self-propelled vehicle used for transporting persons or commodities on public roads.

(12) New motor vehicle is any motor vehicle that has never been previously titled or registered in this or any other jurisdiction and whose ownership document remains as a manufacturer’s certificate of origin.

(13) Repair means to replace any component of an engine, transmission, exhaust, and/or electrical system of a motor vehicle.

(14) Repair facility is any garage, muffler shop, dealership, or other commercial establishment that performs engine, transmission, and/or exhaust system repairs, including electronic computer systems associated with the above-mentioned systems, on motor vehicles.

(15) Repair technician is any person who:

(a) is professionally engaged full-time in vehicle repair or employed by an ongoing business whose

purpose is vehicle repair, or (b) is a certified mechanic with valid certifications that are current from the National Institute for Automotive Service Excellence (ASE) in Electrical Systems (A6), Engine Performance (A8), and Advanced Engine Performance Specialist (L1); or (c) has satisfactorily completed an independent or vehicle manufacturer’s training course, or has passed a nationally-recognized test, which course or test covers the emissions test methods used, diagnosis of the causes for failures, and repair work most frequently done for vehicles failing the transient emission test.

(16) Routine maintenance is the replacing of motor vehicle parts that routinely wear as a result of normal operation.

(17) Tampering means to modify, remove, render inoperative, cause to be removed, or make less operative any air pollution emission control device or element of design installed on a motor vehicle or motor vehicle engine which results in an increase in emissions beyond established federal motor vehicle standards. Tampering includes, but is not limited to, any of the following:

(a) Removing or rendering inoperative such devices as catalytic converter, air pump, or EGR valve;

(b) Disconnecting or plugging vacuum lines or electrical or mechanical portions of the pollution control system such as electrical solenoids or vacuum-activated valves;

(c) Modifying a motor vehicle’s emission control design to other than the manufacturer’s specifications;

(d) Installing any replacement part that is not equivalent in design and function to the part that was originally on the motor vehicle;

(e) Adding a part on a motor vehicle that does not meet the manufacturer’s specifications, such as installation of dual carburetors to replace a single carburetor, or installing a dual exhaust prior to the catalytic converter on a vehicle that was manufactured as single exhaust only;

(f) Installing a motor vehicle engine unless the resulting motor vehicle is identical to a configuration of the same or newer model year as the original motor vehicle chassis. This configuration must comply with the federal motor vehicle standards;

(g) Introducing leaded gasoline or any gasoline additive into a motor vehicle that was originally designed to use unleaded gasoline only that would result in the poisoning of the catalysts;

(h) Installing any electrical device that is attached to the motor vehicle’s computer system that is designed to give false onboard diagnostic readiness codes and is used as an attempt to pass the onboard diagnostic test;

(i) Introducing any chemical or fuel into the gasoline other than what is recommended by the manufacturer to be an approved fuel or fuel additive;

(j) Detuning the motor vehicle engine to a lower or higher idle to run out of manufacturer’s design specifications;

(k) Operating the motor vehicle without the appropriate fuel cap or the appropriate fuel inlet restrictor;

(l) Installing high performance chips which reprogram or override the motor vehicle’s on-board computer system; and (m) Installing any aftermarket part that does not meet the manufacturer’s specifications.

(18) Technical Secretary is the Technical Secretary of the Air Pollution Control Board of the State of Tennessee or his designated representative.

(19) Vehicle owner is any individual, business, or corporation that holds the title to a motor vehicle.

History

• Authority: TCA 68-201-105, 68-201-120, and 4-5-202.
• Administrative History: Original rule filed October 15, 2004; effective December 29, 2004.

Tenn. Comp. R. & Regs. 1200-03-36-.03 MOTOR VEHICLE TAMPERING PROHIBTED

(1) No person shall cause, suffer, allow, or permit tampering of a motor vehicle or motor vehicle engine that is in compliance with federal motor vehicle standards except where the purpose of modification or removal of the air pollution emission control device is to install another device which is equally effective in reducing emissions from the vehicle.

(2) No person shall manufacture, sell, offer to sell, or install any part or component on a motor vehicle or motor vehicle engine where the purpose of the part or component is to bypass, defeat, or render inoperative any device or element of design installed on or in a motor vehicle or motor vehicle engine that is in compliance with the federal motor vehicle standards.

(3) No person shall perform emission related repairs on any part of a motor vehicle that is in a tampered state unless such repairs are performed that bring the vehicle into compliance with federal motor vehicle standards. This provision applies regardless of the age or mileage of a vehicle that was designed to meet federal motor vehicle standards.

History

• Authority: TCA 68-201-105, 68-201-120, and 4-5-202.
• Administrative History: Original rule filed October 15, 2004; effective December 29, 2004.

Tenn. Comp. R. & Regs. 1200-03-36-.04 RECORD KEEPING REQUIREMENTS

(1) The repair facility and/or the person performing the repairs, and the vehicle owner shall maintain a complete record of all emission repairs (as related to the manufacturer’s warranty) for a minimum period of one (1) year from the date of the repair. These documents must contain the following: vehicle identification number (VIN), vehicle make, vehicle model, model year, name, address and telephone number of the vehicle owner.

(2) In the event of a catalytic converter replacement, the old replaced catalyst must be kept for a minimum of fifteen (15) days. The new replacement catalyst must be accompanied by a copy of the warranty tag issued with it.

History

• Authority: TCA 68-201-105, 68-201-120, and 4-5-202.
• Administrative History: Original rule filed October 15, 2004; effective December 29, 2004.

Tenn. Comp. R. & Regs. 1200-03-36-.05 EXEMPTIONS

(1) The Technical Secretary may exempt any motor vehicle or motor vehicle engine from Rule 1200-3-36- .03 subsection (1) or (2) upon such terms and conditions as he may find necessary for the purpose of investigations, demonstrations, or training.

(2) The following classes of motor vehicles are exempt from the requirements established in Rule 1200-3- 36-.03 of this chapter:

(a) antique motor vehicles (b) kit cars (3) Routine maintenance and repair of motor vehicles and motor vehicle engines which require the use of an aftermarket part, alteration or add-on part will not constitute tampering if the repair does not adversely affect emissions performance.

History

• Authority: TCA 68-201-105, 68-201-120, and 4-5-202.
• Administrative History: Original rule filed October 15, 2004; effective December 29, 2004.

Chapter 1200-03-37 Repealed

Tenn. Comp. R. & Regs. 1200-03-37-.01 REPEALED

History

• Authority: T.C.A. §§ 68-201-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 15, 2007; effective August 29, 2007. Repeal filed October 10, 2012; effective January 8, 2013.

1200-04 Bureau of Environmental Health Services Division of Ground Water Protection Division of Water Pollution Control

Chapter 1200-04-01 Repealed (Transferred to 0400-40-01)

Tenn. Comp. R. & Regs. 1200-04-01-.01 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-01.

Tenn. Comp. R. & Regs. 1200-04-01-.02 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-01.

Tenn. Comp. R. & Regs. 1200-04-01-.03 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-01.

Tenn. Comp. R. & Regs. 1200-04-01-.04 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-01.

Tenn. Comp. R. & Regs. 1200-04-01-.05 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-01.

Tenn. Comp. R. & Regs. 1200-04-01-.06 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-01.

Tenn. Comp. R. & Regs. 1200-04-01-.07 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-01.

Chapter 1200-04-02 Repealed (Transferred to 0400-40-02)

Tenn. Comp. R. & Regs. 1200-04-02-.01 REPEALED

History

• Authority: T.C.A. § 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 25, 1977; effective December 26, 1977. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-02.

Tenn. Comp. R. & Regs. 1200-04-02-.02 REPEALED

History

• Authority: T.C.A. § 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 25, 1977; effective December 26, 1977. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-02.

Tenn. Comp. R. & Regs. 1200-04-02-.03 REPEALED

History

• Authority: T.C.A. § 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 25, 1977; effective December 26, 1977. Amendment filed June 29, 1988; effective August 13, 1988. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-02.

Tenn. Comp. R. & Regs. 1200-04-02-.04 REPEALED

History

• Authority: T.C.A. § 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 25, 1977; effective December 26, 1977. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-02.

Tenn. Comp. R. & Regs. 1200-04-02-.06 REPEALED

History

• Authority: T.C.A. § 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 25, 1977; effective December 26, 1977. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-02.

Tenn. Comp. R. & Regs. 1200-00-02-.05 REPEALED

History

• Authority: T.C.A. § 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 25, 1977; effective December 26, 1977. Amendment filed June 29, 1988; effective August 13, 1988. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-02.

Tenn. Comp. R. & Regs. 1200-04-02-.07 REPEALED

History

• Authority: T.C.A. § 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 25, 1977; effective December 26, 1977. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-02.

Tenn. Comp. R. & Regs. 1200-04-02-.08 REPEALED

History

• Authority: T.C.A. § 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 25, 1977; effective December 26, 1977. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-02.

Tenn. Comp. R. & Regs. 1200-04-02-.09 REPEALED

History

• Authority: T.C.A. § 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 25, 1977; effective December 26, 1977. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-02.

Tenn. Comp. R. & Regs. 1200-04-02-.10 REPEALED

History

• Authority: T.C.A. § 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 25, 1977; effective December 26, 1977. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-02.

Tenn. Comp. R. & Regs. 1200-04-02-.11 REPEALED

History

• Authority: T.C.A. § 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 25, 1977; effective December 26, 1977. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-02.

Tenn. Comp. R. & Regs. 1200-04-02-.12 REPEALED

History

• Authority: T.C.A. § 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 25, 1977; effective December 26, 1977. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-02.

Chapter 1200-04-03 Repealed (Transferred to 0400-40-03)

Tenn. Comp. R. & Regs. 1200-04-03-.01 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 1, 1975; effective December 30, 1975. Amendment filed November 25, 1977; effective December 26, 1977. Amendment filed March 30, 1983; effective April 29, 1983. Amendment filed July 16, 1991; effective August 30, 1991. Amendment filed May 16, 1995; effective July 30, 1995. Amendment filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-03.

Tenn. Comp. R. & Regs. 1200-04-03-.02 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 1, 1975; effective December 30, 1975. Amendment filed November 25, 1977; effective December 26, 1977. Amendment filed March 30, 1983; effective April 29, 1983. Amendment filed July 16, 1991; effective August 30, 1991. Amendment filed May 16, 1995; effective July 30, 1995. Amendment filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-03.

Tenn. Comp. R. & Regs. 1200-04-03-.03 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 1, 1975; effective December 30, 1975. Amendment filed November 25, 1977; effective December 26, 1977. Amendment filed March 30, 1983; effective April 29, 1983. Amendment filed July 16, 1991; effective August 30, 1991. Amendment filed May 16, 1995; effective July 30, 1995. Amendment filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-03.

Tenn. Comp. R. & Regs. 1200-04-03-.04 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 1, 1975; effective December 30, 1975. Amendment filed November 25, 1977; effective December 26, 1977. Amendment filed March 30, 1983; effective April 29, 1983. Amendment filed July 16, 1991; effective August 30, 1991. Amendment filed May 16, 1995; effective July 30, 1995. Amendment filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Repeal and new rule filed March 2, 2011; effective May 31, 2011. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-03.

Tenn. Comp. R. & Regs. 1200-04-03-.05 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 1, 1975; effective December 30, 1975. Amendment filed November 25, 1977; effective December 26, 1977. Amendment filed March 30, 1983; effective April 29, 1983. Amendment filed July 16, 1991; effective August 30, 1991. Amendment filed May 16, 1995; effective July 30, 1995. Amendment filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Amendment filed March 2, 2011; effective May 31, 2011. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-03.

Tenn. Comp. R. & Regs. 1200-04-03-.06 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 1, 1975; effective December 30, 1975. Amendment filed November 25, 1977; effective December 26, 1977. Amendment filed March 30, 1983; effective April 29, 1983. Amendment filed July 16, 1991; effective August 30, 1991. Amendment filed May 16, 1995; effective July 30, 1995. Amendment filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-03.

Tenn. Comp. R. & Regs. 1200-04-03-.07 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 28, 1999; effective September 11, 1999. Amendment filed July 13, 1999; effective October 11, 1999. Repeal and new rule filed March 24, 2008; effective June 7, 2008. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-03.

Tenn. Comp. R. & Regs. 1200-04-03-.08 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 28, 1999; effective September 11, 1999. Amendment filed July 13, 1999; effective October 11, 1999. Repeal and new rule filed March 24, 2008; effective June 7, 2008. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-03.

Tenn. Comp. R. & Regs. 1200-04-03-.09 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 28, 1999; effective September 11, 1999. Amendment filed July 13, 1999; effective October 11, 1999. Repeal and new rule filed March 24, 2008; effective June 7, 2008. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-03.

Tenn. Comp. R. & Regs. 1200-04-03-.10 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 28, 1999; effective September 11, 1999. Amendment filed July 13, 1999; effective October 11, 1999. Repeal and new rule filed March 24, 2008; effective June 7, 2008. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-03.

Tenn. Comp. R. & Regs. 1200-04-03-.11 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 28, 1999; effective September 11, 1999. Amendment filed July 13, 1999; effective October 11, 1999. Repeal and new rule filed March 24, 2008; effective June 7, 2008. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-03.

Tenn. Comp. R. & Regs. 1200-04-03-.12 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq. Authority: Original rule filed March 24, 2008; effective June 7, 2008. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-03.

Chapter 1200-04-04 Repealed (Transferred to 0400-40-04)

Tenn. Comp. R. & Regs. 1200-04-04-.01 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Amendment filed December 1, 1975; effective December 30, 1975. Amendment filed November 25, 1977; effective December 26, 1977. Amendment filed March 30, 1983; effective April 29, 1983. Amendment filed July 16, 1991; effective August 30, 1991. Amendment filed May 16, 1995; effective July 30, 1995. Amendment filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-04.

Tenn. Comp. R. & Regs. 1200-04-04-.02 HATCHIE RIVER BASIN

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-04.

Tenn. Comp. R. & Regs. 1200-04-04-.03 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-04.

Tenn. Comp. R. & Regs. 1200-04-04-.04 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-04.

Tenn. Comp. R. & Regs. 1200-04-04-.05 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-04.

Tenn. Comp. R. & Regs. 1200-04-04-.06 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-04.

Tenn. Comp. R. & Regs. 1200-04-04-.07 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-04.

Tenn. Comp. R. & Regs. 1200-04-04-.08 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-04.

Tenn. Comp. R. & Regs. 1200-04-04-.09 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-04.

Tenn. Comp. R. & Regs. 1200-04-04-.10 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-04.

Tenn. Comp. R. & Regs. 1200-04-04-.11 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-04.

Tenn. Comp. R. & Regs. 1200-04-04-.12 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-04.

Tenn. Comp. R. & Regs. 1200-04-04-.13 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Repeal and new rule filed April 3, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-04.

Tenn. Comp. R. & Regs. 1200-04-04-.14 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 13, 1999; effective October 11, 1999. Amendment filed October 24, 2003; effective January 7, 2004. Amendment filed July 23, 2007; effective October 6, 2007. Repeal and new rule filed April 2, 2013; effective July 2, 2013. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-04.

Chapter 1200-04-05 Repealed (Transferred to 0400-40-05)

Tenn. Comp. R. & Regs. 1200-04-05-.01 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Amendment filed May 22, 2007; effective August 5, 2007. Repeal filed November 20, 2013; effective February 18, 2014. Rule renumbered 0400-40-05.

Tenn. Comp. R. & Regs. 1200-04-05-.02 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Amendment filed May 22, 2007; effective August 5, 2007. Repeal and new rule filed March 2, 2011; effective May 31, 2011. Repeal filed November 20, 2013; effective February 18, 2014. Rule renumbered 0400-40-05.

Tenn. Comp. R. & Regs. 1200-04-05-.03 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Amendment filed May 22, 2007; effective August 5, 2007. Repeal filed November 20, 2013; effective February 18, 2014. Rule renumbered 0400-40-05.

Tenn. Comp. R. & Regs. 1200-04-05-.04 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Amendment filed May 22, 2007; effective August 5, 2007. Repeal filed November 20, 2013; effective February 18, 2014. Rule renumbered 0400-40-05.

Tenn. Comp. R. & Regs. 1200-04-05-.05 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Amendment filed May 22, 2007; effective August 5, 2007. Repeal filed November 20, 2013; effective February 18, 2014. Rule renumbered 0400-40-05.

Tenn. Comp. R. & Regs. 1200-04-05-.06 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Amendment filed May 22, 2007; effective August 5, 2007. Repeal filed November 20, 2013; effective February 18, 2014. Rule renumbered 0400-40-05.

Tenn. Comp. R. & Regs. 1200-04-05-.07 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Amendment filed May 22, 2007; effective August 5, 2007. Repeal filed November 20, 2013; effective February 18, 2014. Rule renumbered 0400-40-05.

Tenn. Comp. R. & Regs. 1200-04-05-.08 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Amendment filed May 22, 2007; effective August 5, 2007. Repeal filed November 20, 2013; effective February 18, 2014. Rule renumbered 0400-40-05.

Tenn. Comp. R. & Regs. 1200-04-05-.09 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Amendment filed May 22, 2007; effective August 5, 2007. Repeal filed November 20, 2013; effective February 18, 2014. Rule renumbered 0400-40-05.

Tenn. Comp. R. & Regs. 1200-04-05-.10 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Amendment filed May 22, 2007; effective August 5, 2007. Repeal filed November 20, 2013; effective February 18, 2014. Rule renumbered 0400-40-05.

Tenn. Comp. R. & Regs. 1200-04-05-.11 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Amendment filed May 22, 2007; effective August 5, 2007. Repeal filed November 20, 2013; effective February 18, 2014. Rule renumbered 0400-40-05.

Tenn. Comp. R. & Regs. 1200-04-05-.12 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Amendment filed May 22, 2007; effective August 5, 2007. Repeal filed November 20, 2013; effective February 18, 2014. Rule renumbered 0400-40-05.

Tenn. Comp. R. & Regs. 1200-04-05-.13 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Amendment filed May 22, 2007; effective August 5, 2007. Repeal filed November 20, 2013; effective February 18, 2014. Rule renumbered 0400-40-05.

Tenn. Comp. R. & Regs. 1200-04-05-.14 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq..
• Administrative History: Original rule filed November 25, 1977; effective December 26, 1977. Amendment filed May 7, 2004; effective July 21, 2004. Amendment filed May 22, 2007; effective August 5, 2007. Repeal and new rule filed March 2, 2011; effective May 31, 2011. Repeal filed November 20, 2013; effective February 18, 2014. Rule renumbered 0400-40-05.

Chapter 1200-04-06 Repealed

Tenn. Comp. R. & Regs. 1200-04-06-.01 REPEALED

History

• Authority: T.C.A. § 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule August 9, 1985; effective September 8, 1985. Repeal filed September 12, 2012; effective December 11, 2012. Rule renumbered 0400-45-06.

Tenn. Comp. R. & Regs. 1200-04-06-.02 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed led August 9, 1985; effective September 8, 1985. Amendment filed April 11, 2001; effective June 25, 2001. Amendment filed March 28, 2002; effective June 11, 2002. Amendment filed February 17, 2010; effective May 18, 2010. Repeal filed September 12, 2012; effective December 11, 2012. Rule renumbered 0400-45-06.

Tenn. Comp. R. & Regs. 1200-04-06-.03 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 9, 1985; effective September 8, 1985. Amendment filed April 11, 2001; effective June 25, 2001. Amendments filed February 17, 2010; effective May 18, 2010. Repeal filed September 12, 2012; effective December 11, 2012. Rule renumbered 0400-45-06.

Tenn. Comp. R. & Regs. 1200-04-06-.04 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 9, 1985; effective September 8, 1985. Amendment filed April 11, 2001; effective June 25, 2001. Amendment filed February 17, 2010; effective May 18, 2010. Repeal filed September 12, 2012; effective December 11, 2012. Rule renumbered 0400-45-06.

Tenn. Comp. R. & Regs. 1200-04-06-.05 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 9, 1985; effective September 8, 1985. Amendment filed April 11, 2001; effective June 25, 2001. Repeal filed September 12, 2012; effective December 11, 2012. Rule renumbered 0400-45-06.

Tenn. Comp. R. & Regs. 1200-04-06-.06 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 9, 1985; effective September 8, 1985. Amendment filed April 11, 2001; effective June 25, 2001. Amendments filed February 17, 2010; effective May 18, 2010. Repeal filed September 12, 2012; effective December 11, 2012. Rule renumbered 0400-45-06.

Tenn. Comp. R. & Regs. 1200-04-06-.07 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 9, 1985; effective September 8, 1985. Amendment filed April 11, 2001; effective June 25, 2001. Amendment filed February 17, 2010; effective May 18, 2010. Repeal filed September 12, 2012; effective December 11, 2012. Rule renumbered 0400-45-06.

Tenn. Comp. R. & Regs. 1200-04-06-.08 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 9, 1985; effective September 8, 1985. Amendment filed April 11, 2001; effective June 25, 2001. Amendments filed February 17, 2010; effective May 18, 2010. Repeal filed September 12, 2012; effective December 11, 2012. Rule renumbered 0400-45-06.

Tenn. Comp. R. & Regs. 1200-04-06-.09 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 9, 1985; effective September 8, 1985. Amendment filed April 11, 2001; effective June 25, 2001. Amendments filed February 17, 2010; effective May 18, 2010. Repeal filed September 12, 2012; effective December 11, 2012. Rule renumbered 0400-45-06.

Tenn. Comp. R. & Regs. 1200-04-06-.10 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 9, 1985; effective September 8, 1985. Amendment filed April 11, 2001; effective June 25, 2001. Amendment filed March 28, 2002; effective June 11, 2002. Amendments filed February 17, 2010; effective May 18, 2010. Repeal filed September 12, 2012; effective December 11, 2012. Rule renumbered 0400-45-06.

Tenn. Comp. R. & Regs. 1200-04-06-.11 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 9, 1985; effective September 8, 1985. Amendment filed April 11, 2001; effective June 25, 2001. Amendments filed February 17, 2010; effective May 18, 2010. Repeal filed September 12, 2012; effective December 11, 2012. Rule renumbered 0400-45-06.

Tenn. Comp. R. & Regs. 1200-04-06-.12 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 9, 1985; effective September 8, 1985. Amendment filed April 11, 2001; effective June 25, 2001. Repeal filed September 12, 2012; effective December 11, 2012. Rule renumbered 0400-45-06.

Tenn. Comp. R. & Regs. 1200-04-06-.13 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 9, 1985; effective September 8, 1985. Amendment filed April 11, 2001; effective June 25, 2001. Amendment filed February 17, 2010; effective May 18, 2010. Repeal filed September 12, 2012; effective December 11, 2012. Rule renumbered 0400-45-06.

Tenn. Comp. R. & Regs. 1200-04-06-.14 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 9, 1985; effective September 8, 1985. Amendment filed April 11, 2001; effective June 25, 2001. Amendments filed February 17, 2010; effective May 18, 2010. Repeal filed September 12, 2012; effective December 11, 2012. Rule renumbered 0400-45-06.

Tenn. Comp. R. & Regs. 1200-04-06-.15 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 9, 1991; effective September 23, 1991. Amendment filed April 11, 2001; effective June 25, 2001. Repeal filed September 12, 2012; effective December 11, 2012. Rule renumbered 0400-45-06.

Tenn. Comp. R. & Regs. 1200-04-06-.16 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed April 11, 2001; effective June 25, 2001. Amendments filed February 17, 2010; effective May 18, 2010. Repeal filed September 12, 2012; effective December 11, 2012. Rule renumbered 0400-45-06.

Tenn. Comp. R. & Regs. 1200-04-06-.17 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed April 11, 2001; effective June 25, 2001. Repeal filed September 12, 2012; effective December 11, 2012. Rule renumbered 0400-45-06.

Tenn. Comp. R. & Regs. 1200-04-06-.18 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed April 11, 2001; effective June 25, 2001. Amendment filed March 28, 2002; effective June 11, 2002. Amendment filed February 17, 2010; effective May 18, 2010. Repeal filed September 12, 2012; effective December 11, 2012. Rule renumbered 0400-45-06.

Tenn. Comp. R. & Regs. 1200-04-06-.19 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed April 11, 2001; effective June 25, 2001. Repeal filed September 12, 2012; effective December 11, 2012. Rule renumbered 0400-45-06. Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.

Chapter 1200-04-07 Repealed (Transferred to 0400-40-07)

Tenn. Comp. R. & Regs. 1200-04-07-.01 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed February 26, 1987; effective April 12, 1987. Amendment filed October 8, 1991; effective November 22, 1991. Amendment filed August 25, 2000; effective November 8, 2000. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-07.

Tenn. Comp. R. & Regs. 1200-04-07-.02 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed February 26, 1987; effective April 12, 1987. Amendment filed October 8, 1991; effective November 22, 1991. Amendment filed August 25, 2000; effective November 8, 2000. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-07.

Tenn. Comp. R. & Regs. 1200-04-07-.03 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed February 26, 1987; effective April 12, 1987. Amendment filed October 8, 1991; effective November 22, 1991. Amendment filed August 25, 2000; effective November 8, 2000. Repeal and new rule filed March 2, 2011; effective May 31, 2011. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-07.

Tenn. Comp. R. & Regs. 1200-04-07-.04 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed February 26, 1987; effective April 12, 1987. Amendment filed October 8, 1991; effective November 22, 1991. Amendment filed August 25, 2000; effective November 8, 2000. Amendment filed March 2, 2011; effective May 31, 2011. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-07.

Tenn. Comp. R. & Regs. 1200-04-07-.05 through 1200-04-07-.11 REPEALED.

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed February 26, 1987; effective April 12, 1987. Amendment filed October 8, 1991; effective November 22, 1991. Repeal filed August 25, 2000; effective November 8, 2000. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-07.

Chapter 1200-04-08 Repealed (Transferred to 0400-40-08)

Tenn. Comp. R. & Regs. 1200-04-08-.01 REPEALED

History

• Authority: T.C.A. §§ 69-1-117 and 4-5-201 et seq.
• Administrative History: Original rule filed March 29, 1988; effective May 13, 1988. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-08.

Tenn. Comp. R. & Regs. 1200-04-08-.02 REPEALED

History

• Authority: T.C.A. §§ 69-1-117 and 4-5-201 et seq.
• Administrative History: Original rule filed March 29, 1988; effective May 13, 1988. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-08.

Tenn. Comp. R. & Regs. 1200-04-08-.03 REPEALED

History

• Authority: T.C.A. §§ 69-1-117 and 4-5-201 et seq.
• Administrative History: Original rule filed March 29, 1988; effective May 13, 1988. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-08.

Chapter 1200-04-09 Repealed (Transferred to 0400-45-09)

Tenn. Comp. R. & Regs. 1200-04-09-.01 REPEALED

History

• Authority: T.C.A. §§ 69-10-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed February 21, 1990; effective April 7, 1990. Amendment filed June 21, 1993; effective August 5, 1993. Amendment filed October 12, 1998; effective December 26, 1998. Repeal and new rule filed December 1, 2004; effective February 14, 2005. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-09.

Tenn. Comp. R. & Regs. 1200-04-09-.02 REPEALED

History

• Authority: T.C.A. §§ 69-10-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed February 21, 1990; effective April 7, 1990. Amendment filed October 12, 1998; effective December 26, 1998. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-09.

Tenn. Comp. R. & Regs. 1200-04-09-.03 REPEALED

History

• Authority: T.C.A. §§ 69-10-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed February 21, 1990; effective April 7, 1990. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-09.

Tenn. Comp. R. & Regs. 1200-04-09-.04 REPEALED

History

• Authority: T.C.A. §§ 69-10-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed February 21, 1990; effective April 7, 1990. Amendment filed October 12, 1998; effective December 26, 1998. Repeal and new rule filed December 1, 2004; effective February 14, 2005. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-09.

Tenn. Comp. R. & Regs. 1200-04-09-.05 REPEALED

History

• Authority: T.C.A. §§ 69-10-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed February 21, 1990; effective April 7, 1990. Amendment filed October 12, 1998; effective December 26, 1998. Repeal and new rule filed December 1, 2004; effective February 14, 2005. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-09.

Tenn. Comp. R. & Regs. 1200-04-09-.06 REPEALED

History

• Authority: T.C.A. §§ 69-10-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed February 21, 1990; effective April 7, 1990. Amendment filed October 12, 1998; effective December 26, 1998. Repeal and new rule filed December 1, 2004; effective February 14, 2005. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-09.

Tenn. Comp. R. & Regs. 1200-04-09-.07 REPEALED

History

• Authority: T.C.A. §§ 69-10-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed February 21, 1990; effective April 7, 1990. Repeal and new rule filed December 1, 2004; effective February 14, 2005. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400- 45-09.

Tenn. Comp. R. & Regs. 1200-04-09-.08 REPEALED

History

• Authority: T.C.A. §§ 69-10-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed February 21, 1990; effective April 7, 1990. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-09.

Tenn. Comp. R. & Regs. 1200-04-09-.09 REPEALED

History

• Authority: T.C.A. §§ 69-10-101 et seq., and 4-5-201 et seq .
• Administrative History: Original rule filed February 21, 1990; effective April 7, 1990. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-09.

Tenn. Comp. R. & Regs. 1200-04-09-.10 REPEALED

History

• Authority: T.C.A. §§ 69-10-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed June 21, 1993; effective August 5, 1993. Amendment filed October 12, 1998; effective December 26, 1998. Amendments filed December 1, 2004; effective February 14, 2005. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-09.

Tenn. Comp. R. & Regs. 1200-04-09-.11 REPEALED

History

• Authority: T.C.A. §§ 69-10-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed June 21, 1993; effective August 5, 1993. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-09.

Tenn. Comp. R. & Regs. 1200-04-09-.12 REPEALED

History

• Authority: T.C.A. §§ 69-10-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed June 21, 1993; effective August 5, 1993. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-09.

Tenn. Comp. R. & Regs. 1200-04-09-.13 REPEALED

History

• Authority: T.C.A. §§ 69-10-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed June 21, 1993; effective August 5, 1993. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-09.

Tenn. Comp. R. & Regs. 1200-04-09-.14 REPEALED

History

• Authority: T.C.A. §§ 69-10-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed June 21, 1993; effective August 5, 1993. Amendment filed October 12, 1998; effective December 26, 1998. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-09.

Tenn. Comp. R. & Regs. 1200-04-09-.15 REPEALED

History

• Authority: T.C.A. §§ 69-10-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed June 21, 1993; effective August 5, 1993. Amendment filed October 12, 1998; effective December 26, 1998. Repeal and new rule filed December 1, 2004; effective February 14, 2005. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-09.

Tenn. Comp. R. & Regs. 1200-04-09-.16 REPEALED

History

• Authority: T.C.A. §§ 69-10-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed October 12, 1998; effective December 26, 1998. Repeal and new rule filed December 1, 2004; effective February 14, 2005. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400- 45-09.

Tenn. Comp. R. & Regs. 1200-04-09-.17 REPEALED

History

• Authority: T.C.A. §§ 69-10-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 1, 2004; effective February 14, 2005. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-09.

Tenn. Comp. R. & Regs. 1200-04-09-.18 REPEALED

History

• Authority: T.C.A. §§ 69-10-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed December 1, 2004; effective February 14, 2005. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-09.

Chapter 1200-04-10 Repealed (Transferred to 0400-40-10)

Tenn. Comp. R. & Regs. 1200-04-10-.01 REPEALED

History

• Authority: T.C.A. §§ 69-1-117 and 4-5-201 et seq.
• Administrative History: Original rule filed August 12, 1992; effective September 26, 1992. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-10.

Tenn. Comp. R. & Regs. 1200-04-10-.02 REPEALED

History

• Authority: T.C.A. §§ 69-1-117 and 4-5-201 et seq.
• Administrative History: Original rule filed August 12, 1992; effective September 26, 1992. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-10.

Tenn. Comp. R. & Regs. 1200-04-10-.03 REPEALED

History

• Authority: T.C.A. §§ 69-1-117 and 4-5-201 et seq.
• Administrative History: Original rule filed August 12, 1992; effective September 26, 1992. Amendment filed September 11, 1996; effective November 25, 1996. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-10.

Tenn. Comp. R. & Regs. 1200-04-10-.04 REPEALED

History

• Authority: T.C.A. §§ 69-1-117 and 4-5-201 et seq.
• Administrative History: Original rule filed August 12, 1992; effective September 26, 1992. Repeal filed August 31, 2000; effective December 29, 2000. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-10.

Tenn. Comp. R. & Regs. 1200-04-10-.05 REPEALED

History

• Authority: T.C.A. §§ 69-1-117 and 4-5-201 et seq.
• Administrative History: Original rule filed Autust 12, 1992; effective September 26, 1992. Repeal filed August 31, 2000; effective December 29, 2000. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-10.

Tenn. Comp. R. & Regs. 1200-04-10-.06 REPEALED

History

• Authority: T.C.A. §§ 69-1-117 and 4-5-201 et seq.
• Administrative History: Original rule filed March 18, 1994; effective June 1, 1994. Repeal filed August 31, 2000; effective December 29, 2000. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-10.

Tenn. Comp. R. & Regs. 1200-04-10-.07 REPEALED

History

• Authority: T.C.A. §§ 69-1-117 and 4-5-201 et seq.
• Administrative History: Original rule filed April 19, 1995; effective July 3, 1995. Repeal filed August 31, 2000; effective December 29, 2000. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-10.

Chapter 1200-04-11 Repealed (Transferred to 0400-40-11)

Tenn. Comp. R. & Regs. 1200-04-11-.01 REPEALED

History

• Authority: T.C.A. § 69-3-101 et seq., 68-203-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 9, 1991; effective September 23, 1991. Amendment filed August 12, 1992; effective September 26, 1992. Amendment filed September 26, 1995; effective December 10, 1995. Amendment filed November 15, 2000; effective January 30, 2001. Amendment filed May 22, 2007; effective August 5, 2007. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-11.

Tenn. Comp. R. & Regs. 1200-04-11-.02 REPEALED

History

• Authority: T.C.A. § 69-3-101 et seq., 68-203-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 9, 1991; effective September 23, 1991. Amendment filed August 12, 1992; effective September 26, 1992. Amendment filed September 26, 1995; effective December 10, 1995. Amendment filed November 15, 2000; effective January 30, 2001. Amendment filed May 22, 2007; effective August 5, 2007. Repeal and new rule filed March 31, 2008; effective June 14, 2008. Public necessity rule filed June 30, 2009; effective through December 12, 2009. Amendments filed September 9, 2009; effective December 8, 2009. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-11.

Tenn. Comp. R. & Regs. 1200-04-11-.03 REPEALED

History

• Authority: T.C.A. § 69-3-101 et seq., 68-203-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed August 9, 1991; effective September 23, 1991. Amendment filed August 12, 1992; effective September 26, 1992. Amendment filed September 26, 1995; effective December 10, 1995. Amendment filed November 15, 2000; effective January 30, 2001. Amendment filed May 22, 2007; effective August 5, 2007. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-11.

Chapter 1200-04-12 Repealed (Transferred to 0400-40-12)

Tenn. Comp. R. & Regs. 1200-04-12-.01 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 18, 2001; effective October 1, 2001. Repeal filed September 18, 2013; effective December 17, 2013. Rule renumbered 0400-40-12.

Tenn. Comp. R. & Regs. 1200-04-12-.02 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 18, 2001; effective October 1, 2001. Repeal filed September 18, 2013; effective December 17, 2013. Rule renumbered 0400-40-12.

Tenn. Comp. R. & Regs. 1200-04-12-.03 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 18, 2001; effective October 1, 2001. Repeal filed September 18, 2013; effective December 17, 2013. Rule renumbered 0400-40-12.

Tenn. Comp. R. & Regs. 1200-04-12-.04 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 18, 2001; effective October 1, 2001. Repeal filed September 18, 2013; effective December 17, 2013. Rule renumbered 0400-40-12.

Tenn. Comp. R. & Regs. 1200-04-12-.05 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 18, 2001; effective October 1, 2001. Repeal filed September 18, 2013; effective December 17, 2013. Rule renumbered 0400-40-12.

Chapter 1200-04-13 Repealed (Transferred to 0400-40-13)

Tenn. Comp. R. & Regs. 1200-04-13-.01 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq., 69-7-201 et seq. and 4-5-201 et seq.
• Administrative History: New Rule filed December 29, 2000; effective March 14, 2001. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-13.

Tenn. Comp. R. & Regs. 1200-04-13-.02 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq., 69-7-201 et seq. and 4-5-201 et seq.
• Administrative History: New rule filed December 29, 2000; effective March 14, 2001. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-13.

Tenn. Comp. R. & Regs. 1200-04-13-.03 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq., 69-7-201 et seq. and 4-5-201 et seq.
• Administrative History: New rule filed December 29, 2000; effective March 14, 2001. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-13.

Tenn. Comp. R. & Regs. 1200-04-13-.04 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq., 69-7-201 et seq. and 4-5-201 et seq.
• Administrative History: New rule filed December 29, 2000; effective March 14, 2001. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-13.

Tenn. Comp. R. & Regs. 1200-04-13-.05 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq., 69-7-201 et seq. and 4-5-201 et seq.
• Administrative History: New rule filed December 29, 2000; effective March 14, 2001. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-13.

Tenn. Comp. R. & Regs. 1200-04-13-.06 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq., 69-7-201 et seq. and 4-5-201 et seq.
• Administrative History: New rule filed December 29, 2000; effective March 14, 2001. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-13.

Tenn. Comp. R. & Regs. 1200-04-13-.07 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq., 69-7-201 et seq. and 4-5-201 et seq
• Administrative History: New rule filed December 29, 2000; effective March 14, 2001. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-13.

Tenn. Comp. R. & Regs. 1200-04-13-.08 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq., 69-7-201 et seq. and 4-5-201 et seq.
• Administrative History: New rule filed December 29, 2000; effective March 14, 2001. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-13.

Tenn. Comp. R. & Regs. 1200-04-13-.09 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq., 69-7-201 et seq. and 4-5-201 et seq.
• Administrative History: New rule filed December 29, 2000; effective March 14, 2001. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-13.

Tenn. Comp. R. & Regs. 1200-04-13-.10 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq., 69-7-201 et seq. and 4-5-201 et seq.
• Administrative History: New rule filed December 29, 2000; effective March 14, 2001. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-13.

Tenn. Comp. R. & Regs. 1200-04-13-.11 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq., 69-7-201 et seq. and 4-5-201 et seq.
• Administrative History: New rule filed December 29, 2000; effective March 14, 2001. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-13.

Chapter 1200-04-14 Repealed (Transferred to 0400-40-14)

Tenn. Comp. R. & Regs. 1200-04-14-.01 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-14.

Tenn. Comp. R. & Regs. 1200-04-14-.02 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-14.

Tenn. Comp. R. & Regs. 1200-04-14-.03 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-14.

Tenn. Comp. R. & Regs. 1200-04-14-.04 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-14.

Tenn. Comp. R. & Regs. 1200-04-14-.05 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-14.

Tenn. Comp. R. & Regs. 1200-04-14-.06 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-14.

Tenn. Comp. R. & Regs. 1200-04-14-.07 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-14.

Tenn. Comp. R. & Regs. 1200-04-14-.08 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007 Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-14.

Tenn. Comp. R. & Regs. 1200-04-14-.09 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-14.

Tenn. Comp. R. & Regs. 1200-04-14-.10 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-14.

Tenn. Comp. R. & Regs. 1200-04-14-.11 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-14.

Tenn. Comp. R. & Regs. 1200-04-14-.12 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-14.

Tenn. Comp. R. & Regs. 1200-04-14-.13 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-14.

Tenn. Comp. R. & Regs. 1200-04-14-.14 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-14.

Tenn. Comp. R. & Regs. 1200-04-14-.15 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-14.

Tenn. Comp. R. & Regs. 1200-04-14-.16 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-14.

Tenn. Comp. R. & Regs. 1200-04-14-.17 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-14.

Tenn. Comp. R. & Regs. 1200-04-14-.18 REPEALED

History

• Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400-40-14. APPENDIX A REPEALED. Authority: T.C.A. §§ 69-3-101 et seq. and 4-5-201 et seq.

1200-05 Bureau of Environmental Health Services Division of Food and General Sanitation Division of Water Supply

Chapter 1200-05-01 Repealed (Transferred to 0400-45-01)

Tenn. Comp. R. & Regs. 1200-05-01-.01 REPEALED

History

• Authority: T.C.A. §§ 68-221-701 et seq., 68-203-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed June 30, 1977; effective August 1, 1977. Amendment filed February 3, 1984; effective February 12, 1985. Amendment filed September 26, 1988; effective November 10, 1988. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.02 REPEALED

History

• Authority: T.C.A. §§ 68-221-701 et seq., 68-203-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed June 30, 1977; effective August 1, 1977. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.03 REPEALED

History

• Authority: T.C.A. §§ 68-221-701 et seq., 68-203-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed June 30, 1977; effective August 1, 1977. Amendment filed February 3, 1984; effective February 12, 1985. Amendment filed September 26, 1988; effective November 10, 1988. Repeal and new rule filed August 15, 2005; effective October 29, 2005. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.04 REPEALED

History

• Authority: T.C.A. § 68-221-701 et seq., 68-203-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed June 30, 1977; effective August 1, 1977. Amendment filed February 3, 1984; effective February 12, 1985. Amendment filed September 26, 1988; effective November 10, 1988. Amendment filed November 26, 1990; effective January 10, 1991. Amendment filed August 24, 1992; effective October 8, 1992. Amendment filed October 22, 1993, effective January 5, 1994. Amendment filed April 12, 1996; effective June 26, 1996. Amendment filed February 17, 1999; effective May 3, 1999. Amendment filed October 31, 2000; effective January 14, 2001. Amendment filed July 15, 2002; effective September 28, 2002. Amendment filed December 30, 2002; effective March 15, 2003. Amendment filed July 31, 2006; effective October 14, 2006. Amendment filed June 12, 2008; effective August 26, 2008. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.05 REPEALED

History

• Authority: T.C.A. §§ 68-221-701 et seq., 68-203-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed June 30, 1977; effective August 1, 1977. Amendment filed February 3, 1984; effective February 12, 1985. Amendment filed August 24, 1992; effective October 8, 1992. Amendment filed April 12, 1996; effective June 26, 1996. Amendment filed October 31, 2000; effective January 14, 2001. Amendments filed August 15, 2005; effective October 29, 2005. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.06 REPEALED

History

• Authority: T.C.A. §§ 68-221-701 et seq., 68-203-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed June 30, 1977; effective August 1, 1977. Amendment filed February 3, 1984; effective February 12, 1985. Amendment filed September 26, 1988; effective November 10, 1988. Amendment filed November 26, 1990; effective January 10, 1991. Amendment filed August 24, 1992; effective October 8, 1992. Amendment filed October 22, 1993; effective January 5, 1994. Amendment filed October 31, 2000; effective January 14, 2001. Amendment filed November 21, 2001; effective February 4, 2002. Amendment filed April 12, 2002; effective June 26, 2002. Amendment filed July 15, 2002; effective September 28, 2002. Amendment filed April 19, 2004; effective July 3, 2004. Amendment filed July 31, 2006; effective October 14, 2006. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.07 REPEALED

History

• Authority: T.C.A. §§ 68-221-701 et seq., 68-203-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed June 30, 1977; effective August 1, 1977. Amendment filed February 3, 1984; effective February 12, 1985. Amendment filed November 26, 1990; effective January 10, 1991. Amendment filed August 24, 1992; effective October 8, 1992. Amendment filed October 22, 1993, effective January 5, 1994. Amendment filed April 12, 1996, effective June 26, 1996. Amendment filed October 31, 2000; effective January 14, 2001. Amendments filed August 15, 2005; effective October 29, 2005. Amendments filed June 12, 2008; effective August 26, 2008. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.08 REPEALED

History

• Authority: T.C.A. §§ 68-221-701 et seq., 68-203-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed June 30, 1977; effective August 1, 1977. Amendment filed February 3, 1984; effective February 12, 1985. Amendment filed November 26, 1990; effective January 10, 1991. Amendment filed April 12, 1996; effective June 26, 1996. Amendment filed August 15, 2005; effective October 29, 2005. Amendment filed June 12, 2008; effective August 26, 2008. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400- 45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.09 REPEALED

History

• Authority: T.C.A. §§ 68-221-701 et seq., 68-203-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 30, 1977; effective August 1, 1977. Amendment filed February 3, 1984; effective February 12, 1985. Amendment filed August 24, 1992; effective October 8, 1992. Amendment filed October 22, 1993; effective January 5, 1994. Amendment filed April 12, 1996; effective June 26, 1996. Amendment filed February 17, 1999; effective May 3, 1999. Amendment filed July 15, 2002; effective September 28, 2002. Amendment filed August 15, 2005; effective October 29, 2005. Amendments filed June 12, 2008; effective August 26, 2008. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.10 REPEALED

History

• Authority: T.C.A. §§ 68-221-701 et seq., 68-203-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 30, 1977; effective August 1, 1977. Amendment filed February 3, 1984; effective February 12, 1985. Amendment filed August 24, 1992; effective October 8, 1992. Amendment filed October 22, 1993; effective January 5, 1994. Amendment filed April 12, 1996; effective June 26, 1996. Amendment filed February 17, 1999; effective May 3, 1999. Amendment filed November 21, 2001; effective February 4, 2002. Amendment filed July 15, 2002; effective September 28, 2002. Amendment filed August 15, 2005; effective October 29, 2005. Amendments filed June 12, 2008; effective August 26, 2008. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.11 REPEALED

History

• Authority: T.C.A. §§ 68-221-701 et seq., 68-203-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 30, 1977; effective August 1, 1977. Amendment filed February 3, 1984; effective February 12, 1985. Amendment filed August 24, 1992; effective October 8, 1992. Amendment filed November 21, 2001; effective February 4, 2002. Amendment filed April 12, 2002; effective June 26, 2002. Amendment filed August 15, 2005; effective October 29, 2005. Amendments filed June 12, 2008; effective August 26, 2008. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.12 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed June 30, 1977; effective August 1, 1977. Amendment filed February 3, 1984; effective February 12, 1985. Amendment filed September 26, 1988; effective November 10, 1988. Amendment filed August 24, 1992; effective October 8, 1992. Amendment filed April 12, 1996; effective June 26, 1996. Amendment filed February 17, 1999; effective May 3, 1999. Amendment filed June 12, 2008; effective August 26, 2008. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.13 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed June 30, 1977; effective August 1, 1977. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.14 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed June 30, 1977; effective August 1, 1977. Amendment filed February 3, 1984; effective February 12, 1985. Amendment filed September 26, 1988; effective November 10, 1988. Amendment filed November 26, 1990; effective January 10, 1991. Amendment filed August 24, 1992; effective October 8, 1992. Amendment filed November 21, 2001; effective February 4, 2002. Amendment filed July 31, 2006; effective October 14, 2006. Repeal of and new rule filed June 12, 2008; effective August 26, 2008. Amendments filed March 23, 2009; effective June 6, 2009. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.15 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed June 30, 1977; effective August 1, 1977. Amendment filed September 26, 1988; effective November 10, 1988. Amendment filed August 24, 1992; effective October 8, 1992. Amendments filed June 12, 2008; effective August 26, 2008. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.16 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed June 30, 1977; effective August 1, 1977. Amendment filed April 12, 1996; effective June 26, 1996. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.17 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed June 30, 1977; effective August 1, 1977. Amendment filed February 3, 1984; effective February 12, 1985. Amendment filed September 26, 1988; effective November 10, 1988. Amendment filed November 26, 1990; effective January 10, 1991. Amendment filed August 24, 1992; effective October 8, 1992. Amendment filed October 22, 1993; effective January 5, 1994. Amendment filed April 12, 1996; effective June 26, 1996. Amendment filed February 17, 1999; effective May 3, 1999. Amendment filed October 31, 2000; effective January 14, 2001. Amendment filed November 21, 2001; effective February 4, 2002. Amendment filed December 30, 2002; effective March 15, 2003. Amendments filed August 15, 2005; effective October 29, 2005. Amendments filed June 12, 2008; effective August 26, 2008. Amendments filed March 23, 2009; effective June 6, 2009. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.18 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule. filed June 30, 1977; effective August 1, 1977. Amendment filed February 3, 1984; effective February 12, 1985. Amendment filed September 26, 1988; effective November 10, 1988. Amendment filed August 24, 1992; effective October 8, 1992. Amendment filed November 21, 2001; effective February 4, 2002. Amendments filed June 12, 2008; effective August 26, 2008. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.19 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed June 30, 1977; effective August 1, 1977. Amendment filed February 3, 1984; effective February 12, 1985. Amendment filed September 26, 1988; effective November 10, 1988. Amendment filed April 10, 1989; effective May 25, 1989. Amendment filed November 26, 1990; effective January 10, 1991. Amendment filed August 24, 1992; effective October 8, 1992. Amendment filed October 22, 1993, effective January 5, 1994. Amendment filed May 2, 1994; effective July 16, 1994. Amendment filed April 12, 1996; effective June 26, 1996. Amendment filed October 31, 2000, effective January 14, 2001. Amendment filed November 21, 2001; effective February 4, 2002. Amendment filed April 12, 2002, effective June 26, 2002. Amendment filed July 15, 2002, effective September 28, 2002.Amendment filed August 15, 2005, effective October 29 ,2005. Amendment filed July 31, 2006; effective October 14, 2006. Amendments filed June 12, 2008; effective August 26, 2008. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.20 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed June 30, 1977; effective August 1, 1977. Amendment filed February 3, 1984; effective February 12, 1985. Amendment filed August 24, 1992; effective October 8, 1992. Amendment filed April 12, 1996; effective June 26, 1996. Amendment filed November 21, 2001; effective February 4, 2002. Amendments filed August 15, 2005; effective October 29, 2005. Amendment file July 31, 2006; effective October 14, 2006. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.21 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704
• Administrative History: Original rule filed June 30, 1977; effective August 1, 1997. Repeal and new rule filed February 3, 1984; effective February 12, 1985. Repeal and new rule filed August 15, 2005; effective October 29, 2005. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.22 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed June 30, 1977; effective August 1, 1997. Repeal and new rule filed February 3, 1984; effective February 12, 1985. Amendment filed October 31, 2000; effective January 14, 2001. Repeal and new rule filed August 15, 2005; effective October 29, 2005. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.23 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed June 30, 1977; effective August 1, 1997. Repeal and new rule filed February 3, 1984; effective February 12, 1985. Amendment filed February 17, 1999; effective May 3, 1999. Amendment filed October 31, 2000; effective January 14, 2001. Repeal and new rule filed August 15, 2005; effective October 29, 2005. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.24 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed June 30, 1977; effective August 1, 1997. Repeal and new rule filed February 3, 1984; effective February 12, 1985. Amendment filed February 17, 1999; effective May 3, 1999. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.25 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed May 17, 1978; effective June 16, 1978. Repeal filed February 3, 1984; effective February 12, 1985. Amendment filed September 26, 1988; effective November 10, 1988. Amendment filed August 24, 1992; effective October 8, 1992. Amendment filed October 22, 1993; effective January 5, 1994. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.26 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed May 17, 1978; effective June 16, 1978. Repeal filed February 3, 1984; effective February 12, 1985. Repeal and new rule filed September 26, 1988; effective November 10, 1988. Amendment filed August 24, 1992; effective October 8, 1992. Amendment filed October 22, 1993; effective January 5, 1994. Amendment filed April 12, 1996; effective June 26, 1996. Amendment filed February 17, 1999; effective May 3, 1999. Amendment filed November 21, 2001; effective February 4, 2002. Amendment filed July 15, 2002; effective September 28, 2002. Amendments filed August 15, 2005; effective October 29, 2005. Amendments filed June 12, 2008; effective August 26, 2008. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.27 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed May 17, 1978; effective June 16, 1978. Repeal filed February 3, 1984; effective February 12, 1985. Repeal and new rule filed September 26, 1998; effective November 10, 1988. Repeal and new rule filed August 15, 2005; effective October 29, 2005. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.28 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed May 17, 1978; effective June 16, 1978. Repeal filed February 3, 1984; effective February 12, 1985. Repeal and new rule filed September 26, 1988; effective November 10, 1988. Amendment filed August 24, 1992; effective October 8, 1992. Amendment filed October 22, 1993; effective January 5, 1994. Amendment filed April 12, 1996; effective June 26, 1996. Amendment filed February 17, 1999; effective May 3, 1999. Amendment filed October 31, 2000; effective January 14, 2001. Repeal and new rule filed August 15, 2005; effective October 29, 2005. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.29 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed May 17, 1978; effective June 16, 1978. Repeal filed February 3, 1984; effective February 12, 1985. Repeal and new rule filed September 26, 1988; effective November 10, 1988. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.30 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed May 17, 1978; effective June 16, 1978. Repeal filed February 3, 1984; effective February 12, 1985. Repeal and new rule filed September 26, 1988; effective November 10, 1988. Amendment filed August 24, 1992; effective October 8, 1992. Repeal and new rule filed August 15, 2005; effective October 29, 2005. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.31 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed November 26, 1990; effective January 10, 1991. Amendment filed April 12, 1996; effective June 26, 1996. Amendment filed October 31, 2000; effective January 14, 2001. Amendment filed November 21, 2001; effective February 4, 2002. Amendment filed April 12, 2002; effective June 26, 2002. Amendment filed December 30, 2002; effective March 15, 2003. Amendment filed April 19, 2004; effective July 3, 2004. Amendments filed August 15, 2005; effective October 29, 2005. Amendment file July 31, 2006; effective October 14, 2006. Amendments filed June 12, 2008; effective August 26, 2008. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.32 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed August 9, 1991; effective September 23, 1991. Amendment filed August 12, 1992; effective September 26, 1992. Amendment filed May 2, 1994; effective July 16, 1994. Amendment filed April 12, 1996; effective June 26, 1996. Amendment filed March 5, 2002; effective May 19, 2002. Amendment filed August 15, 2005; effective October 29, 2005. Amendments filed June 12, 2008; effective August 26, 2008. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.33 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed August 24, 1992; effective October 8, 1992. Amendment filed October 22, 1993; effective January 5, 1994. Amendment filed April 12, 1996; effective June 26, 1996. Amendment filed February 17, 1999; effective May 3, 1999. Amendment filed January 4, 2001; effective March 21, 2001. Amendment filed June 12, 2008; effective August 26, 2008. Amendments filed March 23, 2009; effective June 6, 2009. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.34 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed October 22, 1993; effective January 5, 1994. Repeal and new rule filed August 15, 2005; effective October 29, 2005. Amendment filed July 31, 2006; effective October 14, 2006. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.35 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed February 8, 1999; effective April 4, 1999. Amendment filed October 31, 2000; effective January 14, 2001. Amendment filed November 21, 2001; effective February 4, 2002. Amendment filed April 12, 2002; effective June 26, 2002. Amendment filed July 15, 2002; effective September 28, 2002. Amendments filed August 15, 2005; effective October 29, 2005. Amendment filed July 31, 2006; effective October 14, 2006. Amendments filed June 12, 2008; effective August 26, 2008. Amendments filed March 23, 2009; effective June 6, 2009. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.36 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Amendment filed October 31, 2000; effective January 14, 2001. Amendment filed November 21, 2001; effective February 4, 2002. Amendments filed August 15, 2005; effective October 29, 2005. Amendment filed July 31, 2006; effective October 14, 2006. Amendment filed June 12, 2008; effective August 26, 2008. Amendments filed March 23, 2009; effective June 6, 2009. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.37 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed July 31 ,2006; effective October 14, 2006. Amendment filed June 12, 2008; effective August 26, 2008. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.38 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed July 31, 2006; effective October 14, 2006. Amendment filed June 12, 2008; effective August 12, 2008. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.39 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: New rule filed July 31, 2006; effective October 14, 2006. Amendments filed June 12, 2008; effective august 26, 2008. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Tenn. Comp. R. & Regs. 1200-05-01-.40 REPEALED

History

• Authority: T.C.A. §§ 4-5-201 et seq., 4-5-202, 68-221-701 et seq, and 68-221-704.
• Administrative History: Original rule filed June 12, 2008; effective August 26, 2008. Repeal filed August 1, 2012; effective October 30, 2012. Chapter renumbered 0400-45-01.

Chapter 1200-05-02 Repealed (Transferred to 0400-40-16)

Tenn. Comp. R. & Regs. 1200-05-02-.01 REPEALED

History

• Authority: T.C.A. §§ 68-221-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 7, 1974. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400- 40-16.

Tenn. Comp. R. & Regs. 1200-05-02-.02 REPEALED

History

• Authority: T.C.A. §§ 68-221-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 7, 1974. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400- 40-16.

Tenn. Comp. R. & Regs. 1200-05-02-.03 REPEALED

History

• Authority: T.C.A. §§ 68-221-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 7, 1974. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400- 40-16.

Tenn. Comp. R. & Regs. 1200-05-02-.04 REPEALED

History

• Authority: T.C.A. §§ 68-221-101 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 7, 1974. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400- 40-16.

Tenn. Comp. R. & Regs. 1200-05-02-.05 REPEALED

History

• Authority: T.C.A. §§ 68-221-101 et seq. and 4-5-201 et seq. Administrative History. Original rule filed June 7, 1974. Repeal filed September 17, 2013; effective December 16, 2013. Rule renumbered 0400- 40-16.

Chapter 1200-05-03 Repealed (Transferred to 0400-49-01)

Tenn. Comp. R. & Regs. 1200-05-03-.01 REPEALED

History

• Authority: T.C.A. §§ 68-221-901 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1982; effective July 1, 1982. Repeal and new rule filed June 9, 1986; effective July 10, 1986. Amendment filed September 18, 1990; effective December 1, 1990. Amendment filed September 12, 1994; effective December 14, 1994. Amendment filed June 29, 2001; effective September 10, 2001. Amendment filed March 8, 2007; effective May 22, 2007. Public necessity rule filed June 30, 2009; effective through December 12, 2009. Amendments filed September 9, 2009; effective December 8, 2009. Repeal filed May 21, 2014; effective August 19, 2014. Rule renumbered 0400-49-01.

Tenn. Comp. R. & Regs. 1200-05-03-.02 REPEALED

History

• Authority: T.C.A. §§ 68-221-901 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1982; effective July 1, 1982. Repeal and new rule filed June 9, 1986; effective July 10, 1986. Amendment filed September 18, 1990; effective December 1, 1990. Amendment filed September 12, 1994; effective December 14, 1994. Amendment filed July 31, 2000; effective October 14, 2000. Repeal filed May 21, 2014; effective August 19, 2014. Rule renumbered 0400-49-01.

Tenn. Comp. R. & Regs. 1200-05-03-.03 REPEALED

History

• Authority: T.C.A. §§ 68-221-901 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1982; effective July 1, 1982. Repeal and new rule filed June 9, 1986; effective July 10, 1986. Amendment filed September 18, 1990; effective December 1, 1990. Amendment filed September 12, 1994; effective December 14, 1994. Amendment filed April 21, 1998; effective July 5, 1998. Amendment filed July 31, 2000; effective October 14, 2000. Amendment filed June 29, 2001; effective September 10, 2001. Public necessity rule filed June 30, 2009; effective through December 12, 2009. Amendment filed September 9, 2009; effective December 8, 2009. Repeal filed May 21, 2014; effective August 19, 2014. Rule renumbered 0400-49-01.

Tenn. Comp. R. & Regs. 1200-05-03-.04 REPEALED

History

• Authority: T.C.A. §§ 68-221-901 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1982; effective July 1, 1982. Repeal and new rule filed June 9, 1986; effective July 10, 1986. Amendment filed September 18, 1990; effective December 1, 1990. Amendment filed September 12, 1994; effective December 14, 1994. Amendment Filed April 21, 1998; effective July 5, 1998. Amendment filed July 31, 2000; October 14, 2000. Repeal filed May 21, 2014; effective August 19, 2014. Rule renumbered 0400-49-01.

Tenn. Comp. R. & Regs. 1200-05-03-.05 REPEALED

History

• Authority: T.C.A. §§ 68-221-901 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1982; effective July 1, 1982. Repeal and new rule filed June 9, 1986; effective July 10, 1986. Amendment filed September 18, 1990; effective December 1, 1990. Amendment filed September 12, 1994; effective December 14, 1994. Amendment filed July 31, 2000; effective October 14, 2000. Amendment filed September 9, 2009; effective December 8, 2009. Repeal filed May 21, 2014; effective August 19, 2014. Rule renumbered 0400-49-01.

Tenn. Comp. R. & Regs. 1200-05-03-.06 REPEALED

History

• Authority: T.C.A. §§ 68-221-901 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1982; effective July 1, 1982. Repeal and new rule filed June 9, 1986; effective July 10, 1986. Amendment filed September 18, 1990; effective December 1, 1990. Amendment filed September 12, 1994; effective December 14, 1994. Amendment Filed April 21, 1998; effective July 5, 1998. Amendment filed July 31, 2000; effective October 14, 2000. Amendment filed March 8, 2007; effective May 22, 2007. Repeal filed May 21, 2014; effective August 19, 2014. Rule renumbered 0400-49-01.

Tenn. Comp. R. & Regs. 1200-05-03-.07 REPEALED

History

• Authority: T.C.A. §§ 68-221-901 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1982; effective July 1, 1982. Repeal and new rule filed June 9, 1986; effective July 10, 1986. Amendment filed September 18, 1990; effective December 1, 1990. Amendment filed September 12, 1994; effective December 14, 1994. Amendment filed April 21, 1998; effective July 5, 1998. Amendment filed July 31, 2000; effective October 14, 2000. Amendment filed June 29, 2001; effective September 10, 2001. Amendments filed September 9, 2009; effective December 8, 2009. Repeal filed May 21, 2014; effective August 19, 2014. Rule renumbered 0400-49-01.

Tenn. Comp. R. & Regs. 1200-05-03-.08 REPEALED

History

• Authority: T.C.A. §§ 68-221-901 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1982; effective July 1, 1982. Repeal and new rule filed June 9, 1986; effective July 10, 1986. Amendment filed September 18, 1990; effective December 1, 1990. Amendment filed September 12, 1994; effective December 14, 1994. Amendment filed April 21, 1998; effective July 5, 1998. Amendment filed June 29, 2001; effective September 10, 2001. Repeal filed May 21, 2014; effective August 19, 2014. Rule renumbered 0400-49-01.

Tenn. Comp. R. & Regs. 1200-05-03-.09 REPEALED

History

• Authority: T.C.A. §§ 68-221-901 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1982; effective July 1, 1982. Repeal and new rule filed June 9, 1986; effective July 10, 1986. Amendment filed September 18, 1990; effective December 1, 1990. Amendment filed September 12, 1994; effective December 14, 1994. Amendment filed April 21, 1998; effective July 5, 1998. Amendment filed July 31, 2000; effective October 14, 2000. Amendment filed June 29, 2001; effective September 10, 2001. Amendments filed September 9, 2009; effective December 8, 2009. Repeal filed May 21, 2014; effective August 19, 2014. Rule renumbered 0400-49-01.

Tenn. Comp. R. & Regs. 1200-05-03-.10 REPEALED

History

• Authority: T.C.A. §§ 68-221-901 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1982; effective July 1, 1982. Repeal and new rule filed June 9, 1986; effective July 10, 1986. Amendment filed September 18, 1990; effective December 1, 1990. Amendment filed September 12, 1994; effective December 14, 1994. Amendment filed July 31, 2000; effective October 14, 2000. Repeal filed May 21, 2014; effective August 19, 2014. Rule renumbered 0400-49-01.

Tenn. Comp. R. & Regs. 1200-05-03-.11 REPEALED

History

• Authority: T.C.A. §§ 68-221-901 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal filed March 31, 1982; effective July 1, 1982. New rule filed June 9, 1986; effective July 10, 1986. Amendment filed September 18, 1990; effective December 1, 1990. Amendment filed September 12, 1994; effective December 14, 1994. Amendment filed March 8, 2007; effective May 22, 2007. Repeal filed May 21, 2014; effective August 19, 2014. Rule renumbered 0400-49-01.

Tenn. Comp. R. & Regs. 1200-05-03-.12 REPEALED

History

• Authority: T.C.A. §§ 68-221-901 et seq. and 4-5-201 et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1982; effective July 1, 1982. New rule filed June 9, 1986; effective July 10, 1986. Amendment filed September 18, 1990; effective December 1, 1990. Amendment filed September 12, 1994; effective December 14, 1994. Amendment filed March 8, 2007; effective May 22, 2007. Repeal filed May 21, 2014; effective August 19, 2014. Rule renumbered 0400-49-01.

Tenn. Comp. R. & Regs. 1200-05-03-.13 REPEALED

History

• Authority: T.C.A. §§ 68-221-901 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed September 18, 1990; effective December 1, 1990. Amendment filed September 12, 1994; effective December 14, 1994. Amendment filed April 21, 1998; effective July 5, 1998. Amendment filed June 29, 2001; effective September 10, 200/ Repeal filed March 8, 2007; effective May 22, 2007. Repeal filed May 21, 2014; effective August 19, 2014. Rule renumbered 0400-49-01.

Chapter 1200-05-04 Repealed (Transferred to 0400-45-04)

Tenn. Comp. R. & Regs. 1200-05-04-.01 REPEALED

History

• Authority: T.C.A. §§ 68-221-501 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 7, 1974. Amendment filed November 12, 1974; effective December 15, 1974. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-04.

Tenn. Comp. R. & Regs. 1200-05-04-.02 REPEALED

History

• Authority: T.C.A. §§ 68-221-501 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 7, 1974. Amendment filed November 12, 1974; effective December 15, 1974. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-04.

Tenn. Comp. R. & Regs. 1200-05-04-.03 REPEALED

History

• Authority: T.C.A. §§ 68-221-501 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 7, 1974. Amendment filed November 12, 1974; effective December 15, 1974. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-04.

Tenn. Comp. R. & Regs. 1200-05-04-.04 REPEALED

History

• Authority: T.C.A. §§ 68-221-501 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 7, 1974. Amendment filed November 12, 1974; effective December 15, 1974. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-04.

Tenn. Comp. R. & Regs. 1200-05-04-.05 REPEALED

History

• Authority: T.C.A. §§ 68-221-501 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 7, 1974. Amendment filed November 12, 1974; effective December 15, 1974. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-04.

Tenn. Comp. R. & Regs. 1200-05-04-.06 REPEALED

History

• Authority: T.C.A. §§ 68-221-501 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 7, 1974. Amendment filed November 12, 1974; effective December 15, 1974. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-04.

Tenn. Comp. R. & Regs. 1200-05-04-.07 REPEALED

History

• Authority: T.C.A. §§ 68-221-501 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 7, 1974. Amendment filed November 12, 1974; effective December 15, 1974. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-04.

Chapter 1200-05-05 Repealed

Tenn. Comp. R. & Regs. 1200-05-05-.01 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 7, 1974. Repeal filed June 20, 2013; effective September 18, 2013.

Tenn. Comp. R. & Regs. 1200-05-05-.02 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 7, 1974. Repeal filed June 20, 2013; effective September 18, 2013.

Tenn. Comp. R. & Regs. 1200-05-05-.03 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 7, 1974. Repeal filed June 20, 2013; effective September 18, 2013.

Tenn. Comp. R. & Regs. 1200-05-05-.04 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 7, 1974. Repeal filed June 20, 2013; effective September 18, 2013.

Tenn. Comp. R. & Regs. 1200-05-05-.05 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 7, 1974. Repeal filed June 20, 2013; effective September 18, 2013.

Tenn. Comp. R. & Regs. 1200-05-05-.06 REPEALED

History

• Authority: T.C.A. §§ 68-221-401 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed June 7, 1974. Repeal filed June 20, 2013; effective September 18, 2013.

Chapter 1200-05-06 Repealed

Tenn. Comp. R. & Regs. 1200-05-06 Repealed

RULES

OF THE TENNESSEE DEPARTMENT OF ENVIRONMENT AND CONSERVATION

BOARD OF WATER AND WASTEWATER OPERATOR CERTIFICATION

Authority: T.C.A. §§ 68-221-901 et seq. and 4-5-201 et seq. Administrative History. Original Chapter filed November 22, 1978, effective. January 8, 1979. Repeal filed May 21, 2014; effective August 19, 2014.

Chapter 1200-05-07 Repealed (Transferred to 0400-45-07)

Tenn. Comp. R. & Regs. 1200-05-07-.01 REPEALED

History

• Authority: T.C.A. §§ 69-11-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 19, 1987; effective October 3, 1987. Amendment filed August 2, 1995; effective October 15, 1995. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-07.

Tenn. Comp. R. & Regs. 1200-05-07-.02 REPEALED

History

• Authority: T.C.A. §§ 69-11-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 19, 1987; effective October 3, 1987. Amendment filed August 2, 1995; effective October 15, 1995. Amendment filed December 6, 2000; effective February 19, 2001. Amendment filed April 18, 2008; effective July 2, 2008. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-07.

Tenn. Comp. R. & Regs. 1200-05-07-.03 REPEALED

History

• Authority: T.C.A. §§ 69-11-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 19, 1987; effective October 3, 1987. Amendment filed August 2, 1995; effective October 15, 1995. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-07.

Tenn. Comp. R. & Regs. 1200-05-07-.04 REPEALED

History

• Authority: T.C.A. §§ 69-11-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 19, 1987; effective October 3, 1987. Amendment filed August 2, 1995; effective October 15, 1995. Amendment filed December 6, 2000; effective February 19, 2001. Amendment filed April 18, 2008; effective July 2, 2008. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-07.

Tenn. Comp. R. & Regs. 1200-05-07-.05 REPEALED

History

• Authority: T.C.A. §§ 69-11-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 19, 1987; effective October 3, 1987. Amendment filed August 2, 1995; effective October 15, 1995. Amendment filed December 6, 2000; effective February 19, 2001. Amendment filed April 18, 2008; effective July 2, 2008. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-07.

Tenn. Comp. R. & Regs. 1200-05-07-.06 REPEALED

History

• Authority: T.C.A. §§ 69-11-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 19, 1987; effective October 3, 1987. Amendment filed August 2, 1995; effective October 15, 1995. Amendment filed December 6, 2000; effective February 19, 2001. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-07.

Tenn. Comp. R. & Regs. 1200-05-07-.07 REPEALED

History

• Authority: T.C.A. §§ 69-11-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 19, 1987; effective October 3, 1987. Amendment filed August 2, 1995; effective October 15, 1995. Amendment filed December 6, 2000; effective February 19, 2001. Amendments filed April 18, 2008; effective July 2, 2008. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-07.

Tenn. Comp. R. & Regs. 1200-05-07-.08 REPEALED

History

• Authority: T.C.A. §§ 69-11-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 19, 1987; effective October 3, 1987. Amendment filed August 2, 1995; effective October 15, 1995. Amendment filed December 6, 2000; effective February 19, 2001. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-07.

Tenn. Comp. R. & Regs. 1200-05-07-.09 REPEALED

History

• Authority: T.C.A. §§ 69-11-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 19, 1987; effective October 3, 1987. Amendment filed August 2, 1995; effective October 15, 1995. Amendment filed December 6, 2000; effective February 19, 2001. Amendment filed April 18, 2008; effective July 2, 2008. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-07.

Tenn. Comp. R. & Regs. 1200-05-07-.10 REPEALED

History

• Authority: 69-11-101 et seq., and 4-5-201 et seq
• Administrative History: Original rule filed August 19, 1987; effective October 3, 1987. Amendment filed August 2, 1995; effective October 15, 1995. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-07.

Tenn. Comp. R. & Regs. 1200-05-07-.11 REPEALED

History

• Authority: T.C.A. §§ 69-11-101 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 19, 1987; effective October 3, 1987. Repeal filed August 2, 1995; effective October 15, 1995. Repeal filed October 16, 2012; effective January 14, 2013. Rule renumbered 0400-45-07.

Chapter 1200-05-08 Repealed (Transferred to 0400-45-08)

Tenn. Comp. R. & Regs. 1200-05-08-.01 REPEALED

History

• Authority: T.C.A. §§ 69-7-301 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 5, 2003; effective October 19, 2003.Repeal and new rule filed December 11, 2006; effective February 24, 2007. Repeal filed June 18, 2012; effective September 16, 2012. Chapter was renumbered 0400-45-08.

Tenn. Comp. R. & Regs. 1200-05-08-.02 REPEALED

History

• Authority: T.C.A. §§ 69-7-301 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 5, 2003; effective October 19, 2003.Repeal and new rule filed December 11, 2006; effective February 24, 2007. Repeal filed June 18, 2012; effective September 16, 2012. Chapter was renumbered 0400-45-08.

Tenn. Comp. R. & Regs. 1200-05-08-.03 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 69-7-301 et seq., and 69-7-306.
• Administrative History: Original rule filed August 5, 2003; effective October 19, 2003 Repeal and new rule filed December 16, 2006; effective February 24, 2007. Repeal filed June 18, 2012; effective September 16, 2012. Chapter was renumbered 0400-45-08.

Tenn. Comp. R. & Regs. 1200-05-08-.04 REPEALED

History

• Authority: T.C.A. §§ 69-7-301 et seq., and 4-5-201 et seq. .
• Administrative History: Original rule filed August 5, 2003; effective October 19, 2003.repeal and new rule filed December 11, 2006; effective February 24, 2007. Repeal filed June 18, 2012; effective September 16, 2012. Repeal filed June 18, 2012; effective September 16, 2012. Chapter was renumbered 0400-45-08.

Tenn. Comp. R. & Regs. 1200-05-08-.05 REPEALED

History

• Authority: T.C.A. §§4-5-202, 69-7-301 et seq., and 69-7-306.
• Administrative History: Original rule filed August 5, 2003; effective October 19, 2003. Repeal and new rule filed December 11, 2006; effective February 24, 2007. Repeal filed June 18, 2012; effective September 16, 2012. Chapter was renumbered 0400-45-08.

Tenn. Comp. R. & Regs. 1200-05-08-.06 REPEALED

History

• Authority: T.C.A. §§ 69-7-301 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 5, 2003; effective October 19, 2003.repeal and new rule filed December 11, 2006; effective February 24, 2007. Repeal filed June 18, 2012; effective September 16, 2012. Chapter was renumbered 0400-45-08.

Tenn. Comp. R. & Regs. 1200-05-08-.07 REPEALED

History

• Authority: T.C.A. §§ 69-7-301 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 5, 2003; effective October 19, 2003.Repeal and new rule filed December 11, 2005; effective February 24, 2007. Repeal filed June 18, 2012; effective September 16, 2012. Chapter was renumbered 0400-45-08.

Tenn. Comp. R. & Regs. 1200-05-08-.08 REPEALED

History

• Authority: T.C.A. §§ 69-7-301 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 5, 2003; effective October 19, 2003.repeal and new ruled filed December 11, 2006; effective February 24, 2007. Repeal filed June 18, 2012; effective September 16, 2012. Chapter was renumbered 0400-45-08.

Tenn. Comp. R. & Regs. 1200-05-08-.09 REPEALED

History

• Authority: T.C.A. §§ 69-7-301 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 5, 2003; effective October 19, 2003 Repeal and new rule filed December 11, 2006; effective February 24, 2007. Repeal filed June 18, 2012; effective September 16, 2012. Chapter was renumbered 0400-45-08.

Tenn. Comp. R. & Regs. 1200-05-08-.10 REPEALED

History

• Authority: T.C.A. §§ 69-7-301 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 5, 2003; effective October 19, 2003. Repeal and new rule filed December 11, 2006; effective February 24, 2007. Repeal filed June 18, 2012; effective September 16, 2012. Chapter was renumbered 0400-45-08.

Tenn. Comp. R. & Regs. 1200-05-08-.11 REPEALED.

History

• Authority: T.C.A. §§ 69-7-301 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 5, 2003; effective October 19, 2003. Repeal and new rule filed December 11, 2006; effective February 24, 2007. Repeal filed June 18, 2012; effective September 16, 2012. Chapter was renumbered 0400-45-08.

Tenn. Comp. R. & Regs. 1200-05-08-.12 REPEALED

History

• Authority: T.C.A. §§ 69-7-301 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 5, 2003; effective October 19, 2003. Repeal and new rule filed December 11, 2006; effective February 24, 2007. Repeal filed June 18, 2012; effective September 16, 2012. Chapter was renumbered 0400-45-08.

Tenn. Comp. R. & Regs. 1200-05-08-.13 REPEALED

History

• Authority: T.C.A. §§ 69-7-301 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 5, 2003; effective October 19, 2003. Repeal and new rule filed December 11, 2006; effective February 24, 2007. Repeal filed June 18, 2012; effective September 16, 2012. Chapter was renumbered 0400-45-08.

1200-06 Medical Laboratory Board

Chapter 1200-06-01 General Rules Governing Medical Laboratory Personnel

Tenn. Comp. R. & Regs. 1200-06-01-.01 DEFINITIONS

This section sets forth the more important and/or frequently used terms and acronyms used in these rules and the meanings to be ascribed to them.

(1) Accrediting Bureau of Health Education Schools (ABHES). Accreditation organization in the United States specializing in the accreditation of institutions that offer allied health education programs leading to associate degrees or certificates for medical laboratory technicians and provides a pathway for certification by the American Medical Technologists.

(2) The Act. The Tennessee Medical Laboratory Act.

(3) Applicant. Any individual seeking licensure by the Board and who has submitted an official application and paid all required fees.

(4) Board. The Tennessee Medical Laboratory Board.

(5) Board Administrative Office. The office of the administrator assigned to the Board located at 665 Mainstream Drive, Nashville, TN 37243.

(6) CLIA. The Clinical Laboratory Improvement Amendments of 1988 as found in 42 CFR Part 493.

(7) Closed File. An administrative action which renders an incomplete or denied file inactive.

(8) Commission on Accreditation of Allied Health Education Programs (CAAHEP). Accreditation agency that accredits laboratory training programs.

(9) Committee. The Personnel and Education Licensure Committee which oversees all matters pertaining to the licensure of medical laboratory personnel and of medical laboratory education programs.

(10) Continuing Education. Planned, organized learning acts acquired during licensure to maintain, improve, or expand a licensee’s knowledge and skills relevant to medical laboratory practice in order for the licensee to develop knowledge and skills relevant to the practice, education, or theory development to improve the safety and welfare of the public.

(11) Cytology Supervisor. A person who is responsible for day-to-day supervision or oversight of the cytology laboratory operation, personnel performing testing and reporting test results.

(12) Cytotechnologist. A person who processes and interprets cellular material delineating data regarding cytopathological disease with minimal supervision by the director or supervisor.

(13) Department. Tennessee Department of Health.

(14) Esoteric Laboratory Personnel. Personnel performing testing in an esoteric laboratory licensed under T.C.A. § 68-29-138 who are exempt from requirements to be licensed as a technologist, technician, laboratory trainee, or special analyst.

(15) Examination. Refers to national certification exams or other exams approved by the Board.

(16) Full Time Work Experience. A minimum of thirty (30) hours per week or one thousand five hundred sixty (1,560) hours per year.

(17) Internationally Trained. Having graduated from a degree program and/or a laboratory training program outside of the United States or its territories.

(18) License. Document issued to an applicant who successfully completes the licensure process.

The license takes the form of an “artistically designed” lic ense as well as other versions bearing an expiration date.

(19) Licensee. Any person duly licensed by the Board to engage in the practice of laboratory medicine.

(20) May. Discretionary.

(21) Medical Laboratory. Any institution, building, or place in which operations and procedures for the microbiological, chemical, hematological, immunohematological, immunological, molecular, cytological, pharmacological, pharmacogenetical or biophysical examination of specimens taken from the human body are performed to obtain information for diagnosis, prophylaxis, or treatment or (where any examination, determination, or test is made on any sample used as a basis for health advice) or where any sample is collected for the purpose of transfusion or processing of blood or blood fractions, or for the training of medical laboratory personnel.

(22) Medical Laboratory Director. A person who is responsible for the administration of the technical and scientific operation of a medical laboratory, including supervision of procedures for testing and the reporting of results.

(23) Medical Laboratory Personnel. Individuals licensed by this board, including the medical laboratory director, supervisor, technologist, technician, or special analyst, but not including medical laboratory assistants, trainees or other persons employed by a medical laboratory to perform clerical or other administrative responsibilities involving no laboratory testing.

(24) Medical Laboratory Supervisor. A person who under the general supervision of a medical laboratory director, supervises technical personnel, performs tests requiring special scientific skills, and, in the absence of the director, is held responsible for the proper performance of all medical laboratory procedures and the reporting of results.

(25) Medical Laboratory Technician. A person other than the medical laboratory director, supervisor, technologist, or trainee who functions under the supervision of a medical laboratory director, supervisor, or technologist and performs medical laboratory procedures in which the technician is quali fied by education, training, and experience.

(26) Medical Laboratory Technologist. A person who performs tests which require the exercise of independent judgment and responsibility with minimal supervision by the director or supervisor, in only those specialt ies or subspecialties in which the technologist is qualified by education, training, and experience.

(27) Medical Laboratory Trainee. A person who is enrolled in a medical laboratory approved training program seeking experience required to meet minimum qualifications for a license in the state. Trainees may perform procedures only under direct, responsible supervision of a duly licensed director, supervisor, technologist, or special analyst. Trainees shall only be employed within the laboratory where training is received.

(28) Moderate/High Complexity. A clinical laboratory test category assigned by CLIA-88 based on the test characteristics. See 42 CFR § 493.17.

(29) National Accrediting Agency for Clinical Laboratory Sciences (NAACLS). Accreditation agency that accredits laboratory training programs.

(30) Person. Any individual, firm, partnership, association, corporation, municipality, political subdivision, or any other entity whether organized for profit or not.

(31) Physician. Any doctor of medicine or doctor of osteopathy duly licensed to practice such doctor’s profession in Tennessee.

(32) Point of Care Laboratory Testing. Laboratory testing performed by health care personnel/ professionals not licensed by the Medical Laboratory Act, T.C.A. §§ 68-29-101, et seq., and performed outside the duly licensed laboratory and under the auspices of a laboratory required to be licensed by the Department, pursuant to the Medical Laboratory Act.

(33) Regionally Accredited College/University. An institution of higher education accredited by one of the following United States Associations of Colleges and Schools: Middle States, Northwest, North Central, New England, Southern or Western.

(34) Shall. Mandatory.

(35) Special Analyst. Any person performing a singular or limited type of medical laboratory test or group of tests, such as, but not limited to, Andrology, Embryology, Cytology, Molecular Diagnostics, Cytogenetics, Toxicology, Fl ow Cytometry, Virology, Histocompatability/Immunogenetics, on human specimens but who is not trained to perform the broad range of tests required of licensed medical laboratory personnel.

(36) Trainee Permit. A permit that is issued to a trainee that is valid during the training period provided that the facility where the training is being gained is approved for practice training.

The trainee permit shall be onsite at the training facility during the student rotation.

(37) Waived Laboratory Tests. Those tests, as defined by the Board, which may be performed by individuals not licensed under the Medical Laboratory Act, and which pose no reasonable risk of harm if performed incorrectly.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-103, 68-29-105, 68-29-116, 68-29-117, 68-29-119, 68-29- 120, and 68-29-134.
• Administrative History: Original rule filed May 3, 1995; effective July 17, 1995. Amendment filed March 4, 1998; effective May 20, 1998. Amendment filed April 29, 2002; effective July 13, 2002. Amendment filed August 25, 2003; effective November 8, 2003. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-01-.02 SCOPE OF PRACTICE

Medical laboratory personnel and special analysts may perform and report clinical laboratory tests that provide vital information to the medical practitioner for the purpose of determining the nature, cause and extent of the patient’s medical condition.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-102, 68-29-104, 68-29-105, 68-29-117, and 68-29-118.
• Administrative History: Original rule filed May 3, 1995; effective July 17, 1995. Amendment filed August 25, 2003; effective November 8, 2003. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-01-.03 NECESSITY OF LICENSURE AND LICENSURE EXEMPTIONS

(1) All medical laboratory personnel and special analysts in Tennessee must hold current Tennessee licensure, unless specifically exempt by statute or rules promulgated by the Board.

(2) This section shall not apply to pathologists certified or eligible for certification by the American Board of Pathology, or any other person recognized by the Board as having special qualifications and who is duly licensed and registered to practice medicine in the state of Tennessee.

(3) Use of Titles - Any person who possesses a license issued by the Board has the right to use the title or acronym that represents being a medical laboratory director (Ph.D.), medical laboratory technologist (M.T.), medical laboratory technician (M.L.T.) or special analyst (S.A.) as defined in T.C.A. § 68-29-103, or the title or acronym that represents being a cytotechnologist (C.T.) as defined in Rule 1200-06-01-.01(9). Violation of this rule regarding use of titles shall constitute unethical conduct and subject the licensee to disciplinary action.

(4) Unless otherwise exempt by statute, personnel listed in Rule 1200-06-01-.26 are exempt from the licensure requirements imposed pursuant to the “Tennessee Medical Laboratory Act.”

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-102, 68-29-103, 68-29-104, 68-29-105, 68-29-116, 68-29- 127, and 68-29-129.
• Administrative History: Original rule filed May 3, 1995; effective July 17, 1995. Amendment filed August 25, 2003; effective November 8, 2003. Amendment filed March 16, 2007; effective May 30, 2007. Amendment filed April 1, 2009; effective June 15, 2009. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-01-.05 PROCEDURES FOR PERSONNEL LICENSURE

This section explains the procedures and requirements that are necessary for an applicant to become licensed.

(1) To perform the duties of a medical laboratory director, medical laboratory supervisor, medical laboratory technologist, medical laboratory technician, or special analyst, a person must possess a lawfully issued license from the Board.

(a) An application packet may be obtained from the Board’s administrative office or from the Board’s website at https://www.tn.gov/health/health-program-areas/healthprofessional-boards/medlab-board.html.

(b) Applications shall include all supporting documentation to be considered complete.

(c) It is the applicant’s responsibility to request an official transcript from the registrar’s office to be sent directly to the Board’s administrative office. Transcripts shall be sent from all institutions attended. The transcript shall show that the degree has been conferred and carry the official seal of the institution. Int ernationally trained applicants must meet the requirements of Rule 1200-06-01-.05(2)(a).

(d) It is the applicant’s responsibility to request proof that the laboratory training program from which the applicant graduated is accredited and from what agency. This must be submitted directly from the director of the training program, or a source acceptable to the Board, directly to the Board’s administrative office. Applicants trained in the military shall present proof of training through official military documentation, most commonly DD214. Internationally trained applicants must meet the requirements of Rule 1200-06- 01-.05(2).

(e) It is the applicant’s responsibility to request that proof of current national certification/qualification be submitted directly to the Board’s administrative office from a certifying body that is acceptable to the Board. The national certification must be in the laboratory specialty in which licensure is being sought.

(f) It is the applicant’s responsibility to request proof of clinical laboratory work experience from current and previous employers if required. The letter shall be on official letterhead and state the applicant’s name, job title and/or description of duties, dates of employment, and the number of hours worked per week.

(g) Applications will be accepted throughout the year.

(h) An applicant shall respond truthfully and completely to every question or request for information in the application form. The application form shall be submitted with all required documentation and fees to the Board’s administrative office. All application materials may be submitted online.

(i) An applicant shall submit with the application the nonrefundable application fee and the state regulatory fee as provided in Rule 1200-06-01-.06.

(j) An applicant shall submit with the application a “passport” type photograph taken within the preceding twelve (12) months.

(k) Personal resumes are not acceptable and will not be reviewed.

(l) An applicant shall disclose the circumstances surrounding any of the following:

1. Conviction of any crime in any country, state, or municipality, except for minor traffic violations.

2. The denial of licensure or the discipline of a licensee by any other state, country, or municipality.

3. Loss or restriction of licensure.

4. Any civil judgment or civil suit settlement in which the applicant was a party defendant including, without limitation, actions involving malpractice, breach of contract, antitrust activity, or any other civil action remedy recognized under that country’s, state’s, or municipality’s statutory, common, or case law.

(m) The applicant shall cause to be submitted to the Board’s administrative office directly from the vendor identified in the Board’s licensure application materials, the result of a criminal background check.

(n) The burden is on the applicant to prove by a preponderance of the evidence that his course work and credentials are equivalent to the Board’s requirements.

(o) Application review and licensure decisions shall be governed by Rule 1200-06-01-.07.

(p) Compliance with Rule 1200-06-01-.08 is a prerequisite to licensure.

(2) Internationally trained applicants.

(a) In addition to fulfilling the above requirements in paragraph (1), an internationally trained applicant shall also:

1. Have all educational credentials evaluated by a foreign evaluation company approved by the Board. The foreign evaluation company shall submit directly to the Board’s administrative office the results of the evaluation. The evaluation must clearly indicate that the applicant’s education is equivalent to that which is required for licensure of United States graduates at the level of licensure being sought. A list of approved foreign evaluation companies can be obtained from the Board’s administrative office.

2. Submit to the Board’s administrative office current documentation of legal entry and right to work in the United States if not a U.S. citizen.

(b) An internationally trained applicant who is a citizen of Mexico or Canada may apply as a professional under the North American Free Trade Agreement (NAFTA) when all federal requirements have been met; and 1. The profession is on the NAFTA list; and 2. The applicant possesses the specific criteria for that profession; and 3. The prospective position requires someone in that professional capacity; and 4. The applicant is going to work for a U.S. employer.

History

• Authority: T. C.A. §§ 4-5-202, 4-5-204, 68-29-104, 68-29-105, 68-29-116, 68-29-117, 68-29-118, and 68- 29-127.
• Administrative History: Original rule filed May 3, 1995; effective July 17, 1995. Amendment filed September 11, 1996; effective November 25, 1996. Amendment filed March 4, 1998; effective May 20, 1998. Amendment filed August 25, 2003; effective November 8, 2003. Amendment filed March 14, 2006; effective May 28, 2006. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-01-.06 . If retirement reactivation is requested prior to the expiration of one year from the date of retirement the Board will require payment of the late renewal fee and all past due licensure renewal fees as prescribed in Rule 1200-06-01-.06.

(c) Submit evidence of successful completion of the continuing education requirements pursuant to Rule 1200-06-01-.12.

(4) Licensure reactivation applications shall be treated as licensure applications and review and decisions shall be governed by Rule 1200-06-01-.07.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-111, 68-29-105, and 68-29-119.
• Administrative History: Original rule filed September 9, 1996; effective November 23, 1996. Amendment filed August 8, 2005; effective October 22, 2005. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-01-.07 APPLICATION, REVIEW, APPROVAL AND DENIAL

(1) Initial review of all applications to determine whether or not the application file is complete may be delegated to the Board’s administrator provided that final approval of all applications is made and ratified by the Board.

(2) If an application is incomplete when received in the Board’s administrative office, a deficiency letter will be sent to the applicant. Applications are not complete until all information and fees have been received by the Board’s administrative office.

(3) The Board may at its discretion delay a decision on eligibility for licensure for any applicant for whom the Board wishes additional information.

(4) If a completed application has been denied and ratified as such by the Board, the action shall become final and the following shall occur:

(a) A notification of the denial shall be sent by the Board’s administrative office by certified mail return receipt requested. Specific reasons for denial will be stated, and the notification shall contain all the specific statutory or rule authorities for the denial.

(b) The notification shall also contain a statement of the applicant’s right to request a contested case hearing under the Tennessee Administrative Procedures Act (T.C.A. §§ 4-5-301, et seq.) to contest the denial and the procedure necessary to accomplish that action.

(c) An applicant has a right to a contested case hearing if the licensure denial was based on subjective or discretionary criteria.

(d) An applicant has a right to a contested case hearing if the licensure denial is based on objective, clearly defined criteria only if, after review and attempted resolution by the Board’s administrative staff, the licensure application can not be approved for reasons which present a genuine issue of fact and/or law which is appropriate for appeal.

(e) Requests for appeals of licensure denials must be made in writing to the Office of General Counsel, Department of Health, within 30 days of the receipt of the notice of denial from the Board.

(5) Any person furnishing false information or omitting pertinent information in such application may be denied licensure. If the applicant has already been licensed before the falseness of such information has been made known to the Board, the license may be subject to disciplinary action by the Board.

(6) If the Board finds it has erred in the issuance of a license, the Board will give written notice by certified mail of its intent to annul the license. The notice will allow the applicant the opportunity to meet the requirements of licensure within thirty (30) days from date of receipt of the notification.

(7) Whenever requirements for licensure, except passing the examination, are not completed within sixty (60) days from the date of the initial review of application and credentials, written notification will be mailed to the applicant, and the application file will be closed. An applicant whose file has been closed shall subsequently be considered for licensure only upon the filing of a new application and payment of all appropriate fees. All closed files shall be ratified by the Board.

(8) Supporting documents may be accessed up to a year after being received in the Board’s administrative office.

(9) If an applicant requests licensure and wishes to change that application to a different type of licensure, the applicant shall submit a request in writing to the Board’s administrati ve office.

Any additional supporting documents necessary for the new type of licensure shall also be submitted.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-301, 68-29-105, 68-29-117, 68-29-118, and 68-29-127.
• Administrative History: Original rule filed May 3, 1995; effective July 17, 1995. Amendment filed March 4, 1998; effective May 20, 1998. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-01-.08 EXAMINATIONS

The Board adopts the examinations utilized by all nationally recognized medical laboratory personnel certifying agencies in each classification of licensure. The following shall apply:

(1) The exam administration schedule is determined by each national certification agency.

(2) Applicants that do not successfully pass the national certification exam will need to reschedule with the national certification agency.

(3) The passing score for the national certification exam is determined by each national certification agency.

(4) It is the applicant’s responsibility to request that verification of national certification be sent to Board staff.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-105, 68-29-117, and 68-29-118.
• Administrative History: Original rule filed May 3, 1995; effective July 17, 1995. Amendment filed March 4, 1998; effective May 20, 1998. Amendment filed August 25, 2003; effective November 8, 2003. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-01-.09 RENEWAL OF LICENSE

(1) Renewal Application (a) Pursuant to the Division of Health Related Board’s biennial birthdate renewal system, the due date for renewal, which is indicated on the license, is the last day of the month in which a licensee’s birthdate falls. The licensee is personally responsible for meeting all requirements for renewal prior to the expiration date to legally continue in practice.

(b) Methods of Renewal - Licensees may accomplish renewal by one (1) of the following methods:

1. Int ernet Renewals - Individuals may apply for renewal and pay the renewal and State regulatory fees as provided in Rule 1200-06-01-.06 via the Internet. The application to renew can be accessed at: https://lars.tn.gov/datamart/login.do;jsessionid=uT2QH-droIrQBZL8NqmNFv5j 2. Paper Renewals - If a licensee does not renew via the Internet, s/he shall submit the following to the Division of Health Related Boards on or before the expiration date:

(i) A completed renewal application form; and (ii) The renewal and State regulatory fees as provided in Rule 1200-06-01-.06.

(c) Anyone submitting a renewal form, electronically or otherwise, which is found to be fraudulent or untrue may be subject to disciplinary action.

(d) Licensees who fail to comply with the renewal rules or notification received by them concerning failure to timely renew shall have their licenses processed pursuant to Rule

Tenn. Comp. R. & Regs. 1200-06-01-.11 RETIREMENT AND REACTIVATION

(1) A person who holds a current license and does not intend to practice as a Medical Laboratory Professional in Tennessee may apply to convert an active license to retired status. An individual who holds a retired license will not be required to pay a renewal fee.

(2) A person who holds an active license may apply for retired status in the following manner:

(a) Obtain from the Board’s administrative office or via the Internet an affidavit of retirement form; and (b) Complete and submit the affidavit affirming that, while in retired status, the licensee will not practice or in any way indicate or imply that s/he holds an active Tennessee license.

(3) License holders whose licenses have been retired may reactivate their licenses in the following manner:

(a) Submit a written request for licensure reactivation to the Board’s administrative office;

(b) Pay the current licensure renewal fees and State regulatory fee as provided in Rule

Tenn. Comp. R. & Regs. 1200-06-01-.12 CONTINUING EDUCATION

(1) Basic requirements - The Tennessee Medical Laboratory Board requires each licensee to successfully complete twenty-four (24) hours of approved continuing education pertaining to laboratory technology or laboratory management for the two (2) calendar year (January 1- December 31) period that precedes the licensure renewal year. New licensees are not subject to a continuing education audit until completion of the first license renewal cycle.

(a) The following organizations, entities, and their affiliates and chapters are authorized to present or sponsor courses for continuing education credit:

1. American Association of Blood Banks.

2. American Board of Bioanalysis.

3. American Board of Clinical Chemistry.

4. American Board of Histocompatibility and Immunogenetics.

5. American Board of Medical Genetics.

6. American Board of Medical Laboratory Immunology.

7. American Board of Medical Microbiology.

8. American Board of Oral and Maxillofacial Pathology.

9. American Board of Pathology.

10. American College of Health Care Executives.

11. American Medical Association.

12. American Medical Technologists (AMT).

13. American Osteopathic Board of Pathology.

14. American Red Cross.

15. American Society for Clinical Laboratory Science.

16. American Society for Clinical Pathologists (ASCP).

17. American Society of Cytopathology.

18. American Society for Cytotechnology.

19. American Society for Microbiology.

20. Center for Phlebotomy Education.

21. Centers for Disease Control.

22. Centers for Medicare and Medicaid Services.

23. Clinical Laboratory Management Association.

24. Clinical and Laboratory Standards Institute (CLSI).

25. College of American Pathologists.

26. Greater Memphis Association of Blood Banks.

27. International Academy of Cytology.

28. National Accrediting Agency for Clinical Laboratory Sciences (NAACLS).

29. National Laboratory Training Network (NLTN).

30. Southern Association of Clinical Microbiologists.

31. Tennessee Association of Blood Banks.

32. Tennessee Department of Health.

33. Tennessee Hospital Association.

34. Tennessee Medical Association.

35. Tennessee Professional Assistance Program (TN-PAP) or any Board-approved peer assistance program.

36. Tennessee Society of Pathologists.

37. Tennessee Society of Clinical Laboratory Scientists.

38. Tennessee State Society of American Medical Technologists.

39. Accredited colleges and universities.

40. Hospitals licensed by the Tennessee Department of Health, Division of Health Care Facilities.

41. Laboratories, blood donor centers, plasmapheresis centers, ambulatory surgical treatment centers, and collection stations licensed by the Board whose continuing education courses have been approved by the medical laboratory director or his/her designee.

42. Organizations and entities approved by other state laboratory personnel licensing agencies.

43. Organizations and entities approved as P.A.C.E.® (Professional Acknowledgment for Continuing Education) course providers.

(b) Continuing education credit for preparing and teaching continuing education courses - Credit may be earned by preparing and teaching a course presented, sponsored, or approved by an organization or entity listed in subparagraph (a). Documentation of preparing and teaching continuing education courses shall be required as provided in paragraph (3).

1. Courses that were prepared by developing thorough, high quality, readable and carefully prepared written materials will qualify for continuing education credit on the basis of four (4) hours of credit for each hour taught.

2. Courses that were prepared by developing less than five (5) pages of outlines, or not accompanied by written materials, will qualify for continuing education credit on the basis of two (2) credits for each hour taught.

3. Repeat courses qualify for one-half (½) of the credits awarded for the initial course.

4. On-site commentators at multi-media courses will receive credit at the rate of two (2) hours for each hour of the program if they have either viewed the course in advance or otherwise engaged in preparation appropriate to the role of commentator.

5. Each teacher involved in a joint or panel portion of an approved activity shall receive credit as though he or she were the only teacher.

6. No more than eight (8) hours of continuing education credit shall be awarded for preparing and teaching continuing education courses during any two (2) calendar year period.

(c) Continuing education credit for published articles - Four (4) hours credit may be earned by preparing and writing an article pertaining to laboratory technology or laboratory management that is published in a peer review journal.

(d) Continuing education credit will be assigned on the following basis:

1. Any single session lasting not less than two and one-half (2½) clock hours will be assigned three (3) hours of continuing education credit.

2. Any single session lasting not less than one (1) clock hour and forty (40) clock minutes will be assigned two (2) hours of continuing education credit.

3. Any single session lasting not less than fifty (50) clock minutes will be assigned one (1) hour of continuing education credit.

4. The hours assigned shall be based on actual instruction or program time, excluding registration time and breaks, but including question and answer time.

5. The new licensee is not subject to a continuing education audit until completion of the first license renewal cycle.

(2) Documentation (a) Each licensee must retain proof of attendance and completion of all continuing education requirements for a period of three (3) years from the end of the two (2) calendar year period in which the continuing education was required. This documentation shall be produced for a continuing education audit, if requested in writing by the Board, during its verification process. The Board will not maintain continuing education files for individual licensees.

(b) If a licensee submits documentation for training that is not clearly identifiable as appropriate continuing education, the Board will request a written description of the training and its applicability. If the Board determines that the training can not be considered appropriate continuing education, the individual will be given ninety (90) days to replace the hours not allowed. Those hours will be considered replacement hours and cannot be counted toward completion of any other continuing education requirement.

(3) Continuing Education Formats (a) Continuing education courses may be presented in the traditional lecture and classroom formats or, with successful completion of a written post experience examination to evaluate material retention, in multi-media and/or electronic formats.

(b) Notwithstanding the provisions of subparagraph (4)(a), if a continuing education course includes a laboratory experience as a component of the course, the laboratory experience must occur at or be provided by a CLIA-approved site or an accredited college or university.

(4) Continuing education credit will not be allowed for the following:

(a) Membership in, holding office in, or participation on boards or committees, business meetings of professional organizations, or banquet speeches.

(b) Regular work activities, administrative staff meetings, case staffing/reporting, etc., except as provided in subparagraph (1)(b).

(5) Continuing Education for Reactivation or Reinstatement of Retired or Expired License.

(a) Reinstatement of Retired License - Upon application for reinstatement, an individual whose license has been retired for two (2) years or less will be required to fulfill continuing education requirements as outlined in this rule.

(b) Reinstatement of Expired Licensure - No person whose license has expired may be reinstated without submitting evidence of continuing education. The continuing education hours documented at the time of reinstatement must equal the hours required, had the license remained in active status, and must have begun and been successfully completed before the date of reinstatement. However, the person shall not be required to complete more than thirty-six hours of continuing education.

(c) Continuing education hours obtained as a prerequisite for reactivating or reinstating a license may not be counted toward completion of any current two (2) calendar year requirement.

(6) Violations (a) Any licensee who falsely certifies attendance and completion of the required hours of continuing education requirements, or who does not or can not adequately substantiate completed continuing education hours with the required documentation, may be subject to disciplinary action.

(b) Prior to the institution of any disciplinary proceedings, a letter shall be issued to the last known address of the individual stating the facts or conduct which warrant the intended action.

(c) The licensee has thirty (30) days from the date of notification to show compliance with all lawful requirements for the retention of the license.

(d) Any licensee who fails to show compliance with the required continuing education hours in response to the notice contemplated by subparagraph (b) may be subject to disciplinary action.

(e) Continuing education hours obtained as a result of compliance with the terms of a Board Order in any disciplinary action shall not be credited toward any continuing education requirement.

(7) Deadline Extension of Continuing Education Requirements (a) The Board or its designee may grant a maximum extension of six (6) months to complete the required hours of continuing education if it can be shown that compliance was beyond the physical or mental capabilities of the licensee seeking the deadline extension.

(b) Extension of the deadline will be considered only on an individual basis and may be requested by submitting the following items to the Board’s administrative office:

1. A written request for a deadline extension which specifies which deadline is sought to be extended and a written and signed explanation of the reason for the request; and 2. Any documentation which supports the reason(s) for the deadline extension requested or which is subsequently requested by the Board.

(c) A deadline extension approved by the Board is effective only for the two (2) calendar year period for which the deadline extension is sought.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-105, and 68-29-119.
• Administrative History: Original rule filed August 8, 2005; effective October 22, 2005. Amendment filed April 17, 2007; effective July 1, 2007. Amendment filed April 1, 2009; effective June 15, 2009. Amendment filed April 22, 2010; effective July 21, 2010. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-01-.13 TEMPORARY LICENSE

(1) Applicants who have applied for and are approved to take a specific national certification examination and who have met the minimum education and/or experience requirements as described in Rule 1200-06-01-.22 may be issued a temporary license by the Board’s administrative office.

(2) No application other than required by Rule 1200-06-01-.05 is required.

(3) Individuals who possess a state laboratory personnel license in one category will not be eligible for a temporary license in a different category.

(4) The validity and duration of temporary licenses shall be governed by T.C.A. § 68-29-117(d).

(5) It is the applicant’s responsibility to submit verification to the Board of the date of the scheduled exam by submitting a copy of the admission letter received from the national certification agency.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-105, and 68-29-117.
• Administrative History: Original rule filed September 9, 1996; effective November 23, 1995. Amendment filed March 4, 1998; effective May 20, 1998. Amendment filed March 16, 2007; effective May 30, 2007. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-01-.14 TRAINEE PERMITS

(1) Each trainee must submit a trainee application when he begins his practice training in a medical laboratory.

(2) The Board will issue the trainee a trainee permit that will be valid during the training period provided the facility where the training is being gained is approved for practice training.

(3) Trainees may use a trainee permit to work and receive remuneration in those specialties for which they have completed their classroom lectures and clinical practicum, provided they are under direct supervision of licensed medical laboratory personnel at the technologist level or higher. Trainees may only work in the facility in which the specific specialty training was obtained and may begin training only if the facility has possession of a copy of the valid trainee permit.

(4) A trainee permit is void the day the trainee completes or withdraws from the training program.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-105, and 68-29-120.
• Administrative History: Original rule filed May 3, 1995; effective July 17, 1995. Amendment filed August 25, 2003; effective November 8, 2003. Amendment filed October 11, 2004; effective December 25, 2004.

Tenn. Comp. R. & Regs. 1200-06-01-.15 PERSONNEL LICENSURE DISCIPLINE, CIVIL PENALTIES, ASSESSMENT OF

COSTS, AND SUBPOENAS.

(1) Upon a finding by the Board that a licensee has violated any provision of the Tennessee Medical Laboratory Act (T.C.A. §§ 68-29-101, et seq.) or the rules promulgated pursuant thereto, the Board may impose any of the following actions separately or in any combination which is deemed appropriate to the offense:

(a) Letter of Concern/Letter of Warning - This is a written action issued to the licensee for minor or near inf ractions. It i s informal and advisory in nature and does not constitute a formal disciplinary action.

(b) Reprimand - This is a written action issued to a licensee for one time and less severe violations. It is a formal disciplinary action.

(c) Probation - This is a formal disciplinary action which places a licensee on close scrutiny for a fixed period of time. This action may be combined with conditions which must be met before probation will be lifted and/or which restrict the licensee’s activities during the probationary period.

(d) Licensure Suspension - This is a formal disciplinary action which suspends a licensee’s right to practice laboratory medicine for a fixed period of time. It contemplates the reentry of the licensee into practice under the license previously issued.

(e) Licensure Revocation - This is the most severe form of disciplinary action which removes a licensee from the practice of laboratory medicine and terminates the license previously issued. If revoked, it relegates the violator to the status he or she possessed prior to application for licensure. The violator must apply for a new licensure if s/he seeks to practice again in laboratory medicine. However, the Board may in its discretion allow the reinstatement of a revoked license upon conditions and after a period of time it deems appropriate. No petition for reinstatement and no new application for licensure from a person whose license was revoked shall be considered prior to the expiration of at least one (1) year unless otherwise stated in the Board’s revocation order.

(f) Conditions - Any action deemed appropriate by the Board to be required of a disciplined licensee during any period of probation or suspension or as a prerequisite to the lifting of probation or suspension or the reinstatement of a revoked license.

(g) Once ordered, probation, suspension, revocation, assessment of a civil penalty, or any other condition of any type of disciplinary action may not be lifted unless and until the licensee petitions, pursuant to paragraph (2) of this rule, and appears before the Board after the period of initial probation, suspension, revocation, or other conditioning has run and all conditions placed on the probation, suspension, revocation, have been met, and after any civil penalties assessed have been paid.

(2) Order of Compliance - This procedure is a necessary adjunct to previously issued disciplinary orders and is available only when a petitioner has completely complied with the provisions of a previously issued disciplinary order, including an unlicensed practice civil penalty order, and wishes or is required to obtain an order reflecting that compliance.

(a) The Board will entertain petitions for an Order of Compliance as a supplement to a previously issued order upon strict compliance with the procedures set forth in subparagraph (b) in only the following three (3) circumstances:

1. When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued reflecting that compliance; or 2. When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued lifting a previously ordered suspension or probation; or 3. When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued reinstating a license previously revoked.

(b) Procedures 1. The petitioner shall submit a Petition for Order of Compliance, as contained in subparagraph (c), to the Board’s Administrative Office that shall contain all of the following:

(i) A copy of the previously issued order; and (ii) A statement of which provision of subparagraph (a) the petitioner is relying upon as a basis for the requested order; and (iii) A copy of all documents that prove compliance with all the terms or conditions of the previously issued order. If proof of compliance requires testimony of an individual(s), including that of the petitioner, the petitioner must submit signed statements from every individual the petitioner intends to rely upon attesting, under oath, to the compliance. The Board’s consultant and administrative staff, in their discretion, may require such signed statements to be notarized. No documentation or testimony other th an that submitted will be considered in making an initial determination on, or a final order in response to, the petition.

2. The Board authorizes its consultant and administrative staff to make an initial determination on the petition and take one of the following actions:

(i) Certify compliance and have the matter scheduled for presentation to the Board as an uncontested matter; or (ii) Deny the petition, after consultation with legal staff, if compliance with all of the provisions of the previous orde r is not proven and notify the petitioner of what provisions remain to be fulfilled and/or what proof of compliance was either not sufficient or not submitted.

3. If the petition is presented to the Board the petitioner may not submit any additional documentation or testimony other than that contained in the petition as originally submitted.

4. If the Board finds that the petitioner has complied with all the terms of the previous order an Order of Compliance shall be issued.

5. If the petition is denied either initially by staff or after presentation to the Board and the petitioner believes compliance with the order has been sufficiently proven the petitioner may, as authorized by law, file a petition for a declaratory order pursuant to the provisions of T.C.A. § 4-5-223 and Rule 1200-10-01-.11.

(c) Form Petition Petition for Order of Compliance Tennessee Medical Laboratory Board Petitioner’s Name:

Petitioner’s Mailing Address:

Petitioner’s E-Mail Address:

Telephone Number:

Attorney for Petitioner:

Attorney’s Mailing Address:

Attorney’s E-Mail Address:

Telephone Number:

The petitioner respectfully represents, as substantiated by the attached documentation, that all provisions of the attached disciplinary order have been complied with and I am respectfully requesting: (circle one)

1. An order issued reflecting that compliance; or 2. An order issued reflecting that compliance and lifting a previously ordered suspension or probation; or 3. An order issued reflecting that compliance and reinstating a license previously revoked.

Note - You must enclose all documents necessary to prove your request including a copy of the original order. If any of the proof you are relying upon to show compliance is the testimony of any individual, including yourself, you must enclose signed statements from every individual you intend to rely upon attesting, under oath, to the compliance. T he Board’s consultant and administrative staff, in their discretion, may require such signed statements to be notarized. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, this petition.

Respectfully submitted this the day of , 20 .

Petitioner’s Signature (3) Order Modifications - This procedure is not intended to allow anyone under a previously issued disciplinary order, including an unlicensed practice civil penalty order, to modify any findings of fact, conclusions of law, or the reasons for the decision contained in the order. It is also not intended to allow a petition for a lesser disciplinary action, or civil penalty other than the one(s) previously ordered. All such provisions of Board orders were subject to reconsideration and appeal under the provisions of the Uniform Administrative Procedures Act (T.C.A. §§ 4-5-301, et seq.). This procedure is not available as a substitute for reconsideration and/or appeal and is only available after all reconsideration and appeal rights have been either exhausted or not timely pursued. It is also not available for those who have accepted and been issued a reprimand.

(a) The Board will entertain petitions for modification of the disciplinary portion of previously issued orders upon strict compliance with the procedures set forth in subparagraph (b) only when the petitioner can prove that compliance with any one or more of the conditions or terms of the discipline previously ordered is impossible. For purposes of this rule the term “impossible” does not mean that compliance is inconvenient or impractical for personal, financial, scheduling or other reasons.

(b) Procedures 1. The petitioner shall submit a written and signed Petition for Order Modification on the form contained in subparagraph (c) to the Board’s Administrative Office that shall contain all of the following:

(i) A copy of the previously issued order; and (ii) A statement of why the petitioner believes it is impossible to comply with the order as issued; and (iii) A copy of all documents that proves that compliance is impossible. If proof of impossibility of compliance requires testimony of an individual(s), including that of the petitioner, the petitioner must submit signed and notarized statements from every individual the petitioner intends to rely upon attesting, under oath, to the reasons why compliance is impossible.

No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, the petition.

2. The Board authorizes its consultant and administrative staff to make an initial determination on the petition and take one of the following actions:

(i) Certify impossibility of compliance and forward the petition to the Office of General Counsel for presentation to the Board as an uncontested matter; or (ii) Deny the petition, after consultation with legal staff, if impossibility of compliance with the provisions of the previous order is not proven and notify the petitioner of what proof of impossibility of compliance was either not sufficient or not submitted.

3. If the petition is presented to the Board the petitioner may not submit any additional documentation or testimony other than that contained in the petition as originally submitted.

4. If the petition is granted a new order shall be issued reflecting the modifications authorized by the Board that it deemed appropriate and necessary in relation to the violations found in the previous order.

5. If the petition is denied either initially by staff or after presentation to the Board and the petitioner believes impossibility of compliance with the order has been sufficiently proven the petitioner may, as authorized by law, file a petition for a declaratory order pursuant to the provisions of T.C.A. § 4-5-223 and Rule 1200- 10-01-.11.

(c) Form Petition Petition for Order Modification Tennessee Medical Laboratory Board Petitioner’s Name:

Petitioner’s Mailing Address:

Petitioner’s E-Mail Address:

Telephone Number:

Attorney for Petitioner:

Attorney’s Mailing Address:

Attorney’s E-Mail Address:

Telephone Number:

The petitioner respectfully represents that for the following reasons, as substantiated by the attached documentation, the identified provisions of the attached disciplinary order are impossible for me to comply with:

Note - You must enclose all documents necessary to prove your request including a copy of the original order. If any of the proof you are relying upon to show impossibility is the testimony of any individual, including yourself, you must enclose signed and notarized statements from every individual you intend to rely upon attesting, under oath, to the reasons why compliance is impossible. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, this petition.

Respectfully submitted this the day of , 20 .

Petitioner’s Signature (4) Civil Penalties.

(a) Purpose - The purpose of this rule is to set out a schedule designating the minimum and maximum civil penalties which may be assessed.

(b) Schedule of Civil Penalties 1. The Type A Civil Penalty may be imposed whenever the Board finds a person who is required to be licensed by the Board guilty of a willful and knowing violation of the Medical Laboratory Act, or regulations promulgated pursuant thereto, to such an extent that there is or is likely to be, an imminent, substantial threat to the health, safety and welfare of an individual patient or the public. For purposes of this section, willfully and knowingly practicing in the medical laboratory without a license from the Board when licensure is required, is one of the violations of the Medical Laboratory Act for which a Type A Civil Penalty is assessable.

2. A Type B Civil Penalty may be imposed whenever the Board finds the person required to be licensed by the Board guilty of a violation of the Medical Laboratory Act or regulations promulgated pursuant thereto in such a manner as to impact directly on the care of p atients or the public.

3. A Type C Civil Penalty may be imposed whenever the Board finds the person required to be licensed by the Board guilty of a violation of the Medical Laboratory Act or regulations promulgated pursuant thereto, which are neither directly detrimental to patients or the public, nor directly impact their care, but have only an indirect relationship to patient care or the public.

(c) Amount of Civil Penalties 1. Type A Civil Penalties shall be assessed in the amount of not less than $500 nor more than $1,000.

2. Type B Civil Penalties may be assessed in the amount of not less than $100 and not more than $500.

3. Type C Civil Penalties may be assessed in the amount of not less than $50 and not more than $100.

(d) Procedures for Assessing Civil Penalties 1. The Division of Health Related Boards may initiate a civil penalty assessment by filing a Memorandum of Assessment of Civil Penalty. The Division shall state in the memorandum the facts and law upon which it relies in alleging a violation, the proposed amount of the civil penalty and the basis for such penalty. The Division may incorporate the Memorandum of Assessment of Civil Penalty with a Notice of Charges which may be issued attendant thereto.

2. Civil Penalties may also be initiated and assessed by the Board during consideration of any Notice of Charges. In addition, the Board may, upon good cause shown, assess a type and amount of civil penalty which was not recommended by the Division.

3. In assessing the civil penalties pursuant to these rules the Board may consider the following factors:

(i) Whether the amount imposed will be a substantial economic deterrent to the violator;

(ii) The circumstances leading to the violation;

(iii) The severity of the violation and the risk of harm to the public;

(iv) The economic benefits gained by the violator as a result of noncompliance; and (v) The interest of the public.

4. All proceedings for the assessment of civil penalties shall be governed by the contested case provisions of Title 4, Chapter 5, Tennessee Code Annotated.

(5) Assessment of costs in disciplinary proceedings shall be as set forth in T.C.A. §§ 63-1-144 and 68-29-136.

(6) Subpoenas (a) Purpose - Although this rule applies to persons and entities other than medical laboratory personnel, it is the Board’s intent as to medical laboratory personnel that they be free to practice their profession without fear that such practice or its documentation will be unduly subjected to scrutiny outside the profession.

Consequently, balancing that intent against the interest of the public and patients to be protected against substandard care and activities requires that persons seeking to subpoena such information and/or materials must comply with the substance and procedures of these rules.

It is the intent of the Board that the subpoena power outlined herein shall be strictly proscribed. Such power shall not be used by the Division or Board investigators to seek other incriminating evidence against medical laboratory personnel when the Division or Board does not have a complaint or basis to pursue such an investigation. Thus, unless the Division or its investigators have previously considered, discovered, or otherwise received a complaint from either the public or a governmental entity, then no subpoena as contemplated herein shall issue.

(b) Definitions - As used in this chapter of rules the following words shall have the meanings ascribed to them:

1. Probable Cause (i) For Investigative Subpoenas - shall mean that probable cause, as defined by case law at the time of request for subpoena issuance is made, exists that a violation of the Medical Laboratory Practice Act or rules promulgated pursuant thereto has occurred or is occurring and that it is more probable than not that the person(s), or items to be subpoenaed possess or contain evidence which is more probable than not relevant to the conduct constituting the violation.

(ii) The utilization of the probable cause evidentiary burden in proceedings pursuant to this rule shall not in any way, nor should it be construed in any way to establish a more restrictive burden of proof than the existing preponderance of the evidence in any civil disciplinary action which may involve the person(s) or items that are the subject of the subpoena.

2. Presiding Officer - For investigative subpoenas shall mean any elected officer of the Board, or any duly appointed or elected chairperson of any panel of the Board.

(c) Procedures 1. Investigative Subpoenas (i) Investigative Subpoenas are available only for issuance to the authorized representatives of the Tennessee Department of Health, its investigators and its legal staff.

(ii) An applicant for such a subpoena must either orally or in writing notify the Board’s Unit Director of the intention to seek issuance of a subpoena. That notification must include the following:

(I) The time frame in which issuance is required so the matter can be timely scheduled; and (II) A particular description of the material or documents sought, which must relate directly to an ongoing investigation or contested case, and shall, in the instance of documentary materials, be limited to the records of the patient or patients whose complaint, complaints, or records are being considered by the Division or Board.

I. In no event shall such subpoena be broadly drafted to provide investigative access to medical laboratory records of other patients who are not referenced in a complaint received from an individual or governmental entity, or who have not otherwise sought relief, review, or Board consideration of any medical laboratory personnel’s conduct, act, or omission; and II. If the subpoena relates to the prescribing practices of a licensee, then it shall be directed solely to the records of the patient(s) who received the pharmaceutical agents and whom the Board of Pharmacy or issuing pharmacy(ies) has so identified as recipients; and (III) Whether the proceedings for the issuance is to be conducted by physical appearance or electronic means; and (IV) The name and address of the person for whom the subpoena is being sought, or who has possession of the items being subpoenaed.

(iii) The Board’s Unit Director shall cause the following to be done:

(I) In as timely a manner as possible arrange for eit her an elected officer of the Board or any duly appointed or elected chairperson of any panel of the Board to preside and determine if issuing the subpoena should be recommended to the full Board; and (II) Establish a date, time and place for the proceedings to be conducted and notify the Presiding Officer, the applicant and the court reporter; and (III) Maintain a complete record of the proceedings including an audio tape in such a manner as to:

I. Preserve a verbatim record of the proceeding; and II. Prevent the person presiding over the proceedings and/or signing the subpoena from being allowed to participate in any manner in any resulting disciplinary action of any kind, formal or informal, which involves either the person or the documents or records for which the subpoena was issued.

(iv) The Proceedings (I) The applicant shall do the following:

I. Provide for the attendance of all persons whose testimony is to be relied upon to establish probable cause; and II. Produce and make part of the record copies of all documents to be utilized to establish probable cause; and III. Obtain, complete and provide to the Presiding Officer a subpoena which specifies the following:

A. The name and address of the person for whom the subpoena is being sought or who has possession of the items being subpoenaed; and B. The location of the materials, documents or reports for which production pursuant to the subpoena is sought if that location is known; and C. A brief, general description of any materials, documents or items to be produced pursuant to the subpoena; and D. The date, time and place for compliance with the subpoena.

IV. Provide the Presiding Officer testimony and/or documentary evidence which, in good faith, the applicant believes is sufficient to establish that probable cause exists for issuance of the subpoena as well as sufficient proof that all other reasonably available alternative means of securing the materials, documents or items have been unsuccessful.

(II) The Presiding Officer shall do the following:

I. Be selected only after assuring the Board’s Unit Director that he or she has no prior knowledge of or any direct or indirect interest in or relationship with the person(s) being subpoenaed and/or the licensee who is the subject of the investigation; and II. Commence the proceedings and swear all necessary witnesses; and III. Hear and maintain the confidentiality, if any, of the evidence presented at the proceedings and present to the full Board only that evidence necessary for an informed decision; and IV. Control the manner and extent of inquiry during the proceedings and be allowed to question any witness who testifies; and V. Determine, based solely on the evidence presented in the proceedings, whether probable cause exists and if so, make such recommendation to the full Board; and VI. Not participate in any way in any other proceeding whether formal or informal, which involves the matters, items or person(s) which are the subject of the subpoena. This does not preclude the Presiding Officer from presiding at further proceedings for issuance of subpoenas in the matter.

(III) The Board shall do the following:

I. By a vote of two-thirds (2/3) of the Board members issue the subpoena for the person(s) or items specifically found to be rel evant to the inquiry, or quash or modify an existing subpoena by a majority vote; and II. Sign the subpoena as ordered to be issued, quashed or modified.

2. Post-Notice of Charges Subpoenas - If the subpoena is sought for a contested case being heard with an Administrative Law Judge from the Secretary of State’s office presiding, this definition shall not apply and all such post-notice of charges subpoenas should be obtained from the office of the Administrative Procedures Division of the Office of the Secretary of State pursuant to the Uniform Administrative Procedures Act and rules promulgated pursuant thereto.

(d) Subpoena Forms 1. All subpoenas shall be issued on forms approved by the Board.

2. The subpoena forms may be obtained by contacting the Board’s Administrative Office.

(e) Subpoena Service - Any method of service of subpoenas authorized by the Tennessee Rules of Civil Procedure or the rules of procedure for contested cases of the Tennessee Department of State, Administrative Procedures Division may be utilized to serve subpoenas pursuant to this rule.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-217, 4-5-223, 4-5-311, 63-1-122, 63-1-134, 63-1-144, 68-29- 104, 68-29-105, 68-29-109, 68-29-127, 68-29-128, 68-29-129, 68-29-130, 68-29-131, 68-29-132, and 68- 29-136. Admini strative History: Original rule filed May 3, 1995; effective July 17, 1995. Amendment filed September 9, 1996; effective November 23, 1996. Amendment filed December 1, 2000; effective February 14, 2001. Amendment filed March 22, 2001; effective June 5, 2001. Amendment filed July 8, 2004; effective September 21, 2004. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-01-.16 REPLACEMENT LICENSE

A license holder whose “artistically designed” license or renewal certificate has been lost or destroyed may be issued a replacement document upon receipt in the Board’s administrative office of a notarized written request. Such request shall be accompanied by the required fee, pursuant to Rule 1200-06-01- .06.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-106, and 68-29-105.
• Administrative History: Original rule filed September 9, 1996; effective November 23, 1996. Amendment filed August 25, 2003; effective November 8, 2003. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-01-.17 CHANGE OF ADDRESS AND/OR NAME

(1) Change of Address. A licensee who has had a change of address shall file in writing with the Board a current mailing address, giving both the old and new addresses and new phone number. Such notification should be received in the Board’s administrative office no later than thirty (30) days after such change is effective and must reference the individual’s name, profession, and license number.

(2) Change of Name. A licensee shall provide a certified copy of the marriage certificate, divorce decree, or court order indicating a name change to the Board within thirty (30) days of the change. The licensee shall provide both the old and new name and must reference the individual’s profession and license number.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-106, and 68-29-105.
• Administrative History: Original rule filed September 9, 1996; effective November 23, 1996. Amendment filed August 25, 2003; effective November 8, 2003. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-01-.18 UNETHICAL CONDUCT

(1) Unethical conduct shall include, but not be limited to:

(a) Failing to exercise reasonable diligence to prevent partners, associates, and employees from engaging in conduct which would violate any provisions of the Tennessee Medical Laboratory Act or any rule, regulation, or order of the Board.

(b) Penalizing medical laboratory personnel for reporting violations of any provisions of the Tennessee Medical Laboratory Act or any rule, regulation, or order of the Board.

(2) Violations of this rule shall subject a licensee to disciplinary action, as provided in Rule 1200- 06-01-.15.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-105, 68-29-127, and 68-29-129.
• Administrative History: Original ruled filed April 1, 2009; effective June 15, 2009.

Tenn. Comp. R. & Regs. 1200-06-01-.19 BOARD MEETINGS, OFFICERS, CONSULTANTS, DECLARATORY ORDERS, AND

SCREENING PANELS.

(1) Board Meeting:

(a) The time, place, and frequency of Board meetings shall be at the discretion of the Board except at least one meeting shall be held annually. All meetings of the Board shall be open to the public.

(b) Special meetings are called at the discretion of the Chair or at the request of two members of the Board, provided all members are adequately notified.

(c) Non-Board members present at meetings may address the Board only on recognition by the Chairperson.

(2) The Board shall elect annually from its members the following officers:

(a) Full Board Chair - who shall preside at all Board meetings.

(b) Personnel and Education Licensure Committee Chair - who shall preside at Personnel and Education Licensure Committee meetings.

(c) Vice-Chairperson - who shall preside in the absence of the Chair.

(3) The Board has the authority to select a Board consultant who shall serve as a consultant to the Division and who is vested with the authority to do the following acts:

(a) Recommend whether and what type disciplinary actions should be instituted as the result of complaints received or investigations conducted by the Division.

(b) Recommend whether and under what terms a complaint case or disciplinary action might be settled. Any matter proposed for settlement must be subsequently ratified by the full Board before it will become effective.

(c) Undertake any other matters authorized by a majority vote of the Board.

(4) Records and Complaints (a) All requests, applications, notices, other communications, and correspondence shall be directed to the Board’s administrative office. Any requests or inquiries requiring a Board decision or official Board action, except documents relating to disciplinary actions or hearing requests, must be received a minimum of 14 days prior to the scheduled Board meeting and will be retained in the administrative office and presented to the Board at the meeting. Documentation not timely received may be deferred to the next Board meeting.

(b) All records of the Board, except those made confidential by law, are open for inspection and examination under the supervision of an employee of the Division at the Board’s administrative office.

(c) Copies of public records shall be provided to any person upon payment of the cost of copying.

(5) Declaratory Orders - The Board adopts, as if fully set out herein, Rule 1200-10-01-.11 Declaratory Orders of the Division of Health Related Boards and as it may from time to time be amended, as its rule governing the declaratory order process. All declaratory order petitions involving statutes, rules or orders within the jurisdiction of the Board shall be addressed by the Board pursuant to that rule and not by the Division. Declaratory Order Petition forms can be obtained from the Board’s administrative office.

(6) Screening Panels - The Board adopts, as if fully set out herein, Rule 1200-10-01-.13, of the Division of Health Related Boards and as it may from time to time be amended, as its rule governing the screening panel process.

(7) The Board authorizes the member who chaired the Board for a contested case to be the agency member to make the decisions authorized pursuant to Rule 1360-04-01-.18 regarding petitions for reconsiderations and stays in that case.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-223, 4-5-224, 63-1-105, 63-1-113, 63-1-138, 68-29-105, 68- 29-109, and 68-29-127.
• Administrative History: Original rule filed May 3, 1995; effective July 17, 1995. Amendment filed September 9, 1996; effective November 23, 1996. Amendment filed March 4, 1998; effective May 20, 1998. Amendment filed June 10, 1999; effective October 28, 1999. Amendment filed March 22, 2001; effective June 5, 2001. Amendment filed August 25, 2003; effective November 8, 2003. Amendment filed March 16, 2007; effective May 30, 2007. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-01-.20 QUALIFICATIONS AND DUTIES OF THE MEDICAL LABORATORY DIRECTOR

(1) Qualifications. It shall not be necessary for an individual who is licensed as a medical laboratory director to be licensed in any other category under these rules. Pathologists and any other person who is duly licensed and registered to practice medicine in the State of Tennessee and boarded by a national boarding agency acceptable to the Board will not be required to obtain a medical laboratory license in addition to their medical license. This medical license shall be current and in good standing. Individuals that hold an earned doctoral degree (non-medical) are required to obtain a license as a laboratory director from the Board. To be eligible to direct a medical laboratory a person shall meet one (1) or more of the following requirements:

(a) Be a physician licensed in Tennessee and certified or eligible for certification in anatomic or clinical pathology by the American Board of Pathology or the American Osteopathic Board of Pathology. Physicians who are eligible for certification must become certified within three (3) years of assuming directorship.

1. The director of an anatomic laboratory must be certified or eligible for certification in anatomic pathology.

2. The director of a clinical laboratory must be certified or eligible for certification in clinical pathology.

3. The director of a laboratory that conducts anatomic and clinical pathology must be certified or eligible for certification in anatomic and clinical pathology.

(b) Be a physician licensed in Tennessee and certified by the American Board of Medical Microbiology, the American Board of Clinical Chemistry, the American Board of Bioanalysis, American Board of Medical Laboratory Immunology, or other certifying boards acceptable to the Board in one or more of the laboratory specialties for which approval for directorship is being sought. Board certifications must be current.

(c) Hold an earned doctoral degree in a chemical, physical, biological, or clinical laboratory science, from an accredited institution or equivalent and be certified by the American Board of Medical Microbiology, the American Board of Clinical Chemistry, the American Board of Bioanalysis, American Board of Medical Laboratory Immunology or other certifying boards acceptable to the Board in one or more of the laboratory specialties for which approval for directorship is being sought. Board certifications must be current.

(d) Be a physician licensed in Tennessee, who subsequent to graduation has had four (4) years or more experience in pulmonary function. The directorship is limited to blood gas analysis (pH, pO2, pCO2) and co-oximetry analysis (measurement of oxygen saturation), and reporting of the measurement(s) to include carboxyhemoglobin, total hemoglobin, oxyhemoglobin, methemoglobin, and sulfhemoglobin on automated instruments.

1. The phrase “subsequent to graduation” means laboratory training and experience acquired after receipt of the specified degree.

2. The term “experience” means broad, relevant experience gained in a clinical laboratory located in the United States. The Board will evaluate the experience required for qualification within these rules.

(e) Hold an earned doctoral degree from an accredited college/university and, in the opinion of the Board, have appropriate work experience in a subspecialty for which there is no national certification. If boarding is available in a closely related field, that boarding must be sought. These individuals must obtain national boarding in the subspecialty when it becomes available.

(2) The Board shall review and approve all director licenses.

(3) A physician who was qualified and acting as a medical laboratory director at a facility on or before July 16, 1995, may continue acting as the medical laboratory director at that facility.

Otherwise, to qualify as a medical laboratory director the individual must meet the minimum licensure requirements stated in Rule 1200-06-01-.20(1).

(4) Oral Pathology Laboratory Director (a) A dentist may serve as a medical laboratory director limited to the specialty of oral pathology without obtaining medical laboratory licensure if 1. The dentist has a current, unrestricted, and unencumbered license to practice dentistry in Tennessee; and 2. The dentist is currently certified by the American Board of Oral and Maxillofacial Pathology; and 3. The dentist is currently certified in oral pathology by the Tennessee Board of Dentistry.

(b) Otherwise, to qualify as a medical laboratory director the individual must meet the minimum licensure requirements stated in Rule 1200-06-01-.20(1) or (3).

(c) Oral pathology laboratory directors shall limit their responsibilities to only those specimens obtained from the oral cavity.

(5) Duties. The laboratory director is responsible for the overall operation and administration of the laboratory, including the employment of personnel who are competent to perform test procedures, record and report test results promptly, accurately and proficiently, and for assuring compliance with the applicable regulations.

(a) The laboratory director, if qualified, may perform the duties of the medical laboratory supervisor and of testing personnel or may delegate those responsibilities to personnel meeting the qualifications for those respective positions.

(b) The laboratory dire ctor may delegate duties to the medical laboratory supervisor.

However, the director remains responsible for ensuring that all duties are properly performed.

(c) The laboratory director must be accessible to the laboratory to provide onsite, telephone, or electronic consultation as needed. The director shall make periodic and documented on-site visits at a minimum of once per month.

(d) The laboratory director must not direct more than three (3) clinical labs without an exemption from the Board. Collection stations are not considered clinical laboratories.

(e) The laboratory director must - 1. Ensure that testing systems developed and used for each of the tests performed in the laboratory provide quality laboratory services for all aspects of test performance, which includes the preanalytic, analytic, and postanalytic phases of testing;

2. Ensure that the physical plant and environmental conditions of the laboratory are appropriate for the testing performed and provide a safe environment in which employees are protected from physical, chemical and biological hazards;

3. Ensure that - (i) The test methodologies selected have the capability of providing the quality of results required for patient care, (ii) Verification procedures used are adequate to determine the accuracy, precision, and other pertinent performance characteristics of the method; and (iii) Laboratory personnel are performing the test methods as required for accurate and reliable results;

4. Ensure that the laboratory is enrolled in a proficiency testing program approved by the U.S. Department of Health and Human Services for the testing which is performed and that - (i) The proficiency testing samples are tested as required under these rules;

(ii) The results are returned within the timeframes established by the proficiency testing program;

(iii) All proficiency testing reports received are reviewed by the appropriate staff to evaluate the laboratory’s performance and to identify any problems that require corrective action;

(iv) An approved corrective action plan is followed when any proficiency testing result is found to be unacceptable or unsatisfactory; and (v) The regional surveyor is notified in the event the proficiency testing scores are unacceptable or unsatisfactory. The response form shall be completed to include any corrective action implemented to solve the problem(s).

5. Ensure that the quality control and quality assurance programs are established and maintained to assure the quality of laboratory services provided and to identify failures in quality as they occur;

6. Ensure the establishment and maintenance of acceptable levels of analytical performance for each test system;

7. Ensure that all necessary remedial actions are taken and documented whenever significant deviations from the laboratory’s established performance characteristics are identified, and that patient test results are reported only when the system is functioning properly;

8. Ensure that reports of test results include pertinent information required for interpretation;

9. Ensure that consultation is available to the laboratory’s clients on matters relating to the quality of the test results reported and their interpretation concerning specific patient conditions;

10. Ensure that a general supervisor provides supervision of test performance by testing personnel;

11. Ensure that a sufficient number of laboratory personnel are employed who possess the appropriate education and experience or training to provide appropriate consultation, to properly supervise and to accurately perform tests and report test results in accordance with the personnel responsibilities described in Rule 1200-06-01-.22;

12. Ensure that prior to testing patients’ specimens, all personnel have the appropriate education and experience, receive the appropriate training for the type and scope of the services offered, and have demonstrated that they can perform all testing operations reliably to provide and report accurate results;

13. Ensure that policies and procedures are established for monitoring individuals who conduct preanalytical, analytical, and postanalytical phases of testing to assure that they are competent and maintain their competency to process specimens, perform test procedures and report test results promptly and proficiently, and whenever necessary, identify needs for remedial training or continuing education to improve skills;

14. Ensure that an approved procedure manual is available to all personnel responsible for any aspect of the testing process:

15. Ensure, in writing, the responsibilities and duties of each person engaged in the performance of the preanalytic, analytic, and postanalytic phases of testing, that identifies which examinations and procedures each individual is authorized to perform, whether supervision is required for specimen processing, test performance or result reporting and whether supervisory or director review is required prior to reporting patient test results; and 16. Provide consultation regarding the appropriateness of the testing ordered and interpretation of test results.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-103, 68-29-104, 68-29-105, 68-29-111, 68-29-114, 68-29- 116, 68-29-118, 68-29-129, and 68-29-137.
• Administrative History: Original rule filed May 3, 1995; effective July 17, 1995. Amendment filed September 11, 1996; effective November 25, 1996. Amendment filed January 7, 1997; effective March 23, 1997. Amendment filed March 4, 1998; effective May 20, 1998. Amendment filed April 29, 2002; effective July 13, 2002. Amendment filed May 23, 2003; effective August 6, 2003. Amendment filed August 25, 2003; effective November 8, 2003. Amendment filed June 2, 2004; effective August 16, 2004. Amendment filed October 11, 2004; effective December 25, 2004. Amendment filed February 15, 2006; effective May 1, 2006. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-01-.21 QUALIFICATIONS AND DUTIES OF THE MEDICAL LABORATORY SUPERVISOR

(1) The laboratory must have one or more medical laboratory supervisors who, under the direction of the laboratory director, provide day-to-day supervision of testing personnel and reporting of test results. In the absence of the director, the medical laboratory supervisor must be responsible for the proper performance of all laboratory procedures and reporting of test results. An individual who qualifies as medical laboratory director is considered to be qualified as a medical laboratory supervisor.

(a) The medical laboratory supervisor shall meet one of the following qualifications:

1. Be a physician licensed in Tennessee or hold a doctoral degree from an accredited college/university in a chemical, physical, biological, or clinical laboratory science. Subsequent to obtaining a doctoral degree, the applicant must have at least two (2) years of full time clinical laboratory work experience as defined in Rule 1200-06-01-.22(1)(h) in the area they wish to supervise.

2. Hold a valid general medical laboratory technologist license in Tennessee or meet one (1) of the requirements under Rule 1200-06-01-.22(1)(a)1. through 5. and provide all required documentation in support of that qualification and have at least three (3) years of full time clinical laboratory work experience as defined in Rule 1200-06-01-.22(1)(h).

3. Hold a valid medical laboratory technologist license in Tennessee limited to one of the categories of chemistry, hematology, immunohematology, microbiology, or immunology and meet the requirements under Rule 1200-06-01-.22(1)(c) and provide all required documentation in support of that qualification and have at least three (3) years of full time clinical laboratory work experience as defined in

Rule 1200-06-01-.22(1)(h) subsequent to qualifying as a technologist. The license shall be limited to the category for which the applicant is qualified.

4. Hold a valid special analyst license limited to one (1) subspecialty or meet one (1) of the requirements under Rule 1200-06-01-.22(1)(d) and provide all required documentation in support of that qualification and have at least three (3) years of ful l time clinical laboratory work experience as defined in Rule 1200-06-01- .22(1)(h) subsequent to qualifying as a special analyst. The license shall be limited to the subspecialty for which the applicant is qualified.

(b) Clinical laboratory work experience, as required in Rule 1200-06-01-.21(1)(b)2., 3., or 4. begins when the applicant either receives a national certification or state licensure at the technologist or special analyst level.

(c) Unless qualified as a medical laboratory director, in addition to the requirements indicated in subparagraph (1)(b) to be licensed as a medical laboratory supervisor the individual must also provide the fol lowing documentation:

1. Proof of at least forty-five (45) clock hours of management continuing education through professional workshops, seminars or courses (on campus or online) relating to management. Fifteen (15) clock hours will be awarded for each semester hour earned at a college or university; and 2. The management clock hours shall be completed subsequent to qualifying as a medical technologist or special analyst as defined in subparagraph (1)(b).

(2) Duties.

(a) The medical laboratory supervisor - 1. Shall be responsible for laboratory operations as delegated by the medical laboratory director.

2. Shall be on the laboratory premises at a minimum of thirty (30) hours per week and be readily available for consultations during all other hours when tests are performed.

3. Shall be responsible for providing day-to-day supervision of test performance by testing personnel.

4. Shall be responsible for monitoring test analyses and specimen examinations to ensure that acceptable levels of analytic performance are maintained.

(b) The medical laboratory director may delegate, pursuant to written policy, to the medical laboratory supervisor specific duties that do not comprise the practice of medicine, including the following:

1. Assuring that all remedial actions are taken whenever test systems deviate from the laboratory’s established performance specifications;

2. Ensuring that patient test results are not reported until all corrective actions have been taken and the test system is properly functioning;

3. Providing orientation to all testing personnel, and 4. Annually evaluating and documenting the performance of all testing personnel.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-103, 68-29-104, 68-29-105, 68-29-116, and 68-29-118.
• Administrative History: Original rule filed May 3, 1995; effective July 17, 1995. Amendment filed September 11, 1996; effective November 25, 1996. Amendment filed August 25, 2003; effective November 8, 2003. Amendment filed February 15, 2006; effective May 1, 2006. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-01-.22 QUALIFICATIONS, RESPONSIBILITIES AND DUTIES OF TESTING PERSONNEL

(1) Qualifications. All testing personnel shall hold a valid Tennessee license issued by the Board to perform or report a laboratory test.

(a) To become licensed as a medical laboratory technologist, an applicant shall:

1. Submit satisfactory evidence of the successfully completing and passing a national certifying examination and being nationally certified at the technologist level by either the ASCP, NRCC, NRM, ABB, AMT, ASCPi (if taken after January 2015), or any other natio nal certifying agency recognized by the Board (Successful completion of the Health and Human Services proficiency examination in clinical laboratory science does not meet this criteria for licensure); and 2. In addition to possessing the national certification required by Part 1. of this subparagraph, submit satisfactory evidence of having met one (1) of the following educational criteria:

(i) A baccalaureate degree in medical technology or in one of the biological, chemical, or physical sciences and completion of a medical laboratory technologist training program that was, at the time of graduation, either (I) Approved or under the auspices of the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS); or (II) Approved by a national accrediting agency acceptable to the Board; or (III) Completed in a specialty program conducted by a hospital or other institution approved pursuant to Rule 1200-06-02-.04; or (ii) A baccalaureate degree from an accredited college/university, completion of an accredited MLT/CLT training program and three (3) years of full time clinical laboratory work experience as defined in subparagraph (1)(h); the individual must have completed science coursework equivalent to that required in a laboratory science education program as defined by subparagraph (1)(g); or (iii) A baccalaureate degree from an accredited college/university, completion of an official military laboratory procedures course of at least fifty (50) weeks duration in residence and have held the military enlisted occupational specialty pertaining to laboratory medicine, and three (3) years of full time clinical laboratory work experience as defined in subparagraph (1)(h); the individual must have completed science coursework equivalent to that required in a laboratory science education program as defined by subparagraph (1)(g); or (iv) A baccalaureate degree from an accredited college/university and five (5) years of full time clinical laboratory work experience as defined in subparagraph (1)(h); the individual must have completed science coursework equivalent to that required in a laboratory science education program as defined by subparagraph (1)(g).

(b) Those applicants for medical laboratory technologist licensure who do not possess a baccalaureate degree may be approved for licensure upon having submitted to the Board’s administrative office directly from the national certifying agency satisfactory proof of having successfully completed on or before September 1, 1997 (the date on which CLIA required at a minimum an associate’s degree or its equivalent for those who would be performing high complexity testing and the date on which the Board ceased providing the state licensure examination) a medical laboratory technologists national certification examination and submission to the Board’s administrative office directly from the issuing authorities of satisfactory proof that the applicant met one (1) of the following criteria:

1. The applicant had, on or before September 1, 1997, received a passing grade on a Health and Human Services proficiency examination in clinical laboratory science and had completed five (5) years of full time clinical laboratory work experience as defined in subparagraph (1)(h); or 2. The applicant had, on or before September 1, 1997, completed a minimum of ninety (90) semester hours including science course work equivalent to that required in a laboratory science education program as defined by (1)(g) of this

rule; and had, on or before September 1, 1997, completed a medical laboratory technologist training program that was approved at the time of graduation by the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) or a national accrediting agency acceptable to the Board.

(c) To become licensed as a medical laboratory technician an applicant shall:

1. Submit satisfactory evidence of successfully completing and passing a national certifying examination and being nationally certified at the technician level; and 2. In addition to possessing the national certification required by Part 1. of this subparagraph, submit satisfactory evidence of one (1) of the following educational criteria:

(i) Having received an associate degree from an accredited college/university and having completed an accredited medical laboratory technician training program that was approved at the time of graduation by the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) or a national accrediting agency acceptable to the Board; or (ii) Having received an associate degree from an accredited college/university and having completed an official military laboratory procedures course of at least fifty (50) weeks duration in residence and having held the military enlisted occupational specialty pertaining to laboratory medicine; or (iii) An associate degree from an accredited college/university which included at least six (6) semester hours of chemistry and six (6) semester hours of biology and three (3) years of full time clinical laboratory work experience as defi ned in subparagraph (1)(h).

(d) To become licensed as a medical laboratory technologist in any of the following categories: chemistry, hematology, immunohematology, microbiology, or immunology, the applicant shall:

1. Present proof of national certification by a certifying body acceptable to the Board in the laboratory specialty in which licensure is being sought at the technologist level; and 2. Meet one of the additional qualifications referred to in subparagraph (1)(a)2.

(e) To become licensed as a special analyst, an applicant shall:

1. Submit satisfactory evidence of certification by a national certification body approved by the Board, where such certification or qualification exists and possess a baccalaureate degree from an accredited college/university relevant to the subspecialty in which licensure is being sought, or 2. In the absence of national certification, the individual must possess at least a baccalaureate degree from an accredited college/university relevant to the subspecialty in which licensure is being sought and proof of three (3) years of relevant work experience, as approved by the Board. The Board shall review all individuals qualifying in this manner before licensure may be obtained.

Individuals must obtain national certification at such time as it becomes available and must request that proof of said national certification be sent directly to the Board’s administrative office from the certifying agency in order to continue licensure. Failure to obtain national certification may result in revocation of the license.

3. An individual may be issued a special analyst license to perform tests in a limited category (as listed on the license) if the procedure(s) for which licensure is being sought is a new, emerging technology in the clinical laboratory or represents a subspecialty not otherwise regulated. The procedure(s) shall not be a component of chemistry, hematology, microbiology, immunohematology, or immunology.

(f) Testing personnel performing blood gas (pCO2, pO2, and pH) analysis and cooximetry analysis (measurement of oxygen saturation) and reporting of the measurement(s) to include carboxyhemoglobin, total hemoglobin, methemoglobin, and oxyhemoglobin and sulfhemoglobin on automated instruments shall:

1. Hold a valid license as a special analyst limited to blood gases, or 2. Hold a valid arterial blood gas (ABG) endorsement issued by the Board of Respiratory Care, pursuant to the Respiratory Care Practitioner Act and rules promulgated by that board.

(g) The science coursework equivalent to that required in a laboratory science education program includes:

1. Thirty-two (32) semester hours or forty-eight (48) quarter hours of chemical and biological sciences coursework including one class of microbiology (lecture and laboratory) and one course in organic or biochemistry (lecture and laboratory).

These courses may be obtained online or on campus.

2. Survey, audit, remedial courses, non-graded courses, or didactic courses from a medical laboratory technologist training program do not fulfill the biological and chemical science coursework requirement. College level examination program and advanced placement courses may qualify to fulfill the biological and chemical science coursework requirement.

(h) Clinical laboratory work experience shall be:

1. Obtained in a licensed medical laboratory, CLIA-approved site where testing is done at moderate complexity or higher, or other facility approved by the Board with a director qualified under Rule 1200-06-01-.20;

2. Acquired predominantly in the laboratory medicine specialty category in which the individual is seeking licensure; and 3. Documented to the Board’s satisfaction.

(2) Responsibilities and Duties of Testing Personnel (a) Responsibilities and duties of the medical laboratory technologist and special analyst include:

1. Collecting and preparing specimens for analysis. Storing or transporting specimens using appropriate preservation methods.

2. Following prescribed procedures, performing any of the tests within any of the laboratory specialties. Calculating the results of the tests performed if necessary.

3. Operating, calibrating, conducting performance checks, and maintaining any clinical laboratory instrument or equipment.

4. Recognizing and correcting basic instrument malfunctions. Notifying supervisory personnel when appropriate.

5. Preparing reagents or media from a prescribed procedure, making any adjustments needed.

6. Evaluating media, reagents, and calibrators according to established criteria.

7. Conducting established quality control procedures on analytical tests, equipment, reagents, media, and products; evaluating results of quality control and implementing corrective action when indicated.

8. Determining performance specifications for new methods.

9. Establishing basic quality control procedures.

10. Performing comparison studies of precision, accuracy, linearity, and validation on new or existing procedures and reporting results in an established format.

11. Correlating and interpreting data based on knowledge of physiological conditions affecting test results. Assessing plausibility of laboratory results through correlation of data.

12. Indicating the need for additional laboratory tests for definitive diagnostic information in prescribed instances.

13. Confirming and verifying results through knowledge of techniques, principles, and instruments.

14. Recognizing problems, identifying the cause, developing alternatives and determining solutions where no preset criteria are available.

15. Establishing and monitoring quality assurance/continuous quality improvement programs.

16. Establishing and monitoring safety programs in compliance with laboratory regulations.

17. Maintaining records that demonstrate the proficiency testing samples are tested in the same manner as patient specimens.

18. Utilizing laboratory information systems or other methods to accurately and effectively report patient results.

19. Writing laboratory procedures conforming to standardized format.

20. Performing clinical orientation and supervision for students and new or less skilled laboratory personnel.

21. Participating and providing input in competency evaluations.

(b) Responsibilities and duties of the medical laboratory technician include:

1. Collecting and preparing specimens for analysis. Storing and transporting specimens using appropriate preservation methods.

2. Following prescribed methods, performing analytical tests in laboratory specialties in which appropriate training has been received.

3. Calibrating, conducting performance checks, and maintaining any clinical laboratory instrument or equipment. Performance of calibrations on clinical and point of care instruments, when and if those calibration procedures do not require sample manipulati on beyond thawing of the calibration materials or simple reconstitution of the same materials; and where there are no procedures or possibilities for user intervention(s), to include mathematical manipulations of the slope or intercept of the calibration curve.

4. Making calculations as needed to report test results.

5. Operating equipment or instruments necessary to perform high volume analytical tests. Recognizing instrument malfunction and making corrections using preset strategies or notifying a technologist or supervisor.

6. Preparing reagents and media according to prescribed procedures.

7. Performing and recording quality control procedures required for tests assayed.

Recognizing unacceptable quality control results. Correcting problems according to preset strategies or notifying a technologist or supervisor.

8. Recognizing abnormal or unusual test results and following institutional procedures for reporting critical values.

9. Utilizing laboratory information systems or other methods to accurately and effectively report patient results.

10. Performing inventory of supplies according to prescribed lists.

11. Observing all established laboratory safety procedures.

12. Participating in laboratory quality assurance/continuous quality improvement activities.

13. Maintaining records to demonstrate that proficiency testing samples are tested in the same manner as patient specimens.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-103, 68-29-105, 68-29-117, and 68-29-118.
• Administrative History: Original rule filed May 3, 1995; effective July 17, 1995. Amendment filed September 9, 1996; effective November 23, 1996. Amendment filed January 7, 1997; effective March 23, 1997. Amendment filed March 25, 1997; effective June 6, 1997. Amendment filed March 4, 1998; effective May 20, 1998. Amendment filed August 23, 2001; November 6, 2001. Amendment filed January 31, 2003; effective April 16, 2003. Amendment filed August 25, 2003; effective November 8, 2003. Amendment filed April 17, 2007; effective July 1, 2007. Amendment filed April 1, 2009; effective June 15, 2009. Amendment filed April 22, 2010; effective July 21, 2010. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-01-.23 QUALIFICATIONS AND DUTIES OF THE CYTOLOGY SUPERVISOR

(1) Qualifications. A laboratory must have a cytology supervisor who meets the qualifications listed below and provides supervision in accordance with these rules. The cytology supervisor shall:

(a) Hold a valid Cytotechnologist license in Tennessee or meet one (1) of the requirements under Rule 1200-06-01-.24(1) and provide all required documentation in support of that qualification; and (b) Have at least three (3) years of full-time work experience as a Cytotechnologist within the ten (10) years preceding the application. Experience must be obtained in an anatomic pathology laboratory which has a director at the doctoral level or other anatomic laboratories acceptable to the Board; and (c) Unless qualified as an anatomic pathology laboratory director, in addition to the requirements indicated above to be licensed as a cytology supervisor the individual shall also provide the following:

1. Proof of at least forty-five (45) clock hours of continuing education through professional workshops, seminars or courses relating to management. Fifteen (15) clock hours will be awarded for each semester hour earned at a college or university.

2. Proof of at least fifteen (15) clock hours of technical continuing education through professional workshops, seminars or courses relating to anatomic pathology laboratory practice.

3. The management and technical clock hours shall be completed subsequent to qualifying as a special analyst in cytotechnology as defined in Rule 1200-06-01- .21(1)(b).

(2) Duties. The cytology supervisor is responsible for the day-to-day supervision or oversight of the laboratory operation and personnel performing testing and reporting test results.

Responsibilities and duties include:

(a) Shall be on the laboratory premises at a minimum of thirty (30) hours per week and be readily available for consultations during all other hours when tests are performed.

Being accessible to provide consultation to resolve technical problems in accordance with policies and procedures;

(b) Documenting the slide interpretation results of each gynecologic and nongynecologic cytology case he or she examined or reviewed;

(c) For each twenty-four (24) hour period, documenting the total number of slides examined or reviewed in the laboratory as well as the total number of slides examined or reviewed in any other laboratory or for any other employer; and (d) Documenting the number of hours spent examining slides in each twenty-four (24) hour period.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-103, 68-29-105, and 68-29-118.
• Administrative History: Original rule filed May 3, 1995; effective July 17, 1995. Amendment filed September 11, 1996; effective November 25, 1996. Amendment filed August 25, 2003; effective November 8, 2003. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-01-.24 QUALIFICATIONS AND DUTIES OF THE CYTOTECHNOLOGIST

(1) Qualifications - Each person examining cytology slide preparations must possess a current special analyst license as a cytotechnologist issued by the Board. To be eligible for that lic ense the applicant must provide proof of national certification by a certifying agency approved by the Board. All applicants for that license who were awarded national certification on or after August 1, 1988 must also submit proof that the certification was awarded based upon the applicant’s possession of a baccalaureate degree earned at a regionally accredite d college/university and cytology training from a school accredited by the Commission of Accreditation of Allied Health Education Programs (CAAHEP) or other accrediting body acceptable to the Board. Applicants whose national certification was awarded prior to August 1, 1988 need only submit proof that national certification was awarded regardless of the prerequisites upon which it was based.

(2) Responsibilities and duties of the cytotechnologist include:

(a) Processing, performing, reviewing, and correlating diagnostic techniques ancillary to liquid based cytology.

(b) Assisting in the collection and preparation of cytologic specimens for analysis.

(c) Accepting or rejecting the cytologic specimen based upon established criteria.

(d) Storing or transporting specimens using appropriate preservation methods.

(e) Selecting the most appropriate preparation and staining techniques and preparing specimens for microscopic analysis.

(f) Operating, calibrating, conducting performance checks and maintaining any laboratory instrument or equipment.

(g) Recognizing and correcting basic instrument malfunctions and notifying cytology supervisor when appropriate.

(h) Preparing stains and reagents from a prescribed procedure, making any adjustments needed.

(i) Evaluating stains and reagents according to established criteria.

(j) Conducting established quality control procedures on equipment, stains, reagents; evaluating results of quality control and implementing corrective action when indicated.

(k) Determining performance specifications for new preparation techniques.

(l) Establishing basic quality control procedures.

(m) Performing comparison studies on new or existing procedures and reporting results in an established format.

(n) Utilizing the microscope properly for visualization of the specimen, applying knowledge of microscope care and maintenance.

(o) Determining specimen adequacy after microscopic examination.

(p) Screening, detecting, selecting, and marking areas most representative of any pathological process present.

(q) Making an interpretation based upon the microscopic appearance of the cytologic specimen.

(r) Establishing and monitoring quality assurance/continuous quality improvement programs.

(s) Establishing and monitoring safety programs in compliance with laboratory regulations.

(t) Utilizing laboratory information systems or other methods to accurately and effectively report patient results.

(u) Writing laboratory procedures conforming to a standardized format.

(v) Performing orientation and supervision for students and new or less skilled laboratory personnel.

(w) Reporting test results conforming to established procedures.

(x) Documenting the slide interpretation results of each gynecologic and nongynecologic cytology case examined or reviewed.

(y) For each twenty-four (24) hour period, documenting the total number of slides examined or reviewed in the laboratory as well as the total number of slides examined or reviewed in any other laboratory or for any other employer, and (z) Documenting the number of hours spent examining slides in each twenty-four (24) hour period.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-103, 68-29-105, and 68-29-118.
• Administrative History: Original rule filed May 3, 1995; effective July 17, 1995. Amendment filed September 9, 1996; effective November 23, 1996. Amendment filed August 25, 2003; effective November 8, 2003. Amendment filed July 8, 2004; effective September 21, 2004. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-01-.25 QUALIFICATIONS OF ESOTERIC LABORATORY PERSONNEL

(1) Qualifications. Esoteric Laboratory Personnel shall possess a baccalaureate or advanced degree in the appropriate sciences with at least sixteen (16) semester hours of chemistry and/or biological science courses.

(a) “Advanced degree” is a master’s degree, a doctorate or other degree conferred by a postsecondary institution upon completion of a unified program of study at the graduate level;

History

• Authority: T.C.A. §§ 68-29-103, 68-29-105, 68-29-118, and 68-29-138.
• Administrative History: New rul e filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-01-.26 PERSONNEL EXEMPT FROM LICENSURE

All testing performed in a medical laboratory shall be performed by licensed personnel. Medical laboratory personnel and certain other health care professionals shall be exempt from licensure to perform the following functions or specialties under the provisions and conditions as stated herein:

(1) (a) Personnel performing specimen collection shall be exempt from licensure, providing that the specimen collection procedure is performed under the supervision of a physician, medical laboratory director, supervisor or technologist.

(b) When blood is withdrawn from a patient in a home for the aged, nursing home, residential hospice, or recuperative center, or from a patient of a home care organization, the procedure must be performed by:

1. a trained phlebotomist, or 2. a person who has been properly trained to draw blood and who has been licensed in this state by the appropriate board for the respective health care profession of such person.

(c) Records verifying appropriate training of phlebotomists must be maintained by licensed facilities as listed in paragraph (1)(b) above and be available for inspection.

(2) Personnel performing Waived and Point of Care laboratory testing shall be exempt from licensure, provided such testing is performed in accordance with rules 1200-06-03-.16 and

Tenn. Comp. R. & Regs. 1200-06-01-.27 CONSUMER RIGHT-TO-KNOW REQUIREMENTS

(1) Malpractice reporting requirements. The threshold amount below which medical malpractice judgments, awards or settlements in which payments are awarded to complaining parties need not be reported pursuant to the “Health Care Consumer Right-To-Know Act of 1998” shall be ten thousand dollars ($10,000).

(2) Criminal conviction reporting requirements. For purposes of the “Health Care Consumer Right-To-Know Act of 1998,” the following criminal convictions must be reported:

(a) Conviction of any felony.

(b) Conviction or adjudication of guilt of any misdemeanor, regardless of its classification, in which any element of the misdemeanor involves any one or more of the following:

1. Sex.

2. Alcohol or drugs.

3. Physical injury or threat of injury to any person.

4. Abuse or neglect of any minor, spouse or the elderly.

5. Fraud or theft.

(c) If any misdemeanor conviction reported under this rule is ordered expunged, a copy of the order of expungement signed by the judge must be submitted to the Department before the conviction will be expunged from any profile.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-2-101, et seq., 63-51-101, et seq., 68-29-102, 68-29-103, 68- 29-104, and 68-29-105.
• Administrative History: Original rule filed December 1, 2000; effective February 14, 2001. Rule was previously numbered 1200-06-01-.26 but was renumbered 1200-06-01-.27 with the int roduction of a new rule 1200-06-01-.25 filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-10-01-.10 .

(e) For persons licensed under national certification requirements as provided in Rules

Tenn. Comp. R. & Regs. 1200-06-03-.17 governing Medical Laboratories.

(3) Personnel employed in laboratories licensed under T.C.A. § 68-29-138.

(4) All personnel performing the testing described in Rule 1200-06-03-.02(5) in the laboratory (or portion of the otherwise licensed laboratory) exempted from licensure pursuant to that rule.

(5) Public Health Clinic Laboratory Practitioners are exempt to perform public health clinic laboratory tests in state or county health departments.

(a) A Public Health Clinic Laboratory Practitioner is a person with at least a high school diploma who has successfully completed a Public Health Clinic Laboratory Practitioner training program approved by the Board. The practitioner’s scope of practice is limited to these laboratory procedures set out below.

(b) Public health clinic laboratory tests are:

1. Hematocrit 2. Hemoglobin 3. Qualitative Pregnancy Test 4. Blood Glucose/Semi-Quantitative 5. Wet Mount (Trichomonas and Yeast)

2. Mono Test 7. Fecal Occult Blood 8. Urine Dip Stick 9. Rapid Strep Test (6) Medical students performing any laboratory tests on their own patients, provided that this performance is a function of their training, shall not be required to have a license; provided that results of such laboratory studies by medical students shall not constitute an official laboratory report and shall not be recorded on official laboratory report forms.

(7) Regional public health laboratory personnel exempt pursuant to T.C.A. § 68-29-104(11).

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-103, 68-29-104, and 68-29-105.
• Administrative History: Original rule filed May 3, 1995; effective July 17, 1995. Amendment filed January 7, 1997; effective March 23, 1997. Amendment filed February 14, 2000; effective April 29, 2000. Amendment filed August 25, 2003; effective November 8, 2003. Rule was previously numbered 1200-06-01-.25 but was renumbered

Chapter 1200-06-02 Training Programs for Medical Laboratory Personnel

Tenn. Comp. R. & Regs. 1200-06-02-.01 GENERAL REQUIREMENTS FOR ALL PROGRAMS

(1) The Board shall approve the training programs which meet the requirements of one of the following types:

(a) Medical Laboratory Technologist Program (b) Medical Laboratory Technician - Associate Degree Program (c) Medical Laboratory Technologist Specialty Program (d) Special Analyst Program (2) All Programs for the Training of Medical Laboratory Personnel to Apply for Approval.

(a) The owner and/or the director of a training program for medical laboratory personnel shall make application for approval to operate that program on forms provided by the Board at least six (6) months prior to anticipated first day of instruction.

(b) Each school shall be subject to on-site inspection by representatives of the Board and/or complete such paper surveys as requested.

(c) A scheduled on-site inspection to validate the initial application shall be conducted by representatives of the Board.

(d) The Board shall be notified within thirty (30) days of any changes made in the operation of the training program such as a change of ownership, location, accreditation status, directorship, instructors and/or program closure. A new certificate of approval will be issued in the event of change in either ownership or directorship of the training program. A change in ownership shall also include an exchange of stock in an incorporated school.

(e) All training programs must be accredited by a national organization approved by the Board, if applicable.

(3) Fees Amount (a) Initial Training Program Application Fee $200.00 Annual Registration (Renewal) Fee $100.00 State Regulatory Fee $5.00 (b) The Certificate of Approval shall be for one (1) year and shall expire on December 31st of any given year.

(4) Minimum Standards for Facilities, Equipment, and Materials for All Training Programs for Medical Laboratory Personnel.

(a) The Training Program must insure that adequate space, light, and modern operable equipment is available in the teaching laboratory and medical laboratory’s clinical rotation sites. All equipment used in the training program shall be subject to inspection and approval by the Board.

(b) Each training program for medical laboratory personnel shall have adequate classroom, laboratory, office, storage, and sanitary facilities which shall be subject to inspection and approval by the Board.

(c) A designated student laboratory area shall be available for teaching basic techniques, instrumentation and problem solving for procedures not available in the clinical facility(ies).

(d) Each training program facility for medical laboratory personnel must provide written documentation of compliance with local and state fire codes to the Board upon request.

(e) Written fire and safety procedures shall be made available to each student. Pertinent fire safety procedures shall be displayed in conspicuous places in the training program facility.

(f) A library containing up-to-date texts, references, and scientific periodicals pertinent to laboratory medicine as well as the latest editions of books and journals on laboratory technology shall be accessible to the students. Texts required to be purchased by students must not be a substitute library [Older reference texts of value may be retained. Up-to-date is defined as published within the last five (5) years].

(g) Demonstration materials and multimedia instructional material shall be available as provided under other sections of these regulations.

(h) An outline of the instruction provided, including a structured clinical laboratory practicum, shall be filed with the Board. When major revisions/changes are made in the curriculum, a new outline shall be submitted to the Board.

(i) A description of evaluation procedures for both student and program shall be submitted to the Board upon making application for approval of the Training Program. These evaluations shall be maintained for future inspection by the Board or its designee.

Provision must be included for periodic review of the effectiveness of the program by members of the faculty and/or other appropriate groups. Student evaluation procedures must include mechanisms to measure cognitive knowledge, psychomotor and affective behavior.

(j) Student recruitment, admission and matriculation must be nondiscriminatory with respect to color, creed, race, sex, age, handicap(s), and national origin.

(k) Satisfactory records must be kept and shall be available for inspection by the Board.

These shall include but not be limited to:

1. A list of instructors, by category, in the training program and clinical laboratory facilities. This list shall be submitted with initial application and thereafter upon request;

2. Current examinations given to students;

3. Scores on licensure examinations;

4. Records of students, including:

(i) A complete application form;

(ii) Transcript of academic credit;

(iii) Written evidence the student can reasonably be expected to perform the medical laboratory work for which he/she is trained which must include a recent complete physical examination performed by a licensed physician or nurse practitioner prior to beginning clinical rotation;

(iv) Record of attendance, including excused and unexcused absences;

(v) Evaluation by instructors based on appropriate written, practical, and oral examinations covering all types of structured learning experiences (clinical and classroom) related to the medical laboratory; and (vi) Written criteria for passing, failing, and progression in the program must be provided. These must be given to each student at the time of entry into the program and may be provided either electronically or by hard copy.

(l) The program shall be approved for a specific number of students which shall not be exceeded without prior approval by the Board.

(m) There shall be an affiliation agreement between the educational institution and the licensed laboratory agreeing to serve as the clinical rotation site. The agreement shall state the responsibilities of each party regarding the clinical training of the students enrolled in that program and instructions from each clinical facility for exchange of information and views. The affiliation agreement shall be submitted to the Board upon initial application for training program approval and thereafter prior to any change in clinical rotation sites. A clinical rotation fact sheet must accompany the affiliation agreement for each rotation site.

(n) Each student must have access to and experience with contemporary computer technology.

(5) Clinical Facilities and Approved Laboratory Experience - Practicum (bench training).

(a) Programs for the training of medical laboratory personnel shall be approved only when they are affiliated with a hospital(s) or a medical laboratory(ies) for clinical experience (practicum).

The training program may be affiliated with in-state licensed laboratories or out-of-state CLIA certified laboratories. The clinical facility(ies) shall be approved in advance by the Board.

(b) Clinical facilities with a balanced distribution of clinical laboratory material shall meet the following minimum standards in order to train students:

1. The medical laboratory training program Director and/or Education Coordinator must assume responsibility for arranging the approved clinical laboratory experience (practicum) for the student with an affiliated facility(ies). It shall be a violation of these regulations to grant a diploma to any student who has not completed an approved clinical laboratory experience (practicum).

2. Trainee applications shall be submitted for each student prior to the beginning of the approved clinical laboratory experience (practicum). The Board will then issue a trainee permit to the applicant provided they are in an approved facility.

No student shall perform laboratory tests without a valid trainee permit.

(6) The Use of Students as Substitutes for Licensed Medical Laboratory Personnel. No training program substituting students (trainees) for licensed medical laboratory personnel shall be approved. Using students (trainees) to perform laboratory procedures without adequate supervision shall result in withdrawal of training program approval and shall subject the training program to disciplinary action as provided for in the Tennessee Medical Laboratory Act.

(7) Copies of the Law and Regulations to Be Made Available to the Students. A copy of the Tennessee Medical Laboratory Act and the regulations promulgated thereunder shall be made available to each student in either an electronic format or a hard copy format.

(8) Training Programs for Medical Laboratory Technologists and Technicians to Be Separate.

Training Programs for the training of medical technologists and technicians shall be separate and distinct, and students in each class should have separate instruction in the classroom and in the clinical facility(ies).

(9) Penalty for Making Misrepresentations to Prospective Students. Any owner, director, personnel, or agent of a school for the training of medical laboratory personnel who misrepresents facts concerning the facility(ies), student training, or any other facet of the school to prospective students shall be subject to withdrawal of approval of said school. This shall include but not be limited to:

(a) Announcements and advertising must accurately reflect the program offered.

(b) Student recruitment and academic policies shall be non-discriminatory with respect to race, color, creed, sex, age, handicap(s), and national origin.

(c) Academic credit and costs to the student shall be accurately stated, published and made known to all applicants.

(d) Policies and procedures for student withdrawal and refunds of tuition and fees shall be published and made known to all applicants upon admission.

(e) If more than one level of medical laboratory educational program is offered at one institution, e.g., Medical Technology and Medical Laboratory Technician, the institution must demonstrate that each program is being conducted to assure appropriate instruction for the students at the different educational levels.

(f) The program must culminate in an associate degree or higher. The granting of the degree must not be contingent upon the student’s passing any type of external certification or licensure examination.

(g) In the event that the program is discontinued or restructured, the program should provide a plan for the protection of its students accepted or enrolled in the program.

(10) Curricular Structure. The applied courses must be taught in a clinically equipped teaching laboratory on the college campus, in an affiliated clinical facility, or in both facilities sufficient for developing basic skills, understanding principles, and mastering the procedures.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-105, and 68-29-110.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Amendment filed June 30, 1987; effective August 14, 1987. Amendment filed July 13, 1990; effective August 27, 1990. Amendment filed February 21, 1991; effective April 7, 1991. Repeal and new rule filed January 7, 1997; effective March 23, 1997. Amendments filed October 3, 2014; effective January 1, 2015. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-02-.02 FACULTY REQUIREMENTS FOR MEDICAL LABORATORY TRAINING

PROGRAMS.

(1) Medical Director/Advisor (a) The following programs shall have a medical director/advisor:

1. Medical Laboratory Technologist Program 2. Medical Laboratory Technician - Associate Degree Program 3. Medical Laboratory Technologist Specialty Program 4. Special Analyst Program (b) Qualifications:

2. The medical director/advisor shall be a physician who is certified in clinical pathology by the American Board of Pathology or the American Osteopathic Board of Pathology or who possesses qualifications which are equivalent to those required for such certification (Board eligible) and shall be licensed to practice medicine in Tennessee.

3. The medical director/advisor of the Program for Training Medical Laboratory Specialties shall meet one of the minimum qualifications of Medical Laboratory Director, as set forth in Rule 1200-06-01-.20. The program he/she directs must be related to his/her training. Special analyst training programs must comply with this rule.

(c) The director of the Program for Training Medical Laboratory Specialties shall meet one of the minimum qualifications of Medical Laboratory Director, as set forth in Rule 1200- 06-01-.20 of the regulations governing the Tennessee Medical Laboratory Act. The program he or she directs must be related to his/her training.

(2) Program Director/Education Coordinator. Each Program shall have a Program Director or Education Coordinator. The Program Director may also serve as the education coordinator.

In the case of a program for the training of medical laboratory specialties, the medical director may serve as a program director.

(a) Program Director.

1. A program director is defined as the responsible licensed technologist based in a university, community college, or hospital program who meets the following criteria:

(i) Has a faculty appointment either in the approved academic institution or an affiliated institution.

(ii) Has documented evidence of continuing education in technical and educational methodologies to provide adequate and appropriate training in the areas of curriculum design and teaching techniques for medical laboratory personnel.

(iii) Has the major responsibility for directing the educational program.

(iv) Is a licensed technologist with a master’s degree or doctoral degree.

(v) Has at least three (3) years experience in a clinical laboratory, including teaching experience acceptable to the Board in a clinical laboratory under the supervision of a licensed physician who meets the qualifications of Medical Laboratory Director as set forth in Rule 1200-06-01-.20 promulgated pursuant to Tennessee Medical Laboratory Act.

(vi) Is free from service responsibilities to accomplish his/her teaching, educational, and administrative responsibilities with the medical or specialty director of the program.

2. In consultation with the medical director for the specialty, the education coordinator, and the faculty, the program director is responsible for overall direction of the program.

(b) Education Coordinator.

1. Education Coordinator is defined as the responsible licensed technologist serving as liaison between the program administration and other institutions involved in the clinical experience.

2. The education coordinator shall be at least a licensed technologist and have a baccalaureate degree plus three (3) years of experience in a clinical laboratory 3. The education coordinator must be sufficiently free from service responsibilities to accomplish teaching, educational, and administrative responsibilities.

3. The education coordinator will share responsibilities with the program director for the organization and operation of the program, including classroom and laboratory instruction.

(c) Instructor (Classroom and Clinical) Credentials.

1. All instructors of medical laboratory subjects shall be licensed medical laboratory personnel or have met the education requirements of not less than those required in these Rules for a medical laboratory technologist. Credentials for qualification must be submitted on forms supplied by the Board. The Board may query instructors during the on-site inspection. Such information gained from an instructor may be used in the determination, approval, or denial of the training program’s application if there is a doubt about his/her knowledge of a subject.

2. Instructor Student Ratio: In the clinical laboratory training facility(ies), the number of licensed qualified personnel must be adequate to meet both service and teaching responsibilities. It shall be the responsibility of the medical and program directors to insure that the number of instructors is adequate to provide appropriate instruction in all areas of the program. When students are present in the laboratory, a licensed technologist shall be present and shall be responsible for supervising their education.

(i) For classroom didactic instruction, there must be a student-faculty ratio of no more than 30:1.

(ii) Student laboratories must have a student-instructor ratio of no more than 10:1.

(iii) Clinical laboratory experience (internship) must not exceed a ratio of two students to one (2:1) qualified instructor in any rotation area.

(iv) Student experiences at different clinical sites must be comparable to enable all students to achieve entry level competencies.

(d) Advisory Committee.

(1) There must be an advisory committee composed of individual(s) from the community of interest (i.e. pathologists, other physicians, scientific consultants, academic professionals, administrators, practicing clinical laboratory scientists/medical technologists, practicing clinical laboratory technicians/medical laboratory technicians and other professionals) who have knowledge of clinical laboratory science education.

(2) Responsibilities: The advisory committee of the program shall have input into any aspect of the program/curriculum with regard to its current relevancy and effectiveness.

(3) The medical or specialty director/advisor shall share with the program director and/or education coordinator the responsibility for the organization and operation of the program including classroom and laboratory instruction. The medical or specialty director should be available for orientation and available as a student advisor for clinical problems as needed.

The medical or specialty director shall give a minimum of one (1) lecture to each class of students.

(4) The division of responsibility and authority between the medical or specialty director and program director or education coordinator within each institution shall be clearly established in writing.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-105, and 68-29-110.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Repeal and new rule filed January 7, 1997; effective March 23, 1997. Amendments filed October 3, 2014; effective January 1, 2015. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-02-.03 THE MEDICAL LABORATORY TECHNICIAN ASSOCIATE DEGREE PROGRAM

MINIMUM REQUIREMENTS.

(1) Minimum Institutional Requirements:

(a) Programs for the Medical Laboratory Technician - Associate Degree Program shall be conducted by accredited community colleges, technical institutes, or universities and colleges offering an associate degree.

(b) The Medical Laboratory Technician - Associate Degree Program must result in the granting of an associate degree.

(c) Where part of the instruction is provided by an educational institution and part is provided in a hospital or other laboratory facility(ies), approval shall be given to the educational institution’s program. The parent educational institution may affiliate with several laboratories, and shall be responsible for coordinating instruction, maintaining standards, and evaluating student progress.

(2) Minimum Prerequisites for Admission of Students:

(a) Applicants for medical laboratory technician - associate degree programs must meet the admission requirements established by the sponsoring educational institution.

Arrangements shall be available whereby student credits can be accepted from other medical laboratory programs; or, (b) Students may be accepted with advanced standing by one of the institutions mentioned in subparagraph (1)(a) (above) on the basis of transfer credits or equivalent examinations but not on the basis of experience alone. Documentation of such arrangements shall also be a part of the student’s record.

(3) Minimum Curriculum Requirements and Standards:

(a) The medical laboratory technician - associate degree program is a total educational program; hence, the general educational and clinical laboratory segments shall be integrated to the greatest extent possible.

(b) Occupational competence in the medical laboratory shall be the prime objective of the total program and curriculum shall be planned to achieve this objective.

(c) The program shall be a structured educational curriculum comprised of general education, laboratory sciences (including clinical laboratory) and related subjects.

(d) The student’s training must be limited to medical laboratory procedures and related subjects. No other subjects covering unrelated fields of study, such as x-ray, can be taught during this period of time.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-105, and 68-29-110.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Repeal and new rule filed January 7, 1997; effective March 23, 1997. Amendment filed October 3, 2014; effective January 1, 2015.

Tenn. Comp. R. & Regs. 1200-06-02-.04 MEDICAL LABORATORY TECHNOLOGIST SPECIALTY PROGRAM MINIMUM

REQUIREMENTS.

(1) Minimum Institutional Requirements:

(a) A specialty program may be conducted in one of the following ways:

1. An integrated program in an accredited college or university that will culminate in at least a baccalaureate degree in one of the medical laboratory specialties.

2. A one year program for students (trainees) who already possess a baccalaureate degree in a chemical, physical or biological science. The program shall consist of appropriate didactic classroom instruction. The remainder of the year shall be spent in gaining meaningful clinical laboratory experience in the applicable specialty.

(b) Specialty programs may be conducted by hospitals or other institutions approved in advance by the Board.

(2) Minimum prerequisites for admission of students: The prerequisites for all specialty programs shall be those approved in advance by the Board.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-105, and 68-29-110.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Repeal and new rule filed January 7, 1997; eff ective March 23, 1997. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-02-.05 MEDICAL LABORATORY TECHNOLOGIST PROGRAM MINIMUM

REQUIREMENTS.

(1) Minimum Curriculum Requirements:

(a) The program must provide a structured curriculum that documents the clinical education with clearly written program goals and a course syllabus which includes both individual course objectives and competency levels to be achieved. The curriculum shall include all the major subject areas commonly offered in the clinical laboratory.

Objectives which address the cognitive, psychomotor, and affective domains must be provided for didactic and clinical aspects of the program and must include clinical significance. These course objectives shall show progression to the level consistent with entry into the profession. The curriculum shall include:

1. Principles and methodologies for all major areas commonly practiced by a modem clinical laboratory;

2. Clinical significance of laboratory procedures in diagnosis and treatment;

3. Principles and practices of quality assurance;

4. Principles of laboratory management, supervision, safety, and problem solving;

5. Educational methodology; and 6. Computer application in the clinical laboratory sciences.

(b) Educational programs for medical laboratory technologists shall be conducted by accredited colleges and universities, hospitals, or other institutions that have been approved in advance by the Board.

(2) Minimum Prerequisites for Admission of Students:

(a) The educational prerequisites for admission to schools for medical laboratory technologists shall be three (3) years of academic study plus one (1) year of a training program (3 + 1) with graduation (or equivalent) from high school and successful completion of 90 semester hours (135 quarter hours) of academic credit in a college or university accredited by the Southern Association of Colleges and Schools Commission on Colleges or an equivalent thereto. The 90 semester hours (135 quarter hours) shall be acceptable as the first three (3) years of a baccalaureate program. The three years of collegiate education must include biological sciences, chemistry and mathematics that provide the foundation for course work required in the laboratory science program that is currently accredited by NAACLS.

(b) The educational prerequisites for admission to a medical laboratory technologist (2+2) program based in a college or university shall be graduation from high school or equivalent and successful completion of a minimum of 60 semester hours (90 quarter hours) of academic credit in a college or university accredited by the Southern Association of Colleges and Schools Commission on Colleges or an equivalent thereto.

The 60 semester hours of collegiate education must include biological sciences, chemistry and mathematics that provide the foundation for course work required in the laboratory science program that is currently accredited by NAACLS.

(c) The educational prerequisites for admission to a medical laboratory technologist 4+1 program shall be a baccalaureate degree including successful completion of 120 semester hours (180 quarter hours) of academic credit in a college or university accredited by the Southern Association of Colleges and Schools Commission on Colleges or an equivalent thereto. The four years of collegiate education must include biological sciences, chemistry and mathematics that provide the foundation for course work required in the laboratory science program that is currently accredited by NAACLS.

(3) Additional Administrative Requirements:

(a) Unless a student is given equivalent credit by examination, the curriculum shall consist of a minimum of 12 months of structured educational experience.

(b) Clinical laboratory experience acceptable to the Board shall be included in the college or university-based programs.

(c) Reasonable vacation or sick leave may be granted at the discretion of the director.

General rules regarding this should be in the program’s brochure/student handbook.

(d) Students shall be oriented in medical ethics and institutional functions or regulations at the beginning of their clinical experience.

(e) The curriculum shall be comprised of all the major subjects commonly involved in the clinical laboratory. The curriculum must also include but not be limited to:

1. Principles of representative procedures and instruments: clinical significance of laboratory procedures in diagnosis and treatment including normal values; principles and practices of quality control and problem solving;

2. Principles of laboratory organization, management, and supervision;

3. Uses of laboratory data by physicians in patient management; and 4. Such other topics which may be of value in laboratory medicine.

(f) A complete outline of the curriculum must be submitted to the Board with the application form for approval to operate. It must include:

1. Expected capability of the graduates (what they should be able to do and at what level of competence);

2. Outline of learning experience, including:

(i) Lecture outlines;

(ii) Demonstrations; and (iii) Laboratory rotational plan;

3. Description of procedures to be used in evaluation of knowledge, performance, professional attitude, and competence. Criteria for pass/fail decisions should be established and failing performance must be documented; and 4. A grievance process for student objections.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-105, and 68-29-110.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Repeal and new rule filed January 7, 1997; effective March 23, 1997. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-02-.06 CONTENTS OF APPLICATIONS FOR ADMISSION TO TRAINING PROGRAMS

(1) The applicant to each program for the training of medical laboratory personnel shall submit the following information:

(a) Personal history data:

1. Name, permanent address, local address, telephone number, parent’s or guardian’s name (address and telephone number if appropriate);

2. Date of birth, place of birth, citizenship status, and marital status;

3. Employment record;

4. Military service record (form DD214); and 5. Social Security Number;

(b) A transcript of college credits where indicated; and (c) Evidence of good health which shall consist of a record of medical history and a complete physical examination certified by a licensed physician or nurse practitioner.

(2) All records of students shall be kept on file for a minimum of ten (10) years.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-105, and 68-29-110.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Repeal and new rule filed January 7, 1997; effective March 23, 1997. Amendment filed October 2, 2014; effective January 1, 2015.

Tenn. Comp. R. & Regs. 1200-06-02-.07 MEDICAL LABORATORY SPECIAL ANALYST PROGRAM MINIMUM

REQUIREMENTS.

(1) Special Analyst Programs (a) Molecular Diagnostics Training Program 1. Medical Director (i) The medical director shall be a physician who is certified in clinical pathology by the American Board of Pathology or the American Osteopathic Board of Pathology or who possesses qualifications which are equivalent to those required for such certification (Board eligible).

(ii) The medical director shall be licensed to practice medicine in Tennessee.

(iii) The medical director shall meet one of the minimum qualifications of Medical Laboratory Director, as set forth in Rule 1200-06-01-.20. The program he or she directs must be related to his or her training.

2. Program Director (i) The program must have a qualified program director.

(ii) The program director must be a medical laboratory professional who:

(I) Has an earned master’s or doctoral degree;

(II) Holds nationally recognized certification. (The certification examination must be accredited and require a bachelor’s degree for eligibility.) If the program director is not certified in the same discipline as the program, a qualified professional who holds nationally recognized certification in the program discipline must be appointed as Education Coordinator;

(III) Regularly engages in continuing professional education as documented by the certification maintenance program or other sources;

(IV) Has three years of teaching experience; and (V) Has knowledge of education methods and administration as well as current NAACLS, or other board approved agency accreditation procedures.

(iii) The program director must:

(I) Be responsible for the organization, administration, instruction, evaluation, continuous quality improvement, curriculum planning and development, directing other program faculty/staff, and general effectiveness of the program;

(II) Provide evidence that he or she participates in the budget preparation process;

(III) Be responsible for maintaining NAACLS, or other board approved agency accreditation; and (IV) Have regular and consistent contact with students, faculty, and program personnel.

3. Education Coordinator (when required)

(i) The Education Coordinator must be a medical laboratory professional who:

(I) Has at least a baccalaureate degree and three years of experience in the program discipline;

(II) Holds nationally recognized certification in the program discipline, e.g., MB(ASCP)CM;

(III) Has completed thirty-six hours of professional continuing education within the past three years;

(IV) Has three years of experience in medical laboratory science education; and (V) Has knowledge of education methods and administration as well as current NAACLS, or other board approved agency accreditation procedures.

(ii) The Education Coordinator must provide supervision and coordination of the instructional faculty in the academic and clinical phases of the education program.

4. On-site Program Coordinator (when required, one at each participating entity in a consortium or joint venture)

(i) The on-site program coordinator must:

(I) Have an academic degree appropriate to the program level;

(II) Hold an appropriate nationally recognized certification required of a program director; and (III) Have at least one year of experience in medical laboratory science education.

(ii) The on-site program coordinator, when required, is responsible for:

(I) Coordinating teaching and clinical education;

(II) Evaluating program effectiveness; and (III) Maintaining appropriate communications with the program director.

5. Didactic Instructor (i) The program must have qualified faculty/instructors who hold appointments within the educational program (e.g., certified professionals in their respective or related fields). The program must ensure and document ongoing professional development of the program faculty/instructors.

(ii) Faculty/instructors designated by the program must:

(I) Demonstrate adequate knowledge and proficiency in their content areas and (II) Demonstrate the ability to teach effectively at the appropriate level.

(iii) The responsibilities of the faculty/instructors must include:

(I) Participation in teaching courses;

(II) Evaluation of student achievement;

(III) Development of curriculum, policy and procedures; and (IV) Assessment of program outcomes.

6. Clinical Coordinator (i) At least one clinical coordinator must be designated at each clinical site affiliated with the program to provide clinical experience to students.

(ii) The Clinical Coordinator must:

(I) Be a medical laboratory professional who holds nationally recognized certification and professional licensure in the program discipline;

(II) Demonstrate proficiency in and adequate knowledge of the program discipline;

(III) Have at least one year experience as a practicing professional in the program discipline; and (IV) Demonstrate ability to teach clinical skills/content effectively at the appropriate level.

(iii) The Clinical Coordinator must be responsible for:

(I) Coordinating and ensuring effectiveness of clinical instruction at the site;

(II) Evaluating effectiveness of clinical instruction;

(III) Monitoring and evaluating students’ clinical performance; and (IV) Maintaining effective communication with the program director.

7. Advisory Committee (i) There must be an advisory committee composed of individuals from the community of interest (e.g. practicing professionals, academic professionals, scientific consultants, administrators, pathologists and other physicians, and public members) who have knowledge of clinical laboratory science education.

(ii) The advisory committee of the program shall have input into the program/curriculum to maintain current relevancy and effectiveness.

8. Instructional Areas (i) Prerequisite courses in biology including genetics, chemistry and mathematics that provide the foundation for course work required in the laboratory science program.

(ii) The curriculum must address pre-analytical, analytical and post-analytical components of diagnostic molecular laboratory services covering diagnostic molecular tests used to detect or diagnose acquired (infectious and non-infectious) diseases and genetic predisposition or disorders. This includes principles and methodologies, performance of assays, problemsolving, troubleshooting techniques, interpretation and evaluation of clinical procedures and results, statistical approaches to data evaluation, principles and practices of quality assurance/quality improvement, and continuous assessment of laboratory services.

(iii) The program curriculum must include the following scientific content:

(I) Organic and/or biochemistry, genetics, cell biology, microbiology, immunology, and diagnostic molecular biology;

(II) Principles, methodologies, and applications of molecular microbiology (infectious diseases), molecular pathology (hematology/oncology), and molecular genetics. Techniques of molecular science must include current techniques in each of the following areas: separation and detection, amplification, and sequence analysis;

(III) Clinical significance of laboratory procedures in diagnosis and treatment;

(IV) Application of safety and governmental regulations and standards as applied to diagnostic molecular science;

(V) Principles and practices of professional conduct and the significance of continuing professional development;

(VI) Communications sufficient to serve the needs of patients, the public and members of the health care team;

(VII) Principles and practices of administration, supervision, and quality management as applied to diagnostic molecular science;

(VIII) Evaluation of laboratory information systems;

(IX) Educational methodologies and terminology sufficient to train/educate users and providers of laboratory services; and (X) Principles and practices of applied study design, implementation and dissemination of results.

9. Institutional Requirements (i) A specialty program may be conducted in one of the following ways:

(I) An integrated program in an accredited college or university that will culminate in at least a baccalaureate degree in one of the medical laboratory specialties.

(II) A one year program for students (trainees) who already possess a baccalaureate degree in a chemical, physical or biological science.

The program shall consist of appropriate didactic classroom instruction. The remainder of the year shall be spent in gaining meaningful clinical laboratory experience in the applicable specialty.

(b) Cytogenetic Technology Training Program 1. Medical Director (i) The medical director shall be a physician who is certified in clinical pathology by the American Board of Pathology or the American Osteopathic Board of Pathology or who possesses qualifications which are equivalent to those required for such certification (Board eligible).

(ii) The medical director shall be licensed to practice medicine in Tennessee.

(iii) The medical director shall meet one of the minimum qualifications of Medical Laboratory Director, as set forth in Rule 1200-06-01-.20. The program he or she directs must be related to his or her training.

2. Program Director (i) The program director must be a medical laboratory professional who:

(I) Has an earned master’s or doctoral degree;

(II) Maintains current certification or licensure in cytogenetic technology, medical genetics, or another human genetics area;

(III) Regularly engages in continuing professional education as documented by the certification maintenance program or other sources;

(IV) Has three years of teaching experience; and (V) Has knowledge of education methods and administration as well as current NAACLS, or other board approved agency accreditation procedures.

(ii) The program director must:

(I) Be responsible for the organization, administration, instruction, evaluation, continuous quality improvement, curriculum planning and development, directing other program faculty/staff, and general effectiveness of the program;

(II) Provide evidence that he or she participates in the budget preparation process;

(III) Be responsible for maintaining NAACLS, or other board approved agency accreditation. Training programs licensed prior to June 1, 2014 are not required to obtain or maintain NAACLS accreditation;

(IV) Have regular and consistent contact with students, faculty, and program personnel.

3. On-site Program Coordinator (required for consortia or multi-location only; one at each participating site)

(i) The on-site program coordinator must:

(I) Have an academic degree appropriate to the program level;

(II) Hold an appropriate nationally recognized certification required of a program director; and (III) Have at least one year of experience in medical laboratory science education.

(ii) The on-site program coordinator, when required, is responsible for:

(I) Coordinating teaching and clinical education;

(II) Evaluating program effectiveness; and (III) Maintaining appropriate communications with the program director.

4. Didactic Instructor (i) The program must have qualified faculty/instructors who hold appointments within the educational program (e.g., certified professionals in their respective or related fields). The program must ensure and document ongoing professional development of the program faculty/instructors.

(ii) Faculty/instructors designated by the program must:

(I) Demonstrate adequate knowledge and proficiency in their content areas and (II) Demonstrate the ability to teach effectively at the appropriate level.

(iii) The responsibilities of the faculty/instructors must include:

(I) Participation in teaching courses;

(II) Evaluation of student achievement;

(III) Development of curriculum, policy and procedures; and (IV) Assessment of program outcomes.

5. Clinical Coordinator (i) At least one clinical coordinator must be designated at each clinical site affiliated with the program to provide clinical experience to students.

(ii) The Clinical Coordinator must:

(I) Be a medical laboratory professional who holds nationally recognized certification and professional licensure in the program discipline;

(II) Demonstrate proficiency in and adequate knowledge of the program discipline;

(III) Have at least one year experience as a practicing professional in the program discipline; and (IV) Demonstrate ability to teach clinical skills/content effectively at the appropriate level.

(iii) The Clinical Coordinator must be responsible for:

(I) Coordinating and ensuring effectiveness of clinical instruction at the site;

(II) Evaluating effectiveness of clinical instruction;

(III) Monitoring and evaluating students’ clinical performance; and (IV) Maintaining effective communication with the program director.

6. Advisory Committee (i) There must be an advisory committee composed of individuals from the community of interest (e.g. practicing professionals, academic professionals, scientific consultants, administrators, pathologists and other physicians, and public members) who have knowledge of clinical laboratory science education.

(ii) The advisory committee of the program shall have input into the program/curriculum to maintain current relevancy and effectiveness.

7. Instructional Areas (i) Prerequisite content in biology, chemistry and mathematics that provides the foundation for course work required in the laboratory science program.

(ii) The program curriculum must include the following scientific content:

(I) Specimen Preparation (sample acquisition, transport/storage, preparation, culture, harvest, slide preparation, and staining);

(II) Molecular Cytogenetic Testing (utilize appropriate techniques for preparation and analysis of molecular cytogenetic specimens);

(III) Chromosome Analysis and Imaging (selection, analysis, and description of suitable metaphase or interphase cells using microscopy and imaging);

(IV) Laboratory Operations (general laboratory skills, guidelines/ government regulations, safety, quality assurance/control and professional standards and conduct);

(V) Principles of interpersonal and interdisciplinary communication and team-building skills and the significance of continuing professional development;

(VI) Principles and practices of administration and supervision;

(VII) Educational methodologies and terminology sufficient to train/educate users and providers of laboratory services sufficient for future clinical faculty); and (VIII) Principles and practices of applied study design, implementation and dissemination of results.

8. Institutional Requirements (i) A specialt y program may be conducted in one of the following ways:

(I) An integrated program in an accredited college or university that will culminate in at least a baccalaureate degree in one of the medical laboratory specialties.

(II) A one year program for students (trainees) who already possess a baccalaureate degree in a chemical, physical or biological science.

The program shall consist of appropriate didactic classroom instruction. The remainder of the year shall be spent in gaining meaningful clinical laboratory experience in the applicable specialty.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-105, and 68-29-110.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Repeal and new rule filed January 7, 1997; effective March 23, 1997. Repeal and new rule filed October 3, 2014; effective January 1, 2015. Amendments filed January 13, 2022; effective April 13, 2022.

Tenn. Comp. R. & Regs. 1200-06-02-.08 ADVERTISING

(1) Policy Statement. The lack of sophistication on the part of many of the public concerning medical laboratory personnel training programs, the importance of the interests affected by the choosing of a medical laboratory personnel training program and the foreseeable consequences of unrestricted advertising by medical laboratory personnel training programs which is recognized to pose special possibilities for deception, require that special care be taken by medical laboratory personnel training programs to avoid misleading the public.

Medical laboratory personnel training programs must be mindful that the benefits of advertising depend upon its reliability and accuracy. Since advertising by medical laboratory personnel training programs is calculated and not spontaneous, reasonable regulation designed to foster compliance with appropriate standards serves the public interest without impeding the flow of useful, meaningful, and relevant information to the public.

(2) Definitions (a) Advertisement - Informational communication to the public in any manner designed to attract public attention to medical laboratory personnel training programs that are approved to educate in Tennessee.

(b) Licensee - Any medical laboratory personnel training programs holding a Certificate of Approval to educate in the State of Tennessee. Where applicable this shall include partnerships and/or corporations.

(c) Material Fact - Any fact which an ordinary reasonable and prudent person would need to know or rely upon in order to make an informed decision concerning the choice of medical laboratory personnel training programs to serve his or her particular needs.

(3) Advertising Tuition Fees and Services (a) Fixed Tuition Fees - Fixed tuition fees may be advertised.

(b) Discount Tuition Fees - Discount tuition fees may be advertised if:

1. The discount tuition fee is in fact lower than the licensee’s customary or usual tuition fee; and 2. The licensee provides the same quality and components of education at the discounted tuition fee that are normally provided at the regular, non-discounted tuition fee.

(c) Related Services and Additional Fees - Related services which may be required in conjunction with the advertised services for which additional fees will be charged must be identified as such in any advertisement.

(d) Time Period of Advertised Fees.

1. Advertised fees shall be honored for those seeking the advertised services during the entire time period stated in the advertisement whether or not the services are actually rendered or completed within that time.

2. If no time period is stated in the advertisement of fees, the advertised fee shall be honored for thirty (30) days from the last date of publication or until the next scheduled publication whichever is later whether or not the services are actually rendered or completed within that time.

(4) Advertising Content. The following acts or omissions in the context of advertisement by any licensee shall constitute unethical conduct, and subject the licensee to disciplinary action pursuant to T.C.A. § 68-29-127(9) and (10).

(a) Claims that the education offered is professionally superior to that which is ordinarily offered, or that convey the message that one licensee is better than another when superiority of services, personnel, materials or equipment cannot be substantiated.

(b) The misleading use of an unearned or non-health degree in any advertisement.

(c) Promotion of professional services which the licensee knows or should know is beyond the licensee’s ability to perform.

(d) Techniques of communication which intimidate, exert undue pressure or undue influence over a prospective client.

(e) Any appeals to an individual’s anxiety in an excessive or unfair manner.

(f) The use of any personal testimonial attesting to a quality of competency of a service or treatment offered by a licensee that is not reasonably verifiable.

(g) Utilization of any statistical data or other information based on past performances for prediction of future services, which creates an unjustified expectation about results that the licensee can achieve.

(h) The communication of personal identifiable facts, data, or information about a patient without first obtaining patient consent.

(i) Any misrepresentation of a material fact.

(j) The knowing suppression, omission or concealment of any material fact or law without which the advertisement would be deceptive or misleading.

(k) Statements concerning the benefits or other attributes of medical procedures or products that involve significant risks without including:

1. A realistic assessment of the safety and efficiency of those procedures or products; and 2. The availability of alternatives; and 3. Where necessary to avoid deception, descriptions or assessment of the benefits or other attributes of those alternatives.

(l) Any communication which creates an unjustified expectation concerning the potential results of any treatment.

(m) Failure to comply with the rules governing advertisement of fees and services, or advertising records.

(n) Misrepresentation of a licensee’s credentials, training, experience, or ability.

(o) Failure to include the corporation, partnership or individual licensee’s name, address, and telephone number in any advertisement. Any corporation, partnership or association which advertises by use of a trade name or otherwise fails to list all licensees practicing at a particular location shall:

1. Upon request provide a list of all licensees practicing at that location; and 2. Maintain and conspicuously display at the licensee’s office, a directory listing all licensees practicing at that location.

(p) Failure to disclose the fact of giving compensation or anything of value to representative of the press, radio, television or other communicative medium in anticipation of or in return for any advertisement (for example, newspaper article) unless the nature, format or medium of such advertisement make the fact of compensation apparent.

(q) After thirty (30) days of a personnel departure, the use of the name of any medical laboratory personnel formerly practicing at or associated with any advertised location or on office signs or buildings. This rule shall not apply in the case of a retired or deceased former associate who practiced in association with one or more of the present occupants if the status of the former associate is disclosed in any advertisement or sign.

(r) Stating or implying that a certain licensee provides all services when any such services are performed by another licensee.

(s) Directly or indirectly offering, giving, receiving, or agreeing to receive any fee or other consideration to or from a third party for the referral of a patient in connection with the performance of professional services.

(5) Advertising Records and Responsibility (a) Each licensee who is a principal partner, or officer of a firm or entity identified in any advertisement, is jointly and severally responsible for the form and content of any advertisement. This provision shall also include any licensed professional employees acting as an agent of such firm or entity.

(b) Any and all advertisement are presumed to have been approved by the licensee named therein.

(c) A recording of every advertisement communicated by electronic media, and a copy of every advertisement communicated by print media, and a copy of any other form of advertisement shall be retained by the licensee for a period of two (2) years from the last date of broadcast or publication and be made available for review upon request by the Board or its designee.

(d) At the time any type of advertisement is placed, the licensee must possess and rely upon information which, when produced, would substantiate the truthfulness of any assertion, omission or representation of material fact set forth in the advertisement or public information.

(6) Use of Titles in Advertisements. Any medical laboratory training program licensed by the Board which includes in its advertisements the names of its laboratory personnel must, in every “advertisement” [as that term is defined in Rule 1200-06-02-.08(2)(a)] it publishes, use an appropriate personnel title for each such licensee as authorized by Rule 1200-06-01- .03(3) of this rule. Failure to do so may constitute an omission of a material fact which makes the advertisement misleading and deceptive and subjects the medical laboratory training program to disciplinary action pursuant to T.C.A. §§ 68-29-126(9), 68-29-126(11), 68-29- 126(13), 68-29-127(9), 68-29-127(9), 68-29-127(10), and/or 68-29-129(8).

(7) Severability. It is hereby declared that the sections, clauses, sentences and part of these rules are severable, are not matters of mutual essential inducement, and any of them shall be rescinded if these rules would otherwise be unconstitutional or ineffective. If any one or more sections, clauses, sentences or parts shall for any reason be questioned in court, and shall be adjudged unconstitutional or invalid, such judgment shall not affect, impair or invalidate the remaining provisions thereof, but shall be confined in its operation to the specific provision or provisions so held unconstitutional or invalid, and the inapplicability or invalidity of any section, clause, sentence or part in any one or more instance shall not be taken to affect or prejudice in any way its applicability or validity in any other instance.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-145, 63-1-146, 68-29-105, 68-29-110, 68-29-126, 68-29- 127, and 68-29-129.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Amendment filed April 22, 2010; effective July 21, 2010.

Chapter 1200-06-03 General Rules Governing Medical Laboratories

Tenn. Comp. R. & Regs. 1200-06-03-.01 DEFINITIONS

As used in this chapter of Rules the following terms and acronyms shall have the following meanings ascribed to them:

(1) ASTC - Ambulatory Surgical Treatment Center, specifically any institution, place or building devoted primarily to the maintenance and operation of a facility for the performance of surgical procedures or any facility in which a medical or surgical procedure is utilized to terminate a pregnancy and is licensed by the Tennessee Board for Licensing Health Care Facilities under Rule 1200-08-10.

(2) Anatomic laboratory - Any medical laboratory performing only the biophysical examination of specimens pertaining to the clinical specialty of pathology, to include histopathology, oral pathology, and cytopathology. The examination of these specimens taken from the human body are performed to obtain information for diagnosis, prophylaxis, or treatment or where any examination, determination or test is made of any sample used as a basis for health advice, or where any sample is collected for the purpose of transfusion or processing of blood or blood fractions, or the training of medical laboratory personnel. Compliance with

Rule 1200-06-01-.20 is required to be the director of an anatomic laboratory.

(3) Authorized person - A physician or intern or resident in an American Medical Association approved training program or a duly licensed optometrist or a duly licensed dentist or a duly licensed chiropractic physician or other health care professional legally permitted to submit to a medical laboratory a written request for tests appropriate to that professional’s practice or a law enforcement officer acting in accordance with T.C.A. § 55-10-406.

(4) Board - The Tennessee Medical Laboratory Board.

(5) CLIA - The Clinical Laboratory Improvement Amendments as found in 42 CFR 493.

(6) CLSI – The Clinical Laboratory and Standards Institute.

(7) CMS - The Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services.

(8) Center for Disease Control (CDC) - The United States Center for Disease Control, headquartered in Atlanta, GA.

(9) Clinical Laboratory - see Medical Laboratory.

(10) Code of Federal Regulations (CFR) - The documents that detail under Title 42, Chapter IV

Part 493, the Laboratory Requirements under CLIA, and under Title 21, Parts 600 to 799, the Food and Drug Requirements.

(11) Condition - A specific requirement from the Board’s rules that must be met for continued possession of a license to operate a medical laboratory in Tennessee. Unmet conditions of compliance with the Board’s rules can result in harm to patients or facility personnel.

(12) Condition Level Deficiency - A significant deficiency of non-compliance with a rule. A deficiency that must be corrected before a license is continued, issued or is renewed.

(13) Days - Calendar days unless otherwise designated.

(14) Department - The Department of Health, State of Tennessee.

(15) FDA - The U.S. Food and Drug Administration.

(16) HCF - The Department of Health, Division of Health Care Facilities.

(17) HHS - The U.S. Department of Health and Human Services.

(18) Human Leukocyte Antigens (HLA) - Identification of the human histocompatibility complex antigens on the surface of nucleated cells.

(19) Independent Lab - A medical laboratory performing patient tests that is independent of both attending and consulting physician’s offices and independent of a hospital also known as a reference laboratory.

(20) Manufacturer’s instructions - Information found on the FDA approved product label.

(21) May - Discretionary.

(22) Medical Laboratory - Any institution, building, or place in which operations and procedures for the microbiological, serological, chemical, hematological, immunohematological, or biophysical examination of specimens taken from the human body are performed to obtain information for diagnosis, prophylaxis, or treatment or where any examination, determination, or test is made on any sample used as a basis for health advice, or where any sample is collected for the purpose of transfusion or processing of blood fractions, or for the training of medical laboratory personnel.

(23) Must - Mandatory.

(24) Office for the Medical Laboratory Board - The Office responsible for laboratory facility licensure.

(25) Performance Improvement (PI) - An ongoing process encompassing all facets of the laboratory or collection station technical and nontechnical functions at all locations/sites where testing is performed.

(26) Plan of Correction - The laboratory’s or collection station’s response to any citation of noncompliance with regulations. The Plan of Correction must be reasonable, contain specific actions to correct deficiencies with estimated correction dates and contain the signature of the Laboratory Director or his authorized Designee or collection station director or his authorized designee.

(27) Point of Care Laboratory Testing - Those tests performed by health care professionals, not licensed by this chapter, upon approval by the board, provided that the testing is performed outside the duly licensed laboratory, and under the auspices of a laboratory required to be licensed by the division of health care facilities in the department of health, pursuant to this

chapter.

(28) Physician Office Laboratory - A laboratory operated by a duly licensed physician for the sole

purpose of testing samples collected from their own patients.

(29) Reference Laboratory - A medical laboratory performing patient tests that is independent of both attending and consulting physician’s offices and independent of a hospital also known as an independent laboratory.

(30) Shall - Mandatory.

(31) Standard - A specific requirement from the state rules that must be met for continued possession of a license to operate a medical laboratory or collection station in Tennessee.

Unmet standards of compliance usually reflect unsatisfactory performance of laboratory or collection station operations according to accepted standards of medical laboratory practice.

(32) Standard Level Deficiency - A deficiency of non-compliance with a regulation for which a license would be issued or renewed, provided an acceptable plan of correction with an estimated completion date has been submitted and approved.

(33) Statement of Deficiencies - An official notification of non-compliance with one (1) or more regulatory requirements.

(34) Unsatisfactory Proficiency Testing Performance - Failure to attain the minimum satisfactory score for an analyte, test, subspecialty, or specialty for a testing event.

(35) Unsuccessful Proficiency Testing Performance - Failure to attain the minimum satisfactory score for an analyte, test, subspecialty, or specialty for two (2) consecutive or two (2) of three (3) consecutive testing events.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-103, 68-29-105, 63-29-111, 68-29-116, and Public Acts of 2002, Chapter 623.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Amendment filed December 14, 1981; effective January 28, 1982. Amendment filed June 30, 1987; effective August 14, 1987. Repeal and new rule filed May 15, 1990; effective June 29, 1990. Amendment filed November 30, 1990; effective January 14, 1991. Amendment filed February 21, 1991; effective April 7, 1991. Repeal filed May 3, 1995; effective July 17, 1995. New rule filed January 7, 1997; effective March 23, 1997. Repeal and new rule filed June 18, 2002; effective September 1, 2002. Amendment filed May 23, 2003; effective August 6, 2003. Amendment filed March 14, 2006; effective May 28, 2006.

Tenn. Comp. R. & Regs. 1200-06-03-.02 LICENSING PROCEDURES AND LICENSURE EXEMPTIONS

(1) Applications (a) An application for a medical laboratory license shall be made under oath, by the owner and director of the medical laboratory or public official responsible for the operation of a city or county medical laboratory or institution that contains a medical laboratory, upon forms provided by the Board.

(b) All laboratories performing tests must file a separate application for each laboratory address.

(c) Laboratories within a hospital that are located in contiguous buildings on the same campus and under common direction may file a single application or multiple applications for the laboratory sites within the same physical location or street address.

(d) Each application shall include, in alphabetical order, a roster of all personnel currently employed in the laboratory, the classification/category in which the employee functions and is licensed, license number, expiration date and social security number. This shall include all medical laboratory directors, consultants, supervisors and testing personnel.

(e) The application will be returned to the applicant if it is incomplete or requires correction.

(f) After submission of the completed application, the laboratory or collection station may be issued a letter of temporary license which shall be valid for a period of not longer than three (3) months from the date the application is received by the Board. This temporary license will allow the laboratory to perform testing and allow the collection station to collect specimens until an on-site inspection is conducted and a determination is made whether the laboratory or collection station is in compliance. The laboratory shall be fully operational, including but not limited to the reporting of patient results, at the time of the on-site inspection. The collection station shall be fully operational at the time of the on-site inspection. If the laboratory or collection station is found to be in compliance, it shall be issued a permanent license, provided all other requirements for licensure have been met.

(2) License - Issued (a) A license shall be issued authorizing the performance of one (1) or more medical laboratory specialties or subspecialties, the location of testing, the name of the laboratory director and type of ownership.

(b) A license shall be issued authorizing the collection of specimens, the location of collection, the name of the physician and type of ownership.

(c) A license shall be valid only in the hands of the person or persons to whom it is issued and shall not be the subject of sale, assignment, or transfer, voluntary or involuntary, nor shall a license be valid for any premises other than those for which issued.

(d) The license shall be displayed at all times in a prominent place where it may be viewed by the public.

(3) Fees - The fees established by the Board pursuant to the Tennessee Medical Laboratory Act (T.C.A. §§ 68-29-101, et seq.) for licensure are as follows:

(a) Initial Laboratory Application Fee - This fee is nonrefundable. $1000.00 (b) Laboratory License Renewal Fee - To be paid annually by all licensees. $1000.00 (c) Late Laboratory License or Collection Station Renewal Penalty Fee - To be paid when a licensee fails to timely renew annual license. $ 500.00 (d) Annual State Regulatory Fee - To be paid by all licensees. $ 5.00 (e) Replacement License (other than 1200-06-03-.03) when lost or misplaced. $ 50.00 (f) Initial Collection Station Application Fee $ 700.00 (g) Collection Station Renewal Fee $ 700.00 (h) T.C.A. § 68-29-112 Fee – A nonrefundable fee to be paid when there is a change in laboratory ownership, directorship, or location. $ 100.00 (4) Fees may be paid in the following manner:

(a) All fees paid by money order, certified, personal, or corporate check must be submitted to the Board’s Administrative Office and made payable to the Tennessee Medical Laboratory Board.

(b) Fees may be paid by Division-approved credit cards or other Division-approved electronic methods.

(5) Pursuant to T.C.A. § 68-29-104(8) the Board hereby exempts the following laboratories (or portions of otherwise licensed laboratories) and the personnel performing tests in those laboratories (or portions of otherwise licensed laboratories) from the requirements imposed pursuant to the "Tennessee Medical Laboratory Act":

(a) Any laboratory (or portion of an otherwise licensed laboratory) which is operated by the Tennessee Department of Health and in which the only testing on human specimens is that which is required pursuant to an investigation ordered by or in cooperation with the State Epidemiologist or law enforcement agency the results of which are reported only to the State Epidemiologist, CDC or law enforcement officials as required by federal law.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-103, 68-29-104, 68-29-105, and 68-29-113.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Amendment filed June 30, 1987; effective August 14, 1987. Amendment filed February 21, 1991; effective April 7, 1991. Repeal and new rule filed January 7, 1997; effective March 23, 1997. Amendment filed August 31, 2001; effective November 14, 2001. Repeal and new rule filed June 18, 2002; effective September 1, 2002. Amendment filed July 8, 2004; effective September 21, 2004. Amendment filed December 27, 2006; effective March 12, 2007. Amendment filed April 17, 2007; effective July 1, 2007. Amendment filed April 1, 2009; effective June 15, 2009.

Tenn. Comp. R. & Regs. 1200-06-03-.03 CHANGE IN LOCATION, DIRECTOR, OWNER, SUPERVISOR OR TESTING IN A

MEDICAL LABORATORY.

(1) It shall be the responsibility of the owner of a laboratory to notify the Department in writing of a change in the location, director, owners or supervisor of the laboratory within fifteen (15) days of the actual change.

(2) If the matter involves a change of the owner, and/or director and/or the location an application for a new license, including payment of the T.C.A. § 68-29-112 Fee as provided in Rule 1200-06-03-.02(4), must be filed and a new license obtained before the laboratory may provide services. That new license may be applied for and issued prior to the actual change but will be void should the change not actually take place.

(3) It shall be the responsibility of the owner to notify the Department in writing in order to add a specialty or subspecialty not presently authorized by the facility’s license prior to the commencement of testing and reporting patient test results. The Department must conduct an on-site inspection prior to the issuance of authorization for the specialty or subspecialty. A replacement license which includes the new specialty or subspecialty shall be issued by the Department at no cost to the facility.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-105, 68-29-112, and 68-29-114.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Repeal filed May 3, 1995; effective July 17, 1995. New rule filed January 7, 1997; effective March 23, 1997. Repeal and new rule filed June 18, 2002; effective September 1, 2002. Amendment filed December 27, 2006; effective March 12, 2007.

Tenn. Comp. R. & Regs. 1200-06-03-.04 INSPECTIONS - REPORTS

(1) Biennial Inspections of Licensed Laboratories (a) The Board or its Designee will conduct announced and/or unannounced inspections on at least a biennial basis of any laboratory at any time during its hours of operation to assess compliance with the applicable requirements.

(b) It is board policy that regular biennial inspections be unannounced.

(c) Written reports of inspection results will be submitted to the medical laboratory director within ten (10) working days of the on-site visit.

(d) The medical laboratory director must respond to any deficiencies cited with a written plan of correction that includes estimated correction dates, within ten (10) working days of the receipt of the statement of deficiencies.

(2) Inspection for Initial License - The laboratory shall be issued an initial license only after an on-site inspection is conducted and the laboratory has no deficiencies, or has submitted an acceptable plan of correction for all standard level deficiencies. All condition level deficiencies must be corrected before the laboratory shall be issued a license.

History

• Authority: T.C.A. §§ 4-5-204, 4-5-204, 68-29-105, 68-29-106, and 68-29-113.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Amendment filed December 14, 1981; effective January 28, 1982. Repeal and new rule filed January 7, 1997; effective March 23, 1997. Repeal and new rule filed June 18, 2002; effective September 1, 2002.

Tenn. Comp. R. & Regs. 1200-06-03-.05 LICENSURE DISCIPLINE, CIVIL PENALTIES, ASSESSMENT OF COSTS,

SUBPOENAS, AND SCREENING PANELS.

(1) Upon a finding by the Board that a licensee has violated any provision of the Tennessee Medical Laboratory Act (T.C.A. §§ 68-29-101, et seq.) or the rules promulgated pursuant thereto, the Board may impose any of the following actions separately or in any combination which is deemed appropriate to the offense:

(a) Private Censure - This is a written action issued by the Board to the licensee for minor infractions of these rules. It is informal and advisory in nature and does not constitute a formal disciplinary action.

(b) Public Censure or Reprimand - This is a formal disciplinary action consisting of a written admonishment issued by the Board to a licensee for one (1) time and less severe infractions.

(c) Probation - This is a formal disciplinary action which places a licensee on close scrutiny for a fixed period of time. This action may be combined with conditions which must be met before probation will be lifted and/or which restrict the licensee’s activities during the probationary period.

(d) Licensure Suspension - This is a formal disciplinary action which suspends a licensee’s right to operate a medical laboratory for a fixed period of time. It contemplates the reentry of the licensee into operation under the license previously issued.

(e) Licensure Revocation - This is the most severe form of disciplinary action which removes a licensee from the operation of a medical laboratory and terminates the license previously issued. If revoked, it relegates the violator to the status he or she possessed prior to application for licensure. However, the Board may in its discretion allow the reinstatement of a revoked license upon conditions and after a period of time it deems appropriate. No petition for reinstatement and no new application for licensure from a medical laboratory whose license was revoked shall be considered prior to the expiration of at least one (1) year unless otherwise stated in the Board’s revocation Order.

(f) Civil Penalty - A monetary disciplinary action assessed by the Board pursuant to paragraph (5) of this rule.

(g) Once ordered, probation, suspension, revocation, or any other condition of any type of disciplinary action may not be lifted unless and until the licensee petitions, pursuant to paragraph (2) of this rule, and appears before the Board after the period of initial probation, suspension, revocation, or other conditioning has run and all conditions placed on the probation, suspension, revocation, have been met.

(2) Order of Compliance - This procedure is a necessary adjunct to previously issued disciplinary orders and is available only when a petitioner has completely complied with the provisions of a previously issued disciplinary order, and wishes or is required to obtain an order reflecting that compliance.

(a) The Board will entertain petitions for an Order of Compliance as a supplement to a previously issued order upon strict compliance with the procedures set forth in subparagraph (b) in only the following three (3) circumstances:

1. When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued reflecting that compliance; or 2. When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued lifting a previously ordered suspension or probation; or 3. When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued reinstating a license previously revoked.

(b) Procedures 1. The petitioner shall submit a Petition for Order of Compliance, as contained in subparagraph (c), to the Board’s Administrative Office that shall contain all of the following:

(i) A copy of the previously issued order; and (ii) A statement of which provision of subparagraph (a) the petitioner is relying upon as a basis for the requested order; and (iii) A copy of all documents that prove compliance with all the terms or conditions of the previously issued order. If proof of compliance requires testimony of an individual(s), including that of the petitioner, the petitioner must submit signed statements from every individual the petitioner intends to rely upon attesting, under oath, to the compliance. The Board’s consultant and administrative staff, in their discretion, may require such signed statements to be notarized. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, the petition.

2. The Board authorizes its consultant and administrative staff to make an initial determination on the petition and take one of the following actions:

(i) Certify compliance and have the matter scheduled for presentation to the Board as an uncontested matter; or (ii) Deny the petition, after consultation with legal staff, if compliance with all of the provisions of the previous order is not proven and notify the petitioner of what provisions remain to be fulfilled and/or what proof of compliance was either not sufficient or not submitted.

3. If the petition is presented to the Board the petitioner may not submit any additional documentation or testimony other than that contained in the petition as originally submitted.

4. If the Board finds that the petitioner has complied with all the terms of the previous order an Order of Compliance shall be issued.

5. If the petition is denied either initially by staff or after presentation to the Board and the petitioner believes compliance with the order has been sufficiently proven the petitioner may, as authorized by law, file a petition for a declaratory order pursuant to the provisions of T.C.A. § 4-5-223 and rule 1200-10-01-.11.

(c) Form Petition Petition for Order of Compliance Tennessee Medical Laboratory Board Petitioner’s Name:

Petitioner’s Mailing Address:

Petitioner’s E-Mail Address:

Telephone Number:

Attorney for Petitioner:

Attorney’s Mailing Address:

Attorney’s E-Mail Address:

Telephone Number:

The petitioner respectfully represents, as substantiated by the attached documentation, that all provisions of the attached disciplinary order have been complied with and I am respectfully requesting: (circle one)

1. An order issued reflecting that compliance; or 2. An order issued reflecting that compliance and lifting a previously ordered suspension or probation; or 3. An order issued reflecting that compliance and reinstating a license previously revoked.

Note - You must enclose all documents necessary to prove your request including a copy of the original order. If any of the proof you are relying upon to show compliance is the testimony of any individual, including yourself, you must enclose signed statements from every individual you intend to rely upon attesting, under oath, to the compliance. The Board’s consultant and administrative staff, in their discretion, may require such signed statements to be notarized. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, this petition.

Respectfully submitted this the day of , 20 .

Petitioner’s Signature (3) Order Modifications - This procedure is not intended to allow anyone under a previously issued disciplinary order, to modify any findings of fact, conclusions of law, or the reasons for the decision contained in the order. It is also not intended to allow a petition for a lesser disciplinary action. All such provisions of Board orders were subject to reconsideration and appeal under the provisions of the Uniform Administrative Procedures Act (T.C.A. §§ 4-5- 301, et seq.). This procedure is not available as a substitute for reconsideration and/or appeal and is only available after all reconsideration and appeal rights have been either exhausted or not timely pursued. It is also not available for those who have accepted and been issued a reprimand.

(a) The Board will entertain petitions for modification of the disciplinary portion of previously issued orders upon strict compliance with the procedures set forth in subparagraph (b) only when the petitioner can prove that compliance with any one or more of the conditions or terms of the discipline previously ordered is impossible. For purposes of this rule the term “impossible” does not mean that compliance is inconvenient or impractical for personal, financial, scheduling or other reasons.

(b) Procedures 1. The petitioner shall submit a written and signed Petition for Order Modification on the form contained in subparagraph (c) to the Board’s Administrative Office that shall contain all of the following:

(i) A copy of the previously issued order; and (ii) A statement of why the petitioner believes it is impossible to comply with the order as issued; and (iii) A copy of all documents that proves that compliance is impossible. If proof of impossibility of compliance requires testimony of an individual(s), including that of the petitioner, the petitioner must submit signed and notarized statements from every individual the petitioner intends to rely upon attesting, under oath, to the reasons why compliance is impossible.

No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, the petition.

2. The Board authorizes its consultant and administrative staff to make an initial determination on the petition and take one of the following actions:

(i) Certify impossibility of compliance and forward the petition to the Office of General Counsel for presentation to the Board as an uncontested matter; or (ii) Deny the petition, after consultation with legal staff, if impossibility of compliance with the provisions of the previous order is not proven and notify the petitioner of what proof of impossibility of compliance was either not sufficient or not submitted.

3. If the petition is presented to the Board the petitioner may not submit any additional documentation or testimony other than that contained in the petition as originally submitted.

4. If the petition is granted a new order shall be issued reflecting the modifications authorized by the Board that it deemed appropriate and necessary in relation to the violations found in the previous order.

5. If the petition is denied either initially by staff or after presentation to the Board and the petitioner believes impossibility of compliance with the order has been sufficiently proven the petitioner may, as authorized by law, file a petition for a declaratory order pursuant to the provisions of T.C.A. § 4-5-223 and rule 1200- 10-01-.11.

(c) Form Petition Petition for Order Modification Tennessee Medical Laboratory Board Petitioner’s Name:

Petitioner’s Mailing Address:

Petitioner’s E-Mail Address:

Telephone Number:

Attorney for Petitioner:

Attorney’s Mailing Address:

Attorney’s E-Mail Address:

Telephone Number:

The petitioner respectfully represents that for the following reasons, as substantiated by the attached documentation, the identified provisions of the attached disciplinary order are impossible for me to comply with:

Note – You must enclose all documents necessary to prove your request including a copy of the original order. If any of the proof you are relying upon to show impossibility is the testimony of any individual, including yourself, you must enclose signed and notarized statements from every individual you intend to rely upon attesting, under oath, to the reasons why compliance is impossible. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, this petition. respectfully submitted this the day of , 20 .

Petitioner’s Signature (4) The provisions of the Uniform Administrative Procedures Act, T.C.A. §§ 4-5-301, et seq., shall govern the hearing and judicial review of all disciplinary proceedings.

(5) Civil Penalties (a) Purpose - The purpose of this is to set out a schedule designating the minimum and maximum Civil Penalties which may be assessed pursuant to T.C.A. § 63-1-134.

(b) Schedule of Civil Penalties 1. A Type A Civil Penalty may be imposed whenever the Board finds the medical laboratory or collection station which is required to be licensed by the Board guilty of a willful and knowing violation of the Tennessee Medical Laboratory Act, or regulations promulgated pursuant thereto, to such an extent that there is, or is likely to be an imminent, substantial threat to the health, safety and welfare of an individual patient or the public. For purposes of this section, willfully and knowingly operating a medical laboratory or collection station without a license from the Board is one of the violations of the Tennessee Medical Laboratory Act for which a Type A Civil Penalty is assessable.

2. A Type B Civil Penalty may be imposed whenever the Board finds the medical laboratory or collection station which is required to be licensed by the Board is guilty of a violation of the Tennessee Medical Laboratory Act, or regulations promulgated pursuant thereto, in such a manner as to impact directly on the care of patients or the public.

3. A Type C Civil Penalty may be imposed whenever the Board finds the medical laboratory or collection station which is required to be licensed by the Board is guilty of a violation of the Tennessee Medical Laboratory Act, or regulations promulgated pursuant thereto, which is neither directly detrimental to the patients or public, nor directly impacts their care, but has only indirect relationship to patient care or the public.

(c) Amount of Civil Penalties 1. Type A Civil Penalties shall be assessed in the amount of not less than $500 nor more than $1,000.

2. Type B Civil Penalties may be assessed in the amount of not less than $100 and not more than $500.

3. Type C Civil Penalties may be assessed in the amount of not less than $50 and not more than $100.

(d) Procedures for Assessing Civil Penalties 1. The Division of Health Related Boards may initiate a Civil Penalty assessment by filing a Memorandum of Assessment of Civil Penalty. The Division shall state in the memorandum the facts and law upon which it relies in alleging a violation, the proposed amount of the civil penalty and the basis for such penalty. The Division may incorporate the Memorandum of Assessment of Civil Penalty with a Notice of Charges which may be issued attendant thereto.

2. Civil Penalties may also be initiated and assessed by the Board during consideration of any Notice of Charges. In addition, the Board may, upon good cause shown, assess a type and amount of civil penalty which was not recommended by the Division.

3. In assessing the Civil Penalties pursuant to these rules the Board may consider the following factors:

(i) Whether the amount imposed will be a substantial economic deterrent to the violator;

(ii) The circumstances leading to the violation;

(iii) The severity of the violation and the risk of harm to the public;

(iv) The economic benefits gained by the violator as a result of noncompliance; and, (v) The interest of the public.

4. All proceedings for the assessment of Civil Penalties shall be governed by the contested case provisions of Title 4, Chapter 5, Tennessee Code Annotated.

(6) Assessment of costs in disciplinary proceedings shall be as set forth in T.C.A. §§ 63-1-144 and 68-29-136.

(7) Subpoenas (a) Purpose - Although this rule applies to persons and entities other than medical laboratories, it is the Board’s intent as to medical laboratories that they be free to operate without fear that such operation or its documentation will be unduly subjected to scrutiny outside the profession. Consequently, balancing that intent against the interest of the public and patients to be protected against substandard care and activities requires that persons seeking to subpoena such information and/or materials must comply with the substance and procedures of these rules.

It is the intent of the Board that the subpoena power outlined herein shall be strictly proscribed. Such power shall not be used by the Division or Board investigators to seek other incriminating evidence against medical laboratory personnel when the Division or Board does not have a complaint or basis to pursue such an investigation. Thus, unless the Division or its investigators have previously considered, discovered, or otherwise received a complaint from either the public or a governmental entity, then no subpoena as contemplated herein shall issue.

(b) Definitions - As used in this chapter of rules the following words shall have the meanings ascribed to them:

1. Probable Cause (i) For investigative subpoenas shall mean that probable cause, as defined by case law at the time of request for subpoena issuance is made, exists that a violation of the Medical Laboratory Practice Act or rules promulgated pursuant thereto has occurred or is occurring and that it is more probable than not that the person(s), or items to be subpoenaed possess or contain evidence which is more probable than not relevant to the conduct constituting the violation.

(ii) The utilization of the probable cause evidentiary burden in proceedings pursuant to this rule shall not in any way, nor should it be construed in any way to establish a more restrictive burden of proof than the existing preponderance of the evidence in any civil disciplinary action which may involve the person(s) or items that are the subject of the subpoena.

2. Presiding Officer - For investigative subpoenas shall mean any elected officer of the Board, or any duly appointed or elected chairperson of any panel of the Board.

(c) Procedures 1. Investigative Subpoenas (i) Investigative Subpoenas are available only for issuance to the authorized representatives of the Tennessee Department of Health, its investigators and its legal staff.

(ii) An applicant for such a subpoena must either orally or in writing notify the Board’s Unit Director of the intention to seek issuance of a subpoena. That notification must include the following:

(I) The time frame in which issuance is required so the matter can be timely scheduled; and (II) A particular description of the material or documents sought, which must relate directly to an ongoing investigation or contested case, and shall, in the instance of documentary materials, be limited to the records of the patient or patients whose complaint, complaints, or records are being considered by the Division or Board.

(III) In no event shall such subpoena be broadly drafted to provide investigative access to medical laboratory records of other patients who are not referenced in a complaint received from an individual or governmental entity, or who have not otherwise sought relief, review, or Board consideration of any medical laboratory personnel’s conduct, act, or omission; and (IV) Whether the proceedings for the issuance is to be conducted by physical appearance or electronic means; and (V) The name and address of the person for whom the subpoena is being sought, or who has possession of the items being subpoenaed.

(iii) The Board’s Unit Director shall cause the following to be done:

(I) In as timely a manner as possible arrange for either an elected officer of the Board or any duly appointed or elected chairperson of any panel of the board to preside and determine if issuing the subpoena should be recommended to the full board; and (II) Establish a date, time and place for the proceedings to be conducted and notify the Presiding Officer, the applicant and the court reporter; and (III) Maintain a complete record of the proceedings including an audio tape in such a manner as to:

I. Preserve a verbatim record of the proceeding; and II. Prevent the person presiding over the proceedings and/or signing the subpoena from being allowed to participate in any manner in any resulting disciplinary action of any kind, formal or informal, which involves either the person or the documents or records for which the subpoena was issued.

(iv) The Proceedings (I) The applicant shall do the following:

I. Provide for the attendance of all persons whose testimony is to be relied upon to establish probable cause; and II. Produce and make part of the record copies of all documents to be utilized to establish probable cause; and III. Obtain, complete and provide to the Presiding Officer a subpoena which specifies the following:

A. The name and address of the person for whom the subpoena is being sought or who has possession of the items being subpoenaed; and B. The location of the materials, documents or reports for which production pursuant to the subpoena is sought if that location is known; and C. A brief, general description of any materials, documents or items to be produced pursuant to the subpoena; and D. The date, time and place for compliance with the subpoena.

IV. Provide the Presiding Officer testimony and/or documentary evidence which, in good faith, the applicant believes is sufficient to establish that probable cause exists for issuance of the subpoena as well as sufficient proof that all other reasonably available alternative means of securing the materials, documents or items have been unsuccessful.

(II) The Presiding Officer shall do the following:

I. Be selected only after assuring the Board’s Unit Director that he or she has no prior knowledge of or any direct or indirect interest in or relationship with the person(s) being subpoenaed and/or the licensee who is the subject of the investigation; and II. Commence the proceedings and swear all necessary witnesses; and III. Hear and maintain the confidentiality, if any, of the evidence presented at the proceedings and present to the full board only that evidence necessary for an informed decision; and IV. Control the manner and extent of inquiry during the proceedings and be allowed to question any witness who testifies; and V. Determine, based solely on the evidence presented in the proceedings, whether probable cause exists and if so, make such recommendation to the full Board; and VI. Not participate in any way in any other proceeding whether formal or informal, which involves the matters, items or person(s) which are the subject of the subpoena. This does not preclude the Presiding Officer from presiding at further proceedings for issuance of subpoenas in the matter.

(III) The Board shall do the following:

I. By a vote of two thirds (2/3) of the Board members issue the subpoena for the person(s) or items specifically found to be relevant to the inquiry, or quash or modify an existing subpoena by a majority vote; and II. Sign the subpoena as ordered to be issued, quashed or modified.

2. Post-Notice of Charges Subpoenas - If the subpoena is sought for a contested case being heard with an Administrative Law Judge from the Secretary of State’s office presiding, this definition shall not apply and all such post-notice of charges subpoenas should be obtained from the office of the Administrative Procedures Division of the Office of the Secretary of State pursuant to the Uniform Administrative Procedures Act and rules promulgated pursuant thereto.

(d) Subpoena Forms 1. All subpoenas shall be issued on forms approved by the Board.

2. The subpoena forms may be obtained by contacting the Board’s Administrative Office.

(e) Subpoena Service - Any method of service of subpoenas authorized by the Tennessee Rules of Civil Procedure or the rules of procedure for contested cases of the Tennessee Department of State, Administrative Procedures Division may be utilized to serve subpoenas pursuant to this rule.

(8) Screening Panels - The Board adopts, as if fully set out herein, rule 1200-10-01-.13, of the Division of Health Related Boards and as it may from time to time be amended, as its rule governing the screening panel process.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-217, 4-5-223, 4-5-311, 63-1-122, 63-1-134, 63-1-138, 63-1- 144, 68-29-104, 68-29-105, 68-29-109, 68-29-111, 68-29-122, 68-29-126, 68-29-128, 68-29-129, 68-29- 130, 68-29-131, 68-29-132, 68-29-136, and 68-29-405.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Amendment filed December 14, 1981; effective January 28, 1982. Amendment filed September 30, 1987; effective November 14, 1987. Repeal filed May 3, 1995; effective July 17, 1995. New rule filed January 7, 1997; effective March 23, 1997. Amendment filed December 1, 2000; effective February 14, 2001. Amendment filed March 22, 2001; effective June 5, 2001. Repeal and new rule filed June 18, 2002; effective September 1, 2002. Amendment filed July 8, 2004; effective September 21, 2004. Amendments filed May 16, 2005; effective July 30, 2005. Amendment filed March 16, 2007; effective May 30, 2007.

Tenn. Comp. R. & Regs. 1200-06-03-.06 MINIMUM STANDARDS

Each laboratory shall comply with the standards as set forth in 42 C. F. R. Part 493 of the current CLIA Regulations. These standards are deemed to be the minimum standard acceptable to the Board. Failure to meet the CLIA standards may result in disciplinary action as defined in Rule 1200-06-03-.05.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-104, 68-29-105, and 68-29-126.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Repeal filed May 3, 1995; effective July 17, 1995. New rule filed January 7, 1997; effective March 23, 1997. Repeal and new rule filed June 18, 2002; effective September 1, 2002.

Tenn. Comp. R. & Regs. 1200-06-03-.07 PARTICIPATION IN PROFICIENCY TESTING

(1) Condition: Enrollment and Testing of Samples - Each laboratory must enroll in a proficiency testing (PT) program that meets the criteria in 42 CFR Part 493, Subpart I of the current CLIA Regulations and is approved by HHS. The laboratory must enroll in an approved program for each of the specialties and subspecialties for which it seeks licensure. The laboratory must test the samples in the same manner as patient’s specimens.

(a) Standard Enrollment.

1. The laboratory must ensure that the Board is notified yearly of the approved program or programs in which it chooses to participate to meet proficiency testing requirements of this rule.

2. The laboratory must designate the program(s) to be used for each specialty, subspecialty, and analyte or task to determine compliance with the rule if the Laboratory participates in more than one (1) proficiency testing program approved by CMS.

3. For those tests performed by the laboratory for which proficiency testing is not required by 42 CFR Part 493.901, Subpart H of the CLIA regulations, a laboratory must establish and maintain the accuracy and reliability of its testing procedures, in accordance with Rule 1200-06-03-.10(5).

4. For each specialty, subspecialty and analyte or test, the laboratory must participate in one (1) approved proficiency testing program or programs, for one (1) year before designating a different program and must notify the Board before any change in designation.

5. The laboratory must authorize the proficiency testing program to release to the Board all data that may be required to determine the laboratory’s compliance with this rule.

(b) Standard: Testing of proficiency testing samples. The laboratory must examine or test, as applicable, the proficiency testing samples it receives from the proficiency testing program in the same manner as it tests patient specimens.

1. The samples must be examined or tested with the laboratory’s regular patient workload by personnel who routinely perform the testing in the laboratory, using the laboratory’s routine methods.

2. The individual testing or examining the samples and the laboratory director must attest to the routine integration of the samples into the patient workload using the laboratory’s routine methods.

3. The laboratory must test samples the same number of times that it routinely test patient samples.

4. Laboratories that perform tests on proficiency testing samples must not engage in any inter-laboratory communications pertaining to the results of proficiency testing sample(s) until after the date by which the laboratory must report proficiency testing results to the program for the testing event in which the samples were sent.

5. Laboratories with multiple testing sites or separate locations must not participate in any communications or discussions across sites/locations concerning proficiency testing sample results until after the date by which the laboratory must report proficiency testing results to the program.

6. The laboratory must not send proficiency testing samples or portions of samples to another laboratory for any analysis which they are certified to perform in their own laboratory.

7. Any laboratory that the Board determines intentionally referred its proficiency testing samples to another laboratory for analysis and submits the other laboratory’s results as their own shall have its license disciplined, pursuant to

Rule 1200-06-03-.05.

8. Any laboratory that receives proficiency testing samples from another laboratory for testing must notify the Board of the receipt of those samples.

9. The laboratory must document the handling, preparation, processing, examination, and each step in the testing and reporting of results for all proficiency testing samples.

10. The laboratory must maintain copy of all records, including a copy of the proficiency testing program report forms used by the laboratory to record proficiency testing results including the attestation statement provided by the proficiency testing program, signed by the analyst and the laboratory director, documenting that proficiency testing samples were tested in the same manner as patient specimens, for a minimum of two (2) years from the date of the proficiency testing event.

11. Unless otherwise specified in the Rules, proficiency testing is required for only the test system, assay, or examination used as the primary method for patient testing during the proficiency testing event.

(2) Condition: Successful Participation:

(a) Each laboratory performing tests must successfully participate in a proficiency testing program approved by CMS, if applicable, for each specialty, subspecialty, and analyte or test in which the laboratory is certified under CLIA.

(b) If the laboratory fails to participate successfully in proficiency testing for a given specialty, subspecialty, analyte or test sanctions will be taken as defined in Rule 1200- 06-03-.05.

(3) Condition: Reinstatement of Laboratories after Failure to Participate Successfully.

(a) If a laboratory’s license is suspended or placed on probation by the Board or limited pursuant to CLIA regulations because it fails to participate successfully in proficiency testing for one (1) or more specialties, subspecialties, analyte, or voluntarily surrenders its license for the failed specialty, subspecialty, or analyte, the laboratory must then demonstrate sustained satisfactory performance on two (2) consecutive proficiency testing events, before the Board will consider it for reinstatement in that specialty, subspecialty, analyte or test.

(b) The period of suspension of licensure for the failed specialty, subspecialty, or analyte or test is for a period of not less than six (6) months from the date of suspension.

(c) If a laboratory’s license is suspended, the laboratory must take corrective action and petition the Board for the suspension to be lifted and apply for the license to be reinstated and pay any necessary fees as set out in 1200-06-03-.02.

(4) Condition: Specialties and Subspecialties.

(a) Failure to attain an overall testing event score of at least eighty per cent (80%) is unsatisfactory performance for Bacteriology, Mycobacteriology, Mycology, Parasitiology, Virology, Syphilis Serology, General Immunology, Routine Chemistry, Endocrinology, Toxicology, Hematology, Antibody Detection, and Anti-Body Identification.

(b) Failure to attain a score of at least eighty per cent (80%) of acceptable responses for each analyte in each testing event is unsatisfactory analyte performance for the testing event of General Immunology, Routine Chemistry, Endocrinology, Toxicology, and Hematology.

(c) Failure to attain an overall testing event score of at least one hundred per cent (100%) is unsatisfactory performance for ABO grouping, Rh typing, and Compatibility testing.

(d) Failure to participate in a testing event is unsatisfactory performance and results in a score of zero (0) for the testing event.

(e) Consideration may be given to those laboratories failing to participate in a testing event only if the following requirements are met:

1. Patient testing was suspended during the time frame allotted for testing and reporting proficiency testing results; and 2. The laboratory notifies the inspecting agency and the proficiency testing program within the time frame for submitting proficiency testing results of the suspension of patient testing and the circumstances associated with failure to perform tests on proficiency testing samples; and 3. The laboratory had successfully participated in the previous two (2) proficiency testing events.

(f) Failure to return proficiency testing results to the proficiency testing program within the time frame specified by the program is unsatisfactory performance and results in a score of zero (0) for the testing event.

(g) For any unsatisfactory analyte or testing event for reasons other than a failure to participate, the laboratory must undertake appropriate training and employ the technical assistance necessary to correct problems associated with a proficiency testing failure.

(h) For any unsatisfactory analyte or testing event score, remedial action must be taken and documented, and the documentation must be maintained by the laboratory for two (2) years from the date of participation in the proficiency testing event.

(i) Failure to achieve satisfactory performance for the same analyte or test in two (2) consecutive testing events or two (2) out of three (3) consecutive testing events is unsuccessful performance.

(j) Failure to achieve an overall testing event score of satisfactory performance for two (2) consecutive testing events or two (2) out of three (3) consecutive testing events is unsuccessful performance.

(k) All unsuccessful testing events shall be reported to the Department within thirty (30) days of receipt of the hard copy print-out that documents results for unsuccessful proficiency testing.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-104, and 68-29-105.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Amendment filed December 14, 1981; effective January 28, 1982.Amendment filed September 30, 1987; effective November 14, 1987. Repeal filed May 3, 1995; effective July 17, 1995. New rule filed January 7, 1997; effective March 23, 1997. Repeal and new rule filed June 18, 2002; effective September 1, 2002. Amendment filed August 25, 2003; effective November 8, 2003. Amendment filed October 11, 2004; effective December 25, 2004.

Tenn. Comp. R. & Regs. 1200-06-03-.08 PATIENT TEST MANAGEMENT

(1) Condition: Each laboratory must employ and maintain a system that provides for proper patient preparation; proper specimen collection, identification, preservation, transportation, and processing; and accurate result reporting. This system must assure optimum patient specimen integrity and positive identification throughout the testing process and must meet the standards of this rule as they apply to the testing performed.

(a) Standard: Procedures for specimen submission and handling:

1. The laboratory must have available and must follow written policies and procedures for each of the following, if applicable: methods used for the preparation of patients; specimen collection; specimen labeling; specimen preservation; and conditions for specimen transportation and specimen processing.

2. Such policies and procedures must assure positive identification and optimum integrity of patient specimens from the time the specimens are collected until testing has been completed and the results reported.

3. If the laboratory accepts referral specimens, written instructions must be available to clients and must include, as appropriate, the information specified in paragraph (a)1. of this section.

4. Oral explanation of instructions to patients for specimen collections, including patient preparation, may be used as a supplement to written instructions where applicable.

(b) Standard: Test Requisition.

1. The laboratory must perform tests only at the written or electronic request of an authorized person. The laboratory must maintain the written authorization or documentation of efforts made to obtain a written authorization.

2. Outpatient laboratory testing in Tennessee hospitals may be ordered by the following:

(i) Any licensed Tennessee practitioner who is authorized to do so by T.C.A. § 68-29-121;

(ii) Any out of state practitioner who has a Tennessee telemedicine license issued pursuant to rule 0880-02-.16; or (iii) Any duly licensed out of state health care professional as listed in T.C.A. § 68-29-121 who is authorized by his or her state board to order outpatient laboratory testing in hospitals for individuals with whom that practitioner has an existing face-to-face patient relationship as outlined in rule 0880- 02-.14(7)(a)1., 2., and 3.

3. Records of test requisitions or test authorizations must be retained for a minimum of two (2) years. The patient’s chart or medical record, if used as the test requisition, must be retained for a minimum of two (2) years and must be available to the laboratory at the time of testing and available to the Board upon request.

4. The laboratory must assure that the requisition or test authorization includes all of the following:

(i) The patient’s name or other unique identifier.

(ii) The name and address or other suitable identifiers of the authorized person requesting the test and, if appropriate, the individual responsible for utilizing the test results or the name and address of the laboratory submitting the specimen, including, as applicable, a contact person to enable the reporting of imminent life threatening laboratory results or panic values;

(iii) The test(s) to be performed;

(iv) The date of specimen collection;

(v) For PAP smears, the patient’s last menstrual period, age or date of birth, and indication of whether the patient had a previous abnormal report, treatment or biopsy, and (vi) Any additional information relevant and necessary to a specific test to assure accurate and timely testing and reporting of results.

(c) Standard: Test Records:

1. The laboratory must maintain a record system to ensure reliable identification of patient specimens as they are processed and tested to assure that accurate test results are reported. These records must identify the personnel performing the testing procedure.

2. Records of patient testing, including, if applicable, instrument printouts or electronic data storage, must be retained for at least two (2) years.

Immunohematology and transfusion records must be retained for no less than five (5) years.

3. The record system must provide documentation of information specified in Rule 1200-06-03-.08(1)(b)3.(i) through (vi) and include all of the following:

(i) The patient identification number, accession number, or other unique identification of the specimen;

(ii) The date and time of specimen receipt into the laboratory;

(iii) The condition and disposition of specimens that do not meet the laboratory’s criteria for specimen acceptability and (iv) The records and dates of all specimen testing, including the identity of the personnel who performed the test(s), which are necessary to assure proper identification and accurate reporting of patient test results.

(d) Standard: Test report.

1. The results of a laboratory test shall be reported promptly to the authorized person, the individual responsible for using the test results, the laboratory initially requesting the test, or other person required by statute or rule to receive test results.

2. The original report or an exact duplicate of each test report, including final and preliminary reports, must be retained by the testing laboratory for a period of at least two (2) years after the date of reporting. This information may be maintained as part of the patient’s chart or medical record which must be readily available to the laboratory and to the Board upon request.

(i) Immunohematology reports must be retained by the laboratory for a period of no less than five (5) years.

(ii) Pathology test reports must be retained for a period of at least ten (10) years after the date of reporting.

3. The laboratory must have adequate systems in place to report results in a timely, accurate, reliable and confidential manner, and ensure patient confidentiality throughout those parts of the total process that are under the laboratory’s control.

4. Laboratories must comply with Rule 1200-14-01-.41, Reports of Sexually Transmitted Diseases, which states, in part, that the following diseases are declared to be sexually transmitted diseases and, upon their diagnosis or treatment, are subject to reporting requirements as designated in T.C.A. § 68-10- 101.

(i) Acquired Immune Deficiency Syndrome (AIDS) I (ii) Gonorrhea I (iii) Syphilis (by stage) I (iv) Chlamydia trachomatis (v) Nongonococcal Urethritis/NGU (Number of Cases)

(vi) Human Immunodeficiency Virus - all types Confidential (opaque envelope) report required. All information and reports concerning persons infected with sexually transmitted diseases shall be confidential and shall be inaccessible to the public.

5. The test report must indicate the name and address of the laboratory location at which the test was performed, the test performed, the name of the medical laboratory director, the test result and, if applicable, the units of measurement.

6. The laboratory must indicate on the test report any information regarding the condition and disposition of specimens that do not meet the laboratory’s criteria for acceptability.

7. Pertinent “reference, or “normal” ranges, as determined by the laboratory performing the tests must be available to the authorized person who ordered the tests or the individual responsible for utilizing the test results.

8. The results or transcripts of laboratory tests or examinations must be released only to authorized persons or the individual responsible for utilizing the test results.

9. The laboratory must develop and follow written procedures for reporting imminent life-threatening laboratory results or “critical values.” In addition, the laboratory must immediately alert the individual, entity requesting the test or the individual responsible for utilizing the test results.

10. The laboratory must, upon request, make available to clients a list of test methods employed by the laboratory and, in accordance with Rule 1200-06-03- .09 (4), as applicable, the performance specifications of each method used to test patient specimens. In addition, information that may affect the interpretation of test results, such as test interference must be provided upon request.

11. Pertinent updates on testing information must be provided to clients whenever changes occur that affect the test results or interpretation of test results.

12. The original report or exact duplicates of test reports must be maintained by the laboratory in a manner that permits ready identification and timely accessibility.

(e) Standard: Referral of specimens - A laboratory must refer specimens for testing only to an in state laboratory possessing a current Tennessee license and current CLIA certification, or an out of state laboratory having a CLIA certification authorizing the performance of testing in the specialty or subspecialty of service for the level of complexity in which the referred test is categorized. The laboratory shall maintain a copy of the current CLIA certification for the referral or reference laboratory.

1. The referring laboratory must not revise results or information directly related to the interpretation of results provided by the testing laboratory.

2. The referring laboratory may permit each testing laboratory to send the test result directly to the authorized person who initially requested the test. The referring laboratory must retain or be able to produce an exact duplicate of each testing laboratory’s report.

3. The authorized person who orders a test or procedure must be notified by the referring laboratory of the name and address of each laboratory location at which a test was performed.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-103, 68-29-105, 68-29-107, 68-29-121, and 68-29-124.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Repeal filed May 3, 1995; effective July 17, 1995. New rule filed January 7, 1997; effective March 23, 1997. Repeal and new rule filed June 18, 2002; effective September 1, 2002. Amendment filed October 11, 2004; effective December 25, 2004. Amendment filed August 8, 2005; effective October 22, 2005.

Tenn. Comp. R. & Regs. 1200-06-03-.09 QUALITY CONTROL

(1) Condition: General Quality Control - The laboratory must establish and follow written quality control procedures, including but not limited to electronic quality control and internal quality control, for monitoring and evaluating the quality of the analytical testing process of each method. General quality control shall assure the accuracy and reliability of patient test results and reports. The medical laboratory director shall review all general quality control or may designate, in writing, the review to personnel meeting the qualification of those respective positions. The medical laboratory director shall retain the ultimate responsibility for the general quality control of the operation of the laboratory. In addition, the laboratory must meet the applicable standards in paragraphs 1200-06-03-.09(2) through 1200-06-03-.09(11) of this

rule.

(2) Standard: Laboratory Testing: For each test performed, the laboratory will be in compliance if it (a) Meets all applicable quality control requirements specified in this rule; or (b) Follows manufacturer’s instructions when using their products (instruments, kits, or test systems). In addition, the laboratory must comply with requirements within any paragraph of this rule that are unique to the laboratory facility and cannot be met by manufacturer’s instructions.

(3) Standard: Test Methods, Equipment, Instrumentation, Reagents, Materials, and Supplies.

The laboratory must utilize test methods, equipment instrumentation, reagents, materials, and supplies that provide accurate and reliable test results and test reports.

(a) Test methodologies and equipment must be selected and testing performed in a manner that provides test results within the laboratory’s stated performance specifications for each test method as determined under Rule 1200-06-03-.09(4).

1. The laboratory must have appropriate and sufficient equipment, instruments, reagents, materials, and supplies for the type and volume of testing performed and for the maintenance of quality during all phases of testing.

2. The accuracy of analytical balance weights must be verified annually against appropriate standard sources.

3. The accuracy of thermometers must be verified annually against appropriate standard sources or following the manufacturer’s instructions.

4. The accuracy of pipettes must be verified annually against appropriate standard sources or following the manufacturer’s instructions.

5. The accuracy of centrifuge(s) must be verified annually against appropriate standard sources or following manufacturer’s instructions.

6. The accuracy of timers must be verified annually against, appropriate standard sources or following manufacturer’s instructions.

(b) The laboratory must define criteria for those conditions that are essential for proper storage of reagents and specimens, for accurate and reliable test system operation, and for test result reporting.

1. These conditions include, if applicable, the following:

(i) Water quality;

(ii) Temperature;

(iii) Humidity; and (iv ) Protection of equipment and instrumentation from fluctuations and interruptions in electrical current that adversely affect patient test results and test reports.

2. Remedial actions taken to correct conditions that fail to meet the criteria specified in this subparagraph must be documented.

(c) Reagents, solutions, culture media, control materials, calibration materials and other supplies, as appropriate, must be labeled to indicate the following:

1. Identity and, when significant, titer, strength or concentration;

2. Recommend storage requirements;

3. Preparation and expiration date;

4. The date of receipt and date opened; and 5. Other pertinent information required for proper use.

(d) Reagents, solutions, culture media, control materials, calibration materials and other supplies must be prepared, stored, and handled in a manner to ensure the following:

1. Reagents, solutions, culture media, controls, calibration materials and other supplies are not used when they have exceeded their expiration date or when they have deteriorated or are of substandard quality. The laboratory must comply with the FDA product dating requirements of 21 CFR 610.53 for blood products and other biologicals, and with the labeling requirement of 21 CFR 809.10 for all other in-vitro diagnostics. Any exception to the product dating requirements in 21 CFR 610.53, will be granted by the FDA in the form of an amendment of the product license, in accordance with 21 CFR 610.53(d). All exceptions must be documented by the laboratory; and 2. Components of reagent kits of different lot numbers are not interchanged unless otherwise specified by the manufacturer.

(4) Standard: Procedure Manual.

(a) A written procedure manual for the performance of all analytical methods used by the laboratory must be readily available and followed by laboratory personnel. Textbooks may be used as supplements to these written descriptions but may not be used in lieu of the laboratory’s written procedures for testing or examining specimens. Procedure should be substantially in compliance with the CLSI, GP-2A, current version, or any subsequent version.

(b) The procedure manual must include, when applicable to the test procedure, all of the following:

1. Requirements for specimen collection and processing, and criteria for specimen rejection;

2. Procedures for microscopic examination, including the detection of inadequately prepared slides;

3. Step-by-step performance of the procedure, including test calculations and interpretation of results;

4. Preparation of slides, solutions, calibrators, controls, reagents, stains and other materials using in testing;

5. Calibration and calibration verification procedures;

6. The reportable range for patient test results as established or verified in Rule 1200-06-03-.09(5);

7. Control procedures;

8. Remedial action to be taken when calibration or control results fail to meet the laboratory’s criteria for acceptability;

9. Limitations in methodologies, including interfering substances;

10. Reference range (normal values);

11. Imminent life-threatening laboratory results or “critical values”;

12. Current pertinent literature references;

13. Appropriate criteria for specimen storage and preservation to ensure specimen integrity until testing is completed;

14. The laboratory’s system for reporting patient results including when appropriate, the protocol for reporting critical values;

15. Description of the course of action to be taken in the event that a test system becomes inoperable; and 16. Criteria for the referral of specimens including procedures for specimen submission and handling as described in Rule 1200-06-03-.07(1)(a).

(c) Manufacturers’ package inserts or operator manuals may be used, when applicable, to meet the requirements of parts (b)1. through (b) 13. of this paragraph. Information not provided by the manufacturer must be provided by the laboratory.

(d) Procedures must be re-approved, signed and dated by the medical laboratory director or designee.

(e) Procedures must be re-approved, signed and dated if the directorship of the laboratory changes.

(f) Each change in a procedure must be approved, signed, and dated by the current medical laboratory director or his or her designee approved, in writing, by the medical laboratory director.

(g) The laboratory must maintain a copy of each procedure with the dates of initial use and discontinuance. These records must be retained for two (2) years after a procedure has been discontinued.

(5) Standard: Establishment and Verification of Method Performance Specifications. Prior to reporting patient test results, the laboratory must verify or establish, for each method, the performance specifications for the following performance characteristics: accuracy; precision; analytical sensitivity and specificity, if applicable; the reportable range of patient test results; the reference range(s) (normal values); and any other applicable performance characteristic.

(a) The provisions of this section are not retroactive.

(b) A laboratory that introduces a new procedure for patient testing must, prior to reporting patient test results:

1. Verify or establish for each method the performance specifications for the following performance characteristics, as applicable:

(i) Accuracy;

(ii) Precision;

(iii) Analytical sensitivity;

(iv) Analytical specificity to include interfering substances;

(v) Reportable range of patient test results;

(vi) Reference range(s); and (vii) Any other performance characteristic required for test performance.

2. Establish calibration and control procedures for patient testing as required under Rules 1200-06-03-.09(7) and 1200-06-03-.09(8), based upon the performance specifications verified or established in accordance with Rule 1200-06-03-.09(5).

(c) The laboratory must have documentation of the verification or establishment of all applicable test performance specifications.

(6) Standard: Equipment Maintenance and Function Checks - The laboratory must perform equipment maintenance and function checks to assure accurate and reliable test results and reports. This includes electronic, mechanical and operational checks of equipment, instruments, and test systems necessary for proper test performance and test result reporting.

(a) Maintenance of equipment, instruments, and test systems - For equipment, instruments or test systems the laboratory must:

1. Establish a maintenance protocol that ensures equipment, instrument, and test system performance necessary for accurate and reliable test results and test result reporting;

2. Perform maintenance with at least the frequency specified in the abovementioned maintenance protocol; and 3. Document all maintenance performed.

(b) Function checks of equipment, instruments, and test systems - For equipment, instruments, or test systems the laboratory must:

1. Define a function check protocol that ensures equipment, instrument, and test system performance necessary for accurate and reliable test results and test result reporting;

2. Perform function checks including background or baseline checks as specified in the above-mentioned function check protocol. Function checks must be within the laboratory’s established limits before patient testing is conducted; and 3. Document all function checks performed.

(7) Standard: Calibration and Calibration Verification Procedures - Calibration and calibration verification procedures are required to substantiate the continued accuracy of the test method throughout the laboratory’s reportable range for patient test results. Calibration is the process of testing and adjusting an instrument kit, or test system to provide a known relationship between the measurement response and the value of the substance that is being measured by the test procedure. Calibration verification is the assaying of calibration materials in the same manner as patient samples to confirm that the calibration of the instrument, kit, or test system has remained stable throughout the laboratory’s reportable range for patient test results. The reportable range for patient test results is the range of test result values over which the laboratory can establish or verify the accuracy of instrument, kit or test system measurement response. Calibration and calibration verification must be performed and documented as required in this rule unless otherwise specified in paragraphs 1200-06-03-.09(12) through 1200-06-03-.09(34). For each method the laboratory must:

(a) Perform calibration procedures 1. At a minimum, in accordance with manufacturer’s instructions, if provided, using calibration materials provided or specified, as appropriate, and with at least the frequency recommended by the manufacturer;

2. In accordance with criteria established by the laboratory.

(i) Including the number, type and concentration of calibration materials, acceptable limits for calibration, and the frequency of calibration if manufacturer’s instructions are not provided; and (ii) Using calibration materials appropriate for the methodology and, if possible, traceable to a reference method or reference material of known value; and 3. Whenever calibration verification fails to meet the laboratory’s acceptable limits for calibration verification; and (b) Perform calibration verification procedures 1. In accordance with the manufacturer’s calibration verification instructions when they meet or exceed the requirements specified by the laboratory as described in

Rule 1200-06-03-.09(7)(b)2., or 2. In accordance with criteria established by the laboratory (i) Including the number, type, and concentration of calibration materials, acceptable limits for calibration verification and frequency of calibration verification; and (ii) Using calibration materials appropriate for (I) The methodology and, if possible, traceable to a reference method or reference material of known value; and (II) Verifying the laboratory’s established reportable range of patient test results, which must include at least a minimal (or zero[0]) value, a mid-point value, and a maximum value at the upper limit of that range; and (iii) At least once every six (6) months and whenever any of the following occur:

(I) A complete change of reagents for a procedure is introduced, unless the laboratory can demonstrate that changing reagent lot numbers does not effect the range used to report patient test results, and control values are not adversely affected by reagent lot number changes.

Note: If reagents are obtained from a manufacturer and all of the reagents for a test are packaged together, the laboratory is not required to perform calibration verification for each package of reagents, provided the packages of reagents are received in the same shipment and contain the same lot number;

(II) There is major preventive maintenance or replacement of critical parts that may influence test performance;

(III) Controls reflect an unusual trend or shift or are outside of the laboratory’s acceptable limits and other means of assessing and correcting unacceptable control values have failed to identify and correct the problem; or (IV) The laboratory’s established schedule for verifying the reportable range for patient test results requires more frequent calibration verification than specified in Rule 1200-06-03-.09(7)(b)2.(i), (ii), or (iii) and (c) Document all calibration verification procedures performed.

(8) Standard: Control Procedures – Control procedures are performed on a routine basis to monitor the stability of the method or test system; control materials provide a means to indirectly assess the accuracy and precision of patient test results. Control procedures must be performed as defined in this paragraph unless otherwise specified in paragraphs 1200-06- 03-.09(12) through 1200-06-03-.09(34).

(a) Control samples must be tested in the same manner as patient specimens.

1. For qualitative tests, the laboratory must include a positive and negative control with each run of patient specimens.

2. For quantitative tests, the laboratory must include at least two (2) samples of different concentrations of either calibration materials, control materials, or a combination thereof with the frequency determined in subparagraph 1200-06-03- .09(3)(a), but not less frequently than once each run of patient specimens.

3. For electrophoretic determinations (i) At least one (1) control sample must be used in each electrophorectic cell; and (ii) The control sample must contain fractions representative of those routinely reported in patient specimens.

4. Each day of use, the laboratory must evaluate the detection phase of direct antigen systems using an appropriate positive and negative control material (organism or antigen extract). When direct antigen systems include an extraction phase, the system must be checked each day of use using a positive organism.

5. If calibration materials and control materials are not available, the laboratory must have an alternative mechanism to assure the validity of patient test results.

(b) Control samples must be tested in the same manner as patient specimens.

(c) When calibration or control materials are used, statistical parameters (e.g. mean and standard deviation) for each lot number of calibration material and each lot of control material must be determined through repetitive testing.

1. The stated values of an assayed control material may be used as the target values provided the stated values correspond to the methodology and instrumentation employed by the laboratory and are verified by the laboratory.

2. Statistical parameters for unassayed materials must be established over time by the laboratory through concurrent testing with calibration materials or control materials having previously determined statistical parameters.

(d) Control results must meet the laboratory’s criteria for acceptability prior to reporting patient test results.

(e) Reagent and supply checks.

1. The laboratory must check each lot or shipment of reagents, discs, stains, antisera and identification systems (systems using two (2) or more substrates) when prepared or opened for positive and negative reactivity, as well as graded reactivity if applicable.

2. Each day of use (unless otherwise specified in this rule), the laboratory must test staining materials for intended reactively to ensure predictable staining characteristics.

3. The laboratory must check fluorescent stains for positive and negative reactivity each time of use (unless otherwise specified in this rule).

4. The laboratory must check each batch or shipment of media for sterility, if it is intended to be sterile and if sterility is required for testing. Media must also be checked for its ability to support growth, and as appropriate, selectivity/inhibition and/or biochemical response. The laboratory may use manufacturer’s control checks of media provided the manufacturer’s product insert specifies that the manufacturer’s quality control checks meet the current standards of the Clinical and Laboratory Standards Institute (CLSI) for media quality control. The laboratory must document that the physical characteristics of the media are not compromised and report any deterioration in the media to the manufacturer. The laboratory must follow the manufacturer’s specifications for using the media and be responsible for the test results.

5. A batch of media (solid, semi-solid, or liquid) consists of all tubes, plates, or containers of the same medium prepared at the same time and in the same laboratory, or, if received from an outside source of commercial supplier, consists of all of the plates, tubes or containers of the same medium that have the same lot numbers and are received in a single shipment.

(f) For each method that is developed in-house, that is a modification of the manufacturer’s test procedure, the laboratory must evaluate instrument and reagent stability and operator variance in determining the number, type, and frequency of testing calibration or control materials and establish criteria for acceptability used to monitor test performance during a run of patient specimen(s). A run is an interval within which the accuracy and precision of a testing system is expected to be stable, but cannot be greater than twenty-four (24) hours or less than the frequency recommended by the manufacturer. For each procedure, the laboratory must monitor test performance using calibration materials or a combination thereof.

(9) Standard: Remedial Actions - Remedial action policies and procedures must be established by the laboratory and applied as necessary to maintain the laboratory’s operation for testing patient specimens in a manner that assures accurate and reliable patient test results and reports. The laboratory must document all remedial actions taken when any of the following occur:

(a) The laboratory shall take any remedial action to correct a noted error in specimen collection or loss of specimen.

(b) Test systems that do not meet the laboratory’s established performance specifications, as determined in Rule 1200-06-03-.09(5) include but are not limited to the following:

1. Equipment or methodologies that perform outside of established operating parameters or performance specifications;

2. Patient test values that are outside of the laboratory’s reportable range of patient test results; and 3. The determination that the laboratory’s reference range for a test procedure is inappropriate for the laboratory’s patient population.

(c) Results of control and calibration materials that fail to meet the laboratory’s established criteria for acceptability. All patient test results obtained in the unacceptable test run or since the last acceptable test run must be evaluated to determine if patient test results have been adversely affected. The laboratory must take the remedial action necessary to ensure the reporting of accurate and reliable patient test results;

(d) If the laboratory cannot report patient test results within its established time frames the laboratory must determine, based on the urgency of the patient test(s) requested, the need to notify the appropriate individual of the delayed testing; and (e) Errors in the reported patient test results are detected. The laboratory must 1. Promptly notify the authorized person ordering or individual utilizing the test results of reporting errors;

2. Issue corrected reports promptly to the authorized person ordering the test or the individual utilizing the test results; and 3. Maintain exact duplicates of the original report as well as the corrected report for two (2) years.

(f) There must be a procedure of review in operation to verify highly unusual results such as delta values and critical values. This review must be performed and documented by the supervisor or other person designated in writing on a daily basis to identify possibly erroneous tests.

(10) Standard: Quality Control Records - The laboratory must document and maintain records of all quality control activities specified in paragraphs 1200-06-03-.09(2) through 1200-06-03- .09(34) and retain records for at least two (2) years. Immunohematology quality control records must be maintained for a period of no less than five (5) years. In addition, quality control records for blood and blood products must be maintained for a period not less than five (5) years. In addition, quality control records for blood and blood products must be maintained for a period not less than five (5) years after processing records have been completed, or six (6) months after the latest expiration date, whichever is the later date, in accordance with 21 CFR 6060.160(d).

(11) Condition: Quality Control - Specialties and Subspecialties - The laboratory must establish and follow written policies and procedures for an acceptable quality control program that include verification and assessment of accuracy, measurement of precision and detection of error for all analyses and procedures performed by the laboratory. In addition to the general requirements specified in paragraphs 1200-06-03-.09(1) through 1200-06-03-.09(11), the laboratory must meet the applicable requirements of paragraphs 1200-06-03-.09(12) through 1200-06-03-.09(34) or an CMS approved equivalent procedure and the following:

(a) Meets quality control requirements specified in this paragraph; or (b) Follows manufacturer’s instructions when using products (instruments, kits, or test systems) as well as specialty and subspecialty quality control.

(c) Failure to meet any of the applicable conditions in paragraph 1200-06-03-.09(12) through 1200-06-03-.09(34) may result in revocation of licensure for the entire specialty or subspecialty to which the condition applies, in accordance with Rule 12-06-03-.05.

(12) Condition: Microbiology - The laboratory must meet the applicable quality control requirements in paragraphs 1200-06-03-.09(1) through 1200-06-03-.09(11) and in paragraphs 1200-06-03-.09(13) through 1200-06-03-.09(17) for the subspecialties for which it is certified under the specialty of microbiology.

(13) Condition: Bacteriology - To meet the quality control requirements for bacteriology in paragraphs 1200-06-03-.09(1) through 1200-06-03-.09(11) and in paragraphs 1200-06-03- .09(13) through 1200-06-03-.09(17) for the subspecialties for which it is certified under the specialty of microbiology.

(a) The laboratory must check positive and negative reactivity with control organisms as specified below:

1. Each day of use for catalase, coagulase, beta-lactamase, and oxidase reagents and DNA probes;

2. Each week of use for Gram and acid-fast stains, bacitracin, optochin, ONPG, X and V discs or strips; and 3. Each month of use for antisera.

(b) Each week of use, the laboratory must check XV discs or strips with a positive control organism.

(c) For antimicrobial susceptibility tests, the laboratory must check each new batch of media and each lot of antimicrobial discs before, or concurrent with, initial use, using approved reference organisms.

1. The laboratory’s zone sizes or minimum inhibitory concentration for reference organisms must be within established limits before reporting patient results.

2. The laboratory must use the appropriate control organism(s) to check the procedure as required by current law under CLIA.

(14) Condition: Mycobacteriology - To meet the quality control requirements for mycobacteriology, the laboratory must comply with the applicable requirements in paragraph 1200-06-03-.09(1) through 1200-63-.09(11) and with subparagraphs (a) through (d) of this paragraph. All quality control activities must be documented.

(a) Each day of use, the laboratory must check the iron uptake test with at least one (1) acid-fast organism that produces a positive reaction and with an organism that produces a negative reaction and check all other reagents or test procedures used for mycobacteria identification with at least one (1) acid-fast organism that produces a positive reaction.

(b) The laboratory must check flurochrome acid-fast stains for positive and negative reactivity each week of use.

(c) The laboratory must check acid-fast stains each week of use with an acid-fast organism that produces a positive reaction.

(d) For susceptibility tests performed on Mycobacterium tuberculosis, the laboratory must comply with the applicable requirements in paragraphs 1200-06-03-.09(1) through 1200-06-03-.09(11) and with subparagraphs (a) through (d) of this paragraph. All quality control activities must be documented.

(15) Condition: Mycology - To meet the quality control requirements for mycology, the laboratory must comply with the applicable requirements in paragraphs 1200-06-03-.09(1) though 1200- 06-03-.09(11) and with subparagraphs (a) through (d) of this paragraph. All quality control activities must be documented.

(a) Each day of use, the laboratory using the auxanographic medium for nitrate assimilation must check the nitrate reagent with a peptone control.

(b) Each week of use, the laboratory must check all reagents used with biochemical tests and other test procedures for mycological identification with an organism that produces a positive reaction.

(c) Each week of patient testing, the laboratory must check acid-fast stains for positive and negative reactivity.

(d) For susceptibility tests, the laboratory must test each drug each day of use with at least one (1) control strain that is susceptible to the drug. The laboratory must establish control limits. Criteria for acceptable control results must be met prior to reporting patient results.

(16) Condition: Parasitology - To meet the quality control requirements for parasitology, the laboratory must comply with the applicable requirements of paragraphs 1200-06-03-.09(1) through 1200-06-03-.09(11) and with subparagraphs (a) through (c) of this paragraph. All quality control activities must be documented.

(a) The laboratory must have available a reference collection of slides or photographs, and, if available, gross specimens for identification of parasites and must use these references in the laboratory for appropriate comparison with diagnostic specimens.

(b) The laboratory must calibrate and use the calibrated ocular micrometer for determining the size of ova and parasites, if size is a critical parameter. Recalibration must be performed if the ocular micrometer is moved to another microscope or objectives are changed.

(c) Each month of use, the laboratory much check permanent stains using a fecal sample control that will demonstrate staining characteristics.

(17) Condition: Virology - To meet the quality control requirements for virology, the laboratory must comply with the applicable requirements in paragraph 1200-06-03-.09(1) through 1200- 06-03-.09(11) and with subparagraphs (a) through (c) of this paragraph. All quality control activities must be documented.

(a) The laboratory must have available host systems for the isolation of viruses and test methods for the identification of viruses that cover the entire range of viruses that are etiologically related to clinical diseases for which services are offered.

(b) The laboratory must maintain records that reflect the systems used and the reactions observed.

(c) In tests for the identification of viruses, the laboratory must simultaneously culture uninoculated cells or cell substrate control as a negative control to detect erroneous identification results.

(18) Condition: Diagnostic Immunology - The laboratory must meet the applicable quality control requirements in paragraph 1200-06-03-.09(1) through 1200-06-03-.09(11) and paragraphs 1200-3-.09(19) through 1200-06-03-.09(20) for the subspecialties for which it is certified under the specialty of diagnostic immunology.

(19) Condition: Syphilis Serology - To meet the quality control requirements for syphilis serology, the laboratory must comply with the applicable requirements in paragraphs 1200-06-03- .09(1) through 1200-06-03-.09(11) and with subparagraphs (a) through (c) of this paragraph.

All quality control activities must be documented.

(a) For laboratories performing syphilis testing, the equipment, glassware, reagents, controls, and techniques for tests for syphilis must conform to manufacturers’ specifications.

(b) The laboratory must run serologic tests on patient specimens concurrently with a positive serum control of known titer or controls of graded reactivity plus a negative control.

(c) The laboratory must employ positive and negative controls that evaluate all phases of the test system to ensure reactivity and uniform dosages.

(d) The laboratory may not report test results unless the predetermined reactivity pattern of the controls is observed.

(e) All facilities manufacturing blood and blood products for transfusion or serving as referral laboratories for these facilities must meet the syphilis serology testing requirements of 21 CFR 640.5(a).

(20) Condition: General Immunology - To meet the quality control requirements for general immunology, the laboratory must comply with the applicable requirements in paragraphs 1200-06-03-.09(1) through 1200-06-03-.09(11) and with subparagraphs (a) through (d) of this paragraph. All quality control activities must be documented.

(a) The laboratory must run serologic tests on patient specimens concurrently with a positive serum control of know titer or controls of graded reactivity and uniform dosages when positive and negative controls are not sufficient.

(b) The Laboratory must employ controls that evaluate all phases of the test system (antigens, complement, erythrocyte indicator systems, etc.) to ensure reactivity and uniform dosages when positive and negative controls alone are not sufficient.

(c) The laboratory may not report test results unless the predetermined reactivity pattern of the controls is observed.

(d) All facilities manufacturing blood and blood products for transfusion or serving as referral laboratories for these facilities must meet 1. The HIV testing requirements of 21 CFR 610.45; and 2. Hepatitis testing and requirements of 21 CFR 610.40.

(21) Condition: Chemistry - The laboratory must meet the applicable quality control requirements in paragraphs 1200-06-03-.09(1) through 1200-06-03-.09(11) and paragraphs 1200-06-03- .09(22) through 1200-06-03-.09(24) for the subspecialties for which it is certified under the specialty of chemistry.

(22) Condition: Routine Chemistry - To meet the quality control requirements for routine chemistry, the laboratory must comply with the applicable requirements in paragraphs 1200- 06-03-.09(1) through 1200-06-03-.09(11). All quality control activities must be documented. In addition, for blood gas analyses, the laboratory must:

(a) Calibrate or verify calibration according to the manufacturer’s instructions and with at least the frequency recommended by the manufacturer;

(b) Test one (1) sample of control material for each eight (8) hours of testing or as set out in the manufacturer’s instructions;

(c) Use a combination of calibrators and control materials that include both low and high values on each day of testing or as set out in the manufacturer’s instruction; and (d) Include one (1) sample of calibration material or control material each time patients are tested unless automated instrumentation internally verifies calibration at least every thirty (30) minutes or as set out in the manufacturer’s instruction.

(23) Condition: Endocrinology - To meet the quality control requirements for endocrinology, the laboratory must comply with the applicable requirements contained in paragraphs 1200-06- 03-.09(1) through 1200-06-03-.09(11). All quality control activities must be documented.

(24) Condition: Toxicology - To meet the quality control requirements for toxicology, the laboratory must comply with the applicable requirements in paragraphs 1200-06-03-.09(1) through 1200-06-03-.09(11). However, this subsection shall not apply to drug testing for employment purposes. All quality control activities must be documented. In addition, for drug abuse screening using thin layer chromatography:

(a) Each plate must be spotted with at least one (1) sample of calibration material containing all drug groups identified by thin layer chromatography which the laboratory reports; and (b) At least one (1) control sample must be included in each chamber, and the control sample must be processed through each step of patient testing, including extraction procedures.

(25) Condition: Hematology - To meet the quality control requirements for hematology, the laboratory must comply with the applicable requirements in paragraphs 1200-06-03-.09(1) through 1200-06-03-.09(11) and with subparagraphs (a) through (d) of this paragraph. All quality control activities must be documented.

(a) For automated hematology testing systems, excluding coagulation, the laboratory must include two (2) levels of controls for each twenty-four (24) hours of operation.

(b) For all automated coagulation testing systems, the laboratory must include two (2) levels of control for each eight (8) hours of operation and each time a change in reagents occurs.

(c) For manual hemoglobin determinations (cyanmethemoglobin), the procedure must be standardized with reference materials of known, certified values. At least four (4) different hemoglobin concentrations must be used to prepare the calibration curve or to calibrate the readout instruments. For procedures using calibration curves, all curves must be repeated regularly and verified after serving or recalibration of instruments.

Photometer functions checks must be run and recorded daily. Photometers must be checked for linearity periodically and when instrument adjustments have been made with appropriate filters or solutions.

(d) For manual hematocrit determinations, the speed and timer of the microhematocrit centrifuge must be checked at specific intervals. The constant packing time (minimum spin to reach maximum packing of cells) must be assessed on installation and reassessed when there has been a change in either the speed or time.

(26) Condition: Pathology - The laboratory must meet the applicable quality control requirements in paragraphs 1200-06-03-.09(1) through 1200-06-03-.09(11) and paragraphs 1200-06-03- .09(27) through 1200-06-03-.09(29) for the subspecialties; for which it is certified under the specialty of pathology. All quality control activities must be documented.

(27) Condition: Cytology - To meet the quality control requirements for cytology, the laboratory must comply with the applicable requirements in paragraphs 1200-06-03-.09(1) through 1200-06-03-.09(11) and subparagraphs (a) through (g) of this paragraph.

(a) The laboratory must assure that 1. All gynecologic smears are stained using a Papanicolaou or modified Papanicolaou staining method;

2. Effective measures are taken to prevent cross-contamination between gynecologic and nongynecologic specimens during the staining process;

3. Nongynecologic specimens that have a high potential for cross-examination are stained separately from other nongynecologic specimens, and the stains are filtered or changed following staining;

4. Diagnostic interpretations are not reported on unsatisfactory smears; and 5. All cytology slide preparations are evaluated on the premises of a laboratory certified to conduct testing in the subspecialty of cytology.

(b) The laboratory is responsible for ensuring the following:

1. Each individual engaged in the evaluation of cytology preparations by nonautomated microscopic technique examines no more than one hundred (100) slides (one patient per slide, gynecologic or nongynecologic, or both) in a twentyfour (24) hour period, irrespective of the site or laboratory. This limit represents an absolute maximum number of slides and is not being employed as a performance target for each individual. Previously examined reactive, reparative, atypical, premalignant or malignant gynecologic cases as defined in part (c)1. of this paragraph, previously examined nongynecologic cytology preparations, and tissue pathology slides examined by a pathologist are not included in the one hundred (100) slide limit.

2. For purposes of workload calculations, each slide preparation (gynecologic or nongynecologic) made using automated, semi-automated, or other liquid-based slide preparatory techniques which result in cell dispersion over one-half (½) or less of the total available slide area and which is examined by nonautomated microscopic technique counts as one-half (½) slide.

3. Records are maintained of the total number of slides examined by each individual during each twenty-four (24) hour period, irrespective of the site or laboratory, and the number of hours each individual spends examining slides in the twenty-four (24) hour period; and (i) The maximum number of one hundred (100) slides described in part (b)1. of this paragraph may not be examined in less than an eight (8) hour workday, and (ii) For the purposes of establishing workload limits for individual examining slides by nonautomated microscopic technique on other than an eight (8) hour workday basis (includes full-time employees with duties other than slide examination and part-time employees), a period of eight (8) hours must be used to prorate the number of slides that may be examined. The following formula shall be used to determine maximum slide volume to be examined:

(iii) (Number of hours examining slides x 100) - 8 (c) A pathologist must ensure the following:

1. All gynecologic smears interpreted to be showing reactive or reparative changes, atypical squamous or glandular cells of undetermined significance, or to be in the premalignant (dysplasia, cervical intraepithelial neoplasia or all squamous intraepithelial lesions including human papillomavirus-associated changes) or malignant category are confirmed by a pathologist qualified by certification in anatomic pathology by the American Board of Pathology. The report must be signed to reflect the review or, if a computer report is generated with signature, it must reflect an electronic signature authorized by the pathologist;

2. All nongynecologic cytologic preparation are reviewed by the pathologist. The report must be signed to reflect the pathologist’s review or, if a computer report is generated with signature, it must reflect an electronic signature authorized by the pathologist;

3. The slide examination performance of each cytotechnologist is evaluated and documented, including performance evaluation through the reexamination of normal and negative cases and feedback on the reactive, reparative, a typical, malignant or premalignant cases as defined in part (c)1. of this paragraph; and 4. A maximum number of slides, not to exceed the maximum workload limit described in subparagraph (b) of this paragraph is established by the pathologist for each individual examining slide preparations by nonautomated microscopic technique.

(i) The actual workload limit must be documented for each individual and established in accordance with the individual’s capability based on the performance evaluation as described in part (c)3. of this paragraph.

(ii) Records are available to document that each individual’s workload limit is reassessed at least every six (6) months and adjusted when necessary.

(d) The laboratory must establish and follow a program designed to detect errors in the performance of cytologic examinations and the reporting of results.

1. The laboratory must establish a program that includes a review of slides from at least ten per cent (10%) of the gynecologic cases interpreted to be negative for reactive, reparative, atypical premalignant or malignant conditions as defined in

part (c)1. This review must be done by a pathologist qualified by certification in anatomic pathology by the American Board of Pathology, a cytology general supervisor qualified under Rule 1200-06-01-.23 or a cytotechnologist qualified under Rule 1200-06-01-.24.

(i) The review must include negative cases selected at random from the total caseload and from patients or groups of patients that are identified as having a high probability of developing cervical cancer, based on available patient information;

(ii) Records of initial examinations and rescreening results must be available; and (iii) The review must be completed before reporting patient results on those cases selected.

2. The laboratory must compare clinical information, when available, with cytology reports and must compare all malignant and premalignant (as defined in part (c)1. of this paragraph) gynecology reports with the histopathology report, if available in the laboratory (either on-site or in storage), and determine the causes of any discrepancies.

3. For each patient with a current high grade intraepithelial lesion (moderate dysplasia or CIN-2 or above), the laboratory must review all normal or negative gynecologic specimens received within the previous five (5) years, if available in the laboratory (either on-site or in storage). If significant discrepancies are found that would affect patient care, the laboratory must notify the patient’s physician and issue an amended report.

4. The laboratory must establish and document an annual statistical evaluation of the number of cytology cases examined, number of specimens processed by specimen type, volume of patient cases reported by diagnosis (including the number reported as unsatisfactory for diagnostic interpretation), number of gynecologic cases where cytology and available histology are discrepant, the number of gynecologic cases where any rescreen of a normal or negative specimen results in reclassification as malignant or premalignant, as defined in

part (c)1. of this paragraph, and the number of gynecologic cases for which

history results were unavailable to compare with malignant or premalignant cytology cases as defined in part(c)1. of this paragraph.

5. The laboratory must evaluate the case reviews of each individual examining slides against the laboratory’s overall statistical values, document any discrepancies, including reasons for the deviation, and document corrective action, if appropriate.

(e) The laboratory report must:

1. Clearly distinguish specimens or smears, or both, that are unsatisfactory for diagnostic interpretation; and 2. Contain narrative descriptive nomenclature for all results.

(f) Corrected reports issued by the laboratory must indicate the basis for correction.

(g) The laboratory must retain all slide preparations for five (5) years from the date of examination, or slides may be loaned to proficiency testing programs, in lieu of maintaining them for this time period, provided the laboratory receives written acknowledgement of the receipt of slides by the proficiency testing program and maintains the acknowledgement to document the loan of such slides. Documentation for slides loaned or referred for purposes other than proficiency testing must also be maintained. All slides must be retrievable upon request.

(28) Condition: Histopathology - To meet the quality control requirements for histopathology, a laboratory must comply with the applicable requirements in paragraphs 1200-06-03-.09(1) through 1200-06-03-.09(11) and subparagraphs (a) through (c) of this paragraph. All quality control activities must be documented.

(a) A control slide of known reactivity must be included with each slide or group of slides for differential, or special stains. Reaction(s) of the control slide with each special stain must be documented each day of testing.

(b) The laboratory performing the histopathology testing must retain stained slides at least ten (10) years from the date of examination and retain specimen blocks at least five (5) years from the date of examination.

(c) The laboratory must retain remnants of tissue specimens in a manner that assures proper preservation of the tissue specimens until the portions submitted for microscopic examination have been examined and a diagnosis made by an individual qualified by certification in anatomic pathology by the American Board of Pathology.

(d) All tissue pathology reports must be signed by an individual qualified as specified in subparagraph (c) of this paragraph. If a computer report is generated with an electronic signature, it must be authorized by the individual qualified as specified in subparagraph (c) of this paragraph.

(e) The laboratory must utilize acceptable terminology of a recognized system of disease nomenclature in reporting results.

(29) Condition: Oral Pathology - To meet the quality control requirements for oral pathology, the laboratory must comply with the applicable requirements in paragraphs 1200-06-03-.09(1) through 1200-06-03-.09(11) and 1200-06-03-.09(28). All quality control activities must be documented.

(30) Condition: Radiobioassay - To meet quality control requirements for radiobioassay, the laboratory must comply with the applicable requirements of paragraphs 1200-06-03-.09(1) through 1200-06-03-.09(11). All quality control activities must be documented.

(31) Condition: Histocompatibility - In addition to meeting the applicable requirements for general quality control in paragraphs 1200-06-03-.09(1), for quality control for general immunology in paragraph 1200-06-03-.09(20) and for immunohematology in paragraph 1200-06-03-.09(33), the laboratory must comply with the applicable requirements in subparagraphs (a) through (d) of this paragraph. All quality control activities must be documented.

(a) For renal allotransplantation, the laboratory must meet the following requirements:

1. The laboratory must have available and follow criteria for the following:

(i) Selecting appropriate patient serum samples for crossmatching;

(ii) The technique used in crossmatching;

(iii) Preparation of donor lymphocytes for crossmatching; and (iv) Reporting crossmatch results;

2. The laboratory must (i) Have available results of final crossmatches before an organ or tissue is transplanted, and (ii) Make a reasonable attempt and document efforts to have available serum specimens for all potential transplant recipients at initial typing, for periodic screening, for preptransplantation crossmatch and following sensitizing events, such as transfusion and transplant loss;

3. The laboratory’s storage and maintenance of both recipient sera and reagents must (i) Be at an acceptable temperature range for sera and components;

(ii) Use a temperature alarm system and have an emergency plan for alternate storage; and (iii) Ensure that all specimens are properly identified and easily retrievable;

4. The laboratory’s reagent typing sera inventory (applicable only to locally constructed trays) must indicate source, bleeding date and identification number, and volume remaining.

5. The laboratory must properly label and store all labile components utilized in histocompatibility testing.

6. The laboratory must:

(i) HLA type all potential transplant recipients;

(ii) Type cells from organ donors referred to the laboratory; and (iii) Have available and follow a policy that establishes when antigen redefinition and retyping are required;

7. The laboratory must have available and follow criteria for (i) The preparation of lymphocytes for HLA-A, B and DR typing;

(ii) Selecting typing reagents, whether locally or commercially prepared;

(iii) The assignment of HLA antigens; and (iv) Assuring that reagents used for typing recipients and donors are adequate to define all major and International Workshop HLA-A, B and DR specificities for which reagents are readily available;

8. The laboratory must do the following:

(i) Screen potential transplant recipient sera for performed HLA-A and B antibodies with a suitable lymphocyte panel on sera collected (I) At the time of the recipient’s initial HLA typing; and (II) Thereafter, following sensitizing events and upon request; and (ii) Use a suitable cell panel for screening patient sera (antibody screen), a screen that contains all the major HLA specificities and common splits (I) If the laboratory does not use commercial panels, it must maintain a list of individuals for fresh panel bleeding; and (II) If the laboratory uses frozen panels, it must have a suitable storage system, 9. The laboratory must check (i) Each typing tray using (I) Positive control sera;

(II) Negative control sera; and (III) Positive controls for specific cell types when applicable (i.e., T. cells, B cells, and monocytes); and (ii) Each compatibility test (i.e. mixed lymphocyte cultures, homozygous typing cells or DNA analysis) and typing for disease-associated antigens using controls to monitor the test components and each phase of the test system to ensure an acceptable performance level;

10. Compatibility testing for cellularly-defined antigens must utilize techniques such as the mixed lymphocyte culture test, homozygous typing cells or DNA analysis;

11. If the laboratory reports the recipient’s or donor’s, or both, ABO blood group and D(Rho) typing, the testing must be performed in accordance with 1200-06-03- .09(33);

12. If the laboratory utilizes immunologic reagents (such as antibodies or complement) to remove contaminating cells during the isolation of lymphocytes or lymphocyte subsets, the efficiency of the methods must be verified with appropriate quality control procedures;

13. At least once each month, the laboratory must have each individual performing tests evaluate a previously tested specimen as an unknown to verify his or her ability to reproduce test results. Records of the results for each individual must be maintained; and 14. The laboratory must participate in at least one (1) national or regional cell exchange program, if available, or develop an exchange system with another laboratory in order to validate inter-laboratory reproducibility.

(b) If the laboratory performs histocompatibility testing for:

1. Transfusion and other non-renal transplantation, excluding bone marrow and living transplant, all the requirements specified in this paragraph, as applicable, except for the performance of mixed lymphocyte cultures, must be met;

2. Bone marrow transplantation, all the requirements specified in this paragraph, including the performance of mixed lymphocyte cultures or other augmented testing to evaluate class 11 compatibility, must be met; and 3. Non-renal solid organ transplantation, the results of final crossmatches must be available before transplantation when the recipient has demonstrated presensitization by prior serum screening except for emergency situations. The laboratory must document the circumstances, if known, under which emergency transplants are performed, and records must reflect any information concerning the transplant provided to the laboratory by the patient’s physician.

(c) Laboratories performing HLA typing for disease-associated studies must meet all the requirements specified in this paragraph except for the performance of mixed lymphocyte cultures, antibody screening and crossmatching.

(d) For laboratories performing organ donor HIV testing the requirements of paragraph 1200-06-03-.09(20) for the transfusion of blood and blood products must be met.

(32) Condition: Clinical Cytogenetics - To meet the quality control requirements for clinical cytogenetics, the laboratory must comply with the applicable requirement of paragraphs 1200-06-03-.09(1) through 1200-06-03-.09(11) and with subparagraphs (a) through (d) of this paragraph. All quality control activities must be documented.

(a) When determination of sex is performed by X and Y chromatin counts, these counts must be based on an examination of an adequate number of cells. Confirmatory testing such as full chromosome analysis must be performed for all atypical results.

(b) The laboratory must have records that reflect the media used and document the reactions observed, number of cells counted, the number of cells karyotyped, the number of chromosomes counted for each metaphase spread, and the quality of the banding that the resolution is sufficient to support the reported results; and that an adequate number of karyotypes are prepared for each patient.

(c) The laboratory also must have policies and procedures for assuring an accurate and reliable patient sample identification during the process of accessioning, cell preparation, photographing or other image reproduction technique, and photographic printing, and storage and reporting of results or photographs.

(d) The laboratory report must include the summary and interpretation of the observations and number of cells counted and analyzed and the use of recognized nomenclature, such as the International System of Cytogenetic Nomenclature.

(e) Adequate slides, films, hard copies of karyotypes and reports shall be retained for twenty (20) years.

(33) Condition: Immunohematology - To meet the quality control requirements for immunohematology, the laboratory must comply with the applicable requirements in paragraphs 1200-06-03-.09(1) through 1200-06-03-.09(11) and with subparagraphs (a) through (d) of this paragraph. All quality control activities must be documented.

(a) The laboratory must perform ABO group and D(Rho) typing, unexpected antibody detection, antibody identification and compatibility testing in accordance with manufacturer’s instruction, if provided, and as applicable, with 21 CFR 606 (with the exception of 21 CFR 606.20a, Personnel) and 21 CFR 640, et. seq.

(b) The laboratory must perform ABO group by concurrently testing unknown red cells with anti-A and anti-B grouping reagents. For confirmation of ABO group, the unknown serum must be tested with known A, and B red cells.

(c) The laboratory must determine the D(Rho) type by testing unknown red cells with anti- D(anti-Rho) blood grouping reagent.

(d) If required in the manufacturer’s package insert for anti-D reagents, the laboratory must employ a control system capable of detecting false positive D(Rho) test results.

(34) Condition: Transfusion services and bloodbanking - If a facility provides services for the transfusion of blood and blood products, the facility must be under the adequate control and technical supervision of a pathologist or other doctor of medicine or osteopathy meeting the qualifications in Rule 1200-6-1-.20, technical supervision in immunohematology. The facility must ensure that there are facilities for procurement, safekeeping and transfusion of blood and blood products and that blood and blood products must be available to meet the needs of the physicians responsible for the diagnosis, management, and treatment of patients. The facility meets this condition by complying with the standards in paragraphs 1200-06-03- .09(34)(a) through (f).

(a) Standard: Immunohematological collection, processing, dating periods, labeling and distribution of blood and blood products.

In addition to the requirements of parts 1. through 4. of this subparagraph, the facility must also meet the applicable quality control requirements in 1200-06-03-.09(1) through 1200-06-03-.09(10).

1. Blood and blood product collection, processing and distribution must comply with 21 CFR Part 640 and 21CFR Part 606, and the testing laboratory must meet the applicable requirements of 42 CFR Part 493.

2. Dating of blood and blood products must conform to 21 CFR 610.53.

3. Labeling of blood and blood products conform to 21 CFR Part 606, Subpart G.

4. Policies to ensure positive identification of a blood or blood product recipient must be established, documented and followed.

(b) Standard: Blood and blood product storage facilities 1. The blood and blood products must be stored under appropriate conditions, which include an adequate temperature alarm system that is checked and documented daily.

(i) An audible alarm system, including a chart recorder, must monitor proper blood and blood product storage temperature continuously.

(ii) Activation, to include high and low limits, of alarm system must be documented periodically, no less frequently than quarterly.

(iii) A remote alarm system is required if location where blood or blood products are stored is not continuously staffed.

(iv) There must be a written procedure for response to an alarm when temperature limits are exceeded.

(v) There must be a written procedure for response to an alarm indicating specific personnel to respond and their appropriate action.

2. If blood is stored or maintained for transfusion purposes outside of a monitored refrigerator, the facility must ensure and document that storage conditions, including temperature, are appropriate to prevent deterioration of the blood or blood product.

(c) Standard: Arrangement for services - In the case of services provided outside the blood bank, the facility must have an agreement reviewed and approved by the director that governs the procurement, transfer, and availability of blood and blood products.

(d) Standard: Provision of testing - There must be provision for prompt ABO blood group, D(Rho) type, unexpected antibody detection and compatibility testing in accordance with 1200-06-03-.09(34) of this rule and the laboratory investigation of transfusion reactions, either through the facility or under arrangement with an approved facility on a continuous basis, under the supervision of a pathologist or other doctor of medicine or osteopathy meeting the qualifications of 1200-06-01-.20.

(e) Standard: Retention of samples of transfused blood and patient specimens.

1. Samples of each unit of transfused blood and the patient specimens must be retained for a minimum of seven (7) days for further testing in the event of reactions according to the facility’s established procedures.

2. The facility must promptly dispose of blood not retained for further testing that has passed its expiration date.

(f) Standard: Investigation of transfusion reactions.

1. The facility, according to its established procedures, must promptly investigate all transfusion reactions occurring in all facilities for which it has investigational responsibility and make recommendations to the medical staff regarding improvements in transfusion procedures.

2. The facility must document that all necessary remedial actions are taken to prevent future recurrence of transfusion reactions and that all policies and procedures are reviewed to assure that they are adequate to ensure the safety of individuals being transfused within the facility.

3. When a fatality occurs as a result of a complication of blood or blood component transfusions, the Director, Office of Compliance and Biologics Quality, Center for Biological Evaluation and Research (CBER), FDA, must be notified within twenty-four (24) hours. Within seven (7) days after the fatality, a written report of the investigation must be submitted to the Director at 1401 Rockville Pike, Suite 200 N, Rockville, MD 20852-1448. A copy of the report should be sent to the collecting facility if appropriate. See AABB Accreditations Requirements Manual.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-105, and 68-29-125.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Amendment filed December 14, 1981; effective January 28, 1982. Repeal filed May 3, 1995; effective July 17, 1995. New rule filed January 7, 1997; effective March 23, 1997. Repeal and new rule filed June 18, 2002; effective September 1, 2002. Amendment filed October 11, 2004; effective December 25, 2004. Amendment filed January 14, 2005; effective March 30, 2005. Amendment filed February 15, 2006; effective May 1, 2006. Amendment filed March 14, 2006; effective May 28, 2006.

Tenn. Comp. R. & Regs. 1200-06-03-.10 PERFORMANCE IMPROVEMENT PROGRAM

(1) Condition: Performance improvement. Each laboratory must establish and follow written policies and procedures for a comprehensive quality assurance program which is designed to monitor and evaluate the ongoing and overall quality of the total testing process. The laboratory’s performance improvement program must evaluate the effectiveness of its policies and procedures; identify and correct problems; assure the accurate, reliable and prompt reporting of test results; and assure the adequacy and competency of the staff.

(a) The laboratory must revise policies and procedures as necessary based upon the results of those evaluations.

(b) The laboratory must meet the standards of this rule as they apply to the services offered, tests performed, test results reported, and the unique practices of each testing entity. All performance improvement activities must be documented.

(2) Standard: Patient test management assessment. The laboratory must have an ongoing mechanism for monitoring and evaluating the systems required under Rule 1200-06-03-.08, Patient Test Management. The laboratory must monitor, evaluate, and revise, if necessary, based on the results of its evaluations, the following:

(a) The criteria established for patient preparation, specimen collection, labeling, preservation and transportation;

(b) The information solicited and obtained on the laboratory’s test requisition for its completeness, relevance, and necessity for testing of patient specimens;

(c) The use and appropriateness of the criteria established for specimen rejection;

(d) The completeness, usefulness, and accuracy of the test report information necessary for the interpretation or utilization of test results;

(e) The timely reporting of test results based on testing priorities (STAT, routine, etc.); and (f) The accuracy and reliability of test reporting systems, appropriate storage of records and retrieval of test results.

(3) Standard: Quality control assessment. The laboratory must have an ongoing mechanism to evaluate the corrective actions taken under paragraph 1200-06-03-.09(9), Remedial Actions.

Ineffective policies and procedures must be revised based on the outcome of the evaluation.

The mechanism must evaluate the effectiveness of corrective actions taken for the following:

(a) Problem identified during the evaluation of calibration and control data for each test, method;

(b) Problems identified during the evaluation of patient test values for the purpose of verifying the reference range of test method; and (c) Errors detected in reported results.

(4) Standard: Quality control assessment. Under Rule 1200-06-03-.07, Participation in Proficiency Testing, the corrective actions taken for any unsatisfactory or unsuccessful proficient testing result(s) must be evaluated for effectiveness.

(5) Standard: Comparison of test results. If a laboratory performs the same test using different methodologists or performs the same test at multiple testing sites, the laboratory must have a system that twice a year evaluates and defines the relationship between test results using different methodologies, instruments, or testing sites. If a laboratory performs tests that are not included under 42 CFR §493.901 of CLIA, Proficiency Testing Programs, the laboratory must have a system for verifying the accuracy and reliability of its test results are least twice a year.

(6) Standard: Relationship of patient information to patients test results. The laboratory must have a mechanism to identify and evaluate patient test results that appear inconsistent with relevant criteria such as:

(a) Patient age;

(b) Sex;

(c) Diagnosis or pertinent clinical data, when provided;

(d) Distribution of patient test results when available; and (e) Relationship with other test parameters, when available within the laboratory.

(7) Standard: Personnel assessment. The laboratory must have an ongoing mechanism to evaluate the competency of all laboratory personnel (8) Standard: Communications.

(a) The laboratory must have a system in place to document problems that occur as a result of breakdowns in communication between the laboratory and the authorized individual who orders or receives the results of test procedures or examinations.

(b) Corrective actions taken to resolve the problems and to minimize communications breakdowns must be documented.

(9) Standard: Complaint investigations. The laboratory must have a system in place to assure that all complaints and problems reported to the laboratory are documented. Investigations of complaints must be made, when appropriate, and, as necessary, corrective actions must be instituted.

(10) Standard: Performance improvement review with staff. The laboratory must have a mechanism for documenting and assisting problems identified during performance improvement reviews and discussing them with the staff. The laboratory must take corrective actions that are necessary to prevent recurrence.

(11) Standard: Performance improvement records. The laboratory must maintain documentation of all performance improvement activities including problems identified and corrective actions taken. All performance improvement records must be maintained for period of two (2) years and available to the Board or its designee upon request.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, and 68-29-105.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Repeal filed May 3, 1995; effective July 17, 1995. New rule filed January 7, 1997; effective March 23, 1997. Repeal and new rule filed June 18, 2002; effective September 1, 2002.

Tenn. Comp. R. & Regs. 1200-06-03-.11 FACILITIES, SAFETY, INFECTIOUS AND HAZARDOUS WASTE DISPOSAL

(1) Condition: The laboratory must have facilities, space and environmental conditions necessary for conducting the services offered, must provide a reasonably safe, working environment, and must properly dispose of infectious and hazardous wastes.

(a) Standard: Facilities. The laboratory must be constructed, arranged, and maintained to ensure the space, ventilation, utilities necessary for conducting all phases of testing, including the testing process, as appropriate.

(b) Standard: Safety. Safety precautions must be established, posted, and observed to ensure protection from physical hazards and biohazards materials. Adequate fire precautions shall be observed; volatile chemicals and flammable reagents must be properly stored.

(c) Infectious and Hazardous Waste Disposal. Each facility must develop, maintain, and implement written policies and procedures for the definition and handling of its infectious and hazardous wastes which must comply with the requirements of the Occupational Safety and Health Act, 29 U.S.C.A. §§ 65 1, et seq.

(d) The following waste shall be considered to be infectious waste:

1. Waste contaminated by patients who are isolated due to communicable disease, as provided in the U.S. Centers for Disease Control “Guidelines for Isolation Precautions in Hospitals”;

2. Cultures and stocks of infectious agents including specimen cultures collected from medical and pathological laboratories, cultures and stocks of infectious agents form research and industrial laboratories, wastes from the production of biologicals, discarded live and attenuated vaccines, and culture dishes and devices used to transfer, inoculate, and mix cultures;

3. Waste human blood and blood products such as serum, plasma, and other blood components;

4. Pathological waste, such as tissues, organs, body parts, and body fluids that are removed during surgery and autopsy;

5. All discarded sharps (e.g., hypodermic needles, syringes, pasture pipettes, broken glass, scalpel blades) used in patient care or which have come into contact with infectious agents during use in medical, research, or industrial laboratories;

6. Contaminated carcasses, body parts, and bedding of animals that were exposed to pathogens in research, in the production of biologicals, or in the in vivo testing of pharmaceuticals;

7. Other waste determined to be infectious by the facility in its written policy.

(2) Infectious and hazardous waste must be segregated from other waste at the point of generation (i.e., the point at which the material becomes a waste) within the facility.

(3) Waste must 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 must provide for containment of the waste from the point of generation up to the point of proper treatment or disposal. Packaging must be selected and utilized for the type of waste the packaging will contain, how the waste will be treated and disposed, and how it will be handled and transported, prior to treatment and disposal.

(a) Contaminated sharps must be directly placed in leakproof, rigid, and puncture-resistant containers which must then be tightly sealed.

(b) Whether disposable or reusable, all containers, bags, and boxes used for containment and disposal of infectious waste must be conspicuously identified. Packages containing infectious waste which pose additional hazards (e.g., chemical, radiological) must also be conspicuously identified to clearly indicate those additional hazards.

(c) Reusable containers for infectious waste must be thoroughly sanitized each time they are emptied, unless the surfaces of the containers have been completely protected from contamination by disposable liners or other devices removed with the waste.

(d) Opaque packaging must be used for pathological waste.

(4) After packaging, waste must be handled and transported by methods ensuring containment and preservation of the integrity of the packaging, including the use of secondary containment where necessary. Plastic bags of infections waste must be transported by hand.

(5) After packaging, waste must be handled and transported by methods ensuring containment and preserving the integrity of the packaging, including the use of secondary containment where necessary.

(a) Waste must not be compacted or ground (i.e., in a mechanical grinder) prior to treatment, except that pathological waste may be ground prior to disposal.

(b) Plastic bags of infectious waste must be transported by hand.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, and 68-29-105.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Repeal filed May 3, 1995; effective July 17,1995. New rule filed January 7, 1997; effective March 23, 1997. Amendment filed March 22, 2001; effective June 5, 2001. Repeal and new rule filed June 18, 2002; effective September 1, 2002.

Tenn. Comp. R. & Regs. 1200-06-03-.12 REPORTABLE DISEASES

The director of a medical laboratory shall submit reports and/or cultures of microorganisms of reportable diseases established by the Commissioner of Health to the Department in accordance with Tenn. Comp.

R. & Regs. Chapter 1200-14-01.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-105, and 68-29-107.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Repeal filed May 3, 1995; effective July 17, 1995. New rule filed January 7, 1997; effective March 23, 1997. Repeal and new rule filed June 18, 2002; effective September 1, 2002. Amendment filed September 17, 2003; effective December 1, 2003. Amendment filed February 15, 2006; effective May 1, 2006. Amendment filed July 10, 2006; effective September 23, 2006. Amendment filed August 19, 2010; effective November 17, 2010; however on October 26, 2010 a 10-day stay was filed by the Government Operations Committee; new effective date October 27, 2010.

Tenn. Comp. R. & Regs. 1200-06-03-.13 .

(f) The performance of additional testing that includes but is not limited to donor accessing (ABO, Rh, Antibody Detection and/or identification, STS, HIV, hepatitis tests, ALT, protein electrophoresis, etc.) shall require the facility to comply with Rule 1200-06-03- .14.

(g) The Donor Center/Plasmapheresis Center shall report the results of all positive tests for hepatitis to the Division of Communicable Disease Control of the Department within two (2) weeks after the last day of each month. The report shall contain the name, address, birth date and social security number of the donor and the name and address of the Center.

(h) Any inquiries and/or complaints referred to the Department in regard to donor selection, bleeding products, etc. will be referred to the U.S. Food and Drug Administration for investigation.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-104, and 68-29-105.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Amendment filed December 14, 1981; effective January 28, 1982. Amendment filed September 30, 1987; effective November 14, 1987. Repeal and new rule filed January 7, 1997; effective March 23, 1997. Amendment filed February 14, 2000; effective April 29, 2000. Amendment filed December 1, 2000; effective February 14, 2001. Repeal and new rule filed June 18, 2002; effective September 1, 2002. Amendment filed August 25, 2003; effective November 8, 2003. Amendments filed May 16, 2005; effective July 30, 2005.

Tenn. Comp. R. & Regs. 1200-06-03-.14 PERSONNEL REQUIREMENTS FOR A MEDICAL LABORATORY

(1) Condition: All laboratories regulated under T.C.A. 68, Chapter 29 shall meet the personnel standards in Chapter 1200-06-01.

(2) Condition: Each laboratory shall designate a medical laboratory director, general supervisor and testing personnel who meet the qualifications of each level and fulfill the listed responsibilities for each level. If so qualified, one (1) individual may serve in more than one (1) position.

(3) Condition: All individuals qualified to perform laboratory tests, including the medical laboratory director, shall possess a current license issued by the Department. Each individual shall be licensed at the highest level for which he qualified and functions. Laboratory procedures shall only be performed by appropriately licensed individuals, or personnel with a current trainee permit.

(4) Standard: An adequate number of qualified testing personnel shall be provided for the volume and diversity of procedures and tests performed, as determined by the Department by on site survey.

(5) A medical laboratory director may direct no more than three (3) laboratories unless authorized by the Board.

(6) The medical laboratory director shall make periodic on-site visits at a minimum of once per month.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-105. 68-29-114, and 68-29-118.
• Administrative History: Original rule filed October 26, 1979; effective December 10, 1979. Repeal filed May 3, 1995; effective July 17,1995. New rule filed January 7, 1997; effective March 23, 1997. Repeal and new rule filed June 18, 2002; effective September 1, 2002.

Tenn. Comp. R. & Regs. 1200-06-03-.15 SPECIAL REGULATIONS FOR ASTC, BLOOD DONOR CENTERS, AND

PLASMAPHERESIS CENTERS.

(1) An exception to the requirements of 1200-06-03-.14 concerning direction and supervision may be made for a licensed Ambulatory Surgical Treatment Center (ASTC) providing the following are met:

(a) Condition: The laboratory is directed by a physician currently licensed in Tennessee.

(b) Condition: The facility employs a licensed technologist as laboratory supervisor.

(c) Condition: The facility participates successfully in an approved proficiency testing program (d) Condition: The facility is in substantial compliance with laboratory regulations as determined by an on-site survey conducted by a representative of the Department.

(e) Condition: The facility performs only the following procedures: CBC, urinalysis, ABO grouping and Rh typing, Pregnancy tests, Gram’s stain, wet mounts and Rh immune globulin testing. Performance of additional procedures will necessitate that the laboratory meet all regulatory requirements.

(2) An exception to the requirements of Rule 1200-06-03-.14 concerning direction, supervision and technical laboratory personnel may be made for Blood Donor Centers and Plasmaphersis Centers providing the following conditions are met:

(a) The laboratory is directed by a physician licensed in Tennessee who possesses a current Tennessee license.

(b) Screening tests for the purpose of determining donor suitability are limited to:

1. Hemogoblin or hematocrit.

2. Total serum protein.

3. Dipstick urine test for glucose and protein.

4. Urine drug screens for opiates and morphine.

5. Platelet pre-counts.

(c) Screening tests for educational purposes are limited to blood groups (ABO) and blood type (Rh).

(d) The personnel performing the screening tests shall be trained in the performance of these tests, quality control and recordkeeping duties. The Laboratory Director shall have on record at the facility where the “trained personnel” are employed, documentation of training with date(s) of training and signed by the person(s) administering the training. These “training personnel” shall not be required to have a medical laboratory personnel license.

(e) The facility is in compliance with Rules 1200-06-03-.01 through 1200-06-03-.11 and

Tenn. Comp. R. & Regs. 1200-06-03-.16 ALTERNATE SITE TESTING

(1) Point of Care Laboratory Testing.

(a) Definition: “Point of Care” laboratory testing is laboratory testing performed by health care personnel/professionals not licensed by the Medical Laboratory Act, T.C.A. §§ 68- 29-101, et seq., and is performed outside the duly licensed laboratory and under the auspices of a laboratory required to be licensed by the Department, pursuant to the Medical Laboratory Act.

(b) All point of care laboratory testing must be approved by the Board in accordance with the following guidelines.

1. For those tests determined by the Board to be appropriate for safe and accurate performance in a point of care setting (see waived test list) written notification shall be submitted on forms provided by the Board to the Administrative Office of the Board.

2. For all other tests not covered under part 1 of this subparagraph (above), a facility must petition, and appear before the Board and satisfy the Board that approval for point of care testing is appropriate. A facility that has received approval from the Board for instrument/method to be used by identified personnel and/or department(s) for point of care testing of an analyte does not have to appear before the Board again to add analytes to the approved instrument/method and may add them by submitting written notification to the Board’s administrative office. It is only when the facility wants to change or add personnel or department(s) to the previously approve instrument/method that another hearing before the Board is required.

3. Requests to perform non-waived point of care tests must be submitted in writing and must include at least:

(i) Statement of medical need for performance outside a laboratory setting.

(ii) Analyte and methodology.

(iii) Personnel authority and responsibility.

(iv) Quality assurance protocols.

(v) Maintenance of records.

(vi) Performance and improvement protocols.

(c) The performance of point of care laboratory testing must comply with the following minimum guidelines:

1. Documentation must show that the method used for testing has been approved by the Medical Laboratory Director.

2. Documentation must show that an adequate training protocol, demonstration of competency, and annual in-service with demonstration of competency for each person performing the testing, has been approved by the Medical Laboratory Director.

3. Records shall be retained for at least two (2) years, which show that manufacturer recommendations regarding the performance of quality control were met. Quality control records shall be reviewed by a person with appropriate

authority according to an established performance improvement program.

4. Results of point of care laboratory testing must be recorded in an appropriate clinical record and include the identity of the patient, date and time of specimen collection, units of measurement, test location and identity of the analyst performing the test. Such records must be readily retrievable for inspection.

5. The Medical Laboratory Director, once having established critical values, shall have the discretion to determine if, consistent with good patient care, there is a need for verification by the clinical laboratory when values fall above or below the established critical values.

6. Written policies and procedures, as approved by the Medical Laboratory Director, shall be available in the laboratory and at all locations where point of care laboratory testing is performed. Such procedures shall be appropriate to the personnel and location performing the testing.

(d) Approval to perform point of care laboratory testing may be granted annually provided all minimum guidelines are met. The criteria for withdrawal of approval to perform such testing shall include but not be limited to:

1. Performance of testing by unauthorized personnel.

2. Failure to comply with the above stated guidelines 3. Unsatisfactory performance on two (2) consecutive or two (2) of three (3) consecutive proficiency test surveys.

3. Failure to comply with other State or Federal guidelines.

4. Deficiencies without an acceptable plan of correction cited by the Tennessee Medical Laboratory Board surveyors upon and on-site inspection of the laboratory.

(2) Physician’s Office Laboratories - Physician Office Laboratories (POLs) are exempt from licensure requirements of the Medical Laboratory Act (a) To be eligible for this exemption, the following conditions must be met:

1. The laboratory collects, accepts, and tests only specimens from the private and personal patients of the physician who operates the practice or from the private and personal patients of any physician who is a member of a medical/physician group practice that operates the laboratory regardless of the distance of any member physician’s practice location from the group practice’s laboratory or the number of specimens collected, accepted, and/or tested; and 2. The laboratory must be operated by the physician or through the employees of the physician. In a medical/physician group practice, one (1) of the group’s physicians must be designated to operate the laboratory. The designated physician is responsible for actual supervision and direct responsibility for the performance of the laboratory and its personnel which includes, but is not limited to, actual supervision and direct responsibility for quality assurance, quality control, and test management; and 3. The tests performed in the laboratory are used only for diagnosis and/or treatment of patients of the individual or group practice and are maintained in the practice’s medical records for the patients for whom the tests were performed.

(b) In the case of a medical/physician group practice, proof of affiliation with the group practice must be maintained at all offices in which the laboratory is not physically located and produced upon request by an authorized agent of the Department.

(c) Industrial or company physician practices, student health services and other arrangements in which a licensed physician is responsible for the continuing care of a group of patients on an ongoing basis will be designated to be POLs.

(3) Screening Programs – Screening programs are offerings of specified medical laboratory tests to the general public, the purpose of which is educational rather than for diagnosis of disease, and the results of which are immediately available on the site of the program to the person being tested except for those tests which for methodological reasons must be submitted to a medical laboratory in which case they shall be sent to a Tennessee licensed medical laboratory.

(a) Screening programs conducted by for-profit hospitals or nonprofit organizations are exempt from the licensure requirements of the Medical Laboratory Act, pursuant to T.C.A. § 68-29-104(6), when the following conditions are met:

(b) The screening program must be under the direct supervision of a physician licensed in Tennessee. Direct supervision means that a physician will be responsible for quality assurance of the testing performed and review of the results of such testing. The physician is not required to be on site for the screening program event.

(c) The results of the screening program testing must be submitted to the personal physician of the individual being screened or reviewed by the physician responsible for the screening program. During the screening process, the individual being screened must be afforded reasonable privacy and, when required, on-site confidential counseling about the results of the testing.

(d) A written notification to conduct a screening program must be submitted to the Administrative Office for the Medical Laboratory Board, indicating compliance with these rules and providing the following information:

1. Location of testing.

2. Date of testing.

3. Type of tests to be performed and methodology to be used.

4. Name of the licensed physician supervising the screening.

5. Name and address of the for-profit hospital or nonprofit organization conducting the screening.

6. Statement indicating that the testing staff has appropriate training and competency to conduct the testing.

7. Assurance that the for-profit hospital or nonprofit organization is in compliance with Rule 1200-06-03-.11 regarding the handling of infectious and hazardous waste.

(e) A copy of the written notification submitted to the Administrative office must be retained by the for-profit hospital or nonprofit organization conducting the screening program and must be available for inspection at the site of the screening program.

(f) Notification of screening is not required when the for-profit hospital or nonprofit organization is a licensed medical laboratory, provided the laboratory has complied with Rules 1200-06-03-.17 regarding the performance of waived testing and 1200-06- 03-.16 regarding point of care testing.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-104, and 68-29-105.
• Administrative History: Original rule filed February 14, 2000; effective April 29, 2000. Amendment filed December 1, 2000; effective February 14, 2001. Repeal and new rule filed June 18, 2002; effective September 1, 2002. Amendment filed May 23, 2003; effective August 6, 2003. Amendment filed February 15, 2006; effective May 1, 2006. Amendment filed March 14, 2006; effective May 28, 2006. Amendment filed July 10, 2006; effective September 23, 2006. Amendment filed December 27, 2006; effective March 12, 2007. Amendment filed October 3, 2014; effective January 1, 2015.

Tenn. Comp. R. & Regs. 1200-06-03-.17 WAIVED TESTING

(1) Definition: “Waived” means those laboratory tests, as defined by the Board, which may be performed by individuals not licensed under the Medical Laboratory Act, and which pose no reasonable risk of harm if performed incorrectly.

(2) Clinical laboratory tests which are designated as waived shall:

(a) be determined by the Board;

(b) be an analyte and/or methodology previously deemed as waived under CLIA; and (c) apply to any and all testing sites (3) Clinical laboratories, pharmacies, and other health care facilities licensed by the State of Tennessee who perform waived testing must comply with the following minimum guidelines:

(a) Notification must be provided to the Administrative Office for the Board using Board approved forms and protocols.

(b) Performance of waived testing by a licensed medical laboratory must be approved by a Medical Laboratory Director as defined by the Tennessee Medical Laboratory Act, T.C.A. § 68-29-103.

(c) In the absence of a Medical Laboratory Director as defined by the Tennessee Medical Laboratory Act, T.C.A. § 68-29-103, performance of waived testing must be approved by the physician legally responsible for laboratory testing performed by that health care facility or pharmacy.

(d) Personnel must perform such testing in accordance with manufacturer recommendations, including quality control.

(e) Patient test results must be recorded in a clinical record, to include date and time of specimen collection, units of measurement and identity of analyst performing the test.

(f) The laboratory, pharmacy, or health care facility must identify personnel responsible for performing and supervising the waived testing.

(g) Personnel performing the waived testing must have adequate, specific training and orientation to perform the tests, and must demonstrate satisfactory levels of competence before performing patient testing, and at a minimum, annually thereafter.

(h) Performance of waived testing will be evaluated by Laboratory surveyors at the time of inspection.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-104, and 68-29-105.
• Administrative History: Original rule filed June 18, 2002; effective September 1, 2002.

Tenn. Comp. R. & Regs. 1200-06-03-.18 COLLECTION STATIONS

(1) Facilities deemed as collection stations shall perform no clinical testing procedures on site.

(2) Collection stations owned and operated by a clinical laboratory licensed under the Tennessee Medical Laboratory Act shall not be required to obtain an individual license.

(3) Collections must submit to the requirements set forth in Rule 1200-06-03-.08, .09, .10, .13, and .14.

(4) On-site inspections shall be performed per Rule 1200-06-03-.04.

(5) It shall be the responsibility of the owner to notify the Department in writing of a change in the location or physician or owner within fifteen (15) days of the actual change. A replacement license shall be issued by the Department at no cost for the remainder of the calendar year for a new location, director, or owner, provided that in the case of change of directors, the new director is already licensed or is eligible for licensure as a medical laboratory director under the Medical Laboratory Act and the regulations promulgated thereunder.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-104, and 68-29-105.
• Administrative History: Original rule filed June 18, 2002; effective September 1, 2002.

Tenn. Comp. R. & Regs. 1200-06-03-.19 PREPARATORY PORTIONS OF LABORATORY TESTS

(1) Tennessee Code Annotated, Section 68-29-129 makes it a violation of the law to allow any person to perform “medical laboratory procedures” except individuals licensed and registered under this chapter. For purposes of that section, the words “medical laboratory procedures” include only the non-preparatory portions of any test required to be performed in a medical laboratory. The preparatory portions of the tests, while they must be performed in a facility licensed by the Board, do not require the extensive education and specialized knowledge required for licensure and may therefore be performed by persons not licensed under the Medical Laboratory Act.

(2) The following are considered to be preparatory portions of tests to be performed in a medical laboratory that may be assigned to persons not licensed under the Medical Laboratory Act:

(a) centrifuging, pouring off and preparing specimens for testing.

(b) preparing peripheral smears at bedside or in the laboratory.

(c) staining peripheral smears by automated methods.

(d) loading primary bar-coded specimens on analyzers.

(e) automated process of sorting, decapping, aliquoting and archiving of specimens.

(f) primary inoculation of microbiology specimens.

(g) Any activities required prior to microscopic evaluation of cytology specimens.

(3) A medical laboratory director, as defined by T.C.A. § 68-29-103, must approve preparatory portions of tests performed by individuals not licensed under the Tennessee Medical Laboratory Act.

(4) The laboratory must identify personnel responsible for performing preparatory portions of tests and those with responsibility for supervising them.

(5) Personnel performing preparatory portions of tests must have adequate, specific training and orientation and must demonstrate satisfactory levels of competency before performing preparatory portions of tests, and a competency demonstration must be performed at least annually thereafter.

(6) Laboratory surveyors will evaluate preparatory portions of tests at the time of inspection.

History

• Authority: §§ 4-5-202, 4-5-204, 68-29-105, and 68-29-129.
• Administrative History: Original rule filed April 10, 2003; effective June 24, 2003. Amendment filed September 17, 2003; effective December 1, 2003. Amendment filed April 17, 2007; effective July 1, 2007.

Tenn. Comp. R. & Regs. 1200-06-03-.20 ADVERTISING

(1) Policy Statement. The lack of sophistication on the part of many in the health care community concerning medical laboratories, the importance of the interests affected by the choosing of a medical laboratory and the foreseeable consequences of unrestricted advertising by medical laboratories which is recognized to pose special possibilities for deception, require that special care be taken by medical laboratories to avoid misleading the health care community.

Medical laboratories must be mindful that the benefits of advertising depend upon its reliability and accuracy. Since advertising by medical laboratories is calculated and not spontaneous, reasonable regulation designed to foster compliance with appropriate standards serves the public interest without impeding the flow of useful, meaningful, and relevant information to the health care community.

(2) Definitions (a) Advertisement – Informational communication to the health care community in any manner designed to attract attention to the medical laboratories which are licensed to practice in Tennessee.

(b) Licensee - Any entity holding a license to operate as a medical laboratory in the State of Tennessee. Where applicable this shall include partnerships and/or corporations.

(c) Material Fact - Any fact which a health care provider would need to know or rely upon in order to make an informed decision concerning the choice of medical laboratories to serve its particular needs.

(d) Bait and Switch Advertising - An alluring but insincere offer to sell a product or service which the advertiser in truth does not intend or want to sell. Its purpose is to switch consumers from buying the advertised service or merchandise, in order to sell something else, usually for a higher fee or on a basis more advantageous to the advertiser.

(e) Discounted Fee - Shall mean a fee offered or charged by a medical laboratory or a product or service that is less than the fee the medical laboratory usually offers or charges for the product or service. Products or services expressly offered free of charge shall not be deemed to be offered at a "discounted fee."

(f) Health Care Community – Shall mean hospitals, ambulatory surgical treatment centers, medical practices, individual physicians, and other health care providers with legal

authority to order laboratory tests.

(3) Advertising Fees and Services (a) Fixed Fees - Fixed fees may be advertised for any service. It is presumed unless otherwise stated in the advertisement that a fixed fee for a service shall include the cost of all professional recognized components within generally accepted standards that are required to complete the service.

(b) Range of Fees. A range of fees may be advertised for services and the advertisement must disclose the factors used in determining the actual fee, necessary to prevent deception of the health care community.

(c) Discount Fees. Discount fees may be advertised if:

1. The discount fee is in fact lower than the licensee's customary or usual fee charged for the service; and 2. The licensee provides the same quality and components of service and material at the discounted fee that are normally provided at the regular, non-discounted fee for that service.

(d) Related Services and Additional Fees. Related services which may be required in conjunction with the advertised services for which additional fees will be charged must be identified as such in any advertisement.

(e) Time Period of Advertised Fees.

1. Advertised fees shall be honored for those seeking the advertised services during the entire time period stated in the advertisement whether or not the services are actually rendered or completed within that time.

2. If no time period is stated in the advertisement of fees, the advertised fee shall be honored for thirty (30) days from the last date of publication or until the next scheduled publication whichever is later whether or not the services are actually rendered or completed within that time.

(4) Advertising Content. The following acts or omissions in the context of advertisement by any licensee shall constitute unethical conduct, and subject the licensee to disciplinary action pursuant to T.C.A. § 68-29-127(9) and (10).

(a) Claims that the services performed, personnel employed, materials or office equipment used are professionally superior to that which is ordinarily performed, employed, or used, or that convey the message that one licensee is better than another when superiority of services, personnel, materials or equipment cannot be substantiated.

(b) The misleading use of an unearned or non-health degree in any advertisement.

(c) Promotion of professional services which the licensee knows or should know is beyond the licensee's ability to perform.

(d) Techniques of communication which intimidate, exert undue pressure or undue influence over a prospective client.

(e) Any appeals to an individual's anxiety in an excessive or unfair manner.

(f) The use of any personal testimonial attesting to a quality of competency of a service or treatment offered by a licensee that is not reasonably verifiable.

(g) Utilization of any statistical data or other information based on past performances for prediction of future services, which creates an unjustified expectation about results that the licensee can achieve.

(h) The communication of personal identifiable facts, data, or information about a patient without first obtaining patient consent.

(i) Any misrepresentation of a material fact.

(j) The knowing suppression, omission or concealment of any materials fact or law without which the advertisement would be deceptive or misleading.

(k) Statements concerning the benefits or other attributes of medical procedures or products that involve significant risks without including:

1. A realistic assessment of the safety and efficiency of those procedures or products; and 2. The availability of alternatives; and 3. Where necessary to avoid deception, descriptions or assessment of the benefits or other attributes of those alternatives.

(l) Any communication which creates an unjustified expectation concerning the potential results of any laboratory test.

(m) Failure to comply with the rules governing advertisement of fees and services, or advertising records.

(n) The use of "bait and switch" advertisements. Where the circumstances indicate "bait and switch" advertising, the Board may require the licensee to furnish data or other evidence pertaining to those sales at the advertised fee as well as other sales.

(o) Misrepresentation of a licensee's credentials, training, experience, or ability.

(p) Failure to include the corporation, partnership or individual licensee's name, address, and telephone number in any advertisement. Any corporation, partnership or association which advertises by use of a trade name or otherwise fails to list all licensed laboratory personnel practicing at a particular location shall:

1. Upon request provide a list of all licensed laboratory personnel practicing at that location; and 2. Maintain and conspicuously display at the licensee's office, a directory listing all licensed laboratory personnel practicing at that location.

(q) Failure to disclose the fact of giving compensation or anything of value to representatives of the press, radio, television or other communicative medium in anticipation of or in return for any advertisement (for example, newspaper article) unless the nature, format or medium of such advertisement make the fact of compensation apparent.

(r) After thirty (30) days of the licensee’s departure, the use of the name of any licensed laboratory personnel formerly practicing at or associated with any advertised location or on office signs or buildings. This rule shall not apply in the case of a retired or deceased former associate who practiced in association with one or more of the present licensees if the status of the former associate is disclosed in any advertisement or sign.

(s) Stating or implying that a certain licensee provides all services when any such services are performed by another licensee.

(5) Advertising Records and Responsibility (a) Each licensee who is a principal partner, or officer of a firm or entity identified in any advertisement, is jointly and severally responsible for the form and content of any advertisement. This provision shall also include any licensed professional employees acting as an agent of such firm or entity.

(b) Any and all advertisement are presumed to have been approved by the licensee named therein.

(c) A recording of every advertisement communicated by electronic media, and a copy of every advertisement communicated by print media, and a copy of any other form of advertisement shall be retained by the licensee for a period of two (2) years from the last date of broadcast or publication and be made available for review upon request by the Board or its designee.

(d) At the time any type of advertisement is placed, the licensee must possess and rely upon information which, when produced, would substantiate the truthfulness of any assertion, omission or representation of material fact set forth in the advertisement or public information.

(6) Use of Titles in Advertisements. Any medical laboratory licensed by the Board which includes in its advertisements the names of its laboratory personnel must, in every “advertisement” [as that term is defined in rule 1200-06-03-.20(2)(a)] it publishes, use an appropriate personnel title for each such licensee as authorized by rule 1200-06-01-.03(3) of this rule. Failure to do so may constitute an omission of a material fact which makes the advertisement misleading and deceptive and subjects the medical laboratory to disciplinary action pursuant to T.C.A. § 68-29-126(9), 68-29-126(11), 68-29-126(13), 68-29-127(8), 68-29-127(9), 68-29-127(10), and/or 68-29-129(8).

(7 ) Severability. It is hereby declared that the sections, clauses, sentences and parts of these rules are severable, are not matters of mutual essential inducement, and any of them shall be rescinded if these rules would otherwise be unconstitutional or ineffective. If any one or more sections, clauses, sentences or parts shall for any reason be questioned in court, and shall be adjudged unconstitutional or invalid, such judgment shall not affect, impair or invalidate the remaining provisions thereof, but shall be confined in its operation to the specific provision or provisions so held unconstitutional or invalid, and the inapplicability or invalidity of any section, clause, sentence or part in any one or more instance shall not be taken to affect or prejudice in any way its applicability or validity in any other instance.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-145, 63-1-146, 68-29-105, 68-29-126, and 68-29-129.
• Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Amendment filed April 22, 2010; effective July 21, 2010.

Tenn. Comp. R. & Regs. 1200-06-03-.21 RENEWAL OF LABORATORY LICENSE

(1) The license to operate a laboratory or collection station shall expire annually on the anniversary of the date that the license was originally issued. To continue operations, laboratories and collection stations must renew their licenses on or before the expiration date.

(2) Methods of Renewal (a) Internet Renewals - Laboratories and collection stations may apply for renewal and pay the necessary fees via the Internet. The application to renew can be accessed at: www.tennessee.gov/health (b) Paper Renewals - For laboratories or collection stations that have not renewed their license online via the Internet, a renewal application form will be mailed to each laboratory and collection station licensed by the Board at least sixty (60) days prior to the expiration date to the last address provided to the Board. Failure to receive such notification does not relieve the laboratory or collection station from the responsibility of meeting all requirements for renewal.

(3) To be eligible for renewal, a laboratory or collection station must submit to the Division of Health Related Boards on or before the expiration date all of the following:

(a) A completed renewal application form, signed by the owner and director of the medical laboratory or public official responsible for the operation of a city or county medical laboratory or institution that contains a medical laboratory; and (b) In alphabetical order, a roster of all personnel currently employed in the laboratory, the classification/category in which the employee functions and is licensed, license number, expiration date and social security number. This shall include all medical laboratory directors, consultants, supervisors and testing personnel; and (c) The renewal and state regulatory fees as provided in Rule 1200-06-03-.02.

(4) All laboratories performing tests must file a separate renewal application for each laboratory address.

(5) Laboratories within a hospital that are located in contiguous buildings on the same campus and under common direction may file a single renewal application or multiple renewal applications for the laboratory sites within the same physical location or street address.

(6) Laboratories and collection stations which submit a signed renewal form or letter that is found to be untrue may be subject to disciplinary action as provided in Rule 1200-06-03-.05.

(7) Laboratories and collection stations which fail to comply with the renewal rules or notification received by them concerning failure to timely renew shall have their licenses processed pursuant to rule 1200-10-01-.10.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-105, 68-29-113, and 68-29-126.
• Administrative History: Original rule filed April 17, 2007; effective July 1, 2007.

Tenn. Comp. R. & Regs. 1200-06-03-.22 SPECIAL REGULATIONS REGARDING LABORATORIES LICENSED UNDER T.C.A

§ 68-29-138.

(1) Medical laboratories performing advanced esoteric applied toxicological, forensic, or biochemical analysis utilizing emerging technology shall be licensed.

(a) Licensing procedures set out in Rule1200-06-03-.02 shall be met.

(b) Laboratories licensed under T.C.A. § 68-29-138(a) are subject to all provisions of the Medical Laboratory Act except for the provisions of the Medical Laboratory Act and rules promulgated under the Act that require persons who accept specimens for laboratory examination and perform analytical testing or report the results of a laboratory examination to be licensed as a technologist, technician, laboratory trainee, or special analyst.

1. To be eligible for the licensed personnel exemption, a medical laboratory must obtain a license pursuant to T.C.A. § 68-29-138. This license shall be unique and in addition to other licenses for laboratories located in contiguous buildings on the same campus that do not fall within the exemption.

(c) The application for licensure under this exemption shall require a specific testing menu.

(2) Laboratories licensed under this rule shall be subject to on-site surveys by the Department.

The survey shall include inspection of the following: laboratories, tools therein, and educational requirements of personnel defined in T.C.A. § 68-29-138(c).

(3) Only medical laboratories engaged in advanced esoteric applied toxicological, forensic, or biochemical laboratory analysis utilizing emerging technologies shall be given an exemption defined in subparagraph (1)(b).

(a) Definition: advanced esoteric applied toxicological, forensic, or biochemical laboratory analysis is narrowly focused analysis that takes place within independent laboratories.

(b) Emerging technologies include, but are not limited to, chromatographic and nonchromatographic techniques coupled with mass spectrometer based detector systems and molecular diagnostic techniques.

(4) Personnel in laboratories licensed under T.C.A. § 68-29-138 shall not be required to complete the procedures for personnel licensure as provided in Rule 1200-06-01-.05.

However, personnel who analyze or report laboratory results shall possess a baccalaureate or advanced degree in the appropriate sciences with at least sixteen (16) semester hours of chemistry and/or biological science courses.

(a) Licensed personnel shall be allowed to perform tasks for which they are appropriately licensed and trained in laboratories exempt from hiring licensed personnel.

(b) Determining the appropriate sciences for baccalaureate or advanced degree for unlicensed personnel shall be left to the medical director of the laboratory.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-29-103, 68-29-104, 68-29-105, 68-29-111, 68-29-113, 68-29- 114, 68-29-115, and 68-29-138.
• Administrative History: Original rule filed April 1, 2015; effective June 30, 2015.

Chapter 1200-06-04 Repealed

Tenn. Comp. R. & Regs. 1200-06-04 Repealed

RULES

OF THE TENNESSEE DEPARTMENT OF HEALTH

BUREAU OF MENPOWER AND FACILITIES

DIVISION OF HEALTH RELATED BOARDS

Chapter 1200-06-05 Repealed

Tenn. Comp. R. & Regs. 1200-06-05 Repealed

RULES

OF TENNESSEE DEPARTMENT OF HEALTH

BUREAU OF STATE SERVUCES

1200-07 Division of Vital Records Bureau of Health Informatics

Chapter 1200-07-01 Vital Records

Tenn. Comp. R. & Regs. 1200-07-01-.01 DUTIES OF STATE REGISTRAR

(1) Forms. All forms, certificates, and reports used in the system of vital records are the property of the Department of Public Health and shall be surrendered to the State Registrar of Vital Records hereinafter referred to as “State Registrar” upon demand. The forms prescribed and distributed by the State Registrar for reporting vital events shall be used only for official purposes. No forms shall be used in the reporting of vital events or making copies thereof except those furnished or approved by the State Registrar.

(2) Requirements for Preparation of Certificates. All certificates and records relating to vital events must be prepared on a typewriter with a black ribbon. All signatures required shall be entered in black, unfading ink. Unless otherwise directed by the State Registrar, no certificate shall be complete and correct and acceptable for registration:

(a) That does not have the certifier’s name typed or printed legibly under his signature;

(b) That does not supply all items of information called for thereon or satisfactorily account for their omission;

(c) That contains alterations or erasures;

(d) That does not contain handwritten signatures as required;

(e) That is marked “copy” or “duplicate,”

(f) That is a carbon copy;

(g) That is prepared on an improper form;

(h) That contains improper or inconsistent data;

(i) That contains an indefinite cause of death which denotes only symptoms of disease or conditions resulting from disease;

(j) That is not prepared in conformity with regulations or instructions issued by the State Registrar.

(3) Designation of Additional Offices.

(a) The State Registrar shall determine whether offices other than the Division of Vital Records are needed in this State to aid in the efficient administration of the system of vital records. Such determination shall be based on the most efficient method by which the needs of the people of this State can be met.

(b) If the State Registrar determines additional offices are necessary, such offices shall be designated with the approval of the Department. The duties and responsibilities may be assigned to currently existing offices or special branch offices of the Division of Vital Records may be established in those areas where they are deemed necessary, or a combination of existing offices and branch offices may be used. In all cases where existing offices are utilized, the employees of such offices shall be deemed to be employees of the Division of Vital Records and subject to the control of the State Registrar when they are performing functions relating to the system of Vital Records.

(c) The State Registrar shall delegate such duties and responsibilities to such offices as he deems necessary to insure the efficient operation of the system of vital records. These may include any or all of the following:

1. The receipt and processing of birth, death and fetal death records. This would include the receipt of these records from the person responsible for filing the record, checking them for accuracy and completeness, and forwarding them to the Division of Vital Records at intervals prescribed by the State Registrar.

2. Issuance of certified copies of birth and/or death records. The records from which the certified copies are issued shall be provided by the Division of Vital Records.

All forms and procedures used to issue the copies shall be provided or approved by the State Registrar. If it is deemed appropriate and feasible, any such office may be authorized and provided copies of all birth and/or death records filed in this State.

3. Act as the agent of the State Registrar in their area and provide assistance to physicians, hospitals, funeral directors, and others in matters related to the system of vital records.

(d) The State Registrar shall determine the responsibilities and duties of each office independently.

History

• Authority: T.C.A. §§ 53-404 and 53-444.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed January 18, 1978; effective February 17, 1978. Amendment filed May 17, 1979; effective July 2, 1979. Amendment filed April 16, 1981; effective June 1, 1981.

Tenn. Comp. R. & Regs. 1200-07-01-.02 INFANTS OF UNKNOWN PARENTAGE; FOUNDLING REGISTRATION

(1) (a) The report for an infant of unknown parentage shall be registered on a Birth Report of Foundling form and shall:

1. Show the required facts as determined by approximation.

2. Show the signature and title of the custodian in lieu of the attendant.

3. If a “Birth Report of Foundling” is not registered within one year of the date found, the report of foundling may be filed by order of a court in the county where the foundling was located, or in the county where the institution having custody is located.

(b) When a report has been sealed as provided by Chapter 4 of Title 53, T.C.A., the State Registrar may inspect such information for purposes of properly administering the vital records program.

History

• Authority: T.C.A. §§ 53-404 and 53-444.
• Administrative History: Original rule filed June 7, 1974. Repeal and new rule filed January 18, 1978; effective February 17, 1978.

Tenn. Comp. R. & Regs. 1200-07-01-.03 DELAYED REGISTRATION OF BIRTH

(1) Registration - Ten days to one year.

(a) Certificates of birth filed after ten days, but within six months from the date of birth, shall be registered on the standard form of live birth certificate in the manner prescribed in Section 6 of the Vital Records Act. Such certificate shall not be marked “Delayed.”

(b) Certificates of birth filed after six months, but within one year from date of birth, shall be registered on the standard form of live birth certificate in the manner prescribed in T.C.A. §§ 68-3-301 through 68-3-306. Such certificates shall be marked “delayed” on the face of the certificate.

(c) In any case where the certificate is signed by someone other than the attendant or person in charge of the institution where birth occurred, a notarized statement setting forth the reason therefore must be attached to the certificate. The State Registrar may require additional evidence in support of the facts of birth and/or an explanation of why the certificate of birth was not filed within the required ten days.

(2) Delayed Certificate of Birth Form. All certificates registered one year or more after the date of birth are to be registered on a delayed certificate of birth form prescribed by the State Registrar.

(3) Who May Request the Registration of and Sign a Delayed Certificate of Birth.

(a) Any person born in this State whose birth is not recorded in this State, or his parent, guardian, next of kin, and having personal knowledge of the facts of birth may request the registration of a delayed certificate of birth, subject to these regulations and instructions issued by the State Registrar.

(b) Each delayed certificate of birth shall be signed and sworn to before an official authorized to administer oaths by the person whose birth is to be registered if such person is at least 12 years old and is competent to sign and swear to the accuracy of the facts stated therein; otherwise the certificate shall be signed and sworn to by one of the following in the indicated order of priority.

1. One of the parents of the registrant, or 2. The guardian of the registrant, or 3. The next of kin of the registrant.

(4) Facts to Be Established for a Delayed Registration of Birth.

(a) The minimum facts which must be established by documentary evidence shall be the following:

1. The full name of the person at the time of birth;

2. The date of birth and place of birth;

3. The full name of the mother;

4. The full name of the father; except that if the mother was not married either at the time of conception or birth the name of the father shall not be entered on the delayed certificate except as provided in Regulation 3.5.

(5) Delayed Registration Following a Legal Change of Status.

(a) When evidence is presented reflecting a legal change of status by adoption, legitimation, paternity determination or acknowledgment, a new certificate of birth may be prepared on a form in current use to reflect such change.

(b) The existing certificate and the evidence upon which the new certificate was based shall be placed in a special file. Such file shall not be subject to inspection except upon order of a court of competent jurisdiction or by the State Registrar for purposes of properly administering the vital records program.

(6) Documentary Evidence - Requirements.

(a) To be acceptable for filing, the name of the registrant and the date and place of birth entered on a delayed certificate of birth shall be supported by at least:

1. An affidavit of a parent or the attendant at birth and one piece of documentary evidence establishing the facts of birth, or 2. An affidavit of two persons, at least one of whom is not related to the registrant by blood or marriage, and one piece of documentary evidence establishing the facts of birth, or 3. Two pieces of documentary evidence which establish the facts of birth.

(b) Facts of parentage shall be supported by at least one document which may be one of the documents above other than an affidavit of personal knowledge.

(7) Documentary Evidence - Acceptability.

(a) The State Registrar may establish a priority of best evidence.

(b) Documents presented, such as census, hospital, church, and school records, must be from independent sources and shall be in the form of the original record or a duly certified copy thereof or a signed statement from the custodian of the record or document.

(c) All documents submitted in evidence, other than an affidavit of personal knowledge, must have been established at least five years prior to the date of application or have been established prior to the applicant’s tenth birthday.

(d) An affidavit of personal knowledge, to be acceptable, must be prepared by one of the parents, the next of kin, or any older person and must be signed before an official authorized to administer oaths. In all cases, the affiant must be at least ten years older than the applicant and have personal knowledge of the facts of birth.

(8) Abstraction of Documentary Evidence.

(a) The State Registrar, or any Local Registrar shall abstract on the delayed certificate of birth a description of each document submitted to support the facts shown on the delayed birth certificate. This description shall include:

1. The title or description of the document;

2. The name and address of the affiant, if the document is an affidavit of personal knowledge or of the custodian, if the document is an original or certified copy of a record or a signed statement;

3. The date of the original filing of the document being abstracted;

4. The information regarding the birth facts contained in the document.

(b) All documents submitted in support of the delayed birth registration shall be returned to the applicant after review and abstraction.

(9) Certification by the State Registrar.

(a) The State Registrar, or any Local Registrar, shall, by his signature, certify:

1. That no prior birth certificate is on file for the person whose birth is to be recorded;

2. That he has reviewed the evidence submitted to establish the facts of birth;

3. That the abstract of the evidence appearing on the delayed certificate of birth accurately reflects the nature and content of the document.

(10) Dismissal After One Year. Applications for delayed certificates which have not been completed within one year from the date of application may be dismissed at the discretion of the State Registrar. Upon dismissal, the State Registrar shall advise the applicant of his decision and all documents submitted in support of such registration shall be returned to the applicant.

History

• Authority: T.C.A. §§ 4-5-202, 63-3-103, and 68-3-308.
• Administrative History: Original rule filed June 7, 1974. Repeal and new rule filed January 18, 1978; effective February 17, 1978. Amendments filed March 27, 1989; effective May 11, 1989. Amendment filed August 12, 1999; effective October 26, 1999.

Tenn. Comp. R. & Regs. 1200-07-01-.04 NEW CERTIFICATES OF BIRTH FOLLOWING ADOPTION, LEGITIMATION,

PATERNITY DETERMINATION AND PATERNITY ACKNOWLEDGMENT.

(1) Adoption. A new certificate of birth shall be prepared by the State Registrar for a child born in Tennessee, if a certificate in the name at birth is on file and upon receipt of (a) A certified Certificate of Adoption or (b) A certified copy of an adoption decree and a completed application for a New Certificate of Birth by Adoption on a form prescribed or approved by the State Registrar.

(2) If the court that granted the adoption, the adopting parent(s), or the adopted person requests that a new certificate is not to be prepared, then a new certificate shall not be prepared. For a child born in another state and adopted in a court of record in Tennessee, the adoption papers shall be forwarded to the state of birth.

(3) The clerk of the court of competent jurisdiction shall notify the State Registrar of each revocation of adoption. Upon receiving a certified copy of the court order revoking or annulling the adoption and if a new birth certificate based on adoption has been prepared, the new certificate will be removed and placed in a sealed file with other documents related to the adoption and the revocation or annulment. The birth certificate for the registrant prior to the adoption will be reinstated in the active files.

(4) Legitimation by Subsequent Marriage of the Parents. A new certificate of birth shall be prepared by the State Registrar for a child born in Tennessee, if a certificate in the name at birth is on file and upon receipt of (a) An Application for a New Certificate of Birth by Subsequent Marriage of Parents, including affidavits of the mother and father;

(b) Information for locating the original birth certificate and for preparing the new birth certificate on a form prescribed by the State Registrar; and (c) A certified copy of the parents’ marriage certificate or information for locating the parents’ marriage certificate, if the certificate is filed in the Division of Vital Records.

(5) If either parent is deceased or unavailable to provide the affidavit required in (a), the State Registrar may accept a copy of an order, judgment, or decree whereby a court determined the husband to be the father of the child.

(6) However, if the husband is already shown as father on the child’s birth certificate, a new certificate will not be prepared. If another man is shown as father of the child on the child’s birth certificate, a new certificate may be prepared only when a certified copy of a court order specifically refuting the man listed as father or other indisputable legal evidence is provided to the State Registrar.

(7) Court Determination of Parentage. A new certificate of birth shall be prepared by the State Registrar for a child born in Tennessee if a certificate in the name at birth is on file and upon receipt of the following:

(a) A court order of parentage, regardless of whether the order was entered before or after the birth of the child, and (b) A completed Application for a New Birth Certificate.

(8) However, a new birth certificate will not be prepared if the man determined to be the father is already shown as the father on the child’s birth certificate.

(9) If an order of parentage is abrogated by a later judgment or order of the same or higher court, the clerk of the court which entered such order shall notify the State Registrar in writing. If a new birth certificate has been prepared, that certificate will be removed and placed in a sealed file with other information relating to the order of parentage, and the previous birth certificate will be reinstated in the active files.

(10) New Certificate. The new certificate of birth shall be on a form prescribed by the State Registrar and shall include the following items necessary to complete the certificate:

(a) The full name of the child;

(b) The date and place of birth, sex, and date of filing as shown on the original or delayed certificate in the name at birth;

(c) The names and personal information of the parent(s); and (d) The signature of the State Registrar in the space provided for the signature of the certifier of the birth.

(11) Report of Foreign Birth. A Report of Foreign Birth shall be prepared on a form prescribed by the State Registrar upon receipt of a certified copy of the final order of adoption and an Application for Report of Foreign Birth for Adopted Child. The Report shall include the following items:

(a) Full adoptive name of the child;

(b) Actual date and place of birth and sex of the child as provided by the Clerk of the Court;

(c) Full names of the adoptive parents and their legal residence at the time the adoption was granted;

(d) Date of filing of the Report;

(e) Signature of the State Registrar; and (f) Statement that the Report is not evidence of United States citizenship.

(12) Sealing of documents. After preparation of a new certificate of birth or report of foreign birth, the certificate in the name at birth and/or the legal documents upon which the new certificate or report was prepared are to be placed in an envelope and sealed. Such sealed file may be opened by the State Registrar for the issuance of a copy of the certificate in the name at birth only upon order of a court of competent jurisdiction or upon receipt of a directive from the Tennessee Department of Children’s Services.

History

• Authority: T.C.A. §§ 4-5-202, 36-1-120, 36-1-126, 36-1-127, 36-1-130, 36-1-138, 68-3-103, 68-3-310, 68-3-311, 68-3-312, and 68-3-313.
• Administrative History: Original rule filed June 7, 1974. Repeal and new rule filed January 18, 1978; effective February 17, 1978. Amendments filed March 27, 1989; effective May 11, 1989. Amendment filed August 12, 1999; effective October 26, 1999. Amendments filed March 24, 2022; effective June 22, 2022.

Tenn. Comp. R. & Regs. 1200-07-01-.05 DEATH REGISTRATION, INCOMPLETE

(1) If all information necessary to complete a death certificate is not available within the time prescribed for filing of the certificate, the funeral director or person acting as such shall file the certificate with all information that is available and satisfactorily account for all the items that are omitted. In all cases, the medical certification must be provided by the person responsible for such certification. If the cause of death is unknown or pending investigation, the cause of death shall be shown as such on the certificate. A supplemental report providing the personal information omitted from the original certificate shall be filed by the funeral director or person acting as such with the State Registrar as soon as possible, but in all cases within 30 days of the date the death occurred.

(2) The physician signing the medical certification of the certificate or the medical examiner who has assumed responsibility for the case shall report the cause of death on a form provided by the State Registrar as soon as possible, but in all cases within 6 months of the date the death occurred.

History

• Authority: T.C.A. §§ 4-5-202, 68-3-103, and 68-3-502.
• Administrative History: Original rule filed June 7, 1974. Repeal and new rule filed January 18, 1978; effective February 17, 1978. Amendment filed August 12, 1999; effective October 26, 1999.

Tenn. Comp. R. & Regs. 1200-07-01-.06 DELAYED REGISTRATION OF DEATH

(1) The registration of a death after the time prescribed by statute and regulations shall be registered on the standard certificate of death form in the manner prescribed below:

(a) If the attending physician or medical examiner at the time of death and the attending funeral director or person who acted as such are available to complete and sign the certificate of death, it may be completed without additional evidence and filed with the State Registrar. However, for those certificates filed one year or more after the date of death, the physician or medical examiner and the funeral director or person who acted as such must state in accompanying affidavits that the information on the certificate is based on records kept in their files.

(b) In the absence of the attending physician or medical examiner, and the funeral director or person who acted as such, the certificate may be filed by the next of kin of the deceased and shall be accompanied by:

1. An affidavit of the person filing the certificate swearing to the accuracy of the information on the certificate;

2. Two documents which identify the deceased and his date and place of death.

(2) In all cases, the State Registrar may require additional documentary evidence to prove the facts of death.

(3) A summary statement of the evidence submitted in support of the delayed registration shall be endorsed on the certificate.

History

• Authority: T.C.A. §§ 53-404 and 53-444.
• Administrative History: Original rule filed June 7, 1974. Repeal and new rule filed January 18, 1978; effective February 17, 1978.

Tenn. Comp. R. & Regs. 1200-07-01-.07 REPORTS OF FETAL DEATH AND INDUCED TERMINATION OF PREGNANCY

(1) Reports of induced termination of pregnancy are statistical reports only and are not to be incorporated into the official records of the Division of Vital Records. The reports are to be forwarded directly to the Department of Health within ten (10) days after the procedure by the person in charge of the institution in which the procedure was performed or by the physician in attendance, if the induced termination did not occur in an institution. The State Registrar is authorized to dispose of such reports when all statistical processing of the reports has been accomplished. However, the State Registrar may establish an electronic file of such records, so that they will be available for future statistical and research projects; provided, however, such file shall not be made a part of the official records and the reports shall not be made available for the issuance of certified copies. Such file shall be retained for as long as the State Registrar deems necessary and it shall then be destroyed consistent with laws and rules pertaining to record retention.

(2) A report of fetal death shall be submitted for each fetal death of a fetus weighing three hundred fifty (350) grams or more or for each fetal death of twenty (20) completed weeks gestation or more. The State Registrar shall not maintain any report of fetal death for a fetus weighing less than three hundred fifty (350) grams or, if weight is not reported, that shows less than twenty (20) completed weeks of gestation.

(3) The report of fetal death is to be submitted within ten (10) days after delivery to the State Registrar by the person in charge of the institution in which the fetus was delivered; or by the physician in attendance, if the fetal death did not occur in an institution; or by the appropriate medical examiner, if the fetal death occurred without medical attendance.

(4) Except as noted in 1200-07-01-.07(3), reports of fetal death are not copied, issued, or otherwise released, except for statistical or research purposes approved by the State Registrar.

History

• Authority: T.C.A. §§ 4-5-202, 68-3-103, 68-3-504, and 68-3-505.
• Administrative History: Original rule filed June 7, 1974. Repeal and new rule filed January 18, 1978; effective February 17, 1978. Amendment filed May 17, 1979; effective July 2, 1979. Amendment filed August 6, 2002; effective October 20, 2002. Emergency rule filed July 26, 2010; effective through January 22, 2011. Emergency rule expired effective January 23, 2011; and the rule reverted to its previous status. Amendments filed November 10, 2010; effective February 8, 2011.

Tenn. Comp. R. & Regs. 1200-07-01-.08 AUTHORIZATION FOR FINAL DISPOSITION

(1) Removal of Body.

(a) Before removing a dead body or fetus from the place of death, the funeral director or person acting as such shall:

1. Obtain assurance from the attending physician that death is from natural causes and that the physician will assume responsibility for certifying to the cause of death or fetal death and receive permission to remove the body from the place of death; or 2. Notify the medical examiner if the case comes within his jurisdiction and receive authorization from him to remove the body;

(b) The funeral director or person acting as such shall secure and file a death certificate with the local registrar within five (5) days.

(2) Disinterment Permits.

(a) A disinterment permit shall be issued by the State Registrar or Local Registrar upon receipt of a written affidavit signed by the next of kin and the person who is in charge of the disinterment or upon receipt of an order of a court of competent jurisdiction directing such disinterment.

(b) Upon receipt of a court order or signed affidavit of the next of kin the State Registrar may issue one permit to authorize disinterment and reinterment of all remains in a mass disinterment provided that, insofar as possible, the remains of each body be identified and the place of disinterment and reinterment specified. The disinterment permit shall be authorization for disentombment, disinterment, transportation and reentombment or reinterment.

(c) A dead body properly prepared by an embalmer and deposited in a receiving vault shall not be considered a disinterment when removed from the vault for final disposition.

(3) Disposition of Fetal Remains.

(a) An abortion facility, as that term defined by T.C.A. § 39-15-219, shall comply with that

section regarding disposition of fetal remains from a surgical abortion.

1. Pursuant to T.C.A. § 39-15-219(b)(1), interment and cremation are the only authorized methods of disposition. Fetal remains shall not be disposed of as infectious waste.

2. An abortion facility shall implement and utilize the forms promulgated by the Commissioner of Health under T.C.A. §§ 39-15-219(m)(1)(A), (B), and (C).

(b) Within ten (10) days of a surgical abortion, the facility shall carry out the arrangements for the interment or cremation of the remains, unless the patient has chosen to make alternate arrangements under T.C.A. § 39-15-219 (c)(1).

(c) An abortion facility shall develop policies to ensure that fetal remains are properly accounted for during transportation and delivery by and to persons and entities involved in the disposition of the fetal remains, and in a manner that does not disclose the protected healthcare information or identity of the patient.

(d) Forms utilized by an abortion facility in accordance with subsection (a) shall be retained by the facility and shall not be submitted to the Division of Vital Records.

History

• Authority: T.C.A. §§ 4-5-202, 39-15-219, 68-3-103, 68-3-104, 68-3-502, and 68-3-507.
• Administrative History: Original rule filed June 7, 1974. Repeal and new rule filed January 18, 1978; effective February 17, 1978. Amendment filed August 12, 1999; effective October 26, 1999. Amendments filed March 24, 2022; effective June 22, 2022.

Tenn. Comp. R. & Regs. 1200-07-01-.09 DELAYED REGISTRATION OF MARRIAGE

(1) The registration of a marriage after the time prescribed by statute shall be made on the standard certificate of marriage form in the manner prescribed below:

(a) The certificate must be filed with the County Court Clerk where the marriage license was originally issued;

(b) To be acceptable for registration by the State Registrar the delayed certificate of marriage must be supported by:

1. A copy of the license or of the application for license if the license was granted.

2. A signed statement from the officiant or the custodian of the official record and from one witness to the wedding ceremony proving that there was a marriage and the date and place of the marriage.

(2) In all cases, the State Registrar may require additional documentary evidence to prove the facts of marriage.

History

• Authority: T.C.A. §§ 53-404 and 53-444.
• Administrative History: Original rule filed June 7, 1974. Repeal and new rule filed January 18, 1978; effective February 17, 1978.

Tenn. Comp. R. & Regs. 1200-07-01-.10 AMENDMENT OF VITAL RECORDS

(1) Amendment of Minor Errors on Certificates During the First Year.

(a) Amendment of obvious errors, transposition of letters in words of common knowledge, or the addition of omitted information may be made by the State Registrar within the first year after the date of the event either upon his own observation or query or upon request of the person defined in 1200-07-01-.10(3). When such additions or minor amendments are made by the State Registrar, a notation as to the source of the information together with the date the change was made shall be maintained in such a way as not to become a part of any certification issued. The certificate is not to be marked “Amended”.

(b) The State Registrar may at his discretion accept an affidavit only to correct inaccurate information recorded on a certificate within the first year after the date of the event.

The affidavit must be signed and sworn to by the individual, institutional representative, clerk or funeral director who originally provided the information for the certificate or prepared the certificate. The State Registrar may require supporting documentation to amend the certificate. The certificate will be marked “Amended”.

(2) All Other Amendments.

(a) Unless otherwise provided in these rules or by statute, all other amendments to vital records shall be supported by:

1. An affidavit signed by one of the persons defined in 1200-07-01-.10(3) setting forth the information to identify the certificate, the incorrect data as it is listed on the certificate, and the correct data as it should appear; and 2. One or more items of documentary evidence which support the alleged facts and which were created at least five years prior to the date of the application for amendment or within seven years of the date of the event, i.e., birth, death, marriage or divorce related to the record.

2. The date of birth on a birth certificate cannot be changed to a date which is after the date of filing. The date of birth can be corrected by an affidavit required in (2)(a)(1) and either of the following:

(i) One item of documentary evidence which was created before the registrant’s tenth birthday which supports the correct date of birth, or (ii) A transcript of the Federal Census which next followed the registrant’s birth to establish the year of birth and a document which was made prior to the registrant’s twenty-first birthday which supports the correct date of birth, or (iii) To amend only a day of birth (with month and year to remain as originally recorded) documentary evidence established before the registrant’s twenty-first birthday that supports the correct date of birth.

4. To amend the records for births that occurred more than seventy years prior to the application, the State Registrar may at his discretion require documentary evidence only. The documents must be at least five years old at the time of amendment.

5. No item on a certificate may be amended by an order of a court of competent jurisdiction except in accordance with the Vital Records Act of 1977 and regulations adopted by the department. A certified copy of the order must be submitted to the State Registrar.

6. An item that was established by court order on a certificate can only be amended by an order of a court of competent jurisdiction, preferably the court which granted the original decree. A certified copy of the order signed by the clerk of the court must be submitted to the State Registrar.

7. A legal change of name order from a court of competent jurisdiction is required to change the name as shown on the certificate, unless the registrant presents documentary evidence that the name was incorrectly recorded at the time of registration of birth. In order to prove incorrect recording, the documentary evidence should be the oldest document available, preferably a hospital birth worksheet or other record created very soon after birth, that proves the correct name.

(b) The State Registrar shall evaluate the evidence submitted in support of any amendment and, when he finds reason to doubt its validity or adequacy, he may reject the amendment and in writing shall advise the applicant of the reasons for this action.

(3) Who May Apply.

(a) To amend a birth certificate, application may be made by one of the parents named on the birth certificate, the guardian, the registrant (if 18 years of age or older), or the individual or institution responsible for filing the certificate.

(b) To amend a death certificate, application may be made by the next of kin, the informant listed on the death certificate, or the funeral director or person acting as such who submitted the death certificate. Applications to amend the date of death or the medical certification of cause of death shall be made by the physician who signed the medical certification or the medical examiner.

(c) Applications for amendment of a certificate of marriage shall be made jointly by both parties to the marriage or by the survivor. In the event the marriage to which the application relates was terminated by divorce or annulment on or before the date of application for amendment, the applicant may request amendment only of those items on the certificate of marriage which relate to the applicant.

(d) Applicants for amendment of matters contained in a certificate of divorce or annulment which are not part of the decree may be made by either party to the marriage so terminated. Applications for amendment of matters contained in a certificate of divorce or annulment which are part of the decree may only be made by the court which ordered the divorce or annulment upon which the report was made.

(4) Amendment of Registrant’s Given Name on Birth Certificates Within the First Year.

(a) Until the registrant’s first birthday, given names may be amended upon receipt of an affidavit signed by the parent(s) named on the certificate or the guardian, person, or agency having legal custody of the registrant.

(b) After one year from the date of birth, the provisions of Rule 1200-07-01-.10(2) must be followed to amend a given name, if the name was entered incorrectly on the birth certificate. A legal change of name order must be submitted from a court of competent jurisdiction to change a given name after one year and the order must be certified.

(5) Addition of Given Name.

(a) Given names, for a child whose birth was recorded without a given name, may be added to the certificate upon affidavit of the parent(s) named on the certificate or the guardian, person, or agency having legal custody of the registrant.

(b) If a birth was recorded without a given name and the registrant is age 18 years or older, he may sign the affidavit to add given names only when supported by documentary evidence at least five years old which establishes the name.

(6) Addition of Father’s Name to Birth Certificate.

(a) A birth certificate may be amended to show the father’s name and personal information in a case in which the parents were married at the time of their child’s birth, if the father’s name was omitted from the birth certificate or another man was shown as the father on the birth certificate.

1. If another man is listed on the birth certificate as the father, a certified copy of a court order specifically refuting the man listed as father must be submitted to the State Registrar before the certificate can be amended to show the correct information. The original entries concerning the father will be blocked. If the child’s surname is to be changed, the original entry will be blocked.

2. The father’s name and personal information may be added, if those items on the original certificate are blank, upon submission of the following to the State Registrar:

(i) An affidavit of both natural parents attesting to the fact that the man is the natural father and stating the surname to be given to the child, and (ii) A certified copy of the marriage certificate of the father and mother showing that the marriage occurred before the child’s birth, or information for locating the marriage certificate if the certificate is filed in the Division of Vital Records.

(iii) The State Registrar shall evaluate the evidence and affidavits submitted in support of this amendment, and, when he finds reason to doubt its validity or adequacy, he may reject the amendment and shall advise the applicant in writing of the reasons for this action.

(iv) In all cases the fact of amendment will be noted on the certificate and on all certified copies issued.

(b) In cases in which the mother was not married at the time of the child’s birth and no information about the father is shown on the child’s birth certificate, the father’s name and personal information may be entered on the birth certificate, if prior to the child’s nineteenth birthday both natural parents submit a voluntary acknowledgment of paternity form attesting to the fact that the man is the natural father and stating the surname to be given to the child.

1. If the parents elect to change the child’s surname, the original surname will be blocked.

2. The record will be marked as amended, but certified copies will not bear the amendment notation.

(7) Removal of Father’s Name and Personal Information. The originally shown father’s name and personal data may be removed from a birth certificate only upon receipt of either (a) A properly completed Rescission of Voluntary Acknowledgment of Paternity received by the State Registrar within 60 days of the date on which the Voluntary Acknowledgment of Paternity was completed, or (b) A certified copy of an order from a court of competent jurisdiction which determines that the named man is not the father.

(8) If a Rescission of Voluntary Acknowledgment of Paternity is accepted to make the amendment, the child’s surname will be changed to the mother’s legal surname at the time of birth. If a court order to remove the father is received, the child’s name will be changed only if so authorized by the court.

(9) Medical Items. All items in the medical certification or of a medical nature may be amended only upon receipt of an affidavit from those persons responsible for the completion of such items or the medical examiner. The State Registrar may require documentary evidence to substantiate the requested amendment.

(10) Amendment of the Same Item More than Once. Once an amendment of an item is made on a vital record, that item shall not be amended again, except upon receipt of an order from a court of competent jurisdiction, and the order must be certified.

(11) Methods of Amending Certificates.

(a) Certificates of birth, death, marriage, and divorce or annulment may be amended by the State Registrar in the following manner upon receipt of the required documentation:

1. Completing the item in any case where the item was left blank on the existing certificate or 2. Drawing a single line through the item to be amended and inserting the correct data immediately above or to the side thereof. The line drawn through the original entry must not obliterate such entry. The original entry will be blocked out only if the court so orders or blocking is required by statute.

(b) In all cases, there shall be inserted on or filed with the certificate a statement identifying the affidavit and documentary evidence used as proof of the correct facts and the date the amendment was made. As required by statute or rule, the certificate shall be marked “Amended”.

(12) Old Records That Will Not Be Amended. When one hundred years have elapsed after the date of birth or fifty years have elapsed after the date of death, marriage or divorce, the record of the event will not be amended.

History

• Authority: T.C.A. §§ 4-5-202, 24-7-113, 68-3-101, 68-3-102, 68-3-103, 68-3-202, 68-3-203, 68-3-301, 68-3-302, 68-3-303, 68-3-304, 68-3-305, 68-3-308, 68-3-309, 68-3-310, 68-3-311, 68-3-312, 68-3-401, 68-3-402, 68-3-501, and 68-3-502.
• Administrative History: Original rule filed June 7, 1974. Repeal and new rule filed January 18, 1978; effective February 17, 1978. Amendment filed March 27, 1989; effective May 11, 1989. Amendment filed August 12, 1999; effective October 26, 1999. Amendments filed March 24, 2022; effective June 22, 2022.

Tenn. Comp. R. & Regs. 1200-07-01-.11 DISCLOSURE OF RECORDS

(1) Vital records are public records and information from a record may be provided and verified upon request except that (a) Information from the “Information for Medical and Health Use Only” section of the birth certificate and information from the “Confidential Information” section of the certificate of marriage or the certificate of divorce or annulment may not be provided except for statistical or research purposes.

(b) Information concerning the cause of death from the death certificate may be provided only to the spouse, children, parents, or other next of kin of the decedent or their respective authorized representative or for one of the following reasons:

1. When a documented need for the cause of death to establish a legal right or claim has been demonstrated;

2. When the request for the information is made by or on behalf of an organization that provides benefits to the decedent’s survivors or beneficiaries;

3. When needed for research purposes approved by the State Registrar;

4. When requested by local, state or federal agencies for research or administrative purposes approved by the State Registrar; or 5. Upon the order of a court of competent jurisdiction ordering such release.

(c) Information from birth records which have been sealed pursuant to T.C.A. § 68-3-313 will not be verified. The sealed records are subject to opening only pursuant to T.C.A. §§ 68-3-313, 36-1-126, 36-1-127 and 36-1-138.

(d) To be consistent with the purpose of protecting persons in the federal witness protection program, verified information concerning such person will not be provided to anyone other than the subject person or that person’s supervising federal marshal.

(e) In order to protect the personal, identifying information of children who are adopted or legitimated within the first year after birth, requests for listings or copies of the database of birth records that are not for research purposes and are received from nongovernmental agencies will not be filled until eighteen (18) months past the end of the calendar year in which the birth occurred.

(2) To maintain the physical security of the documents, the records in the custody of the State Registrar or Local Registrars are not available for hands-on public inspection.

(3) A search for the record will be conducted when the applicant provides sufficient information to locate the record in question, including, but not limited to, the year of the event; for births, the name of the registrant or the father, if named on the record, or the mother, if the father is not named on the record; for deaths, the name of the decedent; for marriages, the name of the groom; and for divorces, the name of the husband.

(4) Both the request and the response may be verbal or written; however, in all cases, the required fee must be paid at the time of inquiry, pursuant to Rule 1200-07-.13.

(5) The State Registrar may respond to an inquiry seeking verification in any of the following ways:

(a) Provision of the requested verified information.

(b) Notification that no record matching the requested information could be located.

(c) Notification that information submitted by the requestor is insufficient and more information is needed in order to locate the record in question.

(d) Notification that more than one record matches the information submitted so that the requestor may either submit additional information to identify the exact record in question or purchase information from all records matching the requested information.

(6) The term “authorized representative” shall include the attorney, physician, funeral director, or other such authorized agent acting in behalf of the registrant or his family.

(7) The natural parents of adopted children or natural parents whose parental rights have been otherwise terminated shall not be considered to have a direct and tangible interest, as required in T.C.A. § 68-3-206.

(8) The State Registrar may permit the use of data from vital records for research purposes. No data shall be furnished from records for research purposes until the State Registrar has prepared, in writing, the conditions under which the records or data will be used and has received an agreement signed by a responsible agent of the research organization agreeing to meet with and conform to such conditions.

(9) The State Registrar may disclose data which is not confidential from vital records to any federal, state, county or municipal agencies, courts, or law enforcement agencies which request such data in the conduct of their official duties. The Social Security numbers of the parent(s) as listed on the child’s birth certificate may be disclosed for the purpose of child support enforcement.

(10) The State Registrar or Local Registrar shall not issue a certified copy of a record until the applicant has provided sufficient information so that the record can be located. Whenever it shall be deemed necessary to establish an applicant’s right to a certified copy of a vital record, the State Registrar or Local Registrar may also require identification of the applicant or a sworn statement as to the identity of the applicant and the applicant’s relationship to the registrant.

(11) When 100 years have elapsed after the date of birth or 50 years have elapsed after the date of death, marriage or divorce or annulment of marriage, the records of these events in the custody of the State Registrar may be transferred to the State Library and Archives, if procedures of the State Library and Archives will allow for continued safekeeping of the records and for public access to the information from the records.

(12) Records which have been sealed pursuant to T.C.A. § 68-3-313 may be disclosed only pursuant to T.C.A. §§ 68-3-313, 36-1-126, 36-1-127 and 36-1-138.

(a) The requestor must present the original letter of authorization bearing the embossed State Seal from the Tennessee Department of Children’s Services or a certified copy of a court order from a court of competent jurisdiction, must identify the record by either name at birth or adopted name, must provide the full date of birth, and must pay the required fee.

(b) The requestor will be provided copies of all documents in the sealed file, except that information from the “Information for Medical and Health Use Only” section of the birth certificate and information from the “Confidential Information” section of the certificate of marriage or the certificate of divorce or annulment shall not be provided.

(c) If, after opening the sealed file, a review of the contents demonstrates to the State Registrar that the file contains records of siblings or other records that do not pertain to the adoption, legitimation or paternity of the individual case being requested, such records will not be copied and released. Such records will be removed and placed in the correct sealed file or in a separate file as appropriate.

History

• Authority: T.C.A. §§ 4-5-202, 36-1-126, 36-1-127, 36-1-138, 68-3-103, 68-3-104, 68-3-205, 68-3-206, and 68-3-313.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed January 18, 1978; effective February 17, 1978. Amendment filed May 19, 1978; effective June 19, 1978. Amendment filed July 3, 1984; effective August 1, 1984. Amendment filed October 27, 1988; effective December 11, 1988. Amendment filed June 30, 1994; effective September 13, 1994. Amendment filed August 12, 1999; effective October 26, 1999. Amendment filed August 6, 2002; effective October 20, 2002.

Tenn. Comp. R. & Regs. 1200-07-01-.12 COPIES OF DATA FROM VITAL RECORDS

(1) Full or short form certified copies of vital records may be made by mechanical, electronic or other reproductive processes. Certified copies may be issued only to the registrant or the registrant’s spouse, children, parents or guardian or their respective authorized representative. Others who demonstrate that records are required for determination or protection of their personal or property right may be authorized to obtain certified copies.

Information contained in the “Information for Medical and Health Use Only” section of the birth certificate and information contained in the “Confidential Information” section of the certificate of marriage or certificate of divorce or annulment shall not be included.

(2) A certified copy or other copy of a death certificate will not be issued containing the cause of death unless (a) Specifically requested by the spouse, children, parents or other next of kin of the decedent or their respective authorized representatives, or (b) For one of the following reasons: when a documented need for the cause of death to establish a legal right or claim has been demonstrated; when the request for the copy is made by or on behalf of an organization that provides benefits to the decedent’s survivors or beneficiaries; upon specific request by local, state or federal agencies for research or administrative purposes approved by the State Registrar; when needed for research activities approved by the State Registrar; or upon receipt of an order from a court of competent jurisdiction ordering such release.

(3) When a certified copy is issued, each certification shall be signed and certified as a true copy by the officer in whose custody the record is entrusted and shall include the date issued, the registrar’s signature or an authorized facsimile thereof, and the seal of the issuing office shall be affixed thereon.

(4) Verification of the facts contained in a vital record may be furnished by the State Registrar to any federal or state court or law enforcement agency or to any other agency representing the interest of the registrant, subject to the limitations as indicated in (1) and (2) above. Such verifications shall be on forms prescribed and furnished by the State Registrar or on forms furnished by the requesting agency and acceptable to the State Registrar; or, the State Registrar may authorize the verification in other ways when it shall prove in the best interests of his office.

(5) When the State Registrar finds evidence that a certificate was registered through misrepresentation or fraud, he shall have authority to withhold the issuance of a certified copy of such certificate until a court determination of the facts has been made.

(6) The given name of a child shall be entered on the face of the original certificate of birth prior to the issuance of a certified copy in full (or part). Verified information from the record may be provided prior to entering the given name on the face of the certificate.

History

• Authority: T.C.A. §§ 4-5-202, 68-3-103, 68-3-104, 68-3-105, 68-3-205, and 68-3-206.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed January 18, 1978; effective February 17, 1978. Amendment filed June 30, 1994; effective September 13, 1994. Amendment filed August 12, 1999; effective October 26, 1999.

Tenn. Comp. R. & Regs. 1200-07-01-.13 FEES FOR COPIES AND SEARCHES

(1) No certified or uncertified copy or service shall be provided until the current fee for such copy or service is received, unless specific approval has been obtained from the State Registrar or otherwise provided for by statute or regulation. If an applicant claims that he did not receive a certificate that was purchased from the Office of Vital Records, he may use his receipt or cancelled check to purchase another copy within forty-five (45) days; after forty-five (45) days, he must remit the fee in order to obtain another copy.

(2) The State Registrar shall determine the cost, including staff time, computer time, copying cost, and supplies, for handling any non-routine statistical or research project or any other non-routine service other than those described below. The person requesting any such nonroutine service will be responsible for paying the cost associated with completing the service.

(3) Fees for services from the Office of Vital Records.

(a) For a search of the files and issuance of each certi fied or uncertified copy of birth, death, marriage, or divorce record if found: ........................................................... $15.00 (b) For preparing a new certificate of birth by adoption, legitimation, or order of parentage: ........................................................................................................................... $15.00 (c) For amending a birth, death, marriage, or divorce certificate within six months or more after the date of the event: ...................................................................................... $15.00 (d) For preparing and filing a report of an adoption for a foreign-born person adopted in Tennessee: ............................................................................................................ .. $15.00 (e) For preparing and filing a delayed certificate of birth, death, marriage, or divorce: ................................................................................................................................ $15.00 (f) For amending a birth certificate to remove the named fat her based on a Rescission of Voluntary Acknowledgment of Paternity, unless the requestor submits an Affidavit of Indigency to waive the fee entirely: ....................................................................... $15.00 (g) For a certified or uncertified copy of the supporting documentation used to file or amend a record, which must be requested at the same time as the copy of the record is requested, per document: ....................................................................................... $5.00 (h) For opening a sealed file and providing one copy of the contents of the sealed file: ............................................................................................................................... $30.00 (i) For a search of the birth, death, marriage, or divorce files for the purpose of providing verified information on a requested record, even if the record is not found and no information from it can be provided: ........................................................................ $15.00 (j) Up to three free copies of the death certificate of a veteran of the United States Armed Services may be provided. The person requesting such copy must be related to the deceased within two (2) degrees of collateral or lineal kinship.

(k) For a birth, death, marriage, or divorce record copy, certified or uncertified, issued to another government agency: ................................................................................. .. $15.00 (l) For a permit to cremate a dead body: ..................................................................... $25.00 (m) For preparing and filing a certificate of birth resulting in stillbirth: ........................... $15.00 (n) For amending a certificate of birth resulting in stillbirth: .......................................... $15.00 (o) For a search of the files of certificates of birth resulting in stillbirth and issuance of each copy: ...................................................................................................................... $15.00 (p) For preparing and issuance of a Commemorative Certificate of a Non-Viable Birth: .......................................................................................................................... $15.00

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 24-7-113, 24-7-118, 68-3-103, 68-3-205, 68-3-206, 68-3-207, 68- 3-504, 68-3-509, and 68-3-514.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed January 18, 1978; effective February 17, 1978. Amendment filed May 17, 1979; effective July 2, 1979. Amendment filed July 1, 1982; effective August 2, 1982. Amendment filed July 3, 1984; effective August 1, 1984. Amendment filed May 29, 1987; effective July 13, 1987. Amendment filed February 19, 1988; effective April 4, 1988. Amendment filed October 27, 1988; effective December 11, 1988. Amendment filed June 30, 1994; effective September 13, 1994. Amendment filed August 12, 1999; effective October 26, 1999. Amendment filed August 6, 2002; effective October 20, 2002. Amendment filed August 20, 2008; effective November 3, 2008. Emergency rule filed July 26, 2010; effective through January 22, 2011. Emergency rule expired effective January 23, 2011; and the rule reverted to its previous status. Amendment filed November 10, 2010; effective February 8, 2011. Amendment filed March 30, 2015; effective June 28, 2015. Amendments filed March 24, 2022; effective June 22, 2022.

Tenn. Comp. R. & Regs. 1200-07-01-.14 PERSONS REQUIRED TO KEEP RECORDS AND FILE REPORTS

(1) Each funeral director shall keep a record containing, as a minimum, the following information about each dead body or fetus:

(a) The date, place, and time of receipt.

(b) The date, place, and manner of disposition.

(c) If the dead body or fetus is delivered to another funeral director, the date of such delivery and the name and address of the funeral director to whom delivered.

(d) The items required by the certificate of death in use when the event occurs for those events for which he is required to file the certificate.

History

• Authority: T.C.A. §§ 68-3-103 and 68-3-104.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed January 18, 1978; effective February 17, 1978. Amendments filed March 24, 2022; effective June 22, 2022.

Tenn. Comp. R. & Regs. 1200-07-01-.15 CERTIFICATES OF BIRTH RESULTING IN STILLBIRTH

(1) "Stillbirth" means an unintended, intrauterine fetal death after a gestational age of not less than twenty (20) completed weeks or with a weight of three hundred fifty (350) grams or more .

(2) The state registrar shall prepare a certificate of birth resulting in stillbirth when the following conditions are met:

(a) A parent named in the report of fetal death (stillbirth) has submitted a request for a certificate of birth resulting in stillbirth; and (b) The stillborn had attained a weight of three hundred fifty (350) grams or more or a gestational age of at least twenty (20) completed weeks.

(c) In the case of a stillbirth which occurred on or before July 1, 2010, or in the case in which no report of fetal death (stillbirth) is available, evidence that the stillborn met the gestational weight and/or age requirements set forth in (b) above may be proved by the notarized statement of the physician in attendance, birthing institution, nurse-midwife or other knowledgeable informant.

(d) The request for the certificate of birth resulting in stillbirth shall be made on the form provided by the department, which shall include 1. The date of the stillbirth;

2. The county in which the stillbirth occurred;

3. The state file number of the report of fetal death (stillbirth), if known;

4. The sex of the stillborn, if known;

5. The name if any, selected by the requesting parent;

6. The name of the mother who delivered the stillborn;

7. The name of the father of the stillborn;

8. In the case of a stillbirth to an unmarried mother, the father may submit the request upon submission of a voluntary acknowledgment of paternity; or a finding of parentage by a court.

(3) In any case in which no given name is provided to the registrar on the report of fetal death (stillbirth), or the requestor does not provide a name to the registrar, the first name shall be left blank on the certificate, and the last name of the parent or parents shall be entered as provided in T.C.A §§ 68-3-301 et seq.

(4) A certificate of birth resulting in stillbirth may be amended upon the request of the original requestor(s).

(5) A certificate of birth resulting in stillbirth shall not be proof of a live birth for any purpose, nor shall it be used by the Department to calculate live birth statistics. Each certificate of birth resulting in stillbirth shall state “this certificate is not proof of live birth.”

History

• Authority: T.C.A. §§ 68-3-102 and 68-3-514.
• Administrative History: Emergency rule filed July 26, 2010; effective through January 22, 2011. Emergency rule expired effective January 23, 2011; and the rule reverted to its previous status. Original rule filed November 10, 2010; effective February 8, 2011.

Chapter 1200-07-02 Cancer Reporting System

Tenn. Comp. R. & Regs. 1200-07-02-.01 PURPOSE

(1) The purpose of these regulations is to provide for the implementation of the Tennessee Cancer Reporting System Act of 1983 and its amendments requiring all hospitals, laboratories, facilities, and health care practitioners, as defined in the Act, to report certain cancer data to the Department of Health, as well as to provide for the confidentiality of certain data, and for the data to be made available to the public.

History

• Authority: T.C.A. §§ 4-5-202 and 68-1-1001, et seq.
• Administrative History: Original rule filed October 6, 1986; effective November 20, 1986. Amendment filed September 5, 1990; effective October 20, 1990. Repeal and new rule filed February 1, 2002; effective April 17, 2002.

Tenn. Comp. R. & Regs. 1200-07-02-.02 AUTHORITY

(1) The regulations are issued under the authority granted the Commissioner of the Tennessee Department of Health under the Cancer Reporting System Act of 1983 and its amendments, hereinafter referred to as the Act.

History

• Authority: T.C.A. §§ 4-5-202 and 68-1-1001, et seq.
• Administrative History: Original rule filed October 6, 1986; effective November 20, 1986. Repeal and new rule filed February 1, 2002; effective April 17, 2002.

Tenn. Comp. R. & Regs. 1200-07-02-.03 DEFINITIONS

(1) “Cancer” means and includes, but is not limited to:

(a) A large group of diseases characterized by uncontrolled growth and spread of abnormal cells;

(b) Any condition of tumors having the properties of anaplasia, invasion, and metastasis;

(c) A cellular tumor, the natural course of which is fatal;

(d) Malignant neoplasm;

(e) In-situ cancer; and (f) Brain-related tumor.

(2) Brain-related tumor means a listed primary tumor (whether malignant or benign) occurring in any of the following sites:

(a) The brain, meninges, spinal cord, cauda equina, a cranial nerve or nerves, or any other

part of the central nervous system.

(b) The pituitary gland, pineal gland or craniopharyngeal duct.

(3) “Commissioner” means the Commissioner of the Department of Health.

(4) “Data” shall mean the original information contained on the report required by the regulations, including, but not limited to, both identifying and non-identifying information.

(5) “Department” shall mean the Tennessee Department of Health, or “department,” as used in the Act.

(6) “Facility” means a health care facility in which diagnosis or treatment services are provided to patients with cancer, including, but not limited to, an ambulatory surgical treatment center, a freestanding cancer treatment center, a radiation therapy center, a chemotherapy treatment center, a nursing home, an oncology or dermatology clinic, a laboratory, or any other facility which provides screening, detection, diagnostic or therapeutic services to patients with cancer.

(7) “Health care practitioner” means a physician, surgeon, or other health care professional licensed under T.C.A. Title 63 who is engaged in diagnosing and/or treating patients who have cancer.

(8) “Hospital” means an institution as defined by T.C.A. § 68-11-201.

(9) “Identifying information” means any information that could lead to the identification of a patient who has been diagnosed or treated for cancer.

(10) “In situ cancer” means an abnormality of the development and organization of cells without the invasion of neighboring tissue. Examples of in situ cancers include, but are not limited to:

(a) Cervical Intraepitheleal Neoplasia (CIN) II lesions; and (b) Cervical Intraepitheleal Neoplasia (CIN) III lesions.

(11) “Laboratory” means a facility where tests are performed identifying anatomical and cytological changes, and where specimens are interpreted and pathological diagnoses are made.

(12) “Medical records” shall include, but not be limited to, pathology reports, cytology reports, radiology reports, and disease index for both inpatients and outpatients.

(13) “Person” means any member of the “medical, scientific, and academic research community.”

(14) “Policies and Procedures Manual” means the document(s) maintained in the offices of the Tennessee Cancer Registry giving specific written instructions for the implementation of policies and procedures utilized by the Registry and which may be updated from time to time.

(15) “Tennessee Cancer Registry” or “Registry” or “TCR” shall mean the program in the Tennessee Department of Health that administers a population-based statewide cancer registry.

History

• Authority: T.C.A. §§ 4-5-202; 4-5-209; 68-1-1001, et seq.; 68-1-1002; 68-1-1003(a); and 68-1-1004.
• Administrative History: Original rule filed October 6, 1986; effective November 20, 1986. Amendment filed September 5, 1990; effective October 20, 1990. Repeal and new rule filed February 1, 2002; effective April 17, 2002. Public necessity rule filed August 3, 2007; effective through January 15, 2008. Amendment filed August 28, 2007; effective December 28, 2007. Amendment filed August 25, 2009; effective November 23, 2009.

Tenn. Comp. R. & Regs. 1200-07-02-.04 PARTICIPATION IN THE PROGRAM

(1) All hospitals, laboratories, facilities and health care practitioners shall report data concerning Tennessee patients who are diagnosed and/or treated for cancer.

(2) Health care practitioners are not required to report data on cancer patients who are directly referred to or have been previously admitted to a hospital or a facility for cancer diagnosis or treatment.

(3) All hospitals, laboratories, facilities and health care practitioners shall designate one (1) staff member to be responsible for reporting the cancer data and shall notify the department of the name, title, work address, work telephone number, and e-mail address (if available) of the designated staff member.

History

• Authority: T.C.A. §§ 4-5-202 and 68-1-1001, et seq.
• Administrative History: Original rule filed October 6, 1986; effective November 20, 1986. Amendment filed September 5, 1990; effective October 20, 1990. Repeal and new rule filed February 1, 2002; effective April 17, 2002.

Tenn. Comp. R. & Regs. 1200-07-02-.05 CANCER CASE REPORTING

(1) Reportable Cancer Cases (a) Any newly diagnosed in-situ or invasive cancer as defined by the TCR Policies and Procedures Manual is considered a reportable diagnosis. If a patient subsequently develops a new primary cancer, it shall be reported separately.

(2) Format for Reporting (a) The format for reporting, the required codes, and the standards for completeness and quality are defined by the department in the TCR Policies and Procedures Manual.

(3) Data Items to be Reported (a) The standardized report of cancer shall include as a minimum those data items required by the Tennessee Cancer Registry, a list of which is maintained in the TCR Policies and Procedures Manual. The report of cancer shall include the listed demographic, diagnostic, and treatment data as defined by the department.

(4) Deadline for Reporting (a) Reporting shall occur no later than six months after the date of diagnosis of cancer in a patient. Reports shall be submitted to the department according to a time frame communicated by the department to each hospital, facility, laboratory, and health care practitioner.

(5) Failure to Report (a) A hospital, laboratory, facility, or health care practitioner that fails to report data or allow access to records, as required by T.C.A. § 68-1-1003, shall be informed in writing by the department that compliance is mandatory.

(b) If a hospital, laboratory, facility, or health care practitioner fails to provide the required data by the required deadline in the format specified by the department or if the data are of unacceptable quality, the Commissioner or the Commissioner’s authorized representative may casefind and abstract the information by a direct examination of those patients’ medical records. In these cases, the facility shall reimburse the department for the actual cost of casefinding, abstracting, coding, and editing, a maximum of which is seventy dollars ($70) per hour, plus, if necessary, reasonable ancillary and travel expenses. A hospital, laboratory, facility, or health care practitioner from whom reimbursement is sought may appeal the assessment of expenses under the Tennessee Uniform Administrative Procedures Act. The appeal shall be to the Commissioner in writing and within thirty (30) days of receipt of the assessment.

(6) Quality Assurance (a) Staff members from the Tennessee Cancer Registry or their agents shall perform periodic quality assurance studies at all reporting facilities. These studies shall include:

1. Casefinding to ensure that all cancer cases have been accessioned; and 2. Reabstracting the records of cancer patients to ensure that all data have been transcribed and coded correctly.

(b) Reporting facilities shall assist TCR staff by providing the necessary medical records and the office space for conducting quality assurance activities.

(c) In order to improve the quality of the data, the TCR or their agents shall offer training for reporting facility personnel.

History

• Authority: T.C.A. §§ 4-5-202; 68-1-103; 68-1-1001, et seq; and 68-1-1003.
• Administrative History: Original rule filed October 6, 1986; effective November 20, 1986. Amendment filed September 5, 1990; effective October 20, 1990. Repeal and new rule filed February 1, 2002; effective April 17, 2002. Amendment filed October 25, 2019; effective January 23, 2020.

Tenn. Comp. R. & Regs. 1200-07-02-.06 CONFIDENTIALITY

(1) T.C.A. § 68-1-1006 provides for the confidentiality of data obtained from the reports of cancer patients.

(2) TCR Responsibilities (a) The commissioner shall take strict measures to ensure that all patient identifying information is treated as confidential and privileged. All employees or consultants, including auditors of the TCR, shall sign a Tennessee Cancer Registry Employee Confidentiality Pledge and these signed pledges shall be kept on file. An employee or consultant who discloses confidential identifying information willfully or through negligence is subject to penalty, including, but not limited to, the penalty in T.C.A. 68-1- 1009.

(3) Protection of Report Sources (a) Hospitals, laboratories, facilities, or health care practitioners who disclose cancer data to the Tennessee Cancer Registry or its employees in conformity with the Cancer Reporting System Act of 1983 and its amendments shall not be held liable for the release of such data to the department.

(4) Protection of Patient Identifying Information Obtained by Special Studies and Other Research Studies (a) All identifying information such as records of interviews, questionnaires, reports, statements, notes, and memoranda that are procured or prepared by employees or agents of the Tennessee Cancer Registry shall be used solely for statistical, scientific and medical research purposes and shall be held strictly confidential by the TCR. This applies also to identifying information procured by any other person, agency, or organization, including public or private colleges and universities acting jointly with the TCR in connection with special cancer studies and health research investigations.

History

• Authority: T.C.A. §§ 4-5-202 and 68-1-1001, et seq.
• Administrative History: Original rule filed October 6, 1986; effective November 20, 1986. Amendment filed July 14, 1989; effective August 28, 1989. Amendment filed September 5, 1990; effective October 20, 1990. Repeal and new rule filed February 1, 2002; effective April 17, 2002.

Tenn. Comp. R. & Regs. 1200-07-02-.07 RELEASE OF DATA

(1) Release of non-identifying information (a) To federal agencies:

1. The TCR is authorized to collaborate with the National Program of Cancer Registries (NPCR), the Centers for Disease Control and Prevention (CDC), and the National Cancer Institute (NCI) to provide cancer incidence statistics and participate in cancer studies.

(b) To the Tennessee Department of Health 1. The Tennessee Cancer Registry shall work closely with the Tennessee Department of Health in investigating cancer-related issues and in evaluating programs. Because the TCR data are an integral part of the Tennessee Department of Health cancer prevention and control programs, the use of Registry data by public health officials shall be considered an in-house activity.

Data required by the Tennessee Department of Health for responding to concerns expressed about threats to the public health shall receive priority in determining the order of processing requests.

(c) To the general public:

1. Public reports published by the Tennessee Cancer Registry shall include aggregate, not patient identifying information or facility identifying information.

Information that would potentially identify a cancer patient shall not be published.

Non-identifying information may be made available to the general public upon request to the department. The availability of any data shall depend upon the department’s financial or other ability to comply with such requests. The Registry shall respond to public requests as quickly as possible, subject to staffing constraints.

(d) To Others:

1. The TCR is authorized to collaborate with the North American Association of Central Cancer Registries (NAACCR) to provide cancer incidence statistics and participate in cancer studies.

(2) Release of identifying information (a) Identifying information collected from any hospital, laboratory, facility, or health care practitioner may be released to qualified persons for the purposes of cancer prevention, control, and research, provided that each request for identifying information follows the established procedure outlined in the TCR Policies and Procedures Manual and receives prior approval by the department. Identifying information that is collected solely by the Tennessee Cancer Registry for its own special studies shall not be released.

(3) Annual Report (a) A statistical report shall be prepared at the completion of each year’s data collection cycle and will be distributed as requested.

(4) Interstate Exchange of Data (a) Because cancer patients may be diagnosed or receive treatment in another state, the Commissioner or the Commissioner’s authorized representative is authorized to sign agreements with other states to acquire cancer data concerning Tennessee residents and, in return, to provide those states with data relating to their residents. Each signatory state shall agree in writing to keep all patient data confidential and privileged as defined in the contract for data exchange, a copy of which is included in the TCR Policies and Procedures Manual.

History

• Authority: T.C.A. §§ 4-5-202 and 68-1-1001, et seq.
• Administrative History: Original rule filed October 6, 1986; effective November 20, 1986. Amendment filed September 5, 1990; effective October 20, 1990. Repeal and new rule filed February 1, 2002; effective April 17, 2002.

Tenn. Comp. R. & Regs. 1200-07-02-.08 REQUEST PROCEDURE FOR PATIENT IDENTIFYING INFORMATION

(1) Requests for identifying information shall be reviewed and approved by the department according to the policies of the Tennessee Department of Health and the Tennessee Cancer Registry.

(2) The Tennessee Cancer Registry shall review requests for identifying information and shall recommend to the Commissioner whether to approve or deny any identifying information request. The Commissioner shall approve or deny any identifying information request after considering the reason for such request and the planned use of the identifying information.

(3) A detailed description of the procedures for requesting identifying information can be obtained from the Tennessee Cancer Registry.

History

• Authority: T.C.A. §§ 4-5-202 and 68-1-1001, et seq.
• Administrative History: Original rule filed February 1, 2002; effective April 17, 2002.

Chapter 1200-07-03 Hospital Discharge Data System

Tenn. Comp. R. & Regs. 1200-07-03-.01 DEFINITIONS

(1) “Aggregate Data” is defined as a set of multiple data records that are tabulated, combined, or otherwise summarized for the purpose of describing characteristics of a group of patient discharges.

(2) “Department” is defined as the Department of Health.

(3) “Discharge” shall be defined as the formal release of a patient from a hospital in either an inpatient or outpatient situation.

(4) “Error” is defined as data that are incomplete or inconsistent with the specifications in T.C.A. 68-1- 108, these rules, and the Hospital Discharge Data System Procedure Manual.

(5) “Final Joint Annual Report” is defined as the most recent Joint Annual Report filed by a hospital where the data contained therein has been edited, queried and updated by the Department.

(6) “Hospital” shall be defined as in T.C.A. 68-11-201(21)

(7) “Inpatient” shall be defined as a person receiving reception and care in a hospital for a continuous period of twenty-four (24) hours or more for the purpose of giving advice, diagnosis, nursing service, or treatment bearing on the physical health of the person, and a person receiving maternity care involving labor and delivery for any period of time.

(8) “Outpatient” shall be defined as a person receiving reception and care in a hospital for a continuous period less than twenty-four (24) hours for the purpose of giving advice, diagnosis, nursing service, or treatment bearing on the physical health of the person, excluding persons receiving maternity care involving labor and delivery. Reportable outpatient records are defined in the hospital discharge data system manual. Reportable records are defined in terms of the type of service provided and the type of bill on Form UB-92.

(9) “Patient Identifiers” shall be defined to include the following data elements: Patient Control Number, Medical/Health Record Number, Certificate Number/ID Number/SSN, and Patient’s Social Security Number.

(10) “Processed Data” is defined as data that have been reviewed by the Department for the purpose of detecting errors, inconsistencies, and/or incomplete elements in the data set.

(11) “Public” shall be defined as anyone other than the THA and agencies of the government of the State of Tennessee.

(12) “Record Level Data” is defined as a set of data that is specific to a single patient discharge.

(13) “THA” shall be defined as the administrative offices and staff of the Tennessee Hospital Association.

(14) “UB-92” is defined to be CMS Form 1450, the Uniform Hospital Billing Form, or a successor form as established by the National Committee and the State Uniform Billing Implementation Committee.

(15) “Verified Data” is defined as data that have been processed by the Department; the health facilities have had the opportunity to suggest corrections, additions, and/or deletions; and all appropriate revisions have been made to the data by the Department.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-1-108 and 68-11-201.
• Administrative History: Original rule filed July 30, 1987; effective September 13, 1987. Amendment filed May 7, 1997; effective July 21, 1997. Repeal and new rule filed May 7, 1997; effective July 21, 1997. Repeal and new rule filed June 14, 2006; effective August 28, 2006.

Tenn. Comp. R. & Regs. 1200-07-03-.02 REQUIRED DATA ELEMENTS

(1) The Department will prepare the Hospital Discharge Data System (HDDS) Procedure Manual that will list the variables to be reported, their descriptions and reporting format, and other information associated with data submission. The Department shall make future changes in the Procedure Manual when the Commissioner deems changes to be necessary. Reporting entities will be notified by the Department of all revisions. These revisions become effective one hundred and eighty (180) days following the date of notification. At that time, failure to meet the amended requirements are subject to the penalties as prescribed by T.C.A. §68-l-108.

(2) The minimum data set for each reported discharge will include the following data elements:

(a) Patient Control Number (b) Type of Bill (c) Federal Tax Number (d) Statement Covers Period (e) Patient’s Address: City, State and Zip Code (f) Patient’s Date of Birth (g) Patient’s Sex (h) Admission Date (i) Admission Type (j) Source of Admission (k) Patient’s Status (l) Medical/Health Record Number (m) Revenue Codes (n) Date(s) of Service (o) Unit(s) of Service (p) Charges Associated with Revenue Codes (q) Payer Identification (r) Provider Number (s) Patient’s Relationship to Insured (t) Certificate Number/ID Number/SSN (u) Insurance Group Number (v) Employment Status Code (w) Insured’s Employer Name (x) Insured’s Employer Location: Zip Code (y) Principal Diagnosis Codes (z) Other Diagnosis Codes (aa) E Code (bb) Principal Procedure Code and Date (cc) Other Procedure Codes and Dates (dd) Attending Physician ID Number (ee) Other Physician ID Numbers (ff) Patient’s Social Security Number (gg) Patient’s Race/Ethnicity (3) All inpatient discharges are required to be reported.

(4) All outpatient and emergency room discharges are required to be reported.

(5) All data elements reported by the hospital should be the actual values used by the hospital. None should be encrypted or otherwise altered.

(6) All hospitals which are required to report data by T.C.A. §68-1-108 shall designate one staff member to be responsible for reporting the claims data. The Department shall be notified by the hospital, on a form supplied by the Department, with the name, title, work address, and work telephone number of the designated staff member.

(7) All hospitals which are required to report data by T.C.A. §68-1-108 shall notify Health Statistics and Information on a form supplied by HSI of the name, title, work address, and work telephone number of the designated staff member.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, and 68-1-108.
• Administrative History: Original rule filed July 30, 1987; effective September 13, 1987. Amendment filed May 7, 1997; effective July 21, 1997. Amendment filed June 14, 2006; effective August 28, 2006.

Tenn. Comp. R. & Regs. 1200-07-03-.03 SUBMISSION TIME LINE

(1) All required data must be received by the Department each quarter according to the following schedule:

Quarter Time Span Submission Due Date Q1 January 1 – March 31 May 30 Q2 April 1 – June 30 August 29 Q3 July 1 – September 30 November 29 Q4 October 1 – December 31 March 1 (2) All data submissions must be in the form of computer media (e.g., magnetic tape, diskettes).

History

• Authority: T.C.A. §§4-5-202, 4-5-204, and 68-1-108.
• Administrative History: Original rule filed July 30, 1987; effective September 13, 1987. Repeal and new rule filed May 7, 1997; effective July 21, 1997. Repeal and new rule filed June 14, 2006; effective August 28, 2006.

Tenn. Comp. R. & Regs. 1200-07-03-.04 PENALTY ASSESSMENT

(1) The Department of Health will assess a civil penalty of five cents ($.05) per record per day for delinquent discharge reports.

(2) The maximum civil penalty for a delinquent report is ten dollars ($10) for each discharge record.

(3) For hospitals not submitting any discharge reports by the submission deadline, the number of inpatient hospital discharge reports delinquent for a particular facility per quarter will be estimated by dividing the number of total inpatient discharges/or admissions reported in Schedule G of the most current, final Joint Annual Report of Hospitals (JAR-H) on file with the Department for that facility by four (4).

The number of delinquent outpatient claims reports for a quarter will likewise be estimated using data from the facility’s most recent, final Joint Annual Report. This estimate will be obtained by dividing by four (4) the sum of outpatient data from Schedule D for percutaneous lithotripsy procedures, adult and pediatric cardiac catheterizations, adult and pediatric percutaneous transluminal coronary angioplasties, outpatient surgery procedures from dedicated O. R.’s and from procedure rooms, eye, bone, bone marrow, connective, cardiovascular, stem cell, and other transplants, and from Schedule I, total emergency room visits. The sum of the inpatient estimate and the outpatient estimate will be used to calculate the penalty assessed. Any positive or negative adjustments to the final estimate, up to a maximum of ten (10) percent will be made once the actual claims reports are received by the Department.

(4) Hospitals not submitting any discharge reports by the submission deadline will begin accruing penalties starting the day immediately following the submission deadline and ending the day when the actual discharge reports are received by the Department or the maximum penalty is reached (maximum=$10/discharge record).

(5) For all 2006 discharges, the allowable error rate will be no more than 3%. For all discharges in 2007 and subsequent years, the allowable error rate will be no more than 2%. Records that fall within the acceptable rate will not be subject to any penalties. Hospitals that exceed the acceptable error rate will be penalized based on total errors.

(6) Hospitals which do not submit corrected discharge records within the additional fifteen (15) days allocated for error correction will accrue delinquent penalties starting the sixteenth day after error notification and ending the day when the actual corrected discharge reports are received by the Department or the maximum penalty is reached (maximum=$10/discharge record). The Commissioner has the authority to delay any penalty for not correcting any particular data element if the failure to correct is due to force majeure or other events of extraordinary circumstances clearly beyond the control of the hospital.

(7) Upon receipt of the penalty assessment, the hospital has the right to an informal conference with the Commissioner. A written request for an informal conference must be received by the Commissioner within thirty (30) days of the assessment.

(8) A notice of an approximate daily assessment of the civil penalty will be sent to the delinquent hospital(s). The assessment will estimate the approximate penalty per day based on the estimated number of discharge reports. The assessment will state that penalties will accrue until the delinquent discharge reports are received or the maximum penalty is reached. Delinquent penalties will be collected starting thirty (30) days from the date of notice and continuing every thirty days until the maximum penalty is reached or the discharge reports are received.

(9) Penalties continue to accumulate for hospitals requesting an informal conference with the Commissioner.

(10) The Commissioner can grant a waiver from penalties to a hospital in cases of force majeure or other events of extraordinary circumstances clearly beyond the control of the hospital. The hospital must make a written request for the waiver and the informal conference within the first thirty (30) days following notification of the assessment. The proceedings before the Commissioner involving penalty waivers are not subject to the Uniform Administrative Procedures Act.

(11) After the conference with the Commissioner or the time frame for requesting a conference has expired, the Commissioner can collect the penalties unless the hospital appeals the Commissioner's decision.

Penalties may be off set by funds owed to the hospital by the Department of Health and/or the Department of Finance and Administration. However, if the hospital wishes to appeal the decision of the Commissioner, a request in writing for a hearing before an Administrative Law Judge must be sent to the Commissioner within ten (10) business days of the Commissioner's written determination. Issues involving collection of penalties directly from hospitals resolved by an Administrative Law Judge will be in accordance with the Uniform Administrative Procedures Act.

(12) At the date of collection, penalties for the hospitals that have not submitted any discharge data will be collected based on the estimated number of discharges per day delinquent from the submission deadline to the collection date. Penalties for hospitals that have submitted data will be collected based on the actual number of discharge records that are incomplete or inaccurate for the particular quarter and the actual days delinquent.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, and 68-1-108.
• Administrative History: Original rule filed July 30, 1987; effective September 13, 1987. Repeal and new rule filed May 7, 1997; effective July 21, 1997. Amendment filed June 14, 2006; effective August 28, 2006.

Tenn. Comp. R. & Regs. 1200-07-03-.05 PROCESSING AND VERIFICATION

(1) If errors, inconsistencies, or incomplete elements are identified by the Department the errors will be reported to the hospital in writing. Upon receiving written notification of errors, the hospital facility shall investigate the problem and shall supply correct information within fifteen (15) days from notification.

(2) Discharge data reported in an incorrect format or with elements inconsistent with T.C.A. 68-1-108 will be considered in error and returned to the reporting entity.

(3) Discharge data considered in error is subject to the penalties as prescribed in T.C.A. 68-1-108, unless the errors are corrected within fifteen (15) days after the hospital receives notification of existing errors.

(4) After the quarterly data have been computerized, edited, updated, and determined to be the final corrected set by the Department, each hospital shall be given a ten (10) day opportunity to review the quarterly data set relating to their hospital, if they so desire. Upon the expiration of that ten day period, absent receipt of corrections and/or revisions from the hospitals, the quarterly data is considered verified. If corrections and/or revisions are received, the quarterly data is considered verified once the corrections and/or revisions have been made by the Department.

(5) The same procedure as stated in paragraph (4) above shall be used for verification of the final data set at the close of the data year.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, and 68-1-108.
• Administrative History: Original rule filed July 30, 1987; effective September 13, 1987. Repeal and new rule filed May 7, 1997; effective July 21, 1997. Amendment filed June 14, 2006; effective August 28, 2006.

Tenn. Comp. R. & Regs. 1200-07-03-.06 DATA AVAILABILITY

(1) Within thirty (30) days after all hospitals' claims data has been accumulated into the Department’s master database, and has been processed and verified, the Department will send THA a copy of the entire database.

(2) The Commissioner has the authority to delay release of any particular data element(s) if it is determined that the quality or completeness of the information is not acceptable.

(3) The Department may create reports for public release using any available processed and verified aggregate data. It may also provide custom reports, as requested by the public, using any available processed and verified aggregate data. Facility specific aggregate data reports will not be released to the public until the final data set for the calendar year has been processed and verified.

(4) A contractual agent of the Department or of the THA may receive reports of any record necessary, together with any needed patient identifiers, to carry out their contractual duties. This includes any organization contracted with to provide editing, quality control, database management services, or research for the Department or the THA. Any such contractual agent must agree in writing to establish and maintain appropriate controls to protect the confidentiality of the data and must agree to return or destroy any data or records at the termination of the contract.

(5) Record level data files will be made available for public release and purchase under the following conditions. The fee for a quarter of inpatient data will be $300. The fee for a quarter of outpatient data will be $300. The fee for a subset of a quarter of data, inpatient or outpatient, will be $300. The Department maintains a proprietary interest in all record level data files it sells or distributes and such files are made available solely for use by the purchaser and may not be given or sold to another entity.

No record level data files will be made available for public release and purchase until eighteen months following the close of the data year.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, and 68-1-108.
• Administrative History: Original rule filed July 30, 1987; effective September 13, 1987. Repeal and new rule filed May 7, 1997; effective July 21, 1997. Repeal and new rule filed June 14, 2006; effective August 28, 2006.

Tenn. Comp. R. & Regs. 1200-07-03-.07 CONFIDENTIAL INFORMATION

(1) All information reported to the Commissioner under this part is confidential until processed and verified by the Commissioner.

(2) In no event may patient identifiers be released to the public at any time.

(3) Information regarding the name of an employer will not be released to the public. Information about any employer may be released to the employer identified in the data record. Hospitals may receive information regarding the name of employer for their claims only.

(4) The data may be released pursuant to 45 C.F.R. § 164.514 (b) or (e). However if either data files and/or reports are otherwise released to the public, to protect patient confidentiality, they must meet the following criteria:

(a) Patient Address City must be deleted.

(b) The month and day of all dates must be deleted.

(c) All zip code areas having a population under 20,000 must have no more than the first three digits shown. Zip code areas having a population of 20,000 or more must have no more than the first five digits shown.

(d) For patients over 89 years of age the Year of Birth must be deleted and the actual patient age may not be shown.

(e) Information that reasonably could be expected to reveal the identity of a patient including those items contained in 45 C.F.R. §164(b)(2)(i) shall be deleted.

(5) Any agency of the State of Tennessee receiving confidential hospital claims data or reports containing such confidential information, shall agree in writing to follow all confidentiality restrictions of the Department concerning use of this data.

(6) The Commissioner may use or authorize use of this data, including the patient identifiers, for purposes that are necessary to provide for or protect the health of the population and as permitted by law.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, and 68-1-108.
• Administrative History: Original rule filed July 30, 1987; effective September 13, 1987. Repeal and new rule filed May 7, 1997; effective July 21, 1997. Amendment filed June 14, 2006; effective August 28, 2006.

Tenn. Comp. R. & Regs. 1200-07-03-.08 REPEALED

History

• Authority: T.C.A. §§4-5-202, 4-5-204, and 68-1-108.
• Administrative History: Original rule filed May 7, 1997; effective July 21, 1997. Repeal filed June 14, 2006; effective August 28, 2006.

Chapter 1200-07-04 Ambulatory Surgical Treatment Center Data System

Tenn. Comp. R. & Regs. 1200-07-04-.01 DEFINITIONS

(1) "Ambulatory Surgical Treatment Center" shall have the same definition as contained in T.C.A. § 68-11-201.

(2) “ASTC” is the acronym for ambulatory surgical treatment center.

(3) “Claim” shall mean a charge or bill for services rendered, billed to the patient, to another private individual, or to a third party payer, public or private.

(4) “Claims Data” shall mean all data elements collected for all patients for whom an ASTC or ODC provides services that are entered on any claim form prepared by the ASTC or ODC and shall always include those required data elements identified in the subparagraphs listed in rule 1200-07-04-.04, paragraphs (1) and (2).

(5) "CMS-1500" shall mean the claim form “Centers for Medicare & Medicaid Services 1500” or its successor form.

(6) “Commissioner” shall mean the commissioner of the Tennessee Department of Health.

(7) “Data Element” shall mean any individual piece of information collected from a patient by an ASTC or ODC during the process of providing services to that patient for which the ASTC or ODC will file a claim.

(8) “Department” shall mean the Tennessee Department of Health.

(9) "Error" shall mean data that are incomplete or inconsistent with the specifications in the ASTC Data System Procedural Manual, the ODC Data System Procedural Manual, or these rules.

(10) “Final Joint Annual Report” shall mean the most recent Joint Annual Report filed by an ASTC or ODC where the data contained in the report have been edited, queried, and updated when appropriate, by the Department.

(11) “JAR” is the acronym for Joint Annual Report.

(12) “ODC” is the acronym for outpatient diagnostic center.

(13) "Outpatient Diagnostic Center" shall have the same definition as contained in T.C.A. §68-11- 201.

(14) "Personal Identifiers" shall be defined to include all the identifiers contained in 45 C.F.R. § 164.514 (b) or (e).

(15) "Processed Data" shall mean data that have been analyzed by the Department or the Department’s designated data vendor(s) and errors, inconsistencies, and/or incomplete elements in the data set, if any, have been identified.

(16) “Public” shall mean anyone other than the Tennessee Department of Health, its vendors, and its contracted agencies.

(17) "Record Level Data” shall mean a set of data that is specific to individual patient claims.

(18) “State” shall mean the government of the State of Tennessee including all its agencies.

(19) “UB-04” shall mean the CMS Form 1450, [a.k.a. “the Uniform Hospital Billing Form”], or its successor forms as established by the National Uniform Billing Committee and the State Uniform Billing Implementation Committee.

(20) “Vendor” shall mean a third party entity, approved by the Department, through whom an ASTC or ODC submits its claims data for the purpose of compilation and editing according to these rules and the instructions of the Department.

(21) "Verified Data" shall mean data that have been processed by the Department after the ASTCs or ODCs have had the opportunity to suggest corrections and/or deletions, and all appropriate revisions have been made to the data and approved by the Department.

History

• Authority: T.C.A. §§ 68-1-103 and 68-1-119.
• Administrative History: Original rule filed January 27, 2005; effective April 12, 2005. Repeal and new rule filed January 29, 2013; effective June 30, 2013.

Tenn. Comp. R. & Regs. 1200-07-04-.02 PURPOSE

(1) The reporting of ambulatory surgical and outpatient diagnostic data will provide two statewide databases and permit assessment of variations in utilization, practice parameters, access to care, and charges.

History

• Authority: T.C.A. §§ 68-1-103 and 68-1-119.
• Administrative History: Original rule filed January 27, 2005; effective April 12, 2005. Repeal and new rule filed January 29, 2013; effective June 30, 2013.

Tenn. Comp. R. & Regs. 1200-07-04-.03 REPORTING REQUIREMENTS

(1) Each ASTC and ODC shall contract with one of the approved vendors and shall report through its vendor all its claims data. Claims data for all free or charity services provided by any ASTC or ODC that otherwise submits claims for reimbursement shall also be reported to the vendor.

(2) No claim reporting is required for any of the following:

(a) From a licensed ASTC or ODC that provides only free care and never bills for any services.

(b) Regarding any procedures already reported by an ASTC or ODC to the Department under T.C.A. § 68-3-505 or services ancillary thereto such as counseling, testing, or follow-up.

(3) The Department will prepare the ASTC and ODC Data System Procedural Manuals that will list the variables to be reported, their descriptions and reporting format, and other information associated with data submission. The Department shall issue revisions to the Procedural Manuals when the Commissioner deems it necessary. The Department will notify each ASTC, ODC, and vendor of all revisions. These revisions become effective one hundred and eighty (180) days following the date of notification. At that time, failure to meet the amended requirements is subject to the penalties as prescribed by T.C.A. §68-1-119.

(4) Each ASTC or ODC shall report all data elements using the actual values used for billing by the ASTC or the ODC. No data elements shall be encrypted or otherwise altered. This rule shall not be interpreted to prevent encryption of entire files for security in transmission to parties having the appropriate decryption software.

(5) Each ASTC and ODC shall be responsible for submitting its data to the approved vendor in a format and medium approved by the State.

(6) Each ASTC and ODC shall be responsible for the costs associated with the processing of the data by the approved vendors.

(7) Each ASTC and ODC shall report in a format using the data elements which correspond with the claim form used by the ASTC or ODC for billing. If an ASTC or ODC submits claims using both the CMS-1500 and UB-04 forms, the claims data shall be submitted in separate data sets for each form.

(8) Each ASTC and ODC shall report the claims data at least quarterly, pursuant to rule 1200- 07-04-.05, to its approved vendor with a separate data set for each facility location.

(9) Each ASTC and ODC shall designate one staff member to be responsible for reporting the claims data and shall notify the Department and its approved vendor of the name, title, work address, work telephone number, and e-mail address of the designated staff member.

History

• Authority: T.C.A. §§ 68-1-103 and 68-1-119.
• Administrative History: Original rule filed January 27, 2005; effective April 12, 2005. Repeal and new rule filed January 29, 2013; effective June 30, 2013.

Tenn. Comp. R. & Regs. 1200-07-04-.04 REQUIRED DATA ELEMENTS

(1) CMS-1500 Claims Forms (a) Each ASTC and ODC must report to the Department all the following data elements for each and every claim based on the CMS-1500 form:

1. Patient’s Birth Date 2. Patient’s Sex 3. Patient’s Address (State)

2. Patient’s Address (Zip Code)

3. Dates of Service (Through Date)

4. Diagnosis or Nature of Illness or Injury 7. Total Charge 8. Patient’s Social Security Number 9. Patient’s Race/Ethnicity (b) Each ASTC and ODC must report to the Department all CMS-1500 data elements listed in the relevant ASTC or ODC Procedural Manual whenever the data element is collected by the ASTC or ODC and/or used for billing.

(2) UB-04 Claims Forms (a) Each ASTC and ODC must report to the Department all the following data elements for each and every claim based on the UB-04 form:

1. Statement Covers Period 2. Patient’s Address (State)

2. Patient’s Address (Zip Code)

3. Patient’s Date of Birth 5. Patient’s Sex 6. Revenue Codes 7. Total Charges (By Revenue Code Category)

4. Principal Diagnosis Code 9. Patient’s Social Security Number 10. Patient’s Race/Ethnicity (b) Each ASTC and ODC must report to the Department all UB-04 data elements listed in the relevant ASTC or ODC Procedural Manual whenever the data element is collected by the ASTC or ODC and/or used for billing.

(3) Each ASTC and ODC shall report to the Department all data elements that it collected from patients and which it reported by making an entry in any or all of the data element spaces contained on any form other than the CMS-1500 or UB-04 on which it submits a claim.

However, the data elements identified in paragraphs (1)(a) and (2)(a) above that must be collected, entered and reported to the Department by the ASTC or ODC for the identified claim form shall also be reported to the Department when any other claim form is used.

(4) Data elements collected by the ASTC or ODC that are not specifically identified in either paragraphs (1) through (3) of this rule or in the procedural manual shall not be reported to the vendor or the Department.

History

• Authority: T.C.A. §§ 68-1-103 and 68-1-119.
• Administrative History: Original rule filed January 27, 2005; effective April 12, 2005. Repeal and new rule filed January 29, 2013; effective June 30, 2013.

Tenn. Comp. R. & Regs. 1200-07-04-.05 SUBMISSION SCHEDULE

(1) Each ASTC or ODC shall submit all required claims to its approved vendor according to the following quarterly schedule:

Quarter Time Span Submission Due Date Q1 January 1 – March 31 May 30 Q2 April 1 – June 30 August 29 Q3 July 1 – September 30 November 29 Q4 October 1 – December 31 March 1

History

• Authority: T.C.A. §§ 68-1-103 and 68-1-119.
• Administrative History: Original rule filed January 27, 2005; effective April 12, 2005. Repeal and new rule filed January 29, 2013; effective June 30, 2013.

Tenn. Comp. R. & Regs. 1200-07-04-.06 VENDOR REQUIREMENTS

(1) An applicant desiring to be approved as a statewide data processing vendor shall make written application to the Department. To be selected as a statewide vendor by the Department the applicant must demonstrate the ability to do all of the following:

(a) Process the claims data as specified by the Department using the codes and the standards for completeness and quality specified by the Department.

(b) Include in each claims data record the ID number approved by the Department for the reporting ASTC or ODC and all vendor-generated fields specified by the Department.

(c) Examine the claims data it receives for accuracy, inform the ASTC or ODC submitting the data of all potential errors in the data which are discovered as a result of the examination of accuracy, and correct the data as directed by the ASTC, the ODC, and/or the Department.

(d) Submit the claims data to the Department in an electronic or magnetic medium or process approved by the Department.

(e) Report to the Department each ASTC or ODC that has either failed to submit claims data or is tardy in doing so.

(f) Affirm that it is familiar with the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its accompanying regulations, and will comply with all applicable and current HIPAA requirements in the course of doing business with the State. The applicant shall affirm that it will cooperate with the State in the course of its performance so that both parties will be in compliance with HIPAA, including cooperation and coordination with State privacy officials and other compliance officers required by HIPAA and its regulations. The applicant will sign any documents that are reasonably necessary to keep both parties in compliance with HIPAA, including, but not limited to, business associate agreements.

(2) If any approved vendor fails to carry out its requirements as specified in the rules of the Tennessee Department of Health, the Department may remove its approval as a statewide data processing vendor.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-1-103 and 68-1-119.
• Administrative History: Original rule filed January 27, 2005; effective April 12, 2005. Repeal and new rule filed January 29, 2013; effective June 30, 2013.

Tenn. Comp. R. & Regs. 1200-07-04-.07 PROCESSING AND VERIFICATION

(1) Each vendor must review all claims data submitted for completeness and accuracy. If errors, inconsistencies or incomplete elements are identified by the vendor, the vendor must report the errors to the ASTC or ODC in writing.

(2) Upon receiving written notification of errors, the ASTC or ODC shall investigate the problem and shall supply correct information to the vendor within fifteen (15) days from notification.

(3) Each approved vendor must report quarterly to the Department the reporting status of all ASTCs or ODCs utilizing its services. The status of facilities that failed to report, that were delinquent in reporting, or that exceeded the acceptable error rate shall be provided to the Department quarterly and then updated at the initiative of the vendor or upon request of the Department. Each vendor shall maintain and report to the Department any information the Department deems necessary for penalty assessment.

(4) Each approved vendor must report all data received each quarter, including additions and corrections, to the Department no more than sixty (60) days following the submission due date specified in rule 1200-07-04-.05.

(5) Each ASTC and ODC shall be given a ten (10) day period to review the quarterly data set relating to their facility after the quarterly data have been computerized, edited, updated, and determined to be the final corrected set by the Department. Upon the expiration of the ten (10) day period, absent receipt of corrections and/or revisions from an ASTC or ODC, the quarterly data is considered verified. If corrections and/or revisions are received by the Department within the ten day period, the quarterly data is considered verified only after the Department has made any corrections and/or revisions it considers appropriate.

History

• Authority: T.C.A. §§ 68-1-103 and 68-1-119.
• Administrative History: Original rule filed January 27, 2005; effective April 12, 2005. Repeal and new rule filed January 29, 2013; effective June 30, 2013.

Tenn. Comp. R. & Regs. 1200-07-04-.08 PENALTY ASSESSMENT

(1) The Department will assess the civil penalties authorized by T.C.A. § 68-1-119(b) each day claims data are reported later than the submission due date identified in rule 1200-07-04-.05 or not reported at all up to the statutory maximum for each claim record.

(2) Any ASTC or ODC not submitting any claims data by the submission deadline will have the number of quarterly unreported claims records calculated, for purposes of civil penalty assessment, by dividing by four (4), the number of total discharges or admissions reported on Schedule D (Availability and Utilization of Services) of the most current final JAR of the ASTC or ODC on file with the Department for that facility.

(3) An ASTC or ODC not submitting any claims data by the submission deadline will begin accruing penalties the day immediately following the submission deadline and ending the day when the actual claims data are received by the vendor or the maximum penalty is reached.

(4) The Department will report the rate of error it identifies to the ASTC or ODC in writing. The acceptable error rate will be two percent (2%). Records that fall within the acceptable error rate will not be subject to penalties. ASTCs or ODCs that exceed the acceptable error rate will be penalized based on total errors.

(5) An ASTC or ODC that does not timely submit corrected claims records will accrue delinquent penalties starting the sixteenth (16 th ) day after error notification and ending the day when the actual corrected claims data are received by the Department or the maximum penalty is reached.

(6) Upon receipt of the notice of civil penalty assessment the ASTC or ODC has the right to an informal conference with the Commissioner or a formal hearing to contest the assessment.

(a) Informal conferences are governed by T.C.A. § 68-1-119(b) and (c).

(b) A request for a formal hearing must be made in writing and received by the Department within thirty (30) days of the receipt of the notice of assessment or, if an informal conference pursuant to subparagraph (a) was requested, within thirty (30) days of the receipt of the written disposition of the informal conference. Proceedings involving formal contests of civil penalties are subject to the contested case provisions of the Uniform Administrative Procedures Act.

(c) Civil penalties for any ASTC or ODC that continues to violate the law during the pendency of the informal conference will continue to accrue until either the violation ends or the maximum civil penalty is reached.

(d) Waiver of penalties is governed by T.C.A. § 68-1-119(c). However, the ASTC or ODC must make a request for the waiver in its request for an informal conference pursuant to subparagraph (a) or in its request for a formal hearing pursuant to subparagraph (b).”

(7) Unless a request for a formal hearing pursuant to subparagraph (6)(b) is timely received, the civil penalties become final and collectable either on the date that the time for requesting an informal conference has expired without a request being filed, or on the date on which the written final disposition of the informal conference is received.

History

• Authority: T.C.A. §§ 68-1-103 and 68-1-119.
• Administrative History: Original rule filed January 27, 2005; effective April 12, 2005. Repeal and new rule filed January 29, 2013; effective June 30, 2013.

Tenn. Comp. R. & Regs. 1200-07-04-.09 DATA AVAILABILITY

(1) If the Commissioner determines that the quality or completeness of the information is not acceptable, he or she has the authority to delay release of any particular data element(s).

(2) The Department may create reports for public release using any available processed and verified data. It may also provide custom reports, as requested by the public, using any available processed and verified data. Facility specific data reports will not be released to the public based on less than four (4) consecutive quarters of data.

(3) The State, its agents and the vendors may receive reports of any record necessary, together with any needed patient identifiers, to carry out their contractual duties. This includes any organization contracted with to provide editing, quality control, database management services, or research for the State, or to provide keying of paper claims forms for the vendors. Any such contractual agent must agree in writing to establish and maintain appropriate controls to protect the confidentiality of the data and must agree to return or destroy any data or records at the termination of the contract.

(4) The Department will make record level data files available for public release and purchase under the following conditions. The fee for a quarter of data for each data system will be two hundred fifty dollars ($250.00). The fee for a subset of a quarter of data for each data system will be two hundred fifty dollars ($250.00) The Department maintains a proprietary interest in all record level data it sells or distributes and such data are made available solely for use by the purchaser and may not be given or sold to another entity.

History

• Authority: T.C.A. §§ 68-1-103 and 68-1-119.
• Administrative History: Original rule filed January 27, 2005; effective April 12, 2005. Repeal and new rule filed January 29, 2013; effective June 30, 2013.

Tenn. Comp. R. & Regs. 1200-07-04-.10 CONFIDENTIAL INFORMATION

(1) All information reported to the Commissioner under this part is confidential until processed and verified by the Department.

(2) The Commissioner may use or authorize use of this data, including the personal identifiers, for purposes that are necessary to provide for or protect the health of the population and as permitted by law. In no event may personal identifiers be released to the public.

(3) Information regarding the name of an employer will not be released to the public. Information about any employer may be released to the employer identified in the data record. A facility may receive information regarding the name of an employer for its claims only.

(4) The data may be released pursuant to the provisions of 45 C.F. R. § 164.514 (b) or (e).

However, any data released to the public, in addition to those items required by law to be deleted, will also not contain any of the following:

(a) Any patient’s address city;

(b) An insured’s address city;

(c) The month and day of all dates;

(d) Any numbers after the first three numbers of all zip codes for areas having a population under 20,000;

(e) Any numbers after the first five numbers of all zip codes for areas having a population 20,000 or more;

(f) The year of birth and the actual age of any person over eighty nine (89) years of age; and (g) Information that reasonably could be expected to reveal the identity of a patient, including those items contained in 45 C.F.R. § 164.514 (a) and (b)(2)(i).

(5) Any agency of the State of Tennessee seeking confidential ASTC or ODC claims data or reports containing such confidential information, must agree in writing to follow all confidentiality restrictions of the Department concerning use of this data. The agency must also agree in writing to release no record level information to any other entity, and shall forward all such requests for record level information to the Department.

History

• Authority: T.C.A. §§ 68-1-103 and 68-1-119.
• Administrative History: Original rule filed January 27, 2005; effective April 12, 2005. Repeal and new rule filed January 29, 2013; effective June 30, 2013.

1200-08 Board For Licensing Health Care Facilities

Chapter 1200-08-01 Transferred to 0720-14

Tenn. Comp. R. & Regs. 1200-08-01-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-11-106, 68-11-202, 68-11-204, 68-11-207, 68-11-209, 68-11- 210, 68-11-211, 68-11-213, 68-11-224, 68-11-255, 68-11-1802, 68-57-101, 68-57-102, and 68-57-105.
• Administrative History: Original rule certified June 7, 1974. Amendment filed April 3, 1974; effective May 3, 1974. Amendment filed November 30, 1984; effective December 30, 1984. Repeal and new rule filed May 22, 1986; effective June 21, 1986. Amendment filed April 26, 1996; effective July 8, 1996. Amendment filed November 30, 1999; effective February 6, 2000. Repeal, except for Paragraphs (1), (5), (8), (10), (11), (13), (16), (29), and (37) as promulgated February 6, 2000, and new rule filed March 18, 2000; effective May 30, 2000. Amendment filed April 17, 2000; effective July 1, 2000. Amendment filed September 17, 2002; effective December 1, 2002. Amendment filed April 11, 2003; effective June 25, 2003. Amendment filed April 28, 2003; effective July 12, 2003. Amendment filed August 27, 2004; effective November 10, 2004. Amendments filed September 6, 2005; effective November 20, 2005. Amendment filed February 23, 2006; effective May 9, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Amendment filed February 22, 2010; effective May 23, 2010. Amendments filed March 18, 2010; effective June 16, 2010. Amendment filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Amendment filed April 25, 2016; effective July 24, 2016. Amendments filed July 10, 2018; effective October 8, 2018. Transferred to chapter 0720-14 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-01-.15 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, 68-11-224, and 68-11-1805.
• Administrative History: Original rule filed February 16, 2007; effective May 2, 2007. Repeal and new rule filed August 28, 2012; effective November 26, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Amendments filed February 8, 2017; effective May 9, 2017. Transferred to chapter 0720- 14 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-01-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-201, 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11- 206(a)(5), 68-11-209, 68-11-209(a)(1), 68-11-210, 68-11-216, and Chapter 846 of the Public Acts of 2008, § 1.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed May 22, 1986; effective June 21, 1986. Amendment filed January 16, 1992; effective March 2, 1992. Repeal and new rule filed March 18, 2000; effective May 30, 2000. Amendment filed December 2, 2003; effective February 15, 2004. Amendment filed January 19, 2007; effective April 4, 2007. Public necessity rules filed April 29, 2009; effective through October 11, 2009. Emergency rules filed October 9, 2009; effective through April 7, 2010. Amendments filed September 24, 2009; effective December 23, 2009. Amendment filed December 16, 2013; effective March 16, 2014. Amendments filed March 21, 2018; to have been effective June 19, 2018. However, on May 24, 2018, the Government Operations Committee filed a 5-day stay; new effective date June 24, 2018. Transferred to chapter 0720-14 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-01-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11-204, 68-11- 206, 68-11-208, 68-11-209, and 68-11-216.
• Administrative History: Original rule certified June 7, 1974. Amendment filed April 3, 1974; effective May 3, 1974. Amendment filed February 26, 1985; effective March 28, 1985. Repeal and new rule filed May 22, 1986; effective June 21, 1986. Amendment filed December 30, 1986; effective February 13, 1987. Repeal and new rule filed March 18, 2000; effective pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-01-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-15-202, 39-17-1803, 39-17-1805, 68-11-201, 68-11-202, 68- 11-204, 68-11-206, 68-11-209, 68-11-216, 68-11-268, and 71-6-121.
• Administrative History: Original rule filed March 18, 2000; effective May 30, 2000. Amendment filed June 18, 2002; effective September 1, 2002. Amendment filed December 2, 2003; effective February 15, 2004. 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. Amendment filed December 23, 2009; effective March 23, 2010. Amendments filed February 22, 2010; effective May 23, 2010. Amendment filed December 16, 2013; effective March 16, 2014. Transferred to chapter 0720-14 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-01-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, and 68-11-255.
• Administrative History: Original rule filed March 18, 2000; effective May 30, 2000. Amendment filed April 17, 2000; effective July 1, 2000. Amendment filed September 17, 2002; effective December 1, 2002. Amendments filed July 10, 2018; effective October 8, 2018. Amendments filed January 7, 2019; to have become effective April 7, 2019. However, the Government Operations Committee filed a 60-day stay of the effective date of the rules; new effective date June 6, 2019. Transferred to chapter 0720-14 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-01-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-3-511, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11- 209, and 68-11-216.
• Administrative History: Original rule filed March 18, 2000; effective May 30, 2000. Amendment filed December 2, 2003; effective February 15, 2004. Amendment filed May 24, 2004; effective August 7, 2004. Amendment filed September 6, 2005; effective November 20, 2005. Amendment filed July 18, 2007; effective October 1, 2007. Amendment filed December 23, 2009; effective March 23, 2010. Amendment filed March 18, 2010; effective June 16, 2010. Amendment filed December 16, 2013; effective March 16, 2014. Amendments filed July 18, 2016; effective October 16, pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-01-.07 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-3-511, 68-11-202, 68-11-204, 68-11-209, 68-57-101, 68-57- 102, 68-57-104, and 68-57-105.
• Administrative History: Original rule filed March 18, 2000; effective May 30, 2000. Amendment filed April 17, 2000; effective July 1, 2000. Amendment filed June 12, 2003; effective August 26, 2003. Amendment filed July 27, 2005; effective October 10, 2005. Amendment filed February 23, 2006; effective May 9, 2006. Amendment filed February 23, 2007; effective May 9, 2007. Amendment filed February 22, 2010; effective May 23, 2010. Amendment filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Amendments filed July 10, 2018; effective October 8, 2018. Transferred to chapter 0720-14 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-01-.08 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-216, and 68- 11-261.
• Administrative History: Original rule filed March 18, 2000; effective May 30, 2000. Amendment filed February 18, 2003; effective May 4, 2003. Repeal and new rule filed September 6, 2005; effective November 20, 2005. Amendment filed February 23, 2007; effective May 9, 2007. Repeal and new rule filed December 20, 2011; effective March 19, 2012. Amendment filed January 21, 2016; effective April 20, 2016. Transferred to chapter 0720-14 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-01-.09 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed March 18, 2000; effective May 30, 2000. Amendments filed September 6, 2005; effective November 20, 2005. Transferred to chapter 0720-14 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-01-.10 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed March 18, 2000; effective May 30, 2000. Transferred to chapter 0720-14 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-01-.11 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-3-102, 68-11-202, 68-11-204, 68-11-206, 68-11-207, 68-11- 209, 68-11-210, 68-11-211, 68-11-213, and 68-11-310.
• Administrative History: Original rule filed March 18, 2000; effective May 30, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendment filed May 24, 2004; effective August 7, 2004. Amendment filed September 6, 2005; effective November 20, 2005. Amendment filed February 23, 2007; effective May 9, 2007. Amendments filed January 3, 2012; effective April 2, 2012. Transferred to chapter 0720-14 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-01-.12 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed March 18, 2000; effective May 30, 2000. Amendment filed June 18, 2002; effective September 1, 2002. Amendments filed September 6, 2005; effective November 20, 2005. Transferred to chapter 0720-14 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-01-.13 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-211, 68-11- 224, and 68-11-1801 through 68-11-1815.
• Administrative History: Original rule filed March 18, 2000; effective May 30, 2000. Amendment filed April 28, 2003; effective July 12, 2003. Repeal and new rule filed September 6, 2005; effective November 20, 2005. Amendment filed February 7, 2007; effective April 23, 2007. Amendments filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Transferred to chapter 0720-14 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-01-.14 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed March 18, 2000; effective May 30, 2000. Transferred to chapter 0720-14 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-02 Transferred to 0720-15

Tenn. Comp. R. & Regs. 1200-08-02-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-11-106, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11- 211, 68-11-216, 68-11-224, and 68-11-1802.
• Administrative History: Original rule certified June 7, 1974. Amendment filed July 3, 1984; effective August 1, 1984. Repeal and new rule filed May 22, 1986; effective June 21, 1986. Amendment filed April 1, 1992; effective May 16, 1992. Amendment filed January 6, 1995; effective March 22, 1995. Repeal filed March 18, 2000; effective May 30, 2000. New rule filed June 13, 2002; effective August 27, 2002. Amendment filed May 16, 2006; effective July 30, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Amendment filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Amendment filed September 15, 2015; effective December 14, 2015. Transferred to chapter 0720-15 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-02-.14 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, 68-11-224, and 68-11-1805.
• Administrative History: Original rule filed February 16, 2007; effective May 2, 2007. Repeal and new rule filed August 28, 2012; effective November 26, 2012. Amendment filed March 27, 2015; effective June pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-02-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-206(a)(5) [effective January 1, 2009], 68-11-207, 68-11-209, 68-11-209(a)(1), 68-11-210, 68-11-216, and Chapter 846 of the Public Acts of 2008, § 1.
• Administrative History: Original rule certified June 7, 1974. Amendment filed July 3, 1984; effective August 1, 1984. Repeal and new rule filed May, 22, 1986; effective July 21, 1986. Amendment filed October 22, 1987; effective December 6, 1987. Amendment filed April 1, 1992; effective May 16, 1992. Amendment filed November 3, 1992; effective December 18, 1992. Amendment filed March 7, 1994; effective May 21, 1994. Amendment filed December 30, 1994; effective March 18, 1995. Amendment filed June 13, 1997; effective August 27, 1997. Repeal filed March 18, 2000; effective May 30, 2000. New rule filed June 13, 2002; effective August 27, 2002. Amendment filed January 19, 2007; effective April 4, 2007. Public necessity rules filed April 29, 2009; effective through October 11, 2009. Emergency rules filed October 9, 2009; effective through April 7, 2010. Amendments filed September 24, 2009; effective December 23, 2009. Amendment filed December 16, 2013; effective March 16, 2014. Amendments filed March 26, 2019; effective June 24, 2019. Transferred to chapter 0720-15 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-02-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11-204, 68-11- 206, 68-11-207, 68-11-208, 68-11-209, and 68-11-213.
• Administrative History: Original rule certified June 7, 1974. Amendment filed July 3, 1984; effective August 1, 1984. Repeal filed May 22, 1986; effective July 21, 1986. New rule filed June 13, 2002; effective August 27, 2002. Amendment filed March 1, 2007; effective May 15, 2007. Transferred to chapter 0720-15 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-02-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-17-1803, 39-17-1805, 68-11-201, 68-11-202, 68-11-204, 68- 11-206, 68-11-209, 68-11-234, 68-11-268, and 71-6-121.
• Administrative History: Original rule filed June 13, 2002; effective August 27, 2002. Amendment filed April 17, 2007; effective July 1, 2007. Amendment filed July 18, 2007; effective October 1, 2007. Amendment filed February 22, 2010; effective May 23, 2010. Transferred to chapter 0720-15 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-02-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, and 68-11-209. Administrative pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-02-.06 TRANSFERRED

History

• Authority: §§ 4-5-202, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-216, and 68-11- 222.
• Administrative History: Original rule filed June 13, 2002; effective August 27, 2002. Amendment filed December 16, 2013; effective March 16, 2014. Amendment filed September 15, 2015; effective December 14, 2015. Amendments filed July 18, 2016; effective October 16, 2016. Transferred to chapter 0720-15 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-02-.07 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed June 13, 2002; effective August 27, 2002. Amendment filed February 18, 2003; effective May 4, 2003. Amendment filed June 21, 2007; effective September 4, 2007. Repeal and new rule filed December 20, 2011; effective March 19, 2012. Amendment filed January 21, 2016; effective April 20, 2016. Transferred to chapter 0720-15 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-02-.08 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed June 13, 2002; effective August 27, 2002. Amendment filed May 16, 2006; effective July 30, 2006. Amendment filed June 21, 2007; effective September 4, 2007. Transferred to chapter 0720-15 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-02-.09 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, and 68-11-209. Administrative pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-02-.10 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-211.
• Administrative History: Original rule filed June 13, 2002; effective August 27, 2002. Amendment filed Janaury 3, 2012; effective April 2, 2012. Transferred to chapter 0720-15 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-02-.11 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, and 68-11-209. Administrative pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-02-.12 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-224, and 68- 11-1801 through 68-11-1815.
• Administrative History: Original rule filed June 13, 2002; effective August 27, 2002. Repeal and new rule filed May 16, 2006; effective July 30, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Amendments filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Transferred to chapter 0720-15 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-02-.13 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, and 68-11-209. Administrative pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-03 Transferred to 0720-16

Tenn. Comp. R. & Regs. 1200-08-03-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-209, 68-11-202, 68-11-203, and 68-11-209.
• Administrative History: Original rule certified June 7, 1974. Amendment filed April 3, 1974; effective May 3, 1974. Repeal and new rule filed May 22, 1986; effective June 21, 1986. Amendment filed October 22, 1987; effective December 6, 1987. Amendment filed July 28, 1988; effective September 11, 1988. Amendment filed June 29, 1994; effective September 12, 1994. Amendment filed June 13, 1997; effective August 27, 1997. Amendment filed November 30, 1999; effective February 6, 2000. Amendment filed March 18, 2000; effective May 30, 2000. Transferred to chapter 0720-16 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-03-.06 TRANSFERRED

History

• Authority: T.C.A. § 53-1310.
• Administrative History: Original rule certified June 7, 1984. Repeal filed May 22, 1986; effective June 21, 1986. Transferred to chapter 0720-16 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-03-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-209, 68-11-201, et seq., 68-11-202, 68-11-203, 68-11-209, and 68-11- 303.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 30, 1984; effective December 30, 1984. Repeal and new rule filed May 22, 1986; effective June 21, 1986. Amendment filed January 30, 1989; effective March 16, 1989. Amendment filed April 1, 1992; effective May 16, 1992. Amendment filed December 4, 1992; effective January 19, 1993. Amendment filed November 30, 1999; effective February 6, 2000. Amendment filed March 18, 2000; effective May 30, 2000. Transferred to chapter 0720-16 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-03-.03 TRANSFERRED

History

• Authority: T.C.A. § 68-11-209.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed May 22, 1986; effective June 21, 1986. Repeal filed March 18, 2000; effective May 30, 2000. Transferred to chapter 0720-16 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-03-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-202(a) and 68-11-209.
• Administrative History: Original rule certified June 7, 1974. Amendment filed November 30, 1984; effective December 30, 1984. Repeal filed May 22, 1986; effective June 21, 1986. Transferred to chapter 0720-16 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-03-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-202(a) and 68-11-209.
• Administrative History: Original rule certified June 7, 1974. Amendment filed April 3, 1974; effective May 3, 1974. Amendment filed November 30, 1984; effective December 30, 1984. Repeal filed May 22, 1986; effective June 21, 1986. Transferred to chapter 0720-16 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-04 Transferred to 0720-17

Tenn. Comp. R. & Regs. 1200-08-04-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-201, et seq., 68-11-209, and 68-11-303.
• Administrative History: Original rule filed June 7, 1974; effective July 7, 1974. Repeal and new rule filed May 22, 1986; effective June 21, 1986. Amendment filed December 4, 1992; effective January 19, 1993. Repeal filed March 18, 2000; effective May 30, 2000. Transferred to chapter 0720-17 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-04-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-202 and 68-11-209.
• Administrative History: Original rule filed June 7, 1974; effective July 7, 1974. Repeal and new rule filed May 22, 1986; effective June 21, 1986. Repeal filed March 18, 2000; effective May 30, 2000. Transferred to chapter 0720-17 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-04-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-209, 68-11-201, 68-11-202, 68-11-203, 68-11-209, and 68-11-303.
• Administrative History: Original rule filed June 7, 1974; effective July 7, 1974. Repeal and new rule filed May 22, 1986; effective June 21, 1986. Amendment filed October 22, 1987; effective December 6, 1987. Amendment filed December 4, 1992; effective January 19, 1993. Amendment filed November 30, 1999; effective February 6, 2000. Amendment filed March 18, 2000; effective May 30, 2000. Transferred to chapter 0720-17 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-04-.04 TRANSFERRED

History

• Authority: T.C.A. § 68-11-209.
• Administrative History: Original rule filed June 7, 1974; effective July 7, 1974. Repeal and new rule filed May 22, 1986; effective June 21, 1986. Repeal filed March 18, 2000; effective May 30, 2000. Transferred to chapter 0720-17 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-04-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-201, 4-5-202, 68-11-201, 68-11-202, 68-11-203, 68-11-204, 68-11-206, 68-11- 207, 68-11-209, 68-11-210, 68-11-213, 68-11-214, and 68-11-224.
• Administrative History: Original rule filed June 22, 1992; effective August 6, 1992. Repeal filed March 18, 2000; effective May 30, 2000. Transferred to chapter 0720-17 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-04-.06 THROUGH 1200-08-04-.12 TRANSFERRED

History

• Authority: T.C.A. § 53-1310.
• Administrative History: Original rule filed June 7, 1974; effective July 7, 1984. Repeal filed May 22, 1986; effective June 21, 1986. Transferred to chapter 0720-17 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-05 Repealed

Tenn. Comp. R. & Regs. 1200-08-05-.01 REPEALED

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-204, and 68-11-209.
• Administrative History: Original rule certified May 31, 1984. Amendment filed May 22, 1986; effective June 21, 1986. Repeal filed March 18, 2000; effective May 30, 2000. New rule filed October 15, 2002; effective December 29, 2002.Repeal filed August 23, 2006;effective November 6, 2006

Tenn. Comp. R. & Regs. 1200-08-05-.02 THROUGH 1200-8-5-.04 REPEALED

History

• Authority: T.C.A. §§68-11-201, 68-11-04, and 68-11-209.
• Administrative History: Original rule certified May 31, 1984. Amendment filed May 22, 1986; effective June 21, 1986. Repeal filed March 18, 2000; effective May 30, 2000.

Tenn. Comp. R. & Regs. 1200-08-05-.05 THROUGH 1200-8-5-.08 REPEALED

History

• Authority: T.C.A. §§56-4102 (D) and 56-4102 (E).
• Administrative History: Original rule filed February 5, 1975; effective March 7, 1985. Repeal filed May 22, 1986; effective June 21,1986.

Chapter 1200-08-06 Transferred to 0720-18

Tenn. Comp. R. & Regs. 1200-08-06-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-11-106, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11- 207, 68-11-209, 68-11-210, 68-11-211, 68-11-213, 68-11-224, 68-11-234, 68-11-1802, and 71-6-121.
• Administrative History: Original rule filed March 27, 1975; effective April 25, 1975. Repeal and new rule filed July 14, 1983; effective August 15, 1983. Repeal and new rule filed January 31, 2000; effective April 15, 2000. Amendment filed April 10, 2000; effective June 24, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendment filed April 28, 2003; effective July 12, 2003. Amendments filed September 21, 2005; effective December 5, 2005. Amendment filed February 7, 2007; effective April 23, 2007. Amendment filed July 18, 2007; effective October 1, 2007. Amendment filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Amendment filed September 15, 2015; effective December 14, 2015. Amendments filed July 10, 2018; effective October 8, 2018. Transferred to chapter 0720-18 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-06-.16 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, 68-11-224, and 68-11-1805.
• Administrative History: Original rule filed February 16, 2007; effective May 2, 2007. Repeal and new rule filed August 28, 2012; effective November 26, 2012. Amendment filed March 27, 2015; effective June pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-06-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-206(a)(5) [effective January 1, 2009], 68-11-209, 68-11-209(a)(1), 68-11-210, and 68-11-216 and Chapter 846 of the Public Acts of 2008, § 1.
• Administrative History: Original rules filed March 27, 1975; effective April 25, 1975. Repeal and new rule filed July 14, 1983; effective August 15, 1983. Amendment filed March 13, 1986; effective April 12, 1986. Amendment filed December 30, 1986; effective February 13, 1987. Repeal and new rule filed January 31, 2000; effective April 15, 2000. Amendment filed November 19, 2003; effective February 2, 2004. Amendment filed September 21, 2005; effective December 5, 2005. Amendment filed January 19, 2007; effective April 4, 2007. Public necessity rules filed April 29, 2009; effective through October 11, 2009. Emergency rules filed October 9, 2009; effective through April 7, 2010. Amendments filed September 24, 2009; effective December 23, 2009. Amendment filed December 16, 2013; effective March 16, 2014. Amendments filed March 21, 2018; to have been effective June 19, 2018. However, on May 24, 2018, the Government Operations Committee filed a 5-day stay; new effective date June 24, 2018. Transferred to chapter 0720-18 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-06-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11-204, and 68-11-206 through 68-11-209.
• Administrative History: Original rule filed March 27, 1975; effective April 25, 1975. Repeal and new rule filed July 14, 1983; effective August 15, 1983. Amendment filed March 13, 1986; effective April 12, 1986. Amendment filed December 30, 1986; effective February 13, 1987. Repeal and new rule filed January 31, 2000; effective April 15, 2000. Amendment filed May 24, 2004; August 7, 2004. Amendment filed March 1, 2007; effective May 15, 2007. Transferred to chapter 0720-18 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-06-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-17-1803, 39-17-1804, 39-17-1805, 68-11-202, 68-11-204, 68- 11-206, 68-11-209, 68-11-225, 68-11-254, 68-11-256, 68-11-257, 68-11-268, 68-11-906, and 71-6-121.
• Administrative History: Original rule filed March 27, 1975; effective April 25, 1975. Repeal and new rule filed July 14, 1983; effective August 15, 1983. Amendment filed May 24, 1985; effective June 23, 1985. Amendment filed March 13, 1986; effective April 12, 1986. Amendment filed October 22, 1987; effective December 6, 1987. Amendment filed May 10, 1990; effective June 24, 1990. Amendment filed March 9, 1992; effective April 23, 1992. Amendment filed March 10, 1995; effective May 24, 1995. Amendment filed June 13, 1997; effective August 27, 1997. Repeal and new rule filed January 31, 2000; effective April 15, 2000. Amendment filed June 18, 2002; effective September 1, 2002. Amendment filed May 24, 2004; effective August 7, 2004. Amendment filed February 23, 2007; effective May 9, 2007. Amendment filed July 18, 2007; effective October 1, 2007. Amendment filed February 22, 2010; effective May 23, 2010. Amendment filed October 20, 2015; effective January 18, 2016. Transferred to chapter 0720-18 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-06-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11- 257, and 71-6-121.
• Administrative History: Original rule filed March 27; effective April 25, 1975. Repeal and new rule filed July 14, 1983; effective August 15, 1983. Repeal and new rule filed January 31, 2000; effective April 15, 2000. Amendment filed April 10, 2000; effective June 24, 2000. Amendment filed February 23, 2007; effective May 9, 2007. Amendment filed April 17, 2007; effective July 1, 2007. Transferred to chapter 0720-18 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-06-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-3-511, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11- 207, 68-11-209, 68-11-216, 68-11-240, 68-11-241, and 68-11-801.
• Administrative History: Original rule filed March 27, 1975; effective April 25, 1975. Repeal and new rule filed July 14, 1983; effective August 15, 1983. Amendment filed March 13, 1986; effective April 12, 1986. Amendment filed January 29, 1991; effective March 15, 1991. Amendment filed December 29, 1992; effective February 15, 1993. Amendment filed June 15, 1993; effective July 30, 1993. Amendment filed April 17, 1996; effective July 1, 1996. Repeal and new rule filed January 31, 2000; effective April 15, 2000. Amendment filed January 31, 2000; effective April 15, 2000. Amendment filed March 29, 2000; effective June 12, 2000. Amendment filed September 13, 2002; effective November 27, 2002. Amendment filed September 4, 2003; effective November 18, 2003. Amendment filed September 21, 2005; effective December 5, 2005. Amendment filed July 18, 2007; effective October 1, 2007. Amendment filed January 3, 2012; effective April 2, 2012. Amendment filed December 16, 2013; effective March 16, 2014. Amendment filed September 15, 2015; effective December 14, 2015. Amendments filed July 18, 2016; effective October 16, 2016. Emergency rule filed February 28, 2018; effective through August 27, 2018. Amendments filed April 19, 2018; effective July 18, 2018. Emergency rules filed May 29, 2020; effective through November 25, 2020. Emergency rules expired effective November 26, 2020, and the rules reverted to their previous statuses. Transferred to chapter 0720-18 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-06-.07 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-57, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68- 11-261.
• Administrative History: Original rule filed March 27, 1975; effective April 25, 1975. Repeal and new rule filed July 14, 1983; effective August 15, 1983. Amendment filed July 3, 1984; effective August 1, 1984. Amendment filed March 13, 1986; effective April 12, 1986. Amendment filed October 22, 1987; effective December 6, 1987. Amendment filed February 11, 1992; effective March 27, 1992. Amendment filed January 6, 1995; effective March 22, 1995. Amendment filed June 13, 1997; effective August 27, 1997. Repeal and new rule filed January 31, 2000; effective April 15, 2000. Amendment filed February 18, 2003; effective May 4, 2003. Repeal and new rule filed September 21, 2005; effective December 5, 2005. Amendment filed February 23, 2007; effective May 9, 2007. Repeal and new rule filed December 20, 2011; effective March 19, 2012. Amendment filed January 21, 2016; effective April 20, 2016. Transferred to chapter 0720-18 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-06-.08 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-57, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68- 11-261.
• Administrative History: Original rule filed March 27, 1975; effective April 25, 1975. Repeal and new rule filed July 14, 1983; effective August 15, 1983. Amendment filed July 3, 1984; effective August 1, 1984. Amendment filed March 13, 1986; effective April 12, 1986. Amendment filed October 22, 1987; effective December 6, 1987. Amendment filed February 11, 1992; effective March 27, 1992. Amendment filed January 6, 1995; effective March 22, 1995. Amendment filed June 13, 1997; effective August 27, 1997. Repeal and new rule filed January 31, 2000; effective April 15, 2000. Amendment filed February 18, 2003; effective May 4, 2003. Repeal and new rule filed September 21, 2005; effective December 5, 2005. Amendment filed February 23, 2007; effective May 9, 2007. Repeal and new rule filed December 20, 2011; effective March 19, 2012. Amendment filed January 21, 2016; effective April 20, 2016. Transferred to chapter 0720-18 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-06-.09 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed March 27, 1975; effective April 25, 1975. Repeal and new rule filed July 14, 1983; effective August 15, 1983. Repeal and new rule filed January 31, 2000; effective April 15, 2000. Repeal and new rule filed September 21, 2005; effective December 5, 2005. Transferred to chapter 0720-18 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-06-.10 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed March 27, 1975; effective April 25, 1975. Repeal and new rule filed July 14, 1983; effective August 15, 1983. Amendment filed July 3, 1984; effective August 1, 1984. Amendment filed March 13, 1986; effective April 12, 1986. Amendment filed October 22, 1987; effective December 6, 1987. Amendment filed February 11, 1992; effective March 27, 1992. Amendment filed January 6, 1995; effective March 22, 1995. Amendment filed June 13, 1997; effective August 27, 1997. Repeal and new rule filed January 31, 2000; effective April 15, 2000. Transferred to chapter 0720-18 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-06-.11 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-207, 68-11-209, 68-11- 210, 68-11-211, 68-11-213, and 68-11-804.
• Administrative History: Original rule filed March 27, 1975; effective April 25, 1997. Repeal and new rule filed July 14, 1983; effective August 15, 1983. Amendment filed March 13, 1986; effective April 12, 1986. Amendment filed December 29, 1993; effective February 15, 1993. Repeal and new rule filed January 31, 2000; effective April 15, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendment filed September 4, 2003; effective November 18, 2003. Amendment filed April 17, 2007; effective July 1, 2007. Amendments filed January 3, 2012; effective April 2, 2012. Transferred to chapter 0720-18 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-06-.12 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-901, and 68- 11-902.
• Administrative History: Original rule filed March 27, 1975; effective April 25, 1975. Repeal and new rule filed July 14, 1983; effective August 15, 1983. Amendment filed May 24, 2985; effective June 23, 1985. Amendment filed March 13, 1986; effective April 12, 1986. Amendment filed October 22, 1987; effective December 6, 1987. Amendment filed May 10, 1990; effective June 24, 1990. Amendment filed March 9, 1992; effective April 23, 1992. Amendment filed March 10, 1995; effective May 24, 1995. Amendment filed June 13, 1997; effective August 27, 1997. Repeal and new rule filed January 31, 2000; effective April 15, 2000. Amendment filed June 18, 2002; effective September 1, 2002. Amendment filed September 21, 2005; effective December 5, 2005. Transferred to chapter 0720-18 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-06-.13 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-224, and 68- 11-1801 through 68-11-1815.
• Administrative History: Original rule filed June 22, 1992; effective August 6, 1992. Repeal and new rule filed January 31, 2000; effective April 15, 2000. Amendment filed April 28, 2003; effective July 12, 2003. Repeal and new rule filed September 21, 2005; effective December 5, 2005. Amendment filed February 7, 2007; effective April 23, 2007. Amendments filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Transferred to chapter 0720-18 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-06-.14 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed February 9, 1998; effective April 25, 1998. Repeal and new rule filed January 31, 2000; effective April 15, 2000. Amendment filed September 21, 2005; effective December 5, 2005. Transferred to chapter 0720-18 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-06-.15 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-207, 68-11-209, 68-11- 210, 68-11-211, 68-11-213, and 68-11-804 and Public Chapter 148 of 2021.
• Administrative History: Original rule filed September 4, 2003; effective November 18, 2003. Amendment filed March 27, 2015; effective June 25, 2015. Emergency rule filed August 18, 2021; effective through February 14, 2022. Emergency rule expired effective February 15, 2022, and the rule reverted to its previous status. Transferred to chapter 0720-18 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-07 Transferred to 0720-19

Tenn. Comp. R. & Regs. 1200-08-07-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 12-4-320 (Public Acts of 1986, Chapter 927), 53-1310, and 68-11- 209.
• Administrative History: Original rule filed June 7, 1974; effective July 7, 1974. Repeal and new rule filed January 13, 1987; effective February 27, 1987. Amendment filed August 23, 2006;effective November 6, 2006. Transferred to chapter 0720-19 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-07-.07 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-201, 4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 12-4-320 (Public Acts of 1986, Chapter 927), 68-11-208, and 68-11-209.
• Administrative History: Original rule filed June 7, 1974; effective July 7, 1974. Repeal and new rule filed January 13, 1987; effective February 27, 1987. Amendment filed April 1, 1992; effective May 16, 1992. Amendment filed March 1, 2007; effective May 15, 2007. Transferred to chapter 0720-19 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-07-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-201, 12-4-320, and 68-11-209.
• Administrative History: Original rule filed June 7, 1974; effective July 7, 1974. Repeal and new rule filed January 13, 1987; effective February 27, 1987. Amendment filed April 1, 1992; effective May 16, 1992. Transferred to chapter 0720-19 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-07-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-201, et seq., 4-5-202, 4-5-204, 12-4-320 (Public Acts of 1986, Chapter 927), and 68-11-209.
• Administrative History: Original rule filed June 7, 1974; effective July 7, 1974. Repeal and new rule filed January 13, 1987; effective February 27, 1987. Amendment filed June 20, 1988; effective September 28, 1988. Amendment filed December 4, 1992; effective January 19, 1993. Amendment filed August 23, 2006;effective November 6, 2006. Transferred to chapter 0720-19 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-07-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 12-4-320 (Public Acts of 1986, Chapter 927), and 68-11-209.
• Administrative History: Original rule filed June 7, 1974; effective July 7, 1974. Repeal and new rule filed January 13, 1987; effective February 27, 1987. Amendment filed June 19, 1995; effective September 2, 1995. Transferred to chapter 0720-19 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-07-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 12-4-320 (Public Acts of 1986, Chapter 927), and 68-11-209.
• Administrative History: Original rule filed June 7, 1974; effective July 7, 1974. Repeal and new rule filed January 13, 1987; effective February 27, 1987. Amendment filed June 20, 1988; effective September 28, 1988. Amendment filed April 1, 1992; effective May 16, 1992. Amendment filed December 4, 1992; effective January 19, 1993. Amendment filed June 19, 1995; effective September 2, 1995. Amendment filed August 23, 2006; effective November 6, 2006. Transferred to chapter 0720-19 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-07-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 12-4-320 (Public Acts of 1986, Chapter 927), 53-1310, and 68-11- 209.
• Administrative History: Original rule filed June 7, 1974; effective July 7, 1974. Repeal and new rule filed January 13, 1987; effective February 27, 1987. Amendment filed August 23, 2006; effective November 6, 2006. Transferred to chapter 0720-19 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-08 Repealed

Tenn. Comp. R. & Regs. 1200-08-08-.01 REPEALED

History

• Authority: T.C.A. §§4-5-202, 68-11-201, 4-5-208, 68-11-202, 68-11-204, and 68-11-209.
• Administrative History: Original rule filed December 1, 1975; effective December 30, 1975. Amended and new rule filed July, 22, 1976; effective August 21, 1976. Repeal and new rule filed February 9, 1989; effective March 26, 1989. Amendment filed March 4, 1993; effective April 18, 1993. Amendment filed June 9, 1994; effective August 23, 1994. Repeal and new rule filed April 25, 1996; effective July 9, 1996. Amendment filed December 13, 1996; effective February 26, 1997. Amendment filed May 28,1998; effective August 11, 1998. Repeal filed March 18, 2010; effective June 16, 2010.

Tenn. Comp. R. & Regs. 1200-08-08-.02 REPEALED

History

• Authority: T.C.A. §§4-5-202, 68-11-202, 68-11-204, 68-11-206 through 68-11-209, § 68-11-209(a)(1), § 68-11-210, Chapter 846 of the Public Acts of 2008, §1, T.C.A. §68-11-206(a)(5) [effective January 1, 2009].
• Administrative History: Original rule filed December 1, 1975; effective December 30, 1975. Repeal and new rule filed February 9, 1989; effective March 26, 1989. Repeal and new rule filed April 25, 1996; effective July 9, 1996. Amendment filed May 28, 1998; effective August 11, 1998. Public necessity rule filed April 29, 2009; effective through October 11, 2009. Emergency rules filed October 9, 2009; effective through April 7, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Repeal filed March 18, 2010; effective June 16, 2010.

Tenn. Comp. R. & Regs. 1200-08-08-.03 REPEALED

History

• Authority: T.C.A. §§4-5-208, 68-11-202 and 68-11-209.
• Administrative History: Original rule filed December 1, 1975; effective December 30, 1975. New rule filed July 22, 1976; effective August 21, 1976. Amendment filed February 26, 1985; effective March 28, 1985. Amendment filed December 30, 1986; effective February 13, 1987. Repeal and new rule filed February 9, 1989; effective March 26, 1989. Repeal and new rule filed April 25, 1996; effective July 9, 1996 Amendment filed December 10, 1996; effective February 23, 1997. Amendment filed December 13, 1996; effective February 26, 1997. Repeal filed May 31, 2000; effective August 14, 2000.

Tenn. Comp. R. & Regs. 1200-08-08-.04 REPEALED

History

• Authority: T C.A. §§4-5-202, 4-5-204, 68-11-202 and 68-11-209.
• Administrative History: Original rule filed December 1, 1975; effective December 30, 1975. Repeal and new rule filed February 9, 1989, effective March 26, 1989. Repeal and new rule filed April 25, 1996, effective July 9, 1996. Repeal filed April 17, 2000; effective July 1, 2000.

Tenn. Comp. R. & Regs. 1200-08-08-.05 REPEALED

History

• Authority: T.C.A. §§4-5-202, 68-11-202, 68-11-209, and 68-11-224.
• Administrative History: Original rule filed December 1, 1975; effective December 30, 1976. Repeal and new rule filed February 9, 1989; effective March 26, 1989. Repeal and new rule filed April 25, 1996, effective July 9, 1996. Repeal filed March 18, 2010; effective June 16, 2010.

Tenn. Comp. R. & Regs. 1200-08-08-.06 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, and 68-11-209.
• Administrative History: Original rule filed May 28, 1998; effective August 11, 1998. Repeal filed August 24, 2000; effective November 7, 2000.

Chapter 1200-08-09 Repealed

Tenn. Comp. R. & Regs. 1200-08-09 Repealed

RULES

OF THE TENNESSEE DEPARTMENT OF HEALTH

BOARD FOR LICENSING HEALTH CARE FACILITIES

Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202 and 68-11-209. Administrative History: Original Rule filed July 30, 1976; effective August 30, 1976. Repeal filed April 27, 2000; effective July 11, 2000.

Chapter 1200-08-10 Transferred to 0720-20

Tenn. Comp. R. & Regs. 1200-08-10-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-11-106, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11- 211, 68-11-216, 68-11-224, 68-11-1802, 68-57-101, 68-57-102, and 68-57-105.
• Administrative History: Original rule filed July 22, 1977; effective August 22, 1977. Amendment filed August 10, 1982; effective September 9, 1982. Repeal and new rule filed June 30, 1992; effective August 14, 1992. Amendment filed March 12, 1993; effective April 26, 1993. Repeal and new rule filed March 21, 2000; effective June 4, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendment filed April 28, 2003; effective July 12, 2003. Amendment filed June 16, 2003; effective August 30, 2003. Amendment filed May 20, 2004; effective August 3, 2004. Amendments filed September 9, 2005; effective November 23, 2005. Amendment filed February 23, 2006; effective May 9, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Amendment filed February 22, 2010; effective May 23, 2010. Amendment filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Transferred to chapter 0720-20 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-10-.15 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, 68-11-224, and 68-11-1805.
• Administrative History: Original rule filed February 16, 2007; effective May 2, 2007. Repeal and new rule filed August 28, 2012; effective November 26, 2012. Amendment filed March 27, 2015; effective June pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-10-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206(a)(5), 68-11-206, 68-11-209, 68-11-209(a)(1), 68-11-210, and 68-11-216 and Chapter 846 of the Public Acts of 2008, §1.
• Administrative History: Original rule filed July 22, 1977; effective August 22, 1977. Amendment filed February 26, 1985; effective March 28, 1985. Repeal and new rule filed June 30, 1992; effective August 14, 1992. Repeal and new rule filed March 21, 2000; effective June 4, 2000. Amendment filed June 16, 2003; effective August 30, 2003. Amendment filed January 19, 2007; effective April 4, 2007. Amendment filed July 18, 2007; effective October 1, 2007. Public necessity rules filed April 29, 2009; effective through October 11, 2009. Emergency rules filed October 9, 2009; effective through April 7, 2010. Amendments filed September 24, 2009; effective December 23, 2009. Amendment filed December 16, 2013; effective March 16, 2014. Amendments filed March 21, 2018; to have been effective June 19, 2018. However, on May 24, 2018, the Government Operations Committee filed a 5-day stay; new effective date June 24, 2018. Transferred to chapter 0720-20 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-10-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11-204, 68-11- 206, 68-11-208, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed July 22, 1977; effective August 22, 1977. Repeal and new rule filed June 30, 1992; effective August 14, 1992. Repeal and new rule filed March 21, 2000; effective June 4, 2000. Amendment filed March 1, 2007; effective May 15, 2007. Transferred to chapter 0720-20 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-10-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-15-202, 39-17-1803, 39-17-1805, 68-11-201, 68-11-202, 68- 11-204, 68-11-206, 68-11-209, 68-11-216, 68-11-268, and 71-6-121.
• Administrative History: Original rule filed July 22, 1977; effective August 22, 1977. Amendment filed September 10, 1991; effective October 25, 1991. Repeal and new rule filed June 30, 1992; effective August 14, 1992. Repeal and new rule filed March 21, 2000; effective June 4, 2000. Amendment filed June 18, 2002; effective September 1, 2002. Amendment filed June 16, 2003; effective August 30, 2003. Amendment filed September 9, 2005; effective November 23, 2005. Amendment filed April 20, 2006; effective July 4, 2006. Amendment filed July 18, 2007; effective October 1, 2007. Amendment filed October 11, 2007; effective December 25, 2007. Amendment filed February 22, 2010; effective May 23, 2010. Amendment filed December 16, 2013; effective March 16, 2014. Amendments filed July 10, 2018; effective October 8, 2018. Transferred to chapter 0720-20 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-10-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed July 22, 1977; effective August 22, 1977. Repeal and new rule filed June 30, 1992; effective August 14, 1992. Repeal and new rule filed March 21, 2000; effective June pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-10-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68, 68-11-209, 68- 11-216, 68-57-101, 68-57-102, 68-57-104, and 68-57-105.
• Administrative History: Original rule filed July 22, 1977; effective August 22, 1977. Amendment filed September 10, 1991; effective October 25, 1991. Repeal and new rule filed June 30, 1992; effective August 14, 1992. Repeal and new rule filed March 21, 2000; effective June 4, 2000. Amendment filed June 16, 2003; effective August 30, 2003. Amendment filed February 23, 2006; effective May 9, 2006. Amendment filed February 23, 2007; effective May 9, 2007. Amendment filed February 22, 2010; effective May 23, 2010. Amendment filed January 3, 2012; effective April 2, 2012. Amendment filed December 16, 2013; effective March 16, 2014. Amendments filed March 27, 2015; effective June 25, 2015. Amendment filed October 20, 2015; effective January 18, 2016. Amendments filed July 18, 2016; effective October 16, 2016. Amendments filed January 7, 2019; to have become effective April 7, 2019. However, the Government Operations Committee filed a 60-day stay of the effective date of the rules; new effective date June 6, 2019. Transferred to chapter 0720-20 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-10-.07 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-209, and 68-57-105.
• Administrative History: Original rule filed June 30, 1992; effective August 14, 1992. Repeal and new rule filed March 4, 2000; effective June 4, 2000. Amendment filed June 16, 2003; effective August 30, 2003. Amendment filed January 3, 2012; effective April 2, 2012. Transferred to chapter 0720-20 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-10-.08 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-216, and 68- 11-261.
• Administrative History: Original rule filed July 22, 1977; effective August 22, 1977. Amendment filed July 3, 1984; effective August 1, 1984. Repeal and new rule filed June 30, 1992; effective August 14, 1992. Repeal and new rule filed March 4, 2000; effective June 4, 2000. Amendment filed February 18, 2003; effective May 4, 2003. Amendment filed June 16, 2003; effective August 30, 2003. Repeal and new rule filed September 9, 2005; effective November 23, 2005. Amendment filed February 23, 2007; effective May 9, 2007. Repeal and new rule filed December 20, 2011; effective March 19, 2012. Amendment filed January 21, 2016; effective April 20, 2016. Transferred to chapter 0720-20 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-10-.09 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed July 22, 1977; effective August 22, 1997. Amendment filed July 3, 1984; effective August 1, 1984. Repeal and new rule filed June 30, 1992; effective August 14, 1992. Repeal and new rule filed March 21, 2000; effective June 4, 2000. Amendment filed June 16, 2003; effective August 30, 2003. Repeal and new rule filed September 9, 2005; effective November 23, 2005. Transferred to chapter 0720-20 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-10-.10 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed July 22, 1977; effective August 22, 1977. Amendment filed July 3, 1984; effective August 1, 1984. Repeal and new rule filed June 30, 1992; effective August 14, 1992. Repeal and new rule filed March 21, 2000; effective June 4, 2000. Amendment filed June 16, 2003; effective August 30, 2003. Amendment filed September 9, 2005; effective November 23, 2005. Transferred to chapter 0720-20 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-10-.11 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-1-1004, 68-11-202, 68-11-204, 68-11-206, 68-11-207, 68-11- 209, 68-11-210, 68-11-211, 68-11-213, and 68-11-216.
• Administrative History: Original rule filed July 22, 1977; effective August 22, 1977. Amendment filed September 10, 1991; effective October 25, 1991. Repeal and new rule filed June 30, 1992; effective August 14, 1992. Repeal and new rule filed March 21, 2000; effective June 4, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendments filed January 3, 2012; effective April 2, 2012. Amendments filed July 10, 2018; effective October 8, 2018. Transferred to chapter 0720-20 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-10-.12 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed July 22, 1977; effective August 22, 1977. Repeal and new rule filed June 30, 1992; effective August 14, 1992. Repeal and new rule filed March 21, 2000; effective June 4, 2000. Amendment filed June 18, 2002; effective September 1, 2002. Amendment filed September 9, 2005; effective November 23, 2005. Transferred to chapter 0720-20 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-10-.13 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-224, and 68- 11-1801 through 68-11-1815.
• Administrative History: Original rule filed June 22, 1992; effective August 6, 1992. Repeal and new rule filed March 21, 2000; effective June 4, 2000. Amendment filed April 28, 2003; effective July 12, 2003. Repeal and new rule filed September 9, 2005; effective November 23, 2005. Amendment filed February 7, 2007; effective April 23, 2007. Amendments filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Transferred to chapter 0720-20 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-10-.14 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed November 22, 1996; effective August 27, 1997. Repeal and new rule filed March 21, 2000; effective June 4, 2000. Amendment filed June 16, 2003; effective August 30, 2003. Transferred to chapter 0720-20 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-11 Transferred to 0720-21

Tenn. Comp. R. & Regs. 1200-08-11-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-11-106, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11- 207, 68-11-209, 68-11-210, 68-11-211, 68-11-213, 68-11-216, 68-11-224, and 68-11-1802.
• Administrative History: Original rule filed June 21, 1979; effective August 6, 1979. Amendment filed August 16, 1988; effective September 30, 1988. Amendment filed January 30, 1992; effective March 15, 1992. Amendment filed December 7, 1993; effective February 20, 1994. Repeal and new rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendment filed April 28, 2003; effective July 12, 2003.Amendment filed September 8, 2006; effective November 22, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Amendment filed February 23, 2007; effective May 9, 2007. Amendment filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Amendments filed July 10, 2018; effective October 8, 2018. Transferred to chapter 0720-21 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-11-.14 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, 68-11-224, and 68-11-1801 through 68-11-815.
• Administrative History: Original rule filed February 16, 2007; effective May 2, 2007. Repeal and new rule filed August 28, 2012; effective November 26, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Amendments filed February 8, 2017; effective May 9, 2017. Transferred to chapter 0720-21 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-11-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-206(a)(5) [effective January 1, 2009], 68-11-209, 68-11-209(a)(1), 68-11-210, and 68-11-216 and Chapter 846 of the Public Acts of 2008, § 1.
• Administrative History: Original rule filed June 21, 1979; effective August 6, 1997. Amendment filed August 16, 1988; effective September 30, 1988. Amendment filed January 30, 1992; effective March 15, 1992. Repeal and new rule filed July 27, 2000; effective October 10, 2000. Amendment filed November 19, 2003; effective February 2, 2004. Amendment filed September 8, 2006; effective November 22, 2006. Amendment filed January 19, 2007; effective April 4, 2007. Public necessity rules filed April 29, 2009; effective through October 11, 2009. Emergency rules filed October 9, 2009; effective through April 7, 2010. Amendments filed September 24, 2009; effective December 23, 2009. Amendment filed December 16, 2013; effective March 16, 2014. Amendments filed March 21, 2018; to have been effective June 19, 2018. However, on May 24, 2018, the Government Operations Committee filed a 5-day stay; new effective date June 24, 2018. Transferred to chapter 0720-21 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-11-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11-204, 68-11- 206, 68-11-207, 68-11-208, 68-11-209, and 68-11-221.
• Administrative History: Original rule filed June 21, 1979; effective August 6, 1979. Amendment filed August 16, 1988; effective September 30, 1988. Repeal and new rule filed July 27, 2000; effective October 10, 2000. Amendment filed March 1, 2007; effective May 15, 2007. Transferred to chapter 0720-21 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-11-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-17-1803, 39-17-1804, 39-17-1805, 68-11-201, 68-11-202, 68- 11-204, 68-11-206, 68-11-207, 68-11-209, 68-11-213, 68-11-257, 68-11-268, and 71-6-121.
• Administrative History: Original rule filed June 21, 1997; effective August 6, 1979. Amendment filed August 16, 1988; effective September 30, 1988. Repeal and new rule filed July 27, 2000; effective October 10, 2000. 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. Amendment filed February 22, 2010; effective May 23, 2010. Amendments filed July 18, 2016; effective October 16, 2016. Administrative correction made to URL on September 18, 2018. Emergency rules filed May 29, 2020; effective through November 25, 2020. Emergency rules expired effective November 26, 2020, and the rules reverted to their previous statuses. Transferred to chapter 0720-21 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-11-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-210, 68-11- 257, and 71-6-121.
• Administrative History: Original rule filed June 21, 1979; effective August 6, 1997. Amendment filed August 16, 1988; effective September 30, 1988. Repeal and new rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 20, 2006; effective July 4, 2006. Amendment filed February 23, 2007; effective May 9, 2007. Transferred to chapter 0720-21 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-11-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, and 68-11-204.
• Administrative History: Original rule filed June 21, 1979; effective August 6, 1979. Amendment filed August 16, 1988; effective September 30, 1988. Repeal and new rule filed July 27, 2000; effective October 10, 2000. Transferred to chapter 0720- 21 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-11-.07 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-261.
• Administrative History: Original rule filed June 21, 1979; effective August 6, 1979. Amendment filed August 16, 1988; effective September 30, 1988. Amendment filed January 30, 1992; effective March 15, 1992. Amendment filed December 7, 1993; effective February 20, 1994. Amendment filed January 6, 1995; effective March 22, 1995. Repeal and new rule filed July 27, 2000; effective October 10, 2000. Amendment filed February 18, 2003; effective May 4, 2003. Amendment filed September 6, 2006; effective November 22, 2006. Amendment filed February 23, 2007; effective May 9, 2007. Repeal and new rule filed December 20, 2011; effective March 19, 2012. Amendment filed January 21, 2016; effective April 20, 2016. Transferred to chapter 0720-21 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-11-.08 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed June 21, 1979; effective August 6, 1979. Amendment filed August 16, 1988; effective September 30, 1988. Amendment filed January 39, 1992; effective March 15, 1992. Repeal and new rule filed July 27, 2000; effective October 10, 2000. Amendment filed September 6, 2006; effective November 6, 2006. Transferred to chapter 0720-21 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-11-.09 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202 through 4-5-206, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed June 21, 1979; effective August 6, 1979. Repeal and new rule filed July 27, 2000; effective October 10, 2000. Transferred to chapter 0720-21 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-11-.10 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-207, 68-11-209, 68-11- 210, 68-11-211, and 68-11-213.
• Administrative History: Original rule filed June 21, 1979; effective August 6, 1979. Amendment filed February 26, 1985; effective March 28, 1985. Amendment filed August 16, 1988; effective September 30, 1988. Repeal and new rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendment filed December 23, 2009; effective March 23, 2010. Amendments filed January 3, 2012; effective April 2, 2012. Transferred to chapter 0720-21 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-11-.11 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed June 21, 1997; effective August 6, 1979. Amendment filed August 16, 1988; effective September 30, 1988. Repeal and new rule filed July 27, 2000; effective October 10, 2000. Transferred to chapter 0720-21 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-11-.12 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-224, and 68- 11-1801 through 68-11-1815.
• Administrative History: Original rule filed June 22, 1992; effective August 6, 1992. Repeal and new rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 28, 2003; effective July 12, 2003. Amendment filed September 8, 2006; effective November 22, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Amendments filed January 3, 2012; effective pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-11-.13 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed February 9, 1998; effective April 25, 1998. Repeal and new rule filed July 27, 2000; effective October 10, 2000. Transferred to chapter 0720-21 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-12 Transferred to 0720-22

Tenn. Comp. R. & Regs. 1200-08-12-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-201, et seq.
• Administrative History: Original rule filed September 18, 1985; effective October 18, 1985. Repeal and new rule filed December 5, 2011; effective March 4, 2012. Repeal and new rules filed August 6, 2019; effective November 4, 2019. Transferred to chapter 0720-22 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-12-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-209 and 68-11-259.
• Administrative History: New rule filed February 12, 2013; effective May 13, 2013. Repeal filed August 6, 2019; effective November 4, 2019. Transferred to chapter 0720-22 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-12-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-201, 68-11-202, 68-11-209, and 68-11-259.
• Administrative History: Original rule filed September 18, 1985; effective October 18, 1985. Repeal and new rule filed December 5, 2011; effective March 4, 2012. Repeal and new rules filed August 6, 2019; effective November 4, 2019. Transferred to chapter 0720-22 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-12-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-209, and 68-11-259.
• Administrative History: Original rule filed September 18, 1985; effective October 18, 1985. Amendment filed March 31, 1989; effective May 15, 1989. Amendment filed August 16, 2006; effective October 30, 2006. Repeal and new rule filed December 5, 2011; effective March 4, 2012. Amendment filed February 12, 2013; effective May 13, 2013. Repeal and new rules filed August 6, 2019; effective November 4, 2019. Transferred to chapter 0720-22 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-12-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-209, and 68-11-259.
• Administrative History: Original rule filed September 18, 1985; effective October 18, 1985. Amendment filed March 31, 1989; effective May 15, 1989. Amendment filed August 31, 1990; effective October 15, 1990. Amendment filed October 20, 1992; effective December 4, 1992. Amendment filed July 21, 1993; effective October 4, 1993. Amendment filed August 16, 2006; effective October 30, 2006. Repeal and new rule filed December 5, 2011; effective March 4, 2012. Repeal and new rules filed August 6, 2019; effective November 4, 2019. Transferred to chapter 0720-22 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-12-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-209, and 68-11-259.
• Administrative History: Original rule filed March 31, 1989; effective May 18, 1989. Amendment filed July 21, 1993; effective October 4, 1993. Repeal filed December 5, 2011; effective March 4, 2012. Repeal and new rules filed August 6, 2019; effective November 4, 2019. Transferred to chapter 0720-22 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-13 Repealed

Tenn. Comp. R. & Regs. 1200-08-13 Repealed

RULES

OF TENNESSEE DEPARTMENT OF HEALTH AND ENVIRONMENT

DIVISION OF HEALTH CARE FACILITIES

TABLE OF CONTENTS

Authority: T.C.A. §§68-11-701 et seq. and 4-5-201 et seq Administrative History: Original rule filed April 14, 1988; effective May 29, 1988. Repeal filed March 18, 2000; effective May 30, 2000.

Chapter 1200-08-14 Repealed

Tenn. Comp. R. & Regs. 1200-08-14-.01 REPEALED

History

• Authority: T.C.A. §§68-11-201 through 68-11-205, 68-11-207 through 68-11-210, 68-11-213, 68-11- 214, 68-11-216, 68-11-219 through 68-11-221, and 4-5-202.
• Administrative History: Original rule filed January 30, 1989; effective March 16, 1989. Repeal filed December 23, 2009; effective March 23, 2010.

Tenn. Comp. R. & Regs. 1200-08-14-.02 REPEALED

History

• Authority: T.C.A. §§68-11-201 through 68-11-205, 68-11-207 through 68-11-210, 68-11-213, 68-11- 214, 68-11-216, 68-11-219 through 68-11-221, and 4-5-202.
• Administrative History: Original rule filed January 30, 1989; effective March 16, 1989. Repeal filed December 23, 2009; effective March 23, 2010.

Tenn. Comp. R. & Regs. 1200-08-14-.05 REPEALED

History

• Authority: T.C.A. §§68-11-201 through 68-11-205, 68-11-207 through 68-11-210, 68-11-213, 68-11- 214, 68-11-216, 68-11-219 through 68-11-221, and 4-5-202.
• Administrative History: Original rule filed January 30, 1989; effective March 16, 1989. Repeal filed December 23, 2009; effective March 23, 2010.

Tenn. Comp. R. & Regs. 1200-08-14-.03 REPEALED

History

• Authority: T.C.A. §§68-11-201 through 68-11-205, 68-11-207 through 68-11-210, 68-11-213, 68-1-214, 6-1-216, 68-11-219 through 68-11-221, and 4-5-202.
• Administrative History: Original rule filed January 30, 1989; effective March 16, 1989. Repeal filed December 23, 2009; effective March 23, 2010.

Tenn. Comp. R. & Regs. 1200-08-14-.04 REPEALED

History

• Authority: T.C.A. §§68-11-201 through 6-11-205, 68-11-207 through 68-11-210, 68-11-213, 68-11-214, 68-11-216, 68-11-219 through 68-11-221, and 4-5-202.
• Administrative History: Original rule filed January 30, 1989; effective March 16, 1989. Repeal filed December 23, 2009; effective March 23, 2010.

Chapter 1200-08-15 Transferred to 0720-23

Tenn. Comp. R. & Regs. 1200-08-15-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-11-106, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11- 207, 68-11-209, 68-11-210, 68-11-211, 68-11-213, 68-11-224, and 68-11-1802.
• Administrative History: Original rule filed August 18, 1995; effective November 1, 1995. Repeal and new 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 November 22, 2005; effective February 5, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Amendment filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Amendment filed September 15, 2015; effective December 14, 2015. Transferred to chapter 0720-23 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-15-.15 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, 68-11-224, and 68-11-1801 through 68-11-1805.
• Administrative History: Original rule filed February 16, 2007; effective May 2, 2007. Repeal and new rule filed August 28, 2012; effective November 26, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Amendments filed February 8, 2017; effective May 9, 2017. Transferred to chapter 0720-23 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-15-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-206(a)(5) [effective January 1, 2009], 68-11-209, 68-11-209(a)(1), 68-11-210, and 68-11-216 and Chapter 846 of the Public Acts of 2008, § 1.
• Administrative History: Original rule filed August 18, 1995; effective November 1, 1995. Repeal and new rule filed April 27, 2000; effective July 11, 2000. Amendment filed November 19, 2003; effective February 2, 2004. Amendment filed January 19, 2007; effective April 4, 2007. Public necessity rules filed April 29, 2009; effective through October 11, 2009. Emergency rules filed October 9, 2009; effective through April 7, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Amendment filed December 16, 2013; effective March 16, 2014. Amendments filed March 26, 2019; effective June 24, 2019. Transferred to chapter 0720-23 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-15-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11-204, and 68-11-206 through 68-11-209.
• Administrative History: Original rule filed August 18, 1995; effective November 1, 1995. Repeal and new rule filed April 27, 2000; effective July 11, 2000. Amendment filed March 1, 2007; effective May 15, 2007. Transferred to chapter 0720-23 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-15-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-17-1803, 39-17-1805, 68-11-201, 68-11-202, 68-11-204, 68- 11-206, 68-11-209, 68-11-268, and 71-6-121.
• Administrative History: Original rule filed August 18, 1995; effective November 1, 1995. Repeal and new rule filed April 27, 2000; effective July 11, 2000. Amendment filed June 18, 2002; effective September 1, 2002. Amendment filed April 20, 2006; effective July 4, 2006. Amendment filed July 18, 2007; effective October 1, 2007. Amendment filed February 22, 2010; effective May 23, 2010. Transferred to chapter 0720-23 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-15-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 71- 6-121.
• Administrative History: Original rule filed August 18, 1995; effective November 1, 1995. Repeal and new rule filed April 27, 2000; effective July 11, 2000. Amendment filed April 20, 2006; effective July 4, 2006. Transferred to chapter 0720-23 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-15-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed August 18, 1995; effective November 1, 1995. Repeal and new rule filed April 27, 2000; effective July 11, 2000. Amendment filed November 22, 2005; effective February 5, 2006. Amendment filed March 27, 2015; effective June 25, 2015. Amendment filed September 15, 2015; effective December 14, 2015. Amendments filed July 18, 2016; effective October 16, 2016. Transferred to chapter 0720-23 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-15-.07 TRANSFERRED

Administrative History: Transferred to chapter 0720-23 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-15-.08 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-261.
• Administrative History: Original rule filed August 18, 1995; effective November 1, 1995. Repeal and new rule filed April 27, 2000; effective July 11, 2000. Amendment filed February 18, 2003; effective May 4, 2003. Repeal and new rule filed November 22, 2005; effective February 5, 2006. Amendment filed February 23, 2007; effective May 9, 2007. Repeal and new rule filed December 20, 2011; effective March pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-15-.09 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed August 18, 1995; effective November 1, 1995. Repeal and new rule filed April 27, 2000; effective July 11, 2000. Repeal and new rule filed November 22, 2005; effective February 5, 2006. Transferred to chapter 0720-23 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-15-.10 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed August 18, 1995; effective November 1, 1995. Repeal and new rule filed April 27, 2000; effective July 11, 2000. Transferred to chapter 0720-23 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-15-.11 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-207, 68-11-209, 68-11- 210, 68-11-211, 68-11-213, and 68-11-216.
• Administrative History: Original rule filed August 18, 1995; effective November 1, 1995. Repeal and new rule filed April 27, 2000; effective July 11, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendments filed January 3, 2012; effective April 2, 2012. Transferred to chapter 0720-23 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-15-.12 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed August 18, 1995; effective November 1, 1995. Repeal and new rule filed April 27, 2000; effective July 11, 2000. Amendment filed June 18, 2002; effective September 1, 2002. Amendments filed November 22, 2005; effective February 5, 2006. Transferred to chapter 0720-23 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-15-.13 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-224, and 68- 11-1801 through 68-11-1815.
• Administrative History: Original rule filed August 18, 1995; effective November 1, 1995. Repeal and new rule filed April 27, 2000; effective July 11, 2000. Amendment filed April 28, 2003; effective July 12, 2003. Repeal and new rule filed November 22, 2005; effective February 5, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Amendments filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Transferred to chapter 0720-23 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-15-.14 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed August 18, 1995; effective November 1, 1995. Amendment filed February 9, 1998; effective April 25, 1998. Repeal and new rule filed April 27, 2000; effective July 11, pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-16 Transferred to 0720-24

Tenn. Comp. R. & Regs. 1200-08-16-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-1-113, 68-11-102, and 68-11-203; 45 C.F.R., Part 80; and 45 C.F.R., Part 84.
• Administrative History: Original rule filed November 21, 1990; effective January 5, 1991. Transferred to chapter 0720-24 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-16-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-1-113, 68-11-102, and 68-11-203; 45 C.F.R., Part 80; and 45 C.F.R., Part 84.
• Administrative History: Original rule filed November 21, 1990; effective January 5, 1991. Transferred to chapter 0720-24 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-16-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-1-113, 68-11-102, and 68-11-203; 45 C.F.R., Part 80; and 45 C.F.R., Part 84.
• Administrative History: Original rule filed November 21, 1990; effective January 5, 1991. Transferred to chapter 0720-24 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-16-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-1-113, 68-11-102, and 68-11-203; 45 C.F.R., Part 80; and 45 C.F.R., Part 84.
• Administrative History: Original rule filed November 21, 1990; effective January 5, 1991. Transferred to chapter 0720-24 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-17 Transferred to 0940-05-45

Tenn. Comp. R. & Regs. 1200-08-17-.01 TRANSFERRED TO 0940-05-45

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 39-11-106, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11- 207, 68-11-209, 68-11-210, 68-11-211, 68-11-213, 68-11-224, and 68-11-1802 Executive Order Number 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. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-05-45 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-17-.02 TRANSFERRED TO 0940-05-45

History

• Authority: T.C.A. §§4-5-202, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216; 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 to 0940-05-45 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-17-.03 TRANSFERRED TO 0940-05-45

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11-204, and 68-11-206 through 68-11-209 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 to 0940-05-45 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-17-.04 TRANSFERRED TO 0940-05-45

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11- 222, and 71-6-121 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 to 0940-05-45 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-17-.05 TRANSFERRED TO 0940-05-45

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 71- 6-121, 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 to 0940-05-45 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-17-.06 TRANSFERRED TO 0940-05-45

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209, 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 to 0940-05-45 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-17-.07 TRANSFERRED TO 0940-05-45

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209, 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. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-05-45 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-17-.08 TRANSFERRED TO 0940-05-45

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209, 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. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-05-45 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-17-.09 TRANSFERRED TO 0940-05-45

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-204, 68-11-206, and 68-11-209, 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 to 0940-05-45 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-17-.10 TRANSFERRED TO 0940-05-45

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-206, 68-11-207, 68-11-209, 68-11-210, 68-11- 211, and 68-11-213, 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 to 0940-05-45 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-17-.11 TRANSFERRED TO 0940-05-45

History

• Authority: T.C.A. §§4-5-202, 68-11-202, and 68-11-209, 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 to 0940-05-45 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-17-.12 TRANSFERRED TO 0940-05-45

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-224, 68-11- 1801 through 68-11-1815, 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. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-05-45 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-17-.13 TRANSFERRED TO 0940-05-45

History

• Authority: T.C.A. §§4-5-202, 68-11-202, and 68-11-209, 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 to 0940-05-45 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-17-.14 TRANSFERRED TO 0940-05-45

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, 68-11-224, and 68-11-1805, Executive Order 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 to 0940-05-45 on May 15, 2008.

Chapter 1200-08-18 Transferred to 0940-05-43

Tenn. Comp. R. & Regs. 1200-08-18-.01 TRANSFERRED TO CHAPTER 0940-5-43

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-207, 68-11- 209, 68-11-210, 68-11-211, 68-11-213 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. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-5-43 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-18-.02 TRANSFERRED TO CHAPTER 0940-5-43

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216 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. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-5-43 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-18-.03 TRANSFERRED TO CHAPTER 0940-5-43

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11-204, and 68-11-206 through 68-11-209 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 to 0940-5-43 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-18-.04 TRANSFERRED TO CHAPTER 0940-5-43

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11- 222, 71-6-121 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. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-5-43 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-18-.05 TRANSFERRED TO CHAPTER 0940-5-43

History

• Authority: T.C.A. §§4-5-202, 68-11-202, 68-11-204, 68-11-206, and 68-11-209 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 to 0940-5-43 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-18-.06 TRANSFERRED TO CHAPTER 0940-5-43

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209 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 to 0940-5-43 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-18-.07 TRANSFERRED TO CHAPTER 0940-5-43

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-206, and 68-11-209 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. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-5-43 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-18-.08 TRANSFERRED TO CHAPTER 0940-5-43

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209 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. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940- 5-43 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-18-.09 TRANSFERRED TO CHAPTER 0940-5-43

History

• Authority: T.C.A. §§4-5-202, 68-11-202, 68-11-204, 68-11-206, and 68-11-209 and Executive Order 44 (February 23, 2007). Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-5-43 on May 15, 2008.
• Administrative History: Original rule filed April 27, 2000; effective July 11, 2000.

Tenn. Comp. R. & Regs. 1200-08-18-.10 TRANSFERRED TO CHAPTER 0940-5-43

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-206, 68-11-207, 68-11-209, 68-11-210, 68-11- 211, and 68-11-213 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, 2003Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-5-43 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-18-.11 TRANSFERRED TO CHAPTER 0940-5-43

History

• Authority: T.C.A. §§4-5-202, 68-11-202, and 68-11-209 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 to 0940-5-43 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-18-.12 TRANSFERRED TO CHAPTER 0940-5-43

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, and 68-11-209 and Executive Order 44 (February 23, 2007).
• Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Repeal filed April 30, 2003; effective July 14, 2003. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-5-43 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-18-.13 TRANSFERRED TO CHAPTER 0940-5-43

History

• Authority: T.C.A. §§4-5-202, 68-11-202, and 68-11-209 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 to 0940-5-43 on May 15, 2008. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-5-43 on May 15, 2008.

Chapter 1200-08-19 Transferred to 0940-05-39

Tenn. Comp. R. & Regs. 1200-08-19-.01 TRANSFERRED TO 0940-05-39

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 4-5-206, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11- 207, 68-11-209, 68-11-210, 68-11-211, 68-11-213 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 Number 44 (February 23, 2007), rule was transferred to 0940-5-39 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-19-.02 TRANSFERRED TO 0940-05-39

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 4-5-206, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11- 210, 68-11-213 and 68-11-216 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 Number 44 (February 23, 2007), rule was transferred to 0940-5-39 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-19-.03 TRANSFERRED TO 0940-05-39

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11- 204, 68-11-206 through 68-11-209, and 68-11-213 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 Number 44 (February 23, 2007), rule was transferred to 0940-5-39 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-19-.04 TRANSFERRED TO 0940-05-39

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11- 222, 71-6-121 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 Number 44 (February 23, 2007), rule was transferred to 0940-5-39 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-19-.05 TRANSFERRED TO 0940-05-39

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, and 68-11-209 and Executive Order 44 (February 23, 2007).
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order Number 44 (February 23, 2007), rule was transferred to 0940-5-39 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-19-.06 TRANSFERRED TO 0940-05-39

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-209, 68-11-222, 68-11-305, and 68-11- 308 and Executive Order 44 (February 23, 2007).
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order Number 44 (February 23, 2007), rule was transferred to 0940-5-39 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-19-.07 TRANSFERRED TO 0940-05-39

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-206, and 68-11-209 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 Number 44 (February 23, 2007), rule was transferred to 0940-5-39 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-19-.08 TRANSFERRED TO 0940-05-39

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209 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 Number 44 (February 23, 2007), rule was transferred to 0940-5-39 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-19-.09 TRANSFERRED TO 0940-05-39

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-204, 68-11-206, and 68-11-209 and Executive Order 44 (February 23, 2007).
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order Number 44 (February 23, 2007), rule was transferred to 0940-5-39 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-19-.10 TRANSFERRED TO 0940-05-39

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 71-6-.01, 68-11-202, 68-11-206, 68-11-207, 68-11-209, 68-11-210, 68-11-211, and 68-11-213 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 Number 44 (February 23, 2007), rule was transferred to 0940-5-39 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-19-.11 TRANSFERRED TO 0940-05-39

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-209, 68-11-302, and 68-11-304 and Executive Order 44 (February 23, 2007).
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order Number 44 (February 23, 2007), rule was transferred to 0940-5-39 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-19-.12 TRANSFERRED TO 0940-05-39

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, and 68-11-209 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 Number 44 (February 23, 2007), rule was transferred to 0940-5-39 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-19-.13 TRANSFERRED TO 0940-05-39

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-204, 68-11-206, and 68-11-209 and Executive Order 44 (February 23, 2007).
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order Number 44 (February 23, 2007), rule was transferred to 0940-5-39 on May 15, 2008.

Chapter 1200-08-20 Transferred to 0940-05-40

Tenn. Comp. R. & Regs. 1200-08-20-.01 TRANSFERRED TO 0940-5-40

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-207, 68-11- 209, 68-11-210, 68-11-211, 68-11-213 and Executive Order Number 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 Number 44 (February 23, 2007), rule was transferred to 0940-5-40.

Tenn. Comp. R. & Regs. 1200-08-20-.02 TRANSFERRED TO 0940-5-40

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216 and Executive Order Number 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 Number 44 (February 23, 2007), rule was transferred to 0940-5-40.

Tenn. Comp. R. & Regs. 1200-08-20-.03 TRANSFERRED TO 0940-5-40

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11-204, and 68-11-206 through 68-11-209 and Executive Order Number 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 Number 44 (February 23, 2007), rule was transferred to 0940-5-40.

Tenn. Comp. R. & Regs. 1200-08-20-.04 TRANSFERRED TO 0940-5-40

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11- 222, 71-6-121 and Executive Order Number 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 Number 44 (February 23, 2007), rule was transferred to 0940-5-40.

Tenn. Comp. R. & Regs. 1200-08-20-.05 TRANSFERRED TO 0940-5-40

History

• Authority: T.C.A. §§4-5-202, 68-11-202, 68-11-204, 68-11-206, and 68-11-209 and Executive Order Number 44 (February 23, 2007).
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order Number 44 (February 23, 2007), rule was transferred to 0940-5- 40.

Tenn. Comp. R. & Regs. 1200-08-20-.06 TRANSFERRED TO 0940-5-40

History

• Authority: T.C.A. §§ 68-11-202, 68-11-204, 68-11-206, and 68-11-216 and Executive Order Number 44 (February 23, 2007).
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order Number 44 (February 23, 2007), rule was transferred to 0940-5-40.

Tenn. Comp. R. & Regs. 1200-08-20-.07 TRANSFERRED TO 0940-5-40

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-206, and 68-11-209 and Executive Order Number 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 Number 44 (February 23, 2007), rule was transferred to 0940-5-40.

Tenn. Comp. R. & Regs. 1200-08-20-.08 TRANSFERRED TO 0940-5-40

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216 and Executive Order Number 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 Number 44 (February 23, 2007), rule was transferred to 0940-5-40.

Tenn. Comp. R. & Regs. 1200-08-20-.09 TRANSFERRED TO 0940-5-40

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-204, 68-11-206, and 68-11-209 and Executive Order Number 44 (February 23, 2007).
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order Number 44 (February 23, 2007), rule was transferred to 0940-5-40.

Tenn. Comp. R. & Regs. 1200-08-20-.10 TRANSFERRED TO 0940-5-40

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-206, 68-11-207, 68-11-209, 68-11-210, 68-11- 211, and 68-11-213 and Executive Order Number 44 (February 23, 2007).
• 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 Number 44 (February 23, 2007), rule was transferred to 0940-5-40.

Tenn. Comp. R. & Regs. 1200-08-20-.11 TRANSFERRED TO 0940-5-40

History

• Authority: T.C.A. §§4-5-202, 68-11-202, and 68-11-209 and Executive Order Number 44 (February 23, 2007).
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order Number 44 (February 23, 2007), rule was transferred to 0940-5-40.

Tenn. Comp. R. & Regs. 1200-08-20-.12 TRANSFERRED TO 0940-5-40

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, and 68-11-209 and Executive Order Number 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 Number 44 (February 23, 2007), rule was transferred to 0940-5-40.

Tenn. Comp. R. & Regs. 1200-08-20-.13 TRANSFERRED TO 0940-5-40

History

• Authority: T.C.A. §§4-5-202, 68-11-202, and 68-11-209 and Executive Order Number 44 (February 23, 2007).
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order Number 44 (February 23, 2007), rule was transferred to 0940-5-40.

Chapter 1200-08-21 Transferred to 0940-05-42

Tenn. Comp. R. & Regs. 1200-08-21-.01 TRANSFERRED TO 0940-5-42

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-201, 68-11-202, 68-11-207, 68-11-209, 68-11-210, 68-11-211, and 68-11-213 and Executive Order 44 (February 23, 2007).
• 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 to 0940-5-42 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-21-.02 TRANSFERRED TO 0940-5-42

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-210, 68-11-213, and 68-11-216 and Executive Order 44 (February 23, 2007).
• 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 to 0940-5-42 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-21-.03 TRANSFERRED TO 0940-5-42

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11- 204, 68-11-206 through 68-11-209, and 68-11-213 and Executive Order 44 (February 23, 2007).
• 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 to 0940-5-42 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-21-.04 TRANSFERRED TO 0940-5-42

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-210, 68-11-222, and 71-6-121 and Executive Order 44 (February 23, 2007).
• 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 to 0940-5-42 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-21-.05 TRANSFERRED TO 0940-5-42

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, and 68-11-209 and Executive Order 44 (February 23, 2007).
• 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 to 0940-5-42 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-21-.06 TRANSFERRED TO 0940-5-42

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-209, 68-11-222, 68-11-305, and 68-11- 308 and Executive Order 44 (February 23, 2007).
• 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 to 0940-5-42 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-21-.07 TRANSFERRED TO 0940-5-42

History

• Authority: Executive Order 44 (February 23, 2007).
• Administrative History: Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-5-42 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-21-.08 TRANSFERRED TO 0940-5-42

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-204, 68-11-206, and 68-11-209 and Executive Order 44 (February 23, 2007).
• 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 to 0940-5-42 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-21-.09 TRANSFERRED TO 0940-5-42

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-204, 68-11-206, and 68-11-209 and Executive Order 44 (February 23, 2007).
• 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 to 0940-5-42 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-21-.10 TRANSFERRED TO 0940-5-42

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-204, 68-11-206, and 68-11-209 and Executive Order 44 (February 23, 2007).
• Administrative History: Original rule filed June 8, 1999; effective August 22, 1999. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-5- 42 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-21-.11 TRANSFERRED TO 0940-5-42

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-204, 68-11-206, 68-11-207, 68-11-209, 68-11-210, 68-11-211, and 68-11-213 and Executive Order 44 (February 23, 2007).
• 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 to 0940-5-42 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-21-.12 TRANSFERRED TO 0940-5-42

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-209, 68-11-302, and 68-11-304 and Executive Order 44 (February 23, 2007).
• Administrative History: Original rule filed June 8, 1999; effective August 22, 1999. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-5- 42 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-21-.13 TRANSFERRED TO 0940-5-42

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, and 68-11-209 and Executive Order 44 (February 23, 2007).
• 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 to 0940-5-42 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-21-.14 TRANSFERRED TO 0940-5-42

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-204, 68-11-206, and 68-11-209 and Executive Order 44 (February 23, 2007).
• Administrative History: Original rule filed June 8, 1999; effective August 22, 1999. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-5- 42 on May 15, 2008.

Chapter 1200-08-22 Transferred to 0940-05-41

Tenn. Comp. R. & Regs. 1200-08-22-.01 TRANSFERRED TO 0940-5-41

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 39-11-106, 68-11-201, 68-11-202, 68-11-204, 68-11-207, 68-11- 209, 68-11-210, 68-11-211, 68-11-213, 68-11-224, and 68-11-1802 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 to 0940-5-41 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-22-.02 TRANSFERRED TO 0940-5-41

History

• Authority: T.C.A. §§4-5-202, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216 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 to 0940-5- 41 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-22-.03 TRANSFERRED TO 0940-5-41

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11-204, and 68-11-206 through 68-11-209 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 to 0940-5-41 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-22-.04 TRANSFERRED TO 0940-5-41

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11- 222, and 71-6-121 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 to 0940-5-41 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-22-.05 TRANSFERRED TO 0940-5-41

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 71- 6-121 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 to 0940-5-41 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-22-.06 TRANSFERRED TO 0940-5-41

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-609, and 68-11-216 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 to 0940-5-41 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-22-.07 TRANSFERRED TO 0940-5-41

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209 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 to 0940-5-41 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-22-.14 TRANSFERRED TO 0940-5-41

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, 68-11-224, and 68-11-1805 and Executive Order 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 to 0940- 5-41 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-22-.08 TRANSFERRED TO 0940-5-41

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209 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 to 0940-5-41 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-22-.09 TRANSFERRED TO 0940-5-41

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 6811-202, 6811-204, 68-11-206, and 68-11-209 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 to 0940-5- 41 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-22-.10 TRANSFERRED TO 0940-5-41

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-206, 68-11-207, 68-11-209, 68-11-210, 68-11- 211, and 68-11-213 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 to 0940-5-41 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-22-.11 TRANSFERRED TO 0940-5-41

History

• Authority: T.C.A. §§4-5-202, 68-11-202, and 68-11-209 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 to 0940-5-41 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-22-.12 TRANSFERRED TO 0940-5-41

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-224, 68-11- 1801 through 68-11-1815 and Executive Order 44 (February 23, 2007).
• Administrative History: Original rule July 27, 2000; effective October 10, 2000. Repeal filed April 30, 2003; effective July 14, 2003. Repeal and new rule 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 to 0940-5-41 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-22-.13 TRANSFERRED TO 0940-5-41

History

• Authority: T.C.A. §§4-5-202, 68-11-202, and 68-11-209 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 to 0940-5-41 on May 15, 2008.

Chapter 1200-08-23 Transferred to 0940-05-44

Tenn. Comp. R. & Regs. 1200-08-23-.01 TRANSFERRED TO 0940-5-44

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 34-11-101, 39-11-106, 68-11-201, 68-11-202, 68-11-204, 68-11- 206, 68-11-207, 68-11-208, 68-11-209, 68-11-210, 68-11-211, 68-11-213, 68-11-224, and 68-11-1802 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 to 0940-5-44 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-23-.02 TRANSFERRED TO 0940-5-44

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-210, 68-11-213, and 68-11-216 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 to 0940-5-44 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-23-.03 TRANSFERRED TO 0940-5-44

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11- 204, 68-11-206 through 68-11-209, and 68-11-213 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 to 0940-5-44 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-23-.04 TRANSFERRED TO 0940-5-44

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-222, and 71-6-121 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 to 0940-5- 44 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-23-.05 TRANSFERRED TO 0940-5-44

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 71- 6-121 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 to 0940-5-44 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-23-.06 TRANSFERRED TO 0940-5-44

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-222, 68-11-305, and 68-11-308 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 to 0940-5-44 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-23-.07 TRANSFERRED TO 0940-5-44

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 6-11-202, 68-11-204, 6-11-206, and 68-11-209 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 to 0940-5-44 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-23-.08 TRANSFERRED TO 0940-5-44

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-204, 68-11-206, and 68-11-209 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 to 0940-5-44 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-23-.09 TRANSFERRED TO 0940-5-44

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-204, 68-11-206, and 68-11-209 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 to 0940-5-44 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-23-.10 TRANSFERRED TO 0940-5-44

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-204, 68-11-206, 68-11-207, 68-11-209, 68-11-210, 68-11-211, and 63-11-213 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 to 0940-5-44 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-23-.11 TRANSFERRED TO 0940-5-44

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-209, 68-11-302, and 68-11-304 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 to 0940-5-44 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-23-.12 TRANSFERRED TO 0940-5-44

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-224, 68-11- 1801 through 68-11-1815 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 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 to 0940-5-44 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-23-.13 TRANSFERRED TO 0940-5-44

History

• Authority: T.C.A. §§4-5-202 through 4-5-206, 68-11-202, 68-11-204, 68-11-206, and 68-11-209 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 to 0940-5-44 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-08-23-.14 TRANSFERRED TO 0940-5-44

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, 68-11-224, and 68-11-1805 and Executive Order 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 to 0940- 5-44 on May 15, 2008.

Chapter 1200-08-24 Transferred to 0720-25

Tenn. Comp. R. & Regs. 1200-08-24-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-11-106, 68-11-202, 68-11-204, 68-11-206, 68-11-207, 68-11- 209, 68-11-210, 68-11-211, 68-11-213, 68-11-224, 68-11-255, and 68-11-1802.
• Administrative History: Original rule filed March 31, 1998; effective June 12, 1998. Amendment filed September 17, 2002; effective December 1, 2002. 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. Amendment filed January 3, 2012; effective pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-24-.14 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, 68-11-224, and 68-11-1805.
• Administrative History: Original rule filed February 16, 2007; effective May 2, 2007. Repeal and new rule filed August 28, 2012; effective November 26, 2012. Amendment filed March 27, 2015; effective June pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-24-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-206(a)(5), 68-11-209, 68-11-209(a)(1), 68-11-210, and 68-11-216 and Chapter 846 of the Public Acts of 2008, § 1.
• Administrative History: Original rule filed March 31, 1998; effective June 12, 1998. Amendment filed November 19, 2003; effective February 2, 2004. Amendment filed January 19, 2007; effective April 4, 2007. Public necessity rules filed April 29, 2009; effective through October 11, 2009. Emergency rules filed October 9, 2009; effective through April 7, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Amendment filed December 16, 2013; effective March 16, 2014. Amendments filed March 26, 2019; effective June 24, 2019. Transferred to chapter 0720-25 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-24-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11-204, 68-11- 206, 68-11-207, 68-11-208, and 68-11-209.
• Administrative History: Original rule filed March 31, 1998; effective June 12, 1998. Amendment filed March 1, 2007; effective May 15, 2007. Transferred to chapter 0720-25 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-24-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-17-1803, 39-17-1805, 68-11-201, 68-11-202, 68-11-204, 68- 11-206, 68-11-209, 68-11-222, 68-11-268, and 71-6-121.
• Administrative History: Original rule filed March 31, 1998; effective June 12, 1998. Amendment filed April 20, 2006; effective July 4, 2006. Amendment filed July 18, 2007; effective October 1, 2007. Amendment filed February 22, 2010; effective May 23, 2010. Transferred to chapter 0720-25 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-24-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-255.
• Administrative History: Original rule filed March 31, 1998; effective June 12, 1998. Amendment filed September 17, 2002; effective December 1, 2002. Transferred to chapter 0720-25 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-24-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed March 31, 1998; effective June 12, 1998. Amendment filed January 3, 2006; effective March 19, 2006. Amendments filed July 18, 2016; effective October 16, 2016. Transferred to chapter 0720-25 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-24-.07 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed March 31, 1998; effective June 12, 1998. Amendment filed February 18, 2003; effective May 4, 2003. Repeal and new rule filed January 3, 2006; effective March 19, 2006. Repeal and new rule filed December 20, 2011; effective March 19, 2012. Amendment filed January 21, 2016; effective April 20, 2016. Transferred to chapter 0720-25 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-24-.08 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed March 31, 1998; effective June 12, 1998. Amendment filed January 3, 2006; effective March 19, 2006. Repeal and new rule filed December 20, 2011; effective March 19, 2012. Transferred to chapter 0720-25 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-24-.09 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, and 68-11-209. Administrative pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-24-.10 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-207, 68-11-209, 68-11- 210, 68-11-211, and 68-11-213.
• Administrative History: Original rule filed March 31, 1998; effective June 12, 1998. Amendment filed April 11, 2003; effective June 25, 2003. Amendments filed January 3, 2012; effective April 2, 2012. Transferred to chapter 0720-25 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-24-.11 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed March 31, 1998; effective June 12, 1998. Amendment filed January 3, 2006; effective March 19, 2006. Transferred to chapter 0720-25 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-24-.12 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-224, and 68- 11-1801 through 68-11-1815 .
• Administrative History: Original rule filed March 31, 1998; effective June 12, 1998. 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. Amendments filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Transferred to chapter 0720-25 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-24-.13 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, and 68-11-209. Administrative pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-25 Transferred to 0720-26

Tenn. Comp. R. & Regs. 1200-08-25-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-11-106, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11- 207, 68-11-209, 68-11-210, 68-11-211, 68-11-213, 68-11-224, and 68-11-1802.
• Administrative History: Original rule filed February 9, 1998; effective April 25, 1998. Amendment filed November 25, 1998; effective February 8, 1999. Amendment filed September 13, 2002; effective November 27, 2002. Amendment filed April 11, 2003; effective June 25, 2003. Amendment filed April 28, 2003; effective July 12, 2003. Amendments filed January 24, 2006; effective April 9, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Public necessity rule filed May 13, 2009; effective through October 25, 2009. Emergency rule filed October 22, 2009; effective through April 20, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Transferred to chapter 0720-26 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-25-.17 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, 68-11-224, and 68-11-1805.
• Administrative History: Public necessity rule filed May 13, 2009; effective through October 25, 2009. Emergency rule filed October 22, 2009; effective through April 20, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Repeal and new rule filed August 28, 2012; effective November 26, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Amendments filed February 8, 2017; eff ective May 9, 2017. Transferred to chapter 0720-26 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-25-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11- 210, and 68-11-211.
• Administrative History: Original rule filed February 9, 1998; effective April 25, 1998. Amendment filed November 19, 2003; effective February 2, 2004. Amendment filed January 19, 2007; effective April 4, 2007. Amendment filed February 23, 2007; effective May 9, 2007. Public necessity rule filed May 13, 2009; effective through October 25, 2009. Emergency rule filed October 22, 2009; effective through April 20, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Amendment filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Amendments filed July 10, 2018; effective October 8, 2018. Transferred to chapter 0720- 26 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-25-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-201, 68-11-202, 68-11- 204, 68-11-206, 68-11-207, 68-11-208, 68-11-209, 68-11-213, and 68-11-216 and Chapter 846 of the Public Acts of 2008, § 1.
• Administrative History: Original rule filed February 9, 1998; effective April 25, 1998. Amendment filed March 1, 2007; effective May 15, 2007. Public necessity rule filed May 13, 2009; effective through October 25, 2009. Emergency rule filed October 22, 2009; effective through April 20, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Amendment filed December 16, 2013; effective March 16, 2014. Amendments filed July 10, 2018; effective October 8, 2018. Transferred to chapter 0720-26 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-25-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-3-511, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11- 209, 68-11-216, 68-11-257, and 71-6-121.
• Administrative History: Original rule filed February 9, 1998; effective April 25, 1998. Amendment filed November 25, 1998; effective February 8, 1999. Amendment filed September 21, 2001; effective December 5, 2001. 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. Public necessity rule filed May 13, 2009; through October 25, 2009. Emergency rule filed October 22, 2009; effective through April 20, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Amendments filed March 26, 2019; effective June 24, 2019. Transferred to chapter 0720-26 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-25-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-213 (i), and 68-11-257.
• Administrative History: Original rule filed February 9, 1998; effective April 25, 1998. Amendment filed November 25, 1998; effective February 8, 1999. Amendment filed February 15, 2000; effective April 30, 2000. Amendment filed September 13, 2002; effective November 27, 2002. Amendment filed May 24, 2004; effective August 7, 2004. Amendment filed April 20, 2006; effective July 4, 2006. Amendment filed February 23, 2007; effective May 9, 2007. Public necessity rule filed May 13, 2009; effective through October 25, 2009. Emergency rule filed October 22, 2009; effective through April 20, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Transferred to chapter 0720-26 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-25-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 39-17-1804, 39-17-1805, 68-3-511, 68-11-202, 68-11-204, 68-11-206, 68- 11-207, 68-11-209, 68-11-213, 68-11-254, 68-11-268, and 71-6-121.
• Administrative History: Original rule filed February 9, 1998; effective April 25, 1998. Amendment filed January 7, 2000; effective March 22, 2000. Public necessity rule filed May 13, 2009; effective through October 25, 2009. Emergency rule filed October 22, 2009; effective through April 20, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Amendment filed March 27, 2015; effective June 25, 2015. Amendments filed July 18, 2016; effective October 16, 2016. Emergency rules filed May 29, 2020; effective through November 25, 2020. Emergency rules expired effective November 26, 2020, and the rules reverted to their previous statuses. Transferred to chapter 0720-26 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-25-.07 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68- 11-261.
• Administrative History: Original rule filed February 9, 1998; effective April 25, 1998. Amendment filed November 25, 1999; effective February 8, 1999. Amendment filed August 26, 2002; effective November 9, 2002. Amendment filed February 18, 2003; effective May 4, 2003. Repeal and new rule filed January 24, 2006; effective April 9, 2006. Amendment filed February 23, 2007; effective May 9, 2007. Public necessity rule filed May 13, 2009; effective through October 25, 2009. Emergency rule filed October 22, 2009; effective through April 20, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Amendment filed March 27, 2015; effective June 25, 2015. Amendments filed July 10, 2018; effective October 8, 2018. Transferred to chapter 0720-26 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-25-.08 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201(5), 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68- 11-211, 68-11-263, and 68-11-266.
• Administrative History: Original rule filed February 9, 1998; effective April 25, 1998. Amendment filed January 7, 2000; effective March 22, 2000. Amendment filed February 18, 2003; effective May 4, 2003. Repeal and new rule filed January 24, 2006; effective April 9, 2006. Public necessity rule filed May 13, 2009; effective through October 25, 2009. Emergency rule filed October 22, 2009; effective through April 20, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Amendment filed March 27, 2015; effective June 25, 2015. Amendments filed July 10, 2018; effective October 8, 2018. Transferred to chapter 0720-26 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-25-.09 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-261.
• Administrative History: Original rule filed February 9, 1998; effective April 25, 1998. Public necessity rule filed May 13, 2009; effective through October 25, 2009. Emergency rule filed October 22, 2009; effective through April 20, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Amendments filed December 20, 2011; effective March 19, 2012. Amendment filed January 21, 2016; effective April 20, 2016. Transferred to chapter 0720-26 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-25-.10 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-207, 68-11-209, 68-11- 210, 68-11-211, and 68-11-213.
• Administrative History: Original rule filed February 9, 1998; effective April 25, 1998. Amendment filed April 11, 2003; effective June 25, 2003. Public necessity rule filed May 13, 2009; effective through October 25, 2009. Emergency rule filed October 22, 2009; effective through April 20, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Amendments filed July 10, 2018; effective October 8, 2018. Transferred to chapter 0720-26 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-25-.11 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed February 9, 1998; effective April 25, 1998. Public necessity rule filed May 13, 2009; effective through October 25, 2009. Emergency rule filed October 22, 2009; effective through April 20, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Transferred to chapter 0720-26 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-25-.12 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11- 224, and 68-11-1801 through 68-11-1815.
• Administrative History: Original rule filed February 9, 1998; effective April 25, 1998. Amendment filed April 28, 2003; effective July 12, 2003. Repeal and new rule filed January 24, 2006; effective April 9, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Public necessity rule filed May 13, 2009; effective through October 25, 2009. Emergency rule filed October 22, 2009; effective through April 20, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Transferred to chapter 0720-26 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-25-.13 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-211.
• Administrative History: Original rule filed February 9, 1998; effective April 25, 1998. Public necessity rule filed May 13, 2009; effective through October 25, 2009. Emergency rule filed October 22, 2009; effective through April 20, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Amendments filed January 3, 2012; effective April 2, 2012. Transferred to chapter 0720-26 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-25-.14 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, 68-11-224, and 68-11-1805.
• Administrative History: Original rule filed February 16, 2007; effective May 2, 2007. Public necessity rule filed May 13, 2009; effective through October 25, 2009. Emergency rule filed October 22, 2009; effective through April 20, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Transferred to chapter 0720-26 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-25-.15 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-209, 68-11-224, and 68-11-1801, et seq.
• Administrative History: Public necessity rule filed May 13, 2009; effective through October 25, 2009. Emergency rule filed October 22, 2009; effective through April 20, 2010. Amendment filed September 24, 2009; effective December 23, pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-25-.16 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-202 and 68-11-209.
• Administrative History: Public necessity rule filed May 13, 2009; effective through October 25, 2009. Emergency rule filed October 22, 2009; effective through April 20, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Transferred to chapter 0720-26 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-26 Transferred to 0720-27

Tenn. Comp. R. & Regs. 1200-08-26-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-11-106, 68-11-201, 68-11-202, 68-11-207, 68-11-209, 68-11- 210, 68-11-211, 68-11-213, 68-11-224, and 68-11-1802.
• Administrative History: Original rule filed May 31, 2000; effective August 14, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendment filed April 28, 2003; effective July 12, 2003. Amendment filed May 27, 2004; effective August 10, 2004. Amendments filed December 2, 2005; effective February 15, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Amendment filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Amendment filed September 15, 2015; effective December 14, 2015. Transferred to chapter 0720-27 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-26-.15 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, 68-11-224, and 68-11-1805.
• Administrative History: Original rule filed February 16, 2007; effective May 2, 2007. Repeal and new rule filed August 28, 2012; effective November 26, 2012. Amendment filed March 27, 2015; effective June pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-26-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-206(a)(5) [effective January 1, 2009], 68-11-209, 68-11-209(a)(1), 68-11-210, and 68-11-216 and Chapter 846 of the Public Acts of 2008, § 1.
• Administrative History: Original rule filed May 31, 2000; effective August 14, 2000. Amendment filed November 19, 2003; effective February 2, 2004. Amendment filed January 19, 2007; effective April 4, 2007. Public necessity rules filed April 29, 2009; effective through October 11, 2009. Emergency rules filed October 9, 2009; effective through April 7, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Amendment filed December 16, 2013; effective March 16, 2014. Amendments filed March 21, 2018; to have been effective June 19, 2018. However, on May 24, 2018, the Government Operations Committee filed a 5-day stay; new effective date June 24, 2018. Transferred to chapter 0720-27 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-26-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11-204, and 68-11-206 through 68-11-209.
• Administrative History: Original rule filed May 31, 2000; effective August pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-26-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-17-1803, 39-17-1805, 68-11-201, 68-11-202, 68-11-204, 68- 11-206, 68-11-209, 68-11-222, 68-11-268, and 71-6-121.
• Administrative History: Original rule filed May 31, 2000; effective August 14, 2000. Amendment filed June 18, 2002; effective September 1, 2002. Amendment filed April 20, 2006; effective July 4, 2006. Amendment filed July 18, 2007; effective October 1, 2007. Amendment filed February 22, 2010; effective May 23, 2010. Amendment filed March 27, 2015; effective June 25, 2015. Transferred to chapter 0720-27 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-26-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, and 68-11-209.
• Administrative History: Original rule filed May 31, 2000; effective August 14, 2000. Transferred to chapter 0720-27 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-26-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-3-511, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11- 260, and 68-11-304.
• Administrative History: Original rule filed May 31, 2000; effective August 14, 2000. Amendment filed September 13, 2002; effective November 27, 2002. Amendment filed February 23, 2007; effective May 9, 2007. Amendment filed September 15, 2015; effective December 14, 2015. Amendments filed July 18, 2016; effective October 16, 2016. Transferred to chapter 0720-27 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-26-.07 TRANSFERRED

Administrative History: Transferred to chapter 0720-27 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-26-.08 TRANSFERRED

Administrative History: Transferred to chapter 0720-27 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-26-.09 TRANSFERRED

Administrative History: Transferred to chapter 0720-27 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-26-.10 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, and 68-11-209.
• Administrative History: Original rule filed May 31, 2000; effective August 14, 2000. Transferred to chapter 0720-27 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-26-.11 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-207, 68-11-209, 68-11-210, 68-11-211, and 68- 11-213.
• Administrative History: Original rule filed May 31, 2000; effective August 14, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendments filed January 3, 2012; effective April 2, 2012. Transferred to chapter 0720-27 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-26-.12 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed May 31, 2000; effective August 14, 2000. Amendment filed June 18, 2002; effective September 1, 2002. Amendment filed December 2, 2005; effective February 15, 2006. Transferred to chapter 0720-27 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-26-.13 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-224, and 68- 11-1801 through 68-11-1815.
• Administrative History: Original rule filed May 31, 2000; effective August 14, 2000. Amendment filed April 28, 2003; effective July 12, 2003. Repeal and new rule filed December 2, 2005; effective February 15, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Amendments filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Transferred to chapter 0720-27 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-26-.14 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, and 68-11-209.
• Administrative History: Original rule filed May 31, 2000; effective August 14, 2000. Transferred to chapter 0720-27 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-27 Transferred to 0720-28

Tenn. Comp. R. & Regs. 1200-08-27-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-11-106, 68-11-201, 68-11-202, 68-11-204, 68-11-207, 68-11- 209, 68-11-210, 68-11-211, 68-11-213, 68-11-224, and 68-11-1802.
• Administrative History: Original rule filed April 17, 2000; effective July 1, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendment filed April 28, 2003; effective July 12, 2003. Amendments filed December 2, 2005; effective February 15, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Amendment filed December 23, 2009; effective March 23, 2010. Amendment filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Amendment filed September 15, 2015; effective December 14, 2015. Transferred to chapter 0720-28 pursuant to Public Chapter 1119 of 2022 eff ective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-27-.15 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, 68-11-224, and 68-11-1805.
• Administrative History: Original rule filed February 16, 2007; effective May 2, 2007. Repeal and new rule filed August 28, 2012; effective November 26, 2012. Amendment filed March 27, 2015; effective June pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-27-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-206(a)(5) [effective January 1, 2009], 68-11-209, 68-11-209(a)(1), 68-11-210, and 68-11-216 and Chapter 846 of the Public Acts of 2008, § 1.
• Administrative History: Original rule filed April 17, 2000; effective July 1, 2000. Amendment filed November 19, 2003; effective February 2, 2004. Amendment filed January 19, 2007; effective April 4, 2007. Public necessity rules filed April 29, 2009; effective through October 11, 2009. Emergency rules filed October 9, 2009; effective through April 7, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Amendment filed December 12, 2013; effective March 16, 2014. Amendments filed March 26, 2019; effective June 24, 2019. Transferred to chapter 0720-28 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-27-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11-204, and 68-11-206 through 68-11-209.
• Administrative History: Original rule filed April 25, 1996; effective July 9, 1996. Repeal and new rule filed April 17, 2000; effective July 1, 2000. Amendment filed March 1, 2007; effective May 15, 2007. Transferred to chapter 0720-28 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-27-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-17-1803, 39-17-1805, 68-11-201, 68-11-202, 68-11-204, 68- 11-206, 68-11-209, 68-11-222, 68-11-268, and 71-6-121.
• Administrative History: Original filed April 25, 1996; effective July 9, 1996. Repeal and new rule filed April 17, 2000; effective July 1, 2000. Amendment filed June 18, 2002; effective September 1, 2002. 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. Amendment filed February 22, 2010; effective May 23, 2010. Transferred to chapter 0720-28 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-27-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, and 68-11-209.
• Administrative History: Original rule filed April 17, 2000; effective July 1, 2000. Amendment filed December 23, 2009; effective March 23, 2010. Transferred to chapter 0720-28 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-27-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-3-511, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11- 260, and 68-11-304.
• Administrative History: Original rule filed April 17, 2000; effective July 1, 2000. Amendment filed September 13, 2002; effective November 27, 2002. Amendment filed February 23, 2007; effective May 9, 2007. Amendments filed March 27, 2015; effective June 25, 2015. Amendment filed September 15, 2015; effective December 14, 2015. Amendments filed July 18, 2016; effective October 16, 2016. Transferred to chapter 0720-28 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-27-.07 TRANSFERRED

Administrative History: Transferred to chapter 0720-28 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-27-.08 TRANSFERRED

Administrative History: Transferred to chapter 0720-28 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-27-.09 TRANSFERRED

Administrative History: Transferred to chapter 0720-28 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-27-.10 TRANSFERRED

History

• Authority: T. C.A. §§ 4-5-202, 4-5-204, 68-11-202, and 68-11-209.
• Administrative History: Original rule filed April 17, 2000; effective July 1, 2000. Transferred to chapter 0720-28 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-27-.11 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-207, 68-11-209, 68-11-210, 68-11-211, and 68- 11-213.
• Administrative History: Original rule filed April 17, 2000; effective July 1, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendments filed January 3, 2012; effective April 2, 2012. Transferred to chapter 0720-28 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-27-.12 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed April 17, 2000; effective July 1, 2000. Amendment filed June 18, 2002; effective September 1, 2002. Amendment filed December 2, 2005; effective February 15, 2006. Transferred to chapter 0720-28 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-27-.13 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-224, and 68- 11-1801 through 68-11-1815.
• Administrative History: Original rule filed April 17, 2000; effective July 1, 2000. Amendment filed April 28, 2003; effective July 12, 2003. Repeal and new rule filed December 2, 2005; effective February 15, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Amendments filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Transferred to chapter 0720-28 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-27-.14 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, and 68-11-209.
• Administrative History: Original rule filed April 17, 2000; effective July 1, 2000. Transferred to chapter 0720-28 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-28 Transferred to 0720-29

Tenn. Comp. R. & Regs. 1200-08-28-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-11-106, 68-11-202, 68-11-204, 68-11-206, 68-11-207, 68-11- 209, 68-11-210, 68-11-211, 68-11-213, 68-11-216, 68-11-224, and 68-11-1802.
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendment filed April 28, 2003; effective July 12, 2003. Amendments filed December 15, 2005; effective February 28, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Amendment filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Amendment filed September 15, 2015; effective December 14, 2015. Transferred to chapter 0720-29 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-28-.15 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, 68-11-224, and 68-11-1805.
• Administrative History: Original rule filed February 16, 2007; effective May 2, 2007. Repeal and new rule filed August 28, 2012; effective November 26, 2012. Amendment filed March 27, 2015; effective June pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-28-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-206(a)(5), 68-11-209, 68-11-209(a)(1), 68-11-210, and 68-11-216 and Chapter 846 of the Public Acts of 2008, § 1.
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed November 19, 2003; effective February 2, 2004. Amendment filed January 19, 2007; effective April 4, 2007. Public necessity rules filed April 29, 2009; effective through October 11, 2009. Emergency rules filed October 9, 2009; effective through April 7, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Amendment filed December 16, 2013; effective March 16, 2014. Amendments filed March 26, 2019; effective June 24, 2019. Transferred to chapter 0720-29 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-28-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11-204, 68-11- 206, 68-11-207, 68-11-208, and 68-11-209.
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed March 1, 2007; effective May 15, 2007. Transferred to chapter 0720-29 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-28-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-17-1803, 39-17-1805, 68-11-201, 68-11-202, 68-11-204, 68- 11-206, 68-11-209, 68-11-268, and 71-6-121.
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed June 18, 2002; September 1, 2002. Amendment filed April 20, 2006; effective July 4, 2006. Amendment filed July 18, 2007; effective October 1, 2007. Amendment filed February 22, 2010; effective May 23, 2010. Transferred to chapter 0720-29 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-28-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 71- 6-121.
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 20, 2006; effective July 4, 2006. Transferred to chapter 0720-29 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-28-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed September 15, 2015; effective December 14, 2015. Amendments filed July 18, 2016; effective October 16, 2016. Transferred to chapter 0720-29 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-28-.07 TRANSFERRED

Administrative History: Transferred to chapter 0720-29 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-28-.08 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-261.
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed February 18, 2003; effective May 4, 2003. Repeal and new rule filed December 15, 2005; effective February 28, 2006. Amendment filed February 23, 2007; effective May 9, 2007. Repeal and new rule filed December 20, 2011; effective March 19, 2012. Amendment filed January 21, 2016; effective April 20, 2016. Transferred to chapter 0720-29 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-28-.09 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Repeal and new rule filed December 15, 2005; effective February 28, 2006. Transferred to chapter 0720-29 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-28-.10 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Transferred to chapter 0720-29 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-28-.11 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-207, 68-11-209, 68-11- 210, 68-11-211, 68-11-213, and 68-11-216.
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendments filed January 3, 2012; effective April 2, 2012. Transferred to chapter 0720-29 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-28-.12 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed June 18, 2002; September 1, 2002. Amendment filed December 15, 2005; effective February 28, 2006. Transferred to chapter 0720-29 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-28-.13 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-224, and 68- 11-1801 through 68-11-1815.
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 28, 2003; effective July 12, 2003. Repeal and new rule filed December 15, 2005; effective February 28, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Amendments filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Transferred to chapter 0720-29 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-28-.14 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed December 15, 2005; effective February 28, 2006. Transferred to chapter 0720-29 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-29 Transferred to 0720-30

Tenn. Comp. R. & Regs. 1200-08-29-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-207, 68-11-209, 68-11- 210, 68-11-211, 68-11-213, 68-11-224, 68-11-226, 68-11-268, and 68-11-303.
• Administrative History: Original rule filed August 24, 2000; effective November 7, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendment filed April 28, 2003; effective July 12, 2003. Amendment filed May 27, 2004; effective August 10, 2004. Amendment filed June 25, 2007; effective September 8, 2007. Amendment filed October 11, 2007; effective December 25, 2007. Amendments filed December 23, 2009; effective March 23, 2010. Amendment filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Amendments filed January 7, 2019; to have become effective April 7, 2019. However, the Government Operations Committee filed a 60-day stay of the effective date of the rules; new effective date June 6, 2019. Transferred to chapter 0720-30 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-29-.14 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, and 68-11-209.
• Administrative History: Original rule filed August 24, 2000; effective November 7, 2000. Transferred to chapter 0720-30 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-29-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-206(a)(5), 68-11-209, 68-11-209(a)(1), 68-11-210, and 68-11-216 and Chapter 846 of the Public Acts of 2008, § 1.
• Administrative History: Original rule filed August 24, 2000; effective November 7, 2000. Amendment filed November 19, 2003; effective February 2, 2004. Amendment filed January 19, 2007; effective April 4, 2007. Public necessity rules filed April 29, 2009; effective through October 11, 2009. Emergency rules filed October 9, 2009; effective through April 7, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Amendment filed February 22, 2010; effective May 23, 2010. Amendment filed December 16, 2013; effective March 16, 2014. Amendments filed March 26, 2019; effective June 24, 2019. Transferred to chapter 0720-30 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-29-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11-204, and 68-11-206 through 68-11-209.
• Administrative History: Original rule filed August 24, 2000; effective November 7, 2000. Amendment filed March 1, 2007; effective May 15, 2007. Transferred to chapter 0720-30 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-29-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-17-1803, 39-17-1805, 68-11-201, 68-11-202, 68-11-204, 68- 11-206, 68-11-209, 68-1-222, 68-11-226, 68-11-268, and 71-6-121.
• Administrative History: Original rule filed August 24, 2000; effective November 7, 2000. Amendment filed April 20, 2006; effective July 4, 2006. Amendment filed June 25, 2007; effective September 8, 2007. Amendment filed July 18, 2007; effective October 1, 2007. Amendment filed February 22, 2010; effective May 23, 2010. Amendment filed March 27, 2015; effective June 25, 2015. Transferred to chapter 0720-30 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-29-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, and 68-11-209.
• Administrative History: Original rule filed August 24, 2000; effective November 7, 2000. Amendment filed June 25, 2007; effective September 8, 2007. Transferred to chapter 0720-30 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-29-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-206, 68-11-209, 68-11-226, and 68-11-304.
• Administrative History: Original rule filed August 24, 2000; effective November 7, 2000. Amendment filed October 11, 2007; effective December 25, 2007. Amendment filed December 23, 2009; effective March 16, 2010. Amendment filed December 16, 2013; effective March 16, 2014. Amendments filed July 18, 2016; effective October 16, 2016. Amendments filed January 7, 2019; to have become effective April 7, 2019. However, the Government Operations Committee filed a 60-day stay of the effective date of the rules; new effective date June 6, 2019. Transferred to chapter 0720-30 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-29-.07 TRANSFERRED

Administrative History: Transferred to chapter 0720-30 pursuant to Public Chapter 1119 of 2022 eff ective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-29-.08 TRANSFERRED

Administrative History: Transferred to chapter 0720-30 pursuant to Public Chapter 1119 of 2022 eff ective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-29-.09 TRANSFERRED

Administrative History: Transferred to chapter 0720-30 pursuant to Public Chapter 1119 of 2022 eff ective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-29-.10 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, and 68-11-209.
• Administrative History: Original rule filed August 24, 2000; effective November 7, 2000. Transferred to chapter 0720-30 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-29-.11 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-209, 68-11-211, and 68-11-260.
• Administrative History: Original rule filed August 24, 2000; effective November 7, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendment filed September 1, 2004; effective November 15, 2004. Amendment filed February 23, 2007; effective May 9, 2007. Amendments filed January 3, 2012; effective April 2, 2012. Amendments filed January 7, 2019; to have become effective April 7, 2019. However, the Government Operations Committee filed a 60-day stay of the effective date of the rules; new effective date June 6, 2019. Transferred to chapter 0720-30 pursuant to Public Chapter 1119 of 2022 eff ective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-29-.12 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, and 68-11-209.
• Administrative History: Original rule filed August 24, 2000; effective November 7, 2000. Transferred to chapter 0720-30 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-29-.13 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-224.
• Administrative History: Original rule filed August 24, 2000; effective November 7, 2000. Amendment filed April 28, 2003; effective July 12, 2003. Repeal filed September 1, 2004; effective November 15, 2004. Transferred to chapter 0720-30 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-30 Transferred to 0720-31

Tenn. Comp. R. & Regs. 1200-08-30-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-209, and 68-11-251.
• Administrative History: Original rule filed November 30, 1999; effective February 6, 2000. Amendment filed October 15, 2002; effective December 29, 2002. Amendment filed August 16, 2006; effective October 30, 2006. Amendment filed December 4, 2007; effective February 17, 2008. Amendment filed March 27, 2015; effective June 25, 2015. Transferred to chapter 0720-31 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-30-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-206, 68-11-209, and 68-11-251.
• Administrative History: Original rule filed November 30, 1999; effective February 6, 2000. Amendment filed October 15, 2002; effective December 29, 2002. Amendment filed December 4, 2007; effective February 17, 2008. Amendments filed July 18, 2016; effective October 16, 2016. Transferred to chapter 0720-31 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022. 1200-08-30-TABLE 1 TRANSFERRED. Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-209, and 68-11-251.

Tenn. Comp. R. & Regs. 1200-08-30-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-251.
• Administrative History: Original rule filed November 30, 1999; effective February 6, 2000. Transferred to chapter 0720-31 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-30-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-209, and 68-11-251.
• Administrative History: Original rule filed November 30, 1999; effective February 6, 2000. Amendment filed October 15, 2002; effective December 29, 2002. Amendment filed August 16, 2006; effective October 30, 2006. Amendment filed December 4, 2007; effective February 17, 2008. Transferred to chapter 0720-31 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-30-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-209, and 68-11-251.
• Administrative History: pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-31 Transferred to 0720-32

Tenn. Comp. R. & Regs. 1200-08-31-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-827, and 68- 11-832.
• Administrative History: Original rule filed May 17, 2000; effective July 31, 2000. Transferred to chapter 0720-32 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-31-.10 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-827, and 68- 11-832.
• Administrative History: Original rule filed May 17, 2000; effective July 31, 2000. Transferred to chapter 0720-32 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-31-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-827, and 68- 11-832. Administrative History Original rule filed May 17, 2000; effective July 31, 2000. Transferred to chapter 0720-32 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-31-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-827, and 68- 11-832.
• Administrative History: Original rule filed May 17, 2000; effective July 31, 2000. Transferred to chapter 0720-32 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-31-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-827, and 68- 11-832.
• Administrative History: Original rule filed May 17, 2000; effective July 31, 2000. Transferred to chapter 0720-32 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-31-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-827, and 68- 11-832.
• Administrative History: Original rule filed May 17, 2000; effective July 31, 2000. Transferred to chapter 0720-32 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-31-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-827, and 68- 11-832.
• Administrative History: Original rule filed May 17, 2000; effective July 31, 2000. Transferred to chapter 0720-32 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-31-.07 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-827, and 68- 11-832.
• Administrative History: Original rule filed May 17, 2000; effective July 31, 2000. Transferred to chapter 0720-32 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-31-.08 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-827, and 68- 11-832.
• Administrative History: Original rule filed May 17, 2000; effective July 31, 2000. Transferred to chapter 0720-32 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-31-.09 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-827, and 68- 11-832.
• Administrative History: Original rule filed May 17, 2000; effective July 31, 2000. Transferred to chapter 0720-32 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-32 Transferred to 0720-33

Tenn. Comp. R. & Regs. 1200-08-32-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-11-106, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11- 211, 68-11-224, and 68-11-1802.
• Administrative History: Original rule filed April 22, 2003; effective July 6, 2003. Amendment filed April 28, 2003; effective July 12, 2003. Amendments filed December 15, 2005; effective February 28, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Amendment filed December 9, 2010 to have been effective March 9, 2011 was stayed for 28 days by the Government Operations Committee; new effective date March 29, 2011. Amendment filed January 3, 2012; effective pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-32-.15 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, 68-11-224, and 68-11-1805.
• Administrative History: Original rule filed February 16, 2007; effective May 2, 2007. Repeal and new rule filed August 28, 2012; effective November 26, 2012. Amendment filed March 27, 2015; effective June pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-32-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-206(a)(5) [effective January 1, 2009], 68-11-209, 68-11-209(a)(1), 68-11-210, and 68-11-216 and Chapter 846 of the Public Acts of 2008, § 1.
• Administrative History: Original rule filed April 22, 2003; effective July 6, 2003. Amendment file January 19, 2007; effective April 4, 2007. Amendment filed July 18, 2007; effective October 1, 2007. Public necessity rules filed April 29, 2009; effective through October 11, 2009. Emergency rules filed October 9, 2009; effective through April 7, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Amendment filed December 16, 2013; effective March 16, 2014. Amendments filed March 26, 2019; effective June 24, 2019. Transferred to chapter 0720-33 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-32-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11-204, 68-11- 206, 68-11-207, 68-11-208, and 68-11-209.
• Administrative History: Original rule filed April 22, 2003; effective July 6, 2003. Amendment filed March 1, 2007; effective May 15, 2007. Transferred to chapter 0720-33 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-32-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-17-1803, 39-17-1805, 68-11-201, 68-11-202, 68-11-204, 68- 11-206, 68-11-209, 68-11-268, and 71-6-121.
• Administrative History: Original rule filed April 22, 2003; effective July 6, 2003. Amendment filed April 20, 2006; effective July 4, 2006. Amendment filed July 18, 2007; effective October 1, 2007. Amendment filed December 9, 2010 to have been effective March 9, 2011 was stayed for 28 days by the Government Operations Committee; new effective date March 29, pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-32-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-210.
• Administrative History: Original rule filed April 22, 2003; effective July 6, 2003. Transferred to chapter 0720-33 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-32-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed April 22, 2003; effective July 6, 2003. Amendment filed December 15, 2005; effective February 28, 2006. Amendment filed December 9, 2010 to have been effective March 9, 2011 was stayed for 28 days by the Government Operations Committee; new effective date March 29, 2011. Transferred to chapter 0720-33 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-32-.07 TRANSFERRED

Administrative History: Transferred to chapter 0720-33 pursuant to Public Chapter 1119 of 2022 eff ective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-32-.08 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed April 22, 2003; effective July 6, 2003. Repeal and new rule filed December 15, 2005; effective February 28, 2006. Repeal and new rule filed December 20, 2011; effective March 19, 2012. Amendment filed January 21, 2016; effective April 20, 2016. Transferred to chapter 0720-33 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-32-.09 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed April 22, 2003; effective July 6, 2003. Repeal and new rule filed December 15, 2005; effective February 28, 2006. Transferred to chapter 0720-33 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-32-.10 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202 through 4-5-206, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed April 22, 2003; effective July 6, 2003. Transferred to chapter 0720-33 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-32-.11 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-210, and 68- 11-211.
• Administrative History: Original rule filed April 22, 2003; effective July 6, 2003. Amendments filed January 3, 2012; effective April 2, 2012. Transferred to chapter 0720-33 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-32-.12 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed April 22, 2003; effective July 6, 2003. Amendment filed December 15, 2005; effective February 28, 2006. Transferred to chapter 0720-33 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-32-.13 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-224, and 68- 11-1801 through 68-11-1815.
• Administrative History: Original rule filed April 22, 2003; effective July 6, 2003. Amendment filed April 28, 2003; effective July 12, 2003. Repeal and new rule filed December 15, 2005; effective February 28, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Amendments filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Transferred to chapter 0720-33 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-32-.14 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Original rule filed April 22, 2003; effective July 6, 2003. Transferred to chapter 0720-33 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-33 Transferred to 0720-34

Tenn. Comp. R. & Regs. 1200-08-33-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 56-7-2355, 56-32-202, 56-32-203, 56-32-215, 56-32-218, and 68- 1-103.
• Administrative History: Original rules filed April 14, 2003; effective June 28, 2003. Transferred to chapter 0720-34 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-33-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 56-32-215, 56-32-218, 63-51-119, and 68-1-103. Administrative pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-33-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 56-32-203, 56-32-204, 56-32-215, 56-32-218, and 68-1-103.
• Administrative History: Original rules filed April 14, 2003; effective June 28, 2003. Transferred to chapter 0720-34 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-33-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 56-32-203, 56-32-215, 56-32-218, and 68-1-103. Administrative pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-33-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 56-32-215, 56-32-218, and 68-1-103.
• Administrative History: Original rules filed April 14, 2003; effective June 28, 2003. Transferred to chapter 0720-34 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-33-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 56-32-215, 56-32-218, and 68-1-103.
• Administrative History: Original rules filed April 14, 2003; effective June 28, 2003. Transferred to chapter 0720-34 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-34 Transferred to 0720-35

Tenn. Comp. R. & Regs. 1200-08-34-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-11-106, 68-11-201, 68-11-202, 68-11-207, 68-11-209, 68-11- 210, 68-11-211, 68-11-213, 68-11-224, and 68-11-1802.
• Administrative History: Original rule filed January 24, 2003; effective April 9, 2003. Amendments filed December 2, 2005; effective February 15, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Amendment filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Amendment filed September 15, 2015; effective December 14, 2015. Transferred to chapter 0720-35 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-34-.14 TRANSFERRED

Administrative History: Transferred to chapter 0720-35 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-34-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-206(a)(5), 68-11-209, 68-11-209(a)(1), 68-11-210, and 68-11-216 and Chapter 846 of the Public Acts of 2008, § 1.
• Administrative History: Original rule filed January 24, 2003; effective April 9, 2003. Amendment filed May 27, 2004; effective August 10, 2004. Amendment filed January 19, 2007; effective April 4, 2007. Amendment filed July 18, 2007; effective October 1, 2007. Public necessity rules filed April 29, 2009; effective through October 11, 2009. Emergency rules filed October 9, 2009; effective through April 7, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Amendment filed December 16, 2013; effective March 16, 2014. Amendments filed January 7, 2019; to have become effective April 7, 2019. However, the Government Operations Committee filed a 60-day stay of the effective date of the rules; new effective date June 6, 2019. Amendments filed March 26, 2019; effective June 24, 2019. Transferred to chapter 0720-35 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-34-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11-204, and 68-11-206 through 68-11-209.
• Administrative History: Original rule filed January 24, 2003; effective pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-34-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-17-1803, 39-17-1805, 68-11-201, 68-11-202, 68-11-204, 68- 11-206, 68-11-209, 68-11-222, 68-11-268, and 71-6-121.
• Administrative History: Original rule filed January 24, 2003; effective April 9, 2003. Amendment filed April 17, 2007; effective July 1, 2007. Amendment filed July 18, 2007; effective October 1, 2007. Amendment filed February 22, 2010; effective pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-34-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, and 68-11-209.
• Administrative History: Original rule filed January 24, 2003; effective April 9, 2003. Amendments filed July 10, 2018; effective October 8, 2018. Transferred to chapter 0720-35 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-34-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-206, 68-11-209, and 68-11-304.
• Administrative History: Original rule filed January 24, 2003; effective April 9, 2003. Amendment filed September 15, 2015; effective December 14, 2015. Amendments filed July 18, 2016; effective October pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-34-.07 TRANSFERRED

Administrative History: Transferred to chapter 0720-35 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-34-.08 TRANSFERRED

Administrative History: Transferred to chapter 0720-35 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-34-.09 TRANSFERRED

Administrative History: Transferred to chapter 0720-35 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-34-.10 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, and 68-11-209.
• Administrative History: Original rule filed January 24, 2003; effective April 9, 2003. Transferred to chapter 0720-35 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-34-.11 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-207, 68-11-209, 68-11-210, and 68-11-211.
• Administrative History: Original rule filed January 24, 2003; effective April 9, 2003. Amendments filed January 3, 2012; effective April 2, 2012. Transferred to chapter 0720-35 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-34-.12 TRANSFERRED

Administrative History: Transferred to chapter 0720-35 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-34-.13 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-224, and 68- 11-1801 through 68-11-1815.
• Administrative History: Original rule filed December 2, 2005; effective February 15, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Amendment filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Transferred to chapter 0720-35 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-34-.15 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, 68-11-224, and 68-11-1805.
• Administrative History: Original rule filed February 16, 2007; effective May 2, 2007. Repeal and new rule filed August 28, 2012; effective November 26, 2012. Amendment filed March 27, 2015; effective June pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-35 Transferred to 0720-36

Tenn. Comp. R. & Regs. 1200-08-35-.15 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, 68-11-224, and 68-11-1805.
• Administrative History: Original rule filed August 28, 2012; effective November 26, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Amendments filed February 8, 2017; effective May 9, 2017. Transferred to chapter 0720-36 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-35-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11- 211, 68-11-216, 68-11-224, and 68-11-1802.
• Administrative History: Original rule filed October 26, 2005; effective January 9, 2006. Amendment filed February 23, 2007; effective May 9, 2007. Amendment filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Transferred to chapter 0720-36 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-35-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206(a)(5), 68-11-206, 68-11-209, 68-11-209(a)(1), 68-11-210, and 68-11-216 and Chapter 846 of the Public Acts of 2008, § 1.
• Administrative History: Original rule filed October 26, 2005; effective January 9, 2006. Amendment filed January 19, 2007; effective April 4, 2007. Amendment filed July 18, 2007; effective October 1, 2007. Public necessity rules filed April 29, 2009; effective through October 11, 2009. Emergency rules filed October 9, 2009; effective through April 7, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Amendment filed December 16, 2013; effective March 16, 2014. Amendments filed March 26, 2019; effective June 24, 2019. Transferred to chapter 0720-36 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-35-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-219, 4-5-312, 4-5-316, 4-5-317, 68-11-202, 68-11-204, 68-11- 206, 68-11-207, 68-11-208, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed October 26, 2005; effective January 9, 2006. Amendment filed March 1, 2007; effective May 15, 2007. Transferred to chapter 0720-36 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-35-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 39-17-1803, 39-17-1805, 68-11-202, 68-11-204, 68-11-206, 68- 11-209, 68-11-216, 68-11-268, and 71-6-121.
• Administrative History: Original rule filed October 26, 2005; effective January 9, 2006. Amendment filed July 18, 2007; effective October 1, 2007. Amendment filed February 22, 2010; effective May 23, 2010. Tr ansferred to chapter 0720-36 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-35-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed October 26, 2005; effective January 9, 2006. Transferred to chapter 0720-36 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-35-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed October 26, 2005; effective January 9, 2006. Amendment filed October 20, 2015; effective January 18, 2016. Amendments filed July 18, 2016; effective October 16, 2016. Transferred to chapter 0720-36 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-35-.07 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed October 26, 2005; effective January 9, 2006. Transferred to chapter 0720-36 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-35-.08 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed October 26, 2005; effective January 9, 2006. Repeal and new rule filed December 20, 2011; effective March 19, 2012. Amendment filed January 21, 2016; effective April 20, 2016. Transferred to chapter 0720-36 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-35-.09 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed October 26, 2005; effective January 9, 2006. Transferred to chapter 0720-36 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-35-.10 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed October 26, 2005; effective January 9, 2006. Transferred to chapter 0720-36 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-35-.11 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-1-1004, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11- 211, and 68-11-216.
• Administrative History: Original rule filed October 26, 2005; effective January 9, pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-35-.12 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed October 26, 2005; effective January 9, 2006. Transferred to chapter 0720-36 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-35-.13 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-224, 68-11- 1803, 68-11-1804, 68-11-1805, 68-11-1806 through 68-11-1810, 68-11-1813, and 68-11-1814.
• Administrative History: Original rule filed October 26, 2005; effective January 9, 2006. Amendments filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Transferred to chapter 0720-36 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-35-.14 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed October 26, 2005; effective January 9, 2006. Transferred to chapter 0720-36 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-36 Transferred to 0720-37

Tenn. Comp. R. & Regs. 1200-08-36-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-201 and 68-11-209.
• Administrative History: Emergency rule filed November 2, 2010; effective through May 1, 2011. New rule filed January 28, 2011; effective April 28, 2011. Amendment filed March 27, 2015; effective June 27, 2015. Transferred to chapter 0720-37 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-36-.18 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-204, 68-11-209, 68-11-224, and 68-11-1805.
• Administrative History: Emergency rule filed November 2, 2010; effective through May 1, 2011. New rule filed January 28, 2011; effective April 28, 2011. Repeal and new rule filed August 28, 2012; effective November 26, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Amendments filed February 8, 2017; effective May 9, 2017. Transferred to chapter 0720-37 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-36-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-201, 68-11-202, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Emergency rule filed November 2, 2010; effective through May 1, 2011. New rule filed January 28, 2010; effective April 28, 2011. Amendment filed December 16, 2013; effective March 16, 2014. Transferred to chapter 0720-37 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-36-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-209 and 68-11-216.
• Administrative History: Emergency rule filed November 2, 2010; effective through May 1, 2011. New rule filed January 28, 2011; effective April 28, 2011. Amendments filed March 26, 2019; effective June 24, 2019. Transferred to chapter 0720-37 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-36-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-207, 68-11-209, 68-11-210, and 68-11-213.
• Administrative History: Emergency rule filed November 2, 2010; effective through May 1, 2011. New rule filed January 28, 2011; effective April 28, 2011. Transferred to chapter 0720-37 pursuant to Public Chapter 1119 of 2022 eff ective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-36-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 39-17-1804, 68-11-202, 68-11-206, 68-11-207, 68-11-209, 68-11-268, 68-11-270, and 71-6-121.
• Administrative History: Emergency rule filed November 2, 2010; effective through May 1, 2011. New rule filed January 28, 2011; effective April 28, 2011. Amendments filed July 18, 2016; effective October 16, 2016. Transferred to chapter 0720-37 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-36-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-206, 68-11-209, and 68-11-270.
• Administrative History: Emergency rule filed November 2, 2010; effective through May 1, 2011. New rule filed January 28, 2011; effective April pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-36-.07 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-201, 68-11-202, 68-11-206, 68-11-209, and 68-11-270.
• Administrative History: Emergency rule filed November 2, 2010; effective through May 1, 2011. New rule filed January 28, 2010; effective April 28, 2011. Amendment filed March 27, 2015; effective June 25, 2015. Transferred to chapter 0720-37 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-36-.08 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-206, 68-11-209, and 68-11-270.
• Administrative History: Emergency rule filed November 2, 2010; effective through May 1, 2011. New rule filed January 28, 2011; effective April 28, 2011. Transferred to chapter 0720-37 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-36-.09 TRANSFERRED

History

• Authority: T.C.A. § 68-11-209.
• Administrative History: Emergency rule filed November 2, 2010; effective through May 1, 2011. New rule filed January 28, 2011; effective April 28, 2011. Transferred to chapter 0720-37 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-36-.10 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-202 and 68-11-209.
• Administrative History: Emergency rule filed November 2, 2010; effective through May 1, 2011. New rule filed January 28, 2011; effective April 28, 2011. Transferred to chapter 0720-37 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-36-.11 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-202, 68-11-204, 68-11-206, and 68-11-209.
• Administrative History: Emergency rule filed November 2, 2010; effective through May 1, 2011. New rule filed January 28, 2011; effective April 28, 2011. Amendment filed January 21, 2016; effective April 20, 2016. Transferred to chapter 0720-37 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-36-.12 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-202 and 68-11-209.
• Administrative History: Emergency rule filed November 2, 2010; effective through May 1, 2011. New rule filed January 28, 2011; effective April 28, 2011. Transferred to chapter 0720-37 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-36-.13 TRANSFERRED

History

• Authority: T.C.A. § 68-11-209.
• Administrative History: Emergency rule filed November 2, 2010; effective through May 1, 2011. New rule filed January 28, 2011; effective April 28, 2011. Transferred to chapter 0720-37 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-36-.14 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-209 and 68-11-211.
• Administrative History: Emergency rule filed November 2, 2010; effective through May 1, 2011. New rule filed January 28, 2011; effective April 28, 2011. Transferred to chapter 0720-37 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-36-.15 TRANSFERRED

History

• Authority: T.C.A. § 68-11-209.
• Administrative History: Emergency rule filed November 2, 2010; effective through May 1, 2011. New rule filed January 28, 2011; effective April 28, 2011. Transferred to chapter 0720-37 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-36-.16 TRANSFERRED

History

• Authority: T.C.A §§ 68-11-209, 68-11-224, and 68-11-1801, et seq.
• Administrative History: Emergency rule filed November 2, 2010; effective through May 1, 2011. New rule filed January 28, 2011; effective pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-36-.17 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-209.
• Administrative History: Emergency rule filed November 2, 2010; effective through May 1, 2011. New rule filed January 28, 2011; effective April 28, 2011. Transferred to chapter 0720-37 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-37 Transferred to 0720-38

Tenn. Comp. R. & Regs. 1200-08-37-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-201, 68-11-202, and 68-11-273.
• Administrative History: Original rule filed October 28, 2015; effective January 26, 2016. Amendments filed March 26, 2019; effective June 24, 2019. Transferred to chapter 0720-38 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-37-.18 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-209, 68-11-224, and 68-11-1801, et seq.
• Administrative History: Original rule filed October 28, 2015; effective January 26, 2016. Transferred to chapter 0720-38 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-37-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-201, 68-11-202, 68-11-206, 68-11-209, 68-11-210, 68-11-270, and 68-11- 273.
• Administrative History: Original rule filed October 28, 2015; effective January 26, 2016. Amendments filed March 26, 2019; effective June 24, 2019. Transferred to chapter 0720-38 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-37-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-202, 68-11-216, and 68-11-273.
• Administrative History: Original rule filed October 28, 2015; effective January 26, 2016. Amendments filed March 26, 2019; effective June 24, 2019. Transferred to chapter 0720-38 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-37-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-202, 68-11-207, 68-11-209, 68-11-210, 68-11-213, and 68-11-273.
• Administrative History: Original rule filed October 28, 2015; effective January 26, 2016. Transferred to chapter 0720-38 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-37-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 39-17-1804, 39-17-1805, 68-11-202, 68-11-206, 68-11-207, 68-11-209, 68-11-268, 68-11-269, 68-11-270, 68-11-271, and 68-11-273.
• Administrative History: Original rule filed October 28, 2015; effective January 26, 2016. Transferred to chapter 0720-38 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-37-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-202, 68-11-206, 68-11-209, 68-11-270, 68-11-273, and 68-11-274.
• Administrative History: Original rule filed October 28, 2015; effective January 26, 2016. Transferred to chapter 0720-38 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-37-.07 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-202, 68-11-206, 68-11-209, 68-11-270, and 68-11-273.
• Administrative History: Original rule filed October 28, 2015; effective January 26, 2016. Amendments filed March 26, 2019; effective June 24, 2019. Transferred to chapter 0720-38 pursuant to Public Chapter 1119 of 2022 eff ective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-36-.08 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-202, 68-11-206, 68-11-209, 68-11-270, and 68-11-273. Administrative pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-37-.09 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-202, 68-11-206, 68-11-209, 68-11-270, and 68-11-273. Administrative pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-37-.10 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-202, 68-11-206, 68-11-209, 68-11-270, and 68-11-273. Administrative pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-37-.11 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-202, 68-11-206, 68-11-209, 68-11-270, and 68-11-273. Administrative pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-37-.12 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-202, 68-11-206, 68-11-209, 68-11-270, and 68-11-273. Administrative pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-37-.13 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-202, 68-11-206, 68-11-209, 68-11-270, and 68-11-273. Administrative pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-37-.14 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-202, 68-11-209, 68-11-211, 68-11-270, and 68-11-273. Administrative pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-37-.15 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-206, 68-11-207, 68-11-209, 68-11-270, and 68-11-273. Administrative pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-37-.16 TRANSFERRED

History

• Authority: T.C.A §§ 68-11-209, 68-11-224, and 68-11-1801, et seq.
• Administrative History: Original rule filed October 28, 2015; effective January 26, 2016. Transferred to chapter 0720-38 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-37-.17 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-202, 68-11-206, 68-11-209, 68-11-270, and 68-11-273. Administrative pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-08-38 Transferred to 0720-39

Tenn. Comp. R. & Regs. 1200-08-38-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-1001, et seq.
• Administrative History: Original rules filed September 28, 2016; effective December 27, 2016. Transferred to chapter 0720-39 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-38-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-1003(g) and 42 U.S.C.A. § 1396r.
• Administrative History: Original rules filed September 28, 2016; effective December 27, 2016. Transferred to chapter 0720-39 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-38-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-1001, et seq.
• Administrative History: Original rules filed September 28, 2016; effective December 27, 2016. Transferred to chapter 0720-39 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-38-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 63-11-211 and 68-11-1001, et seq.; and 42 C.F.R. § 488.332.
• Administrative History: Original rules filed September 28, 2016; effective December 27, 2016. Transferred to chapter 0720-39 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-38-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 68-11-211 and 68-11-1003 and 42 U.S.C.A. § 5106a.
• Administrative History: pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-08-38-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-301, et seq., 4-5-315, 4-5-316, 4-5-317, 4-5-322, and 68-11-1003; T.C.A. Title 4, Chapter 5, Part 3; Tenn. Comp. R. & Regs. 1360-04-01-.01, et seq; and 42 C.F.R. § 488.335(d).
• Administrative History: Original rules filed September 28, 2016; effective December 27, 2016. Transferred to chapter 0720-39 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-09-01 Repealed

Tenn. Comp. R. & Regs. 1200-09-01 Repealed

RULES

OF THE TENNESSEE DEPARTMENT OF HEALTH

BUREAU OF MANPOWER AND FACILITIES

DIVISION OF HEALTH PLANNING

Authority: T.C.A. §§4-5-202, 53-4006, and 68-1-103. Administrative History: Original Chapter filed April 3, 1974; effective May 3, 1974. Repeal filed November 29, 1999; effective March 29, 2000.

1200-10 Division of Health Related Boards

Chapter 1200-10-01 General Rules and Regulations

Tenn. Comp. R. & Regs. 1200-10-01-.01 GENERAL DEFINITIONS

(1) Commissioner - shall mean the Commissioner of the Tennessee Department of Health.

(2) Department - shall mean the Tennessee Department of Health.

(3) Division Of Health Related Boards - shall mean the Administrative Office established by the Commissioner for the control of all administrative, fiscal, inspectional, clerical and secretarial functions of the following Boards, Councils and Committees:

(a) Board of Chiropractic Examiners (b) Board of Communications Disorders and Sciences (c) Board of Dentistry (d) Board of Dietitian/Nutritionist Examiners (e) Board of Dispensing Opticians (f) Board of Electrolysis Examiners (g) Board of Medical Examiners (h) Board of Nursing (i) Board of Examiners for Nursing Home Administrators (j) Board of Occupational and Physical Therapy Examiners (k) Board of Optometry (l) Board of Osteopathic Examination (m) Committee on Physician Assistants (n) Board of Podiatric Medical Examiners (o) Board for Professional Counselors, Marital and Family Therapists, and Clinical Pastoral Therapists (p) Board of Examiners in Psychology (q) Board of Respiratory Care (r) Board of Social Worker Certification and Licensure (s) Board of Veterinary Medical Examiners (t) Medical Laboratory Board (u) Board of Alcohol and Drug Abuse Counselors (v) Tennessee Massage Licensure Board (w) Committee for Clinical Perfusionists (x) Council of Certified Professional Midwifery (y) Council for Licensing Hearing Instrument Specialists (z) Tennessee Advisory Committee for Acupuncture.

GENERAL RULES AND REGULATIONS CHAPTER-1200-10-01

(4) Director - shall mean the person duly appointed by the Commissioner to serve as the Administrative Officer of the Division of Health Related Boards.

(5) Boards - shall mean all Boards, Councils, and Committees assigned to or hereafter assigned to the Division of Health Related Boards by law.

History

• Authority: T.C.A. § §4-5-202, 4-5-204, 63-1-101, 63-1-132, 63-17-201, and Public Chapters 576 and 685 of the Public Acts of 2000.
• Administrative History: Original rule certified June 7, 1974. (Formerly chapter 1200-06-01; filed December 3, 1990; effective January 15, 1991). Amendment filed August 25, 1995; effective November 8, 1995. Amendment filed November 22, 1999; effective March 29, 2000. Amendment filed August 31, 2000; effective December 29, 2000.

Tenn. Comp. R. & Regs. 1200-10-01-.02 PERSONNEL ADMINISTRATION

(1) The Director of Health Related Boards, with the approval of the Commissioner and the concurrence of the Boards, shall employ all staff assigned to or performing duties for the Boards. Such staff shall be employed in accordance with the rules and regulations governing personnel established by the Department of Personnel and the Department of Finance and Administration and in conformance with the policies of the Tennessee Department of Health.

(a) No personnel shall be employed in any classification until the appropriate position has been established. Positions may not be established unless provided for in the current approved operating budget. Requests for the establishment of positions shall be made to the Director, in writing at least 60 days in advance and forwarded to the Division of Personnel, Tennessee Department of Health.

(b) No personnel shall be employed, or a position filled, without the prior approval of the Director and the Division of Personnel of the Tennessee Department of Health.

(c) All contracts for the services of consultants, court reporters and other special services shall be negotiated through the Office of Business Administration, Tennessee Department of Health.

(d) Requests for ‘‘change of status’’ of incumbent personnel, i.e., promotion, salary adjustment, change in classification, etc., shall be made in writing on the appropriate forms, and shall be approved by the Director and Division of Personnel of the Tennessee Department of Health.

(e) Terminations or separations of full-time personnel, part-time, temporary or Board Members, for any reason, shall be reported to the Director promptly. Such reports shall show the effective date of the separation and the reasons given.

(f) Leave - Annual and sick leave shall be granted in accordance with the regulations of the State Department of Personnel. Only full time, regular employees are eligible to accrue leave. Leave records shall be maintained in the files of the respective boards and the Personnel Office of the Department. Requests for leave shall be approved by the Director and filed with the Division of Personnel of the Tennessee Department of Health.

(g) Personnel employed by or for the Boards shall be used interchangeably between the Boards and other Divisions of the Department at the discretion of the Bureau Director when such utilization is advantageous to the administration of the Boards and\or to the Department and\or the State. Provided however, before employment of any physician to serve as medical director for the Board of Medical Examiners the Director shall inform the President of that Board and make the applicant available for interview by the Board.

GENERAL RULES AND REGULATIONS CHAPTER-1200-10-01

History

• Authority: T.C.A. §§ 63-1-132; 63-1-135; 4-5-202 and 4-5-204.
• Administrative History: Original rule certified June 7, 1974. (Formerly chapter 1200-06-01; filed December 3, 1990; effective January 15, 1991). Amendment filed November 16, 1993; effective January 30, 1994. Amendment filed August 25, 1995; effective November 8, 1995.

Tenn. Comp. R. & Regs. 1200-10-01-.03 TRAVEL

(1) Reimbursement for travel expense including mileage, lodging, meals, etc. shall be made in accordance with the comprehensive travel regulations of the State. Where applicable, receipts must accompany request for reimbursement.

(2) Claims for reimbursement for board members shall be approved by the Director.

History

• Authority: T.C.A. §§ 4-5-221, 63-1-113, and 63-1-132.
• Administrative History: Original rule certified June 7, 1974. (Formerly chapter 1200-06-02; filed December 3, 1990; effective January 15, 1991). Amendment filed November 22, 1999; effective March 29, 2000.

Tenn. Comp. R. & Regs. 1200-10-01-.04 PER DIEM

Per Diem for board members will be allowed within the limits prescribed by statute and the approved annual budgets. Per Diem claimed will be based on ‘‘days’’ of service to the respective Board. Claims for reimbursement of per diem must be approved by the appropriate officer of the Board prior to being submitted to the Director. All claims for per diem must show the actual days worked, the service performed and the amount of Per Diem claimed.

History

• Authority: T.C.A. § 4-5-221.
• Administrative History: Original rules certified June 7, 1974. (Formerly chapter 1200-06-02; filed December 3, 1990; effective January 15, 1991).

Tenn. Comp. R. & Regs. 1200-10-01-.05 ANNUAL BUDGETS

(1) Annual operating budgets of the Boards shall be prepared in accordance with the policies and directives of the Department of Finance and Administration, the Office of Business Administration of the Department, and the State statutes governing the operation of the Boards.

(2) Budgets shall be prepared by the Administrative Office of the Health Related Boards, and submitted to the Director for review prior to submission to the Office of Financial Management of the Tennessee Department of Health.

(3) Budgets shall reflect the actual and necessary operating expenses of the Board and shall be commensurate with the revenues derived through the Boards.

(4) The annual work program will be based upon the funds made available to the Boards by the General Assembly.

History

• Authority: T.C.A. §§ 63-1-132, 63-1-135, 4-85-202, and 4-5-204.
• Administrative History: Original rule certified June 7, 1974. (Formerly chapter 1200-06-01; filed December 3, 1990; effective January 15, 1991). Amendment filed August 25, 1995; effective November 8, 1995.

Tenn. Comp. R. & Regs. 1200-10-01-.06 PURCHASING AND PROCUREMENT

(1) Purchases of materials, supplies and equipment shall be made in accordance with the regulations and policies of the Department of General Services and the Department of Health.

GENERAL RULES AND REGULATIONS CHAPTER-1200-10-01

(2) Requests for the procurement of materials, supplies, and equipment shall be submitted to the Director for review and approval. Requests should include all descriptive information available of the items desired, and shall include an adequate justification of need.

(3) To the extent possible, all printing will be performed in the printing facilities of the State.

Specialized printing will be contracted to private enterprise. Requests for printing, along with samples and/or exhibits are to be submitted to the Director for approval and processing.

(4) Each Board shall be accountable for all non-expendable State property purchased for or assigned to it, and maintain a current inventory of such property.

(5) Special detail memoranda on procurement policies will continue in effect unless cancelled or revised.

(6) All equipment and other non-expendable property purchased for the Boards shall be used interchangeably between the Boards when such utilization is advantageous to the Administration of the Boards and to the State.

History

• Authority: T.C.A. §§ 63-1-132, 63-1-135, 4-5-202, and 4-5-204.
• Administrative History: Original rule certified June 7, 1974. (Formerly chapter 1200-06-01; filed December 3, 1990; effective January 15, 1991). Amendment filed August 25, 1995; effective November 8, 1995.

Tenn. Comp. R. & Regs. 1200-10-01-.07 REVENUES

(1) All fees, fines and other revenues remitted to the Boards, pursuant to law and regulations, shall be deposited to the individual Board’s revenue account unless otherwise directed by statute. The Budget Director shall make such allotments from the general fund as necessary for the proper and necessary operating expenses of the Boards. Such allotments shall be dispersed under the general budgetary laws of the State and the regulations of the Department of Finance and Administration and the Tennessee Department of Health.

(2) Certificates of Deposit shall be forwarded promptly to the Office of Business Administration, Tennessee Department of Health. Deposits shall be made in accordance with procedures established by the State Comptroller. Revenue Codes assigned by the Department will be used to identify the source of the funds.

(3) Receipts, deposit slips and other revenue documents shall be maintained in such order as to satisfy the requirements of the State Comptroller and the Division of Internal Audit of the Department.

(4) Refunds from revenues will be processed by the Department on request on the basis of documentation furnished by the Boards.

History

• Authority: T.C.A. §§ 63-1-132, 63-1-137, 4-5-202, and 4-5-204.
• Administrative History: Original rule certified June 7, 1974. (Formerly chapter 1200-06-01; filed December 3, 1990; effective January 15, 1991). Amendment filed August 25, 1995; effective November 8, 1995.

Tenn. Comp. R. & Regs. 1200-10-01-.08 RESPONSIBILITIES OF THE DIVISION OF HEALTH RELATED LICENSING

(1) The Division of Health Related Boards shall employ the required staff to perform the necessary clerical and administrative functions for the Boards. Requests for personnel shall be sent to the Director who will ascertain the need and classification of such personnel, including inspectors, consultants, court reporters, clerical, administrative, etc.

(2) The Division of Health Related Boards shall employ investigators for the purpose of investigating complaints and charges made against the licensees of all Boards assigned to GENERAL RULES AND REGULATIONS CHAPTER-1200-10-01 the Division. The Boards may request, in writing, that such investigations be made as appropriate and the Division will provide reports of such investigations to the Boards for any action indicated (3) The Division of Health Related Boards shall provide or ascertain that office space is provided to the Boards in order to properly carry out their functions. In providing space, the Director shall determine that the space is consistent with the efficient administration of the Boards.

(4) The Division of Health Related Boards shall be responsible for providing special space requirements for the Boards for the conduct of examinations, hearings and meetings, and the Director shall approve all leases or agreements for the rental of such space in advance.

Available space in the State or public buildings, or other suitable space as may be available at no cost shall be utilized to the fullest extent.

(5) Administrative hearings shall be conducted in accordance with the laws and regulations applicable to each board. Court reporters and witnesses shall be provided as required and shall be compensated as prescribed by law and/or State policy. The office of the Attorney General shall be advised well in advance and kept currently informed of hearings in which he will be expected to participate.

(6) The Division of Health Related Boards shall serve as the coordinating office between the Boards on matters of common concern or interest and it shall be its’ responsibility to assist the Boards in any reasonable manner in carrying out their responsibilities and programs.

History

• Authority: T.C.A. §§ 63-1-132, 68-1-101, 4-5-202, and 4-5-204.
• Administrative History: Original rule certified June 7, 1974. (Formerly chapter 1200-06-01; filed December 3, 1990; effective January 15, 1991). Amendment filed August 25, 1995; effective November 8, 1995.

Tenn. Comp. R. & Regs. 1200-10-01-.09 FEES

(1) Payments for any imposed Civil Penalties shall be made by Cashier’s Check, Certified Check, Money Order or Cash. Payment by personal or business check will not be accepted.

History

• Authority: T.C.A. §§ 63-1-114, 63-1-132, 4-5-202, 4-5-204, 4-4-103, and 10-7-506.
• Administrative History: Original rule filed August 5, 1986; effective September 19, 1986. Amendment filed January 13, 1990; effective March 17, 1990. (Formerly chapter 1200-10-01-.01; filed December 3, 1990; effective January 15, 1991). Amendment filed August 25, 1995; effective November 8, 1995. Amendment filed October 16, 2012; effective October 16, 2012; effective January 14, 2013.

Tenn. Comp. R. & Regs. 1200-10-01-.10 LICENSEE RENEWAL APPLICATIONS

The Division, with the Commissioner of Health’s approval, establishes a system of license renewal at alternative intervals which will allow for the distribution of the license workload as uniformly as is practicable throughout the calendar year.

Notwithstanding any law to the contrary, licenses issued under the alternative method are valid for twenty-four (24) months, and expire on the last day of the last month of the license period. All authorizations to practice must be renewed pursuant to the Division’s alternative renewal system.

(1) Definitions - the following terms as used in this rule shall have the following meanings ascribed to them:

(a) Expiration Date - The date on which an existing license, certification or registration to practice any of the health related professions is scheduled to expire and on which renewal is due.

(b) License - Any license, certificate or registration to practice any profession regulated by Boards, Councils or Committees assigned to the Division of Health Related Boards.

GENERAL RULES AND REGULATIONS CHAPTER-1200-10-01

(c) Licensee - Any person holding a license as defined in this rule.

(d) Prorated Fees - The fees to be assessed to cover the renewal of licenses during any transitional period required to bring a licensee into a twenty-four (24) month renewal cycle.

(2) No renewal application will be accepted after the last day of the month following the licensee’s expiration date under the alternative method authorized in this rule.

(3) Notwithstanding any Board, Council, or Committee rule to the contrary, the Division establishes an electronic renewal procedure whereby licensees may apply via the Internet to request renewal of their authorization to practice their profession. The application to renew an authorization to practice a profession can be accessed at: https://apps.tn.gov/hlrs/

History

• Authority: T.C.A. §§ 4-3-1011, 4-5-202, 4-5-204, 63-1-107, 63-1-108, 63-1-119, and 63-1-132.
• Administrative History: Original rule filed February 11, 1992; effective March 27, 1992. Amendment filed August 18, 1994; effective November 1, 1994. Amendment filed November 22, 1999; effective March 29, 2000. Amendment filed August 31, 2000; effective December 29, 2000. Amendment filed August 23, 2001; effective December 28, 2001.

Tenn. Comp. R. & Regs. 1200-10-01-.11 DECLARATORY ORDERS

(1) Purpose - Whenever any person is affected by any statute governing the Division or any agency listed in T.C.A. § 68-1-101(8) or any statute in which authority is granted to the Division or any of those agencies to take any action, or any rule promulgated or order issued by the Division or any of those agencies, he or she may petition for a declaratory order to determine the validity or applicability of the statute, rule or order. This rule governs the procedures for submission, consideration and disposition of petitions for declaratory orders for the Division of Health Related Boards and each of the agencies listed in T.C.A. § 68-1- 101(8).

(2) Intent (a) It is the intent of this rule that petitions filed pursuant to this rule shall be addressed by the agency whose statute, rule or order is the subject of the petition. The Division shall address only those petitions which involve provisions of T.C.A. Title 63, Chapter 1 or any rule promulgated or any order issued pursuant thereto.

(b) It is the intention of this rule that all informal attempts to resolve any questions of validity or applicability of any statute, rule or order be made prior to the filing of any petition for a declaratory order. Legal representation is not required but persons are encouraged to first contact an attorney to see if their questions can be resolved. If their attorney cannot definitively answer the questions after review of all pertinent law, rules, or opinions and pursuant to all other means provided by law, then a petition for a declaratory order may be appropriate.

(3) Definitions - For purposes of this rule the following terms shall have the meanings ascribed to them:

(a) Affected Person - As these words are used in T.C.A. § 4-5-223 mean a person upon whom a statute, rule or order produces a specific and direct effect or result.

(b) Agency - Any of the Boards, Committees, or Councils listed in T.C.A. § 68-1-101(8).

GENERAL RULES AND REGULATIONS CHAPTER-1200-10-01

(c) Division - The Department of Health’s Division of Health Related Boards and which, for purposes of this rule, is also a separate agency.

(d) Notice of Hearing - The formal document issued by the Department of Health which notifies a petitioner that the Division or an agency has agreed to convene a contested case and issue a declaratory order.

(e) Notice Promulgated - As those words are used in T.C.A. § 4-5-224(c) to specify a date against which the forty-five (45) day notice period runs, mean the first (1st) day of the month in which the published notice of hearing appears in the Tennessee Administrative Register.

(f) Petitioner - The person who has filed a petition for a declaratory order, and who has the burden of going forward with the petition, and as to whom any declaratory order issued shall be binding.

(g) Receipt - As that term is used in T.C.A. § 4-5-223(c) shall mean:

1. For petitions addressable by the Division, the date of receipt of the petition in its offices.

2. For all agencies listed in T.C.A. § 68-1-101(8), the first date after receipt of the petition by the administrative staff that the agency meets and can lawfully conduct business.

(h) Set - As that term is used in T.C.A. §§ 4-5-223(c) and 4-5-224(c) in relation to contested case hearings involved in declaratory order proceedings, means to establish a future date on which the contested case could be heard.

(4) Contents Of The Petition - Any person wishing to file a declaratory order petition must do so by completing the Petition for Declaratory Order form which can be obtained from the Division or any agencies’ administrative office. Failure to provide all requested information in sections 1, 3, 4, 5, 6 and 7 of the form will invalidate the petition. A copy of the form is reproduced in paragraph (10) of this rule.

(5) Filing - All declaratory order petitions must be filed in writing on the approved form by sending them to the appropriate agency’s administrative office.

(6) Consideration Of The Petition - In considering the petition the agency may do the following:

(a) Either grant the petition (agreeing to convene on some future date a contested case hearing after which a declaratory order will be issued), or deny the petition, or take no action.

1. A petition must be denied if:

(i) The only issue raised is the facial constitutionality of a statute; or (ii) The Petitioner is not an affected person; or (iii) The statute, rule or order which is the subject of the petition is not within the agency’s primary jurisdiction. The petition must be addressed towards a statute, or rule in the agency’s practice act or a statute which authorizes it to take action, or an order issued by the agency; or (vi) The petition itself is deficient for failure to include all necessary information.

GENERAL RULES AND REGULATIONS CHAPTER-1200-10-01

2. A petition may be granted at the discretion of the agency only if the petition is addressing:

(i) A statute and the petition concerns any one of the following:

(I) The application of the statute; or (II) The validity of the statute; or (III) The constitutionality of the agency’s application of the statute.

(ii) A rule and the petition concerns any one of the following:

(I) The application of the rule; or (II) The validity of the rule; or (III) The constitutionality of the agency’s application of the rule; or (VI) The facial constitutionality of the rule unless the rule is substantially repetitive of the statute on which it is based.

(iii) An order and the petition concerns any one of the following:

(I) The application of the order; or (II) The validity of the order; or (III) The constitutionality of the agency’s application of the Order.

(b) If the petition is denied, the petitioner shall be notified of that action in writing.

(c) If the petition is granted, the matter will be referred to the attorneys for the Department of Health for filing of a Notice of Hearing. Granting of the petition does not mean that the Petitioner’s requested relief is granted. It merely means that the agency grants a hearing on the request for the declaratory order.

(7) Notice Of Hearing - After the agency grants a petition, a Notice of Hearing shall be issued to the petitioner which contains all of the following information:

(a) All information required by the declaratory order petition form (incorporation by reference and attachment of the petition is allowed); and (b) The date, time and location of the contested case hearing to be held on the petition. No contested case hearing on the petition may be scheduled prior to the expiration of forty five (45) days from the first (1st) day of the month in which the published notice of hearing appears in the Tennessee Administrative Register.

(8) Publication And Distribution - The Notice of Hearing will be filed with the Secretary of State’s Administrative Procedures Division office for assignment of an administrative judge and its Publications Division for publication of the notice in the Tennessee Administrative Register.

Copies of the Notice of Hearing and Petition shall be sent to all professional organizations and associations and other agencies whom the agency reasonably considers are likely to have an interest in the petition.

GENERAL RULES AND REGULATIONS CHAPTER-1200-10-01

(9) Disposition - When the petition is the subject of a contested case hearing, the Petitioner has the burden of proof in persuading the agency of the correctness of his/her position on all issues. After a full hearing on the matter, the agency shall issue an order which complies with the requirements of the “Administrative Procedures Act”, (T.C.A. §§ 4-5-101, et seq., 4-5-201 et seq., and 4-5-301 et seq).

(10) Copy Of Declaratory Order Form:

Petition For Declaratory Order The process for requesting a Declaratory Order is governed by T.C.A. §§ 4-5-223, 224 and 225. For this to be considered an actionable Petition for Declaratory Order you must provide all the information requested below and sign, and deliver the petition. Note - Failure to provide the information required in paragraphs 1, 3, 4, 5, 6, and 7 below will invalidate the petition.

1. Petitioner’s Name: __________________________________________________________________ Address:_______________________________________________________________________ ________________________________________________________________________ Telephone Number: ( ) __________________________ 2. Petitioner’s Attorney’s Name :__________________________________________________________ Address:________________________________________________________________________ ________________________________________________________________________ Telephone Number: ( ) __________________________ 3. Organization, if any, that the Petitioner Represents:

Organization Name:_____________________________________________________________________ Address:____________________________________________________________________ _____________________________________________________________________ Telephone Number: ( ) __________________________ 4. Provide a statement of the facts which led to the filing of this petition. Include all facts you believe necessary for the agency to make a decision in this matter: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 5. Provide a summary of the relief you are requesting including the specific nature of the requested order and the conclusions you would like the agency to reach at the conclusion of the declaratory order process: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 6. Citation to the statute, rule or order which is the subject of the petition: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 7. State how the statute, rule and/or order cited above specifically and directly produces an effect or result upon you: ____________________________________________________________________________________ ____________________________________________________________________________________ GENERAL RULES AND REGULATIONS CHAPTER-1200-10-01 _________________________________ ____________________ Signature Date Mail or Deliver to: Administrator, [Name of Appropriate Agency] 665 Mainstream Drive Nashville, TN 37243

History

• Authority: T.C.A. §§ 4-5-202, 4-5-202, 4-5-223, 4-5-224, and 63-1-132.
• Administrative History: Original rule filed December 17, 1998; effective April, 30 1999.

Tenn. Comp. R. & Regs. 1200-10-01-.12 ORGANIZATION REGISTRATION UNDER THE “VOLUNTEER HEALTH CARE

SERVICES ACT”.

(1) Any sponsoring organization, as defined in T.C.A. § 63-6-703(4), that arranges for the volunteer provision of health care services which includes the provision of health care services by any profession regulated pursuant to Tennessee Code Annotated, Title 63 shall register as required by T.C.A. § 63-6-706 with the Division of Health Related Boards by doing the following:

(a) Obtain from the Division of Health Related Boards a “Volunteer Services Organization” registration form which shall contain the information required by T.C.A. § 63-6-706(a), completing it and submitting it along with any required documentation to the Division; and (b) Submitting along with the registration form the non-refundable fifty dollar ($50.00) registration fee. If the provision of health care services is in response to a natural or manmade disaster no registration fee need be submitted.

(2) The registration form, fee, and the notifications regarding change in registration information, as well as the fifteen (15) day notifications required pursuant to T.C.A. § 63-6-706(b) shall be sent to the following address:

Volunteer Health Care Services Administrator Division of Health Related Boards Department of Health 665 Mainstream Drive Nashville, TN 37243

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-132, and 63-6-701 through 63-6-707.
• Administrative History: Original rule filed October 12, 2004; effective February 28, 2005.

Tenn. Comp. R. & Regs. 1200-10-01-.13 SCREENING PANELS

(1) Any screening panel(s) established pursuant to T.C.A. § 63-1-138 shall have concurrent

authority with the members of the applicable Board and with any individual practitioner designated by the applicable Board pursuant to such Board’s authority to select consultant(s), to decide the following:

(a) What, if any, investigation should be instituted upon complaints received by the Division; and (b) Whether a licensee who is the subject of a complaint received and/or an investigation conducted by the Division is an appropriate candidate pursuant to Board established guidelines for diversion to a professional peer review organization and/or impaired professional association; and GENERAL RULES AND REGULATIONS CHAPTER-1200-10-01 (c) Whether a disciplinary action should be instituted against a licensee; and (d) What, if any, terms of settlement should be offered to a licensee. A proposed settlement for formal discipline will not become final unless it is subsequently ratified by the applicable Board or a duly constituted panel of the applicable Board.

(2) A screening panel comprised of two (2) or more persons shall elect a chairperson prior to convening to conduct business. A screening panel shall include at least one (1) individual currently licensed by the applicable Board.

(3) A screening panel comprised of two (2) or more persons is required in order to conduct the informal hearings set forth in paragraph (6).

(4) When, and only when, a screening panel is used as a mechanism to resolve issues that are internal to the Division involving a complaint and/or an investigation, and no agreement that is binding on the subject of the complaint/investigation is authorized to be reached, the subject of the complaint/investigation need not be present and no prior or subsequent notice of such meeting of a screening panel need be issued to the subject of the complaint/investigation.

(5) The Division shall provide notification and explanation to the Boards when there are substantive amendments to this rule.

(6) After completion of an investigation by the Division, a screening panel, upon request of either the Department or the licensee who is the subject of an investigation, but only with the agreement of the Department, or upon request of both the licensee and the Department, may conduct an informal hearing and make recommendations as a result thereof as to what, if any, disciplinary action is appropriate. Any proposed settlement for formal discipline must be finalized pursuant to subparagraph (c) below.

(a) The Rules of Civil Procedure, the Rules of Alternative Dispute Resolution, the Rules of Evidence, and the Contested Case Procedural Rules under the Administrative Procedures Act shall not apply in informal hearings before the screening panel(s).

(b) A licensee who is the subject of an investigation being considered by a screening panel cannot be compelled to participate in any informal hearing.

(c) Proposed settlements for formal discipline will not become binding and final unless they are:

1. Approved by a majority of the members of the screening panel which issued them; and 2. Agreed to by both the Department and the licensee; and 3. Subsequently presented to and ratified by the applicable Board or a duly constituted panel of the applicable Board.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-132, and 63-1-138.
• Administrative History: Original rule filed April 5, 2006; effective August 28, 2006.

Chapter 1200-10-02 General Rules and Regulations Governing the Practice of Reflexology

Tenn. Comp. R. & Regs. 1200-10-02-.01 DEFINITIONS

As used in this chapter, the following terms shall have the following meaning ascribed to them:

(1) Administrative Office - The office of the staff person assigned to administrate the provisions of this chapter, located at the 665 Mainstream Drive, Nashville, TN 37243.

(2) Client - Any person who engages the services of a reflexology practitioner.

(3) Commissioner - The Commissioner of Health or the commissioner’s designee.

(4) Department - The Department of Health.

(5) Division - The Division of Health Related Boards in the Department of Health.

(6) Health Care Professional - An individual who is presently authorized to practice his or her health related profession, pursuant to T.C.A. Title 63 or Title 68.

(7) Reflexology - The application of specific pressures to reflex points in the hands and feet only.

(8) Reflexology Practitioner / Reflexologist - Any person who engages in the practice of reflexology for compensation and who has completed a study of the principles of reflexology, anatomy and physiology generally included in a regular course of study of reflexology.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-30-102, and 63-30-112.
• Administrative History: Original rule filed April 26, 2002; effective August 28, 2002.

Tenn. Comp. R. & Regs. 1200-10-02-.02 SCOPE OF PRACTICE

The scope of reflexology practice shall be as set forth in Tennessee Code Annotated, Section 63-30-102 and Section 63-30-109.

(1) A registered reflexologist may not use invasive procedures during the practice of reflexology.

(2) A registered reflexologist may not diagnose or treat for specific diseases, practice spinal or other joint manipulations, prescribe, administer, or adjust medication, and prescribe or administer vitamins.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-30-102, 63-30-109, and 63-30-112.
• Administrative History: Original rule filed April 26, 2002; effective August 28, 2002.

Tenn. Comp. R. & Regs. 1200-10-02-.03 NECESSITY OF REGISTRATION

(1) Except as provided in paragraphs (2) and (4), no person shall engage in the practice of reflexology unless such person has registered with the Division of Health Related Boards.

(2) This rule shall not apply to:

(a) The activities or services of physicians, chiropractors, physical therapists, occupational therapists, athletic trainers, cosmetologists, registered nurses, or members of other professions licensed, certified, or registered by the state who may, on occasion, apply pressure to specific reflex points in the hands and feet in the course of their work; and (b) The activities or services of massage therapists, licensed pursuant to Tennessee Code Annotated, Title 63, Chapter 18, who use reflexology techniques or methods or who advertise reflexology as a service offered to massage therapy clients.

(3) Reflexologists registered by the state may hold themselves out as “registered certified reflexologists” and may use the title or the initials “RCR” following the person’s name in connection with the profession. No person may use the title “registered certified reflexologist” or the initials “RCR” unless registered in accordance with this chapter.

(4) Except as provided in paragraph (2), any person who advertises or engages in reflexology for compensation without registering with the division pursuant to this act commits a Class C misdemeanor, punishable by a fine only. It is unlawful to use the word “reflexology” or any other term that implies reflexology technique or method when advertising a service by a person who is not registered under this act.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-30-103, 63-30-104, 63-30-105, 63-30-106, 63-30-107, 63-30- 108, and 63-30-112.
• Administrative History: Original rule filed April 26, 2002; effective August 28, 2002. Amendment filed May 8, 2003; effective September 26, 2003.

Tenn. Comp. R. & Regs. 1200-10-02-.04 REGISTRATION APPLICATIONS AND REQUIREMENTS

(1) Applications (a) Any individual who desires to practice as a registered certified reflexologist in Tennessee shall apply to the Division on forms provided by the Division.

1. All applicants shall submit the fees required by rule 1200-10-02-.06.

2. All applicants shall submit a clear and recognizable, recently taken, “passportstyle” photograph which shows the full head, face forward from at least the top of the shoulders up.

(b) It is the intent of this rule that all steps necessary to accomplish the filing of the required documentation be completed prior to filing an application and that all documentation be filed simultaneously.

(2) Requirements (a) An applicant shall cause to have submitted documentation of completion of a two hundred (200) hour reflexology only course offered by an institution approved by the Tennessee Higher Education Commission or its equivalent in other states. It is the applicant’s responsibility to request that such documentation be submitted directly from the course provider to the Administrative Office.

(b) An applicant shall submit proof that he/she has attained eighteen (18) years of age.

(c) An applicant shall provide evidence of good moral character by submitting two (2) original letters attesting to the applicant’s character from health care professionals on the signator’s letterhead. The letters cannot be from immediate family and/or relatives.

(d) An applicant shall attest that he/she has not been convicted of any felony under the laws of this state or any other state within ten (10) years of applying for registration.

(e) An applicant shall cause to be submitted to the Administrative Office directly from the vendor identified in the Division’s registration application materials, the result of a criminal background check.

(f) If an applicant has ever been authorized to practice as a reflexologist or any other health profession in any other state or country, the applicant shall cause to be submitted the equivalent of a Tennessee Certificate of Endorsement from each such licensing agency which indicates the applicant either holds a current or active authorization to practice as a reflexologist or other health professional and 1. whether the authorization to practice is in good standing; and 2. whether the authorization to practice has imposed or pending disciplinary action; and 3. if the authorization to practice is currently inactive, whether it was in good standing at the time it became inactive.

(g) It is the applicant's responsibility to request the information required in subparagraph (f) be submitted directly from each such licensing agency to the Administrative Office.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-30-102, 63-30-103, 63-30-104, 63-30-106, 63-30-111, and 63- 30-112.
• Administrative History: Original rule filed April 26, 2002; effective August 28, 2002. Amendment filed November 2, 2004; effective March 30, 2005. Amendments filed January 23, 2006; effective May 31, 2006.

Tenn. Comp. R. & Regs. 1200-10-02-.05 REGISTRATION RENEWAL AND REINSTATEMENT

All registered certified reflexologists must renew their registration to be able to continue in practice. Registration renewal is governed by the following:

(1) The due date for renewal is the last day of the month in which a registrant’s birth date falls pursuant to the Division of Health Related Board’s biennial birth date renewal system.

(2) Methods of Renewal (a) Internet Renewals - Individuals may apply for renewal and pay the necessary fees via the Internet. The application to renew can be accessed at: https://apps.tn.gov/hlrs/ (b) Paper Renewals - For individuals who have not renewed their registration online via the Internet, a renewal application form will be mailed to each individual registered by the Division to the last address provided to the Division. Failure to receive such notification does not relieve the registrant from the responsibility of meeting all requirements for renewal.

(3) Registrants who fail to comply with the renewal rules or notification received by them concerning failure to timely renew shall have their registrations processed pursuant to rule

Tenn. Comp. R. & Regs. 1200-10-01-.10 .

(4) Reinstatement of an Expired or Retired Registration (a) Reinstatement of a registration that has expired may be accomplished upon payment of all past due renewal fees, all past due state regulatory fees, and the late renewal fee, pursuant to Rule 1200-10-02-.06.

(b) Reinstatement of a registration that has been retired may be accomplished upon payment of the biennial renewal fee and the biennial state regulatory fee, pursuant to

Rule 1200-10-02-.06.

(5) Anyone submitting a signed renewal form or letter which is found to be untrue may be subject to disciplinary action as provided in Rule 1200-10-02-.07.

History

• Authority: T.C.A. §§ 4-3-1011, 4-5-202, 63-30-110, and 63-30-112.
• Administrative History: Original rule filed April 26, 2002; effective August 28, 2002. Amendment filed June 1, 2006; effective October 27, 2006.

Tenn. Comp. R. & Regs. 1200-10-02-.06 FEES

(1) Application fee $100.00 (2) Biennial renewal fee $225.00 (3) Late renewal fee $ 50.00 (4) Duplicate certificate fee $ 15.00 (5) Biennial state regulatory fee $ 10.00

History

• Authority: T.C.A. §§ 4-3-1011, 4-5-202, 4-5-204, 63-30-103, 63-30-105, 63-30-106, 63-30-108, 63-30- 110, and 63-30-112.
• Administrative History: Original rule filed April 26, 2002; effective August 28, 2002. Amendment filed May 8, 2003; effective September 26, 2003. Amendment filed October 7, 2004; effective February 28, 2005.

Tenn. Comp. R. & Regs. 1200-10-02-.07 REGISTRATION DISCIPLINE, ADVISORY RULINGS, AND SCREENING PANELS

(1) Upon a finding by the Division that a registered certified reflexologist has violated any provision of the Tennessee Code Annotated § 63-30-101, et seq., or the rules promulgated pursuant thereto, the Division may impose any of the following actions separately or in any combination deemed appropriate to the offense.

(a) Registration Suspension - This is a formal disciplinary action which suspends a registered certified reflexologist’s right to practice for a fixed period of time. It contemplates the re-entry of the registered certified reflexologist into practice under the registration previously issued.

(b) Registration Revocation - This is the most severe form of disciplinary action which removes a registered certified reflexologist from the practice of reflexology and terminates the registration previously issued. If revoked, it relegates the violator to the status he/she possessed prior to application for registration. However, the Division may in its discretion allow the reinstatement of a revoked registration upon conditions and after a period of time it deems appropriate. No petition for reinstatement and no new application for registration from a person whose registration was revoked shall be considered prior to the expiration of at least one (1) year, unless otherwise stated in the Division’s revocation order.

(c) Civil penalty - A monetary disciplinary action assessed by the Division pursuant to paragraph (5) of this rule.

(2) Once ordered, suspension, revocation, or assessment of a civil penalty may not be lifted unless and until the registered certified reflexologist petitions, pursuant to paragraph (3) of this rule, and appears before the Division after the period of initial suspension or revocation has run and after any civil penalties assessed have been paid.

(3) Order of Compliance - This procedure is a necessary adjunct to previously issued disciplinary orders and is available only when a petitioner has completely complied with the provisions of a previously issued disciplinary order, including an unregistered practice civil penalty order, and wishes or is required to obtain an order reflecting that compliance.

(a) The Division will entertain petitions for an Order of Compliance as a supplement to a previously issued order upon strict compliance with the procedures set forth in subparagraph (b) in only the following three (3) circumstances:

1. When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued reflecting that compliance; or 2. When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued lifting a previously ordered suspension; or 3. When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued reinstating a registration previously revoked.

(b) Procedures 1. The petitioner shall submit a Petition for Order of Compliance, as contained in subparagraph (c), to the Division’s Administrative Office that shall contain all of the following:

(i) A copy of the previously issued order; and (ii) A statement of which provision of subparagraph (a) the petitioner is relying upon as a basis for the requested order; and (iii) A copy of all documents that prove compliance with all the terms or conditions of the previously issued order. If proof of compliance requires testimony of an individual(s), including that of the petitioner, the petitioner must submit signed statements from every individual the petitioner intends to rely upon attesting, under oath, to the compliance. The Division's administrative staff, in their discretion, may require such signed statements to be notarized. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, the petition.

2. The Division authorizes its administrative staff to make an initial determination on the petition and take one of the following actions:

(i) Certify compliance and have the matter scheduled for presentation to the Division as an uncontested matter; or (ii) Deny the petition, after consultation with legal staff, if compliance with all of the provisions of the previous order is not proven and notify the petitioner of what provisions remain to be fulfilled and/or what proof of compliance was either not sufficient or not submitted.

3. If the petition is presented to the Division the petitioner may not submit any additional documentation or testimony other than that contained in the petition as originally submitted.

4. If the Division finds that the petitioner has complied with all the terms of the previous order an Order of Compliance shall be issued.

5. If the petition is denied either initially by staff or after presentation to the Division and the petitioner believes compliance with the order has been sufficiently proven the petitioner may, as authorized by law, file a petition for a declaratory order pursuant to the provisions of T.C.A. § 4-5-223 and rule 1200-10-1-.11.

(c) Form Petition Petition for Order of Compliance Division of Health Related Boards Petitioner’s Name:

Petitioner’s Mailing Address:

Petitioner’s E-Mail Address:

Telephone Number:

Attorney for Petitioner:

Attorney’s Mailing Address:

Attorney’s E-Mail Address:

Telephone Number:

The petitioner respectfully represents, as substantiated by the attached documentation, that all provisions of the attached disciplinary order have been complied with and I am respectfully requesting: (circle one)

1. An order issued reflecting that compliance; or 2. An order issued reflecting that compliance and lifting a previously ordered suspension; or 3. An order issued reflecting that compliance and reinstating a registration previously revoked.

Note - You must enclose all documents necessary to prove your request including a copy of the original order. If any of the proof you are relying upon to show compliance is the testimony of any individual, including yourself, you must enclose signed statements from every individual you intend to rely upon attesting, under oath, to the compliance.

The Division's administrative staff, in their discretion, may require such signed statements to be notarized. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, this petition.

Respectfully submitted this the day of , 20 .

Petitioner’s Signature (4) Order Modifications - This procedure is not intended to allow anyone under a previously issued disciplinary order, including an unregistered practice civil penalty order, to modify any findings of fact, conclusions of law, or the reasons for the decision contained in the order. It is also not intended to allow a petition for a lesser disciplinary action, or civil penalty other than the one(s) previously ordered. All such provisions of Division orders were subject to reconsideration and appeal under the provisions of the Uniform Administrative Procedures Act (T.C.A. §§ 45-301, et seq.). This procedure is not available as a substitute for reconsideration and/or appeal and is only available after all reconsideration and appeal rights have been either exhausted or not timely pursued.

(a) The Division will entertain petitions for modification of the disciplinary portion of previously issued orders upon strict compliance with the procedures set forth in subparagraph (b) only when the petitioner can prove that compliance with any one or more of the conditions or terms of the discipline previously ordered is impossible. For purposes of this rule the term "impossible" does not mean that compliance is inconvenient or impractical for personal, financial, scheduling or other reasons.

(b) Procedures 1. The petitioner shall submit a written and signed Petition for Order Modification on the form contained in subparagraph (c) to the Division’s Administrative Office that shall contain all of the following:

(i) A copy of the previously issued order; and (ii) A statement of why the petitioner believes it is impossible to comply with the order as issued; and (iii) A copy of all documents that proves that compliance is impossible. If proof of impossibility of compliance requires testimony of an individual(s), including that of the petitioner, the petitioner must submit signed and notarized statements from every individual the petitioner intends to rely upon attesting, under oath, to the reasons why compliance is impossible.

No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, the petition.

2. The Division authorizes its administrative staff to make an initial determination on the petition and take one of the following actions:

(i) Certify impossibility of compliance and forward the petition to the Office of General Counsel for presentation to the Division as an uncontested matter; or (ii) Deny the petition, after consultation with legal staff, if impossibility of compliance with the provisions of the previous order is not proven and notify the petitioner of what proof of impossibility of compliance was either not sufficient or not submitted.

3. If the petition is presented to the Division the petitioner may not submit any additional documentation or testimony other than that contained in the petition as originally submitted.

4. If the petition is granted a new order shall be issued reflecting the modifications authorized by the Division that it deemed appropriate and necessary in relation to the violations found in the previous order.

5. If the petition is denied either initially by staff or after presentation to the Division and the petitioner believes impossibility of compliance with the order has been sufficiently proven the petitioner may, as authorized by law, file a petition for a declaratory order pursuant to the provisions of T.C.A. § 4-5-223 and rule 1200- 10-1-.11.

(c) Form Petition Petition for Order Modification Division of Health Related Boards Petitioner’s Name:

Petitioner’s Mailing Address:

Petitioner’s E-Mail Address:

Telephone Number:

Attorney for Petitioner:

Attorney’s Mailing Address:

Attorney’s E-Mail Address:

Telephone Number:

The petitioner respectfully represents that for the following reasons, as substantiated by the attached documentation, the identified provisions of the attached disciplinary order are impossible for me to comply with:

Note - You must enclose all documents necessary to prove your request including a copy of the original order. If any of the proof you are relying upon to show impossibility is the testimony of any individual, including yourself, you must enclose signed and notarized statements from every individual you intend to rely upon attesting, under oath, to the reasons why compliance is impossible. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, this petition.

Respectfully submitted this the day of , 20 .

Petitioner’s Signature (5) Civil Penalties (a) Purpose The purpose of this rule is to set out a schedule designating the minimum and maximum civil penalties which may be assessed pursuant to T.C.A. § 63-1-134.

(b) Schedule of Civil Penalties 1. A Type A Civil Penalty may be imposed whenever the Division finds a person who is required to be registered by the Division, guilty of a willful and knowing violation of the Reflexology Practitioners Registration Act of 2001 or regulations pursuant thereto, to such an extent that there is, or is likely to be, an imminent, substantial threat to the health, safety and welfare of an individual client or the public.

2. A Type B Civil Penalty may be imposed whenever the Division finds the person required to be registered by the Division is guilty of a violation of the Reflexology Practitioners Registration Act of 2001 or regulations pursuant thereto in such manner as to impact directly on the care of clients or the public.

3. A Type C Civil Penalty may be imposed whenever the Division finds the person required to be registered, or authorized by the Division is guilty of a violation of the Reflexology Practitioners Registration Act of 2001 or regulations promulgated thereto, which are neither directly detrimental to the clients or public, nor directly impact their care, but have only an indirect relationship to client care or the public.

(c) Amount of Civil Penalties 1. Type A Civil Penalties shall be assessed in the amount of not less than $500.00 nor more than $1,000.00.

2. Type B Civil Penalties may be assessed in the amount of not less than $100.00 and not more than $500.00.

3. Type C Civil Penalties may be assessed in the amount of not less than $50.00 and not more than $ 100.00.

(d) Procedures for Assessing Civil Penalties 1. The Division of Health Related Boards may initiate a civil penalty assessment by filing a Memorandum of Assessment of Civil Penalty. The Division shall state in the memorandum the facts and law upon which it relies in alleging a violation, the proposed amount of the civil penalty, and the basis for such penalty. The Division may incorporate the Memorandum of Assessment of Civil Penalty with a Notice of Charges which may be issued attendant thereto.

2. In assessing the civil penalties pursuant to these rules the Division may consider the following factors:

(i) Whether the amount imposed will be a substantial economic deterrent to the violator:

(ii) The circumstances leading to the violation, (iii) The severity of the violation and the risk of harm to the public;

(iv) The economic benefits gained by the violator as a result of noncompliance; and (v) The interest of the public.

3. All proceedings for the assessment of civil penalties shall be governed by the contested case provisions of Title 4, Chapter 5, Tennessee Code Annotated.

(6) Advisory Rulings - Any person who is affected by any matter within the jurisdiction of the Division and who is a registered certified reflexologist, may submit a written request for an advisory ruling.

(a) The procedures for obtaining and issuance of advisory rulings are as follows:

1. The registrant shall submit the request to the Administrative Office on the form contained in subparagraph (b), providing all the necessary information; and 2. The Division shall review and research the request and subsequently make a ruling; and 3. The ruling shall be transmitted to the requesting registrant. The ruling shall have effect only upon the registrant requesting the ruling, and shall have no precedential value for any other inquiry or future contested case.

(b) Any request for an advisory ruling shall be made on the following form, a copy of which may be obtained from the Administrative Office:

Division of Health Related Boards Request for Advisory Ruling Date: ____________________________________ Registrant’s Name:____________________________________ Registrant’s Address:____________________________________ Zip Code ________ Registrant Number:________________ 1. The specific question or issue for which the ruling is requested: __________________________________________________ __________________________________________________ 2. The facts that gave rise to the specific question or issue: __________________________________________________ __________________________________________________ 3. The specific statutes and/or rules which are applicable to the question or issue: __________________________________________________ __________________________________________________ Registrant’s Signature: _______________________________ Mail or Deliver to: Administrator, Reflexology Registry Division of Health Related Boards 665 Mainstream Drive Nashville, TN 37243 (7) Screening Panels – The screening panel process shall be governed by Rule 1200-10-1-.13, of the Division of Health Related Boards and as it may from time to time be amended

History

• Authority: T.C.A. §§ 4-5-202, 63-1-138, 63-30-111, and 63-30-112.
• Administrative History: Original rule filed April 26, 2002; effective August 28, 2002. Amendment filed June 10, 2004; effective October 28, 2004. Amendment filed June 1, 2006; effective October 27, 2006.

Tenn. Comp. R. & Regs. 1200-10-02-.08 ADVERTISING

(1) Policy Statement. The lack of sophistication on the part of many of the public concerning reflexology, the importance of the interests affected by the choice of a reflexologist and the foreseeable consequences of unrestricted advertising by reflexologists which is recognized to pose special possibilities for deception, require that special care be taken by reflexologists to avoid misleading the public. The reflexologist must be mindful that the benefits of advertising depend upon its reliability and accuracy. Since advertising by reflexologists is calculated and not spontaneous, reasonable regulation designed to foster compliance with appropriate standards serves the public interest without impeding the flow of useful, meaningful, and relevant information to the public.

(2) Definitions (a) Advertisement. Informational communication to the public in any manner designed to attract public attention to the practice of a reflexologist who is registered to practice in Tennessee.

(b) Registrant - Any person holding a registration to practice reflexology in the State of Tennessee. Where applicable this shall include partnerships and/or corporations.

(c) Material Fact - Any fact which an ordinary reasonable and prudent person would need to know or rely upon in order to make an informed decision concerning the choice of practitioners to serve his or her particular needs.

(d) Bait and Switch Advertising - An alluring but insincere offer to sell a product or service which the advertiser in truth does not intend or want to sell. Its purpose is to switch consumers from buying the advertised service or merchandise, in order to sell something else, usually for a higher fee or on a basis more advantageous to the advertiser.

(e) Discounted Fee - Shall mean a fee offered or charged by a person for a product or service that is less than the fee the person or organization usually offers or charges for the product or service. Products or services expressly offered free of charge shall not be deemed to be offered at a "discounted fee".

(3) Advertising Fees and Services (a) Fixed Fees - Fixed fees may be advertised for any service. It is presumed unless otherwise stated in the advertisement that a fixed fee for a service shall include the cost of all professional recognized components within generally accepted standards that are required to complete the service.

(b) Range of Fees. A range of fees may be advertised for services and the advertisement must disclose the factors used in determining the actual fee, necessary to prevent deception of the public.

(c) Discount Fees. Discount fees may be advertised if:

1. The discount fee is in fact lower than the registrant's customary or usual fee charged for the service; and 2. The registrant provides the same quality and components of service and material at the discounted fee that are normally provided at the regular, non-discounted fee for that service.

(d) Related Services and Additional Fees. Related services which may be required in conjunction with the advertised services for which additional fees will be charged must be identified as such in any advertisement.

(e) Time Period of Advertised Fees.

1. Advertised fees shall be honored for those seeking the advertised services during the entire time period stated in the advertisement whether or not the services are actually rendered or completed within that time.

2. If no time period is stated in the advertisement of fees, the advertised fee shall be honored for thirty (30) days from the last date of publication or until the next scheduled publication whichever is later whether or not the services are actually rendered or completed within that time.

(4) Advertising Content. The following acts or omissions in the context of advertisement by any reflexologist shall constitute unethical and unprofessional conduct, and subject the registrant to disciplinary action pursuant to T.C.A. § 63-30-111.

(a) Claims that the services performed, personnel employed, materials or office equipment used are professionally superior to that which is ordinarily performed, employed, or used, or that convey the message that one registrant is better than another when superiority of services, personnel, materials or equipment cannot be substantiated.

(b) The misleading use of an unearned or non-health degree in any advertisement.

(c) Promotion of professional services which the registrant knows or should know are beyond the registrant's ability to perform.

(d) Techniques of communication which intimidate, exert undue pressure or undue influence over a prospective client.

(e) Any appeals to an individual's anxiety in an excessive or unfair manner.

(f) The use of any personal testimonial attesting to a quality or competency of a service or treatment offered by a registrant that is not reasonably verifiable.

(g) Utilization of any statistical data or other information based on past performances for prediction of future services, which creates an unjustified expectation about results that the registrant can achieve.

(h) The communication of personal identifiable facts, data, or information about a client without first obtaining client consent.

(i) Any misrepresentation of a material fact.

(j) The knowing suppression, omission or concealment of any material fact or law without which the advertisement would be deceptive or misleading.

(k) Statements concerning the benefits or other attributes of procedures or products that involve significant risks without including:

1. A realistic assessment of the safety and efficiency of those procedures or products; and 2. The availability of alternatives; and 3. Where necessary to avoid deception, descriptions or assessment of the benefits or other attributes of those alternatives.

(l) Any communication which creates an unjustified expectation concerning the potential results of any treatment.

(m) Failure to comply with the rules governing advertisement of fees and services, or advertising records.

(n) The use of "bait and switch" advertisements. Where the circumstances indicate "bait and switch" advertising, the Division may require the registrant to furnish data or other evidence pertaining to those sales at the advertised fee as well as other sales.

(o) Misrepresentation of a registrant’s credentials, training, experience, or ability.

(p) Failure to include the corporation, partnership or individual registrant's name, address, and telephone number in any advertisement. Any corporation, partnership or association which advertises by use of a trade name or otherwise fails to list all registrants practicing at a particular location shall:

1. Upon request provide a list of all registrants practicing at that location; and 2. Maintain and conspicuously display at the registrant's office, a directory listing all registrants practicing at that location.

(q) Failure to disclose the fact of giving compensation or anything of value to representative of the press, radio, television or other communicative medium in anticipation of or in return for any advertisement (for example, newspaper article) unless the nature, format or medium of such advertisement make the fact of compensation apparent.

(r) After thirty (30) days of the registrant’s departure, the use of the name of any registrant formerly practicing at or associated with any advertised location or on office signs or buildings. This rule shall not apply in the case of a retired or deceased former associate who practiced in association with one or more of the present occupants if the status of the former associate is disclosed in any advertisement or sign.

(s) Stating or implying that a certain registrant provides all services when any such services are performed by another registrant.

(t) Directly or indirectly offering, giving, receiving, or agreeing to receive any fee or other consideration to or from a third party for the referral of a client in connection with the performance of professional services.

(5) Advertising Records and Responsibility (a) Each registrant who is a principal partner, or officer of a firm or entity identified in any advertisement, is jointly and severally responsible for the form and content of any advertisement. This provision shall also include any licensed, certified, registered, or otherwise authorized professional employees acting as an agent of such firm or entity.

(b) Any and all advertisements are presumed to have been approved by the registrant named therein.

(c) A recording of every advertisement communicated by electronic media, and a copy of every advertisement communicated by print media, and a copy of any other form of advertisement shall be retained by the registrant for a period of two (2) years from the last date of broadcast or publication and be made available for review upon request by the Division or its designee.

(d) At the time any type of advertisement is placed, the registrant must possess and rely upon information which, when produced, would substantiate the truthfulness of any assertion, omission or representation of material fact set forth in the advertisement or public communication.

(6) Severability. It is hereby declared that the sections, clauses, sentences and parts of these rules are severable, are not matters of mutual essential inducement, and any of them shall be rescinded if these rules would otherwise be unconstitutional or ineffective. If any one or more sections, clauses, sentences or parts shall for any reason be questioned in court, and shall be adjudged unconstitutional or invalid, such judgment shall not affect, impair or invalidate the remaining provisions thereof, but shall be confined in its operation to the specific provision or provisions so held unconstitutional or invalid, and the inapplicability or invalidity of any section, clause, sentence or part in any one or more instances shall not be taken to affect or prejudice in any way its applicability or validity in any other instance.

History

• Authority: T.C.A. §§ 4-5-202, 63-1-145, 63-30-107, 63-30-108, 63-30-111, and 63-30-112.
• Administrative History: New rule filed June 10, 2004; effective October 28, 2004. New rule filed June 1, 2006; effective October 27, 2006.

Chapter 1200-10-03 Drug Testing and Reporting

Tenn. Comp. R. & Regs. 1200-10-03-.01 TIME OF REPORTING

When an employer is required to report a healthcare practitioner’s refusal to submit to a drug test or positive drug test result, such report shall be made in writing to the Tennessee Department of Health, Office of Investigation, within ten (10) business days from the third day allowed the healthcare practitioner to produce a lawful prescription or report to a substance abuse peer assistance program.

History

• Authority: T.C.A. §§ 50-9-115, 63-1-101, 63-1-126, 63-1-150, and 68-1-101.
• Administrative History: Original rule filed September 6, 2018; effective December 5, 2018.

Tenn. Comp. R. & Regs. 1200-10-03-.02 REPORTING REQUIREMENTS

(1) The employer’s report to the Tennessee Department of Health, Office of Investigation shall:

(a) Be in writing;

(b) Detail the date the drug test was refused or administered;

(c) In the case of a positive result, contain a certified copy of the drug test results, chain of custody, and verification;

(d) Contain a certified copy of the notification given to the healthcare practitioner; and (e) Contain the last known address of the healthcare practitioner.

(2) For purposes of this rule, “certified” means accompanied by an affidavit of the custodian or other qualified person certifying, in accordance with Tennessee Rules of Evidence 902(11), that it was produced as a record of a regularly conducted activity. Such a certifying affidavit form can be provided by the Department upon request.

(3) As used in T.C.A. § 63-1-126 the term “lawful prescription” means a prescription that complies with T.C.A. § 53-10-401, and “valid medical reason for using the drug” means a use for which the healthcare practitioner can produce a prescriber’s written recommendation.

History

• Authority: T.C.A. §§ 50-9-115, 63-1-126, and 68-1-101.
• Administrative History: Original rule filed September 6, 2018; effective December 5, 2018.

Tenn. Comp. R. & Regs. 1200-10-03-.03 DISCIPLINARY ACTION REPORTING

(1) The chief administrative official for each hospital or other health care facility, shall make a report if disciplinary action is taken concerning any person licensed under Title 63 or Title 68, where that action is related to professional ethics, professional incompetence or negligence, moral turpitude, or drug or alcohol abuse, in writing, within sixty (60) days of the date of the December, 2018 2 action. The hospital or health care facility shall make available to the Tennessee Department of Health, Office of Investigation, all records pertaining to the disciplinary action taken.

(2) Where an employer reports a refused or positive drug test pursuant to this chapter, the requirement to report a disciplinary action shall be satisfied if the report also contains a statement of the disciplinary action taken.

(3) Notwithstanding the provisions of paragraph (2) above, all other provisions regarding disciplinary reporting remain in effect.

History

• Authority: T.C.A. §§ 63-1-126, 68-1-101, and 68-11-218.
• Administrative History: Original rule filed September 6, 2018; effective December 5, 2018.

Chapter 1200-10-04 Waiver from Electronic Prescription Mandate

Tenn. Comp. R. & Regs. 1200-10-04-.01 PETITION FOR WAIVER

(1) A health care prescriber who is unable to comply with the electronic prescription requirement for any controlled-substance prescription(s) listed in Schedule II, III, IV or V, as indicated in T.C.A. § 63-1-160, may petition the commissioner or the commissioner’s designee of the Tennessee Department of Health, on a form provided on the Tennessee Department of Health website, found at https://tennessee.na1.echosign.com/public/esignWidget?wid=CBFCIBAA3AAABLblqZhCupja dFM1Fh2AmAc-RFlR2N2LS-yKQ5TJcIx80T5K5BzcXigkPNmPxDhKRkFCbTeQ*, for a waiver from the requirement based upon economic hardship, technological limitations that are not reasonably within the control of the health care prescriber or other exceptional circumstance demonstrated by the health care prescriber. A timely petition for renewal of a previously approved waiver shall be submitted at least 60 days in advance of the expiration of the previously approved waiver.

(2) Any health care practice may petition for a waiver for any associated health care prescriber at the practice site.

(3) This chapter does not apply to prescriptions made exempt pursuant to T.C.A. § 63-1-160(d).

History

• Authority: T.C.A. §§ 63-1-160 and 68-1-103.
• Administrative History: New rules filed July 8, 2021; effective October 6, 2021.

Tenn. Comp. R. & Regs. 1200-10-04-.02 PETITION FOR WAIVER INFORMATION

A petition for waiver from the electronic prescription requirement for controlled-substance prescriptions listed in Schedule II, III, IV or V, as indicated in T.C.A. § 63-1-160, shall include, but not be limited to, all of the following:

(1) The name, practice address, and license number of the health care prescriber.

(2) The reason(s) the health care prescriber is seeking a waiver. Reasons include economic hardship, technological limitations that are not reasonably within the control of the health care prescriber or other exceptional circumstance demonstrated by the health care prescriber.

History

• Authority: T.C.A. §§ 63-1-160 and 68-1-103.
• Administrative History: New rules filed July 8, 2021; effective October 6, 2021.

Tenn. Comp. R. & Regs. 1200-10-04-.03 DURATION OF WAIVER OR RENEWAL OF A WAIVER

A waiver or renewal of a waiver issued by the commissioner or the commissioner’s designee of the Tennessee Department of Health shall not exceed one year from the date of issuance.

October, 2021 2

History

• Authority: T.C.A. §§ 63-1-160 and 68-1-103.
• Administrative History: New rules filed July 8, 2021; effective October 6, 2021.

Tenn. Comp. R. & Regs. 1200-10-04-.04 CIRCUMSTANCES WHERE ELECTRONIC PRESCRIBING IS NOT AVAILABLE DUE

TO TEMPORARY TECHNOLOGICAL OR ELECTRICAL FAILURE. An otherwise valid oral, written, or fax prescription, issued when electronic prescribing is not available due to temporary technological or electrical failure, shall be exempt from the electronic prescription requirement so long as the prescription(s) is issued in compliance with all other federal and state laws and regulations regarding prescriptions, provided that a prescription issued pursuant to this paragraph shall indicate on the prescription that the health care prescriber is experiencing a temporary technological or electrical failure.

History

• Authority: T.C.A. §§ 63-1-160 and 68-1-103.
• Administrative History: New rules filed July 8, 2021; effective October 6, 2021.

Tenn. Comp. R. & Regs. 1200-10-04-.05 PRESCRIPTIONS TO BE DISPENSED OUT-OF-STATE

Any prescription issued to a patient which is to be dispensed outside this State shall be issued in accordance with the dispensing state’s laws regarding electronic prescriptions, if any.

History

• Authority: T.C.A. §§ 63-1-160 and 68-1-103.
• Administrative History: New rules filed July 8, 2021; effective October 6, 2021.

1200-11 Health Services Administration

Chapter 1200-11-01 Renal Disease

Tenn. Comp. R. & Regs. 1200-11-01-.01 STATEMENT OF PURPOSE

(1)The Renal Disease Program provides assistance to individuals suffering from end stage renal disease or who are at risk of developing end stage renal disease.

History

• Authority: T.C.A. §§68—35—103 and 4—5—202.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed October 9, 1985; effective January 14, 1986. Amendment filed May 10, 1995; effective September 28, 1995. Repeal and new rule filed September 17, 1998; effective January 28, 1999.

Tenn. Comp. R. & Regs. 1200-11-01-.02 DEFINITIONS

(1)Unless otherwise specifically indicated by the context, for the purpose of these rules and regulations, the terms used herein are defined as follows:

(a)Commissioner - The Commissioner of the Tennessee Department of Health or the Commissioner’s designee.

(b)Department - The Tennessee Department of Health.

(c) End Stage Renal Disease (ESRD)- Kidney function is permanently impaired to the point that the kidney will no longer sustain life.

(d)Family- For the purpose of the Renal Disease Program, a family is defined as follows: 1.two or more persons related by birth, marriage or adoption who reside together.a household includes more than one family, the guidelines are applied separately to each family.); 2.a child under 18 years of age and his/her non-parent custodians when financial responsibility has been assigned to them by the court; or 3.parents of a patient under 18 years of age when the patient has been voluntarily placed outside the parent’s home.

(e)Legend Drug - A pharmaceutical which requires a physician’s prescription before being dispensed.

(f)Renal Dialysis - Any mechanical means of removing impurities from the blood.

(g)Resident of Tennessee - A person who has established a permanent residence in Tennessee.

The test for such residence is (1) an intention to stay in a place, (2) coupled with some objective indication consistent with that intent, such as a Tennessee driver’s license.

(h)Routine Renal Drugs - Any number of pharmaceuticals which are needed to treat a patient’s end stage renal disease or its complications.

History

• Authority: T.C.A. §68—35—103 and 4—5—202.
• Administrative History: Original rule certified June 7, 1974. Amendment filed January 27, 1976; effective February 26, 1976. Repeal and new rule filed October 9, 1985; effective January 14, 1986. Amendment filed January 29, 1992; effective April 29, 1992. Repeal and new rule filed September 17, 1998; effective January 28, 1999.

Tenn. Comp. R. & Regs. 1200-11-01-.03 ELIGIBILITY REQUIREMENTS

(1)Any resident of Tennessee with the presence of end stage renal failure which currently requires chronic dialysis or has necessitated a kidney transplant within the past twelve (12) months is eligible to apply for program services.

(2)To receive program services, the applicant must meet the following criteria.

(a)The applicant must submit a completed, properly signed and dated application provided by the Department. If the applicant is legally incompetent to consent to medical treatment because of age or mental condition, said application shall be completed and signed by the applicant’s parent or legal guardian.

(b)The applicant must meet the medical criteria established in these Rules and must meet the financial criteria at the time of application and/or recertification.

(3)The following is a list of medical criteria to be used in determining diagnostic eligibility for the program.

(a)End stage renal disease shall be determined by the chemical/medical criteria established by the Health Care Finance Administration and available through Renal Network 8, which includes Tennessee; or (b)If the criteria in 1200-11-1-.03 (3)(a) are not met, a detailed explanation of the uremic symptoms leading to a diagnosis of ESRD must be submitted with the application; or (c)Following successful kidney transplantation, a patient will be considered to continue to meet the requirements of 12-11-.03 (3) (a)-(b).

(4)Eligibility for special coverage of Cyclosporine over and above the patient’s monthly drug cap will be determined separate from, and in addition to, program eligibility. The patient must not be eligible for any other third party coverage for the medication other than Medicare.

(5)Individuals will be financially eligible for the Renal Disease Program if the family’s gross income is at or below 200% of the federal poverty level for the number in family. When a family has more than one (1) individual with ESRD, one person may be added to the total number of family members when determining eligibility. All participants in the Renal Disease Program must be financially recertified annually.

The Department shall determine the family income of the applicant as a family according to the following.

(a)Income shall include: 1.wages, salaries and/or commissions; 2.income from rental property or equipment; 3.profits from self-employment enterprises, including farms; 4.alimony and/or child support; 5.inheritances; 6.pensions and benefits; and 7.public assistance grants.

(b)After the income of the family is determined, any verified medical payments, including medical or health insurance premiums made by the family for any family member during the previous twelve (12) months, shall be prorated over twelve months and deducted from the gross monthly income.

(c)Verified child support or alimony paid to another household shall be deducted from the gross monthly income.

(6)All applicants to, or participants in, the Renal Disease Program who have no third party insurance coverage must apply for Medicare and TennCare coverage and provide proof of acceptance or denial to the Renal Disease Program. Denial of coverage by Medicare or TennCare will not prevent the individual from participation in the Renal Disease Program, so long as program eligibility requirements are met. Once accepted for TennCare coverage, Renal Disease Program participants must meet all TennCare eligibility requirements in order to maintain eligibility for the Renal Disease Program.

(7)Applicants will be denied participation in the Renal Disease Program if they are diagnostically ineligible, financially ineligible, or fail to apply for TennCare and Medicare coverage.

(8)Once a patient has been certified for services, the certification extends for twelve months regardless of changes in family income.

(9)The Commissioner may prioritize acceptance into the program according to medical need (as defined in these rules), pharmaceutical requirements, and available program dollars. As vacancies occur each month, those applicants without TennCare or private third party coverage with pharmacy benefits will be given first preference in chronological order of the receipt of the application to fill those vacancies until all slots are filled for the month. Once capitated authorized funding has been exhausted, there will be no more funding.

History

• Authority: T.C.A. §68—35—103 and 4—5—202.
• Administrative History: Original rule certified June 7, 1974. Amendment filed January 17, 1975; effective February 16, 1975. Repeal and new rule filed October 9, 1985; effective January 14, 1986. Repeal and new rule filed September 17, 1998; effective January 28, 1999.

Tenn. Comp. R. & Regs. 1200-11-01-.04 COVERED SERVICES

(1)The Department will assist in the payment for services rendered to eligible renal patients insofar as budget funds will allow. The Department may place a cap on enrollment in the program and/or a cap on expenditures per participant, when the budgetary limits are reached.

(2)Covered services may include:

(a)Legend and over-the-counter drugs required for the treatment of end stage renal disease which are included in the program’s formulary and not covered by a participant’s third party insurer.

For TennCare recipients, legend drugs will be covered by TennCare.

(b)In-center dialysis services for patients who do not have health insurance and are ineligible for TennCare during the waiting period before Medicare eligibility begins following the onset of dialysis.

(c)Medicare insurance premiums for eligible program participants including both “Part A” and “Part B” premiums, as determined by the U.S. Department of Health and Human Services.

(d)Acute Dental services to relieve pain and suffering. Any more extensive rehabilitative work or dentures would have to be approved by the Commissioner and the decision made on the exceptional nature of the need for these services and the availability of funds.

(e)Case management and other services provided by the Renal Disease Intervention Program.

(f)Out-of-state dialysis services for participants. The Renal Disease Program pays Medicare coinsurance for participants to travel out of state. Most out-of-state dialysis units will not accept patients unless they have full coverage.

History

• Authority: T.C.A. §§68—35—103 and 4—5—202.
• Administrative History: Original rule certified June 7, 1974. Amendment filed January 27, 1976; effective February 26, 1976. Repeal and new rule filed October 9, 1985; effective January 14, 1986. Amendment filed June 8, 1989; effective July 14, 1989. Amendment filed January 29, 1992; effective April 29, 1992. Amendment filed May 10, 1995; effective September 28, 1995. Repeal and new rule filed September 17, 1998; effective January 28, 1999.

Tenn. Comp. R. & Regs. 1200-11-01-.05 AUTHORIZATION AND REIMBURSEMENT FOR SERVICES

(1)No payment shall be made for services rendered to any participant under these Rules unless and until all third party payment sources available have been exhausted.

(2)Payment for out-of-state dialysis services must be prior approved and is limited to six (6) dialysis treatments within any twelve (12) month period.

(3)The Department will pay one hundred percent (100%) of the Medicare allowable reimbursement rate for in-center dialysis during that portion of the Medicare waiting period before patients are eligible for Medicare benefits, if the patient does not have health insurance coverage and is not eligible for TennCare benefits. If the patient has only health insurance coverage, the amount which will be paid will be equal to the Medicare allowable reimbursement rate, less any insurance payments.

(4)The Department will reimburse pharmacists for routine renal drugs in an amount not to exceed a set monthly cap, established by the Commissioner based upon the availability of funds. The Commissioner will establish caps for expenditures for those participants who are covered by TennCare and for those who are covered by Medicare only.

(5)Dental services must have prior authorization and will be reimbursed based on the Schedule of Allowances of United Concordia Companies, Inc. (Blue Cross/Blue Shield of Pennsylvania).

(6)All services provided under these Rules are to be obtained within the state, except for services provided to participants who have received prior authorization for out-of-state treatment.

History

• Authority: T.C.A. §§68—35—103 and 4—5—202.
• Administrative History: Original rule certified June 7, 1974. Amendment filed July 22, 1976; effective August 21, 1976. Amendment filed July 22, 1977; effective August 22, 1977. Repeal and new rule filed October 9, 1985; effective January 14, 1986. Amendment filed June 8, 1989; effective July 14, 1989. Amendment filed September 25, 1990; effective December 29, 1990. Amendment filed January 29, 1992; effective April 29, 1992. Amendment filed May 10,1995; effective September 28, 1995. Repeal and new rule filed September 17, 1998; effective January 28, 1999.

Tenn. Comp. R. & Regs. 1200-11-01-.06 REMOVAL FROM PROGRAM

(1)Participants may be removed from the program when they:

(a)move out of state, or (b)become financially ineligible, or (c)fail to apply for TennCare or adhere to TennCare requirements

History

• Authority: T.C.A. §§68—35—103 and 4—5—202.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed October 9, 1985; effective January 14, 1986. Repeal and new rule filed September 17, 1998; effective January 28, 1999.

Tenn. Comp. R. & Regs. 1200-11-01-.07 RECONSIDERATION OF DENIAL

(1)Applicants who are denied participation in the Renal Disease Program or participants who are removed from the program in accordance with 1200-11-1-.06 may ask in writing to the program within ten (10) calendar days of receipt of the program’s written notice of denial or removal that the denial be reconsidered. If the denial is upheld, the individual may ask the Commissioner to review the decision.

The request must be in writing and be sent to the Commissioner within ten (10) calendar days of receipt of the written notice that the denial was upheld after reconsideration by the program. The decision of the Commissioner may be appealed to a hearing before an Administrative Law Judge pursuant to the provisions of the U.A.P.A.

History

• Authority: T.C.A. §§68—35—103 and 4—5—202.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed October 9, 1985; effective January 14, 1986. Amendment filed April 14, 1988; effective May 29, 1988. Amendment filed June 8, 1989; effective July 14, 1989. Amendment filed September 25, 1990; effective December 29, 1990. Amendment filed January 29, 1992; effective April 29, 1992. Amendment filed May 10, 1995; effective September 28, 1995. Repeal and new rule filed September 17, 1998; effective January 28, 1999.

Chapter 1200-11-02 Hemophilia Program

Tenn. Comp. R. & Regs. 1200-11-02-.01 STATEMENT OF PURPOSE

The Hemophilia Program provides assistance to individuals suffering from hemophilia and other genetic bleeding disorders. Through the provision of financial assistance, the program improves access to care and the quality of life for individuals who require continuing suitable treatments in order to avoid the crippling, extensive side effects associated with their bleeding disorders.

History

• Authority: T.C.A. § 68-36-104.
• Administrative History: Original rule filed April 3, 1974; effective May 3, 1974. Amendment filed July 27, 1977; effective August 26, 1977. Repeal and new rule filed May 15, 2000; effective September 28, 2000. Amendments filed August 21, 2025; effective November 19, 2025.

Tenn. Comp. R. & Regs. 1200-11-02-.02 DEFINITIONS

Unless specifically indicated by the context, for the purpose of these rules and regulations, the terms used herein are defined as follows:

(1) Family - For the purpose of the Hemophilia Program, a family is defined as follows:

(a) Two or more persons related by birth, marriage, or adoption who reside together. (If a household includes more than one family, the guidelines are applied separately to each family);

(b) A person 18 years of age or older who is not living with any relatives;

(c) A child under 18 years of age and his/her non-parent custodians when financial responsibility has been assigned to them by the court; or (d) Parents of a patient under 18 years of age when the patient has been voluntarily placed outside the parent’s home.

(2) Resident of Tennessee - A person who has established a bona fide residence in Tennessee.

The test for such residence is (1) an intention to stay indefinitely in a place joined with (2) some objective indication consistent with that intent, such as a Tennessee drivers’ license.

History

• Authority: T.C.A. § 68-36-104.
• Administrative History: Original rule filed April 3,1974; effective May 3, 1974. Amendment filed July 27, 1977; effective August 26, 1977. Repeal and new rule filed May 15, 2000; effective September 28, 2000. Amendments filed August 21, 2025; effective November 19, 2025.

Tenn. Comp. R. & Regs. 1200-11-02-.03 ELIGIBILITY REQUIREMENTS

(1) Any individual diagnosed with a genetic bleeding disorder who is a resident of Tennessee is eligible to apply for program services.

(2) To receive program services, the applicant must meet the following criteria.

(a) The applicant must submit a completed, properly signed, and dated application provided by the Department. If the applicant is legally incompetent to consent to medical treatment because of age or mental condition, said application shall be completed and signed by the applicant’s parent or legal guardian.

(b) The applicant must meet the medical criteria established in these Rules and must meet the financial criteria at the time of application and/or recertification.

(3) Each applicant’s medical diagnosis must be an acceptable diagnosis as established in these Rules. Any medical treatment must directly relate to the diagnosis for which the applicant was accepted as required by these Rules.

(4) An applicant will be determined diagnostically eligible for the program, if the applicant has been diagnosed with any of the following:

(a) Clotting factor deficiencies - including factors I, II, V, VII, VIII, IX, X, XI, XIII; or (b) Other bleeding disorders - including von Willebrand disease, genetic platelet disorders, or other hemorrhagic disorders.

(5) Individuals will be financially eligible for the Hemophilia Program, if the family’s gross income is at or below 300% of the federal poverty level for the number in the family. When a family has more than one (1) individual with a Hemophilia Program eligible condition, one person may be added to the total number of family members for each additional family member with an eligible condition when determining eligibility. The Department shall determine the family income of the applicant as a family as defined in Rule 1200-11-02-.02(1).

(a) Income shall include:

1. Wages, salaries, and/or commissions;

2. Income from rental property or equipment;

3. Profits from self-employment enterprises, including farms;

4. Alimony and/or child support;

5. Inheritances;

6. Pensions and benefits; and 7. Public assistance grants.

(b) After the income of the family is determined, any verified medical payments including medical or health insurance premiums made by the family for any family member during the previous twelve (12) months shall be prorated over twelve months and deducted from the gross monthly income.

(c) Verified child support or alimony paid to another household shall be deducted from the gross monthly income.

(6) All applicants to or participants in the Hemophilia Program who have no third party insurance coverage must apply for TennCare coverage and provide proof of acceptance or denial to the Hemophilia Program. Once accepted for TennCare coverage, Hemophilia Program participants must meet all TennCare requirements in order to maintain eligibility for the Hemophilia Program.

(7) Applicants may be denied participation in the Hemophilia Program, if they are diagnostically ineligible, financially ineligible, or fail to apply for TennCare coverage.

(8) All participants in the Hemophilia Program must be financially certified annually.

(9) Once a patient has been certified for services, the certification extends for one year regardless of changes in family income.

History

• Authority: T.C.A. § 68-36-104.
• Administrative History: Original rule filed April 3, 1974; effective May 3, 1974. Amendment filed July 27, 1977; effective August 26, 1977. Repeal and new rule filed May 15, 2000; effective September 28, 2000. Amendments filed August 21, 2025; effective November 19, 2025.

Tenn. Comp. R. & Regs. 1200-11-02-.04 COVERED SERVICES

Services will be provided according to the availability of funds.

However, when budget constraints are indicated, the Department may place a cap on enrollment in the program and/or a cap on expenditures per participant.

Covered services may include the following.

(1) Appropriate replacement therapy needed for the prevention and control of bleeding.

(2) Out-patient services related to bleeding disorders as follows:

(a) Physician’s services - primary and specialty;

(b) Emergency room services;

(c) X-ray services;

(d) Laboratory services;

(e) Pharmaceuticals - included on the program’s formulary;

(f) Occupational and physical therapy services;

(g) Orthopedic - appliances and equipment; and (h) Other bleed-related services as prescribed.

(3) In-patient hospitalization for bleeding episodes and complications.

(4) Dental services.

(5) Home health care including nursing services and auxiliary supplies.

(6) Case management services.

(7) Medical insurance premiums for eligible program participants including TennCare premiums, Medicare buy-in for Part B coverage, and premiums for conversion coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986.

(8) Diagnostic evaluations needed by program non-participants to determine their eligibility for the program.

(9) Support of the Comprehensive Hemophilia Clinics.

History

• Authority: T.C.A. § 68-36-104.
• Administrative History: Original rule filed April 3, 1974; effective May 3, 1974. Amendment filed July 27, 1977; effective August 26, 1977. Repeal and new rule filed May 15, 2000; effective September 28, 2000. Amendments filed August 21, 2025; effective November 19, 2025.

Tenn. Comp. R. & Regs. 1200-11-02-.05 AUTHORIZATION AND REIMBURSEMENT FOR SERVICES

(1) In-patient hospitalization must be prior approved when the Hemophilia Program is the primary payor.

(2) No payment shall be made for services rendered to any participant who is receiving services under these Rules unless and until all third party payment sources available have been exhausted.

(3) Dental services must have prior authorization and will be reimbursed based on TennCare’s Schedule of Allowable Fees. TennCare’s authorized dental contractor is responsible for administering TennCare covered dental benefits for eligible members.

(4) With the exception of emergency services, all services provided under these Rules must be obtained within the State.

History

• Authority: T.C.A. § 68-36-104.
• Administrative History: Original rule filed April 3, 1974; effective May 3, 1974. Amendment filed July 27, 1977; effective August 26, 1977. Repeal and new rule filed May 15, 2000; effective September 28, 2000. Amendments filed August 21, 2025; effective November 19, 2025.

Tenn. Comp. R. & Regs. 1200-11-02-.06 REMOVAL FROM PROGRAM

Participants may be removed from the program when they (1) Move out of state, (2) Cannot be located, (3) Become financially ineligible, (4) Fail to apply for TennCare or adhere to TennCare requirements, (5) Become incarcerated, or (6) Fail to abide by the articles set out in the above Rules.

History

• Authority: T.C.A. § 68-36-104.
• Administrative History: Original rule filed April 3, 1974; effective May 3, 1974. Amendment filed July 27, 1977; effective August 26, 1977. Repeal and new rule filed May 15, 2000; effective September 28, 2000. Amendments filed August 21, 2025; effective November 19, 2025.

Tenn. Comp. R. & Regs. 1200-11-02-.07 APPEAL PROCESS

Applicants who are denied participation in the Hemophilia Program or participants who are removed from the program in accordance with 1200-11-02-.06 may appeal the decision in writing to the program within ten (10) calendar days of receipt of the program’s written notice of denial or removal. Written notice shall be provided by first-class mail through the United States Postal Service (USPS) or email, if authorized by the participant. Written notice is deemed received and effective on the date postmarked by the USPS, or the date when the e-mail is transmitted. If the denial is upheld, the individual may appeal the decision in writing to the Commissioner within ten (10) calendar days of receipt of the written notice that the initial appeal has been denied. The decision of the Commissioner shall be final.

History

• Authority: T.C.A. § 68-36-104.
• Administrative History: Original rule filed April 3, 1974; effective May 3,1974. Amendment filed July 27, 1977; effective August 26, 1977. Repeal and new rule filed May 15, 2000; effective September 28, 2000. Amendments filed August 21, 2025; effective November 19, 2025.

Tenn. Comp. R. & Regs. 1200-11-02-.08 THROUGH 1200-11-02-.12 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 53-5604, 68-41-102, and 68-41-104.
• Administrative History: Original rule filed April 3, 1974; effective May 3,1974. Amendment filed July 27, 1977; effective August 26, 1977. Repeal filed May 15, 2000; effective September 28, 2000.

Chapter 1200-11-03 Children's Special Services

Tenn. Comp. R. & Regs. 1200-11-03-.01 STATEMENT OF PURPOSE

In an effort to provide comprehensive services and eliminate health barriers and disparities for children with special health care needs in Tennessee, the Tennessee Legislature created the Children’s Special Services (CSS) Program. The program is intended to assure that children in this population are identified early and receive high quality coordinated care and that their families receive support.

The program serves those children who meet the T.C.A. § 68-12-102 definition of “a child with a physical disability.” To the extent that funding is available, program resources provide for diagnostically related services for enrolled children when other payors are unable to provide payment.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-12-101 et seq., 68-12-104, and 42 U.S.C. § 701 (a).
• Administrative History: Original rule filed April 12, 1979; effective May 28, 1979. Repeal and new rule filed December 30, 1983; effective January 29, 1984. Amendment filed May 29, 1990; effective July 13, 1990. Repeal and new rule filed March 21, 2000; effective July 28, 2000. Repeal and new rule filed October 9, 2002; effective December 23, 2002. Repeal and new rules filed September 6, 2016; effective December 5, 2016.

Tenn. Comp. R. & Regs. 1200-11-03-.02 DEFINITIONS

Unless otherwise specifically indicated by the context, for the purpose of these rules and regulations, the terms used herein are defined as follows.

(1) “Assistive technology/augmentative communication device” means any device or equipment that may promote independence and communication skills for children unable to utilize typical methods for independence.

(2) “Care Coordination” means case management services promoting the effective and efficient organization and utilization of resources to assure access to necessary comprehensive services for children with special healthcare needs and their families. Care coordinators assist families with services such as third party payor billing, filing appeals when third party payors deny payment, and seeking prior approval from third party payors for covered services.

(3) “Child” or “children” means a person or persons under the age of twenty-one (21) years.

(4) “Child with a physical disability” means a child under the age of twenty-one (21) who shall be deemed to have a physical disability by any reason, whether congenital or acquired as a result of accident or disease, which requires medical, surgical, dental or rehabilitation treatment, who is or may be totally or partially incapacitated for the receipt of a normal education or for self-support. This definition shall not include those children whose sole diagnosis is blindness or deafness; nor shall this definition include children who are diagnosed as psychotic. This definition does not prohibit CSS from accepting for treatment children with acute conditions such as, but not necessarily limited to, fractures, burns, and osteomyelitis.

(5) “Commissioner” means the Commissioner of the Tennessee Department of Health or the Commissioner’s designee.

(6) “Covered Services” means medical, surgical, and rehabilitative treatment for eligible diagnoses, including the services necessary in order for a child to follow a prescribed treatment plan for an eligible diagnosis.

(7) “Department” means the Tennessee Department of Health.

(8) “Diagnostic evaluation” means physical examinations, medical procedures, laboratory tests, or other procedures deemed necessary for diagnosis.

(9) “Drugs, devices and supplies” means medications, devices and supplies necessary for treatment related to an eligible diagnosis.

(10) “Durable medical equipment” means equipment that can withstand repeated use, is primarily and customarily used to serve a medical purpose, generally is not useful to a person in the absence of illness or injury, and is appropriate for use in the home, including orthotics, prosthetics, and communication aid devices.

(11) “Elective Hospital Admission” means any hospital admission for diagnoses or treatments not immediately necessary to save the pati ent’s life or prevent impending harm.

(12) “Eligible Diagnosis” means a health-related impairment, described in T.C.A. § 68-12-102 and diagnosed by a provider, which may hinder achievement of normal growth and development.

(13) “Hospitalization” means any overnight stay in a hospital which is:

(a) Capable of providing the type of service(s) needed by the child; and (b) Licensed pursuant to applicable regulations and/or statutes.

(14) “Inpatient hospitalization services” means medical and surgical services (including screening, diagnostic evaluation, therapeutic, corrective, preventive, and palliative services) and facility usage charges (including room and board) provided during hospitalization in a licensed hospital.

(15) “Orthodontic/dental treatment” means medical, surgical, and rehabilitative treatment for eligible cranio-facial (including cleft lip and cleft palate) and cranial diagnoses.

(16) “Outpatient hospitalization services” means medical and surgical services (including screening, diagnostic evaluation, therapeutic, corrective, preventive, and palliative services) and facility usage charges (including temporary room and board) provided as an outpatient service by a licensed hospital or hospital-based Ambulatory Surgical Treatment Center.

(17) “Outpatient clinic services” means diagnoses or treatment services deli vered by a licensed health care provider in a facility other than a hospital setting.

(18) “Provider” means a healthcare provider which is a person, persons, or facility licensed pursuant to T.C.A. Titles 63 or 68 to provide healthcare services in Tennessee, or, if the services are being provided in another state, licensed pursuant to the licensing laws of that state.

(19) “Rehabilitation” means services required to assist the individual to achieve or maintain independence. Rehabilitative services may include physical, speech/language, nutriti onal/feeding, and occupational therapies.

(20) “Resident of Tennessee” means a person who has establis hed a bona fide residence in Tennessee. The test for such residence is (1) an intention to stay indefinitely in a place, joined with (2) some objective indication consistent with that intent, e. g., enrollment of a child in school.

(21) “Support services” means activities that may be necessary to assist the individual or family to access medically necessary and/or recommended care to participate in the activities of daily living.

(22) “Third party payor” means a party, other than the recipient of healthcare, who pays for healthcare. Third party payors include private insurance and the following resources:

(a) The Patient Protection and Affordable Care Act, which is the health-related portion of the Health Care and Education Reconciliation Act of 2010.

(b) Children’s Health Insurance Program (CHIP), which is a health insurance program mandated by Title XXI of the Social Security Act that is jointly financed by Federal and State governments and administered by the States. CHIP was previously known as the State Children’s Health Insurance Program (SCHIP). Tennessee’s CHIP includes the CoverKids program.

(c) CoverRX, which is a program that offers affordable prescription drugs to persons ages nineteen (19) years and older who lack pharmacy coverage.

(d) TennCare, which is the State of Tennessee Medicaid Waiver program that replaced the State’s Medicaid program. The TennCare Bureau contracts with managed care organizati ons (MCOs) to provide a network of providers to serve TennCare enrolled individuals.

(23) “Title V Children with Special Health Care Needs (CSHCN)” means the section of the Title V Maternal and Child Health CSHCN Block Grant that supports the program.

(24) “Vendor or supplier” means authorized person, persons, or facilities approved by the State of Tennessee to provide services in conjunction with established Department of Health and Department of Finance and Administration guidelines.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-12-101 et seq, and 42 U.S.C. § 701(b).
• Administrative History: Original rule filed April 12, 1979; effective May 28, 1979. Repeal and new rule filed December 30, 1983; effective January 29, 1984. Amendment filed May 29, 1990; effective July 13, 1990. Amendment filed December 7, 1998; effective April 30, 1999. Repeal and new rule filed March 21, 2000; effective July 28, 2000. Repeal and new rule filed October 9, 2002; effective December 23, 2002. Amendment filed May 27, 2005; effective September 28, 2005. Repeal and new rules filed September 6, 2016; effective December 5, 2016.

Tenn. Comp. R. & Regs. 1200-11-03-.03 ELIGIBILITY REQUIREMENTS

(1) General Eligibility. To be eligible for the Program’s services, a child shall:

(a) Be a resident of Tennessee;

(b) Not have reached his or her twenty-first birthday;

(c) Meet the diagnostic and financial eligibility requirements below;

(d) Complete and sign the application form approved by the Program; and (e) Provide proof of application to Medicaid or CHIP within ninety (90) days of completing and signing the Program’s application form (if Medicaid or CHIP eligible).

(2) Diagnostic Eligibility. To be eligible for the Program’s services, a child shall provide a physician’s certification that the child has an eligible diagnosis which causes the child to meet the definition of “child with a physical disability” defined by T.C.A. § 68-12-102. The physicians shall base the certification upon a physical examination conducted within the 12 months preceding the date of certification.

(3) Financial Eligibility. A child shall be financially eligible for services if his or her family’s gross annual income as adjusted is at or below 200% of the Federal Poverty Guidelines. When a family has more than one (1) child with an eligible diagnosis(es), the program may add one person to the total number of family members when determining eligibility.

(a) For purposes of financial eligibility, a “family” is defined as two or more persons (including the child) related by birth, marriage or adoption who reside together, unless one of the following alternative scenarios applies.

1. If the parent or parents of a child under the age of eighteen (18) have voluntarily placed the child in another party’s home to reside, the child and the parents are a “family.”

2. If the parent or parents of a child under the age of eighteen (18) have been court-ordered to provide financial support to the child when the child lives in another party’s home, the child and the parent or parents are a “family.”

3. If a child eighteen (18) years of age or older does not live with a relative, the child alone is considered a “family.”

4. A foster child alone is considered a “family” and the Department of Children’s Services (DCS) foster care board payments to the foster parents are considered the family’s income.

(b) The program shall determine the family’s gross annual income and financial eligibility by calculating the following:

1. Wages, salaries, tips/gratuities, and/or commissions;

2. Income from rental property or equipment;

3. Profits from self-employment enterprises, including farms; 4 Alimony, maintenance and/or child support;

4. Inherita nces, lottery winnings and/or other windfalls 6. Pensions and benefits;

5. DCS foster care board payments; and 8. Public assistance grants.

(c) After the program determines the family’s gross annual income, the program may adjust income by taking into consideration the probable total cost of treatment and the family’s other financial responsibilities, including but not limited to the following:

1. Verification of medical payments including medical or health insurance premiums made by the family for any family member during the previous twelve (12) months. The program shall deduct this amount from the gross annual income.

2. Verification of alimony, maintenance and/or child support paid to another household, which the program shall deduct from the gross annual income.

3. Number of dependents.

(d) The program shall review its available funding and historical spending annually. In any year in which, in the best judgment of the program, it appears that funds are available to serve families with gross annual income as adjusted greater than 200% of the Federal Poverty Guideline, the program may, in its sole discretion, post on its website an increased income eligibility limit and serve families with gross annual incomes as adjusted up to the posted limits.

(4) Subsequent determinations of eligibility. The program shall recertify enrolled children annually. A child shall meet all eligibility criteria in order to remain enrolled in the program.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-12-101 et seq., 68-12-103, 68-12-112, 42 U.S.C. § 701, and 42 U.S.C. § 705(a)(1)(C) and (a)(3)(B).
• Administrative History: Original rule filed April 12, 1979; effective May 28, 1979. Repeal and new rule filed December 30, 1983; effective January 29, 1984. Amendment filed May 29, 1990; effective July 13, 1990. Repeal and new rule filed March 21, 2000; effective July 28, 2000. Repeal and new rule filed October 9, 2002; effective December 23, 2002. Amendments filed May 27, 2005; effective September 28, 2005. Repeal and new rules filed September 6, 2016; effective December 5, 2016.

Tenn. Comp. R. & Regs. 1200-11-03-.04 COVERED AND NON-COVERED SERVICES

(1) When a child enrolled in the program requires services for which one or more third party payors are financially responsible, the program may provide the child with services limited to care coordination, subject to availability of funding.

(2) Covered servi ces are those described in Rule 1200-11-03-.02 that are not covered by third party payors and are limited to those that directly relate to the child’s eligible diagnosis.

Covered services may include, but are not limited to, the following:

(a) Inpatient hospitalization; outpatient hospitalization or clinic services; care coordination services; orthodontic/dental treatment; drugs, devices and supplies such as medication, and nutritional supplements, standard rehabilitative therapies, assistive technology/augmentative communication devices, co-pays, co-insurance and deducti bles; or other support services as determined by the Commissioner and the program;

(b) Subsequent hospitalizations, clinic visits, routine care, transplants and implants deemed medically necessary, medications (including immunosuppressive therapy), and supplies after transplant and implant surgeries; and (c) Rental or purchase of durable medical equipment; maintenance, repair, or replacement of durable medical equipment; and, where appropriate, training of the enrolled child or the child’s family in the use of the equipment.

(3) Services not eligible for reimbursement from the program include, but are not limited to, the following:

(a) Drugs, food and nutritional/dietary supplements not approved by the Food and Drug Administration (FDA);

(b) Orthodontic/Dental services except treatment for eligible cranio-facial (including cleft lip and cleft palate) and designated cardiac diagnoses;

(c) Psychiatric treatment and psychological services; treatment and services for mental, emotional and behavioral disorders, developmental disabilities and learning disabilities;

(d) Treatment for alcohol and drug abuse and/or dependence;

(e) Ambulance fees and transportation costs, except for emergency transportation from one hospital to another, as related to the child’s eligible diagnosis;

(f) Services rendered while a child is admitted to a nursing home for continuous or episodic care.

(4) The program shall determine the type and amount of covered services by the availability of funds. When budgetary constraints are indicated the program may:

(a) Create a waiting list of children requesti ng elective hospital admissions. (The program will evaluate the waiting list on a monthly basis and approve elective admissions according to availability of funds);

(b) Eliminate inpatient hospitalization services as defined in 1200-11-03-.02, except for lif e-threatening conditions and conditi ons that would cause a permanent disability, if not treated immediately;

(c) Eliminate services for less severe diagnostic categories as designated by the program; and/or (d) Reduce the type and amount of support services, durable medical equipment, care coordination, or other covered services.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-12-101 et seq., and 42 U.S.C. § 704(b)(1).
• Administrative History: Original rule filed April 12, 1979; effective May 28, 1979. Repeal and new rule filed December 30, 1983; effective January 29, 1984. Amendment filed May 29, 1990; effective July 13, 1990. Repeal and new rule filed March 21, 2000; effective July 28, 2000. Repeal and new rule filed October 9, 2002; effective December 23, 2002. Amendments filed May 27, 2005; effective September 28, 2005. Repeal and new rules filed September 6, 2016; effective December 5, 2016.

Tenn. Comp. R. & Regs. 1200-11-03-.08 APPEALS AND TERMINATION OF ENROLLMENT

(1) Appeals (a) An enrolled child who receives a determination of ineligibility for program services (or his or her representative) may appeal the decision in writing to the program director within (30) calendar days of receipt of the program’s written notice of the child’s ineligibility. If the program director upholds the program’s determination of ineligibility, the individual may appeal the decision in writing to the Commissioner within ten (10) calendar days of receipt of the written notice upholding the program’s determination.

The decision of the Commissioner shall be final.

(2) Termination of Enrollment (a) The program may terminate a child’s enrollment in the Program for the following reasons, none of which are subject to appeal:

1. Child has received maximum treatment for the eligible diagnosis;

2. Child has attained the age of twenty-one (21) years;

3. Child has moved out of state;

4. Child is deceased;

5. Child is not diagnostically eligible;

6. Child is not financially eligible;

7. Child’s family is not interested; and/or 8. Child cannot be located by the program.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-12-101 et seq., and 42 U.S.C. § 701(a).
• Administrative History: Original rule filed March 21, 2000; effective July 28, 2000. Repeal and new rule filed October 9, 2002; effective December 23, 2002. Repeal and new rules filed September 6, 2016; effective December 5, 2016.

Tenn. Comp. R. & Regs. 1200-11-03-.05 AUTHORIZATION AND REIMBURSEMENTS

(1) The program shall authorize only those services for reimbursement that relate to the child’s eligible diagnosis(es). The Program shall be a payor of last resort, paying for covered services only after exhaustion of the family’s other payor sources, except for applicable deductibles, co-insurance, and/or co-payment. The program shall not pay the difference between the billed amount for a service and the amount paid by a third party payor based upon a contractual agreement. Except as provided in 1200-11-03-.05(5), the program shall only authorize reimbursement for services for children currently enrolled in the program.

(2) Reimbursement.

(a) The program shall authorize reimbursement for services as follows:

1. Inpatient hospitalization and rehabilitation services shall be based on a per diem rate as negotiated between the Program and the facility.

2. Drug reimbursements shall be based upon the Department’s average wholesale price. The shipping and handling fee may be reimbursed according to the program’s most current Delegated Authority (DA).

3. Services for which there is a Medicare fee shall be at least the equivalent of the prior year’s Medicare fee schedule for Tennessee multiplied by 75%. The program shall update the required minimum reimbursement rate on a biennial

basis, but at its discretion, the program may at other times update the reimbursement rate to account for significant changes in fees. The updated National Conversion Factor is referenced in the Federal Register on or about October 31 each year.

4. T herapies, medical supplies, durable medical equipment, prosthetics, orthotics, and orthodontic/dental treatment services shall be based on the American Medical Association Physicians’ Current Procedural Terminology (CPT) codes relative value units and determined by the State of Tennessee purchasing procedures and the Delegated Purchase Authority for the program.

5. Nutritional supplements, hearing aids, and hearing aid supplies shall be determined by the State of Tennessee purchasing procedures and the Delegated Purchasing Authority for the Program.

6. Non-hospital services for which there is no Medicare fee shall be paid at least 75% of the average of three (3) bids, one from each grand division of the state.

(b) The program shall not authorize reimbursement f or any covered service provided over twelve (12) months prior to the receipt of the request for reimbursement.

(3) The program shall determine authorization of providers and vendors for rei mbursement in accordance with the standards as designated in these rules and determined by the Department of Health and the Department of Finance and Administration.

(4) The Department shall determine billing procedures for hospitals, institutions, facilities, agencies, providers, vendors, or distinct parts thereof rendering services.

(5) Upon receipt of a determination from the assigned provider that a requested service is urgent and medically necessary, the State CSS Program Director may grant authorization prior to exhaustion of resources from third party payors, provided however, that the grant or denial of such authorization shall be final.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-12-101 et seq., 42 U.S.C. § 701(a), 42 U.S.C. § 704(b)(1), and 42 U.S.C. § 706(a)(2).
• Administrative History: Original rule filed April 12, 1979; effective May 28, 1979. Repeal and new rule filed December 30, 1983; effective January 29, 1984. Amendment filed May 29, 1990; effective July 13, 1990. Repeal and new rule filed March 21, 2000; effective July 28, 2000. Repeal and new rule filed October 9, 2002; effective December 23, 2002. Repeal and new rules filed September 6, 2016; effective December 5, 2016.

Tenn. Comp. R. & Regs. 1200-11-03-.06 PROVIDERS

(1) All providers shall be appropriately certified and/or licensed in their respective specialties.

(2) Providers participating in a TennCare Managed Care Organization (MCO) network shall be recognized by the program as providers and must complete an application to the program for reimbursement purposes. Providers not partici pating in a TennCare MCO network must complete an application and be approved to serve as a provider before submitting any costs for reimbursement.

(3) All providers must sign the Department’s vendor agreement and abide by these rules.

(4) Providers shall not submit additional and concurrent charges to the family for the care of a child over and above the amount covered by third party payors, as provided in these rules.

This does not preclude a family or other party from making a contribution toward the care of the child when they are willing and able but providers shall not solicit or accept such contributions from the family of a child on TennCare for services covered in whole or in part by TennCare.

(5) No provider shall charge program enrolled children more than the amount charged for private clients for equivalent accommodations and services.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-12-101 et seq., and § 42 U.S.C. 701(a).
• Administrative History: Original rule filed December 30, 1983; effective January 29, 1984. Amendment filed May 29, 1990; effective July 13, 1990. Repeal and new rule filed March 21, 2000; effective July 28, 2000. Repeal and new rule filed October 9, 2002; effective December 23, 2002. Repeal and new rules filed September 6, 2016; effective December 5, 2016.

Tenn. Comp. R. & Regs. 1200-11-03-.07 OUT-OF-STATE TREATMENT

(1) The program may approve a provider’s services in an out-of-state facility under the following conditions.

(a) The referring physician shall provide evidence that requested services are not available within Tennessee, or shall provide explicit medical justification to prove such out-of-state treatment is in the best interest of the child;

(b) The program shall base reimbursement for services on a negotiated rate paid by the Title V CSHCN Program in that state, or on that state’s Medicaid rate, whichever is less;

(c) The out-of-state length of stay and estimated hospital charge shall be within the limits established by the program;

(d) The out-of-state estimated cost of out-patient follo w-up and/or discharge services shall be equal or comparable to the Title V CSHCN rate in that state or that state’s Medicaid rate, whichever is less;

(e) The program shall provide written approval to the provider prior to the provider’s performance of services.

(2) In order to maintain continuity of care, the program shall refer children receiving services under these rules and regulations who move out of state to the appropriate Title V CSHCN program within the state of new residence upon written permission of the parents or legal guardian, or in the case of an emancipated minor, the minor’s permission.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-12-101 et seq., and 42 U.S.C. § 701(a).
• Administrative History: Original rule filed March 21, 2000; effective July 28, 2000. Repeal and new rule filed October 9, 2002; effective December 23, 2002. Repeal and new rules filed September 6, 2016; effective December 5, 2016.

Chapter 1200-11-04 Child Safety Fund

Tenn. Comp. R. & Regs. 1200-11-04-.01 INTRODUCTION

Tennessee Code Annotated (“T.C.A.”) Section 55-9-602 establishes the requirements for child passenger restraint systems for passenger motor vehicles operating in Tennessee and levies fines for violations of the same. Further, the law establishes within the general fund a revolving special account known as the Child Safety Fund.

Effective July 1, 2004, Section 55-9-602(f)(7) authorizes the Department, pursuant to duly promulgated rules and regulations, to determine equitable distribution of the moneys in the Child Safety Fund to those entities that are best suited for child passenger safety system distribution. These rules carry out this objective.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 55-9-602, and 55-9-610.
• Administrative History: Original rule filed January 10, 2005; effective March 26, 2005.

Tenn. Comp. R. & Regs. 1200-11-04-.02 DEFINITIONS

For purposes of these rules, the terms set forth below shall have the following meanings:

(1) “Child Safety Fund” means moneys disbursed to designated entities to provide child passenger restraint systems pursuant to T.C.A. Section 55-9-602.

(2) “Child passenger restraint system” or “child safety restraint system” means an age or size appropriate child safety seat as required by T.C.A. Section 55-9-602.

(3) “Commissioner” means the Commissioner of the Tennessee Department of Health or a duly authorized designee.

(4) “Department” means the Tennessee Department of Health.

(5) “Distribution” means funds disbursed quarterly from the Child Safety Fund to participating entities based on an equal fraction of available funds.

(6) “Quarter” means a three (3) month period of the year used for monetary accounting purposes.

(7) “Participating entity” or “entity” means an organization or entity approved by the Department to participate in the program.

(8) “Poverty guideline” means the guideline used for determining whether a person or family is financially eligible for assistance or services under a particular federal program as published annually in the Federal Register.

(9) “Quarterly report” means the report to be submitted by participating entities to reflect the three (3)-month period of child passenger restraint system distribution activity.

History

• Authority: T.C.A. §§ 55-9-602 and 55-9-610.
• Administrative History: Original rule filed January 10, 2005; effective March 26, 2005. Amendments filed April 8, 2025; effective July 7, 2025.

Tenn. Comp. R. & Regs. 1200-11-04-.03 DISTRIBUTION OF FUNDS

The following criteria shall apply to the distribution of funds and the types of entities receiving funds for the distribution of child passenger restraint systems.

(1) Funds distributed pursuant to these rules shall not exceed the amount of funds available to the Department from the Child Safety Fund.

(2) The money in the Child Safety Fund shall be allocated and distributed equally in one-third (1/3) increments to qualified entities serving children within the three (3) groups identified below.

(a) One-third (1/3) of the Child Safety Fund shall be allocated to children under one (1) year of age, or any child weighing twenty (20) pounds or less.

(b) One-third (1/3) of the Child Safety Fund shall be allocated for children one (1) through three (3) years of age weighing greater than twenty (20) pounds.

(c) One-third (1/3) of the Child Safety Fund shall be allocated for children four (4) through eight (8) years of age and measuring less than four feet nine inches (4’9”) in height.

(3) Funds shall be used for the purchase of child passenger restraint systems to be given to the parent or guardian of infants and children in accordance with the provisions of these rules.

History

• Authority: T.C.A. §§ 55-9-602 and 55-9-610.
• Administrative History: Original rule filed January 10, 2005; effective March 26, 2005. Amendments filed April 8, 2025; effective July 7, 2025.

Tenn. Comp. R. & Regs. 1200-11-04-.04 ELIGIBILITY

(1) Eligibility Criteria for Participation in the Child Safety Fund.

(a) To be eligible, an entity must (1) be a governmental or nonprofit organization under

section 501(c)(3)of the Internal Revenue Code, and (2) provide services to low income families meeting the federal poverty guidelines.

(b) The entity shall submit to the Department an application to participate, using a form, and in a manner, prescribed by the Department.

(c) Participating entities shall be determined eligible based upon previous experience of providing services to children, age newborn through eight years old, in low income families that meet federal poverty guidelines.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 55-9-602, and 55-9-610.
• Administrative History: Original rule filed January 10, 2005; effective March 26, 2005.

Tenn. Comp. R. & Regs. 1200-11-04-.05 ACCOUNTABILITY OF PARTICIPATING ENTITIES

(1) The Department will collect data through quarterly reports submitted by each participating entity. The data shall be used to document how the entity used the money that was distributed from the Child Safety Fund.

(2) The Department will maintain a database that lists all participating entities and the total number of child passenger restraint systems purchased with money through the Child Safety Fund.

(3) The participating entity is required to submit a quarterly report, in a format prescribed by the Department, no later than 45 days after the end of the quarter.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 55-9-602, and 55-9-610.
• Administrative History: Original rule filed January 10, 2005; effective March 26, 2005.

Tenn. Comp. R. & Regs. 1200-11-04-.06 PARTICIPATING ENTITY RESPONSIBILITIES

(1) It is the responsibility of a participating entity to meet the requirements as set forth in these rules.

(2) An entity is obligated to expend the funds received during the disbursement period no later than the end of the next full quarter following the disbursement period, and in the manner defined in these rules and Departmental policies and procedures.

(3) An entity will not be eligible to receive continued funding if it fails to submit the required quarterly report within forty-five (45) days after the end of the quarter, as stated in 1200-11- 04-.05(3). If the entity fails to submit the required report, a letter will be sent to the entity informing it that its participation has been cancelled until the report is received by the Department.

(4) Fraud or misrepresentation in the implementation process will render the entity ineligible for future participation.

(5) Entity participation in the Child Safety Fund is not a property right, and the Department may refuse or cancel an entity’s participation if the entity fails to abide by these rules or program policies, or for any other reason as deemed necessary by the Department.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 55-9-602, and 55-9-610.
• Administrative History: Original rule filed January 10, 2005; effective March 26, 2005.

Chapter 1200-11-05 Repealed

Tenn. Comp. R. & Regs. 1200-11-05-.01 REPEALED

History

• Authority: T.C.A. §§ 68-1-103 and 68-1-1201 through 68-1-1206.
• Administrative History: Original rule filed July 28, 1989; effective September 11, 1989. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-11-05-.09 REPEALED

History

• Authority: T.C.A. §§ 68-1-103 and 68-1-1201 through 68-1-1206.
• Administrative History: Original rule filed July 28, 1989; effective September 11, 1989. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-11-05-.02 REPEALED

History

• Authority: T.C.A. §§ 68-1-103 and 68-1-1201 through 68-1-1206.
• Administrative History: Original rule filed July 28, 1989; effective September 11, 1989. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-11-05-.03 REPEALED

History

• Authority: T.C.A. §§ 68-1-103 and 68-1-1201 through 68-1-1206.
• Administrative History: Original rule filed July 28, 1989; effective September 11, 1989. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-11-05-.04 REPEALED

History

• Authority: T.C.A. §§ 68-1-103 and 68-1-1201 through 68-1-1206.
• Administrative History: Original rule filed July 28, 1989; effective September 11, 1989. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-11-05-.05 REPEALED

History

• Authority: T.C.A. §§ 68-1-103 and 68-1-1201 through 68-1-1206.
• Administrative History: Original rule filed July 28, 1989; effective September 11, 1989. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-11-05-.06 REPEALED

History

• Authority: T.C.A. §§ 68-1-103 and 68-1-1201 through 68-1-1206.
• Administrative History: Original rule filed July 28, 1989; effective September 11, 1989. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-11-05-.07 REPEALED

History

• Authority: T.C.A. §§ 68-1-103 and 68-1-1201 through 68-1-1206.
• Administrative History: Original rule filed July 28, 1989; effective September 11, 1989. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-11-05-.08 REPEALED

History

• Authority: T.C.A. §§ 68-1-103 and 68-1-1201 through 68-1-1206.
• Administrative History: Original rule filed July 28, 1989; effective September 11, 1989. Repeal filed June 24, 2024; effective September 22, 2024.

Chapter 1200-11-06 Rules and Regulations Governing the Criteria and Standards for Certification as a Tennessee Regional Poison Control Center

Tenn. Comp. R. & Regs. 1200-11-06-.01 INTRODUCTION

Public Chapter No. 393 of the Acts of 1991 authorized the Department of Health to establish and maintain a system of poison control centers in Tennessee. These rules and regulations establish the criteria and standards by which the Commissioner of Health can designate a regional poison control center in Tennessee. Designation as a regional poison control center in Tennessee should assure that the facility can provide appropriate services to the general public and health professionals which would include answering requests by telephone for poison information and making recommendations for appropriate emergency management and treatment referrals of poisoning exposures on a 24-hour a day basis. Additionally, the center would provide professional education and public awareness programs on poison prevention and center utilization, maintain a data collection system and operate within written quality control guidelines.

History

• Authority: T.C.A.. §§4-5-202, 68-1-103, 68-141-101, 68-141-102 and 68-141-104.
• Administrative History: Original rule filed June 22, 1994; effective September 5, 1994.

Tenn. Comp. R. & Regs. 1200-11-06-.02 DEFINITIONS

(1)Poison Control Center - an entity which provides information on poisons and advice for poisoning emergencies to the general public, health care professionals, and worksites; on a 24-hour basis and promotes poison prevention throughout the community.

(2)Region - a group of contiguous counties within the state.

(3)Exposure Case - an intentional or unintentional human poisoning in which the center is called for advice on handling the incident, provides appropriate information and monitors the patient’s progress as appropriate.

History

• Authority: T.C.A. §§4-5-202, 68-1-103, 68-141-101, 68-141-102 and 68-141-104.
• Administrative History: Original rule filed June 22, 1994; effective September 5, 1994.

Tenn. Comp. R. & Regs. 1200-11-06-.03 DETERMINATION OF REGIONAL NETWORK AND CENTERS

(1)Geographical, characteristics. Due to the geographical uniqueness of the state, the Commissioner has designated four discrete regions in Tennessee that will compose the Tennessee Poison Control Network, as follows:

(a)West Tennessee Region - all counties west of the Tennessee River, including Hardin County CENTER (b)Middle Tennessee Region - 1.At its western border, all counties which lie east of the Tennessee River, excluding Hardin County 2.At its eastern border, Sumner, Trousdale, Wilson, Rutherford, Coffee, Moore and Lincoln 3.All counties that lie between (c)Central Tennessee Region - 1. At its western border, Macon, Smith, DeKalb, Cannon, Warren, Grundy and Franklin 2. At its eastern border, Pickett, Fentress, Cumberland, Rhea, Meigs, McMinn and Polk 3. All counties that lie between (d)East Tennessee Region - all counties east of the Central Tennessee Region (2)To assure efficiency and quality of services, a poison control center will be eligible for designation if it handles a minimum of 10,000 exposure cases per year, including out-of-state calls.

(3)The Commissioner may designate one poison control center in each region to implement the poison control program and may designate a center to serve more than one region. However, the Commissioner has the discretion to designate a poison control center in a subregion should it be determined that no center is willing to provide poison control services in an entire region. In no case shall two centers serve the same geographic area.

(4)Designation as a regional poison control center will operate on a 48-month cycle as follows:

(a)Pursuant to an application process, the Department will designate a regional poison control center on a provisional basis for an initial period of 12 months.

(b)At the end of the 12-month provisional period, the Commissioner may: 1.Upgrade the provisional status by designating the facility as the official poison control center in the region for an additional period of 36 months. Designation as the official center would be automatic if the facility operated in full compliance with the criteria and standards at the end of the provisional periods; 2.The public welfare requiring it, extend the provisional status of the facility for a discretionary period of time to allow the center time to cure any deficiencies; or 3.Identify, through another application process, a different facility for designation of a 12month provisional period if the initial designee did not meet all criteria and standards or chose not to seek recognition as the official poison control center in the region. In this case, the 48-month cycle would be reinitiated.

(c)At the end of a completed 48-month cycle, the Department will send written notification to all potential facilities that the designation of the center in a, region(s) has expired. If no other parties apply for designation as a regional poison control CENTER center, the Department will establish a streamlined renewal process leading to official designation of the original facility for another 48-month period, upon a determination by the Department that the original facility satisfactorily met the requirements of these program rules.

(5)If possible, a center should make a reasonable attempt to provide to the Commissioner a 12-month notification of intent to relinquish its designation as a poison control center.

History

• Authority: T.C.A.. §§4-5-202, 68-1-103, 68-141-101, 68-141-102 and 68-141-104.
• Administrative History: Original rule filed June 22, 1994, effective September 5, 1994. Amendment filed April 29, 1995; effective August 28, 1995.

Tenn. Comp. R. & Regs. 1200-11-06-.04 REGIONAL POISON INFORMATION SERVICE

(1)The regional poison control center shall provide information 24 hours per day on a 365 days per year

basis to both health professionals and the public. This criterion will be considered to be met if the center has at least one specialist in poison information in the center at all times, sufficient additional staff to promptly handle the center’s incoming calls (at least 95% of calls get through to the center and are answered within five rings) and has the availability of the medical director or qualified designee, on-call by telephone, at all times.

(2)The regional poison control center shall be readily accessible by telephone from all areas within the region. The criterion will be considered to be met if the center has a direct incoming telephone system that is extensively publicized throughout the region to both health professionals and the public. The center must demonstrate that it provides easy access for the general public and health professionals who reside anywhere in the region.

(3)The regional poison control center shall maintain comprehensive poison information resources. This criterion will be considered to be met if the center maintains:

(a)One or more up-to-date comprehensive toxicology information resources, immediately available at the central telephone answering site. (Preferably, the center should have access to a generallyaccepted, computerized data base(s));

(b)Current comprehensive texts covering both general and specific aspects of acute and chronic poisoning management immediately available at the central telephone answering site;

(c)Primary information resources and ready availability of a medical library; and, (d)A list of poison control center specialty consultants who are available on an on-call basis [(See 1200-116-.04(5)(e) below)].

(4)The regional poison control center shall maintain written operational guidelines which provide a consistent approach to evaluation and management of toxic exposures. This criterion will be considered to be met if the center provides written operational guidelines which include, but are not limited to, the follow-up of all potentially toxic exposures and appropriate criteria for patient disposition. These guidelines must be available in the center at all times and must be approved in writing by the medical director of the program. The poison control center shall maintain a current and easily accessible list of phone numbers of each of the hospitals and pre-hospital transportation systems in the region.

(5)Staff Qualifications and Responsibilities for the Regional Poison Control Center:

CENTER

(a)Medical Director. The medical director should be board certified in internal medicine, pediatrics, family medicine or emergency medicine or, alternatively, be board eligible or board prepared in one of these medical specialties and actively working toward certification. The medical director must be a properly licensed physician in the state of Tennessee and be able to demonstrate ongoing interest and expertise in toxicology as evidenced by publications, research and meeting attendance. The medical director must have an active medical staff appointment at a general or pediatric hospital. The medical director should devote at least an average of 25%, or a minimum of 10 hours per week, of his/her professional activities to toxicology. In addition to clinical, academic teaching and research activities, the medical director must formally commit at least an average of 8 hours per week to poison control center operational activities, involving staff training, development of poison case management guidelines and quality assurance activities.

(b)Managing director. The managing director of a regional poison control center must be a registered nurse, pharmacist, physician or hold a degree in a health science discipline. This individual may also be the medical director The managing director must be a properly licensed health professional in the state of Tennessee who must be able to demonstrate an ongoing commitment to poison control center related activities, including the areas of clinical toxicology, education, research and administration. The managing director should devote an average of 50%, or a minimum of 20 hours per week, to poison control center operational activities.

(c)Specialists in poison information. Specialists in poison information must be physicians, physician assistants, registered nurses or pharmacists who are properly licensed in the state of Tennessee. Specialists in poison information must be qualified to understand and interpret standard poison information resources and to transmit that information in a logical, concise, and understandable way to both health professionals and the public. All specialists in poison information must complete a training program approved by the medical director that meets a minimum level of information and knowledge in the areas of 1.Telephone strategy-clinical history, physical assessment, and toxicology assessment skills and information; 2.Information resource evaluation and utilization; 3.First aid for poison emergencies; 4.Triage and medical referral procedures; 5.Psycho-social assessment and verbal communication skill development; 6.Inter-agency referral and consultation procedures; 7.Case documentation; 8.Follow-up and ongoing assessment; and, 9.Product and substance toxicology information and treatment guidelines as determined by the medical director CENTER Specialists in poison information must spend a minimum annual average of 8 hours per week in poison control center related activities, including providing telephone consultation, teaching, public education, or in poison center operations. The primary responsibility of all specialists in poison information, whether full-time or part-time, must be the provision of poison prevention or intervention information. At the approval and discretion of the medical director, a poison information specialist may be assigned other responsibilities but not to such a degree or extent that would interfere or deny appropriate service for poison calls.

(d)Other poison information providers. Other poison information providers must be qualified to understand and interpret standard poison information resources and to transmit that information understandably to both health professionals and the public under the direct supervision of a specialist in poison information or the medical director. This requirement will be considered to be met if the person has an appropriate health-oriented background and has specific training or experience in poison information sciences which include, at a minimum, the following areas of expertise: 1.Telephone strategy-clinical history and physical assessment and toxicology assessment skills and information; 2.Information resource retrieval and evaluation; 3.First aid for non-life threatening poison emergencies; 4.Triage procedures; 5.Verbal communication skill development; 6.Initial case documentation; 7.Case follow-up and documentation; 8.Other topics as deemed appropriate by the medical director.

(e)Poison control center specialty consultants. Poison control center specialty consultants should be qualified by training or experience to provide sophisticated toxicology or patient care information in their area(s) of expertise. These consultants should be available on-call, with an expressed commitment to provide consultation services on an as needed basis. The list of consultants, which should reflect the type of poisonings encountered in the region, should consist of a minimum core group composed of the following specialties: 1.Emergency Medicine, pediatric and adult; 2.Mycology; 3.Botany; 4.Veterinary Medicine; 5.Herpetology;

CENTER 6.Forensic Medicine; 7.Medical Toxicology; 8.Hazardous Materials; 9.Geriatrics; 10.General Medicine, pediatric and adult; and 11.Clinical Pharmacy (f)Administrative staff. Poison control center administrative personnel should be qualified by training or experience to supervise finances, operations, personnel, data analysis, and other administrative functions of the poison center.

(g)Education Staff. 1.Professional education. Professional education personnel should be available to provide quality professional education lectures or materials to health professionals. This role will be supervised by the medical director. 2.Public education. Public education personnel should be available to provide publicoriented poison center awareness, poison prevention and first aid for poisoning presentations. They must be capable of providing presentations to public audiences, and have sufficient understanding of the material to accurately answer public questions. They may be full-time, part-time or volunteer staff.

(h)The regional poison control center should assure that all specialists and other poison information providers participate in and complete at least 8 hours of continuing education per year as approved by the medical director which is directly relevant to the activities of the poison control center.

(6)The regional poison control center shall have an ongoing quality assurance program. This criterion will be considered to be met if the center has regularly scheduled staff inservices (at least quarterly), mortality chart review, call audits, peer review for documentation and appropriateness of care, audits for outcome and process indicators, demographics including call penetrance, and process review including call volume per specialist, calls placed on hold or interrupted and calls not answered within five rings.

History

• Authority: T.C.A. §§4-5-202, 68-1-103, 68-141-101, 68-141-102 and 68-141-104.
• Administrative History: Original rule filed June 22, 1994; effective September 5, 1994.

Tenn. Comp. R. & Regs. 1200-11-06-.05 REGIONAL DATA COLLECTION SYSTEM

(1)The regional poison control center shall keep records of all exposure cases handled by the center in a form that is acceptable as a medical record. This criterion will be considered to be met if the center completes a record that contains data elements and sufficient narrative to allow for peer review and medical and legal audit, and such records are kept on file in compliance with standards for hospital record keeping in the state.

CENTER

(2)The regional poison control center shall tabulate its experience for regional program evaluation on at least an annual basis. This criterion will be considered to be met if the center completes an annual report summarizing its own experience which includes, at a minimum, the following data elements:

Frequency DistributionsCross Tabulations Number of exposures Number of Information requests Age ---------------------------------------------------------------------Age vs. Sex Sex --------------------------------------------------------------------Age vs. reason for exposure Site of exposure -----------------------------------------------------Age vs. medical outcome Reason for exposure ------------------------------------------------Medical outcome vs. reason Initial symptom assessment ---------------------------------------Substance group vs. age group Site of Management ------------------------------------------------Substance group vs. age reason Medical outcome ----------------------------------------------------Substance group vs. outcome Categorical list of substances Summary of fatalities County of origin Site of caller Payor Source (3)An annual report, or substantially equivalent document, that summarizes the center’s calendar year activities and includes, at a minimum, the data elements listed above as well as a synopsis of community and professional education and prevention programs provided shall be submitted to the Commissioner no later than April 15th of the following year.

History

• Authority: T.C.A. §§4-5-202, 68-1-103, 68-141-101, 68-141-102 and 68-141-104.
• Administrative History: Original rule filed June 22, 1994; effective September 5, 1994.

Tenn. Comp. R. & Regs. 1200-11-06-.06 PROFESSIONAL AND PUBLIC EDUCATION PROGRAMS

(1)The regional poison control center shall provide information on the management of poisoning to the health professionals throughout the region who care for poisoned patients. This criterion will be considered to be met if the center offers ongoing information (e.g., inservices, newsletters, presentations) about poison control center services and availability and updates on new and important advances in poisoning management to the appropriate health professionals throughout the region as determined by the medical director.

CENTER

(2)The regional poison control center shall provide a public education program, offered to all parts of the region, aimed at educating both children and adults about poisoning dangers and other necessary concepts related to poison prevention. This criterion will be considered to be met if the center offers ongoing information, through lectures, public media (newspapers, radio, television), printed educational materials, or through other instructional modalities, describing the following:

(a)Services and availability of the poison control center.

(b)Poison prevention measures.

(c)First aid measures for poisoning management.

History

• Authority: T.C.A. §§4-5-202, 68-1-103, 68-141-101, 68-141-102 and 68-141-104.
• Administrative History: Original rule filed June 22, 1994; effective September 5, 1994.

1200-12 Bureau of Health Licensure and Regulation Division of Emergency Medical Services

Chapter 1200-12-01 General Rules

Tenn. Comp. R. & Regs. 1200-12-01-.01 SANITATION OF AMBULANCE

(1) All ambulances operating pursuant to the provisions of T.C.A. Chapter 140 of Title 68, must meet the following standards. For the purpose of this regulation, the word “sanitary” shall mean the absence of dirt, dust, stains, odors, rodents, vermin, or foreign substances.

(2) Patient Compartment (a) Floor must be sanitary.

(b) Cabinets or storage areas must be sanitary.

(c) All material covering seats, and in headliner must be sanitary.

(d) All equipment in patient compartment must be clean and in workable condition.

(e) Windows must be clean, unbroken, and in workable condition.

(f) All doors leading into passenger compartment must open properly, close tightly with all handles working.

(g) Compartment must be watertight and free of drafts.

(h) All equipment must be contained in such a manner as to be sanitary at all times.

(i) Oxygen if present, must be medical grade and cylinder contain at all times at least 500 PSI.

(3) Driver’s Compartment (a) Must be sanitary.

(b) All doors must open properly and close tightly with all handles working.

(c) Windows and windshield must be clean and free of cracks.

(d) Rear view mirror must be free of cracks.

(e) Seat belts must be in place and in usable condition.

(f) Compartment must be watertight and free of drafts.

History

• Authority: T.C.A. §§ 68-140-501, 68-140-504, and 68-140-507.
• Administrative History: Original rule filed March 20, 1974; effective April 19, 1974. Amendment filed August 7, 2009; effective November 5, 2009.

Tenn. Comp. R. & Regs. 1200-12-01-.02 AMBULANCE SAFETY, DESIGN, AND CONSTRUCTION STANDARDS

(1) All ambulances operating pursuant to the provisions of Chapter 140 of Title 68, Tennessee Code Annotated, must meet the following standards.

(a) All lights must function properly and in accordance with applicable federal and state motor vehicle laws and regulations pursuant to T.C.A. § 55-9-402.

(b) All emergency lights must function in the way in which they were designed to function.

(c) Emergency audible warning devices must function in the way in which they were designed to function.

(d) Body must be free of dents and rust.

(e) Tires must have at least four thirty-seconds inch (4/32”) tread.

(f) Braking system must function properly and safely.

(g) Steering system must function properly.

(h) All safety devices must function properly.

(i) All equipment in the patient compartment must be adequately secured.

(j) Oxygen tanks must bear a current static pressure date.

(k) Exhaust system must function to original standards.

(l) Patient compartment must be free of safety hazards.

(m) All ambulances (and invalid vehicles) shall have an operating odometer.

(n) The owner or operating agent of the ambulance shall subject the vehicle to a periodic mechanical safety inspection which shall be documented for the department.

1. Periodic mechanical safety inspection shall mean an inspection conducted at least annually, or every thirty-thousand (30,000) miles after a vehicle registers two hundred thousand (200,000) miles, whichever first occurs. The inspector must attest that the vehicle is mechanically safe, roadworthy, and maintained to federal and state laws applicable for such vehicles.

2. Mechanical safety inspections shall be conducted by a mechanic with factory training and certification from the original (motor vehicle) equipment manufacturer or the equivalent certification for Emergency Vehicle Technicians (EVT) or from the Institute for Automotive Service Excellence (ASE) Mechanics certification.

3. Mechanical safety inspections shall be conducted in addition to the vehicle and equipment inspections by EMS Division personnel, following the procedures identified in the form or electronic records format adopted by the Board.

4. Records of the periodic mechanical safety inspection shall be submitted upon the initial permit application to the Division of Emergency Medical Services, and shall be maintained for as long as the chassis is actively licensed or permitted. Such records and supporting documents consisting of repair orders and routine maintenance shall be available and submitted for inspection by an authorized representative of the department.

5. Upon observation of possible mechanical safety defects by an authorized representative of the department, or upon citation from a law enforcement agency, a vehicle shall be subject to unscheduled inspection to verify safe operation.

6. Upon failure of an inspection, an ambulance shall be immediately removed from service until such deficiencies are corrected that may in any way impair the safe operation of the ambulance or vehicle.

(2) Design and Construction - Any vehicle permitted pursuant to Chapter 140 of Title 68 shall be maintained according to the standards and specifications that follow: Standards for Emergency Ambulance vehicles.

(3) General Vehicle Requirements.

(a) The ambulance service shall determine the color of the exterior surface of each ambulance; however, the roof of the patient compartment shall be white.

(b) The ambulance service shall ensure that a minimum of one (1) horizontal solid reflective stripe at least six (6) inches in width shall be displayed on the sides and rear, horizontal to the beltline of the ambulance extending below the window line.

(c) The ambulance service may display a chevron striping pattern in the rear of the vehicle, with a pattern of alternating diagonal elements at least six (6) inches in width.

Chevron patterns shall comply with the Manual of Uniform Traffic Control Devices.

(d) Emblems and Markings.

1. The ambulance service shall ensure that the following markings are displayed on each ambulance:

(i) The service name on each side of the ambulance with a minimum of four (4) inch contrasting reflective letters;

(ii) The word “ambulance” displayed in contrasting reflective block letters not less than six (6) inches in height placed on each side of vehicle;

(iii) The word “ambulance” on the rear of each vehicle in contrasting reflective block letters not less than four (4) inches in height;

(iv) A reflective “Star of Life” of not less than sixteen (16) inches in height on each side of the vehicle;

(v) A reflective “Star of Life” of not less than four (4) inches in height on each rear door (if single rear door or sliding door, one on either side or alongside of the word Ambulance);

(vi) A “Star of Life” on the vehicle roof of not less than thirty-two (32) inches in height;

(vii) Numerals and letters used as vehicle call numbers, fleet numbers or chassis numbers placed on the sides and rear of each vehicle between four (4) and fourteen (14) inches in height and in reflective letters contrasting with the vehicle background. Numerals displayed on the vehicle rooftop shall be at least ten (10) inches in height, reflective and contrasting with the vehicle background.

2. An ambulance service shall identify its ambulances with lettering or a service trademark or emblem identifying the service. The service emblem or lettering shall be prominently displayed and shall not be printed over or superimposed over the “Ambulance” lettering or “Star of Life” emblems otherwise required by these rules.

3. An ambulance service shall not display any lettering, decals, or emblem which state(s) or suggest(s) that the ambulance service is affiliated with a business, entity, or government if there is no such affiliation.

4. An ambulance service shall not state or suggest that it has an accreditation that the service has not attained or maintained.

5. An ambulance service shall not have any markings that are commercial endorsements or advertisements for products or services other than ambulance services or services provided by the ambulance service owner.

6. An ambulance service shall not have any markings on vehicles that indicate any contractual arrangements with other businesses, entities, or individuals.

7. An ambulance service may display decals or placards on vehicles for recognized public safety programs as approved by the Division.

8. An ambulance service may display lettering or decals which serve a functional and useful purpose, such as identifying specialty care capability or special community programs as approved by the Division.

9. Within six (6) months of the effective date of this rule, each licensed service shall file a written description of its ambulance color and marking scheme with the Division of Emergency Medical Services. This description shall include a photograph or commercial drawing of the front, side, and rear of a modified vehicle.

(i) All ambulances within the service upon the effective date of this rule shall be modified in accordance with the plan submitted within one (1) year of the adoption of such color and markings plan;

(ii) Ambulances placed into permitted service after the effective date of this

rule and after a design plan is filed with the Division office, shall conform to the service’s adopted color and markings plan;

(iii) If the color and/or marking scheme is subsequently modified, a revised description and photographs shall be filed by the ambulance service with the Division office, and all ambulances within the service shall be modified within one (1) year after adoption of the revised color and markings scheme.

(iv) Upon the effective date of this rule, ambulance services shall ensure that white vehicles with an orange stripe may continue in service until replaced or withdrawn from service.

(e) An ambulance service shall ensure that each ambulance shall be equipped with flashing or oscillating warning lights on the front, sides, and rear of the vehicle, red in color, with a center-mounted white (clear) flashing light visible to the front. One or more amber flashing lights may be visible to the rear. Switching arrangements may provide either synchronized or alternating red warning lights on the front, sides, and rear of the vehicle. Warning lights shall meet minimum photometric standards as described in the Federal Star of Life Ambulance Specifications in effect at the time of end stage manufacture.

(f) Each ambulance service shall ensure that each ambulance has communications and warning devices that shall include but not be limited to a two-way radio with State designated emergency medical telecommunications frequencies and an audible warning and public address system, as follows:

1. Two-way Radio (Mobile).

Mobile radio equipment shall include VHF capabilities at a minimum, as established in Rule 1200-12-01-.08 (EMS Telecommunications), or means of alternative compliance as established in Rule 1200-12-01-.08. Radio control functions for the VHF and dispatch radio shall be accessible to the vehicle operator. The medical communication radio (or radio controls) shall be available in the patient compartment and comply with the respective regional frequency use plans and radio standards as published in the State EMS Telecommunications Plan.

2. Audible Warning and Public Address System.

A combination electronic siren with integral public address system and radio amplification shall be provided. Control functions shall provide public address, radio, manual, wail and yelp selections with remote siren control from the driver’s position.

3. An ambulance service may install a mechanical siren or air horn in emergency vehicles.

(g) An ambulance service shall ensure that each vehicle’s patient compartment has the following minimum dimensions:

1. Inside height of at least 60 inches, floor to ceiling.

2. Inside length from compartment divider to rear door of at least 116 inches.

(h) Each ambulance service placing ambulances in service or obtaining an initial permit in the State of Tennessee shall ensure that ambulances are manufactured and maintained according to the ambulance safety, construction and design standards that were adopted by the Board as of the date of final manufacture. Current Boardapproved standards are posted on the Division’s web page at https://www.tn.gov/content/dam/tn/health/events/Ambulance%20Equipment%20Specifi cations%20Effective%20%20July%202019%20draft%209.20.18.pdf, or at any successor web address, and are hereby incorporated into this rule as if they were fully set out and stated herein. The effective date of any changes in the posted standards will be determined by the Board.

(4) Specialty Care Vehicle Requirements.

Vehicles used exclusively for the provision of specialty care response and/or transport shall conform with the Board-approved ambulance safety, construction and design standards set out in paragraphs (1) through (3) of this rule, with the following exceptions:

(a) Additional markings, legends, or logos may be used to identify the provider and

purpose for specialty care vehicles, except that no letter shall exceed six inches in height. Legends identifying the specialty care provided, such as “Neonatal Intensive and Critical Care Transport,” may be substituted for the word “Ambulance” in exterior markings.

(b) Vehicle electrical systems shall be sufficient to sustain specialized equipment as verified by manufacturer’s certificate. Units shall be equipped with a back-up power system sufficient to operate life support equipment in the event the main power system fails.

(c) Patient compartments, based on the vehicles’ specialty care response, shall conform with the current Tennessee Perinatal Care System Guidelines for Transportation posted at https://www.tn.gov/content/dam/tn/health/documents/GuidelinesTransportationPAC.pdf or any successor site.

(d) Vehicle crashworthiness shall be assured with roll-cage construction, evidenced by compliance with the Ambulance Manufacturer’s Division Standards of the Truck Body and Equipment Association or comparable construction under written statement and performance bond by the manufacturer.

(e) Doors shall provide access to the rear and curb-side of the patient compartment.

Where the vertical lift distance of the patient loading area exceeds 28 inches, a ramp or electrical/hydraulic lift shall be furnished to facilitate patient loading.

(f) Environmental systems on the unit shall meet heating/air conditioning standards as specified in Federal Specifications Ambulance.

(g) Vehicle electrical systems shall be provided to furnish 110 volt AC power sufficient to sustain 3,000 watts at 60 cycles. The unit shall be equipped with a back-up power system sufficient to operate patient care equipment in the event of failure of the main power system. The 110 volt system shall incorporate a ground fault interrupter device for protection against electrical hazards.

(h) Patient compartment shall be so designed to provide the following:

1. One transport incubator configured to allow observation from at least two sides of the patient which shall be capable of being secured in the vehicle.

2. An open bed warmer to allow various stabilization procedures.

3. Compartments for appropriate storage of materials such as culture media and medications.

4. Fixtures to ensure proper hand cleansing during a transport.

5. Illumination at the primary patient care area of at least 75 foot candles.

6. Safety features, to include:

(i) Cabinet corners and latches, sculpted, padded, or recessed to prevent undue injury during sudden deceleration.

(ii) Safety devices shall include:

(I) A grab rail or hand strap, secured according to Federal Motor Vehicle Safety Standards for safety restraints.

(II) Safety belts shall be provided at all attendant seats.

(III) Safety restraint devices for infants for use when the vehicle is in motion.

(i) Patient care equipment shall include the means to provide and monitor mechanical ventilation, and an oxygen system with sufficient capacity to deliver a minimum continuous flow of 8 liters per minute for at least four hours. The installed oxygen system shall be capable of delivering specific monitored blended oxygen concentrations.

(5) A licensed ambulance provider may operate a temporary ambulance upon a written acknowledgment from the Department’s representative under the following conditions:

(a) A vehicle used to replace a permitted ambulance, when the permitted vehicle has been removed from service for repair or maintenance, when such temporary vehicle is not owned or normally operated by the service; or (b) A vehicle acquired to replace a permitted ambulance, with conversion of title to the service or its agent, following the submission to the Division of vehicle information and the appropriate fee, shall be allowed to operate up to fifteen (15) days pending inspection by the department.

(c) Each provider shall assure compliance with all rules applicable to the operation of the vehicle as follows:

1. The replacement vehicle shall comply with all design, construction, equipment and safety standards as promulgated under paragraphs (1) (2) and (3).

2. Insurance coverage obtained by rider or policy revision shall be in evidence pursuant to Rule 1200-12-01-.07.

3. The provider must immediately notify the Division of Emergency Medical Services in writing when the unit is placed in service, submitting information to include:

(i) The license and vehicle identification numbers of the substitute or replacement vehicle, and (ii) The permit number of the unit for which the replacement is substituted.

4. Non-standard radio equipment may be authorized for temporary use in vehicles provided such authorization is requested in writing before placing the vehicle is placed in service. The request should include a reasonable, projected time period over which the non-standard equipment is expected to be used, and the basic capabilities of such equipment.

(d) Vehicles added to an existing fleet, requiring evidence of additional supplies and equipment to extend service, shall not be operated under temporary authorizations, but may be operated under a letter of approval filed by the Division’s authorized representative following payment of fees to the Division’s principal office, and evidence of satisfactory inspection by the authorized representative, pending the issuance of a permit.

(e) A letter of approval from a Division representative shall not be substituted for a vehicle permit for any period exceeding ninety (90) days.

(6) Upon inspection, any vehicle deemed unacceptable and failing an inspection shall be immediately removed from service until approved for return to service by the Division’s authorized representative.

History

• Authority: T.C.A. §§ 68-140-304, 68-140-306, 68-140-307, 68-140-504, 68-140-506, 68-140-507, and 68-140-526.
• Administrative History: Original rule filed March 20, 1974; effective April 19, 1974. Amendment filed February 8, 1983; effective May 16, 1983. Amendment filed November 30, 1984; effective February 12, 1985. Amendment filed April 8, 1987; effective May 23, 1987. Amendment filed May 27, 1988; effective July 11, 1988. Amendment filed March 7, 1989; effective April 21, 1989. Amendment filed November 27, 1990; effective January 11, 1991. Amendment filed August 11, 1993; effective October 25, 1993. Amendment filed June 1, 2007; effective August 15, 2007. Amendment 1200- 12-01-.02(1)(o) filed August 7, 2009; withdrawn November 2, 2009. Amendment filed August 7, 2009; effective November 5, 2009. Amendment filed May 26, 2010; effective August 24, 2010. Amendments filed September 23, 2019; effective December 22, 2019.

Tenn. Comp. R. & Regs. 1200-12-01-.03 EMERGENCY MEDICAL SERVICES EQUIPMENT, MEDICATIONS AND SUPPLIES

Each provider shall maintain the required equipment, medications and supplies for the level of service to provide appropriate emergency care and, where applicable, patient care during transport, on each permitted vehicle. It is anticipated that changes in equipment, medications and supplies may be necessary from time to time. This rule hereby adopts the Ambulance Equipment, Medications and Supplies Specifications posted on the Division’s web page at https://www.tn.gov/content/dam/tn/health/events/Ambulance%20Equipment%20Specifications%20Effecti ve%20%20July%202019%20draft%209.20.18.pdf, or at any successor web address, and incorporates those specifications into this rule as if they were fully set out and stated herein.

(1) Definitions - As used in this rule, the following terms and abbreviations shall have the following meanings:

(a) “Critical” (C) means any equipment, medications or supplies critical for lifesaving patient care and which by its absence would jeopardize patient care.

(b) “Non-Critical” (N) means such equipment, medications or supplies provided in sufficient amounts for patient care, but when missing may not result in serious harm to a patient.

(c) “Optional” (O) means any equipment, medications or supplies of elective use, which shall be operational and sanitary.

(d) “Specifications” refers to the federal standards and performance requirements for equipment, medications and supplies recognized within the emergency medical services industry and adopted by the Board. The current “Ambulance Equipment, Medications and Supplies Specifications” can be found at https://www.tn.gov/content/dam/tn/health/events/Ambulance%20Equipment%20Specifi cations%20Effective%20%20July%202019%20draft%209.20.18.pdf.

(2) A written or electronic copy of protocols must be available for inspection on each ambulance.

(3) Safety equipment is required on each ambulance in accordance with the Ambulance Equipment, Medications and Supplies Specifications.

(4) Oxygen, inhalation, ventilation, and airway management devices are required on each ambulance in accordance with the Ambulance Equipment, Medications and Supplies Specifications.

(5) Diagnostic and assessment devices are required on each ambulance in accordance with the Ambulance Equipment, Medications and Supplies Specifications.

(6) Bandages and dressing material are required on each ambulance in accordance with the Ambulance Equipment, Medications and Supplies Specifications.

(7) Immobilization devices are required on each ambulance in accordance with the Ambulance Equipment, Medications and Supplies Specifications.

(8) Patient care supplies are required on each ambulance in accordance with the Ambulance Equipment, Medications and Supplies Specifications.

(9) Infection control supplies are required on each ambulance in accordance with the Ambulance Equipment, Medications and Supplies Specifications.

(10) Intravenous therapy supplies are required on each ambulance in accordance with the Ambulance Equipment, Medications and Supplies Specifications.

(11) Cardiac defibrillators and monitors are required on each ambulance in accordance with the Ambulance Equipment, Medications and Supplies Specifications.

(12) Medications and required drugs are required on each ambulance in accordance with the Ambulance Equipment, Medications and Supplies Specifications. Medications must be packaged and stored in accordance with pharmacological guidelines for sterility, cleanliness, dosage, and expiration.

(13) A triage system that can be used in mass casualty situations/incidents is required on each ambulance in accordance with the Ambulance Equipment, Medications and Supplies Specifications.

(14) Air ambulances are required to have the equipment, medications and supplies specified under Rule 1200-12-01-.05.

(15) Equipment, medications and supplies requirements as detailed in paragraphs (3) to (12) shall not apply to vehicles used solely for neonatal critical care transport.

(16) Neonatal transport equipment and supplies shall conform to the standards adopted in the Tennessee Perinatal Care System Guidelines for Transportation, Tennessee Department of Health, Maternal and Child Health Section, Sixth Edition, 2014, or successor publication.

(17) Ambulances found to be lacking any critical (C) equipment, medications or supplies, or lacking six or more non-critical (N) equipment, medications or supplies, will fail their inspection. Ambulances found to be lacking five or fewer non-critical (N) equipment, medications or supplies will receive a warning. Conditional acceptance during inspection may be granted by the Division’s representative when good faith efforts to acquire or repair noncritical equipment are made by the provider, subject to recheck of any deficiencies within forty-five (45) days of the initial inspection.

History

• Authority: T.C.A. §§ 68-140-304, 68-140-305, 68-140-306, and 68-140-307.
• Administrative History: Original rule filed March 20, 1974; effective April 19, 1974. Amendment filed February 8, 1983; effective May 16, 1983. Amendment filed November 30, 1984; effective February 12, 1985. Amendment filed August 22, 1985; effective September 21, 1985. Amendment filed April 8, 1987; effective May 23, 1987. Amendment filed March 7, 1989; effective April 21, 1989. Repeal and new rule filed January 7, 1997; effective March 23, 1997. Repeal and new rule filed November 16, 2005; effective January 30, 2006. Amendment filed December 16, 2005; effective March 1, 2006. Amendment filed August 7, 2009; effective November 5, 2009. Amendments filed May 26, 2010; effective August 24, 2010. Repeal and new rule filed December 2, 2014; effective March 2, 2015. A stay of the effective date of the rule was filed January 27, 2015; new effective date March 27, 2015. Another stay of the effective date of the rule was filed February 23, 2015; new effective date April 1, 2015.

Tenn. Comp. R. & Regs. 1200-12-01-.04 EMERGENCY MEDICAL SERVICES (EMS) PERSONNEL CERTIFICATION AND

LICENSURE.

(1) Scope of Practice for Emergency Medical Services Personnel.

(a) Definitions. Terms used in this rule shall be defined as follows:

1. “Advanced Emergency Medical Technician (AEMT)” means a person who has successfully completed the Advanced Emergency Medical Technician training course, has qualified by examinations to perform pre-hospital emergency patient care, and provides basic and limited advanced emergency medical care, under medical direction, pre-hospital and during transportation for critical, emergent, and non-emergent patients who access the emergency medical system.

2. “Board” means the Tennessee Emergency Medical Services Board.

3. “Department” means the Tennessee Department of Health.

4. “Division” means the Division of Emergency Medical Services.

5. “Emergency Medical Responder (EMR)” means a person who has successfully completed the Emergency Medical Responder training course and has qualified by examinations to perform lifesaving interventions while awaiting additional EMS response and to assist higher level personnel at the scene and during transport, under medical direction.

6. “Emergency Medical Technician (EMT)” means a person who has successfully completed the Emergency Medical Technician training course, has qualified by examinations to perform pre-hospital emergency patient care, and provides basic emergency medical care, under medical direction, pre-hospital and during transportation for critical, emergent and non-emergent patients who access the emergency medical system.

7. “Medical Direction” means the supervision by a physician licensed to practice in the State of Tennessee of all medical aspects of patient care within Emergency Medical Services.

8. “Paramedic” means a person who has successfully completed an accredited Paramedic Program at the certificate or associate degree level, has qualified by examinations to perform pre-hospital emergency patient care, and provides basic and advanced emergency medical care, under medical direction, pre-hospital and during transportation for critical, emergent and non-emergent patients who access the emergency medical system.

9. “Protocols” mean a ranking or formal listing of procedures approved by an EMS service’s medical director that may be utilized for patient care after physician or medical facility communications have been established.

10. “Standing Orders” mean orders based on an agreement established by an EMS service’s medical director, delegating authority to agents within their control to commence treatment and authorizing procedures for patient care that may be utilized until the patient is presented for continuing medical care.

(b) Scope of Practice for Certified Emergency Medical Responder (EMR).

1. An EMR will perform lifesaving interventions while awaiting additional EMS response and will assist higher level personnel at the scene and during transport.

2. An EMR functions as part of a comprehensive EMS response, under medical direction.

3. A certified EMR shall possess, at a minimum, skills as defined by the current National EMS Scope of Practice Model and National EMS Education Standards.

4. An EMR’s scope of practice may be extended to include skills the Board authorizes and approves.

(c) Scope of Practice for a Licensed Emergency Medical Technician (EMT).

1. An EMT will provide basic emergency medical care for critical, emergent and non-emergent patients who access the emergency medical system.

2. An EMT functions as part of a comprehensive EMS response, under medical direction.

3. The EMT’s scope of practice includes, at a minimum, the skills listed within the EMR scope of practice as well as the “Minimum Psychomotor” skills set as identified in the current National EMS Scope of Practice Model and National EMS Education Standards for EMTs, including but not limited to, non-invasive interventions to reduce the morbidity and mortality associated with acute out-ofhospital medical and traumatic emergencies for patients of all ages.

4. An EMT’s scope of practice may be extended to include skills the Board authorizes and approves.

(d) Scope of Practice for a Licensed Advanced Emergency Medical Technician (AEMT).

1. An AEMT will provide basic and limited advanced skills that are effective and can be performed safely in an out-of-hospital setting with medical direction and limited training and focused on the acute management and transportation of critical, emergent, and non-emergent patients.

2. An AEMT functions as part of a comprehensive EMS response, under medical direction.

3. The AEMT’s scope of practice includes, at a minimum, the skills listed within the EMT scope of practice as well as the “Minimum Psychomotor” skills set identified in the current National EMS Scope of Practice Model and National EMS Education Standards for the AEMT, including but not limited to, basic noninvasive and limited advanced invasive interventions to reduce the morbidity and mortality associated with acute out-of-hospital medical and traumatic emergencies for patients of all ages.

4. An AEMT’s scope of practice may be extended to include skills the Board authorizes and approves.

(e) Scope of Practice for a Licensed Paramedic.

1. A Paramedic will provide basic and advanced skills that are effective and can be performed safely in an out-of-hospital setting with medical direction and advanced training and focused on the acute management and transportation of critical, emergent, and non-emergent patients.

2. Paramedics function as part of a comprehensive EMS response, under medical direction, to perform interventions with the basic and advanced equipment typically found on an ambulance.

3. The Paramedic scope of practice includes, at a minimum, all basic knowledge and skills of an AEMT as well as the “Minimum Psychomotor” skills set identified in the current National EMS Scope of Practice Model and National EMS Education Standards for a Paramedic, including but not limited to, advanced invasive and non-invasive interventions to reduce the morbidity and mortality associated with acute out-of-hospital medical and traumatic emergencies for patients of all ages.

4. A Paramedic’s scope of practice may be extended to include skills the Board authorizes and approves.

(2) Emergency Medical Responder Initial Certification, Renewal, and Reinstatement Requirements.

(a) Initial Certification as an EMR. To be eligible for initial certification as an EMR by the Division, an applicant shall meet the following requirements:

1. Be at least seventeen (17) years of age;

2. Be able to read, write and speak the English language;

3. Have no documented history within the past three (3) years of habitual intoxication or personal misuse of any drugs or intoxicating liquors, in such a manner as to adversely affect the applicant’s ability to practice as an EMR;

4. Hold a signed current Basic Cardiopulmonary Resuscitation Healthcare Provider card or equivalent;

5. Successfully complete all aspects of a Board-approved Emergency Medical Responder course, including but not limited to, attendance requirements;

6. Achieve an established passing score on a Board-approved examination within two (2) years of completion of an EMR training course;

7. Applicants who fail to pass the examination shall be eligible to reapply for examination.

8. Applicants must successfully complete all requirements for certification within two (2) years of completion of training.

9. Submit the completed Division-provided application from, along with all required supporting documents and the appropriate certification and application fees in accordance with Rule 1200-12-01-.06.

10. If an applicant does not complete all requirements for certification within two (2) years of date of initial application, the application shall be considered abandoned and the Division shall destroy it.

11. Validity of initial EMR certification shall not exceed thirty-six (36) months.

(b) Post Initial Certification Requirements for an EMR.

1. An EMR shall receive training and show competency under EMS service authorized medical direction to be permitted to perform Board-approved extended skills and/or procedures.

2. The EMS service medical director shall monitor performance through a quality assurance program.

(c) Renewal Requirements for Emergency Medical Responder Certification. To be eligible for renewal of certification as an EMR by the Division, an applicant shall meet the following requirements:

1. File the Division-provided renewal application and submission of renewal fees, in accordance with Rule 1200-12-01-.06.

2. Submit a copy of a signed current Basic Cardiopulmonary Resuscitation Healthcare Provider card or equivalent;

3. Submit verification of one of the following:

(i) Successful completion of Board-approved refresher training course; or (ii) Satisfactory completion of the examination as established in part (2)(a)6.; or (iii) Completion of ten (10) Continuing Education Contact Hours, or one (1) college credit hour in EMR-related studies, as approved by the Division. A minimum of two (2) hours must be in pediatric-related topics.

(I) Documentation of skills competency must also be submitted to the Division administrative office with documentation of continuing education.

(iv) The due date for completion of the required continuing education is the expiration date of the EMR’s certification renewal.

(v) All EMRs must retain independent documentation of completion of all continuing education hours. This documentation must be retained for a period of four (4) years from the end of the renewal period in which the continuing education was acquired. This documentation must be produced for inspection and verification, if requested by the Division during its verification process. Certificates verifying the individual’s completion of the continuing education program(s) shall consist of one or more of the following:

(I) Continuing education program’s sponsor, date, length in hours awarded, program title, certified individual’s name, and certificate number; or (II) An original letter on official stationary from the continuing education program’s sponsor indicating date, length in hours awarded, program title, certified individual’s name, and certificate number.

4. Continuing education contact hours shall be obtained through a Divisionapproved agency or institution or program.

5. Validity of renewed EMR certification shall not exceed twenty-four (24) months.

(d) Reinstatement Requirements for Emergency Medical Responder Certification.

1. Those persons who fail to timely renew certification are eligible to apply for reinstatement of their certification as an EMR by the Division, if the applicant completes the following requirements:

(i) Submits an approved reinstatement application;

(ii) Submits payment of the reinstatement fee in accordance with Rule 1200- 12-01-.06;

(iii) Submits a copy of a signed current Basic Cardiopulmonary Resuscitation Healthcare Provider card or equivalent.

(iv) Those persons applying for reinstatement of their certification less than sixty (60) days after expiration of previous certification shall present documentation of successful completion of one of the following:

(I) Required continuing education requirements and documentation of skills competency; or (II) The Board-approved refresher training course, as established in part (2)(a)5.; or (III) The examination, as established in part (2)(a)6.

(e) Those persons applying for reinstatement of their certification sixty (60) days or more after expiration of previous certification shall present documentation of successful completion of both the Board-approved refresher training course and the examination as required in parts (2)(a)5. and 6.

(3) Initial Licensure Procedure for Emergency Medical Services Personnel.

(a) All applicants for licensure pursuant to T.C.A. Title 68, Chapter 140 shall comply with the following requirements to be eligible for licensure:

1. Be at least eighteen (18) years of age;

2. Be able to read, write, and speak the English language;

3. Possess a minimum of an academic high school diploma or a general equivalency diploma (G.E.D.);

4. Have no documented history within the past three (3) years of habitual intoxication or personal misuse of any drugs or the use of intoxicating liquors, in such a manner as to adversely affect the person’s ability to practice emergency medical services.

5. Present evidence to the Division of Emergency Medical Services of a medical examination certifying physical health sufficient to conduct activities associated with patient care, including, but not limited to, visual acuity, speech and hearing, use of all extremities, absence of musculoskeletal deformities, absence of communicable diseases, and suitable emotional fitness to provide for the care and lifting of the ill or injured. This information shall be provided on a form approved by the Board and shall be consistent with the provisions of the Americans with Disabilities Act.

6. Successfully complete Board-approved Tennessee training for the level at which licensure is being requested.

7. Qualify by examination to perform pre-hospital care.

(i) Each applicant shall successfully complete both a Board-approved written and practical examination, for the level at which licensure is being requested.

(ii) Applicants who fail to pass the examination shall be eligible to reapply for examination.

(iii) Applicants must successfully complete all requirements for licensure within two (2) years of completion of training.

8. Submit a completed application for licensure form as provided by the Division with all necessary documents, attachments and appropriate fees.

9. An applicant shall disclose the circumstances surrounding any of the following:

(i) Conviction of any criminal law violation of any country, state or municipality, except minor traffic violations.

(ii) The denial of professional licensure/certification application by any other state or the discipline of licensure/certification in any state.

(iii) Loss or restriction of licensure or certification.

10. If an applicant does not complete all requirements for licensure within two (2) years of date of completion of initial training and/or application, the application shall be considered abandoned and the Division shall destroy it.

11. Remit the appropriate licensure and application fees in accordance with Rule

Tenn. Comp. R. & Regs. 1200-12-01-.05 AIR AMBULANCE STANDARDS

All air ambulance service providers and crew members operating in Tennessee must comply with Chapter 140 of Title 68 of the Tennessee Code Annotated and this rule. Failure to comply shall subject the service provider and/or its personnel to disciplinary action pursuant to T.C.A. § 68-140-311.

(1) Definitions - As used in this rule, the following terms shall have the following meanings:

(a) “Air Medical Communications Specialist” means any person employed by an air ambulance service coordinating acknowledgment of medical requests, medical destination, and medical communications during an air medical response and patient transfer.

(b) “Medical Crew Member” means a registered nurse licensed or authorized to practice as a registered nurse in the State of Tennessee, a physician licensed under either Title 63, Chapter 6 or, Chapter 9, or a paramedic licensed or authorized to practice in the State of Tennessee employed by an air ambulance service for the purpose of providing care to patients transported by and receiving medical care from an air ambulance service.

(c) “Special Medical Equipment” means any device which shall be approved by the air ambulance service medical director for the medical care of an individual patient on an air ambulance.

(d) “Specialty Crew Member” means any person the service medical director assigns as a regular medical crew member for a specialty transport in addition to a medical crew member.

(e) “Specialty Transport” means an air ambulance service assignment necessitating the medical director to substitute Specialty Crew Members and/or equipment to meet the specified needs of an individual patient.

(f) “Utilization Review” means the critical evaluation of health care processes and services delivered to patients to ensure appropriate medical outcome, safety and cost effectiveness.

(2) Each air ambulance service provider shall maintain the required equipment, medications and supplies for air ambulance transport to provide emergency care and, where applicable, patient care during transport on each permitted aircraft. It is anticipated that changes in equipment, medications and supplies may be necessary and will, at a minimum, be reviewed annually. This rule hereby adopts the Air Ambulance Equipment, Medications and Supplies Specifications posted on the Office of Emergency Medical Service’s web page or any successor web page, as those specifications may from time to time be amended.

(a) As used in this section, the following terms and abbreviations shall have the following meanings:

1. “Critical” or “(C)” means any equipment, medication or supplies critical for lifesaving patient care and which by its absence would jeopardize patient care.

2. “Specifications” refers to federal standards and performance requirements for equipment, medications and supplies recognized within the emergency medical services industry and adopted by the Board. The current “Air Ambulance Equipment, Medications and Supplies Specifications” can be found at https://www.tn.gov/health/health-program-areas/health-professional-boards/emsboard/ems-board/general-information.html.

(b) In order to help ensure patient comfort and medical care as well as the safety of patients, crew members and ground personnel, each air ambulance the Board permits shall have an environmental control system with factory-installed or Federal Aviation Administration (“FAA”) approved add-on air conditioner and heater.

(c) The air ambulance service shall have a written policy which addresses avoidance of adverse effects of temperature extremes on patients and personnel on board in the event of a non-functioning air conditioner when cabin temperatures are ninety-five (95) degrees Fahrenheit or greater or in the event of a non-functioning heater when the cabin temperature is fifty (50) degrees Fahrenheit or lower.

(3) Each air ambulance service shall offer its instruction materials to other EMS providers within its response area to familiarize other EMS providers with the air ambulance service’s requirements for control of helicopter access and ground to air communications on the scene.

(4) Air Ambulance Personnel Qualifications and Duties.

(a) Medical director qualifications and duties.

1. Each air ambulance service shall designate a medical director who is responsible for providing medical direction for the air ambulance service.

2. The medical director for an air ambulance service must be a physician having each of the following qualifications:

(i) Currently licensed in the State of Tennessee under either Title 63, Chapter 6 or Title 63, Chapter 9;

(ii) Board certified or eligible for Board certification by a professional association or society in General or Trauma Surgery, Family Practice, Internal Medicine, Pediatrics, Emergency Medicine, or Emergency Medical Services;

(iii) Certification in Advanced Cardiac Life Support (unless Board certified or eligible for Board certification in Emergency Medicine);

(iv) Certification in Advanced Trauma Life Support;

(v) Certification in Pediatric Advanced Life Support or equivalent (unless Board certified or eligible for Board certification in Emergency Medicine);

(vi) Certification in a Neonatal Resuscitation Program; and (vii) Possess adequate knowledge regarding altitude physiology/stressors of flight.

3. Duties of the medical director for an air ambulance service shall include the following:

(i) Active involvement in the Quality Improvement process;

(ii) Active involvement in the hiring, training and continuing education of all medical personnel for the service; and (iii) Responsibility for on-line medical control or involved in orienting and collaborating with physicians providing on-line medical direction according to the policies, procedures and patient care protocols of the medical transport service.

4. The air ambulance service medical director shall establish patient care guidelines. The air ambulance service medical director shall require each medical crew member to complete and maintain documentation of initial and annual training in such procedures, which shall at least include didactic and hands-on components for the following clinical procedures:

(i) Pharmacological Assisted Intubation - Adult and Pediatric;

(ii) Emergency cricothyrotomy;

(iii) Alternative airway management - Adult and Pediatric;

(iv) Chest decompression; and (v) Intraosseous Access - Adult and Pediatric.

(b) Medical crew staffing.

1. Each air ambulance transporting a patient from a scene response shall be staffed by two medical crew members.

2. An air ambulance transporting a patient from an interfacility response shall be staffed with either:

(i) A registered nurse licensed or authorized to practice as a registered nurse in the State of Tennessee or a physician licensed under either Title 63,

Chapter 6 or Title 63, Chapter 9, and an additional medical crew member; or (ii) Upon approval from the air ambulance service medical director in realtime, two paramedics licensed or authorized to practice in Tennessee.

3. The composition of the medical team may be altered for specialty transports upon an order of the air ambulance service medical director.

4. For a non-emergent, scheduled fixed-wing transport only, the service medical director may allow transport of patients in the presence of only one medical professional; the minimum level of licensure in such a situation would be that of a paramedic.

(c) Medical crew members shall not be scheduled on an air ambulance more than twentyfour (24) consecutive hours. A medical crew member shift may be extended for up to twelve (12) additional hours in accordance with an air ambulance service duty extension hold-over policy that addresses fatigue. The air ambulance service shall provide the medical flight crew with adequate rest and mealtime during a shift when circumstances allow for rest and mealtime.

(d) Personnel must have at least ten (10) hours of rest with no work-related interruptions prior to any scheduled shift of twelve (12) hours or more in the air transport environment.

(e) Medical crew training and qualifications.

1. The air ambulance service medical director shall make a determination that each regular medical crew member serving on an air ambulance is physically fit for duty by ensuring the air ambulance service has documentation that each regular crew member has had a pre-employment and annual medical examination.

2. A Registered Nurse serving as a medical crew member on an air ambulance shall meet the following qualifications:

(i) Have three years of registered nursing experience in critical care nursing in a critical care unit or an emergency department, or two years’ fulltime flight paramedic experience and one year critical care nursing experience in a critical care unit or an emergency department;

(ii) Possess a current nursing license issued by either the Tennessee Board of Nursing or the home state of the registered nurse which grants a multistate privilege, unless exempted by T.C.A. § 63-7-102(8);

(iii) Obtain license or authorization to work as an Emergency Medical Technician in Tennessee as an Emergency Medical Technician within twelve (12) months of employment; and (iv) Obtain Board of Certification for Emergency Nursing certification within twelve (12) months of employment as one of the following:

(I) Certified Emergency Nurse;

(II) Critical Care Registered Nurse;

(III) Certified Flight Registered Nurse; or (IV) Certified Transport Registered Nurse.

3. A paramedic serving as a medical crew member on an air ambulance shall meet the following qualifications:

(i) Possess a current paramedic license or authorization to practice in Tennessee and have three years of experience as a paramedic in an advanced life support service;

(ii) Obtain one of the following within twelve (12) months of employment:

(I) International Board of Specialty Certification certified Critical Care Paramedic;

(II) International Board of Specialty Certification Certified Flight Paramedic; or (III) Critical care license endorsement pursuant to Tenn. Comp. R. and Regs. 1200-12-05.

4. A physician serving as a medical crew member on an air ambulance shall possess a current unencumbered Tennessee physician license issued under Title 63, Chapter 6 or Chapter 9 and possess one (1) of the following:

(i) Hold the title of medical director for an air ambulance service pursuant to the qualifications listed in 1200-01-.05(2);or (ii) Hold a certification or received additional training in the specialty of Emergency Medicine or general surgery as a R3 or higher;

(iii) Hold the title of Fellow in Emergency Medicine, Emergency Medical Services Surgical Critical Care; or (iv) Hold a certification or eligibility for board certification in Emergency Medicine, Emergency Medical Services, Surgery Critical Care or Trauma Surgery.

5. Each medical crew member on an air ambulance shall have and maintain certification in Advanced Cardiac Life Support, Pediatric Advanced Life Support, and in Neonatal Resuscitation.

6. Each medical crew member on an air ambulance shall attend and maintain training in one of the following:

(i) Transport Professional Advanced Trauma Course;

(ii) International Trauma Life Support;

(iii) Prehospital Trauma Life Support;

(iv) Trauma Nurse Core Course (Provided, however, that this course shall be accepted only up until twenty-four (24) months after promulgation of this

rule); or (v) Advanced Trauma Life Support (for physicians only).

(f) Each service shall have a Medical Control Physician who shall be available to provide online medical control continuously via radio or telephone who shall be board certified or eligible for board certification by a professional association or society in General or Trauma Surgery, Internal Medicine, Pediatrics, Emergency Medicine, Family Practice, or Emergency Medical Services.

(g) Air medical communications specialist qualifications and duties.

1. Air medical communications specialists shall be certified through the International Association of Medical Transport Communication Specialists or obtain such certification within six (6) months of employment;

2. Each air medical communications specialist shall have initial and recurrent training for medical coordination and telecommunications;

3. Each air ambulance transport shall be coordinated by an air medical communications specialists; and 4. Air medical communications specialists shall not work more than sixteen (16) hours in any one twenty-four (24) hour period.

(5) Flight Coordination.

(a) Each air ambulance service shall maintain policies and procedures which shall include:

1. Criteria for medical conditions including indications or contraindications for transfer;

2. Procedures for call verification and advisories to the requesting party;

3. Radio and telephone communications procedures;

4. Policies and procedures for accidents and incidents;

5. Procedures for informing the requesting party of operations procedure, ambulance arrival, termination of mission and delayed responses, including the following:

(i) Estimated Time Enroute (“ETE”) inclusive of time from acceptance to time of landing at the pickup location; and (ii) Any deviation from ETE greater than five (5) minutes will be reported to the requesting agency;

6. Procedures shall be established for communications failure or overdue transports;

7. Emergency protocols for alerting search and rescue; and 8. Procedures to assess previous flights which have been denied upon request by reasons of weather or other special circumstances, otherwise known as a “turndown,” or multiple air agency response to the same transport request.

(6) Telecommunications.

(a) The operations center for an air ambulance service operating in Tennessee shall include radio and telephone equipment to enable personnel to contact the helicopters and crew. Telecommunications devices shall include the following:

1. EMS Communications on the established frequencies of 155.205 MHz, 155.340 MHz, and/or upon such specific channels or frequencies as may be designated within each region as approved and published as a supplement to the State EMS Telecommunications Plan;

2. Direct telephone circuits accessible by air communication; and 3. Recording equipment for both telephone and radio messages and instant message recall.

(7) Records and Reports.

(a) The air ambulance service shall maintain records including the following:

1. A record for each patient transported including:

(i) Name of the person transported;

(ii) Date of transport;

(iii) Origin and destination of transport;

(iv) Presenting illness, injury, or medical condition necessitating air ambulance service;

(v) Attending and medical personnel;

(vi) Accessory ground ambulance services;

(vii) Medical facilities transferring and receiving the patient;

(viii) Documentation of treatment during transport; and (ix) A copy shall be provided to the receiving facility.

2. Each air ambulance service shall report the number of air ambulance transfers performed annually on the form provided for such purposes to the Office of Emergency Medical Services.

(b) Each air ambulance service shall retain patient records for at least ten years.

(8) Utilization Review (UR).

(a) The air ambulance service management shall ensure appropriate utilization review process with a structured, periodic review of transports being performed at least semiannually and resulting in a written report.

(b) The service shall maintain records of such reviews for two years.

(9) Quality Improvement (QI).

(a) The service shall have an established Quality Improvement program, including, at a minimum, the medical director(s) and management.

(b) The service shall conduct an ongoing Quality Improvement program designed to assess and improve the quality and appropriateness of patient care provided by the air medical service.

(c) The service shall have established patient care guidelines/standing orders. The QI committee and medical director(s) shall periodically review such guidelines/standing orders.

(d) The medical director(s) is responsible for ensuring timely review of patient care, utilizing the medical record and pre-established criteria.

(e) Operational criteria shall include at least the following quantity indicators:

1. Number of completed transports;

2. Number of air medical missions aborted and canceled due to weather; and 3. Number of air medical missions aborted and canceled due to patient condition and use of alternative modes of transport.

(10) For both QI and utilization review programs, the air ambulance service shall record procedures taken to improve problem areas and the evaluation of the effectiveness of such action.

(11) For both QI and utilization review programs, the air ambulance service shall report results to its sponsoring institution(s) or agency (if applicable) indicating that there is integration of the medical transport service’s activities with the sponsoring institution or agency (if applicable).

(12) Compliance. Compliance with the foregoing regulations shall not relieve the air ambulance operator from compliance with other statutes, rules, or regulations in effect for medical personnel and emergency medical services, involving licensing and authorizations, insurance, prescribed and proscribed acts and penalties.

(13) Separation of Services. Air ambulance service shall constitute a separate class of license and authorization from the Board and Office of EMS.

History

• Authority: T.C.A. §§ 68-140-304 and 68-140-307.
• Administrative History: Original rule filed March 20, 1974; effective April 19, 1974. Amendment filed November 30, 1984; effective February 12, 1985. Amendment filed February 4, 1988; effective March 20, 1988. Amendment filed June 28, 1988; effective August 12, 1988. Amendment filed August 11, 1993; effective October 25, 1993. Amendment filed January 7, 1997; effective March 23, 1997. Repeal and new rule filed January 7, 1997; effective March 23, 1997. Repeal and new rule filed June 30, 2011; effective September 28, 2011. Amendment filed October 4, 2012; effective January 2, 2013. Amendments filed March 25, 2026; effective June 23, 2026.

Tenn. Comp. R. & Regs. 1200-12-01-.06 SCHEDULE OF FEES

(1) The fees are as follows:

(a) Application fee for licensure or certification - A fee to be paid by all applicants as indicated, including those seeking licensure by reciprocity. It must be paid each time an application for licensure is filed.

(b) Endorsement/verification - A fee paid for each level of certification or endorsement as may be recognized by the Board within each category of personnel license.

(c) Examination fee - A fee paid each time an applicant requests to sit for any initial, retake, or renewal test or examination, written or practical.

(d) License fee - A fee to be paid prior to the issuance of the initial license.

(e) License Renewal fee - A fee to be paid by all license holders. This fee also applies to personnel who may reinstate an expired or lapsed license.

(f) Reinstatement fee - A fee to be paid when an individual fails to timely renew a license or certification.

(g) Replacement license or permit fee - A fee to be paid when a request is made for a replacement when the initial license has been changed, lost, or destroyed.

(h) Volunteer non-profit ambulance services eligible for reduced license fees under paragraph (5) shall be provided by all volunteer personnel and shall not assess any fees for their services, and shall be primarily supported by donations or governmental support for their charitable purposes.

(2) All fees shall be established pursuant to the rules approved by the Board.

(3) All fees for initial licensing or certification shall be submitted to the Division of Emergency Medical Services to the attention of the Revenue Control office. Fees shall be payable by check or money order payable to the Tennessee Department of Health.

(4) Emergency Medical Services Personnel Fees - Personnel applying for licensure, certification, authorization, renewal, or reinstatement shall remit application processing and license fees as follows.

(a) Fees for licensed personnel Application License 1. Emergency Medical Technican - Basic $50.00 $75.00 2. Emergency Medical Technican - Basic -IV $70.00 $80.00 3. Emergency Medical Tech. - Paramedic $75.00 $100.00 4. Emergency Medical Tech. Paramedic Critical Care - Initial Application for Endorsement $75.00 5. Initial Instructor Authorization $35.00 (b) Renewal fees for all classes of licenses in (a)

License 1. Emergency Medical Technican - Basic $65.00 2. Emergency Medical Technican - Basic -IV $65.00 3. Emergency Medical Tech. - Paramedic $75.00 4. Emergency Medical Tech. Paramedic Critical Care - $90.00 (c) Fees for Emergency Medical First Responders Application License 1. Initial Application and Certification $20.00 $25.00 2. Renewal fee $24.00 (d) Fees for Emergency Medical Dispatcher Application License 1. Initial Application and Certification $30.00 $30.00 2. Renewal fee $45.00 (e) Application fee for license by interstate reciprocity $100.00 (f) When applicable, renewal fees may be pro rated on a birth month renewal system.

(g) Applicants may also be required to pay a fee directly to the National Registry or other appropriate national or Board-approved testing agency.

(5) Service License and Vehicle Permit Fee - Ambulance services and invalid services shall permit fees as follows:

License (a) Initial license fee for a new ground ambulance, invalid, or other regulated ground service $5,000.00 (b) Annual renewal fee for (a) $500.00 (c) Vehicle Permit fee for each ground vehicle to be permitted in a license period- initial and annual $250.00 (d) Initial license fee for volunteer non-profit ambulance service with all volunteer personnel $2,000.00 (e) Annual renewal for volunteer non-profit ambulance service with all volunteer personnel $250.00 (f) Vehicle Permit fee for each ground vehicle operated by a volunteer non-profit ambulance service $100.00 (g) Initial license fee for air ambulance services fixed-wing and helicopter $10,000.00 (h) Air ambulance service - annual renewal fee $5,000.00 (i) A repeat inspection fee for a failed inspection of any aircraft or vehicle requiring inspection by the department $500.00 (6) A licensee or certificate holder requesting reinstatement of an expired certification, authorization, license and/or permit shall pay a reinstatement fee as follows:

Classification Fee (a) First Responders $50.00 (b) All Licensed Personnel, including EMDs $100.00 (c) Volunteer Non-Profit Ambulance Service 1. Service $100.00 2. Vehicle permit (per vehicle) $50.00 (d) Other Ground Ambulance and Invalid Services 1. Service $500.00 2. Vehicle permit (per vehicle) $250.00 (e) Air Ambulance Service $1,000.00 (f) A licensee or certificate holder requesting reinstatement shall pay the reinstatement fee in addition to the renewal fee.

(7) Administrative Documents and Publications Fees.

(a) Copies from official files and records shall be subject to a charge of fifty cents ($.50) per page.

(b) Publications, or copies of reference documents available from the Division shall include:

1. Director of Services $5.00 2. Application Materials Packet $9.00 3. Complied Statutes and Rules $9.00 4. Protocols $5.00 5. Ambulance Design Specifications $5.00 6. Other documents at the authorized cost of publication.

(c) Postage and Handling fees of five dollars ($5.00) will be applied to any mailing of more than twenty (20) pages.

(8) Verification of license status to other states, employers, or agencies shall be subject to a verification fee of fifteen dollars ($15.00). (Excepting automated telephone inquiries not requiring written documentation.)

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-39-508, 68-140-502, 68-140-504, 68-140-505, 68-140-506, 68-140-508, 68-140-517, and 68-440-506.
• Administrative History: Original rule filed September 22, 1981; effective December 29, 1981. Repeal and new rule filed October 13, 1983; effective January 16, 1984. Amendment filed November 30, 1984; effective February 12, 1985. Amendment filed August 22, 1985; effective September 21, 1985. Amendment filed September 24, 1990; effective November 8, 1990. Amendment filed October 21, 1993; effective January 4, 1994. Amendment filed August 12, 1996; effective October 26, 1996. Amendment filed June 18, 1999; effective September 1, 1999. Amendment filed August 29, 2003; effective November 12, 2003. Amendments filed December 16, 2005; effective March 1, 2006. Amendment filed April 13, 2006; effective June 27, 2006. Amendments filed June 4, 2008; effective August 18, 2008. Amendment filed November 10, 2010; effective February 8, 2011.

Tenn. Comp. R. & Regs. 1200-12-01-.07 INSURANCE COVERAGE

(1) All ambulance services and invalid vehicle services operating pursuant to Chapter 140 of Title 68, Tennessee Code Annotated shall maintain for each vehicle owned, and/or operated as an ambulance or invalid vehicle, insurance for vehicular liability coverage of not less than the minimum limits which are set forth in T.C.A. § 29-20-403.

(2) All emergency medical services, first response units and ambulance services shall maintain coverage for negligence (malpractice) or professional liability of not less than three hundred thousand dollars ($300,000) per occurrence.

(3) Each ambulance service and invalid vehicle transport service shall maintain general or professional liability coverage for claims arising in transfer of persons to and from their conveyance, and during transport of not less than three hundred thousand dollars ($300,000) per occurrence.

(4) Evidence that such insurance is in force and effect shall be furnished to the Division of Emergency Medical Services by the insurer upon application, license renewal, and upon request.

(a) Each service shall list the insurance agent, address, telephone number and each carrier and each policy number for insurance required under paragraphs (1), (2), and (3) upon initial and renewal applications, and shall inform the Division of any changes in agent or carrier.

(b) Each service shall have the insurance agent and/or carrier submit to the Division verification of coverage in the form of either a notarized affidavit or such certificate or insurance form as shall be approved by the Department of Commerce and Insurance or the Department of Health.

(c) Local government or state entities maintaining coverage under Governmental Tort Liability limits or self insurance programs may demonstrate compliance by submitting to the Division a letter verifying such coverage or alternate limits applicable to paragraphs (1), (2), and (3) attested by the chief risk management official, listing the address and telephone number and claims procedures.

(5) Air ambulance services shall comply with liability coverage required by the Federal Aviation Administration for air taxi operators, and malpractice and professional liability coverage at not less than three hundred thousand dollars ($300,000) per occurrence. Air ambulance services shall verify coverage as described in paragraph (4).

History

• Authority: T.C.A. §§ 4-5-202, 68-140-504, and 68-140-507.
• Administrative History: Original rule filed February 8, 1983; effective May 16, 1983. Amendment filed November 30, 1984; effective February 12, 1985. Amendment filed December 7, 1993; effective February 20, 1994. Repeal and new rule filed December 16, 2005; effective March 1, 2006.

Tenn. Comp. R. & Regs. 1200-12-01-.08 EMERGENCY MEDICAL SERVICES TELECOMMUNICATIONS

(1) EMS Telecommunications, General. All emergency medical service entities, as described in the Tennessee Code Annotated, § 68-140-202, shall meet the following rules and regulations to provide a statewide emergency medical services telecommunications system.

(a) Any radio system associated with, or operating in the Tennessee emergency medical services radio network and located, or proposed to be located, within the legal jurisdiction of the State of Tennessee, is required to submit to the Division of Emergency Medical Services a description of any new installation of radio equipment, or of changes, additions, and deletions to existing radio equipment.

(b) Each description shall list equipment identified by manufacturer, model number, quantity, frequency(s) and, in case of fixed station equipment, the antenna height type, location, and the number and location of the control point(s) for the station.

(c) Proposed modification to any system involving changes in frequency, radio access to the system, power output, antenna, control point(s), and number of transmitters shall be filed with the Division.

(d) The Director, Division of Emergency Medical Services, is delegated the responsibility and authority to review and approve or disapprove applications, system descriptions and system modifications submitted in accordance with these rules prior to their implementation, in order to maintain consistent development of a statewide telecommunications system.

(2) EMS Telecommunications Resource Coordination Centers, also known as Regional Medical Communications Centers, (RMCC), shall be designated by the Director of the Division of Emergency Medical Services for each emergency medical services area of the State, and shall be charged with the following responsibilities:

(a) The RMCC shall be operational twenty-four (24) hours daily and shall coordinate emergency medical services traffic, as required to:

1. Coordinate radio communications between ambulances, receiving hospitals, and adjacent regional communications centers;

2. Coordinate emergency medical consultation services for hospitals and ambulance services;

3. Monitor the status and availability of hospitals and special services throughout the region;

4. Conduct routine communications checks and systems tests with systems participants; and, 5. Assist in public health, injury, and disease surveillance programs in association with the Department of Health.

(b) The RMCC shall monitor and respond to all EMS telecommunications so directed to the regional center for those messages originating on the designated Tennessee EMS radio frequencies in the very high frequency (VHF) high band spectrum. Where applicable, the RMCC shall also:

1. Assign the UHF MED channels for real-time use by ambulances within two-way radio range of the center’s equipment, assuring an interference-free MED channel for ambulances during multiple or simultaneous runs; and, 2. Monitor and respond to EMS units as enabled on 800 MHz radio systems; and, 3. Shall record all EMS message traffic by date and 2400 hour time and retain the recordings for a minimum of one (1) year.

(c) The RMCC will maintain and coordinate its activities through a regional committee to promote and conduct quality improvement programs and review, and to guide plans and procedures for daily operations,. This committee shall coordinate development of communications procedures and other regional emergency medical services system planning as necessary for disasters and mass casualty incidents, including specialty care for trauma, burn, cardiac, stroke, and pediatric patients.

1. The committee shall be organized of representatives within the region designated from the following provider agencies and officials:

(i) Each hospital with an active emergency department;

(ii) Each primary provider of emergency ambulance services, each helicopter air ambulance service, and those private ambulance services with more than ten (10) permitted ambulances;

(iii) Regional Emergency Medical Services Consultant, Department of Health;

(iv) Regional Hospital Coordinator, Department of Health; and, (v) At least one EMS Medical Director affiliated with an EMS primary provider.

2. The committee shall elect from its membership of designated representatives, an executive committee and officers to preside at and record the business of the committee, including a chairman, vice-chairman, and secretary, and to function as necessary between the regular meetings of the committee.

3. The secretary of the committee shall keep minutes of the committee meetings, which shall be available for public inspection, except for those quality improvement oversight activities that are otherwise exempted by law.

4. Any committee member may place items before the committee for discussion.

(d) The RMCC shall conduct a continuing education program on its communication equipment, assuring that all employees, including supervisory personnel, can function at the telecommunicator position(s).

(e) The RMCC will participate with dispatcher and telecommunicator training and promote training for all personnel within the region involved in EMS radio communications.

(f) The RMCC, within the geographical area of responsibility, shall serve as the coordination point in situations requiring added EMS resources, over those locally available. During a disaster or multiple casualty incident local agencies shall notify the RMCC of changes in status and the need for added resources and upon such notification:

1. The RMCC shall receive scene reports and staging area information, and coordinate communications with the local dispatch center or incident command liaison; and 2. Coordinate emergency medical services resources responding to the incident, including ground and air ambulances, specialty teams, and state officials; and 3. Notify hospitals in accordance with the anticipated system demands and planned activities and allocate patients among hospitals in accordance with the patients’ condition, bed availability, and clinical specialty capabilities.

2. The RMCC will communicate situational information to health department and emergency management officials, and will maintain liaison with the emergency service coordinators at the State Emergency Operations Center, and other officials as identified by the Department of Health or the Tennessee Emergency Management Agency.

(g) The RMCC shall operate with professional radio operator techniques at all times, to monitor and promote system discipline, correct faulty operating practices within the system, and report any violations of system discipline to the regional EMS Consultant for appropriate action.

(h) The RMCC shall cooperate with radio repair services during their performance of maintenance on EMS radio equipment.

(i) The RMCC shall maintain a current and accurate index of Federal Communications Commission (FCC) assigned call signs and commercial telephone numbers of all regional ambulance services and medical facilities participating in the EMS radio communications system and shall assure adherence to applicable Tennessee statutes and rules and regulations of the FCC on the part of all regional participants. All local EMS agencies and participants shall notify the RMCC of any changes of radio call signs and telephone numbers.

(j) The RMCC shall maintain a constant status of emergency readiness, assuring that all employees are knowledgeable of the procedures for emergency operation and are familiar with the operation, capability and limitation of equipment. Centers maintaining controlled entrance to their facilities will provide the regional EMS Consultant with a personal method of access, and will immediately notify that Consultant on learning of an occurrence of a natural or man-made disaster or mass casualty incident that may tax the resources within the region.

(k) Only one RMCC shall be designated in each region.

(3) EMS Telecommunications Equipment Inventory - An inventory of emergency medical services telecommunications equipment shall be maintained under the supervision of the chief official of each emergency medical services entity controlling the use of the equipment.

(a) Upon receipt of a complaint or upon reasonable belief that a violation of Tennessee Code Annotated Title 68, Chapter 140 Part 2 or these rules is or was occurring, each emergency medical services entity shall allow access to identified representatives of the Division of Emergency Medical Services to inspect and verify the status of emergency medical services telecommunications equipment.

(b) The inventory of emergency medical services telecommunications equipment shall include all electronic equipment utilizing radio frequencies to render emergency medical service activity and any communications device requiring licensure by the Federal Communications Commission and used for emergency medical communications.

(c) The inventory will be kept current and will include the items described in (b), above, by quantity, manufacturer, model number, frequency(s), and noun description. In addition, for transmitting equipment, the radio frequency power presented to the antenna will be given. At the option of the controlling entity, other identifying marks such as serial numbers may be listed for inventory and loss control.

(4) EMS Telecommunications Operating Techniques - All emergency medical services entities participating in the Tennessee EMS Telecommunications System shall conform to the radio operation techniques approved by the Division of Emergency Medical Services.

(5) EMS Telecommunications System Access - Access to the statewide emergency medical services telecommunications system, including the use of selective signals or tones, shall comply with technical specifications developed or approved by the Division of Emergency Medical Services, and correspond to the procedures outlined in the State EMS Telecommunications Plan. Emergency medical service entities in the statewide network shall meet the following requirements:

(a) Each ambulance permitted to transact business in the State of Tennessee and each emergency ambulance dispatching center shall have two-way radio capability with the following devices and frequencies as addressed in either part 1. or part 2. of this rule.

1. A Very High Frequency radio on the frequency of 155.205 MHz with approved equipment utilizing Digital coded squelch of 205, not later than six months following the effective date of this rule.

(i) Each entity shall have a valid radio station license or letter providing frequency use agreement from a radio station license issued by the Federal Communications Commission (FCC) for all transmitting equipment on the frequency used; or, (ii) Those services having a FCC license for mobile operation only on 155.205 MHz shall have a written agreement with a nearby service operating a properly licensed base station on this frequency, such agreement extending cooperative communications to radio equipped vehicles of the service.

(iii) The frequency 155.205 MHz shall be used for ambulance mutual aid activities.

2. Those counties with a population of more than 250,000 people according to the 2000 U.S. Census and that rely upon an 800 MHz radio system for public safety communications may apply to use an alternative communications system to accomplish the objectives of this rule, as detailed in paragraphs (a), (b), and (c).

The alternative must provide for ambulance to ambulance and ambulance to hospital communications for the affected Tennessee licensed ambulances when operating outside their primary base of operations.

(i) Communications equipment or techniques proposed as an alternative for VHF radio requirements identified by this rule shall be determined by the Division of Emergency Medical Services on a case by case basis. The Division may review alternative methods by requiring a demonstration of such equipment and procedures at any time to determine whether the alternative process is adequate.

(ii) Communications equipment or techniques proposed as an alternative for such VHF radio requirements for EMS systems interoperability must be accompanied by all of the following:

(I) A realistic assessment of the range, coverage, and efficiency of those procedures and devices which are proposed;

(II) The availability of alternatives and the time necessary to deploy such alternatives; and (III) The cost analysis for deployment of resources outside of the jurisdiction of the primary ambulance service provider for a seventytwo hour period, and statement that such deployment would not affect the capabilities within the primary jurisdiction to provide public safety interoperability.

(b) Each emergency ambulance operated by an emergency medical service entity licensed to transact business in the State of Tennessee shall have mobile two-way radio capability on the frequency 155.295 MHz utilizing digital coded squelch of 155, with approved equipment for on-scene interoperability and communications among health agencies and emergency medical services providers. Radio modifications for this frequency shall be required not later than six months following the effective date of this

rule. All future paging activity on 155.295 MHz within the State of Tennessee shall be prohibited.

(c) Each emergency ambulance operated by an emergency medical service entity licensed to transact business in the State of Tennessee shall have two-way radio capability on the frequency 155.340 MHz with approved equipment. The entity shall have a valid radio station license issued by the FCC (MOBILE ONLY) for all transmitting equipment on this frequency. The entity shall have a written agreement with an adjacent, or nearby, hospital operating a properly licensed base station on this frequency, such agreement extending cooperative communications to radio equipped vehicles of the entity. The ambulance crew shall use this frequency (155.340 MHz) as the primary patient information frequency in the absence of Ultra High Frequency (UHF) or 800 MHz capability between the ambulance and the medical facility.

(d) Each licensed hospital within the State of Tennessee which maintains an emergency room and offers the facilities of this department to the general public shall have a twoway radio base station access capability on the EMS radio frequency(s) of 155.340 MHz and such other frequencies within the predominant service area of the hospital or identified in the approved Regional Frequency Use Plan. The primary service area is defined as a radius of not more than thirty (30) miles from the transmitting antenna site.

The accessing control point for the base station shall be located in, or adjacent to, the emergency department of the hospital. When participating in an ultra high frequency system (MED channels), the hospital must retain a radio for responding to calls on 155.340 MHz. This frequency (155.340 MHz) is intended and dedicated as a two-way voice channel between the emergency medical technician, ambulance, and the hospital emergency department physician or authorized nurse. All paging activity on 155.340 MHz shall be prohibited.

(e) Licensed hospitals within the State of Tennessee may, at their option, license the use of frequency 155.280 MHz. This frequency may be used by the hospital to converse with adjacent hospitals during routine or emergency situations, and may be further licensed for mobile operation and other medical purposes, as approved within the Regional EMS Communications Plan and the EMS Communications Manager.

(f) Audible tones will be restricted to actual emergency radio transmissions alerting EMS or rescue personnel or in accordance with the approved Regional Frequency Use and State EMS Telecommunications Plans. Use of audible tones of more than two seconds preceding, during or following routine EMS radio transmission on these frequencies is prohibited.

(g) The Tennessee Emergency Medical Services State EMS Communications Plan will guide technical specifications and approval of equipment. The plan will be revised, as appropriate, to reflect improvement in technology and systems design. Responsibility for development, implementation, and revision of the plan is delegated to the Director, Division of Emergency Medical Services.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-140-202, 68-140-203, 68-140-204, 68-140-205, 68-140-206, 68-140-207, 68-140-208, 68-140-502, 68-140-504, 68-140-505, and 68-140-513.
• Administrative History: Original rules filed February 8, 1983; effective May 16, 1983. Amendment filed April 8, 1987; effective May 23, 1987. Amendment filed May 27, 1988; effective July 11, 1988. Amendment filed March 7, 1989; effective April 21, 1989. Amendment filed August 11, 1993; effective October 25, 1993. Amendment filed January 7, 1997; effective March 23, 1997. Amendment filed June 1, 2007; effective August 15, 2007.

Tenn. Comp. R. & Regs. 1200-12-01-.09 GROUND INVALID VEHICLE STANDARDS

All invalid vehicles operating in the State of Tennessee shall meet the following standards.

(1) The invalid vehicle shall be used only for the transport of an “invalid.” “Invalid” shall mean a person whose physical impairments render it impractical to use regular common carrier taxi service and who does not require provision of medical attention prior to or during transport.

(2) To preclude substitution of services or the negligent or adverse delivery of medical transportation, after January 1, 1987 no ambulance service shall be authorized permits for invalid vehicles.

(3) Vehicles permitted for invalid transfer shall not display or use markings, flashing lights, sirens, or other devices which might resemble an emergency vehicle.

(a) The word AMBULANCE or the term AMBULANCE SERVICE shall not appear on the vehicle, nor shall these terms be used to identify the nature of service or used in any service advertisement.

(b) All advertising and vehicles used for invalid transfer shall display in a conspicuous manner a placard, visible from the exterior, or a notice on advertisements as follows:

INVALID TRANSPORT - THIS SERVICE DOES NOT PROVIDE MEDICAL CARE

(4) Vehicles permitted for invalid transfer shall meet the following design requirements:

(a) At least two doors shall allow access to the passenger compartment one at the rear for stretcher loading, and one at the side capable of evacuating a stretcher patient. Door latches shall allow operation from the interior and exterior.

(b) The invalid vehicle shall provide the following minimal dimensions:

1. Interior height: 42 inches, floor to ceiling, 2. Interior width: 48 inches, measured fifteen (15) inches above the floor, 3. Interior passenger compartment length of 92 inches, measured fifteen (15) inches from floor, from rear door to divider or driver seat back.

(5) Each invalid vehicle shall conform to sanitation requirements, mechanical and safety standards, and requirements for insurance as specified under Rules 1200-12-01-.01, 1200- 12-01-.02, and 1200-12-01-.07.

(6) Operations and records for invalid transport shall be maintained as follows:

(a) Employee records for all drivers and attendant personnel. Each person transported shall be accompanied in the patient compartment.

(b) Run records showing the name, location and destination for each person transported, and personnel completing transfer, identifying the date, time, and vehicle utilized.

(c) Records on the registration and maintenance of all invalid vehicles.

(d) All records detailed herein shall be made available to the duly authorized representative of the department.

(7) Invalid vehicles shall be equipped as follows:

(a) Each vehicle shall have a crash stable device for securing the stretcher.

(b) Each vehicle shall have a wheeled stretcher adjustable to a semi-sitting position, with at least two patient safety restraining straps.

(c) Each vehicle shall have a blanket and pillow, and clean linen shall be used for each person transported.

(d) Each vehicle shall provide a bedpan, urinal, basin, tissues and towels as needed for personal hygiene during transport.

History

• Authority: T.C.A. §§ 4-5-202, 68-39-504, and 68-39-507.
• Administrative History: Original rule filed February 8, 1983; effective May 16, 1983. Amendment filed April 8, 1987; effective May 23, 1987.

Tenn. Comp. R. & Regs. 1200-12-01-.10 AMBULANCE DRIVER QUALIFICATIONS

The following rules are promulgated to establish minimal qualifications for operators or drivers of ambulances operated by ambulance services licensed by the Tennessee Department of Health:

(1) Notwithstanding any other requirements under this section, an individual who possesses a Class D driver’s license is eligible for service as an ambulance driver or operator.

(2) Any individual who has reached the age of eighteen (18) years old and attained at least one year of licensed driver experience is eligible for service as an ambulance driver or operator.

(3) Reserved.

(4) This rule shall not prohibit the operation of an ambulance by an individual during extraordinary circumstances during which both ambulance personnel must be engaged in patient care or are otherwise incapacitated.

History

• Authority: T.C.A. §§ 68-140-304, 68-140-306, and 68-140-307.
• Administrative History: Original rule filed November 30, 1984; effective February 12, 1985. Amendment filed September 18, 1986; effective December 29, 1986. Amendment filed September 24, 1990; effective November 8, 1990. Emergency rules filed November 19, 2021; effective through May 18, 2022. Emergency rules expired effective May 19, 2022, and the rules reverted to their previous statuses. Amendments filed July 20, 2022; effective October 18, 2022.

Tenn. Comp. R. & Regs. 1200-12-01-.11 AMBULANCE SERVICE OPERATIONS AND PROCEDURES

To establish operating standards for ambulances and emergency medical services.

(1) Each service provider shall assure that safety belts are maintained in good working condition, and that all ambulance personnel, patients, and passengers utilize seat restraints at all times the vehicle is in motion, except as necessary to attend a patient within the patient compartment.

(a) All vehicle operators, crew personnel, or passengers within the driver’s compartment or forward passenger seats shall be secured by a device in compliance with appropriate federal motor vehicle safety standards (49 C.F.R. 571) for restraints, anchorages and mechanisms.

(b) Children under four years of age shall be transported in the front passenger compartment only when the child is appropriately secured in a child passenger restraint system, meeting state and federal motor vehicle safety standards. (T.C.A. § 55-9-214)

(c) Patients shall be secured to stretchers, except as may be necessary to facilitate treatment.

(2) The Division of Emergency Medical Services may deny issuance or renewal of licenses or permits for any of the following:

(a) Incomplete or incorrect information on applications for licenses or permits.

(b) Unsatisfactory inspections or safety deficiencies on more than 25% of the vehicles operated by a service.

(c) Failure to list and record all personnel employed or serving as vehicle operators or emergency care personnel and to record personnel serving on each call or request.

(d) Failure to furnish or maintain accurate verification of insurance coverage.

(e) Change in ownership.

(3) Each ambulance service shall submit an annual report of its operations and may include financial information for statistical compilation. Such information shall be submitted in the manner and upon such forms as may be provided for such purposes by the Division of Emergency Medical Services.

(4) Ambulance Dispatch Procedures.

Ambulance services classified above minimum standards shall process all emergency calls through a designated dispatcher. Whether employed by the service or obtained by cooperative agreement, dispatchers of emergency medical services shall conform to the following standards:

(a) From a listing of staffed ambulances, the dispatcher will assign an available unit within two minutes of receipt of an emergency call. or refer the call by mutual aid agreement, except as provided under T.C.A. § 68-39-516.

(b) Reserved.

(c) Class A - Advanced Life Support Services shall respond first response units to any priority call, including automobile accidents or cardio-respiratory emergencies, where unit arrival can be anticipated to exceed eight minutes, and where such units are organized and can demonstrate capabilities to render more rapid assistance.

(5) Smoking or any other use of a tobacco product within ten (10) feet of an ambulance is prohibited.

(6) Repealed.

History

• Authority: T.C.A. §§ 4-5-201, 4-5-202, 68-39-501, 68-39-504, 68-39-505, 68-39-508, 68-39-509, 68-140- 504, 68-140-505, 68-140-507, 68-140-509, and 68-140-521.
• Administrative History: Original rule filed November 30, 1984; effective February 12, 1985. Amendment filed April 8, 1987; effective May 23, 1987. Amendment filed June 30, 1987; effective August 14, 1987. Amendment filed June 28, 1988; effective August 12, 1988. Amendment filed May 1, 1992; effective June 15, 1992. Amendment filed June 5, 1998; effective August 19, 1998. Amendment filed September 22, 1998; effective December 6, 1998. Amendment filed October 15, 2002; effective December 29, 2002. Amendment filed May 26, 2010; effective August 24, 2010.

Tenn. Comp. R. & Regs. 1200-12-01-.12 AUTHORIZATION OF EMERGENCY MEDICAL SERVICES EDUCATORS

(1) EMS Program Director/Administrator shall mean an individual responsible for the overall coordination of all EMS Programs. The individual shall act as a liaison between faculty, the sponsoring agency, students, the local medical community, and the Division of Emergency Medical Services. The individual is also responsible for the recruitment and continued development of faculty to meet the needs of the institution. The minimum qualifications for EMS Program Director/Administrator shall include:

(a) Professional requirements.

1. Bachelor’s degree required from a regionally accredited college/university.

2. The program director must be licensed in Tennessee as an EMT-Paramedic, registered nurse, or physician.

3. Professional license must be free from history of revocation, denial or suspension.

4. Licensed emergency care experience shall include a minimum of three years’ practice.

5. Administrative experience shall include a minimum of two (2) years in EMS educational administration.

6. Current endorsement in a Board-approved trauma, cardiac, and pediatric course at the provider level.

(b) Authorization Renewal shall be contingent upon:

1. Assisting with at least forty-five (45) hours of advanced EMS instruction on an annual basis.

2. Maintaining current credentials for the course content.

3. Attendance at annual Instructor/Coordinator Conference as required by the Division of Emergency Medical Services.

(c) Denial of Reauthorization or Revocation of Authorization - The authorization of an EMS Program Director/Administrator may be removed or denied by the Director for the following reasons:

1. Two or more instances of failure to cover the prescribed course curriculum or failure to conduct the course in accordance with the practices prescribed by the Board and the Division.

2. Failure to complete and submit required documentation for all students.

3. A lapsed, revoked, suspended or expired license.

4. Any violation of Tennessee Code Annotated, Title 68, Chapter 140 or any rule promulgated by the Board.

(2) EMT-Paramedic Instructor/Coordinator shall mean an employee responsible for the delivery of instruction in accredited Paramedic Programs. The individual shall be knowledgeable in all aspects of prehospital care, capable of applying techniques and modalities of adult education, and of managing resources and resource personnel. The minimum qualifications for EMT-Paramedic Instructor/Coordinator shall include:

(a) Professional requirements.

1. Associate degree from a regionally accredited institution.

2. Currently licensed as a Tennessee EMT-Paramedic, registered nurse, or physician.

3. Professional license must be free from history of revocation, denial or suspension.

4. Licensed emergency care experience shall include a minimum of two years’ practice.

5. Administrative experience shall include a minimum of two (2) years in EMS educational administration or greater than three hundred (300) hours of EMS instruction.

6. Current endorsement in a Board-approved trauma, cardiac, and pediatric course at the provider level.

(b) Authorization Renewal shall be contingent upon:

Assisting with at least one hundred (100) hours of advanced EMS instruction on an annual basis.

1. Maintaining current Tennessee licensure as an Emergency Medical Technician- Paramedic, registered nurse, or physician.

2. Maintaining current CPR instructor endorsement.

3. Attendance at annual EMT Instructor/Coordinators conference as required by the Division of Emergency Medical Services.

(c) Denial of Reauthorization or Revocation of Authorization - The authorization of an EMT-Paramedic Instructor/Coordinator may be removed or denied by the Director for the following reasons:

1. Two or more instances of failure to cover the prescribed course curriculum or failure to conduct the course in accordance with the practices prescribed by the Board and the Division.

2. Failure to complete, and submit as required, all required documentation for all students in each class.

3. A lapsed, revoked, suspended or expired license.

4. Any violation of Tennessee Code Annotated, Title 68, Chapter 140 or any rule promulgated by the Board.

(3) EMT-Paramedic Instructor Assistant shall mean an individual capable of teaching the application of practical skills to include: assisting the faculty in the delivery of instruction, evaluating student performance of skills, maintenance of equipment, and coordinating with the faculty or Instructor/Coordinator to maintain adequate levels of needed equipment. The minimum qualifications for an EMT-Paramedic Instructor Assistant shall include: .

(a) Professional requirements.

1. Currently licensed as a Tennessee EMT-Paramedic, registered nurse, or physician without a history of revocation, denial or suspension of licensure.

2. Licensed experience with a minimum of two years practicing advanced life support in the pre-hospital or emergency department environment.

3. Minimum of two years’ experience in EMS education administration or greater than seventy-five (75) hours of EMS instruction.

4. Current endorsement in an EMS Board-approved trauma, cardiac and pediatric course as an instructor.

5. Completion of an EMS Board-approved instructors’ assistant course.

(b) Authorization Renewal shall be contingent upon:

1. Assisting with at least forty-five (45) hours of advanced EMS instruction on an annual basis.

2. Maintaining current Tennessee licensure as an Emergency Medical Technician- Paramedic, Registered Nurse or Physician.

3. Current endorsement in an EMS Board-approved trauma, cardiac and pediatric course as an instructor.

4. Attendance at annual Instructor update as required by the Division of Emergency Medical Services.

(c) Denial of Reauthorization or Revocation of Authorization - The authorization of an EMT-Paramedic Instructor Assistant may be removed or denied by the Director for the following reasons:

1. Two or more instances of failure to cover the prescribed course curriculum or failure to conduct the course in accordance with the practices prescribed by the Board and the Division.

2. Failure to complete, and submit required documentation for all students.

3. A lapsed, revoked, suspended or expired license.

4. Any violation of Tennessee Code Annotated, Title 68, Chapter 140 or any rule promulgated by the Board.

(4) EMT-Basic Instructor/Coordinator shall mean an individual responsible for the overall coordination of the EMT-Basic Program. The individual shall act as a liaison between faculty, the sponsoring agency, students, the local medical community and the Division of Emergency Medical Services. The individual is also responsible for the delivery of didactic material, demonstration of the psychomotor skills, verification of skill proficiency, and the recruitment and continued development of faculty to meet the needs of the institution. The minimum qualifications for the EMT-Basic Instructor/Coordinator shall include:

(a) Professional requirements.

1. Associate degree from a regionally accredited institution.

2. Currently licensed as a Tennessee EMT-Paramedic, without history of revocation, denial, or suspension of licensure.

3. Experience. Pre-Hospital: Minimum of two years practicing in the pre-hospital environment or one hundred fifty (150) hours of EMS instruction acceptable to the Board. Administrative: Minimum of one year in EMS educational administration.

4. Completion of an EMS Board-approved Instructors’ course.

5. The provisions of subparagraph (a) shall not apply to any EMT-Basic Instructor/Coordinator authorized by the Division prior to July 1, 2001.

(b) Authorization Renewal shall be contingent upon:

1. Assisting with at least seventy-five (75) hours instruction (EMT-Basic or EMT-IV or EMT-I or EMT-P) on an annual basis.

2. Maintaining current Tennessee licensure as an Emergency Medical Technician- Paramedic.

3. Maintaining current CPR instructor endorsement.

4. Attendance at annual EMT Instructor/Coordinators conference as required by the Division of Emergency Medical Services.

(c) Denial of Reauthorization or Revocation of Authorization - The authorization of an EMT-Basic Instructor/Coordinator may be removed or denied by the Director for the following reasons:

1. Two or more instances of failure to cover the prescribed course curriculum or failure to conduct the course in accordance with the practices prescribed by the Board and the Division.

2. Failure to complete and submit, as required, all required documentation for all students in each class.

3. A lapsed, revoked, suspended, or expired license.

4. Any violation of Tennessee Code Annotated, Title 68, Chapter 140 or any rule promulgated by the Board.

(5) EMT Instructor Assistant shall mean an individual capable of teaching the application of practical skills including assisting the faculty in the delivery of instruction, evaluating student performance of skills, maintenance of equipment, and coordinating with the faculty or Instructor/Coordinator to maintain adequate levels of needed equipment. The minimum qualifications for an EMT Instructor Assistant shall include:

(a) Professional requirements.

1. Currently licensed as a Tennessee EMT-Basic, without history of revocation, denial, or suspension of licensure.

2. Licensed experience shall include a minimum of one year practicing in the pre-hospital environment in Tennessee.

3. Must document at least seventy-five (75) hours of EMS instruction acceptable to the Board.

(b) Authorization Renewal shall be contingent upon:

1. Document at least forty-five (45) hours of EMT instruction on an annual basis and acceptable to the Board.

2. Maintaining current Tennessee licensure as an Emergency Medical Technician- Basic.

3. Maintaining current CPR instructor endorsement.

4. Completion of an EMS Board-approved Instructors’ course.

5. Attendance at an annual Instructor update as mandated by the Division of Emergency Medical Services.

(c) Denial of Reauthorization or Revocation of Authorization - The authorization of an EMT Instructor Assistant may be removed or denied by the Director for the following reasons:

1. Two or more instances of failure to cover the prescribed course curriculum or failure to conduct the course in accordance with the practices prescribed by the Board and the Division.

2. Failure to complete and submit, as required, all required documentation for all students in each class.

3. A lapsed, revoked, suspended, or expired license.

4. Any violation of Tennessee Code Annotated Title 68, Chapter 140, or any rule promulgated by the Board.

(6) First Responder Course Coordinator/Instructor shall mean an individual responsible for the overall coordination of the First Responder Program. The individual shall act as a liaison between the sponsoring agency, students, the local medical community and the Division of Emergency Medical Services. The individual is also responsible for the delivery of didactic material, demonstration of the psychomotor skills, and verification of skill proficiency.

(a) The minimal qualifications for First Responder Course Coordinator/Instructor shall be:

1. Currently licensed as a Tennessee EMT-Basic or Paramedic without history of revocation, denial, or suspension of licensure and nominated by a sponsoring EMS agency.

2. Must be certified as a Cardiopulmonary Resuscitation Instructor.

3. Pre-Hospital Experience: Minimum of one year practicing in the pre-hospital environment in Tennessee.

4. Letter of recommendation from sponsoring EMS agency.

(b) Authorization renewal shall be contingent upon:

1. Maintaining current Tennessee licensure as an Emergency Medical Technician- Basic or Paramedic without disciplinary action.

2. Maintaining current CPR instructor endorsement.

3. A letter of recommendation for reauthorization from the sponsoring EMS agency.

4. A letter of recommendation for reauthorization from the Regional EMS Consultant.

5. Completion of an EMS Board-approved Instructor Course.

6. Attendance at an annual First Responder Instructor Update as mandated by the Division of Emergency Medical Services.

(7) Individuals with a Program Director and/or Instructor Coordinator endorsement are authorized to coordinate and instruct in classes at or below their level of authorization, but not above their level of authorization.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-39-504, 68-39-505, 68-39-508, 68-140-504, 68-140-505, 68- 140-508, 68-140-509, and 68-140-518.
• Administrative History: Original rule filed November 30, 1984; effective February 12, 1985. Amendment filed April 8, 1987; effective May 23, 1987. Repeal and new rule filed January 4, 2005; effective March 20, 2005. Amendment filed September 21, 2007; effective December 5, 2007. Amendment filed April 6, 2010; effective July 5, 2010.

Tenn. Comp. R. & Regs. 1200-12-01-.13 EMT, AEMT AND PARAMEDIC EDUCATION PROGRAMS

(1) Definitions. Terms used in this rule shall be defined as follows:

(a) “Approval” means the approval process the Tennessee Emergency Medical Services Board (“Board”) uses to assure that EMT, AEMT, and Paramedic education programs comply with the educational standards, requirements, and policies it adopts.

(b) “Approved Program” means an education program approved by the Tennessee Emergency Medical Services Board.

(c) “Contract or Agreement” means a written agreement between the school and the cooperating agency.

(d) “EMS Educational Institution” means an institution sponsoring an EMT, AEMT, or Paramedic education program shall be an accredited post-secondary educational institution, such as a university, college, community college, technical school, or fire department in accordance with T.C.A. § 68-140-327, or a state agency conducting classes for state law enforcement employees at a state law enforcement training academy, with adequate resources and dedication to educational endeavors.

(e) “Medical Director” means a physician with an unencumbered Tennessee license having experience and current knowledge of emergency care of acutely ill and/or traumatized patients. This individual shall be familiar with base station operation including communication with, and direction of, pre-hospital emergency units. The medical director must have knowledge of administrative problems affecting EMS personnel education programs and legislative issues regarding educational programs for the pre-hospital provider.

(f) “National Accreditation” means accreditation from the Commission on Accreditation of Allied Health Education Programs (“CAAHEP”).

(g) “National Education Standards” shall mean national education standards developed from the National EMS Scope of Practice Model for Emergency Medical Service Personnel as promulgated by the U.S. Department of Transportation, National Highway Traffic Safety Administration.

(2) EMS Educational Programs:

(a) Any EMS Educational Institution sponsoring an EMT, AEMT, or Paramedic education program to qualify applicants for licensure shall ensure that its program conforms, at a minimum, to the national education standards developed from the National EMS Scope of Practice Model for Emergency Medical Service Personnel promulgated by the U.S.

Department of Transportation, National Highway Traffic Safety Administration, which the EMS Board has approved, and to such rules as the Board shall promulgate.

(b) Any EMS Educational Institution sponsoring an EMT, AEMT, or Paramedic education program shall adopt, at a minimum, all parts of the curricula as developed from the national education standards including skills, training requirements, and permitted practices and procedures for appropriate licensure classification which the EMS Board has adopted.

(c) The EMS Educational Institutions sponsoring EMS training programs shall:

1. File a written request for Division approval with the EMS Division at least thirty (30) days prior to the start date of classes;

2. Ensure that the training program has sufficient supervised practice, equipment, and experience for each required clinical skill;

3. Have a medical director whose affiliation is confirmed in writing;

4. File a description of curriculum with the EMS Division; and 5. Meet the instructor/student ratio approved by the Board.

(d) Only students from Tennessee-approved programs or those who have met reciprocity requirements shall be eligible for state licensure.

(e) Purposes of Approval are as follows:

1. To set standards for education programs to prepare emergency medical services licensees to practice safely; and 2. To ensure that graduates of an approved EMS Educational Institution are eligible for admission to the licensure examinations.

(f) Approval shall be categorized, and awarded or revoked in accordance with the following criteria:

1. The Board may grant initial approval to a new program that has not been in operation long enough to graduate its first class, but demonstrates its eligibility for full approval. The Board shall review programs for full approval one year after initial approval or when their first class of students graduates.

2. Approval and renewal of approval shall be based on recommendations of the Division made to the Board based upon application information, survey and site visits, review of clinical experiences and documentation, instructor/student ratio, instructor qualifications, and related evidence of continuing compliance with the regulations of the Board.

3. The Board may grant approval for a period of five (5) years to a program that has met the requirements that are set forth by the Board and the policies of the Division of EMS.

4. The Board may grant conditional approval to a program which has failed to maintain the standards and has been notified that it must meet the requirements within a specified time period or upon demonstration of compliance.

5. The Board shall deny approval for cause, or it may revoke or condition approval for failure to comply with the standards the Board establishes.

6. If the institution does not correct deficiencies within the specified time, and until the Board approves such action, the education program shall not convene a subsequent class.

7. Programs desiring to cease education activities shall notify the Director of EMS in writing.

(g) All programs must maintain for first attempt for licensure, an annual pass rate as approved by the Board. Should a program fail to maintain the required pass rate it shall:

1. Receive a “Letter of Concern” from the Division.

2. Should a program fail to achieve the required pass rate for a second year, the program shall receive a “Letter of Warning” from the Division and be required to submit a “Plan of Correction” to the Division outlining its recommendations for improvement.

3. Should a program fail to achieve the required pass rate for a third year, a representative from the approved program shall be required to appear before the Board to explain the “Plan of Correction” and the steps taken to improve.

4. The Board may, in accordance with the Uniform Administrative Procedures Act (UAPA), condition, suspend, or revoke the educational institution’s approval.

(h) Requirements for Approval.

1. Sponsorship/Affiliation.

(i) EMS Educational Institutions must have affiliation agreements with Tennessee-licensed Emergency Medical Services, and with Tennesseelicensed medical facilities or hospitals which are capable of supporting EMT, AEMT and/or Paramedic education with sufficient supervised practice and experience for the number of students enrolled in the program.

(ii) The EMS Educational Institution must provide the financial support, facilities, and leadership capable of ensuring a sound educational program and appropriate services to faculty and students.

(iii) The EMS Educational Institution shall maintain records of overall student competency in knowledge, skills and experience while maintaining the capability to endorse participants for the license examination.

(iv) The EMS Educational Institution shall notify the Division of any proposed major curriculum or program change in writing which will be subject to Board approval.

2. Curriculum.

(i) Program Goals and Objectives.

(I) The program shall have a written statement of program goals and objectives consistent with and responsive to the demonstrated needs and expectations of the various communities it serves.

(II) Statements of goals and objectives shall provide the basis for program planning, implementation, and evaluation.

(III) An advisory committee shall be designated and charged with assisting the program and sponsoring institutional personnel in formulating appropriate goals and standards, monitoring needs and expectations, and ensuring program responsiveness to change.

(ii) Minimum Expectations.

(I) Program goals and objectives must include, but need not be limited to, providing assurance that graduates demonstrate entry-level competencies, as periodically defined by nationally accepted educational standards and scope of practice for the appropriate level of licensure.

(II) The curriculum shall follow planned outlines, that shall be kept on file for Division review, that appropriately integrate lecture, laboratory, clinical, and field experience sequenced to assure efficient learning and opportunity for every student. Content and support courses shall include basic theoretical and scientific knowledge reflective of state of the art patient care.

(III) The curriculum shall meet, or exceed, the national educational standards and competencies for the appropriate level of licensure as adopted in the United States Department of Transportation National EMS Scope of Practice Model and Education Standards.

3. Administration and Faculty.

(i) Administration of EMS Educational Programs.

(I) EMS Educational Institutions offering paramedic educational programs shall include the following:

I. A full-time Division-authorized EMS Program Director, whose primary responsibility and full-time commitment is to the educational program.

II. The Program Director shall have appropriate training and experience to fulfill the role of program director as indicated in

Rule 1200-12-01-.12(1).

III. The Program Director shall be responsible for the organization, administration, periodic review, development and effectiveness of the paramedic educational program.

IV. The Program Director shall act as a liaison between faculty, the sponsoring service, students, the local medical community, and the Division of Emergency Medical Services.

V. The Program Director is responsible for recruitment and the continued development of faculty to meet the needs of the institution.

(II) EMS Educational Institutions offering AEMT education shall include the following;

I. At a minimum, a Division-authorized AEMT Instructor/ Coordinator, who is responsible for the organization, administration, periodic review, development and effectiveness of the AEMT educational program.

II. An EMS Program Director in EMS institutions authorized to provide Paramedic educational programs may also administer AEMT educational programs.

(III) EMS Educational Institutions offering EMT education shall include the following:

I. At a minimum, a Division-authorized EMT Instructor/ Coordinator, who is responsible for the organization, administration, periodic review, development and effectiveness of the EMT educational program.

II. An EMS Program Director in EMS institutions authorized to provide Paramedic or AEMT educational programs may also administer EMT educational programs.

(IV) Medical Director. The program shall appoint a medical director who shall be responsible for reviewing and approving the educational content of the program’s curriculum. The medical director shall:

I. Review and approve the content and quality of the medical instruction and supervision the EMS educational program delivers;

II. Ensure that each student is appropriately assessed to assure that the student is making adequate progress toward the completion of the educational program; and III. Attest that each student has achieved the desired level of competence prior to graduation.

(V) Instructional Faculty.

I. The faculty shall be authorized by the Division and qualified through academic preparation, training, and experience to teach the courses or topics to which they are assigned in the curriculum.

II. Faculty members shall demonstrate individual proficiency and qualifications by submitting a personal Curriculum Vitae that will be kept on file with the Program Director.

III. The number of faculty instructors shall be sufficient to provide instruction and supervision for each period of the program or field experience.

(VI) An Authorized Paramedic Instructor/Coordinator shall be responsible for the delivery of instruction in a Paramedic education program.

I. The Paramedic Instructor/Coordinator shall be knowledgeable in all aspects of pre-hospital care, capable of applying techniques and modalities of adult education, and of managing resources and resource personnel.

II. Paramedic Instructor Assistants shall be responsible for teaching practical skills to include: assisting the Program Director and/or Instructor/Coordinator in the delivery of instruction, evaluating student performance of skills under supervision of Program Director or Authorized Paramedic Instructor/Coordinator.

(VII) An authorized AEMT Instructor/Coordinator shall be responsible for the delivery of instruction in an AEMT educational program.

I. An authorized AEMT Instructor/Coordinator shall be in the classroom for, at least but not limited to, the following:

A. Delivery of didactic material;

B. Demonstration of the psychomotor skills;

C. Verification of skill proficiency; and D. Supervision of AEMT Instructor Assistants.

II. The education program may utilize Authorized AEMT Instructor Assistants for teaching practical skills including, but not limited to, assisting the Program Director and/or AEMT Instructor/Coordinator in the delivery of instruction and evaluating student performance of skills during a lab.

(VIII) An authorized EMT Instructor/Coordinator shall be responsible for the delivery of instruction in an EMT educational program.

I. An authorized EMT Instructor/Coordinator shall be in the classroom for, at least but not limited to, the following:

A. Delivery of didactic material;

B. Demonstration of the psychomotor skills;

C. Verification of skill proficiency; and D. Supervision of EMT Instructor Assistants.

II. The education program may utilize Authorized EMT Instructor Assistants for teaching practical skills including, but not limited to, assisting the Program Director and/or EMT Instructor/Coordinator in the delivery of instruction and evaluating student performance of skills during a lab.

4. Resources.

(i) Finances. Financial resources adequate for the continued operation of the educational program shall be provided for each class of students enrolled.

(ii) Facilities.

(I) Instructional resources shall include:

I. Classrooms, laboratories and administrative offices with sufficient space to accommodate the number of students matriculating in the program and the supporting faculty;

II. Library resources, related to the curriculum, shall be readily accessible to students and shall include current EMS and medical periodicals, scientific books, audiovisual and selfinstructional resources, and other references; and III. Available sufficient supplies and equipment to be used in the provision of instruction that are consistent with the needs of the curriculum and adequate for the students enrolled.

(II) Clinical Resources.

I. The educational program shall establish clinical affiliations that are confirmed by written affiliation agreements with the institutions and agencies that provide students with clinical experience under appropriate medical direction and clinical supervision.

II. Students shall have access to an adequate number of patients and in distribution by sex and age who present common problems encountered in the delivery of basic and advanced emergency care.

III. Students shall be assigned in clinical settings where experiences are educationally sufficient to achieve the national educational standards for the appropriate level of licensure.

IV. Program instructors or hospital personnel, such as nurses or physicians, who have been approved by the program to so function, shall provide supervision in the clinical setting. The ratio of students to instructors in the clinical facilities shall be adequate to assure effective learning.

V. Students shall be clearly identified by name plate, uniform, or other apparent means to distinguish them from graduate emergency medical services personnel, other health professionals, workers, and other students.

(III) Field Internship.

I. The program’s field internship shall occur within an emergency medical system which demonstrates medical accountability.

The student must be under direct supervision of preceptors the program and/or EMS services designate. Preceptors shall be physicians and/or nurses with pre-hospital experience, AEMTs or paramedics. The program shall assure that there is appropriate, objective evaluation of student progress in acquiring the desired competencies in accordance with the national education standards.

II. Field internship shall occur on an Advanced Life Support vehicle within an EMS system having capability of voice telecommunications with on-line medical direction. The vehicle shall be equipped with equipment and drugs necessary for basic and advanced life support.

III. The majority of the field internship experience shall occur following the completion of the didactic and clinical phases of the program. It must be structured to assure that upon completion of this portion of the program, each student will achieve the desired competencies of the national educational standards.

IV. Adequate manpower shall be available within the EMS system to assure that the assigned student is never a substitute for paid personnel or a required team member.

5. Student Admissions and Conduct.

(i) EMS Educational Institution admission requirements shall be clearly defined and published by the institution, and shall be non-discriminatory with respect to race, color, creed, sex, age, handicaps, or national origin.

(ii) Persons seeking admission to an EMT, AEMT, or Paramedic education program shall:

(I) Meet the admission requirements of the EMS Educational Institution;

(II) Possess an academic or equivalent high school diploma or general education equivalent (GED); or (III) Be a high school senior who is eligible for dual enrollment for college credit, and who will be eighteen (18) years of age within ninety (90) days of completing the training for which admission to a program is sought.

(iii ) Upon selection for admission into the EMT, AEMT, or Paramedic program, the student shall:

(I) Show good physical and mental health and possess no physical handicaps or disabilities which would impede the ability to fulfill the functions and responsibilities of an EMT, AEMT, or Paramedic.

(II) Submit a physical examination form indicating physical health sufficient to perform the duties of an EMT, AEMT, or Paramedic completed by a physician, physician assistant, or nurse practitioner, who has examined the individual. If there are any limitations in the individual’s ability to perform adequately, additional documentation shall be submitted from the appropriate professional evaluator which indicates the applicant’s abilities to perform adequately (i.e.):

I. Speech impairment - Speech Pathologist;

II. Hearing impairment - Audiologist;

III. Physical handicap or disability - Orthopedist or Registered Physical Therapist; or IV. Vision - Ophthalmologist.

(III) Readmission or transfer of students shall be made in accordance with clearly defined and published practices of the institution which shall be non-discriminatory with respect to race, color, creed, sex, age, handicaps, or national origin.

(IV) Dismissal. Students shall be subject to dismissal from the education program for cause.

6. Program Records.

(i) Each student record shall include the following:

(I) A transcript of high school graduation or graduate equivalent (GED), or official academic college transcript in each student’s file;

(II) Medical evidence that the protection of students and the public from injury or the transmission of communicable diseases is assured for each student;

(III) A record of class and practice participation along with evidence of competencies attained throughout the education program;

(IV) Copies of examinations and assessments of the student’s development and attainment of competencies;

(V) Sufficient information to document each student’s satisfactory completion of all didactic, practical skills, laboratory, clinical, and field requirements.

(VI) Copies of proof of malpractice insurance on each student enrolled in the program with minimal coverage of $1,000,000.00/$3,000,000.00 which will extend for the entire duration of the education program; and (VII) The records maintained by the institution shall be complete whether or not a student is successful in completing the prescribed course of instruction.

(ii) Each academic record shall include:

(I) A descriptive synopsis of the current curriculum; and (II) A statement of course objectives, copies of course outlines, class and laboratory schedules, clinical and field internship experience schedules, and teaching plans.

7. Student Admission. In addition to requirements for admission to all EMT education programs, applicants for admission to AEMT Education programs shall meet requirements as follows:

(i) Hold a current Tennessee EMT license prior to admission; or (ii) Have successfully completed the EMT education program within 120 days of beginning an Advanced EMT education program and have successfully completed a Board-approved EMT competency written and practical examination.

(3) Paramedic Education Programs.

(a) Upon initial approval of a paramedic program by the EMS Board, all paramedic education programs must make application to the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) and receive a letter of review for accreditation with the Commission of Accreditation of Allied Health Education Programs (CAAHEP) and shall be accredited within four (4) years of initial application of CAAHEP.

(b) All Paramedic programs must maintain accreditation with CAAHEP.

(c) Additional admission requirements for paramedic education programs.

1. To be eligible for admission an applicant shall be currently licensed as an Advanced Emergency Medical Technician in the State of Tennessee.

2. The applicant must be evaluated using a scale where each requirement will receive a score of 0-5 depending on the quality of achievement with 5 being the highest and 0 being the lowest. Applicants selected shall receive an overall interview rating of 2.5 and above.

3. AEMT knowledge. The applicant having successfully completed an AEMT license exam more than one year prior to the start of Paramedic classes must successfully complete an AEMT assessment written examination approved by the Board.

4. An applicant shall be interviewed and evaluated. Each area evaluated in the interview shall be rated with a score of 0-5 depending on the quality of achievement, with 5 being the highest score and 0 being the lowest. Applicants selected shall receive an overall rating of 2.5 and above.

(i) The applicant shall be interviewed by a committee of at least four (4) individuals and a representative from the Division of Emergency Medical Services. Committee members shall be selected from the following: an EMS educator, a registered nurse, a physician, a paramedic, and/or an ambulance service director.

(ii) The following criteria shall be used for interview evaluation:

(I) EMS related experience;

(II) Level of maturity and motivation;

(III) Level of knowledge;

(IV) Communication ability; and (V) Poise.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-140-304, 68-140-306, 68-140-307, 68-140-504, 68-140-506, 68-140-508, and 68-140-509.
• Administrative History: Original rule filed November 30, 1985; effective February 12, 1985. Amendment filed October 22, 1987; effective December 6, 1987. Amendment filed January 17, 1989; effective March 3, 1989. Amendment filed September 24, 1990; effective November 8, 1990. Amendment filed October 22, 1993; effective January 5, 1994. Amendment filed August 5, 1996; effective October 19, 1996. Repeal and new rule filed January 11, 2013; effective April 11, 2013. Amendment filed May 26, 2010; effective August 24, 2010. Amendments filed September 23, 2019; effective December 22, 2019.

Tenn. Comp. R. & Regs. 1200-12-01-.14 EMERGENCY MEDICAL SERVICES STANDARDS AND CATEGORIES FOR

LICENSED AMBULANCE SERVICE AND MOBILE PREHOSPITAL EMERGENCY CARE. The following rules are promulgated to establish minimum standards and categorical capabilities for emergency medical services and/or ambulance services licensed in Tennessee and to govern emergency medical services provided to a patient.

(1) Definitions.

(a) “Advanced Life Support” means advanced emergency medical technicians, or other EMS personnel having a higher level of licensure, who treat life-threatening or aggravating medical emergencies under medical control.

(b) “Basic Life Support” means EMS personnel, authorized through the appropriate level of licensure, who treat life-threatening medical emergencies under medical control.

(c) “Base of Operations” means the principal location and physical structure (i.e. building), having a street address, city and zip code, from which ambulances and/or personnel operate to provide ambulance service within a service area.

(d) “Division” means the Division of Emergency Medical Services of the Tennessee Department of Health.

(e) “Emergency Medical Condition” means a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that it could put the patient’s health in serious jeopardy, cause serious impairment to bodily function, or cause serious dysfunction of any body organ, system or part without immediate medical attention.

(f) “Emergency Run” means a transport or response, occurring or accomplished without delay, to the perceived need for care for an emergent, trauma or medical condition in order to prevent loss of life or aggravation of illness or injury, including but not limited to the following:

1. Cardiac arrest;

2. Difficulty breathing/shortness of breath/airway impairment;

3. Severe chest pain or heart attack;

4. Severe motor vehicle crashes/entrapment or pin-in;

5. Decreases in level of consciousness/diabetic emergencies;

6. Heat emergencies;

7. Severe lacerations or possible amputations; severe burns (thermal, chemical or electrical);

8. Possible stroke; and 9. Complications of childbirth.

(g) “Emergency Medical Service Director” (“Service Director”) means an individual who directs the planning, development, implementation, coordination, administration, monitoring and evaluation of services provided by a licensed ambulance service.

(h) “Emergency Medical Service Medical Director” (“Medical Director”) means an individual who has an active, unencumbered license to engage in the practice of medicine pursuant to title 63, chapter 6, or chapter 9, and who provides medical advice, direction, oversight, quality assurance and authorization to emergency medical services personnel at a licensed ambulance service, and/or emergency medical services educational institution.

(i) “Medical Control” means the instruction, advice or orders given by a physician in accordance with locally or regionally approved practices.

(j) “Minimum Standards” means the minimum requirements for ambulance and emergency medical services established by law, regulation, and prevailing standards of care.

(k) “Service Area” means the political and geographical area with a population that can be expected to use the services offered by a specific provider.

(l) “Specialty Care Transport” (“SCT”) means the inter-facility transportation of a critically injured or ill patient by a ground ambulance vehicle, including the provision of medically necessary supplies and services, which requires a level of service beyond the scope of a paramedic.

(m) “Substation” means the physical structure from which ambulances and personnel operate on a day-to-day basis to provide ambulance services, which are supplementary to the services provided from the base of operations for the specified city or county.

(n) “Volunteer ambulance service” means a not-for-profit service that uses volunteer personnel and restricts emergency operations to scheduled events or serves as a relief organization under the constraint of the main or governmental emergency medical services provider within a service area.

(2) Ambulance Operations.

(a) Each base of operations must hold a State-issued service license for the county in which it is located.

(b) No ambulance service shall position, post, stage or otherwise offer or make an ambulance available within the service area where the county, municipality or special

purpose district or authority has current ordinances or resolutions preventing such without prior authorization of the governing body of the service area.

(c) Notwithstanding any other provision, nothing shall preclude an ambulance provider with federal contracts from providing service as required under those contracts.

(3) Classification of Services.

(a) Each ambulance service license the Division issues must indicate the minimum clinical level of service that the ambulance service can provide.

(b) The Division shall grant an ambulance service license only after it verifies that the service is in compliance with Division rules for immediate or scheduled patient transport.

(c) The Division recognizes the following classes of service for licensing or authorization of ambulances and/or emergency medical services:

1. Category A: Primary emergency provider. Each ambulance service the local government designates as the primary provider by recognizing it as such or contracting with it to provide initial response to scene emergencies shall operate advanced and/or basic life support ambulances within the service area 24 hours a day. The service may also provide ambulance transport services under its license for its county specific service area. It shall coordinate licensed volunteer ambulance services as well as coordinate and oversee emergency medical response agencies within its jurisdiction.

(i) Level 1: 100% of Emergency runs shall be made with an Advanced Life Support-equipped ambulance and staffed with a paramedic and a minimum of an EMT.

(ii) Level 2: 90% of Emergency runs shall be made with an Advanced Life Support-equipped ambulance and staffed with a paramedic and a minimum of an EMT.

(iii) Level 3: 100% of Emergency runs shall be made with a Basic Life Supportequipped ambulance and staffed with two AEMTs.

(iv) Level 4: 90% of Emergency runs shall be made with a Basic Life Supportequipped ambulance and staffed with an AEMT and an EMT.

2. Category B: Licensed Ambulance Transport Services. Each licensed ambulance service shall operate ambulances for unscheduled or scheduled transportation of patients. The level of the licensed ambulance service must be consistent with their issued service license level.

(i) Level 1: 100% of transports shall be made with an Advanced Life Supportequipped ambulance and staffed with a paramedic and a minimum of an EMT.

(I) Notwithstanding any other requirements under this section, Level 1 transports may be conducted by an Advanced Life Support-equipped ambulance with a paramedic serving as the sole medical staff, provided there is also an ambulance operator who satisfies the ambulance driver requirements of Tenn. Comp. R. & Reg. 1200-12- 01-.10, possesses current CPR certification, has completed a defensive driving course, and has demonstrated competency.

(II) Medical Directors of ambulance services utilizing paramedic-only Level 1 transports shall notify the Office of EMS of their intent to utilize EMS-As or EMRs.

(ii) Level 2: 90% of transports shall be made with an Advanced Life Supportequipped ambulance and staffed with a paramedic and a minimum of an EMT.

(I) Notwithstanding any other requirements under this section, Level 2 transports may be conducted by an Advanced Life Support-equipped ambulance with a paramedic serving as the sole medical staff, provided there is also an ambulance operator who satisfies the ambulance driver requirements of Tenn. Comp. R. & Reg. 1200-12- 01-.10, possesses current CPR certification, has completed a defensive driving course, and has demonstrated competency.

(II) Medical Directors of ambulance services utilizing paramedic-only Level 2 transports shall notify the Office of EMS of their intent to utilize EMS-As or EMRs.

(iii) Level 3: 100% of transports shall be made with a Basic Life Supportequipped ambulance and staffed with two AEMTs 100% of time.

(I) Notwithstanding any other requirements under this section, Level 3 transports may be conducted by a Basic Life Support-equipped ambulance with an Emergency Medical Technician-Basic or Emergency Medical Technician-Advanced serving as the sole medical staff for Basic Life Support ambulances, provided there is also an ambulance operator who satisfies the ambulance driver requirements of Tenn. Comp. R. & Reg. 1200-12-01-.10, possesses current CPR certification, has completed a defensive driving course, and has demonstrated competency.

(II) Medical Directors of ambulance services utilizing EMT Basic or Advanced Level 3 transports shall notify the Office of EMS of their intent to utilize EMS-As or EMRs.

(iv) Level 4: 90% of transports shall be made with a Basic Life Supportequipped ambulance and staffed with a minimum of two EMTs.

(I) Notwithstanding any other requirements under this section, Level 4 transports may be conducted by a Basic Life Support-equipped ambulance with an Emergency Medical Technician-Basic or Emergency Medical Technician-Advanced serving as the sole medical staff for Basic Life Support ambulances, provided there is also an ambulance operator who satisfies the ambulance driver requirements of Tenn. Comp. R. & Reg. 1200-12-01-.10, possesses current CPR certification, has completed a defensive driving course, and has demonstrated competency.

(II) Medical Directors of ambulance services utilizing EMT Basic or Advanced Level 4 transports shall notify the Office of EMS of their intent to utilize EMS-As or EMRs.

(v) Services conducting paramedic-only Level 1 or Level 2 transports are responsible for ensuring that each ambulance operator is properly trained and has demonstrated competency in safely lifting and moving patients via ambulance cot. Operators are forbidden from providing direct patient care that requires licensure as healthcare providers by the Tennessee Department of Health, as these operators lack such licensure. All other statutes and rules regarding patient transport services remain in full force and effect.

(vi) Services conducting EMT Basic or Advanced-only Level 3 or Level 4 transports are responsible for ensuring that each ambulance operator is properly trained and has demonstrated competency in safely lifting and moving patients via ambulance cot. Operators are forbidden from providing direct patient care that requires licensure as healthcare providers by the Tennessee Department of Health, as these operators lack such licensure.

All other statutes and rules regarding patient transport services remain in full force and effect.

(vii) Services must require all operators hired under this part to attain, at minimum, licensure as an EMT-Basic within twelve (12) months from the operator’s original hire date.

(viii) Services are prohibited from employing, as an operator, any individual previously employed in the State of Tennessee under this part, who has failed to attain or will be unable to attain licensure as an EMT-Basic or higher, within twelve (12) months of that individual’s original hire date.

3. Category C: Volunteer not-for-profit ambulance services using volunteer personnel shall restrict emergency operations to scheduled events or serve as a relief organization under the coordination of the primary emergency provider.

Volunteer ambulance services may, in times of disaster, be used in their communities as deemed necessary by local authorities and/or primary service providers. All Category C services shall be Category B, Level 4 transport services at a minimum.

(d) Conditional Ambulance Services. The Division may place a new service or a service having deficiencies in a conditional license category for up to ninety (90) days from the date of the deficiency or issuance of the license. Placing the license in a conditional license category is not disciplinary action.

(4) Personnel. Each ambulance or emergency medical service shall assign qualified persons to perform functions to ensure compliance with its licensure as follows:

Each ambulance service shall retain an Emergency Medical Services Medical Director (“Medical Director”) who serves as medical authority for the ambulance service and functions as a liaison to the medical community, medical facilities, and governmental entities. His or her duties shall include, but not be limited to, the following:

(a) Quality management and improvement of patient care, including the following:

1. Development of protocols, standing orders, training, procedures, approval of medications and techniques permitted for field use by service personnel in accordance with regulations of the Division;

2. Quality management and improvement of field performance as may be achieved by direct observation, field instruction, in-service training or other means including, but not limited to:

(i) Ambulance run report review;

(ii) Review of field communications tapes;

(iii) Post-run interviews and case conferences;

(iv) Critiques of simulated or actual patient presentations; and (v) Investigation of complaints or incidents reports.

(b) The medical director shall have disciplinary and/or corrective action authority sufficient to oversee quality management and improvement of patient care as the service director of the ambulance service deems appropriate.

(5) Each ambulance service shall require and document continuing education of at least fifteen (15) contact hours annually for ninety-five percent (95%) of emergency care personnel. Each service shall implement a competency-based evaluation program in accordance with Board policy.

(6) Each ambulance service shall also conduct training for new procedures or remedial instruction as ordered by the medical director and or emergency medical service director.

(7) EMS/Ambulance Services who do not use educational institutions or other educational accrediting bodies to provide continuing education contact hour credit for in-service training hours for renewal of personnel licenses may count such in-service training hours as continuing education contact hours as required for renewal of personnel licenses, provided the service meets the following requirements:

(a) The service must have an individual who maintains, at a minimum, an authorization of an EMT instructor/coordinator authorized by the Division of EMS to maintain educational records and coordinate in-service education for the service’s personnel.

(b) The service must maintain all educational records for five (5) years.

(c) The service’s educational records must contain:

1. A curriculum vitae establishing the instructor’s expertise in the content for each lesson plan;

2. Lesson plans shall include, but not be limited to:

(i) A list of course objectives, and (ii) A course outline;

3. Course evaluations by students;

4. An evaluation of each student’s performance in the course; and 5. A sign-in sheet bearing the signatures of all students who attended the course.

(d) The service’s training records will be randomly audited annually for compliance.

(8) Service permits issued by the Division shall be specific to the county in which the service has its base of operations. The service owner may maintain records for such operations at a central location. The service owner shall maintain records to detail all activities at the county base of operations.

(9) Licensing Procedures.

(a) No person, partnership, association, corporation, or state, county or local government unit, or division, department, board or agency thereof, shall establish, conduct, operate, or maintain as a business in the State of Tennessee any ambulance, invalid vehicle service or vehicle operated with a patient cot for transport of persons without having a license.

1. A license shall only be issued to the applicant named and only for the base of operations and substations listed in the application for licensure.

2. Licenses are not transferable or assignable and shall expire annually on June 30.

3. The license shall be conspicuously posted at the base of operations.

(b) Initial Licensure.

1. In order to make application for a new license, applicants shall have service names that are unique and the business name shall be registered with the Department of State, Division of Business Services.

2. The applicant shall submit an application on a form prepared by the Division. The service shall report the names, titles and summary of responsibilities of the service director and those persons who will be supervising the ambulance service as officers, directors or other ambulance service officials, and information as to any misdemeanor or felony convictions, or disciplinary sanctions against licenses, certifications, or other authorizations to practice a health care occupation or profession, that have been imposed against them in this or any other state.

3. Each applicant for a license shall pay the annual license fee and permit fees based on the number of ambulances or permitted invalid vehicles. The fees must be submitted with the application and are non-refundable.

4. The issuance of an application form is in no way a guarantee that the completed application will be accepted or that a license will be issued by the Division.

Patients shall not be transported until a license has been issued. Applicants shall not hold themselves out to the public as being an ambulance service until the license has been issued. A license shall not be issued until the service is in substantial compliance with these rules and regulations, including submission of all information required by T.C.A. § 68-140-306, or as later amended, and of all information required by the Division.

5. The applicant shall not use subterfuge or other evasive means to obtain a license, such as filing for a license through a second party when an individual has been denied a license, had a license disciplined, or has attempted to avoid the inspection and review process in this or any other state.

6. An applicant shall allow the premises, the service, and its vehicles to be inspected by a representative of the Division.

7. In the event that deficiencies are noted, the applicant shall submit a plan of corrective action to the Division. Once the deficiencies have been corrected, then the Division shall reconsider the application for licensure. If vehicles have failed inspection, a repeat inspection fee must be submitted to the Division.

(c) License Renewal.

1. In order to renew a license, each service shall subject its premises, operational procedures, records, equipment, personnel and vehicles to periodic inspections by representatives of the Division for compliance with these rules. If deficiencies are noted, the licensee shall submit an acceptable plan of corrective action, remedy the deficiencies and pay any repeat inspection fees. In addition, each licensee shall submit a renewal form approved by the Division and any applicable renewal fees prior to the expiration date of the license.

2. Upon reapplication, the licensee shall submit its base of operations, stations, and vehicles to inspections by representatives of the Division for compliance with these rules.

3. Ambulance services must show documented proof of annual mandatory random drug screening for licensed employees.

4. An ambulance service may renew the service license within sixty (60) days following the license expiration date upon payment of the renewal fee, in addition to a late penalty established by the Board for each month or fraction of a month that payment for renewal is late, provided that the late penalty shall not exceed twice the renewal fee. If the ambulance service license is not renewed within sixty (60) days following the license expiration date, then the licensee shall reapply for licensure in accordance with the rules established by the Board.

(d) Changes of address, insurance agents or policies, service director, officers, or other service officials, EMS medical director, or bankruptcy filings must be reported to the Division no later than five (5) business days after the change or date of effective action.

(e) A proposed change of ownership, including a change in a controlling interest, must be reported to the Division a minimum of thirty (30) days prior to the change. The Division must receive a new application and fee before the license may be issued.

History

• Authority: T.C.A. §§ 68-140-304, 68-140-305, 68-140-306, and 68-140-307.
• Administrative History: Original rule filed November 30, 1984; effective February 12, 1985. Amendment filed March 22, 1985; effective April 21, 1985. Amendment filed June 30, 1987; effective August 14, 1987. Amendment filed September 23, 1991; effective November 7, 1991. Amendment filed October 22, 1993; effective January 5, 1994. Amendment filed March 7, 1994; effective May 21, 1994. Amendment filed January 7, 1997; effective March 23, 1997. Amendment filed May 5, 2014; effective August 3, 2014. Amendment filed May 26, 2010; effective August 24, 2010. Amendments filed September 23, 2019; effective December 22, 2019. Emergency rule filed February 11, 2021; effective through August 10, 2021. Emergency rule expired effective August 11, 2021, and the rule reverted to its previous status. Emergency rules filed November 19, 2021; effective through May 18, 2022. Emergency rules expired effective May 19, 2022, and the rules reverted to their previous statuses. Amendments filed July 20, 2022; effective October 18, 2022.

Tenn. Comp. R. & Regs. 1200-12-01-.15 AMBULANCE SERVICE RECORDS

Each ambulance service and invalid vehicle operator, licensed or permitted by the Tennessee Department of Health and Environment shall maintain records that include, but are not limited to, the following information:

(1) Each ambulance service shall maintain the following records and provide information to the Division office at the request of any authorized representative of the Division relative to ambulance service personnel, including, but not limited to the following:

(a) Records indicating the individual’s driver’s license type and number, emergency medical technician license number, training or expiration date of CPR courses, the date of the individual’s last physical examination, and the status of the individual’s EMS telecommunication training, defensive driving courses, emergency vehicle operation courses, and other in-service training.

(b) Time cards, time sheets, call rosters, or shift schedules accurately indicating the availability of ambulance service personnel and the crews assigned on each date for each staffed ambulance within a specified county or jurisdiction.

(2) Dispatch and Run Records shall be provided for every call to which an ambulance responds or when a patient is evaluated, treated, or transported; including information in accordance with the following requirements:

(a) A dispatch log shall be maintained to record the assignment of all units, including the date, the time the call is received, time and unit dispatched, time of arrival on scene, time of arrival at the destination, and time available for return to service. The dispatch log will specify responding or attending personnel by name and level of licensure, and cross-reference any ambulance run report number. Calls will be logged to reflect immediate emergency or non-emergency response or scheduled transfers. Compliance may be demonstrated by a single log, or such combination of records that can confirm the required information. Ambulance dispatch logs will be retained for a period of at least ten (10) years.

(b) Ambulance service run reports shall be filed with the Division of Emergency Medical Services to include all information in required data fields and such other information as may be detailed in the Board-approved prehospital care data set. This information shall be transmitted in an approved format using Tennessee subset schema definitions (XSD) in Extensible Markup Language (XML) in compliance with information systems procedures adopted by the State of Tennessee. Each service shall submit reports, either web based or via compiled form, to the Division of Emergency Medical Services within sixty (60) days. Notices shall be sent to the service within fifteen (15) days for non-compliance or citing deficiencies in the reported data elements or required information.

(c) For each patient transported to a hospital emergency department or transferred between medical facilities, emergency medical services personnel shall submit a report to the emergency department or hospital personnel in a written or electronic format or method approved by the Division or the Board. This report shall provide brief information identifying the patient by name (if known), age, and gender; the location from which the patient was transported; the approximate times of the medical incident, initiation of transport, and arrival at the hospital; the chief complaint or description of the illness or injuries, with appropriate notation of vital signs and patient condition; and shall describe the care and treatment provided at the scene or during transport. This report shall identify the name(s) and professional license level of the attending personnel, ambulance unit, and ambulance service. The receiving facility should receive any records or copies of physicians’ orders for scope of treatment (POST) that may accompany the patient. Should circumstances or other emergencies preclude the submission of the report at the time of arrival at the emergency department, the report shall be submitted in not less than twenty-four hours from time of transport. If circumstances or other emergencies preclude the submission of the report at the time of arrival at the emergency department, the attending personnel must give a verbal report of above information to receiving personnel at health care facility with that individual signing for receipt of verbal report before attending personnel leave the health care facility. This report, while classified as confidential, shall be deemed as an essential element for continuity of care.

(d) Each licensed service shall file a written report with the Division within five (5) business days from the discovery by the service of any incident that results in serious injury to a patient that could not reasonably be expected as a result of the patient’s condition. A serious injury is one that results in exacerbation, complication or other deterioration of a patient’s condition. Such reportable incidents include, but are not limited to, the following:

1. Medication errors resulting in serious injury;

2. The failure to provide treatment in accordance with the service treatment protocols resulting in serious injury; or 3. A major medical or communications device failure or other equipment failure or user error resulting in serious injury or delay in response or treatment.

(3) Vehicle and Equipment Records - Records regarding the acquisition and maintenance of all vehicles and equipment shall be retained by each service, which shall include the following:

(a) Registration and title certificates or notarized copies of such documents for each vehicle.

(b) Maintenance records shall be maintained on each vehicle, detailing all mechanical work.

(c) Copies of orders, invoices or other documents asserting title or ownership of medical equipment, including contracts or agreements pertaining to state-issued equipment consigned to the service.

(4) Ambulance equipment inventory - An ambulance equipment inventory shall be recorded not less than every three (3) days for each vehicle reflecting an accurate status of patient care equipment, safety devices, and supplies. Each service shall adopt forms or procedures appropriate to this purpose which shall be available for inspection reflecting status of a period of at least three (3) months.

(5) Each ambulance service shall maintain a file of FCC-related records in accordance with 47 C.F.R., Part 90.443. Such records shall include that of any transmitter maintenance, base or mobile, which affects frequency, modulation or power output tolerance of the transmitter, and those periodic reports of inspection of antenna support structures which are required to be illuminated.

(6) All records detailed herein shall be made available when requested for inspection by a duly authorized representative of the department.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-204, 68-140-304, 68-140-306, 68-140-307, 68-140-502, 68- 140-504, 68-140-505, 68-140-507, 68-140-508, 68-140-509, and 68-140-519.
• Administrative History: Original rule filed November 30, 1984; effective February 12, 1985. Amendment filed October 22, 1987; effective December 6, 1987. Amendment filed August 11, 1993; effective October 25, 1993. Amendment filed October 21, 1993; effective January 4, 1994. Amendment filed June 5, 1998; effective August 19, 1998. Amendment filed December 16, 2005; effective March 1, 2006. Amendment filed May 26, 2010; effective August 24, 2010. Amendment filed May 5, 2014; effective August 3, 2014.

Tenn. Comp. R. & Regs. 1200-12-01-.16 EMERGENCY MEDICAL FIRST RESPONDERS

(1) Definitions - The terms used in this rule shall be defined as follows:

(a) Emergency Medical Responder (First Responder) means a person who has completed required training and who participates in an organized program of mobile pre-hospital emergency medical care.

(b) Emergency Medical Responder (First Responder) Certification means successful participation and completion of the Emergency Medical Responder Course and certifying examinations.

(c) Emergency Medical Responder (First Responder) Course means instruction in basic knowledge and skills necessary to provide emergency medical care to the sick and injured individuals who may respond before licensed Basic or Advanced Life Support units arrive.

(d) First Responder Service - shall mean a service providing capabilities for mobile prehospital emergency medical care using emergency medical response vehicles.

(2) Operation of First Responder Services. A licensed ambulance service classified as a primary provider shall coordinate first response services within its service area. If the primary provider is a contracted ambulance service, the county or local government may designate a representative who shall coordinate first responder services within the service area of its jurisdiction. First responder services shall meet the following standards for participation in the community EMS system. To participate in the community EMS system, each First Responder Service shall:

(a) Be a state-chartered or legally recognized organization or service sanctioned to perform emergency management, public safety, fire fighting, rescue, ambulance, or medical functions.

(b) Provide a member on each response who is certified as a First Responder, Emergency Medical Technician, or EMT-Paramedic in Tennessee.

1. Personnel may provide the following additional procedures with devices and supplies consigned under medical direction:

(i) First Responders and Emergency Medical Technicians trained in an appropriate program authorized by the Division may perform defibrillation in a pulseless, nonbreathing patient with an automated mode device.

(ii) Emergency Medical Technicians-IV and EMT-Paramedics may administer:

(I) Intravenous fluids with appropriate administration devices.

(II) Airway retention with Board-approved airway procedures.

(iii) EMT-Paramedics and advanced life support personnel trained and authorized in accordance with these rules may perform skills or procedures as adopted in Rule 1200-12-01-.04(3).

(iv) First Responders and Emergency Medical Technicians participating in a recognized first responder organization within the community EMS system may, upon completion of the approved training, periodic review training, and concurrent quality assurance of the local EMS system Medical Director, utilize a dual-lumen airway device (such as the Combitube or Pharyngeal Tracheal Lumen airway) that has been approved by the EMS Board.

2. Such procedures shall be consistent with protocols or standing orders as established by the ambulance service medical director.

3. Services shall provide at least six (6) hours of annual in-service training to all EMS First Responder personnel, in a plan and with instructors approved by the medical director.

(c) Provide services twenty-four (24) hours a day, seven (7) days a week, and notify the primary service and dispatching agent of any time period in which the service is not available or staffed for emergency medical response.

(d) Provide minimum equipment and supplies and such other equipment and supplies as shall be mutually adopted under the agreement with the primary ambulance service and medical director. The following minimum equipment shall be provided:

1. Emergency Medical Care (Jump) Kit containing:

(i) Dressings and bandaging supplies, with adhesive tape, adhesive bandages, sterile 4” gauze pads, sterile ABD pads, 3” or wider gauze roller bandages, bandage shears, occlusive dressing materials, at least four triangular bandages, and burn sheets.

(ii) Patient assessment and protective supplies including a flashlight, disposable gloves, antibacterial wipes or solution with tissues, trash bags, an adult blood pressure cuff with manometer and a stethoscope.

2. Resuscitative devices including oral airways in at least five sizes, a pocket mask, suction device capable of 12 inches vacuum with suction tips for oropharyngeal suction, and an oxygen administration unit capable of 2 to 15 liters per minute flow rate with a minimum 150 liter supply.

3. Splints for upper and lower extremities.

4. Patient handling equipment including a blanket and appropriate semi-rigid extrication collars.

(e) Develop and maintain a memorandum of understanding or agreement of coordination within the service area with the primary provider of emergency ambulance services. If the primary provider is a contracted ambulance service, said agreement shall be developed and maintained with the designated representative of the county or local government. Such agreement will provide for policies and procedures for the following:

1. Personnel and staffing, including a roster of response personnel and approved procedures for such personnel, and the crew component operational for emergency medical response.

2. Designation of vehicles to be operated as pre-hospital emergency response vehicles, including unit identifiers and station or location from which vehicles will be operated.

3. Nature of calls for which first response services will be dispatched, and dispatch and notification procedures that assure resources are simultaneously dispatched and that ambulance dispatch is not deferred or delayed.

4. Radio communications and procedures between medical response vehicles and emergency ambulance services.

5. On-scene coordination, scene control and responsibilities of the individuals in attendance by level of training.

6. Medical direction and protocols and/or standing orders under the authority of the ambulance service medical director.

7. Exchange and recovery of required minimum equipment and supplies and additional items adopted for local use.

8. Exchange of patient information, records and reports, and quality assurance procedures.

9. Terms of the agreement including effective dates and provisions for termination or amendment.

(f) First responder services shall maintain professional liability insurance providing indemnity to emergency care personnel and the organization. Each first responder service shall maintain the minimum liability coverage which is set forth in T.C.A. § 29- 20-403.

(3) Emergency Medical Responder (First Responder) Training Programs:

(a) Shall utilize texts and curriculums approved by the Board.

(b) Class size shall not exceed twenty-five (25) students per instructor.

(c) Course must be conducted by an instructor authorized by the Division.

(d) Shall obtain course approval from the Division.

(e) Shall provide an attendance policy acceptable to the Division.

(f) Shall maintain accurate attendance records.

(g) Must maintain student records, such as exams, attendance records and skills verification for 5 years.

(h) Must provide documentation of a student’s successful completion of course, attendance, and verification of skills competency to the Division.

(i) Must provide adequate classroom space with adequate lighting and ventilation.

(j) Must provide adequate lab space for skills practice.

(k) Must assure adequate audio visual instructional aids and supplies are available.

(l) Must provide adequate equipment for skills training.

(4) Official response shall be performed only as assigned upon the specific policy guidelines of the coordinating dispatch agency responsible for dispatching emergency ambulances and/or an emergency (911) communications district. No emergency medical first responder or emergency medical response vehicle shall be authorized to make an unofficial response on the basis of information obtained by monitoring a radio frequency of a law enforcement, ambulance service, fire department, rescue squad, or public safety agency.

History

• Authority: §§ 4-5-202, 4-5-204, 68-140-304, 68-140-504, 68-140-504(1) and (2), 68-140-506, 68-140- 506(c), 68-140-507, 68-140-508, 68-140-508(a) & (b), and 68-140-517.
• Administrative History: Original rule filed March 25, 1987; effective May 9, 1987. Amendment filed March 7, 1989; effective April 21, 1989. Amendment filed March 7, 1994; effective May 21, 1994. Amendment filed January 9, 1997; effective March 25, 1997. Amendment filed November 16, 2005; effective January 30, 2006. Amendment filed December 16, 2005; effective March 1, 2006. Amendment filed April 6, 2010; effective July 5, 2010. Amendments filed January 11, 2013; effective April 11, 2013.

Tenn. Comp. R. & Regs. 1200-12-01-.17 UNETHICAL PRACTICES AND CONDUCT

Emergency medical services and emergency medical services personnel shall be subject to discipline or may be denied authorization for unethical practices or conduct which includes but shall not be limited to the following:

(1) Engaging in acts of dishonesty which relate to the practice of emergency medical care.

(2) Failing to report to appropriate personnel facts known to the individual regarding incompetent, unethical, or illegal practice of any other emergency medical services personnel.

(3) Failing to take appropriate action in safeguarding the patient from incompetent health care practices of emergency medical services personnel.

(4) Violating confidentiality of information or knowledge concerning the patient, except when required to do so by a court of law or authorized regulatory agency.

(5) Engaging in the delivery of emergency medical services on a revoked, suspended, expired, or inactive license, or beyond the scope of a modified or conditioned license.

(6) Accepting and performing, or attempting to perform, professional responsibilities which the licensee knows, or has reason to know, he is not competent to perform.

(7) Delegating, assisting, or advising a person to perform professional responsibilities or procedures when the licensee knows, or has reason to know, that such person is not qualified by training, experience, or license to perform such procedures.

(8) Failing to provide supervision of students in a clinical experience or field internship.

(9) Exercising influence on a patient in such a manner as to exploit the patient for financial gain of the licensee or a third party, which shall include, but not be limited to, the promoting or selling of services, goods, appliances, or drugs.

(10) Disseminating any written materials within an emergency medical services relationship, including those of a religious or political nature, which do not pertain to patient care, insurance reimbursement, support or follow-up services.

(11) Exercising influence within an emergency medical services relationship for the purposes of engaging a patient in any sexual activity, or indecently exposing oneself to a patient.

(12) Willfully failing to file a report or record required by state or federal law, or willfully impeding or obstructing such filing, or inducing another person or licensee to do so.

(13) Providing false information to regulatory officials in inspection reports regarding defective or faulty equipment, or willfully concealing known deficiencies during an inspection.

(14) Misrepresentation of the level of services provided and/or false or misleading advertising.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-140-502, 68-140-504, 68-140-505, 68-140-506, 68-140-507, 68-140-508, 68-140-509, and 68-140-511.
• Administrative History: Original rule filed June 5, 1998; effective August 19, 1998.

Tenn. Comp. R. & Regs. 1200-12-01-.18 EMERGENCY MEDICAL DISPATCHER STANDARDS

(1) Definitions - The terms used in this rule shall be defined as follows:

(a) Department - The Tennessee Department of Health, Division of Emergency Medical Services.

(b) Emergency Medical Dispatcher (EMD) - An individual certified by the Department as having successfully completed a Department-approved Emergency Medical Dispatch Course.

(c) Emergency Medical Dispatch Priority Reference System (EMDPRS) - A Departmentapproved protocol system used by a dispatch agency to dispatch aid to medical emergencies which must include:

1. Systemized caller interrogation questions;

2. Systemized pre-arrival instructions; and 3. Protocols matching the dispatcher’s evaluation of injury or illness severity with vehicle response mode and configuration.

(d) Medical Director - A person approved by the Department who assumes medical leadership for the provision of emergency medical services, including basic and/or advanced life support, and/or medical dispatch services in the dispatch agency’s geographical area.

(e) Pre-Arrival Instructions - Telephone-rendered, medically approved, written instructions given by trained EMDs through callers which help to provide aid to the victim and control of the situation prior to the arrival of pre-hospital personnel. The dispatcher shall adhere to the written wording as closely as possible.

(f) Vehicle Response Mode - The use of emergency driving techniques, such as red-light and siren, versus routine driving response.

(g) Vehicle Response Configuration - The specific vehicle(s) of varied types, capabilities, and numbers responding to render assistance in a particular emergency situation.

(2) Requisites for providing Medical Dispatch Service.

(a) Any dispatching entity receiving and dispatching calls for emergency medical services which provides pre-arrival medical care instructions may require persons assigned to handle such calls to be certified as emergency medical dispatchers as defined in T.C.A. § 68-140-502. All such dispatching entities shall have medically approved dispatch protocols.

(b) The Department shall assist local dispatch agencies in implementing an Emergency Medical Dispatch Priority Reference System by:

1. Providing medical direction; and 2. Providing technical assistance; and 3. Identifying an approved standard Emergency Medical Dispatch Priority Reference System which must include at a minimum caller interrogation questions, pre-arrival instructions, and vehicle response mode/configuration protocols as defined by these Rules.

(c) The EMDPRS including its questions, instructions, and protocols, shall be used exactly as approved by the Department.

(d) Dispatch agencies shall provide for medical dispatch quality assurance by initiating an ongoing medical call review procedure and a quality assurance program as established by the agency’s Medical Director.

(3) Emergency Medical Dispatcher Curriculum.

(a) All Emergency Medical Dispatch training program curricula shall be approved by the Department based on an approved checklist of required basic components and elements as approved by the EMS Board.

(b) Any curriculum submitted for approval shall conform to the guidelines of the National Association of EMS Physician’s (Position Paper on Emergency Medical Dispatching) and ASTMF 1258-90 (Standard Practice for Emergency Medical Dispatch) and/or its successor standards as a minimum.

(c) The length of the course shall be a minimum of 24 hours.

(4) Personnel Standards.

(a) Certification - The Department shall develop, establish, or approve an Emergency Medical Dispatch certification and re-certification program. To be initially certified as an EMD, an individual shall:

1. Successfully complete a Department-approved EMD Course; and 2. Maintain proficiency in cardiopulmonary resuscitation for basic life support procedures; and 3. Successfully pass an exam given through an approved dispatch organization that has pre-qualified for testing; or submit proof of having successfully certified as an EMD through an approved medical dispatch organization that has prequalified for certification reciprocity.

2. An applicant shall cause to be submitted to the administrative office of the Division of Emergency Medical Services, directly from the vendor identified in the Division’s certification application materials, the result of a criminal background check.

(b) Recertification - Recertification is required every two (2) years to maintain Department certification. To recertify an EMD shall:

1. Submit to the Department a completed application form provided by the Department; and 2. Maintain proficiency in cardiopulmonary resuscitation for basic life support procedures; and 3. Meet one of the following:

(i) Complete ten hours or 1.0 continuing education unit (CEU) of Departmentapproved continuing medical dispatch education or in-service during the 2year recertification period; or (ii) Successfully complete an examination given through an approved medical dispatch organization that has qualified for recertification testing; or, (iii) Submit proof of having successfully recertified as an EMD through an approved medical dispatch organization that has qualified for recertification reciprocity (c) Reciprocal certification - Reciprocity for applicants certified outside Tennessee may be granted by the Department based on the following considerations:

1. Applicants shall provide to the Department a current copy of their Emergency Medical Dispatcher certification; and 2. Applicants shall provide to the Department proof that the certifying course meets the standards established by the Department or shall provide the Department the curriculum; and 3. Applicants shall successfully complete the Department written examination; and 4. Applicants shall meet all Department certification requirements demonstrating proof that the applicant has certified in a State having current certification reciprocity with the Department.

(d) Certification and Recertification for the Handicapped - These rules shall not preclude any physically handicapped individual from certifying or recertifying who can demonstrate proficiency in verbally describing the treatment methods outlined in the Department approved EMD course and/or CPR course to a caller.

(e) Lapsed certification - Individuals who permit their certification to lapse may be recertified by completion of the recertification requirement.

(f) Instructor Standards - Instructors who teach Emergency Medical Dispatchers shall meet training and certification standards established by the Department.

(5) Proscribed Acts for Emergency Medical Dispatchers - The Department may refuse to issue a certification or recertification, or suspend or revoke a certification for any of the causes listed in T.C.A. § 68-140-511.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-140-203, 68-140-204, 68-140-502, 68-140-504, 68-140-505, 68-140-506, 68-140-508, 68-140-511, 68-140-513, and 68-140-525.
• Administrative History: Original rule filed January 7, 1997; effective March 23, 1997. Amendment filed April 13, 2006; effective June 27, 2006. Amendments filed August 18, 2009; effective November 16, 2009.

Tenn. Comp. R. & Regs. 1200-12-01-.19 AUTOMATED EXTERNAL DEFIBRILLATOR PROGRAMS

(1) Each entity shall submit a written notice to the local primary emergency medical services provider or emergency communications district that provides the following information:

(a) The name of the entity, the owner of the AED, and a contact person and an alternate with telephone numbers, and mailing address of the placement facility;

(b) The street location and site within the facility where the AED shall be placed, means to access the AED, hours during the day when the AED may be available, and whether the AED may be used off-site;

(c) Description of the AED by manufacturer and model;

(d) Listing of the area emergency medical services and contact information for the EMS agency and emergency communications district;

(e) The name and contact information of the physician supervising the AED placement; and, (f) How the use of the AED is coordinated with the local EMS system.

(2) Each entity shall maintain and submit a copy of a written AED plan to the local primary emergency medical services provider or emergency communications district that includes:

(a) Designation of the training programs adopted by the entity to prepare expected users;

(b) A list of individuals appropriately trained and authorized;

(c) A plan of action for proper use of the AED;

(d) Registration with local emergency medical services with acknowledgement by their representatives of the AED placement, plan, and program;

(e) Description of how the AED program coordinates with EMS and the dispatching entity;

(f) Maintenance and testing procedures necessary to maintain the device, as well as sample forms to document proper maintenance; and, (g) Reports that shall be made of AED use along with other records to be maintained by the program.

(3) Each entity shall complete a report of the use of an AED and submit a copy to the responding EMS agency and the supervising physician to document the following:

(a) Time of use or deployment of the device;

(b) The model of AED used;

(c) Names of the AED responders;

(d) Patient information, when known, to include name, age, race, and gender of the patient;

(e) Condition of the patient upon arrival of AED responders and resuscitative actions taken;

(f) Condition of the patient upon arrival of EMS; and, (g) Patient outcome.

(4) Each placement of an AED shall be supervised and endorsed by a physician with an unrestricted license to practice medicine or osteopathy in Tennessee.

(5) Each automated external defibrillator shall comply with the provisions of T.C.A. § 68-140-710 and shall perform the following capabilities:

(a) Analyze heart rhythm and deliver electrical impulses (countershocks) for at least thirty (30) minutes after deployment;

(b) Deliver visual or audible warnings of low battery power;

(c) Provide an audible or visual warning of loose connections of the electrodes; and (d) Incorporate an internal event record providing the time of activation, times of rhythm analysis, and times of delivery of countershocks.

(6) The following training programs in cardiopulmonary resuscitation and AED use are consistent with the scientific guidelines of the American Heart Association and have been approved by the Tennessee Emergency Medical Services Board.

(a) Heartsaver AED and Basic Life Support for Healthcare Professional CPR and AED Courses of the American Heart Association (b) Advanced Cardiac Life Support Course of the American Heart Association (for Healthcare professionals in conjunction with Basic Life Support for Healthcare Providers)

(c) Workplace First Aid and Safety; Adult CPR/AED Training Course of the American Red Cross (d) AED Training Course of the American Red Cross (in conjunction with Adult and Professional Rescuer CPR courses)

(e) AED Course of the National Safety Council (in conjunction with AHA, NSC, or ARC Adult CPR Courses)

(f) Heartsaver FACTS Course of the National Safety Council or American Heart Association;

(g) Medic First Aid family of programs for Basic Life Support for Professionals and AED Training by EMP International, Inc.

(h) American Safety and Health Institute programs for Basic CPR and AED education and training.

(i) Coyne First Aid CPR and AED training program.

History

• Authority: T.C.A. §§ 4-5-202, 68-140-504, 68-140-505, and 68-140-705.
• Administrative History: Original rule filed January 24, 2002; effective April 9, 2002. Amendment filed August 15, 2005; effective October 29, 2005.

Tenn. Comp. R. & Regs. 1200-12-01-.20 TRAINING FOR EMERGENCY MEDICAL SERVICES FOR CHILDREN

Training programs for emergency medical care for children shall be provided as follows (1) Within twenty-four (24) months of the effective date of this rule, each EMT-Paramedic shall demonstrate capability of recognizing and managing overt shock and respiratory failures and stabilizing pediatric trauma patients, including recognition and stabilization of problems that may lead to shock and respiratory failure in children. Successful completion of courses, such as the Pediatric Education for Prehospital Professionals, EMS-C/Pediatric Advanced Life Support (American Heart Association courses), or Emergency Nursing Pediatric Courses, can be utilized to demonstrate this clinical capability.

(2) Each service shall ensure that licensed EMS personnel employed by the service receive a minimum of one and one half (1.5) hours of pediatric emergency medical care refresher training each year. Attendance in courses or subjects from the Pediatric Education for Prehospital Professionals, EMS-C/Pediatric Advanced Life Support, Neonatal Resuscitation Program (American Heart Association courses), Emergency Nursing Pediatric Courses, or other programs approved by the Board may be credited to fulfill this requirement. Such inservice shall follow and shall be in addition to the initial completion of a pediatric emergency care training program by EMT-Paramedics, or by other EMS personnel appropriate to their level of licensure.

(3) All accredited EMT and EMT-Paramedic training programs shall offer and provide pediatric emergency care training, including courses in pediatric advanced life support and trauma care. Such programs shall be offered subject to demand and enrollment, but at least annually.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-140-504, 68-140-509, and 68-140-521.
• Administrative History: Original rule filed November 15, 2002; effective January 29, 2003.

Tenn. Comp. R. & Regs. 1200-12-01-.21 DESTINATION DETERMINATION

Sick or injured persons who are in need of transport to a health care facility by a ground or air ambulance requiring licensure by the State of Tennessee should be transported according to these destination rules.

(1) Trauma patients - The goal of the pre-hospital component of the trauma system and destination guidelines is to minimize injury through safe and rapid transport of the injured patient. The patient should be taken directly to the center most appropriately equipped and staffed to handle the patient’s injury as defined by the region’s trauma system. These destinations should be clearly identified and understood by regional prehospital personnel and should be determined by triage protocols or by direct medical direction. Ambulances should bypass those facilities not identified by the region’s trauma system as appropriate destinations, even if they are closest to the incident.

(2) Beginning no later than six (6) months after the designation of a trauma center in any region, persons in that region, who are in need of transport who have been involved in a traumatic incident and who are suffering from trauma or a traumatic injury as a result thereof as determined by triage at the scene, should be transported according to the following rules.

(a) Adult (greater than or equal to fifteen (15) years of age) and Pediatric (less than fifteen (15) years of age) Trauma Patients will be triaged and transported according to the flow chart labeled “Field Triage Decision Scheme” in “Resources For Optimal Care of the Injured Patient: 1999,” or any successor publication. The Pediatric Trauma Score shall be used as published in “Basic Trauma Life Support for Paramedics and Other Advanced EMS Providers,” Fourth Edition, 2000. Copies of the charts are available from the Division.

1. Step One and Step Two patients should go to a Level 1 Trauma Center or Comprehensive Regional Pediatric Center (CRPC), either initially or after stabilization at another facility. EMS field personnel may initiate air ambulance response.

2. Step One or Step Two pediatric patients should be transported to a Comprehensive Regional Pediatric Center (CRPC) or to an adult Level 1 Trauma Center if no CRPC is available. Local Destination Guidelines should assure that in regions with two CRPC’s or one CRPC and another facility with Level 1 Adult Trauma capability, that seriously injured children are cared for in the facility most appropriate for their injuries.

3. For pediatric patients, a Pediatric Trauma Score of less than or equal to 8 (<8) will be considered as a cutoff level for Step One patients.

4. Local or Regional Trauma Medical Control may establish criteria to allow for nontransport of clearly uninjured patients.

5. Trauma MedicallControl will determine patient destinations within thirty (30) minutes by ground transport of a Level 1 Trauma Center or CRPC.

(b) Exceptions apply in the following circumstances:

1. For ground ambulances, when transport to a Level I Trauma Center will exceed thirty (30) minutes, Trauma Medical Control will determine the patient’s destination. If Trauma Medical Control is not available, the patient should be transported to the closest appropriate medical facility.

2. For air ambulances, Step One patients will be transported to the most rapidly accessible Level I Trauma Center, taking safety and operational issues into consideration. Step Two, Three, and Four patients will be transported to a Level I Trauma Center as determined by the air ambulance’s Medical Control. The Flight Crew will make determination of patient status on arrival of the air ambulance.

3. Air ambulances will not transport chemical or radiation contaminated patients prior to decontamination.

4. If the Trauma Center chosen as the patient’s destination is overloaded and cannot treat the patient, Trauma Medical Control shall determine the patient’s destination. If Trauma Medical Control is not available, the patient’s destination shall be determined pursuant to regional or local destination guidelines.

5. A transport may be diverted from the original destination:

(i) If a patient’s condition becomes unmanageable or exceeds the capabilities of the transporting unit; or (ii) If Trauma Medical Control deems that transport to a Level I Trauma Center is not necessary.

(c) Utilization of any of the exceptions listed above should prompt review of that transport by the quality improvement process and the medical director of the individual EMS providers.

(d) Trauma Medical Control can be accomplished by a Trauma or Emergency Physician on duty at a designated Trauma Center or by protocols established in conjunction with a Regional Level I Trauma Center.

(3) Pediatric Medical Emergency - Pediatric patients represent a unique patient population with special care requirements in illness and injury. Tennessee has a comprehensive destination system for emergency care facilities in regards to pediatric patients where there are variable levels of available care, as defined in Rule 1200-08-30-.01.

(a) There are circumstances in pediatric emergency care as determined by local medical control where it would be appropriate to bypass a basic or a primary care facility for a general or comprehensive regional pediatric center.

1. Examples of such circumstances include, but are not limited to the following (i) On-going seizures (ii) A poorly responsive infant or lethargic child (iii) Cardiac arrest (iv) Significant toxic ingestion history (v) Progressive respiratory distress (cyanosis)

(vi) Massive gastrointestinal (GI) bleed (vii) Life threatening dysrhythmias (viii) Compromised airway (ix) Signs or symptoms of shock (x) Severe respiratory distress (xi) Respiratory arrest (xii) Febrile infant less than two months of age.

2. Pediatric medical emergency transport may be diverted from the original destination if the patient’s condition becomes unmanageable or exceeds the capability of the transporting unit, in which case the patient should be treated at the closest facility.

3. Pediatric medical emergency air ambulance transports must go to a Comprehensive Regional Pediatric Center.

(b) Pediatric trauma patients should be taken to trauma facilities as provided in paragraph (2).

(4) Any patient who does not qualify for transport to a Trauma Center or a Comprehensive Regional Pediatric Center should be transported to the most appropriate facility in accordance with regional or local destination guidelines.

(5) Adults or children with specialized healthcare needs beyond those already addressed should have their destination determined by Medical or Trauma Control, by regional or local guidelines, or by previous arrangement on the part of patient (or his/her family or physician).

(6) A transport may be refused or an alternate destination requested. If so, non-transport of the patient, or transport of the patient to an alternate destination shall not violate this rule and shall not constitute refusal of care.

History

• Authority: T.C.A. §§ 4-5-202, 68-140-504, 68-140-505, 68-140-509, and 68-140-521.
• Administrative History: Original rule filed October 15, 2002; effective December 29, 2002.

Tenn. Comp. R. & Regs. 1200-12-01-.22 PAY SUPPLEMENT FOR IN-SERVICE TRAINING

(1) Definitions. As used in Tenn. Comp. R. and Regs. 1200-12-01-.22, the following terms have the following meanings:

(a) Licensed Tennessee Ambulance Service - The same as “Ambulance Service” defined at Tenn. Code Ann. Section 68-140-302(2).

(b) Board - Board of Emergency Medical Services.

(c) Department - The Tennessee Department of Health, Office of Emergency Medical Services.

(d) Emergency Medical Services Personnel (“EMS Personnel”) - Any person licensed or certified by the Board as an emergency medical responder, an emergency medical technician, an advanced emergency medical technician, or a paramedic.

(e) Full-Time Employment - Employment by a licensed Tennessee ambulance service licensed by the Board, for a minimum of thirty (30) hours of service per week or sixty (60) hours biweekly.

(f) In-Service Training Course - At least forty (40) hours of in-service training at a training center commensurate to the licensure classification of the EMS personnel, as defined in 1200-12-.01-.22(1)(d).

(g) Training Center - An eligible EMS educational program approved by the Department.

(h) Agency or Group - The professional associations, training programs, internal training programs, education institutions, ambulance service and/or conferences that are approved to provide the forty (40) hours of in-service training.

(2) In-Service Training Course Eligibility.

(a) Pursuant to Tenn. Code Ann. Section 68-140-335, to be eligible for the training pay supplement, a licensed Tennessee ambulance service must submit to the Department the Board-approved roster listing all eligible personnel for the training pay supplement within thirty (30) days upon request of the Department. The Department shall make requests for rosters at least twice each calendar year. The agency or group’s submission is subject to audit at the State’s request.

(b) To be eligible for the training pay supplement, training must occur on or after January 1, 2024.

(c) Credit for attendance at an in-service-training course shall not be awarded until the Department approves the course. The Department shall approve the in-service-training course as either 1. Live; or 2. As an online program with live face-to-face interaction.

(d) The forty (40) hours of training must include routine functions in the practice of emergency medical services.

(e) Instructors shall be authorized by the Department and qualified through academic preparation, training, and experience to teach the courses or topics to which they are assigned in the curriculum. Instructors shall not teach themselves. However, instructors of in-service training courses shall receive one (1) hour credit toward the forty (40) hour total of in-service hours for each hour taught provided that the teaching shall not consist of the use of electronic media exclusively and shall require the instructor to interact with the attendees of the class to obtain credit.

(f) The licensed Tennessee ambulance service providing the training and/or validating the eligible personnel shall be the custodian of record for all training and attendance for a minimum of five (5) years from the date of completion of the course.

(3) Qualifications of Satisfactory Completion.

(a) Proof of satisfactory completion, of the training program by the EMS personnel for each class, course, or component towards the forty (40) hour training pay supplement shall be a certificate of completion.

(b) Satisfactory completion is achieved once the agency or group provides proof of completion to the licensed Tennessee ambulance service. The licensed Tennessee ambulance service shall notify the Department within thirty (30) days of the Department’s request. The agency or group’s notification is subject to audit at the State’s request.

(c) Forty (40) hours of training must be completed within the scope of practice of the EMS personnel at their current level of licensure or certification. EMS personnel who are enrolled in an education training program for a higher tier of license are eligible to take training courses which count toward the forty (40) hour requirement in both the current license level and/or the license tier for which the EMS personnel is training to achieve.

(d) Continuing education hours obtained as a result of disciplinary action, are ineligible to be counted towards the forty-hour satisfactory completion requirement.

(4) Reimbursement Procedures.

(a) The training pay supplement shall be based on the availability of funds appropriated by the General Assembly.

(b) Payment will be made by the Department or other state government agency after demonstration of successful completion of forty (40) hours of training to the Department. Payment will not be advanced or furnished in anticipation of completing forty (40) hours of training.

(c) To receive a training pay supplement from the Department or other state government agency, which is issued to qualifying EMS personnel by the Tennessee licensed ambulance service, a licensed Tennessee ambulance service shall register as a supplier with the State of Tennessee.

(d) To begin the registration process, a licensed Tennessee ambulance service must register as a Supplier within the State of Tennessee’s EDISON software platform at https://hub.edison.tn.gov/psp/paprd/EMPLOYEE/EMPL/h/?tab=PAPP_GUEST under the “Supplier Portal Home Page” tab (“website”) and complete the registration procedures by submitting all required information and documents as expressed on the website.

(e) Once a completed registration is processed, the State of Tennessee shall issue a Supplier ID to the licensed Tennessee ambulance service.

(f) A training pay supplement distribution shall only occur after the licensed Tennessee ambulance service receives a Supplier ID through the registration process and submits proof of completion and their Supplier ID to the Department.

(g) Payment shall be made by the Department, or other state government agency, biannually in batches directly to the licensed Tennessee ambulance service. The Department shall process a proof of completion received by June 30 in the first batch of distributions and by December 31 in the second batch of distributions. The date of receipt of the proof of completion by the Department determines whether a distribution shall be processed in the first batch or second batch.

(h) To remain eligible for a training pay supplement distribution, EMS personnel must be a full-time employee of a Tennessee licensed ambulance service at the time the biannual batch period closes (i) If an eligible individual is separated from the licensed Tennessee ambulance service for any of the following reasons, after becoming qualified, the EMS licensee will be considered as having met the December 31 requirements if the licensee:

1. Becomes eligible and accepts a service retirement and begins drawing retirement benefits;

2. Becomes eligible and accepts a disability retirement; or 3. Dies while employed by the qualifying ambulance service.

(j) The licensed Tennessee ambulance service that awards the training pay supplement shall be responsible for withholding any and all tax and other federal withholding requirements and for the payment of other applicable taxes of the training pay supplement.

(k) The balance of the training pay supplement shall be distributed to qualifying EMS personnel within thirty (30) calendar days or the next appropriate pay cycle after disbursement to the licensed Tennessee ambulance service.

(l) The licensed Tennessee ambulance service receiving the funds shall be responsible for any increase in the employer’s contribution to social security or like programs necessitated by the increase in the employee’s annual base earnings.

(m) EMS personnel shall not be eligible for the training pay supplement from more than one (1) licensed Tennessee ambulance service in a calendar year.

(5) Military Service Member EMS Personnel.

(a) EMS personnel who qualify under Tenn. Code Ann. Section 68-140-335 are eligible to receive the training pay supplement.

(6) Audit Procedures.

(a) All accounts shall be subject to audit by the State Comptroller.

(b) All records pertaining to and generated for the pay supplement for in-service training shall be made available for inspection to a member of the Department and shall be stored for five (5) years by the licensed Tennessee ambulance service after the pay supplement was issued.

(c) All licensed Tennessee ambulance services that submit EMS personnel for receipt of the training pay supplement, are subject to annual, random audit by the Department.

(d) All EMS personnel, who received the training pay supplement, are subject to annual, random audit by the Department.

(7) Disciplinary Action and Prosecution of False Claims.

(a) To guard against the misuse of State funds, Tennessee licensed ambulance services shall report to the Department and the Attorney General’s Office within ten (10) days of discovery any fraudulent conduct or false representation in connection with the completion of training requirements committed by any EMS personnel in order to unjustly obtain the training pay supplement.

(b) The Board recognizes the possibility of inadvertent mistakes involved in record keeping. The Board shall seek immediate reimbursement of such funds erroneously paid to the licensed Tennessee ambulance service. If such reimbursement is not immediately forthcoming, the Department, in conjunction with the Office of General Counsel, shall commence legal action accordingly.

(c) The training pay supplement is subject to Tenn. Code Ann. Section 66-29-101. If the training supplement is designated for a dormancy period, licensed Tennessee ambulance service in possession of a training pay supplement would be responsible for following the due diligence and reporting requirements as required by law designated at https://treasury.tn.gov/Unclaimed-Property/Report-Unclaimed-Property/Submit-Your- Report-Online.

(d) The Board may revoke, modify, suspend or condition the license of any licensed Tennessee ambulance service and/or EMS personnel, if it finds, after appropriate notice and hearing, that:

1. The requirements for the training pay supplement had not been met as pursuant to this rule but certified to the Department as complete; or 2. Any fraud, collusion, misrepresentation or substantial mistake was involved in the procurement of training pay supplement.

History

• Authority: T.C.A. §§ 68-140-304 and 68-140-335.
• Administrative History: Emergency rule filed April 9, 2024; effective through October 6, 2024. Emergency rule expired effective October 7, 2024, and the rule reverted to its previous status. New rule filed March 25, 2026; effective June 23, 2026.

Chapter 1200-12-02 Disasters, Emergencies and Mass Casualty Events

Tenn. Comp. R. & Regs. 1200-12-02-.01 INTRODUCTION

(1) During the response to emergency situations such as those precipitated by a terrorist event, emergency responders or persons may encounter patients or suffer self-exposure to toxic chemical agents requiring the immediate administration of antidotes or medications to preserve and sustain life and vital functions. Upon the exposure to a significant risk, this rule authorizes emergency treatment by use of autoinjection or intramuscular injection of such antidotes or medications as shall be approved by the Board or the State Medical Officer.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-204, 68-140-503, 68-140-504, 68-140-509, and 68-140-510.
• Administrative History: Original rule filed January 4, 2005; effective March 20, 2005.

Tenn. Comp. R. & Regs. 1200-12-02-.02 DEFINITIONS

Within the meaning of this rule:

(1) “Emergency responder” – Emergency responder means emergency medical technicians, paramedics, fire fighters, emergency medical first response workers, law enforcement and other public safety officials or volunteers making an authorized response or rendering emergency care at the scene of an emergency.

(2) “Exposure” – Exposure means the presence of an injurious agent in such circumstances that life threatening symptoms may reasonably be anticipated, and that such situations impose an immediate threat to life.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-204, 68-140-503, 68-140-504, 68-140-509, and 68-140-510.
• Administrative History: Original rule filed January 4, 2005; effective March 20, 2005.

Tenn. Comp. R. & Regs. 1200-12-02-.03 PROCEDURES

(1) EMS personnel or emergency responders may utilize or administer the antidotes or medications upon the availability of antidote kits or means to administer antidotes or other medications approved for intramuscular injection or autoinjection by the Board or the Commissioner of Health.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-204, 68-140-503, 68-140-504, 68-140-509, and 68-140-510.
• Administrative History: Original rule filed January 4, 2005; effective March 20, 2005. DISASTERS, EMERGENCIES AND MASS CASUALTY EVENTS 1200-12-02

Tenn. Comp. R. & Regs. 1200-12-02-.04 REPORTS

(1) Upon the administration of such antidotes or medication by autoinjection or intramuscular injection during an emergency situation, the time and use of such antidotes or medications shall be reported to the appropriate medical personnel assuming care for the patient.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-204, 68-140-503, 68-140-504, 68-140-509, and 68-140-510.
• Administrative History: Original rule filed January 4, 2005; effective March 20, 2005.

Tenn. Comp. R. & Regs. 1200-12-02-.05 NOTIFICATION

(1) Upon a situation or event involving suspected chemical agents or other toxic substances responding personnel shall immediately notify an emergency dispatch center and inform appropriate public safety and health officials.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-204, 68-140-503, 68-140-504, 68-140-509, and 68-140-510.
• Administrative History: Original rule filed January 4, 2005; effective March 20, 2005.

Tenn. Comp. R. & Regs. 1200-12-02-.06 IMMUNIZATIONS DURING DECLARED DISASTERS AND EMERGENCIES

(1) Notwithstanding any rule to the contrary, during declared disasters and emergencies under T.C.A. § 58-2-101, et. seq., emergency medical technician-IVs (EMT-IVs), advanced emergency medical technicians (AEMTs), paramedics and critical care paramedics (CCPs) may administer immunizations to the public in vaccination clinics operated by State or local health departments in areas covered by the order(s) declaring the disaster or emergency, subject to the following conditions:

(a) Public health departments shall provide required, "just-in-time" training for vaccination clinics and document successful completion by EMT-IVs, AEMTs, paramedics or CCPs prior to their administering immunizations in the vaccination clinic.

(b) Public health departments shall provide medical direction and control for EMT-IVs, AEMTs, paramedics and CCPs at clinics.

History

• Authority: T.C.A. §§ 68-140-303, 68-140-304, 68-140-309, and 68-140-310.
• Administrative History: Original rule filed April 10, 2014; effective July 9, 2014.

Chapter 1200-12-03 Response Agencies for Cardiac Emergencies

Tenn. Comp. R. & Regs. 1200-12-03-.01 GENERAL RULES

(1) A county, local government or emergency communications district shall coordinate the response of public safety agencies in its jurisdiction for the purpose of deploying automated external defibrillators to victims of sudden cardiac arrest. Such programs shall be coordinated as a part of the emergency medical services system by the local dispatch entity in addition to the dispatch of ambulances and emergency medical first responders. Each emergency services agency that responds when dispatched to cardiac emergencies shall:

(a) Be a state-chartered or legally recognized organization or service sanctioned to perform emergency management, public safety, fire fighting, rescue, ambulance, or medical and health care functions and which provides services twenty-four (24) hours a day, seven (7) days a week.

(b) Provide a responding vehicle equipped with an automated external defibrillator that is appropriately supplied and maintained in accordance with the manufacturer’s standards and in compliance with the provisions of T.C.A Title 68, Chapter 140, Part 7. Such vehicles may display placards or markings indicating that the vehicle is equipped with an automated external defibrillator.

(c) Provide two-way radio communications with all public safety personnel who may respond to such incidents as part of the coordinated community response.

(d) Include on each response team a person who has completed an approved course of instruction in cardiopulmonary resuscitation and the use of an automated external defibrillator, as recognized by the Tennessee Emergency Medical Services Board, or who is certified as an Emergency Medical First Responder, or licensed as an Emergency Medical Technician, EMT- Paramedic, Physician or Registered Nurse in Tennessee.

(e) Maintain medical control of the response program under the direction of a physician licensed to practice medicine in the State of Tennessee.

(2) Each participating entity shall develop and maintain a memorandum of understanding or agreement of coordination within the service area with the primary provider of emergency ambulance services and all responding agencies. Such agreement shall include a roster of response personnel participating in the program, and it shall provide policies and procedures for the following:

(a) Identification of vehicles to be operated in the program, including unit identifiers and the area in which vehicles will be operated;

(b) Restricting the use and dispatch of the participating entity to those emergencies which are reasonably believed to involve sudden cardiac arrests, and ensuring that the participating entity will be the service area’s primary responder in the event of such cardiac emergencies;

November, 2005 (c) Radio communications procedures between response vehicles, dispatch agencies, and emergency medical services;

(d) Coordination of responsibilities of the individual on-scene responders according to their respective levels of training;

(e) Medical direction, protocols and/or standing orders by the authority of the ambulance service medical director;

(f) Exchange and recovery of required minimum equipment and supplies and additional items adopted for local use; and (g) Exchange of patient information, records and reports, and quality assurance procedures.

(3) Each participating entity shall assure that the agencies maintain minimum liability coverage in accordance with the requirements of T.C.A. § 29-20-403 for vehicles used for cardiac emergency response.

(4) Provisions governing a coordinated community response specific to instances involving or reasonably believed to involve sudden cardiac arrest shall in no event violate the terms of rule 1200-12-1-.16, which regulates emergency medical first responders.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-204; 68-140-504, 68-140-506, 68-140-507; 68-140-703, 68-140-704, and 68-140-705.
• Administrative History: Original rule filed September 9, 2005; effective November 23, 2005.

Chapter 1200-12-04 Emergency Medical Technician Or Emergency Medical Technician-Paramedic In Hospital Emergency Services

Tenn. Comp. R. & Regs. 1200-12-04-.01 RESPONSIBILITIES OF THE EMERGENCY MEDICAL TECHNICIAN (EMT) OR

EMERGENCY MEDICAL TECHNICIAN-PARAMEDIC (EMT-P) when providing patient care while functioning in Hospital Emergency Services under nursing supervision.

(1) Emergency Medical Technicians and Emergency Medical Technician-Paramedics shall be permitted to perform extended skills or procedures when such treatment is conducted under authorized medical control and nursing supervision and within the scope of practice as identified in 1200-12-1-.04 Paragraph (3).

(2) All individuals who are employed in this capacity shall demonstrate continued training and competence in order to perform their professional duties.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-140-504, 68-140-508, and 68-140-509.
• Administrative History: Original Rule filed August 25, 2006; effective November 8, 2006.

Tenn. Comp. R. & Regs. 1200-12-04-.02 Each hospital employing an Emergency Medical Technician or EMT-Paramedic in hospital emergency services will maintain evidence of the continued competence of such individuals, including records of any in-service training or continuing education.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-140-504, 68-140-508, and 68-140-509.
• Administrative History: Original Rule filed August 24, 2006; effective November 7, 2006.

Chapter 1200-12-05 Critical Care Paramedic

Tenn. Comp. R. & Regs. 1200-12-05-.01 PREAMBLE: To provide for the on-going care of a critically injured or ill patient during an inter-facility transport and other special situations, the Tennessee Emergency Medical Services Board authorizes endorsement of EMT-Paramedics with additional training to perform special critical care. The Emergency Medical Technician-Paramedic Critical Care shall be a person who is licensed as a Tennessee Emergency Medical Technician Paramedic and has successfully completed a critical care paramedic program recognized by the Division of Emergency Medical Services, Tennessee Department of Health or comparable training and education, and received endorsement from the training institution and the department, and who is licensed to practice advanced emergency medical care upon the order or under the supervision of a physician or authorized registered nurse.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-140-504, 68-140-506, 68-140-508, and 68-140-517.
• Administrative History: Original rule filed August 24, 2006; effective November 7, 2006.

Tenn. Comp. R. & Regs. 1200-12-05-.02 SCOPE OF PRACTICE FOR CRITICAL CARE PARAMEDIC: An experienced Paramedic who has received additional training and possesses the following skills can conduct care for critically ill patients of all ages through the ability to:

(1) Provide patient care during transport and in special situations with such devices as are approved by the EMS Board.

(2) Access existing and manage invasive lines such as but not limited to: Parenteral Internal Central Catheters (PICC), Hickman catheters, Portacaths, central, and arterial lines.

(3) Initiate and manage ventilators.

(4) Manage care of tracheostomy tubes.

(5) Initiate and manage surgical airways and chest tubes.

(6) Provide care for cardiac patients, with but not limited to, cardiac interventions and advanced therapeutic devices.

(7) Perform and interpret 12-lead electrocardiograms.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-140-504, 68-140-506, 68-140-508, and 68-140-517.
• Administrative History: Original rule filed August 24, 2006; effective November 7, 2006. November, 2006

Tenn. Comp. R. & Regs. 1200-12-05-.03 CRITICAL CARE PARAMEDIC REQUIREMENTS

All persons desiring endorsement of their Paramedic license as a Critical Care Paramedic pursuant to T.C.A Title 68,

Chapter 140, Part 5 must comply with the following requirements and standards:

(1) Emergency Medical Technician Paramedic Critical Care Paramedic endorsement requirements:

(a) Must meet all the Emergency Medical Technician Paramedic requirements in 1200-12-1- .04(2) and must be currently licensed as paramedic in good standing in Tennessee and submit an application and fees to the Division for modification of the license by endorsement demonstrating:

1. Successful completion of a Board approved Critical Care Paramedic Program; and, 2. Successful completion with a passing score as established by the Board on an approved endorsement examination.

(i) After the third attempt to complete the exam an individual must show remediation from the critical care program before they may take the examination again.

(ii) After six unsuccessful attempts in less than two years, the individual must repeat the entire training before attempting examination.

(b) Endorsement must be obtained within two years of completion of an approved course.

(2) Individuals completing a Critical Care Paramedic Course prior to effective date of this

rule may make application for endorsement. Individuals must show documentation of completion of a Critical Care Paramedic Course and must complete a qualifying examination as outlined in (1) (a) 2. Individuals will have two (2) years to complete the examination requirements before being required to repeat the course.

(3) Emergency Medical Technician Paramedic Critical Care or such students during training in an approved Critical Care Program may utilize procedures under medical control as identified (above in .02, Scope of Practice).

(4) Continued endorsement is contingent on renewal of Emergency Medical Technician Paramedic license and meeting the following requirements:

(a) Shall demonstrate a minimum of ten (10) additional continuing education contact hours in critical care topics within a two year period in order to perform their professional duties.

(b) Continued competence activities may include but are not limited to continuing education, in-service, and attendance and participation in other approved critical care programs.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-140-504, 68-140-506, 68-140-508, and 68-140-517.
• Administrative History: Original rule filed August 24, 2006; effective November 7, 2006. November, 2006

Tenn. Comp. R. & Regs. 1200-12-05-.04 EMERGENCY MEDICAL TECHNICIAN- PARAMEDIC -CRITICAL CARE

PARAMEDIC TRAINING PROGRAMS.

(1) Definitions. Within this Rule, the following terms shall apply:

(a) Approval: Means the process of training program approval used to assure compliance with the requirements of the Tennessee Emergency Medical Services Board and the policies of the Division of Emergency Medical Services.

(b) Approved Program: Means a training program approved by the Tennessee Emergency Medical Services Board.

(c) Contract or Agreement: Means a written agreement between the training program and the cooperating agency.

(2) All programs offered by facilities, institutions, or agencies desiring to qualify applicants for EMT-P Critical Care endorsement shall conform to the standards approved by the Tennessee Emergency Medical Services Board and such rules as shall be promulgated by the Department.

(a) Purpose of Approval 1. To insure the safety and quality of practice by the Emergency Medical Technician Paramedic - Critical Care (EMT-P CC) by setting standards for each program preparing the critical care provider.

2. To insure graduates of approved programs eligibility for endorsement.

(3) Approval shall be categorized, and awarded or revoked in accordance with the following criteria.

(a) Initial approval is granted a new program that has not been in operation long enough to complete its first class but demonstrates its eligibility for full approval. The program shall be reviewed after one year or when the first students complete the program.

(b) Full approval is granted a program for a period of four (4) years that has met the requirements that are set forth by the EMS Board and the policies of the Division of EMS.

(c) Conditional approval may be accorded a program which has failed to maintain minimum standards and has been notified that it must meet the requirements within a specified time period.

(d) Approval shall be denied or may be revoked or conditioned for failure to comply with the standards established by the board.

(e) Renewal of approval. Renewal for a period of four (4) years shall be based on recommendations of the Division to the Board utilizing surveys, site visits, conferences, review of documentation instructor student ratio, instructor qualifications and related evidence of continuing compliance with the regulations of the Board and policies of the Division. If deficiencies are not November, 2006 corrected within the specified time, and until such action is approved by the board, the program shall not convene a subsequent class.

(4) Philosophy, Purpose, Capabilities and Organization (a) All facilities, institutions, or agencies seeking initial and continuing approval shall have a written statement of the educational philosophy and purpose of the program.

(b) Capabilities. The facilities, institutions, or agencies shall:

1. Maintain liaison with a hospital which is capable of supporting Critical Care Paramedic Clinical training; and, 2. Ensure the financial support, equipment, facilities, and leadership which will provide for a sound educational program; and, 3. Ensure student competency in knowledge and experience and shall endorse participants for eligibility to complete endorsement examinations.

(c) Organization:

1. The facilities, institutions, or agencies shall demonstrate effective organization and shall be administered in ways conducive to the management of training programs.

2. An accurate, comprehensive records system shall be maintained for all phases of the program and shall be available for inspection during survey visits.

(5) Faculty: The faculty shall be experienced in the field area for course content, such as, but not limited to, critical care professionals, attorneys, and Registered Respiratory Therapists.

(6) Medical Director (a) Each program shall have a licensed physician who serves as the medical advisor.

(7) Student admission:

(a) Each student must hold a current license as a Paramedic in Tennessee with a minimum of two years experience as an Advanced Care Provider; and, (b) Must hold current certification in an Advanced Cardiac Life Support, Pediatric Advanced Life Support, and an advanced Trauma Care course.

(8) Training Facilities (a) Classrooms, Laboratories, Offices. Facilities, institutions, or agencies shall provide adequate teaching facilities and laboratories and clinical facilities sufficient for instruction.

(b) Clinical Facilities: The clinical facilities must provide for student learning experiences as identified in the Board approved curriculum.

November, 2006 (9) Curriculum Review: A copy of the complete curriculum, statements of course objectives, copies of course outlines, class schedules, schedules of supervised clinical experience, and teaching plans shall be on file and available for review and inspections by an authorized representative of the EMS Division with other information as follows:

(a) Evidence of student competency in achieving the performance of the educational objectives of the program shall be kept on file.

(b) Procedures for evaluation of teaching effectiveness and instruction shall be established by the program.

(10) Only students from Tennessee approved programs or those who have completed an equivalent curriculum in other states, as determined by the board or the Division shall be eligible for State endorsement.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-140-504, 68-140-506, 68-140-508, and 68-140-517.
• Administrative History: Original rule filed August 24, 2006; effective November 4, 2006. November, 2006

Chapter 1200-12-06 Emergency Medical Services Board Officers and Procedures

Tenn. Comp. R. & Regs. 1200-12-06-.01 RESPONSIBILITIES OF THE BOARD CHAIRPERSON

(1) The Board shall annually elect from its members a Board Chairperson, or at the next board meeting as a vacancy occurs or as a term expires, who shall preside at all Board meetings.

(2) The Chairperson is authorized to call and schedule such meetings as necessary to conduct the business of the Board and to certify the actions of the Board.

(3) In the absence of the duly elected chairperson, the Board may elect a Chairperson pro tem, who may preside over that meeting and certify the actions or orders from that meeting.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-140-503, 68-140-504, 68-140-514, and 68-140-522.
• Administrative History: Original rule filed June 1, 2007; effective August 15, 2007.

Tenn. Comp. R. & Regs. 1200-12-06-.02 PROCEDURES FOR CONTESTED CASES BEFORE THE EMS BOARD

(1) All contested cases before the Board shall be conducted pursuant to the Uniform Rules of Procedure for Hearing Contested Cases Before State Administrative Agencies of the Rules of the Secretary of State as compiled at Chapter 1360-4-1.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-140-503, 68-140-504, 68-140-514, and 68-140-522.
• Administrative History: Original rule filed June 1, 2007; effective August 15, 2007.

Tenn. Comp. R. & Regs. 1200-12-06-.03 PETITIONS FOR RECONSIDERATION AND STAYS

(1) The Board authorizes the member who chaired the Board for a contested case to be the agency member to make the decisions authorized pursuant to rule 1360-4-1-.18 regarding petitions for reconsideration and stays in that case.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-140-503, 68-140-504, 68-140-514, and 68-140-522.
• Administrative History: Original rule filed June 1, 2007; effective August 15, 2007.

Chapter 1200-12-07 Community Paramedicine

Tenn. Comp. R. & Regs. 1200-12-07-.01 PURPOSE

The purpose of mobile integrated healthcare is to focus on patient-centered navigation by integrating existing infrastructure and using emergency care resources more efficiently, and to improve access to primary care for medically underserved populations. As a vital component of mobile integrated healthcare, community paramedics will work with EMS services and other healthcare and social service providers to address specific local problems in the out-of-hospital environment. Community Paramedics are licensed EMS professionals that complete a formal standardized educational program approved by the EMS Board.

The Community Paramedic has demonstrated competence in the provision of health education, monitoring, and services beyond the roles of traditional emergency care and transport and works in conjunction with medical direction.

History

• Authority: T.C.A. §§ 68-140-302, 68-140-304, and 68-140-309.
• Administrative History: Original rules filed December 16, 2019; effective March 15, 2020.

Tenn. Comp. R. & Regs. 1200-12-07-.02 SCOPE OF PRACTICE

A community paramedic is an experienced paramedic who has received additional training through a standardized curriculum, to serve communities more broadly in the areas of, primary care, public health, disease management, prevention and wellness, mental health and oral health. A community paramedic’s scope of practice includes, at a minimum, all basic knowledge and skills of a paramedic as well as the psychomotor skills set identified in the current National EMS Scope of Practice Model and National EMS Education Standards for a Paramedic. Community paramedics are not independent practitioners and must practice under the supervision of an entity with an approved integrated healthcare program. The community paramedic’s duties and scope of services shall be determined by local protocols established by the medical director as defined in 1200-12-07-.03. Community paramedics are subject to the same standards prohibiting unethical practices and conduct as all other emergency medical services personnel as outlined in 1200-12- 01-.17.

History

• Authority: T.C.A. §§ 68-140-302, 68-140-304, and 68-140-309.
• Administrative History: Original rules filed December 16, 2019; effective March 15, 2020.

Tenn. Comp. R. & Regs. 1200-12-07-.03 DEFINITIONS

(1) Definitions. Within these rules, the following terms shall apply:

(a) “Approved Program” means a Community Paramedic training program approved by the Tennessee Emergency Medical Services Board;

March, 2020 2 (b) “Board” means the Tennessee Emergency Medical Services Board;

(c) “Community Paramedic” means an individual who:

1. ls licensed as a paramedic that delivers care in emergency and non-urgent prehospital settings with oversight of a physician;

2. Has received specialized training in physiology, disease processes, injury and illness prevention, and medical system navigation, in addition to general paramedic training; and 3. Meets the requirements for additional endorsement as a community paramedic as established by the Board;

(d) “Community Paramedicine” means the practice by emergency medical services personnel, primarily in an out-of-hospital setting, that may include the provisions of such services as patient evaluation, advice, treatment directed at preventing or improving a particular medical condition, or referrals to other community resources, which may be provided occasionally or at irregular intervals;

(e) “Medical Control” means the instruction, advice, or orders given by a physician in accordance with locally or regionally approved protocols related to the practice of a community paramedic;

(f) “Medical Director” means an individual who has an active, unencumbered license to engage in the practice of medicine pursuant to Title 63, Chapter 6 or Chapter 9, who is knowledgeable of the mobile integrated healthcare program, and provides medical advice, direction, oversight, quality assurance and authorization to the community paramedicine personnel within a board-approved program;

(g) “Mobile integrated health care” (MIHC) means the provision of health care using patientcentered, mobile resources in the out-of-hospital environment under local medical control as part of a community-based team of health and social services providers to include, but not be limited to, home health organizations and community paramedics.

History

• Authority: T.C.A. §§ 68-140-302, 68-140-304, and 68-140-309.
• Administrative History: Original rules filed December 16, 2019; effective March 15, 2020.

Tenn. Comp. R. & Regs. 1200-12-07-.04 COMMUNITY PARAMEDIC APPLICANT REQUIREMENTS

(1) Persons seeking endorsement as Community Paramedics in Tennessee shall:

(a) Comply with all rules governing paramedics under Chapter 1200-12-01;

(b) Hold a current, unencumbered Tennessee paramedic license with at least five years of work experience as a paramedic with an advanced life support EMS service;

(c) Using the prescribed form, complete and submit a Community Paramedic endorsement application accompanied by the Application Fee and Initial Endorsement Fee as outlined in 1200-12-01-.05(4) to the Division;

(d) Complete a Board-approved Community Paramedic Training Program;

(e) Demonstrate specialized training in physiology, disease processes, injury and illness prevention, and medical system navigation, in addition to general paramedic training;

March, 2020 3 (f) Pass a Board-approved Community Paramedic endorsement examination with a passing score as established by the Board, subject to the following:

1. Anyone who fails the examination three (3) times within two (2) years of completing a Board-approved Community Paramedic Training Program must show remediation from such program before they may take the examination again. After showing remediation, each person may take the examination up to three (3) more times within two (2) years of completing a Board-approved Community Paramedic Training Program.

2. Anyone who fails the examination six (6) times within two (2) years of completing a Board-approved Community Paramedic Training Program, or for any reason fails to be endorsed as a Community Paramedic within two (2) years of completing a Board-approved Community Paramedic Training Program, must repeat all of their Community Paramedic training before they may take the examination again;

(g) Cause the result of a criminal background check to be submitted directly from the vendor identified in the Division’s endorsement application materials to the administrative office of the Division. Such criminal background check shall include the sex offender and abuse registries for states in which the prospective student has lived during the previous seven (7) years. Persons whose names appear on either registry are not eligible for Community Paramedic endorsement. Such result shall be valid for one (1) year from the date it is received by the Division;

(2) Persons completing a Community Paramedic Training Program prior to the effective date of these rules may apply for endorsement, pending the rules becoming effective. Applicants must show documentation of completing a Community Paramedic Training Program that meets the Board-approved Community Paramedic curriculum, and must complete the qualifying examination referred to above;

(3) Only graduates of Tennessee Board-approved programs or those who have completed an equivalent curriculum in other states, as determined by the Board or the Division, are eligible for State community paramedic endorsement.

History

• Authority: T.C.A. §§ 68-140-302, 68-140-304, and 68-140-309.
• Administrative History: Original rules filed December 16, 2019; effective March 15, 2020.

Tenn. Comp. R. & Regs. 1200-12-07-.05 ENDORSEMENT RENEWAL, RETIREMENT, REACTIVATION, AND

REINSTATEMENT.

(1) Renewal of a community paramedic endorsement must be obtained every two years and is contingent on meeting the following requirements:

(a) Complying with all rules governing paramedics under Chapter 1200-12-01, including, but not limited to, Rule 1200-12-01-.04(1)(e), which establishes the scope of practice for paramedics and requires that all patient care provided by paramedics be under medical direction;

(b) Having a current, unencumbered paramedic license;

(c) Paying the applicable fees as outlined in 1200-12-07-.05(4); and (d) Obtaining ten (10) continuing education contact hours in mobile integrated healthcare topics within the two-year period preceding renewal of the endorsement. Such hours are required in addition to the continuing education hours required for any other endorsement/license.

March, 2020 4 (2) Retirement of an Endorsement (a) A licensee may retire a community paramedicine endorsement by meeting the requirements found in Rule 1200-12-01-.04(7)(a); and (b) A licensee requesting reactivation of a retired endorsement shall meet the requirements of Rule 1200-12-01-.04(4)(d) and (8), and pay the Reactivation/Reinstatement Fee as outlined in Rule 1200-12-07-.05(4)(d).

(3) Reinstatement of an Expired/Lapsed Endorsement (a) A licensee requesting reinstatement of an expired/lapsed endorsement shall pay the Reactivation/Reinstatement Fee in addition to the renewal fee;

(b) To reinstate an endorsement that has lapsed over sixty (60) days but less than two (2) years, a licensee must meet the requirements found in Rule 1200-12-01-.04(4)(d); and (c) To reinstate an endorsement that has lapsed over two (2) years, a licensee must meet the requirements found in Rule 1200-12-01-.04(4)(d) and must reenroll in and complete a Board-approved community paramedicine training program.

(4) Community Paramedic - Fees for initial endorsement, renewal, reactivation, and reinstatement shall be remitted as follows:

(a) Application and Initial Endorsement Fee $75.00 (b) Renewal Fee $90.00 (c) Late Fee $25.00 (if renewal submitted within sixty (60) days of the date of renewal and renewal requirements were met prior to the renewal date)

(d) Reactivation/Reinstatement Fee $100.00

History

• Authority: T.C.A. §§ 68-140-302, 68-140-304, and 68-140-309.

Tenn. Comp. R. & Regs. 1200-12-07-.06 COMMUNITY PARAMEDIC TRAINING PROGRAMS – REQUIREMENTS FOR

APPROVAL.

(1) In order to be a Board-approved Community Paramedic Training Program, the program shall:

(a) Have a written statement of the educational philosophy and purpose of the program;

(b) Maintain a written agreement with hospitals and/or agencies that are capable of supporting Community Paramedic clinical training;

(c) Have a physician with an unencumbered Tennessee license to practice medicine who serves as medical director;

(d) Ensure that the program’s funding, equipment, facilities and leadership are adequate for a sound educational program;

(e) Ensure that students who complete the program are competent, and support students taking endorsement examinations;

March, 2020 5 (f) Be effectively organized and well-administered;

(g) Utilize faculty that are experienced in the subject matter of the courses they teach, including but not limited to community health, home health, mental health, hospice, and other specialty areas;

(h) Evaluate teacher effectiveness according to criteria established by the program;

(i) Maintain an appropriate instructor/student ratio;

(j) Maintain the following records:

1. A copy of the program’s complete curriculum;

2. Statements of course objectives for each course;

3. Copies of course outlines, class schedules, schedules of supervised clinical experience, and teaching plans;

4. Evidence of student competency in achieving the educational objectives of the program;

(k) Maintain the following student admission requirements:

1. Have five years’ experience as a paramedic with an advanced life support EMS service;

2. Hold an unencumbered paramedic license;

3. Cause a letter of recommendation to be submitted directly from the applicant’s employer to the program. If the applicant is unemployed, the applicant must cause two letters of recommendation to be submitted directly from former employers and/or supervisors to the program. Such letter(s) shall specify the applicant’s title, duties and dates of employment, and shall attest to applicant’s character;

4. Undergo a criminal background check, to be requested by the program, to include the sex offender and abuse registries for states in which the prospective student has lived during the previous seven (7) years. Persons whose name appears on either registry are not eligible for admission to a Board-approved Community Paramedic program;

(l) Comply with the Board-approved standards posted on the educational program section of the Board’s website, as well as any applicable Board rules.

History

• Authority: T.C.A. §§ 68-140-302, 68-140-304, and 68-140-309.
• Administrative History: Original rules filed December 16, 2019; effective March 15, 2020.

Tenn. Comp. R. & Regs. 1200-12-07-.07 COMMUNITY PARAMEDIC TRAINING PROGRAMS – TYPES OF APPROVAL;

RENEWAL.

(1) The Board may approve or deny approval of Community Paramedic training programs as follows:

(a) Initial approval may be granted for a period of one (1) year to a new program that has not been in operation long enough to complete its first class, but has otherwise demonstrated its eligibility for full approval: The program shall be reviewed after one year March, 2020 6 or when its first students complete the program, whichever comes first. A program’s failure to meet the requirements for full approval after such time is grounds for denying full approval;

(b) Full approval may be granted for a period of five (5) years to a program that has met the applicable requirements;

(c) Conditional approval may be granted to a program that has failed to meet the applicable requirements and has been notified that it must meet the requirements within a specified time period.

(2) Renewal of approval shall be made by the Board on the recommendation of the Division, based on surveys, site visits, conferences, a review of documentation, the program’s instructor/student ratio and instructor qualifications, and by compliance with this Chapter.

History

• Authority: T.C.A. §§ 68-140-302, 68-140-304, and 68-140-309.
• Administrative History: Original rules filed December 16, 2019; effective March 15, 2020.

Tenn. Comp. R. & Regs. 1200-12-07-.08 MOBILE INTEGRATED HEALTHCARE PROGRAMS – APPROVAL

(1) Approval (a) An ambulance service or licensed healthcare organization wishing to establish a mobile integrated healthcare program must submit the following to the Division for approval 1. A completed application 2. A letter from the medical director who has agreed to provide medical advice, direction, oversight, quality assurance, and authorization to the community paramedic personnel within an approved program.

(b) MIHC program approval is not transferable or assignable.

(c) In the event that deficiencies are noted after submission of a completed application, the applicant shall submit a plan of corrective action to the Division. Once the deficiencies have been corrected, the Division shall reconsider the application for approval.

(d) Changes of address, insurance agent or policies, program director, other program officials, MIHC medical director, or bankruptcy filings must be reported to the Division no later than five (5) business days after the change or the date of effective action.

(e) A proposed change of ownership, including a change in a controlling interest, must be reported to the Division a minimum of thirty (30) days prior to the change. The new owner must submit a new application to the Division for approval.

History

• Authority: T.C.A. §§ 68-140-302, 68-140-304, and 68-140-309.
• Administrative History: Original rules filed December 16, 2019; effective March 15, 2020.

1200-13 Division of TennCare

Chapter 1200-13-01 TennCare Long-Term Care Programs

Tenn. Comp. R. & Regs. 1200-13-01-.01 PURPOSE

(1) The purpose of this Chapter is to set forth requirements pertaining to the Long-Term Services and Supports (LTSS; formerly and also known as the Long-Term Care or LTC) delivery system.

(2) The Bureau of TennCare (Bureau) offers the following LTSS programs and services. Each of these programs is operated in accordance with the authority granted under the Medicaid State Plan or the applicable Waiver authority granted by CMS, and these rules.

(a) TennCare CHOICES Program (CHOICES). (See Rule 1200-13-01-.05.) This program has two components:

1. NF services.

2. HCBS for the elderly and adults who have Physical Disabilities.

(b) Employment and Community First (ECF) CHOICES (See Rule 1200-13-01-.31.)

(c) Intermediate Care Facility services for persons with Mental Retardation (or pursuant to federal law, Intermediate Care Facility services for the Mentally Retarded) (ICFs/MR).

(See Rule 1200-13-01-.30.)

(d) HCBS waivers for individuals with MR.

1. Statewide MR Waiver. (See Rule 1200-13-01-.25.)

2. Arlington MR Waiver. (See Rule 1200-13-01-.28.)

3. Self-Determination MR Waiver. (See Rule 1200-13-01-.29.)

(e) PACE. This is a program for certain dually eligible Medicare and Medicaid beneficiaries that is offered through the Tennessee Medicaid State Plan, Attachment 3.1-A, #26.

(3) Individuals receiving LTSS shall be enrolled in Managed Care Contractors (MCCs) as follows:

(a) Individuals receiving TennCare-reimbursed LTSS, other than those enrolled in the PACE Program, are also enrolled in a TennCare MCO for primary care, behavioral health services, and acute care services.

(b) In addition to enrollment in an MCO, the following LTSS Enrollees, other than those enrolled in the PACE Program, are enrolled with the TennCare Pharmacy Benefits Manager for coverage of prescription drugs:

1. Children under the age of twenty-one (21); and 2. Adults aged twenty-one (21) and older who are not Medicare beneficiaries.

(c) Children under the age of twenty-one (21) who are LTSS Enrollees are also enrolled with the TennCare Dental Benefits Manager (DBM) for coverage of dental services.

(4) Acronyms. The following are acronyms used throughout this Chapter and the terms they represent:

(a) AAAD – Area Agencies on Aging and Disability (b) ACLF – Assisted Care Living Facility (c) ADL – Activity of Daily Living (d) CBRA – Community-Based Residential Alternative (e) CD – Consumer Direction (f) CEA – Cost Effective Alternative (g) CMS – Centers for Medicare and Medicaid Services (h) DBM – Dental Benefits Manager (i) DD – Developmental Disability(ies)

(j) DIDD – Tennessee Department of Intellectual and Developmental Disabilities (formerly known as Tennessee Department of Finance and Administration’s Division of Intellectual Disabilities Services or DIDS)

(k) DMH – Tennessee Department of Mental Health and Substance Abuse Services (formerly known as the Tennessee Department of Mental Health and Developmental Disabilities)

(l) ECF CHOICES – Employment and Community First CHOICES (m) EPSDT – Early and Periodic Screening, Diagnostic, and Treatment (n) EVV – Electronic Visit Verification (o) F&A – Tennessee Department of Finance and Administration (p) FEA – Fiscal Employer Agent (q) FERP – Federal Estate Recovery Program (r) FFS – Fee-for-Service (s) FPL – Federal Poverty Level (t) HCBS – Home and Community Based Services (u) HH – Home Health (v) I/DD – Intellectual or Developmental Disability(ies)

(w) IADL – Instrumental Activity of Daily Living (x) ICF/IID – Intermediate Care Facility for Individuals with Intellectual Disabilities (formerly and also known as Intermediate Care Facility for persons with Mental Retardation or ICF/MR).

(y) ID – Intellectual Disability(ies) (formerly and also known as MR).

(z) LOC – Level of Care (aa) LTC – Long-Term Care (also known as LTSS)

(bb) LTSS – Long-Term Services and Supports (formerly and also known as LTC)

(cc) MCC – Managed Care Contractor (dd) MCO – Managed Care Organization (ee) MI – Mental Illness (ff) MR – Mental Retardation (also known as ID)

(gg) NF – Nursing Facility (hh) OAA – Operational Administrative Agency (ii) PACE – Program of All-Inclusive Care for the Elderly (jj ) PAE – PreAdmission Evaluation (kk) PASRR – PreAdmission Screening and Resident Review (ll) PBM – Pharmacy Benefits Manager (mm) PCSP – Person-Centered Support Plan (nn) PDN – Private Duty Nursing (oo) PERS – Personal Emergency Response System (pp) PNA – Personal Needs Allowance (qq) POC – Plan of Care (rr) QIT – Qualifying Income Trust (ss) QMRP – Qualified Mental Retardation Professional (tt) SNF – Skilled Nursing Facility (as defined under Medicare)

(uu) SPOE – Single Point of Entry (vv) SSI – Supplemental Security Income (ww) SSI FBR – Supplemental Security Income Federal Benefit Rate (xx) TCAD – Tennessee Commission on Aging and Disability (yy) TPAES – TennCare Pre-Admission Evaluation System (zz) TPL – Third Party Liability

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 71-5-105, 71-5-106, 71-5-109, 71-5-110, 71-5-111, 71-5-112, and 71-5-164; TennCare II/III Section 1115(a) Medicaid Demonstration Waiver Extension; and Executive Order No. 11.
• Administrative History: Original rule filed September 10, 1975; effective October 10, 1975. Repealed and refiled July 13, 1977; effective August 12, 1977. Repealed and refiled November 17, 1977; effective December 19, 1977. Amendment filed August 31, 1981; effective October 15, 1981. Amendment filed June 27, 1984; effective July 27, 1984. Amendment filed February 9, 1987; effective April 9, 1987. Amendment filed May 30, 1989; effective July 14, 1989. Amendment filed November 28, 1990; effective January 12, 1991. Amendment filed February 22, 1991; effective April 9, 1991. Amendment filed September 16, 1991; effective October 31, 1991. Amendment filed September 19, 1991; effective November 3, 1991. Amendment filed January 10, 1992; effective February 24, 1992. Amendment filed May 1, 1992; effective June 15, 1992. Amendment filed October 20, 1999; effective January 3, 2000. Amendment filed June 29, 2000; effective September 12, 2000. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendment filed May 27, 2010; effective August 25, 2010. Amendments filed September 26, 2012; effective December 25, 2012. Amendment filed September 26, 2013; effective December 25, 2013. Emergency rules filed July 1, 2016; effective through December 28, 2016. Amendments filed September 30, 2016; effective December 29, 2016. Emergency rules filed November 20, 2020; effective through May 19, 2021. Amendments filed February 17, 2021; effective May 18, 2021.

Tenn. Comp. R. & Regs. 1200-13-01-.02 . If an exception is granted, the Member’s Expenditure Cap shall be based on the average annualized cost of the comparable level of care in an institution as follows:

I. For an ECF CHOICES Group 6 member who has an intellectual disability and is assessed pursuant to the Level of Need process described in Rule 1200-13-01-.02 to have exceptional medical or behavioral needs, the Member’s Expenditure Cap shall be based on the average annualized cost of services in a private ICF/IID (Intermediate Care Facility for Individuals with Intellectual Disabilities).

II. For an ECF CHOICES Group 6 member who has a developmental disability and is assessed pursuant to the Level of Need process described in Rule 1200-13-01-.02 to have exceptional medical or behavioral needs, the Member’s Expenditure Cap shall be based on the average annualized cost of nursing facility services plus the average annualized cost of specialized services that a person with a developmental disability would be expected to need in a nursing facility. On a case-by-case basis and applicable only to an ECF CHOICES Group 6 member who has a developmental disability and is assessed pursuant to the Level of Need process described in Rule 1200-13-01-.02 to have exceptional medical or behavioral needs, and is receiving Community Living Supports (not Family Model) at the CLS-4 level of reimbursement, this Expenditure Cap may be exceeded when necessary to permit access to Supported Employment Individual Employment Support.

III. The average annualized cost of the comparable level of care in an institution (private ICF/IID or NF) shall be adjusted by TennCare each calendar year.

IV. The average annualized cost of specialized services that a person with a developmental disability would be expected to need in a nursing facility may also be adjusted each calendar year.

V. When an ECF CHOICES Group 6 member has exceptional medical or behavioral needs and has an Expenditure Cap based on the average annualized cost of care in a private ICF/IID or NF plus specialized services in the NF, the cost of any home health or private duty nursing reimbursed by TennCare shall be counted against the Member’s Expenditure Cap.

2. The Expenditure Cap shall be used to determine:

(i) Whether or not an Applicant qualifies to enroll in an ECF CHOICES benefit group (4, 5, or 6);

(ii) Whether or not a Member qualifies to remain enrolled in an ECF CHOICES benefit group (4, 5, or 6);

(iii) The total cost of ECF CHOICES HCBS a Member can receive while enrolled in an ECF CHOICES Benefit Group, excluding only for Members in Group 4 the cost of Minor Home Modifications. The Expenditure Cap functions as a limit on the total cost of ECF CHOICES HCBS, excluding only for Members in Group 4 the cost of Minor Home Modifications, that can be provided by the MCO to the Member in the home or community setting. ECF CHOICES HCBS in excess of a Member’s Expenditure Cap are non-covered benefits.

3. A Member shall not be entitled to receive services up to the amount of the Expenditure Cap. A Member shall receive only those services that are medically necessary (i.e., required in order to help ensure the Member’s health, safety and welfare in the home or community setting and to delay or prevent the need for NF placement). Determination of the services that are needed shall be based on a comprehensive assessment of the Member’s needs and the availability of Natural Supports and other (non-TennCare reimbursed) services to meet identified needs, which shall be conducted by the Member’s Support Coordinator.

4. Application of the Expenditure Cap.

(i) When a Member is enrolled in any ECF CHOICES Group (including transition from another CHOICES or ECF CHOICES Group), the Member’s Expenditure Cap shall be pro-rated for the remainder of that calendar year (i.e., the portion of the calendar year that the Member will actually be enrolled in the ECF CHOICES Group).

(ii) When an ECF CHOICES Group 6 member has exceptional medical or behavioral needs and has an Expenditure Cap based on the average annualized cost of care in a private ICF/IID or NF (plus specialized services in the NF), the cost of any home health or private duty nursing reimbursed by TennCare shall be counted against the Member’s Expenditure Cap.

(iii) Except as specified in Rule 1200-13-01-.31(4)(d)1.(iii)(III)V., TennCare services other than ECF CHOICES HCBS shall not be counted against a Member’s Expenditure Cap.

(iv) The annual Expenditure Cap shall be applied on a calendar year basis.

The Bureau and the MCOs will track utilization of ECF CHOICES HCBS excluding only for Members in Group 4 the cost of Minor Home Modifications, across each calendar year.

(v) A Member’s Expenditure Cap must also be applied prospectively on a twelve (12) month basis. This is to ensure that a Member’s PCSP does not establish a threshold level of supports that cannot be sustained over the course of time. This means that, for purposes of person-centered planning, the MCO will always project the total cost of ECF CHOICES HCBS (excluding only for Members in Group 4 the cost of Minor Home Modifications) forward for twelve (12) months in order to determine whether the Member’s needs can continue to be met based on the most current PCSP that has been developed. The cost of one-time services such as short-term services or short-term increases in services must be counted as part of the total cost of ECF CHOICES HCBS for a full twelve (12) month period following the date of service delivery.

(vi) If it can be reasonably anticipated, based on the ECF CHOICES HCBS currently received or determined to be needed (in addition to non- CHOICES HCBS available through TennCare, e.g., home health, services available through Medicare, private insurance or other funding sources, and unpaid supports provided by family members and other caregivers) in order to safely meet the person’s needs in the community, that the person will exceed his Expenditure Cap, then the person does not qualify to enroll in or to remain enrolled in ECF CHOICES.

(vii) Notwithstanding the Expenditure Caps specified herein, a person enrolled in ECF CHOICES shall not be disenrolled, nor shall currently authorized ECF CHOICES HCBS be reduced, if the sole reason the person’s Expenditure Cap would be exceeded is the targeted rate increases in ECF CHOICES HCBS provided via Tennessee’s HCBS Spending Plan under

Section 9817 of the American Rescue Plan Act of 2021.

5. As the setting of an individual’s Expenditure Cap does not, in and of itself, result in any increase or decrease in a Member’s services, notice of action shall not be provided regarding the Bureau’s Expenditure Cap calculation.

(i) A Member has a right to due process regarding his Expenditure Cap when services are denied or reduced, when a determination is made that an Applicant cannot be enrolled into ECF CHOICES, or a currently enrolled ECF CHOICES Member can no longer remain enrolled in ECF CHOICES because his needs cannot be safely and effectively met in the home and community-based setting at a cost that does not exceed his Expenditure Cap.

(ii) When an adverse action is taken, notice of action shall be provided, and the Applicant or Member shall have the right to a fair hearing regarding any valid factual dispute pertaining to such action, which may include, but is not limited to, whether his Expenditure Cap was calculated appropriately, and to present all relevant and material evidence pertaining to such action.

(iii) Denial of or reductions in ECF CHOICES HCBS based on a Member’s Expenditure Cap shall constitute an adverse action, as defined in Rules

Tenn. Comp. R. & Regs. 1200-13-01-.03 NURSING FACILITY (NF) PROVIDER REIMBURSEMENT

See Chapter 1200-13-02.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-205, 4-5-208, 71-5-105, and 71-5-109; Executive Order No. 23; and Public Chapter 358 of the Acts of 1993.
• Administrative History: Original rule filed November 17, 1977; effective December 19, 1977. Amendment filed January 3l, 1979; effective March 16, 1979. Amendment filed August 31, 1981; effective October 15, 1981. Amendment filed November 4, 1981; effective December 21, 1981. Amendment filed September 27, 1982; effective October 27, 1982. Amendment filed February 11, 1983; effective March 14, 1983. Amendment filed May 27, 1983; effective June 27, 1983. Amendment filed June 23, 1983; effective July 25, 1983. Amendment filed February 14, 1984; effective March 15, 1984. Amendment filed March 12, 1984; effective April 11, 1984. Amendment filed June 27, 1984; effective July 27, 1984. Amendment filed June 25, 1984; effective September 11, 1984. Amendment filed September 10, 1985; effective October 10, 1985. Amendment filed November 4, 1985; effective December 4, 1985. Amendment filed November 4, 1985; effective February 12, 1986. Amendment filed April 29, 1986; effective May 29, 1986. Original rule filed July 30, 1987; effective September 13, 1987. Amendment filed September 30, 1987; effective November 14, 1987. Amendment filed January 22, 1988; effective March 7, 1988. Amendment filed September 30, 1988; effective November 14, 1988. Amendment filed October 27, 1988; effective December 11, 1988. Amendment filed November 10, 1988; effective December 25, 1988. Amendment filed December 15, 1988; effective January 29, 1989. Amendment filed May 30, 1989; effective July 14, 1989. Amendment filed July 22, 1989; effective August 4, 1989. Amendment filed August 31, 1989; effective October 15, 1989. Amendment filed November 27, 1989; effective January 11, 1990. Amendment filed January 29, 1990; effective March 15, 1990. Amendment filed March 1, 1990; effective April 15, 1990. Amendment filed November 5, 1990; effective December 20, 1990. Amendment filed January 17, 1991; effective March 3, 1991. Amendment filed January 31, 1991; effective March 17, 1991. Amendment filed February 12, 1991; effective March 29, 1991. Amendment filed February 21, 1991; effective April 7, 1991. Amendment filed February 27, 1991; effective April 13, 1991. Amendment filed June 12, 1991; effective July 27, 1991. Amendment filed September 11, 1991; effective October 26, 1991. Amendment filed September 17, 1991; effective November 1, 1991. Amendment filed October 25, 1991; effective December 9, 1991. Amendment filed November 27, 1991; effective January 11, 1992. Amendment filed March 9, 1992; effective April 23, 1992. Amendment filed March 10, 1992; effective April 24, 1992. Amendment filed March 17, 1992; effective May 1, 1992. Amendment filed April 14, 1992; effective May 29, 1992. Amendment filed April 30, 1992; effective June 14, 1992. Amendment filed May 1, 1992; effective June 15, 1992. Amendment filed December 4, 1992; effective January 19, 1993. Amendment filed November 17, 1993; effective January 31, 1994. Amendment filed December 7, 1993; effective February 20, 1994. Amendment filed March 18, 1994; effective June 1, 1994. Public necessity rule filed July 1, 2005; effective through December 13, 2005. Public necessity rule filed September 26, 2005; effective through March 10, 2006. Amendment filed December 20, 2005; effective March 5, 2006. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendment filed May 27, 2010; effective August 25, 2010. Emergency rules filed July 1, 2016; effective through December 28, 2016. Amendments filed September 30, 2016; effective December 29, 2016. Amendment filed May 1, 2018; effective July 30, 2018.

Tenn. Comp. R. & Regs. 1200-13-01-.04 REPEALED

History

• Authority: T.C.A. §§ 4-5-202 and 71-5-105.
• Administrative History: Original rule filed November 17, 1977; effective December 19, 1977. Amendment filed January 31, 1979; effective March 16, 1979. Amendments filed May 29, 1987; effective July 13, 1987. Amendment filed June 22, 1989; effective August 4, 1989. Amendment filed August 31, 1989; effective October 15, 1989. Repeal filed February 1, 2013; effective July 29, 2013.

Tenn. Comp. R. & Regs. 1200-13-01-.05 TENNCARE CHOICES PROGRAM

(1) Definitions. See Rule 1200-13-01-.02.

(2) Program components. The TennCare CHOICES Program is a managed LTSS program that is administered by the TennCare MCOs under contract with the Bureau. The MCOs are responsible for coordinating all covered physical, behavioral, and LTSS for their Members who qualify for and are enrolled in CHOICES. The program consists of two components:

(a) NF services, as described in this Chapter.

(b) CHOICES HCBS, as described in this Chapter.

(3) Eligibility for CHOICES.

(a) There are three (3) groups in TennCare CHOICES:

1. CHOICES Group 1. Participation in CHOICES Group 1 is limited to TennCare Members of all ages who qualify for and are receiving TennCare-reimbursed NF services. Eligibility for TennCare-reimbursed LTSS is determined by DHS.

Medical (or LOC) eligibility is determined by the Bureau as specified in Rule

Tenn. Comp. R. & Regs. 1200-13-01-.06 SPECIAL FEDERAL REQUIREMENTS PERTAINING TO NURSING FACILITIES

(1) Anti-discrimination.

No Medicaid-reimbursed resident of a NF shall, on the ground of race, color, or national origin be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination by any such facility.

(a) A NF may not directly or through contractual or other arrangements, on ground of race, color, or national origin:

1. Deny a Medicaid-reimbursed resident any service or benefit provided under the program.

2. Provide any service or benefit to a Medicaid-reimbursed resident which is different, or is provided in a different manner, from that provided to others under the program.

3. Subject a Medicaid-reimbursed resident to segregation or separate treatment in any matter related to the receipt of any service or benefit under the program.

4. Restrict a Medicaid-reimbursed resident in any way in the enjoyment of any advantage or privilege enjoyed by others receiving any service or benefit under the program.

5. Treat a Medicaid-reimbursed resident differently from others in determining whether he satisfies any admission, enrollment, quota, eligibility, membership or other requirement or condition which the resident must meet in order to be provided any service or benefit provided under the program.

(b) A NF, in determining the types of services, or benefits which will be provided under any such program, or the Medicaid-reimbursed resident to whom, or the situations in which, such services or benefits will be provided under the program, or the Medicaidreimbursed resident to be afforded an opportunity to participate in the program, may not, directly or through contractual or other arrangements, utilize criteria or methods of administration which have the effect of subjecting those residents to discrimination because of their race, color, or national origin, or have the effect of defeating or substantially impairing accomplishments of the objective of the program with respect to those residents of a particular race, color, or national origin.

(c) As used in this rule, the services or benefits provided by a NF shall be deemed to include any service, or benefit provided in or through a facility participating in this program.

(d) The enumeration of specific forms of prohibited discrimination in this rule does not limit the generality of the prohibition in this rule.

(e) When a NF has previously discriminated against persons on the ground of race, color, or national origin, the facility must take affirmative action to overcome the effects of prior discrimination.

(f) Even in the absence of such prior discrimination, a facility may take affirmative action to overcome the effects of conditions which resulted in limiting participation by persons of a particular race, color, or national origin.

(2) Admissions, transfers, and discharges from NFs.

(a) All NFs shall establish written policies and procedures addressing admission, transfer and discharge, consistent with these rules. These policies and procedures shall be available for inspection by the state.

(b) A NF that has entered into a provider agreement with the Bureau of TennCare or an MCO shall admit individuals on a first come, first served basis, except as otherwise permitted by state and federal laws and regulations.

(c) NFs participating in the Medicaid Program shall not as a condition of admission to or continued stay at the facility request or require:

1. Transfer or discharge of a Medicaid-eligible resident because Medicaid has been or becomes the resident’s source of payment for long-term care.

2. Payment of an amount from a Medicaid-eligible resident in excess of the amount of Patient Liability determined by DHS.

3. Payment in excess of the amount of Patient Liability determined by DHS from any resident who is financially eligible for medical assistance but who has not submitted a PAE for consideration or whose appeal rights for a denied PAE have not been exhausted.

4. Any person to forego his or her right to Title XIX Medical Assistance benefits for any period of time.

5. A third party (i.e. responsible party) signature, except as required of a court appointed legal guardian or conservator, or require payment of any kind by a third party on behalf of a Medicaid Eligible individual.

(d) NFs participating in the Medicaid Program must comply with the following guidelines regarding transfers, discharges and/or readmissions.

1. Transfer and Discharge Rights.

(i) A NF must permit each resident to remain in the facility and must not transfer or discharge the resident from the facility unless:

(I) The transfer or discharge is necessary to meet the resident’s welfare which cannot be met in the facility;

(II) The transfer or discharge is appropriate because the resident’s health has improved sufficiently so the resident no longer needs the services provided by the facility;

(III) The safety of individuals in the facility is endangered;

(IV) The health of individuals in the facility would otherwise be endangered;

(V) The resident has failed, after reasonable and appropriate notice, to pay (or to have paid under Title XIX or Title XVIII on the resident’s behalf) for a stay at the facility; or (VI) The facility ceases to operate.

(ii) In each of the cases described above, no resident shall be discharged or transferred without a written order from the attending physician or through other legal processes and timely notification of next of kin and/or sponsor or authorized representative, if any. Each NF shall establish a policy for handling residents who wish to leave the facility against medical advice.

The basis for the transfer or discharge must be documented in the resident’s clinical record. In the cases described in items (I) and (II) above, the documentation must be made by the resident’s physician, and in the case described in item (IV) above, the documentation must be made by a physician. For purposes of item (V), in the case of a resident who becomes eligible for assistance under Title XIX after admission to the facility, only charges which may be imposed under Title XIX shall be considered to be allowable.

(iii) When a resident is transferred, a summary of treatment given at the facility, condition of resident at time of transfer and date and place to which transferred shall be entered in the record. If transfer is due to an emergency; this information will be recorded within forty-eight (48) hours; otherwise, it will precede the transfer of the resident.

(iv) When a resident is transferred, a copy of the clinical summary should, with consent of the resident, be sent to the NF that will continue the care of the resident.

(v) Where an involuntary transfer is proposed, in addition to any other relevant factors, the following factors shall be taken into account:

(I) The traumatic effect on the resident.

(II) The proximity of the proposed NF to the present facility and to the family and friends of the resident.

(III) The availability of necessary medical and social services at the proposed NF.

(IV) Compliance by the proposed NF with all applicable federal and State regulations.

2. Pre-Transfer and Pre-Discharge Notice. Before effecting a transfer or discharge of a resident, a NF must:

(i) Notify the resident (and, if known, a family member of the resident or legal Representative) of the transfer or discharge and the reasons therefore.

(ii) Record the reasons in the resident’s clinical record (including any documentation required pursuant to Part 1. above) and include in the notice the items described in Part 4. below.

(iii) Notify the Department of Health and the LTC Ombudsman.

(iv) Not transfer or discharge a resident until the above agencies have designated their intention to intervene and until any appeal process is complete, should the resident request a fair hearing.

3. Timing of Notice. The notice under Part 2. above must be made at least thirty (30) days in advance of the resident’s transfer or discharge except:

(i) In a case described in Items 1200-13-01-.06(2)(d)1.(i)(III) and (IV).

(ii) In a case described in Item 1200-13-01-.06(2)(d)1.(i)(II) where the resident’s health improves sufficiently to allow a more immediate transfer or discharge.

(iii) In a case described in Item 1200-13-01-.06(2)(d)1.(i)(I) where a more immediate transfer or discharge is necessitated by the resident’s urgent medical needs.

(iv) In a case where a resident has not resided in the facility for thirty (30) days.

In the case of such exceptions, notice must be given as many days before the date of transfer or discharge as is practicable.

4. Items included in notice. Each pre-transfer and pre-discharge notice under Part 2. above must include:

(i) Notice of the resident’s right to appeal the transfer or discharge.

(ii) The name, mailing address, and telephone number of the LTC Ombudsman.

(iii) In the case of residents with developmental disabilities, the mailing address and telephone number of the agency responsible for the protection and advocacy system for developmentally disabled individuals.

(iv) In the case of mentally ill residents, the mailing address and telephone number of the agency responsible for the protection and advocacy system for mentally ill individuals established under the Protection and Advocacy for Mentally Ill Individuals Act.

5. Orientation. A NF must provide sufficient preparation and orientation to residents to ensure safe and orderly transfer discharge from the facility.

6. Notice of Bed-Hold Policy and Readmission. Before a resident of a NF is transferred for hospitalization or therapeutic leave, a NF must provide written information to the resident and a family member or legal representative concerning:

(i) The provisions of the State Plan under this Title XIX regarding the period (if any) during which the resident will be permitted under the State Plan to return and resume residence in the facility, and (ii) The policies of the facility consistent with Part 7. below, regarding such a period.

7. Notice Upon Transfer. At the time of transfer of a resident to a hospital or for therapeutic leave, a NF must provide written notice to the resident and a family member or legal representative of the duration of any period under the State Plan allowed for the resumption of residence in the facility.

(e) NFs participating in the Medicaid Program must establish and follow a written policy under which an Enrollee, whose hospitalization or therapeutic leave exceeds the bed hold period, is readmitted to the NF immediately upon the first availability of a bed in a semi-private room if the Enrollee:

1. Requires the services provided by the NF; and 2. Is eligible for the level of NF care services.

(3) Single Wait List.

(a) Each NF participating in the TennCare must develop and consistently implement policies and procedures regarding its admissions, including the development and maintenance of a single Wait List of persons requesting admission to those facilities.

This list must at a minimum contain the following information pertaining to each request for admission:

1. The name of the applicant.

2. The name of the contact person or designated representative other than the applicant (if any).

3. The address of the applicant and the contact person or designated representative (if any).

4. The telephone number of the applicant and the contact person or designated representative (if any).

5. The name of the person or agency referring the applicant to the NF.

6. The sex and race of the applicant.

7. The date and time of the request for admission.

8. Reason(s) for refusal/non-acceptance/other-action-taken pertaining to the request for admission.

9. The name and title of the NF staff person taking the application for admission.

10. A notation stating whether the applicant is anticipated to be Medicaid eligible at time of admission or within one year of admission.

(b) The Wait List should be updated and revised at least once each quarter to remove the names of previous applicants who are no longer interested in admission to the NF.

Following three (3) contacts each separated by a period of at least ten (10) days, the NF shall, consistent with the written notice required in this section move an applicant to the end of the single admission list whenever an available bed is not accepted at the time of the vacancy, but the applicant wishes to remain on the admissions list.

Applicants shall be advised of these policies at the time of their inquiry, and must be notified in writing, in a format approved by the Department of Health, when their name is removed from the list or moved to the end of the list. Such contacts shall be documented in the facility log containing the Wait List. The date, time and method of each contact shall be recorded along with the name of the facility staff person making the contact, and the identity of the applicant or contact person contacted. The log of such contacts shall also summarize the communication between the facility staff person and the applicant or contact person.

(c) Each facility shall send written confirmation that an applicant’s name has been entered on the Wait List, their position on the wait list, and a notification of their right of access to the wait list as provided in Subparagraph (h) of this Rule. This confirmation shall include at a minimum the date and time of entry on the wait list and shall be mailed by first class postage to the applicant and their designated representative (if any) identified pursuant to the requirements in Subparagraph (a) of this Rule.

(d) Each NF participating in TennCare shall admit applicants in the chronological order in which the referral or request for admission was received by the facility, except as permitted in Subparagraph (e) of this Rule.

(e) Documentation justifying deviation from the order of the Wait List must be maintained for inspection by the State. Inspection shall include the right to review and/or make copies of these records. Deviation may be based upon:

1. Medical need, including, but not necessarily limited to, the expedited admission of patients being discharged from hospitals and patients who previously resided in a NF at a different level of care, but who, in both cases, continue to require institutional medical services;

2. The applicant’s sex, if the available bed is in a room or a part of the facility that exclusively serves residents of the opposite sex;

3. Necessity to implement the provisions of a plan of affirmative action to admit racial minorities, if the plan has previously been approved by the Department of Health;

4. Emergency placements requested by the Department when evacuating another health care facility or by the Adult Protective Service of the Tennessee Department of Human Services;

5. Other reasons or policies, e.g., previous participation in a community based waiver or other alternative care program, when approved by the Medical Director of the Department of Health’s Bureau of Health Licensure and Regulation, provided, however, that no such approval shall be granted if to do so would in any way impair the Department’s or the facility’s ability to comply with its obligations under federal and state civil rights laws, regulations or conditions of licensure or participation.

6. If a Medicaid-eligible recipient’s hospitalization or therapeutic leave exceeds the period paid for under the Tennessee Medicaid program for the holding of a bed in the facility for the resident and if the resident continues to require the services provided by the NF, then the resident must be readmitted to the facility immediately upon the first availability of a bed in the facility, consistent with Part 2. above;

7. Where, with the participation and approval of the Department of Health, expedited admission is approved for residents who are being displaced from another facility or its waiting list as a result of that facility’s withdrawal from the Medicaid program.

(f) Telephone requests to be placed on the Wait List shall be accepted. The information required in Subparagraph (a) of this Rule shall be documented.

(g) If an applicant, whether on his own behalf or acting through another, requests admission or to be placed on a list of applicants awaiting admission, the information on the waiting list must be recorded and preserved.

(h) Applicants or their representatives shall have the right to be informed by telephone of their position on the Wait List. Ombudsmen and appropriate State and federal personnel shall have access to the Wait List when requested, and such access shall include the right to review and/or copy the Wait List.

(i) Any referrals received from the DHS shall be handled in the following manner.

1. Applicants shall be placed on a Wait List without formal application until such facility is within sixty (60) days of admission to the facility based on experience.

2. When the applicant is within sixty (60) days of admission to the facility as estimated by the facility based on its experience, the facility shall notify the applicant and DHS in writing so that a formal application can be made prior to consideration for admittance.

3. If, after sixty (60) days from the date notification is issued, the facility has not received a completed application then the facility may remove the applicant’s name from the Wait List.

(4) Physician visits.

(a) NFs are responsible for assuring that physician visits are made according to the schedule set out at 42 C.F.R. § 483.40. To meet the requirement for a physician visit, the physician must, at the time of the visit, 1. See the resident;

2. Review the resident’s total program of care, including treatments;

3. Verify that the resident continues to need the designated level of NF care and document it in the progress notes or orders;

4. Write, sign, and date progress notes; and 5. Sign all orders.

(b) At the option of the physician, required visits after the initial visit may alternate between visits by a physician and visits by a physician assistant or nurse practitioner working under the physician’s delegation.

(c) A physician visit will be considered to be timely if it occurs not later than ten (10) days after the date of the required visit. Failure of the visit to be made timely will result in non-payment of claims, or a recoupment of all amounts paid by the Bureau or the MCO during the time that the physician visit has lapsed.

(d) NFs are responsible for assuring that the physician verify at the time of each physician’s visit the Medicaid recipient’s continued need for NF LOC and whether or not he is being served at the appropriate LOC.

1. Failure to obtain the verification at the time of the scheduled physician visit may result in a recoupment of all amounts paid by the Bureau or the MCO during the time that the verification/physician visit has lapsed.

2. If such a recoupment is made, the participating facility shall not:

(i) Attempt to recoup from the resident; or (ii) Discharge the resident based on the recoupment.

3. In cases where the physician refused to make the required verification because the physician believes that the LOC is no longer appropriate, a new resident assessment must be completed by the NF.

(5) Termination of NF provider agreements.

(a) Facilities requesting voluntary termination of provider agreements shall comply with the following:

1. Facilities that choose to voluntarily terminate their provider agreements may do so by notifying the Bureau or the MCO(s) in writing of such intent. The effective date of the termination will be determined by the Bureau consistent with the terms of the TennCare Provider Agreement then in force between the Bureau or the MCO(s) and the facility.

2. The facility will not be entitled to payment for any additional or newly admitted TennCare eligible residents from the date of the facility’s notice of withdrawal from the TennCare Program. The facility may, however, at its election, continue to receive TennCare payment for those individuals who resided in the facility, on the date of such notice, so long as they continue to reside in and receive services from the facility and provided that such individuals are TennCare-eligible during the period for which reimbursement is sought. The facility’s right to continue to receive TennCare payments for such individuals following the date of its notice of intent to withdraw from the TennCare program is contingent upon:

(i) The facility’s compliance with all requirements for TennCare participation; and (ii) Its agreement to continue to serve, and accept TennCare payment for, on a non-discriminatory basis, all individuals residing in the facility on the date of notification of withdrawal, who are or become TennCare eligible.

3. The notification must provide the following information:

(i) The reason(s) for voluntary termination;

(ii) The names and TennCare identification numbers of all TennCare-eligible residents;

(iii) Name of the resident and name of the contact person for the resident (if any) for each resident with an application for TennCare eligibility pending;

(iv) A copy of the letter the facility will send to each resident informing him of the voluntary termination, and a copy of the letter to be sent to all TennCare-eligible residents regarding this action;

(v) A copy of the letter sent to all applicants on the Wait List informing them of the facility’s voluntary termination;

(vi) Whether or not the facility intends to continue to provide services to non- TennCare residents who were residents of the facility on the date withdrawal was approved, in the event they convert to TennCare eligibility; and a copy of the notice to residents explaining that decision; and, (vii) Other information determined by the Bureau or the MCOs as necessary to process the request for termination.

4. The termination of the provider’s involvement in TennCare must be done in such a manner as to minimize the harm to current residents.

(i) Residents who are currently TennCare-eligible shall be informed, in a notice to be provided by the facility and approved by the Bureau, that the facility has elected to withdraw from the TennCare program. If the facility has elected under Subpart (ii) of the section to continue to receive TennCare payments for residents of the facility as of the date of notice of withdrawal from the TennCare Program, the notice shall inform the resident of the right to remain in the facility as a TennCare resident as long as he wishes to do so and remain otherwise eligible under the rules of the TennCare Program. The notice shall also inform the resident that, if he wishes to transfer to another facility, under the supervision of TennCare, the NF where he now resides will assist in locating a new placement and providing orientation and preparation for the transfer, in accordance with 42 U.S.C.A. § 1396r(c)(2)(B) and implementing regulations and guidelines, if any.

(ii) All other residents of the facility shall receive a separate notice informing them of the facility’s intention to withdraw from the TennCare program.

The notice will be provided by the facility after having been first reviewed and approved by the Bureau. The notice shall inform such residents that, should they become eligible for TennCare coverage, they will be able to convert to TennCare from their current source of payment and remain in the facility only during a period that ends with the termination of the facility’s provider agreement, a date to be determined in accordance with the terms of the provider agreement. They will not be eligible for TennCare coverage of their care in the facility thereafter. Transfer of these residents shall be considered an involuntary transfer and shall comply with federal and State regulations governing involuntary transfer or discharges.

The same notice will caution these residents that, if they require care as TennCare residents after the facility’s provider agreement is terminated, they will have to transfer to another facility. The notice will also inform the residents that, when their present facility is no longer participating in the TennCare program, certain legal rights and protections that apply to all residents (regardless of source of payment) in TennCare facilities will no longer be available to those who remain in the NF. Readers of the notice will be informed that, if they wish to transfer, or to have their names placed on Wait Lists at other facilities, the facility that is withdrawing from the program will assist them by providing preparation and orientation under the supervision of the Bureau, as required by 42 U.S.C.A. § 1396r(c)(2)(B) and implementing regulations and guidelines, if any.

(iii) Applicants whose names are on the facility’s Wait List will be notified by the facility on a form that has been reviewed and approved by the Bureau that the facility intends to withdraw from the TennCare Program. They will be cautioned that they will not be able to obtain TennCare coverage for any care that they receive in the facility. The notice shall also inform them that certain legal rights and protections that apply to all residents (regardless of source of payment) in TennCare participating facilities will not be available in the NF to which they have applied, once that facility has withdrawn from the TennCare program.

Applicants shall be informed in the notice that, if they wish to make application at other facilities, the withdrawing facility, under the supervision of TennCare, shall assist them in seeking placement elsewhere.

5. Following submission of a notice of withdrawal from the TennCare Program a facility cannot opt to receive continued TennCare payments for any resident unless it agrees to accept continual TennCare payment for all individuals who are residents on the date of the notice of withdrawal, and who are or become TennCare-eligible provided, however, that the Bureau or the Enrollee’s MCO will pay the facility for all covered services actually provided to TennCare-eligible residents following notice of the facility’s withdrawal and pending the resident’s transfer or discharge. In instances where facilities elect to continue to receive such TennCare payments, their provider agreements will remain in effect until the last TennCare-eligible individual, who resided in the facility as of the date of notification of withdrawal, has been discharged or transferred from the facility in accordance with TennCare and State licensure requirements.

6. Facilities which terminate their provider agreement shall not be permitted to participate in TennCare for a period of at least two (2) years from the date the provider agreement is terminated.

7. Unless the facility notifies the Bureau within thirty (30) days after giving a notice of termination, the facility may not stop the termination procedure consistent with this order without written approval from the Bureau.

(b) NFs may be involuntarily decertified by the Tennessee Department of Health’s Division of Health Care Facilities because of their failure to comply with the provisions of these rules. Facilities that are involuntarily decertified shall not be permitted to participate in the Medicaid program for a minimum of five (5) years from the date of the decertification.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 12-4-301, 71-5-105, and 71-5-109 and Executive Order No. 23.
• Administrative History: Original rule filed November 17, 1977; effective December 19, 1977. Amendment filed January 31, 1979; effective March 16, 1979. Amendment filed August 31, 1981; effective October 15, 1981. Amendment filed September 16, 1981; effective November 2, 1981. Amendment filed November 6, 1981; effective December 21, 1981. Amendment filed August 18, 1982; effective September 17, 1982. Amendment filed September 2, 1982; effective October 4, 1982. Amendment filed September 27, 1982; effective October 27, 1982. Amendment filed November 12, 1982; effective December 13, 1982. Amendment filed June 23, 1983; effective July 25, 1983. Amendment filed August 31, 1983; effective September 30, 1983. Amendment filed March 12, 1984; effective April 11, 1984. Amendment filed June 27, 1984; effective July 27, 1984. Amendments filed March 27, 1985; effective April 26, 1985. Amendment filed June 4, 1985; effective July 4, 1985. Amendment filed September 18, 1985; effective October 18, 1985. Amendment filed April 29, 1986; effective May 29, 1986. Amendment filed June 30, 1986; effective July 30, 1986. Amendment filed July 17, 1986; effective August 31, 1986. Amendment filed September 2, 1986; effective October 17, 1986. Amendment filed July 30, 1987; effective September 13, 1987. Amendment filed September 30, 1987; effective November 14, 1987. Amendment filed February 19, 1988; effective April 4, 1988. Amendment filed June 2, 1988; effective July 17, 1988. Amendment filed September 6, 1988; effective October 21, 1988. Amendment filed November 10, 1988; effective December 25, 1988. Amendment filed March 22, 1989; effective May 8, 1989. Amendment filed June 22, 1989; effective August 4, 1989. Amendment filed June 29, 1989; effective August 14, 1989. Amendment filed July 26, 1989; effective September 10, 1989. Amendment filed August 31, 1989; effective October 15, 1989. Amendment filed October 11, 1989; effective November 25, 1989. Amendment filed November 30, 1989; effective January 14, 1990. Amendment filed December 8, 1989; effective January 22, 1990. Amendments filed January 29, 1990; effective March 15, 1990. Amendment filed July 5, 1990; effective August 19, 1990. Amendment filed August 17, 1990; effective October 1, 1990. Amendment filed November 27, 1990; effective January 11, 1991. Amendment filed December 14, 1990; effective January 28, 1991. Amendment filed January 16, 1991; effective March 2, 1991. Amendment filed February 19, 1991; effective April 5, 1991. Amendment filed February 26, 1991; effective April 12, 1991. Amendment filed May 7, 1991; effective June 21, 1991. Amendment filed June 12, 1991; effective July 27, 1991. Amendment filed June 14, 1991; effective July 29, 1991. Amendment filed September 16, 1991; effective October 31, 1991. Amendment filed September 17, 1991; effective November 1, 1991. Amendment filed September 30, 1991; effective November 14, 1991. Amendment filed October 14, 1991; effective November 28, 1991. Amendment filed October 21, 1991; effective December 5, 1991. Amendment filed October 23, 1991; effective December 7, 1991. Amendment filed March 10, 1992; effective April 24, 1992. Amendment filed March 26, 1992; effective May 10, 1992. Amendment filed April 29, 1992; effective June 13, 1992. Amendment filed September 29, 1992; effective November 13, 1992. Amendment filed October 20, 1992; effective December 4, 1992. Amendment filed December 7, 1993; effective February 20, 1994. Amendment filed March 18, 1994; effective June 1, 1994. Amendment filed May 25, 1994; effective August 9, 1994. Amendment filed November 10, 1994; effective January 24, 1995. Amendment filed August 1, 1995; effective October 14, 1995. Amendment filed October 20, 1995; effective January 3, 1996. Amendment filed July 15, 1996; effective September 28, 1996. Amendment filed April 20, 1998; effective July 4, 1998. Amendment filed October 14, 1998; effective December 28, 1998. Amendment filed January 3, 2000; effective March 18, 2000. Amendment filed June 22, 2000; effective September 5, 2000. Amendment filed January 9, 2002; effective March 25, 2002. Amendment filed July 24, 2003; effective October 7, 2003. Public necessity rule filed July 1, 2005; effective through December 13, 2005. Public necessity rule filed September 26, 2005; effective through March 10, 2006. Amendments filed December 20, 2005; effective March 5, 2006. Amendment filed January 16, 2006; effective April 1, 2006. Amendment filed July 17, 2007; effective September 30, 2007. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendment filed May 27, 2010; effective August 25, 2010.

Tenn. Comp. R. & Regs. 1200-13-01-.07 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, and 71-5-109 and Public Chapter 358 of the Acts of 1993.
• Administrative History: Original rule filed November 17, 1977; effective December 19, 1977. Amendment filed January 31, 1979; effective March 16, 1979. Amendment filed June 23, 1983; effective July 25, 1983. Amendment filed June 27, 1984; effective July 27, 1984. Amendment filed May 8, 1985; effective August 13, 1985. Amendment filed April 29, 1986, effective May 29, 1986. Amendment filed January 22, 1988; effective March 7, 1988. Amendment filed January 30, 1989; effective March 16, 1989. Amendment filed January 29, 1990; effective March 15, 1990. Amendment filed February 23, 1990; effective April 9, 1990. Amendment filed July 5, 1990; effective August 19, 1990. Amendment filed August 30, 1990; effective October 14, 1990. Amendment filed October 30, 1990; effective December 14, 1990. Amendment filed January 9, 1991; effective February 23, 1991. Amendment filed February 27, 1991; effective April 13, 1991. Amendment filed April 29, 1991; effective June 13, 1991. Amendment filed May 8, 1991; effective June 22, 1991. Amendment filed June 12, 1991; effective July 27, 1991. Amendment filed September 19, 1991; effective November 3, 1991. Amendment filed March 9, 1992; effective April 23, 1992. Amendment filed March 26, 1992; effective May 10, 1992. Amendment filed March 27, 1992; effective May 11, 1992. Amendment filed May 1, 1992; effective June 15, 1992. Amendment filed August 4, 1992; effective September 18, 1992. Amendment filed September 29, 1992; effective November 13, 1992. Amendment filed October 20, 1992; effective December 4, 1992. Amendment filed December 4, 1992; effective January 19, 1993. Amendment filed December 30, 1992; effective February 16, 1993. Amendment filed December 10, 1993; effective February 23, 1994. Amendment filed March 18, 1994; effective June 1, 1994. Repeal filed January 28, 2007; effective April 11, 2007.

Tenn. Comp. R. & Regs. 1200-13-01-.08 PERSONAL NEEDS ALLOWANCE (PNA), PATIENT LIABILITY, THIRD PARTY

INSURANCE AND ESTATE RECOVERY FOR PERSONS RECEIVING LTSS.

(1) Personal Needs Allowance (PNA). The PNA is established for each Enrollee receiving LTSS in accordance with the Tennessee Medicaid State Plan, approved Section 1915(c) Waiver applications, and these rules. It is deducted from the Enrollee’s monthly income in calculating Patient Liability for LTSS.

(a) The PNA for each person receiving TennCare-reimbursed services in a NF or an ICF/IID is $50. Persons with no income have no PNA. Persons with incomes that are less than $50 per month (including institutionalized persons receiving SSI payments) may keep the entire amount of their income as their PNA.

(b) The maximum PNA for persons participating in CHOICES Group 2, CHOICES Group 3, or ECF CHOICES is 300% of the SSI FBR.

(c) The maximum PNA for persons participating in one of the State’s Section 1915(c)

HCBS Waivers is as follows:

1. The Statewide ID Waiver: 200% of the SSI FBR.

2. The Arlington ID Waiver: 200% of the SSI FBR.

3. The Self-Determination ID Waiver: 300% of the SSI FBR.

(2) Patient Liability.

(a) Enrollees receiving LTSS are required to contribute to the cost of their LTSS if their incomes are at certain levels. They are subject to the post-eligibility treatment of income rules set forth in Section 1924 of the Social Security Act (42 U.S.C.A. § 1396r- 5), and 42 C.F.R. § 435.725.

(b) For Enrollees being served in HCBS Waivers, the State must also use institutional eligibility and post-eligibility rules for determining Patient Liability.

(c) For Members of the CHOICES 217-Like Group, the CHOICES At-Risk Demonstration Group, the ECF CHOICES 217-Like Group, the Interim ECF CHOICES At-Risk Group, and upon implementation of Phase 2 of ECF CHOICES, the ECF CHOICES At-Risk and ECF CHOICES Working Disabled Demonstration Groups, the State uses institutional eligibility and post-eligibility rules for determining Patient Liability in the same manner as specified under 42 C.F.R. §§ 435.217, 435.236, and 435.726 and

Section 1924 of the Social Security Act (42 U.S.C.A. § 1396r-5), if the HCBS were provided under a Section 1915(c) Waiver.

(d) For a Member of CHOICES Group 2, CHOICES Group 3, or ECF CHOICES receiving the Short-Term NF Care benefit (for up to 90 days) or an Enrollee in one of the State’s

Section 1915(c) Waiver programs who is temporarily placed in a medical institution, i.e., a hospital, NF or ICF/IID (for up to 90 days), the post-eligibility calculation shall be performed as if the individual is continuing to receive HCBS. The purpose is to ensure that the individual can maintain a community residence for transition back to the community. After 90 days, or as soon as it appears that the inpatient stay will not be a short-term stay, whichever comes first, a CHOICES Group 2, CHOICES Group 3, or ECF CHOICES Member will be transitioned to CHOICES Group 1 (see 1200-13-01- .31(6)(b) for requirements pertaining to ECF CHOICES Members), or a Waiver participant must be disenrolled from the Waiver, and the institutional post-eligibility calculation shall apply.

(e) Patient Liability shall be collected as follows:

1. If the Enrollee resides in a NF, ICF/IID, or receives CBRA services other than Companion Care (i.e., ACLF, Critical Adult Care Home, Community Living Supports, or Community Living Supports-Family Model), the Enrollee must pay his Patient Liability to the residential facility or provider. The residential facility or provider shall reduce the amount billed to the Bureau or the MCO, as applicable, by the amount of the Enrollee’s Patient Liability obligation, regardless of whether such amount is actually collected by the facility.

2. If a CHOICES Group 2, CHOICES Group 3, or ECF CHOICES Member does not receive CBRA services other than Companion Care, i.e., the Member is receiving HCBS in his own home, the Member must pay his Patient Liability to the MCO.

The amount of Patient Liability collected will be used to offset the cost of CHOICES Group 2, CHOICES Group 3, or ECF CHOICES benefits or CEA services provided as an alternative to covered CHOICES Group 2, CHOICES Group 3, or ECF CHOICES benefits that were reimbursed by the MCO for that month. The amount of Patient Liability collected by the MCO cannot exceed the cost of CHOICES Group 2, CHOICES Group 3 or ECF CHOICES benefits (or CEA services provided as an alternative to CHOICES Group 2, CHOICES Group 3 or ECF CHOICES benefits) reimbursed by the MCO for that month.

(f) A CHOICES or ECF CHOICES provider, including an MCO, may decline to continue to provide LTSS to a CHOICES or ECF CHOICES Member who fails to pay his Patient Liability. If other Contract Providers or the other TennCare MCO(s) operating in the Grand Division are unwilling to provide LTSS to a CHOICES or ECF CHOICES Member who has failed to pay his Patient Liability, the Member may be disenrolled from the CHOICES or ECF CHOICES program in accordance with the procedures set out in this Chapter.

(3) TPL for LTSS.

(a) LTC insurance policies are considered TPL and the Bureau is subrogated to all rights of recovery.

(b) Applicants for the CHOICES or ECF CHOICES programs who have LTC insurance policies must report these policies to TennCare upon enrollment in the CHOICES or ECF CHOICES program. Applicants may be subject to criminal prosecution for knowingly providing incorrect information.

(c) Obligations of CHOICES or ECF CHOICES Members receiving NF or CBRA services (other than Companion Care) having insurance that will pay for care in a NF or other residential facility (including cash benefits to the Member for the cost of such services):

1. If the benefits are assignable, the Member must assign them to the NF or residential facility or provider. These benefits will be used to reduce the amounts that the MCO would otherwise be required to pay the NF or the residential facility or provider for LTSS.

2. If the benefits are not assignable, the Member must provide payment to the NF or the residential facility or provider immediately upon receipt of the benefits.

These benefits will be used to reduce the amounts that the MCO would otherwise be required to pay the NF or the residential facility or provider for LTSS.

(d) Obligations of CHOICES or ECF CHOICES Members receiving non-residential CHOICES HCBS or Companion Care services, or non-residential ECF CHOICES services having insurance that will pay for CHOICES HCBS or ECF CHOICES HCBS (including cash benefits to the Member for the cost of such services):

1. If the benefits are assignable, the Member must assign them to the MCO. These benefits will be used to reduce the amounts that the MCO would otherwise be required to pay for CHOICES HCBS or ECF CHOICES HCBS for the Member.

2. If the benefits are not assignable, the Member must make payment to the MCO immediately upon receipt of the benefits. These benefits will be used to reduce the amounts that the MCO would otherwise be required to pay for CHOICES HCBS or ECF CHOICES HCBS for the Member.

(e) TPL payments do not reduce the amount of Patient Liability an Enrollee is obligated to contribute toward the cost of LTSS, except in instances where the total cost of LTSS for the month is less than the combined total of TPL payments and the member’s Patient Liability amount, in which case, TPL shall be collected first. The NF shall then collect Patient Liability up to the total cost of LTSS provided for the month.

(f) If benefits received by the policyholder are not paid to the facility or MCO, as applicable, such benefits shall be considered income, and may render the person ineligible for TennCare (including LTSS) benefits.

(4) Estate Recovery. Persons enrolled in TennCare LTSS programs are subject to the requirements of the FERP as set forth under Section 1917(b) of the Social Security Act, 42 U.S.C.A. § 1396p(b).

(a) The State is required to seek adjustment or recovery for certain types of medical assistance from the estates of individuals as follows:

1. For persons age fifty-five (55) and older, the State is obligated to seek adjustment or recovery for NF (including ICF/IID) services, HCBS, and related hospital and prescription drug services.

2. For permanently institutionalized persons under age fifty-five (55), the State is obligated to seek adjustment or recovery for the institutional services.

(b) Estate recovery shall apply to the estates of individuals under age fifty-five (55) who are inpatients in a NF, ICF/IID, or other medical institution and who cannot reasonably be expected to be discharged home.

(c) A determination that an individual cannot reasonably be expected to be discharged to return home shall be made in accordance with the following.

1. The PAE for LOC that is certified by the physician shall specify whether discharge is expected and the anticipated length of stay in the institution.

2. The following shall be deemed sufficient evidence that a person cannot reasonably be expected to be discharged to return home and is thus permanently institutionalized:

(i) An approved PAE certified by the physician indicating that discharge is not expected; or, (ii) The continued stay of a resident of a medical institution at the end of a temporary stay predicted by his physician at the time of admission to be no longer than six (6) months in duration.

(d) Written notice of the determination that the individual residing in a medical institution cannot reasonably be expected to be discharged to return home shall be issued to the individual or his Designated Correspondent. The notice shall explain the right to request a reconsideration review. Such request must be submitted in writing to the Bureau, Long-Term Services and Supports, within thirty (30) days of receipt of the written notice. The reconsideration review shall be conducted as a Commissioner’s Administrative Hearing in the manner set out in Rule 1200-13-01-.10(7).

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed May 15, 1980; effective June 29, 1980. Amendment filed May 27, 1983; effective June 27, 1983. Amendment filed February 22, 1991; effective April 9, 1991. Emergency rule filed March 1, 2009; effective through August 28, 2010. Amendment filed May 27, 2010; effective August 25, 2010. Emergency rules filed June 29, 2012; effective through December 26, 2012. Repeal and new rule filed September 26, 2012; effective December 25, 2012. Emergency rules filed July 1, 2016; effective through December 28, 2016. Amendments filed September 30, 2016; effective December 29, 2016.

Tenn. Comp. R. & Regs. 1200-13-01-.09 THIRD PARTY SIGNATURE

(1) No facility may require a third party signature for a Medicaid recipient as a condition of application or admission to, or continued stay in, the facility. However, any person appointed by a court of competent jurisdiction to act on behalf of a recipient may be required to perform all requirements normally required of an applicant.

(2) If a facility has collected an advance payment or deposit from or on behalf of a person retroactively determined to be eligible for Medicaid, the amount collected less the amount determined by the Department of Human Services to be the patient’s liability for that period of time shall be refunded within ten (10) days after receiving payment for retroactive period from the state of its agents.

(3) The facility must file for such retroactive reimbursement for the full period of retroactive eligibility on the next claim for reimbursement filed by the facility following the date of notification of eligibility.

History

• Authority: T.C.A. §§ 14-1945 and 14-23-109.
• Administrative History: Original rule filed May 15, 1980; effective June 29, 1980. Amendment filed October 8, 1985; effective November 7, 1985.

Tenn. Comp. R. & Regs. 1200-13-01-.10 MEDICAL (LEVEL OF CARE) ELIGIBILITY CRITERIA FOR TENNCARE

REIMBURSEMENT OF CARE IN NURSING FACILITIES, CHOICES HCBS AND PACE.

(1) Definitions. See Rule 1200-13-01-.02.

(2) PreAdmission Evaluations and Discharge/Transfer/Hospice Forms.

(a) A PAE is required in the following circumstances:

1. When a TennCare Eligible is admitted to a NF for receipt of TennCarereimbursed NF Services.

2. When a private-paying resident of a NF attains TennCare Eligible status.

3. When Medicare reimbursement for SNF services has ended and TennCare Level 2 reimbursement for NF services is requested.

4. When a NF Eligible is changed from TennCare Level 1 to TennCare Level 2 reimbursement, or from TennCare Level 1 or Level 2 reimbursement to a Chronic Ventilator or Tracheal Suctioning Enhanced Respiratory Care rate, except as specified in Rule 1200-13-01-.10(5)(f).

5. When a NF Eligible is changed from TennCare Level 2 reimbursement or an Enhanced Respiratory Care rate to TennCare Level 1 reimbursement, unless the person has an approved unexpired Level 1 PAE.

6. When a NF Eligible is changed from an Enhanced Respiratory Care rate to TennCare Level 2 reimbursement, unless the person has an approved unexpired Level 2 PAE.

7. When a NF Eligible requires continuation of the same LOC beyond the expiration date assigned by the Bureau.

8. When a NF Eligible no longer requires the specific skilled nursing or rehabilitative services for which a Level 2 PAE was approved but requires other skilled nursing or rehabilitative services for which Level 2 reimbursement may be authorized in a NF.

9. When a Member enrolled in CHOICES Group 1 or Group 2 on or after July 1, 2012, no longer meets NF LOC and wants to enroll in CHOICES Group 3 for HCBS.

10. When a Member enrolled in CHOICES Group 3 (including Interim CHOICES Group 3) on or after July 1, 2012, wants to enroll in CHOICES Group 1 or 2.

(b) NFs are required to complete and submit to the Member’s MCO a Discharge/Transfer/Hospice Form any time a Member discharges from the facility or stops receiving NF services in the facility, which shall include but is not limited to the following circumstances:

1. When a CHOICES Member transfers from one NF to another such facility.

2. When a CHOICES Member discharges to the hospital (even when readmission to the NF is expected following the hospital stay).

3. When a CHOICES Member elects to receive hospice services (even if Medicare will be responsible for payment of the hospice benefit).

4. When a CHOICES Member discharges home, with or without HCBS. In this case, the NF is obligated to notify the MCO before the Member is discharged from the facility and to coordinate with the MCO in discharge planning in order to ensure that any home and community based services needed by the Member will be available upon discharge, and to avoid a lapse in CHOICES and/or TennCare eligibility.

5. Upon the death of a CHOICES Member.

(c) A PreAdmission Evaluation is not required in the following circumstances:

1. When a NF Eligible with an approved unexpired Level 1 PAE returns to the NF after being hospitalized.

2. When a NF Eligible with an approved unexpired Level 2 PAE returns to the NF after being hospitalized, if there has been no change in the skilled nursing or rehabilitative service for which the PAE was approved.

3. When a NF Eligible changes from Level 2 to Level 1 NF reimbursement and has an approved unexpired Level 1 PAE.

4. To receive Medicaid co-payment when Medicare is the primary payer of SNF care.

5. When a Discharge/Transfer/Hospice Form is appropriate in accordance with (2)(b).

6. For authorization by an MCO of Ventilator Weaning services or short-term payment at the Tracheal Suctioning Enhanced Respiratory Care rate for a person who has just been weaned from the ventilator, but who still requires short-term intensive respiratory intervention. Medical necessity determinations and authorization of Ventilator Weaning services and short-term payment at the Tracheal Suctioning Enhanced Respiratory Care rate during the post-weaning period will be managed by the person’s MCO.

7. When a person will be receiving hospice services in the NF.

(d) If a NF admits or allows continued stay of a TennCare Eligible without an approved PAE, it does so at its own risk and in such event the NF shall give the Applicant a plain language written notice, in a format approved by the Bureau, that Medicaid reimbursement will not be paid unless the PAE is approved and if it is not finally approved the Applicant can be held financially liable for services provided, including services delivered prior to the effective date of the PAE and enrollment in CHOICES Group 1, unless a third party is liable.

(e) Except as specified in 1200-13-01-.10(2)(e)2., an approved PAE is valid for ninety (90) calendar days beginning with the PAE Approval Date, unless an earlier expiration date has been established by TennCare (see 1200-13-01-.10(2)(h)). A valid approved PAE that has not been used within ninety (90) calendar days of the PAE Approval Date must be updated before it can be used. For purposes of Medicaid-reimbursed NF services, such update may be completed only upon submission of a confirmed Medicaid Only Payer Date. To update the PAE, the physician (in the case of NF services) or a Qualified Assessor (in the case of HCBS) shall certify that the Applicant’s medical condition on the revised PAE Request Date is consistent with that described in the initial certification and/or assessment and that NF services, or alternative HCBS, as applicable, are medically necessary for the Applicant. If the Applicant’s medical condition has significantly changed such that the previously approved PAE does not reasonably reflect the Applicant’s current medical condition and functional capabilities, a new PAE shall be required.

1. A PAE that is not used within 365 days of the PAE Approval Date shall expire and shall not be updated.

2. A PAE shall also expire upon the person’s discharge from a NF, unless:

(i) The person transfers to another NF.

(ii) The person is discharged to the hospital and returns directly to the NF or to another NF.

(iii) The person is discharged home for therapeutic leave and returns to the NF within no more than ten (10) days.

(iv) The person is discharged home and a request to transition to CHOICES Group 2 is submitted by the MCO and approved by TennCare prior to the person’s discharge from the NF.

3. For persons electing hospice:

(i) If a person receiving NF services elects to receive hospice, is disenrolled from CHOICES Group 1, and subsequently withdraws the hospice election and wishes to re-enroll in CHOICES Group 1, the approved PAE may be used so long as:

(I) The person has remained in the NF;

(II) The person’s condition has not changed;

(III) No more than thirty (30) days have lapsed since the person’s disenrollment from CHOICES Group 1; and (IV) NF LOC criteria have not changed.

(ii) If the person’s condition has changed or if more than thirty (30) days have lapsed since the person’s disenrollment from CHOICES Group 1, a new PAE shall be required.

(iii) If the PAE effective date was prior to July 1, 2012, a new PAE must be submitted and the person must qualify based on the new NF LOC criteria in place as of July 1, 2012.

(f) A PAE must include a recent history and physical or current medical records that support the Applicant’s functional and/or skilled nursing or rehabilitative needs, as reflected in the PAE. A history and physical performed within 365 calendar days of the PAE Request Date may be used if the Applicant’s condition has not significantly changed. Medical records (progress notes, office records, discharge summaries, etc.) may be used to supplement a history and physical and provide current medical information if changes have occurred since the history and physical was performed, or may be used in lieu of a history and physical, so long as the records provide medical evidence sufficient to support the functional and/or skilled or rehabilitative needs reflected in the PAE.

(g) A PAE must be certified as follows:

1. Physician certification shall be required for reimbursement of NF services and enrollment into CHOICES Group 1. Consistent with requirements pertaining to certification of the need for SNF care set forth at 42 CFR § 424.20 and in Section 3108 of the Affordable Care Act, certification of the need for NF care may be performed by a nurse practitioner, clinical nurse specialist, or physician assistant, none of whom has a direct or indirect employment relationship with the facility but who is working in collaboration with a physician.

2. Certification of the level of care assessment by a Qualified Assessor shall be required for all PAEs.

(h) A PAE may be approved by the Bureau for a fixed period of time with an expiration date based on an assessment by the Bureau of the Applicant’s medical condition and anticipated continuing need for inpatient nursing care. Notice of appeal rights shall be provided when a PAE is approved with an expiration date.

(i) PASRR.

1. All Applicants who reside in or seek admission to a Medicaid-certified NF must have a PASRR Level I screen for mental illness and mental retardation. The initial Level I screen must be completed prior to admission to the NF and submitted to TennCare regardless of:

(i) Payer source;

(ii) Whether the PASRR screening is positive or negative (including specified exemptions); and (iii) The level of NF reimbursement requested.

2. If the Level I screen indicates the need for a PASRR Level II evaluation of need for specialized services for mental illness and/or mental retardation, the Applicant must undergo the PASRR Level II evaluation prior to admission to the NF.

(j) Medicaid payment will not be available for any dates of NF services rendered prior to the date the PASRR process is complete and the Applicant has been determined appropriate for nursing home placement. The PASRR process is complete when either:

1. TennCare has received a negative Level I PASRR screen form and no contradictory information is subsequently received; or 2. For Applicants with a positive Level I PASRR screen (as submitted or upon review and determination by the Bureau), the Bureau has received a certified exemption or advance categorical determination signed by the physician; or a determination by DMH and/or DIDD, as applicable, that the Applicant is appropriate for NF placement. Determination by the Bureau that a Level II PASRR evaluation must be performed may be made:

(i) Upon receipt of a positive PASRR screen from the NF or other submitting entity;

(ii) Based on TennCare review of a negative PASRR screening form or history and physical submitted by a NF or other entity; or (iii) Upon review of any contradictory information submitted in the PAE application or supporting documentation at any time prior to disposition of the PAE.

(k) A NF that has entered into a provider agreement with a TennCare MCO shall assist a NF resident or Applicant as follows:

1. The NF shall assist a NF resident or an Applicant for admission in applying for Medicaid eligibility and in applying for Medicaid-reimbursed NF care. This shall include assistance in properly completing all necessary paperwork and in providing relevant NF documentation to support the PAE. For Applicants not currently eligible for Medicaid, the NF may request assistance from the AAAD in completing the Medicaid application process in order to expedite the eligibility determination by DHS. Reasonable accommodations shall be made for an Applicant with disabilities or, alternatively, for a Designated Correspondent with disabilities when assistance is needed with the proper completion and submission of a PAE.

2. The NF shall request a Notice of Disposition or Change from the Department of Human Services upon learning that a resident or Applicant has, or is likely to have, applied for Medicaid eligibility.

(l) The Bureau shall process PAEs independently of determinations of Medicaid eligibility by DHS; however, Medicaid reimbursement for NF care shall not be available until the PASRR process has been completed, and both the PAE and financial eligibility have been approved.

(3) Medicaid Reimbursement.

(a) A NF that has entered into a provider agreement with a TennCare MCO is entitled to receive Medicaid reimbursement for covered services provided to a NF Eligible if:

1. The NF has completed the PASRR process as described in 1200-13-01-.10(2)(i) above and pursuant to 1200-13-01-.23.

2. The Bureau has received an approvable PAE for the person within ten (10) calendar days of the PAE Request Date or the physician certification date, whichever is earlier. The PAE Approval Date shall not be more than ten (10) days prior to date of submission of an approvable PAE. An approvable PAE is one in which any deficiencies in the submitted application are cured prior to disposition of the PAE.

3. The NF has entered into the TennCare PreAdmission Evaluation System (TPAES) a Medicaid Only Payer Date.

4. The person has been enrolled into CHOICES Group 1.

5. For a retroactive eligibility determination, the Bureau has received a Notice of Disposition or Change and has received an approvable request to update an approved, unexpired PAE within thirty (30) calendar days of the mailing date of the Notice of Disposition or Change, so long as the person has remained in a NF since the PAE was completed (except for short-term hospitalization). The effective date of payment for NF services shall not be earlier than the PAE Approval Date of the original approved, unexpired PAE that has been updated.

6. If the NF participates in the Enrollee’s MCO, reimbursement will be made by the MCO to the NF as a Network Provider. If the NF does not participate in the Enrollee’s MCO, reimbursement will be made by the MCO to the NF as a nonparticipating provider, in accordance with Rule 1200-13-01-.05(10).

(b) Any deficiencies in a submitted PAE application must be cured prior to disposition of the PAE to preserve the PAE submission date for payment purposes.

1. Deficiencies cured after the PAE is denied but within thirty (30) days of the original PAE submission date will be processed as a new application, with reconsideration of the earlier denial based on the record as a whole (including both the original denied application and the additional information submitted). If approved, the effective date of PAE approval can be no more than ten (10) days prior to the date of receipt of the information which cured the original deficiencies in the denied PAE. Payment will not be retroactive back to the date the deficient application was received or to the date requested in the deficient application.

2. Once a PAE has been denied, the original denied PAE application must be resubmitted along with any additional information which cures the deficiencies of the original application. Failure to include the original denied application may delay the availability of Medicaid reimbursement for NF services.

(c) The earliest date of Medicaid reimbursement for care provided in a NF shall be the date that all of the following criteria are met:

1. Completion of the PASRR process, as described in 1200-13-01-.10(2)(i) above and pursuant to 1200-13-01-.23;

2. The effective date of level of care eligibility as reflected by the PAE Approval Date;

3. The effective date of Medicaid eligibility;

4. The date of admission to the NF; and 5. The effective date of enrollment into CHOICES Group 1.

(d) Application of new LOC criteria. The new LOC criteria set forth in 1200-13-01-.10(4) shall be applied to all Applicants enrolled into CHOICES on or after July 1, 2012, based on their effective date of enrollment into the CHOICES program.

1. It is the date of enrollment into CHOICES and not the date of PAE submission, approval, or the PAE effective date which determines the LOC criteria that must be applied.

2. TennCare may review a PAE that had been reviewed and approved based on the NF LOC criteria in place as of June 30, 2012, to determine whether an Applicant who will be enrolled into CHOICES on or after July 1, 2012, meets the new LOC criteria. However, all Applicants enrolled into CHOICES with an effective date of enrollment on or after July 1, 2012, shall meet the criteria in place at the time of enrollment, and in accordance with these rules.

(e) A NF that has entered into a provider agreement with a TennCare MCO and that admits a TennCare Eligible without completion of the PASRR process and without an approved PAE does so without the assurance of Medicaid reimbursement.

(f) TennCare reimbursement will only be made to a NF on behalf of the NF Eligible and not directly to the NF Eligible.

(g) A NF that has entered into a provider agreement with a TennCare MCO shall admit persons on a first come, first served basis, except as otherwise permitted by State and federal laws and regulations.

(4) Level of Care Criteria for Medicaid Level 1 Reimbursement of Care in a Nursing Facility, CHOICES HCBS, ECF CHOICES HCBS and PACE.

(a) The NF must have completed the PASRR process, as applicable and as described in 1200-13-01-.10(2)(i) above and pursuant to 1200-13-01-.23.

(b) An Applicant must meet both of the following LOC criteria in order to be approved for TennCare-reimbursed care in a NF, CHOICES HCBS, ECF CHOICES HCBS or PACE, as applicable:

1. Medical Necessity of Care:

(i) Applicants requesting TennCare-reimbursed NF care. Care in a NF must be expected to improve or ameliorate the Applicant’s physical or mental condition, to prevent a deterioration in health status, or to delay progression of a disease or disability, and such care must be ordered and supervised by a physician on an ongoing basis.

(ii) Applicants requesting HCBS in CHOICES, ECF CHOICES or PACE.

HCBS must be required in order to allow the Applicant to continue living safely in the home or community-based setting and to prevent or delay placement in a NF, and such HCBS must be specified in an approved plan of care and needed on an ongoing basis.

(I) The need for one-time CHOICES HCBS or one-time ECF CHOICES HCBS is not sufficient to meet medical necessity of care for HCBS.

(II) If a Member’s ongoing need for assistance with activities of daily living and/or instrumental activities of daily living can be met, as determined through the needs assessment and care planning processes, through the provision of assistance by family members and/or other caregivers, or through the receipt of services available to the Member through community resources (e.g., Meals on Wheels) or other payer sources (e.g., Medicare), the Member does not require HCBS in order to continue living safely in the home and community-based setting and to prevent or delay placement in a NF.

2. Need for Inpatient Nursing Care:

(i) Applicants requesting TennCare-reimbursed NF care.

The Applicant must have a physical or mental condition, disability, or impairment that, as a practical matter, requires daily inpatient nursing care.

The Applicant must be unable to self-perform needed nursing care and must meet one (1) or more of the following criteria on an ongoing basis:

(I) Have a total score of at least nine (9) on the TennCare NF LOC Acuity Scale; or (II) Meet one (1) or more of the ADL or related criteria specified in 1200- 13-01-.10(4)(b)2.(iii) on an ongoing basis and be determined by TennCare through approval of a Safety Determination Request to not be able to be safely served within the array of services and supports that would be available if the Applicant was enrolled in CHOICES Group 3, including CHOICES HCBS up to the Expenditure Cap, non-CHOICES HCBS available through TennCare (e.g., home health), cost-effective alternative services (as applicable), services available through Medicare, private insurance or other funding sources, and natural supports provided by family members and other caregivers who are willing and able to provide such care. An Applicant who cannot be safely served in CHOICES Group 3 does not qualify to enroll in CHOICES Group 3. An applicant who could be safely served in CHOICES Group 3 except that he does not meet Medicaid categorical and financial eligibility criteria for CHOICES Group 3 (i.e. is not an SSI recipient) shall not be eligible for CHOICES Group 1 as a result of a Safety Determination.

(ii) Applicants eligible to receive care in a NF, but requesting HCBS in CHOICES Group 2, ECF CHOICES or PACE.

The Applicant must have a physical or mental condition, disability, or impairment that requires ongoing supervision and/or assistance with activities of daily living in the home or community setting. In the absence of ongoing CHOICES HCBS, ECF CHOICES HCBS or PACE, the Applicant would require and must qualify to receive NF services in order to remain eligible for HCBS. The Applicant must be unable to self-perform needed nursing care and must meet one (1) or more of the following criteria on an ongoing basis:

(I) Have a total score of at least nine (9) on the TennCare NF LOC Acuity Scale; or (II) For a CHOICES Group 2 Applicant, meet one (1) or more of the ADL or related criteria specified in 1200-13-01-.10(4)(b)2.(iii) on an ongoing basis and be determined by TennCare through approval of a Safety Determination Request to not be able to be safely served within the array of services and supports that would be available if the Applicant was enrolled in CHOICES Group 3, including CHOICES HCBS up to the Expenditure Cap, non-CHOICES HCBS available through TennCare (e.g., home health), cost-effective alternative services (as applicable), services available through Medicare, private insurance or other funding sources, and natural supports provided by family members and other caregivers who are willing and able to provide such care. An Applicant who cannot be safely served in CHOICES Group 3 does not qualify to enroll in CHOICES Group 3. An applicant who could be safely served in CHOICES Group 3 except that he does not meet Medicaid categorical and financial eligibility criteria for CHOICES Group 3 (i.e. is not an SSI recipient) shall not be eligible for CHOICES Group 2 as a result of a Safety Determination; or (III) For an ECF CHOICES Applicant age twenty-one (21) or older, have an intellectual or developmental disability and be determined through approval of a Safety Determination Request to not be able to be safely served within the array of services and supports that would be available if the Applicant was enrolled in ECF CHOICES Group 5, including ECF CHOICES HCBS up to the Expenditure Cap; one-time emergency assistance up to $6,000; non-ECF CHOICES HCBS available through TennCare (e.g., home health); cost-effective alternative services (as applicable); services available through Medicare, private insurance or other funding sources; and natural supports provided by family members and other caregivers who are willing and able to provide such care.

(iii) Applicants not eligible to receive care in a NF, but at risk of NF placement and requesting HCBS in CHOICES Group 3, including Interim CHOICES Group 3.The Applicant must have a physical or mental condition, disability, or impairment that requires ongoing supervision and/or assistance with activities of daily living in the home or community setting. In the absence of ongoing CHOICES HCBS, the Applicant would not be able to live safely in the community and would be at risk of NF placement. The following criteria shall reflect the individual’s Applicant’s capabilities on an ongoing

basis and not isolated, exceptional, or infrequent limitations of function in a generally independent person who is able to function with minimal supervision or assistance. The Applicant must be unable to self-perform needed nursing care and must meet one (1) or more of the following criteria on an ongoing basis:

(I) Transfer. The Applicant is incapable of transfer to and from bed, chair, or toilet unless physical assistance is provided by others on an ongoing basis (daily or at least four days per week). Approval of this deficit shall require documentation of the medical condition(s) contributing to this deficit, as well as the specific type and frequency of transfer assistance required.

(II) Mobility. The Applicant requires physical assistance from another person for mobility on an ongoing basis (daily or at least four days per week). Mobility is defined as the ability to walk, using mobility aids such as a walker, crutch, or cane if required, or the ability to use a wheelchair (manual or electric) if walking is not feasible. The need for a wheelchair, walker, crutch, cane, or other mobility aid shall not by itself be considered to meet this requirement. Approval of this deficit shall require documentation of the medical condition(s) contributing to this deficit, as well as the specific type and frequency of mobility assistance required.

(III) Eating. The Applicant requires physical assistance with gastrostomy tube feedings or physical assistance or constant one-on-one observation and verbal assistance (reminding, encouraging) 4 or more days per week to consume prepared food and drink (or selfadminister tube feedings, as applicable) or must be fed part or all of each meal. Food preparation, tray set-up, assistance in cutting up foods, and general supervision of multiple residents shall not be considered to meet this requirement. Approval of this deficit shall require documentation which supports the need for such intervention, along with evidence that in the absence of such physical assistance or constant one-on-one observation and verbal assistance, the Applicant would be unable to self-perform this task.

For PAEs submitted by the AAAD (or entity other than an MCO, NF, or PACE Organization), an eating or feeding plan specifying the type, frequency and duration of supports required by the Applicant for feeding, along with evidence that in the absence of such physical assistance or constant one-on-one observation and verbal assistance, the Applicant would be unable to self-perform this task shall be required.

(IV) Toileting. The Applicant requires physical assistance from another person to use the toilet or to perform incontinence care, ostomy care, or catheter care on an ongoing basis (daily or at least four days per week). Approval of this deficit shall require documentation of the specific type and frequency of toileting assistance required.

(V) Expressive and Receptive Communication. The Applicant is incapable of reliably communicating basic needs and wants (e.g., need for assistance with toileting; presence of pain) in a manner that can be understood by others, including through the use of assistive devices; or the Applicant is incapable of understanding and following very simple instructions and commands without continual intervention (daily or at least four days per week). Approval of this deficit shall require documentation of the medical condition(s) contributing to this deficit, as well as the specific type and frequency of communication assistance required.

(VI) Orientation. The Applicant is disoriented to person (e.g., fails to remember own name, or recognize immediate family members), place (e.g., does not know residence is a NF), or event/situation (e.g., is unaware of current circumstances in order to make decisions that prevent risk of harm) daily or at least four days per week.

Approval of this deficit shall require documentation of the specific orientation deficit(s), including the frequency of occurrence of such deficit(s), and the impact of such deficit(s) on the Applicant.

(VII) Medication Administration. The Applicant is not cognitively or physically capable (daily or at least four days per week) of selfadministering prescribed medications at the prescribed schedule despite the availability of limited assistance from another person.

Limited assistance includes, but is not limited to, reminding when to take medications, encouragement to take, reading medication labels, opening bottles, handing to Applicant, reassurance of the correct dose, and the use of assistive devices including a prepared medication box. An occasional lapse in adherence to a medication schedule shall not be sufficient for approval of this deficit; the Applicant must have physical or cognitive impairments which persistently inhibit his or her ability to self-administer medications.

Approval of this deficit shall require evidence that such interventions have been tried or would not be successful, and that in the absence of intervention, the Applicant’s health would be at serious and imminent risk of harm.

(VIII) Behavior. The Applicant requires persistent staff or caregiver intervention and supervision (daily or at least four days per week) due to an established and persistent pattern of behavioral problems which are not primarily related to a mental health condition (for which mental health treatment would be the most appropriate course of treatment) or a substance abuse disorder (for which substance abuse treatment would be the most appropriate course of treatment), and which, absent such continual intervention and supervision, place the Applicant or others at imminent and serious risk of harm. Such behaviors may include physical aggression (including assaultive or self-injurious behavior, destruction of property, resistive or combative to personal and other care, intimidating/threatening, or sexual acting out or exploitation) or inappropriate or unsafe behavior (including disrobing in public, eating non-edible substances, fire setting, unsafe cooking or smoking, wandering, elopement, or getting lost). Approval of this deficit shall require documentation of the specific behaviors and the frequency of such behaviors.

(IX) Skilled Nursing or Rehabilitative Services. The Applicant requires daily skilled nursing or rehabilitative services at a greater frequency, duration, or intensity than, for practical purposes, would be provided through daily home health visits. Approval of such skilled nursing or rehabilitative services shall require a physician’s order and other documentation as specified in the PAE. Level 2 reimbursement for rehabilitative services and acuity points for such rehabilitative services shall not be approved for chronic conditions, exacerbations of chronic conditions, weakness after hospitalization, or maintenance of functional status, although the NF shall be required to ensure that appropriate services and supports are provided based on the individualized needs of each resident.

(iv) Applicants not eligible to receive care in a NF, but at risk of NF placement and requesting HCBS in ECF CHOICES Group 4 or 5. The Applicant has an intellectual or developmental disability as defined under Tennessee state law, including for an Applicant with ID, limitations in two (2) or more adaptive skill areas (i.e., communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure, and work); and for an Applicant age five (5) or older with DD, substantial functional limitations in three (3) or more major life activities (i.e., self-care; receptive and expressive language; learning; mobility; self-direction; capacity for independent living; and economic selfsufficiency); such that, in the absence of the provision of a moderate level of ECF CHOICES home and community based services and supports on an ongoing basis, the individual’s condition and/or ability to continue living in the community will likely deteriorate, resulting in the need for more expensive institutional placement.

(c) For continued TennCare reimbursement of care in a NF, a Member must continue to be financially eligible for TennCare reimbursement for NF care and must continue to meet NF LOC (including medical necessity of care and the need for inpatient care) in place at the time of enrollment into CHOICES Group 1.

(d) A NF Eligible admitted to a NF and enrolled in CHOICES Group 1 prior to July 1, 2012, who continues to meet the LOC criteria in place at the time of enrollment into CHOICES Group 1 shall continue to meet NF LOC for purposes of enrolling in CHOICES Group 2, subject to requirements set forth in 1200-13-01-.05(3) and 1200- 13-01-.05(4).

(e) A NF Eligible receiving HCBS in CHOICES Group 2 prior to July 1, 2012, shall be required to meet the NF LOC in place as of July 1, 2012, in order to qualify for Medicaid-reimbursed NF care unless TennCare determines that the Member’s needs can no longer be safely and cost-effectively met in CHOICES Group 2.

(5) Criteria for Medicaid Level 2 and Enhanced Respiratory Care Reimbursement of Care in a NF.

(a) The NF must have completed the PASRR process as described in 1200-13-01-.10(2)(i) above and pursuant to 1200-13-01-.23.

(b) An Applicant must meet both of the following criteria in order to be approved for Medicaid Level 2 reimbursement of care in a NF:

1. The Applicant must meet NF LOC as defined in 1200-13-01-.10(4) above.

2. Need for Inpatient Skilled Nursing or Rehabilitative Services on a Daily Basis:

The Applicant must have a physical or mental condition, disability, or impairment that requires skilled nursing or rehabilitative services on a daily basis or skilled rehabilitative services at least five days per week when skilled rehabilitative services constitute the primary basis for the approval of the PAE. The Applicant must require such services at a greater frequency, duration, or intensity than, for practical purposes, would be provided through a daily home health visit. In addition, the Applicant must be mentally or physically unable to perform the needed skilled services or the Applicant must require skilled services which, in accordance with accepted medical practice, are not usually and customarily selfperformed. For interpretation of this rule, the following shall apply:

(i) Administration of oral medications, ophthalmics, otics, inhalers, subcutaneous injections (e.g., fixed-dose insulin, subtherapeutic heparin, and calcitonin), topicals, suppositories, nebulizer treatments, oxygen administration, shall not, in and of itself, be considered sufficient to meet the requirement of (5)(b)2.

(ii) Nursing observation and assessment, in and of itself, shall not be considered sufficient to meet the requirement of (5)(b)2. Examples of nursing services for which Level 2 reimbursement might be provided include, but are not limited to, the following:

(I) Gastrostomy tube feeding (II) Sterile dressings for Stage 3 or 4 pressure sores (III) Total parenteral nutrition (IV) Intravenous fluid administration (V) Nasopharyngeal and tracheostomy suctioning (VI) Ventilator services (iii) A skilled rehabilitative service must be expected to improve the Applicant’s condition. Restorative and maintenance nursing procedures (e.g., routine range of motion exercises; stand-by assistance during ambulation; applications of splints/braces by nurses and nurses’ aides) shall not be considered sufficient to fulfill the requirement of (5)(b)2. Factors to be considered in the decision as to whether a rehabilitative service meets, or continues to meet, the requirement of (5)(b)2. shall include, but not be limited to, an assessment of the type of therapy and its frequency, the remoteness of the injury or impairment, and the reasonable potential for improvement in the Applicant’s functional capabilities or medical condition.

(iv) Effective July 1, 2012, level 2 NF reimbursement for sliding scale insulin may be authorized for an initial period of no more than two (2) weeks for Applicants with unstable blood glucose levels that require daily monitoring and administration of sliding scale insulin. Approval of such reimbursement will require a physician’s order and supporting documentation including a plan of care for stabilizing the Applicant’s blood sugar and transitioning to fixed dosing during the approval period.

Additional periods of no more than two (2) weeks per period, not to exceed a maximum total of sixty (60) days, may be authorized upon submission of a new PAE and only with a physician’s order and detailed explanation regarding why previous efforts to stabilize and transition to fixed dosing were not successful.

(c) In order to be approved for TennCare-reimbursed care in a NF at the Chronic Ventilator rate of reimbursement, an Applicant must be ventilator dependent for at least 12 hours each day with an invasive patient end of the circuit (i.e., tracheostomy cannula). On a case-by-case basis, TennCare may, subject to additional medical review, authorize Chronic Ventilator Reimbursement for an Applicant who is ventilator dependent with a progressive neuromuscular disorder or spinal cord injury, and is ventilated using noninvasive positive pressure ventilation (NIPPV) by mask or mouthpiece for at least 12 hours each day in order to avoid or delay tracheostomy.

(d) In order to be approved by the Bureau for TennCare-reimbursed care in a NF at the Secretion Management Tracheal Suctioning rate of reimbursement:

1. An Applicant must have a functioning tracheostomy and a copious volume of secretions, and require either:

(i) Invasive tracheal suctioning, at a minimum, once every three (3) hours with documented assessment pre- and post-suctioning; or (ii) The use of mechanical airway clearance devices and/or heated high flow molecular humidification via the tracheostomy, at a minimum, three (3) times per day with documented assessment pre-and post.

(I) A copious volume of secretions shall be defined as 25 to 30 ml per day occurring over the course of the day, and not necessarily at every suctioning.

(II) The requirement for invasive tracheal suctioning, at a minimum, once every three (3) hours shall be applied as a marker of the severity of the Applicant’s respiratory care needs. Secretion Management Tracheal Suctioning is not a scheduled intervention and shall not be performed as a medication would be delivered, i.e., at scheduled intervals (except as prescribed by an appropriately licensed health care professional practicing within the scope of his or her license).

Rather, tracheal suctioning should be provided as clinically indicated, based on the needs of each person requiring such care; evidence of the need should be clearly and accurately documented. This could mean a shorter or longer interval at any point, but with a clinical need for invasive tracheal suctioning an average of every three (3) hours or more often in order to qualify for Secretion Management Tracheal Suctioning Reimbursement, except when mechanical airway clearance devices and/or heated high flow molecular humidification via the tracheostomy are used to manage secretions.

(III) When mechanical airway clearance devices and/or heated high flow molecular humidification via the tracheostomy are used to manage secretions, there must be documented evidence of the Applicant’s copious secretions, but they are managed non-invasively using a cough assist device periodically or high flow molecular humidity continuously or at least three (3) times per day as ongoing treatment.

The device is expected to provide ongoing relief of the copious volume of secretions, which shall not negate the need for intervention (and eligibility for Secretion Management Tracheal Suctioning Reimbursement), if absent the high flow device, the copious volume of secretions would require more invasive management.

2. The suctioning (or airway clearance, as applicable) must be required to remove excess secretions and/or aspirate from the trachea, which cannot be removed by the Applicant’s spontaneous effort. Suctioning of the nasal or oral cavity does not qualify for this higher level of reimbursement. An MCO may authorize, based on medical necessity, short-term payment at the Sub-Acute Tracheal Suctioning Enhanced Respiratory Care rate for a person who has just been weaned from the ventilator, but who still requires short-term intensive respiratory intervention during the post-weaning period which shall include documented progress in weaning from the tracheostomy.

3. A PAE for Secretion Management Tracheal Suctioning Reimbursement shall be approved for no more than a period of thirty (30) days. Clinical review and approval of a new PAE shall be required for ongoing coverage, which shall include evaluation of clinical progress and the NF’s efforts to improve secretion management through alternative methods. TennCare may, on a case-by-case

basis, approve a PAE for Secretion Management Tracheal Suctioning Management Reimbursement for a period of more than thirty (30) days, e.g., if a person has ALS (amyotrophic lateral sclerosis) or another progressive neuromuscular disorder, spinal cord injury, or chronic respiratory failure, or is in a persistent vegetative state, and evidence clearly supports that ongoing secretion management tracheal suctioning is expected to continue.

4. A NF who has an approved PAE for Tracheal Suctioning Reimbursement for any resident as of July 1, 2016 shall be entitled to continue to receive such level of reimbursement no later than July 31, 2016 (or any earlier date that may be specified in the approved PAE). The NF shall submit a new PAE for such resident no later than July 19, 2016 in order to determine whether Secretion Management Tracheal Suctioning Reimbursement will be continued, or whether a different level of NF reimbursement is appropriate.

(e) Determination of medical necessity and authorization for Ventilator Weaning Reimbursement, or short-term payment at the Sub-Acute Tracheal Suctioning Enhanced Respiratory Care rate for a person who has just been weaned from the ventilator, but who still requires short-term intensive respiratory intervention shall be managed by the Enrollee’s MCO.

(6) TennCare Nursing Facility Level of Care Acuity Scale.

(a) Effective July 1, 2012, for all new enrollments into CHOICES Groups 1 and 2 and for approval of NF LOC for individuals applying for enrollment into ECF CHOICES, LOC eligibility for TennCare-reimbursement of NF services shall be based on an assessment of the following measures:

1. The Applicant’s need for assistance with the following Activities of Daily Living (ADLs):

(i) Transfer;

(ii) Mobility;

(iii) Eating; and (iv) Toileting.

2. The Applicant’s level of independence (or deficiency) in the following ADL-related functions:

(i) Communication (expressive and receptive);

(ii) Orientation (to person and place);

(iii) Dementia-related behaviors; and (iv) Self-administration of medications.

3. The Applicant’s need for certain skilled and/or rehabilitative services.

(b) One or more questions on the PAE for NF LOC shall be used to assess each of the ADL or related measures specified above. There are four (4) possible responses to each question.

(c) Weighted Values.

1. Interpretation of possible responses for all measures except behavior:

(i) “Always” shall mean that the Applicant is always independent with that ADL or related activity.

(ii) “Usually” shall mean that the Applicant is usually independent (requiring assistance fewer than 4 days per week).

(iii) “Usually not” shall mean that the Applicant is usually not independent (requiring assistance 4 or more days per week).

(iv) “Never” means that the Applicant is never independent with that ADL or related activity.

2. Interpretation of possible responses for the behavior measure:

(i) “Always” shall mean that the Applicant always requires intervention for dementia-related behaviors.

(ii) “Usually” shall mean that the Applicant requires intervention for dementiarelated behaviors 4 or more days per week.

(iii) “Usually not” shall mean that the Applicant requires intervention for dementia-related behaviors, but fewer than 4 days per week.

(iv) “Never” shall mean that the Applicant does not have dementia-related behaviors that require intervention.

3. The weighted value of each of the potential responses to a question regarding the ADL or related functions specified above when supported by the medical evidence submitted with the PAE shall be as follows:

ADL (or related) question Condition Always Usually Usually not Never Maximum Individual Acuity Score Maximum Acuity Score for the Measure(s)

Transfer Highest value of two measures 0 1 3 4 4 Mobility 0 1 2 3 3 Eating 0 1 3 4 4 4 Toileting Highest value of three questions for the toileting measure 0 0 1 2 2 Incontinence care 0 1 2 3 3 Catheter/ ostomy care 0 1 2 3 3 Orientation 0 1 3 4 4 4 Expressive communication Highest value of two questions for the communication measure 0 0 0 1 1 Receptive communication 0 0 0 1 1 Selfadministration of medication First question only; excludes SS insulin Behavior 3 2 1 0 3 3 Maximum possible ADL (or related) Acuity Score 21 4. The weighted value for each of the skilled and/or rehabilitative services for which level 2 or enhanced respiratory care NF reimbursement could be authorized when determined by TennCare to be needed by the Applicant on a daily basis or at least five days per week for rehabilitative services, based on the medical evidence submitted with the PAE shall be as follows:

Skilled or rehabilitative service Maximum Individual Acuity Score Ventilator 5 Frequent tracheal suctioning 4 New tracheostomy or old tracheostomy requiring suctioning through the tracheostomy multiple times per day at less frequent intervals, i.e., < every 4 hours Total Perenteral Nutrition (TPN) 3 Complex wound care (i.e., infected or dehisced wounds) 3 Wound care for stage 3 or 4 decubitus 2 Peritoneal dialysis 2 Tube feeding, enteral 2 Intravenous fluid administration 1 Injections, sliding scale insulin 1 Injections, other IV, IM 1 Isolation precautions 1 PCA pump 1 Occupational Therapy by OT or OT assistant 1 Physical Therapy by PT or PT assistant 1 Teaching catheter/ostomy care 0 Teaching self-injection 0 Other 0 Maximum Possible Skilled Services Acuity Score 5 5. Conditions.

(i) Maximum Acuity Score for Transfer and Mobility:

(I) Assessment of the need for assistance with transfer and the need for assistance with mobility are separate but overlapping measures of an Applicant’s physical independence (or dependence) with movement.

(II) The maximum individual acuity score for transfer shall be four (4).

(III) The maximum individual acuity score for mobility shall be three (3).

(IV) The highest individual acuity score among the transfer and mobility measures shall be the Applicant’s total acuity score across both measures.

(V) The maximum acuity score across both of the transfer and mobility measures shall be four (4).

(ii) Maximum Acuity Score for Toileting:

(I) Assessment of the need for assistance with toileting shall include the following:

I. An assessment of the Applicant’s need for assistance with toileting;

II. Whether the Applicant is incontinent, and if so, the degree to which the Applicant is independent in incontinence care; and III. Whether the Applicant requires a catheter and/or ostomy, and if so, the degree to which the Applicant is independent with catheter and/or ostomy care.

(II) The highest individual acuity score among each of the three (3) toileting questions shall be the Applicant’s total acuity score for the toileting measure.

(III) The maximum acuity score for toileting shall be two (2).

(iii) Maximum Acuity Score for Communication:

(I) Assessment of the Applicant’s level of independence (or deficiency) with communication shall include an assessment of expressive as well as receptive communication.

(II) The highest individual acuity score across each of the two (2) communication questions shall be the Applicant’s total score for the communication measure.

(III) The maximum possible acuity score for communication shall be one (1).

(iv) Maximum Acuity Score for Self-Administration of Medication:

(I) Assessment of the Applicant’s level of independence (or deficiency) with self-administration of medications as an ADL-related function shall not take into consideration whether the Applicant requires sliding scale insulin and the Applicant’s level of independence in selfadministering sliding scale insulin.

(II) Sliding scale insulin shall be considered along with other skilled and/or rehabilitative services for which TennCare could authorize level 2 NF reimbursement .

(III) The maximum individual acuity score for self-administration of medication shall be two (2).

(IV) The maximum individual acuity score for sliding scale insulin shall be one (1).

(v) Maximum Skilled Services Acuity Score:

(I) The highest individual acuity score across all of the skilled and/or rehabilitative services shall be the Applicant’s total acuity score for skilled and/or rehabilitative services.

(II) The maximum possible acuity score for skilled and/or rehabilitative services shall be five (5).

(d) Maximum Acuity Score 1. The maximum possible acuity score for Activities of Daily Living (ADL) or related deficiencies shall be twenty-one (21).

2. The maximum possible acuity score for skilled and/or rehabilitative services shall be five (5).

3. The maximum possible total NF LOC acuity score shall be twenty-six (26).

(e) Calculating an Applicant’s Total Acuity Score.

1. Subject to the conditions set forth in 1200-13-01-.10(6)(c)5., an Applicant’s acuity score for each functional measure (i.e., eating, toileting, orientation, communication, self-administration of medication, or behavior), or in the case of transfer and mobility, the Applicant’s acuity score across both measures shall be added in order to determine the Applicant’s total ADL or related acuity score (up to a maximum of 21).

2. The Applicant’s total ADL or related acuity score shall then be added to the Applicant’s skilled services acuity score (up to a maximum of 5) in order to determine the Applicant’s total acuity score (up to a maximum of 26).

(7) PreAdmission Evaluation Denials and Appeal Rights.

(a) A TennCare Eligible or the legal representative of the TennCare Eligible has the right to appeal the denial of a PAE and to request an Administrative Hearing by submitting a written letter of appeal to the Bureau of TennCare, Division of Long-Term Services and Supports, within thirty (30) calendar days of receipt of the notice of denial.

(b) If the Bureau denies a PAE, the Applicant will be notified in the following manner:

1. A written Notice of denial shall be sent to the Applicant and, where applicable, to the Designated Correspondent. A Notice of denial shall also be provided to the NF. This notice shall advise the Applicant of the right to appeal the denial decision within thirty (30) calendar days. The notice shall also advise the Applicant of the right to submit within thirty (30) calendar days either the original PAE with additional information for review or a new PAE. The Notice shall be mailed to the Applicant’s address as it appears upon the PAE. If no address appears on the PAE and supporting documentation, the Notice will be mailed to the NF for forwarding to the Applicant.

2. If the PAE is resubmitted with additional information for review or if a new PAE is submitted, and the Bureau continues to deny the PAE, another written notice of denial shall be sent as described in (7)(b)1.

(c) The Applicant has the right to be represented at the hearing by anyone of his/her choice. The hearing will be conducted according to the provisions of the Tennessee Uniform Administrative Procedures Act.

(d) Reasonable accommodations shall be made for Applicants with disabilities who require assistance with an appeal.

(e) Any Notice required pursuant to this section shall be a plain language written Notice.

(f) When a PAE is approved for a fixed period of time with an Expiration Date determined by the Bureau, the Applicant shall be provided with a Notice of appeal rights, including the opportunity to submit an appeal within thirty (30) calendar days of receipt of the notice of denial. Nothing in this section shall preclude the right of the Applicant to submit a new PAE establishing medical necessity of care when the Expiration Date has been reached.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 71-5-105, 71-5-106, 71-5-109, 71-5-110, 71-5-111, 71-5-112, and 71-5-164 and TennCare II/III Section 1115(a) Medicaid Demonstration Waiver Extension.
• Administrative History: Original rule filed October 22, 1981; effective December 7, 1981. Amendment filed March 1, 1982; effective April 15, 1982. Amendment filed June 23, 1983; effective July 25, 1983. Amendment filed May 24, 1985; effective June 23, 1985. Amendment filed November 9, 1988; effective December 24, 1988. Amendment filed March 30, 1995; effective June 15, 1995. Repeal and new rule filed June 29, 2000; effective September 12, 2000. Amendment filed July 24, 2003; effective October 7, 2003. Amendment filed September 30, 2005; effective December 14, 2005. Public necessity rule filed July 1, 2009; effective through December 13, 2009. Amendment filed September 11, 2009; effective December 10, 2009. Emergency rules filed March 1, 2010; effective through August 28, 2010. Amendments filed May 27, 2010; effective August 25, 2010. Emergency rule filed June 29, 2012; effective through December 26, 2012. Repeal and new rule filed September 26, 2012; effective December 25, 2012. Emergency rule filed June 30, 2015; effective through December 27, 2015. Amendment filed April 14, 2015; effective July 13, 2015. Amendment filed September 23, 2015; effective December 22, 2015. Emergency rules filed July 1, 2016; effective through December 28, 2016. Amendments filed September 30, 2016; effective December 29, 2016. Amendments filed July 3, 2017; effective October 1, 2017. Emergency rules filed November 20, 2020; effective through May 19, 2021. Amendments filed February 17, 2021; effective May 18, 2021. Amendments filed November 1, 2022; effective January 30, 2023.

Tenn. Comp. R. & Regs. 1200-13-01-.11 MEDICAL (LEVEL OF CARE) ELIGIBILITY CRITERIA FOR TENNCARE

REIMBURSEMENT OF CARE FOR CHILDREN IN THE KATIE BECKETT PROGRAM.

(1) Definitions. See Rule 1200-13-01-.02.

(2) PreAdmission Evaluations (PAE).

(a) A PAE is required in the following circumstances:

1. To determine medical (LOC) eligibility for the Katie Beckett program. A child must have an approved PAE for the applicable LOC to be enrolled into the Katie Beckett program or to be on the waiting list for the Katie Beckett program. 2 When a child requires continuation of the same LOC beyond an expiration date assigned by TennCare.

2. When a child’s condition has improved such that the previously approved LOC criteria may no longer be met.

3. To determine medical (LOC) eligibility to transition from Medicaid Diversion Group Part B to Katie Beckett Group Part A, unless the child has an approved, unexpired PAE for institutional (LOC).

(b) A PAE is not required in the following circumstances:

1. To transition from Katie Beckett Group Part A to Medicaid Diversion Group Part B unless the child’s condition has improved such that a new PAE is needed to ensure the child would meet “at-risk” LOC.

2. To transition from the Continued Eligibility Group Part C to Katie Beckett Group

Part A.

(c) Medical (LOC) eligibility for children in the Katie Beckett program is determined only in accordance with these criteria established specifically for children under age 18.

(d) Subject to (f) below, an approved PAE for a child applying for Katie Beckett Group Part A or Medicaid Diversion Group Part B shall be valid for 365 calendar days beginning with the PAE Approval Date, unless an earlier expiration date is established by TennCare.

(e) A valid approved PAE that has not been used within 365 calendar days of the PAE Approval Date must be updated before it can be used for purposes of enrollment into Katie Beckett. To update a PAE for Katie Beckett, the physician shall certify that the Applicant’s medical condition on the revised PAE Request Date is consistent with that described in the initial certification and/or assessment and that home-based services, including HCBS, are medically necessary and that the child’s needs can be met at home. Such update need not occur until such time that there is a slot available for enrollment into Katie Beckett for which the child meets prioritization criteria. An updated PAE shall not be required for purposes of remaining on the waiting list, unless the Applicant’s medical condition has significantly changed such that the previously approved PAE does not reasonably reflect the Applicant’s current medical condition and functional capabilities or the Applicant’s LOC prioritization score.

(f) If the Applicant’s medical condition has significantly changed such that the previously approved PAE does not reasonably reflect the Applicant’s current medical condition and functional capabilities or the Applicant’s LOC prioritization score, a new PAE shall be required.

(g) A PAE must include a recent history and physical or current medical records that support the Applicant’s functional and/or skilled nursing or rehabilitative needs, as reflected in the PAE. A history and physical performed within 365 calendar days of the PAE Request Date may be used if the Applicant’s condition has not significantly changed. Medical records (progress notes, office records, discharge summaries, etc.) may be used to supplement a history and physical and provide current medical information if changes have occurred since the history and physical was performed, or may be used in lieu of a history and physical, so long as the records provide medical evidence sufficient to support the functional and/or skilled or rehabilitative needs reflected in the PAE.

(h) A PAE must be certified as follows:

1. Physician certification shall be required for enrollment into Katie Beckett Group

Part A and the Continued Eligibility Group Part C. Certification of the need for NF care may be performed by a nurse practitioner, clinical nurse specialist, or physician assistant, working in collaboration with a physician.

2. Physician certification shall not be required for enrollment into Medicaid Diversion Group Part B.

3. Certification of the level of care assessment by a Qualified Assessor shall be required for all PAEs.

(i) A PAE may be approved by the Division for a fixed period of time with an expiration date based on an assessment by the Division of the Applicant’s medical condition and anticipated continuing need for inpatient nursing care. Notice of appeal rights shall be provided when a PAE is approved with an expiration date.

(j) Any deficiencies in a submitted PAE application must be cured prior to disposition of the PAE to preserve the PAE submission date for payment purposes.

1. Deficiencies cured after the PAE is denied but within thirty (30) days of the original PAE submission date will be processed as a new application, with reconsideration of the earlier denial based on the record as a whole (including both the original denied application and the additional information submitted). If approved, the effective date of PAE approval can be no more than ten (10) days prior to the date of receipt of the information which cured the original deficiencies in the denied PAE. Payment will not be retroactive back to the date the deficient application was received or to the date requested in the deficient application.

2. Once a PAE has been denied, the original denied PAE application must be resubmitted along with any additional information which cures the deficiencies of the original application. Failure to include the original denied application may delay the availability of Medicaid reimbursement for NF services.

(3) Level of Care Criteria for Katie Beckett Program.

(a) Institutional Level of Care. There shall be two Tiers for Institutional LOC (Tier 1 and Tier 2).

1. Tier 1 Institutional LOC. There shall be two types of Tier 1 Institutional LOC (Medical and Behavioral).

(i) Tier 1 – Medical Institutional LOC. In order to qualify for Tier 1 – Medical Institutional LOC, all of the following must be met:

(I) The child has a medical diagnosis from a qualified treating medical professional of a severe, lifelong chronic medical condition with high mortality and morbidity rates resulting in severe functional limitations and complex medical needs;

(II) The child’s medical needs are chronic, persistent and expected to last at least twelve (12) months from the date of review;

(III) The child’s medical needs require high health care service needs and utilization (e.g., frequent ED visits and/or hospital admissions, multiple surgeries, multiple subspecialists);

(IV) The child’s overall health condition presents the constant potential for complications or rapid deterioration. As a result, the child requires continuous (round-the-clock) observation by an awake trained care provider—a professional nurse, parent, or others properly instructed to immediately detect potential life-threatening situations, respond promptly to render appropriate care, and perform emergency procedures to prevent hospitalization or death;

(V) The child’s medical needs require frequent, direct, skilled medical interventions (whether provided by a licensed nurse or by a parent or other caregiver who has been trained to provide such care), including skilled medical tasks that are performed multiple times during each 8-hour period and the use of medical equipment to sustain life and prevent life-threatening situations.

I. The frequency and complexity of the required skilled medical interventions must be so substantial that without these direct, continuous skilled medical interventions, the child is at imminent risk of institutionalization within an in-patient medical hospital.

II. The complex skilled medical interventions must include at least one (1) of the following:

A. Ventilator care or non-invasive positive pressure ventilation when required for at least 8 hours per day as a life-sustaining measure for chronic respiratory failure;

B. Tracheostomy care requiring suctioning multiple times each 8-hour period;

C. Oxygen administration for chronic hypoxia requiring at least 8 hours of oxygen use daily, round-the-clock monitoring of O2 saturation levels, and titration of O2 levels administered;

D. Parenteral Nutrition (TPN); and/or E. Dialysis: hemodialysis or peritoneal, in home or at clinic.

III. Any interventions not specified above, including site care, shall not meet this criterion.

IV. The skilled care needs cannot be acute or of a short-term duration.

V. Tasks that are performed only when necessary (PRN) and are not required on an ongoing basis do not meet this criterion.

(ii) Tier 1 – Behavioral Institutional LOC. In order to qualify for Tier 1 – Behavioral Institutional LOC, all of the following criteria must be met:

(I) The child has one of the following:

I. Severe or profound deficits in intellectual and/or adaptive behavior functions, which must include significant communication deficits; or II. Autism and a severe or profound communication disorder;

(II) The child has severe co-occurring behavioral health support needs that have persisted for at least six (6) months and are expected to last at least twelve (12) months from the date of review and include persistent and dangerous behaviors that place the child or others at imminent and significant risk of serious physical harm. To meet this criterion, a child must demonstrate dangerous behaviors in at least one of the two dangerous behaviors categories:

I. Self-injurious behaviors. These behaviors include:

A. Self-hitting, cutting, scratching, burning, pinching, or picking. Repeated and intentional hitting one’s self; cutting, burning, scratching, pinching, picking or abrading one’s skin hard and frequently enough to break skin, or create a visible mark, burn or tissue damage (does not include piercing or tattooing);

B. Severe self-biting. Repeated, intentional and severe biting by child of child’s own body parts, in attempt to rupture skin (does not include biting nails or cuticles or biting lip without intent to injure);

C. Tearing at or out body parts. Repeated, intentional and severe picking or tearing at body parts in a manner and degree that is likely to cause severe injury (includes rectal digging but does not include picking at a scab or scratches until a body part bleeds or hair pulling);

D. Inserting harmful objects into body orifices. Repeated and intentional insertion into body orifices of harmful objects that can tear or puncture the skin;

E. Head-banging. Repeated, intentional and severe banging one’s head against hard surfaces;

F. Body slamming or dropping. Making contact between the body and any object with enough force to make a visible mark or forcefully falling to the floor with no visible cause to fall;

G. Self-gagging or strangulation. Any instance of using a hand or other object to induce gagging or vomiting, or strangulation involving the production of unconsciousness or near unconsciousness by restriction of the supply of oxygenated blood to the brain; and H. Eating disorders, the effects of which must be life threatening, as determined by physician. In the case of Anorexia/Bulimia, the child must have malnutrition, electrolyte imbalances or body weight/development below 20th percentile due to the eating disorder or in the case of Pica or Prader Willi syndrome, must at least 4 days per week attempt to ingest non-edible substances or gorge self, as applicable, and require continuous (round-the-clock) “within arm’s reach” supervision and immediate engagement of a paid or unpaid trained caregiver to prevent serious harm to the child.

II. Physically Aggressive Behaviors toward others:

A. A persistent pattern of physically aggressive behaviors not explained by the age or lack of maturity of the aggressor that results in serious harm to others, or that would result in serious harm without intervention or restraints. Includes targeting of violent behaviors against a parent, sibling or other that results in serious harm, or that was intended to inflict serious harm even if actual harm did not occur, or if the act was interrupted and not carried out. May include hitting (using a hand or arm with a closed or open fist to make forceful physical contact with another person), hitting with objects (whether held or thrown), kicking (with foot or leg), headbutting (using the head or face to make forceful physical contact with another person), biting, scratching that breaks skin, pinching when hard enough to cause severe pain, forceful pushing, or hair pulling; or B. Sexually Aggressive Behavior. Attempts and/or successes at touching, groping, undressing others, or grabbing others in their private areas or making physical contact of a perceived sexual nature which is unwanted by the other person; sexual molestation or abuse of others.

III. The intensity and frequency of the dangerous behaviors is such that without continuous (round-the-clock) supervision and monitoring and direct, daily community-based therapeutic support and intervention, the child will engage in severe selfinjury or physical aggression toward others and is at imminent risk for institutionalization in an inpatient psychiatric hospital or other placement outside the home (e.g., residential treatment, State custody, or incarceration), even if a formal mental health diagnosis (other than I/DD or autism) has not been made.

A. Self-Injurious Behaviors and/or Physically Aggressive Behaviors must occur at least four days a week and require all of the following:

(A) Continuous (round-the-clock) “eyes on” observation, supervision and immediate engagement of a paid or unpaid trained caregiver to prevent serious harm to the child or others;

(B) Environmental or other restraints; and (C) Engagement of behavioral health professionals for treatment and support; or B. Self-Injurious behaviors and/or physically aggressive behaviors must occur at least once a week if the intensity of such behaviors routinely requires engagement of crisis supports, including behavior crisis teams, law enforcement, or emergency medical treatment to prevent or treat serious harm to the child or others.

IV. The child is involved with service systems and/or is receiving treatment from such service systems, but such involvement and/or treatment has not been effective in reducing the child’s behaviors or the significant risk of serious physical harm to the child or others, or in increasing the family’s capacity to effectively manage the child’s behaviors. Involvement with service systems must include at least one of the following:

A. Crisis Mental Health Services. The child has an established pattern of utilization of crisis-related behavioral health services over the previous six months, which may include repeated mobile crisis calls, emergency department visits, psychiatric hospitalizations, and/or residential or intensive in-home treatment. The use of psychotropic medications (including PRN usage for purposes of chemical restraint in a behavioral crisis) is not considered a crisis-related behavioral health service. Nor is routine psychiatric care or outpatient therapy.

B. Child Protective Services. The child has formal ongoing involvement with the child welfare system specifically related to his or her severe behavioral health needs.

C. Criminal Justice System. The child has been engaged with the criminal justice system in the past six months specifically related to his or her severe behavioral health needs. Includes Juvenile and Adult Justice Systems, if applicable.

2. Tier 2 Institutional LOC. There shall be three (3) standards for Tier 2 Institutional LOC (Medical, Behavioral, and Functional). A child must meet only one of these standards to meet Tier 2 Institutional LOC.

(i) Tier 2 Institutional LOC - Standard 1: Medical. To meet Tier 2 Institutional LOC - Standard 1: Medical, a child must meet all of the following criteria:

(I) The child has a medical diagnosis from a qualified treating medical professional of a severe chronic medical condition expected to last at least twelve (12) months and which significantly diminishes his/her functional capacity and interferes with the ability to perform age appropriate activities of daily living at home and in the community;

(II) The child requires daily skilled nursing interventions and/or intensive therapy services as defined below:

I. Daily skilled nursing interventions may include any of the complex skilled medical interventions listed in Tier 1 – Medical Institutional LOC above (ventilator care or NIPPV, tracheostomy care, O2 administration, TPN, and dialysis), including daily ventilator care or NIPPV for less than 8 hours per day, tracheostomy care requiring daily suctioning but not multiple times per each 8 hours, or daily O2 use less than 8 hours daily.

II. Daily skilled nursing interventions may also include, but are not limited to, the following:

A. Tube feedings: G-tube, J-tube or NG-tubes;

B. Respiratory treatments for airway clearance: chest PT, C-PAP, Bi-PAP, vest device or cough assist device, IPPB treatments. This does not include inhalers or nebulizers.

C. Ileostomy, colostomy, or appendicostomy (Malone procedure) care; and D. Need for urinary catheterization daily, or presence of vesicostomy or Mitrofanoff appendecovesicostomy.

III. PRN orders do not qualify as daily skilled nursing interventions.

IV. Site care, diabetes management, and medication administration, including topical or oral medication, eye drops, inhalers, nebulizers, growth hormone injections, insulin injections, or chemotherapy, shall not meet this criterion.

V. Intensive therapy services shall include only medically necessary physical, occupational, or speech therapy provided by a licensed professional therapist and shall apply only if the child is involved in six or more sessions per week with professional therapists.

(III) The child has at least two (2) substantial functional limitations in activities of daily living. For purposes of this rule, substantial functional limitations shall include only the following:

I. Learning: A substantial functional limitation in learning is defined as a 30% (25% if the child is under one year of age) or greater delay or a score of at least 2 (1.5 if the child is under one year of age) standard deviations below the mean based on valid, standardized and norm referenced measures of aggregate intellectual functioning.

II. Communication: A substantial functional limitation in communication is defined as a 30% (25% if the child is under one year of age) or greater delay or a standard score of at least 2 (1.5 if the child is under one year of age) standard deviations below the mean on valid, standardized and norm referenced measures of both expressive and receptive communication functioning.

III. Self-Care: The child must demonstrate a deficit in at least one of the following five areas of self-care:

A. Bathing B. Grooming C. Dressing D. Toileting E. Eating If a child exhibits deficits in multiple of the self-care activities of daily living identified above, this shall still be counted as one substantial functional limitation (in self-care).

IV. Mobility: The inability to run or to move long distances or between environments related to stamina or ease of movement shall not constitute a mobility deficit.

(IV) The child requires an extraordinary (continuous or nearly continuous) level of hands on assistance from others throughout their day to complete everyday activities and supervision/intervention that is significantly beyond that which is routinely provided to other children of the same age; and (V) The intensity and frequency of required skilled interventions and assistance with activities of daily living must be so substantial that it would require at least the level of direct, daily intervention that would be provided in a medical institution, i.e., a nursing facility or intermediate care facility for individuals with intellectual disabilities (ICF/IID).

(ii) Tier 2 Institutional LOC - Standard 2: Behavioral. To meet Tier 2 Institutional LOC - Standard 2: Behavioral, a child must meet all of the following criteria:

(I) The child has severe or profound deficits in intellectual or adaptive behavior functions, which must include significant communication deficits, or has autism and a severe or profound communication disorder;

(II) The child has severe co-occurring behavioral health support needs that have persisted for at least six (6) months and are expected to last at least twelve (12) months from the date of review, including self-injurious behaviors or physically aggressive behaviors toward others as defined in Subpart (3)(a)1.(ii) above, including the intensity and frequency of behaviors, except that an extraordinary level of hands on assistance shall be required as defined in (IV) below;

(III) The child has at least two (2) substantial functional limitations in activities of daily living;

(IV) The child requires an extraordinary (continuous or nearly continuous) level of hands on assistance to complete everyday activities and supervision/intervention from others throughout their day that is significantly beyond that which is routinely provided to other children of the same age; and (V) The intensity and frequency of required behavioral interventions and assistance with activities of daily living must be so substantial that it would require at least the level of direct, daily intervention that would be provided in a medical institution, i.e., a nursing facility or intermediate care facility for individuals with intellectual disabilities (ICF/IID).

(iii) Tier 2 Institutional LOC - Standard 3: Functional. To meet Tier 2 Institutional LOC – Standard 3: Functional, a child must meet all of the following criteria:

(I) The child has an intellectual or developmental disability as defined in

Rule .02 and at least four (4) substantial functional limitations in activities of daily living that are expected to continue for at least 12 months;

(II) The child requires an extraordinary (continuous or nearly continuous) level of hands on assistance to complete everyday activities and supervision/intervention from others throughout their day that is significantly beyond that which is routinely provided to other children of the same age; and (III) The intensity and frequency of assistance with activities of daily living must be so substantial that it would require at least the level of direct, daily intervention that would be provided in a medical institution, i.e., a nursing facility or intermediate care facility for individuals with intellectual disabilities (ICF/IID).

(b) At-Risk Level of Care. There shall be two (2) standards for At-Risk LOC (I/DD and Medical). A child must meet only one of these standards to meet At-Risk LOC.

1. At-Risk Level of Care Standard 1: I/DD. To meet At-Risk LOC – Standard 1:

I/DD, a child must meet both of the following criteria:

(i) The child has an intellectual or developmental disability as defined in State law and regulation which significantly diminishes his/her functional capacity and interferes with the ability to perform age appropriate activities of daily living at home and in the community.

(ii) This child requires daily intermittent (not continuous) assistance from others to complete everyday activities that is significantly beyond that which is routinely provided to children of that age; or 2. At-Risk Level of Care Standard 2: Medical. To meet At-Risk LOC – Standard 2:

Medical, a child must meet all of the following criteria:

(i) The child has a medical diagnosis from a qualified treating medical professional of a severe chronic medical condition expected to last at least twelve (12) months and which significantly diminishes his/her functional capacity and interferes with the ability to perform age appropriate activities of daily living at home and in the community.

(ii) The child requires daily skilled nursing interventions and/or intensive therapy services as defined in Tier 2 Institutional LOC Standard 1: Medical above.

(iii) The child has at least one (1) substantial functional limitation in activities of daily living requiring daily intermittent (not continuous) assistance from others to complete everyday activities that is significantly beyond that which is routinely provided to children of that age.

(4) Katie Beckett LOC Determinations (a) An Applicant for Katie Beckett shall first be reviewed for At-Risk LOC.

(b) All At-Risk LOC determinations for Katie Beckett Applicants shall be made by DIDD in accordance with these rules.

(c) An Applicant must be approved for At-Risk LOC in order to be reviewed for Institutional LOC.

(d) DIDD will refer an Applicant approved for At-Risk LOC to also be reviewed for Institutional LOC if the Applicant meets certain triggers which indicate he or she may also meet Institutional LOC.

(e) The parent or legal guardian of a child applying for Katie Beckett may request that the child is reviewed for Institutional LOC, even if such triggers are not met.

(f) All initial Institutional LOC determinations for Katie Beckett Applicants shall be made by a neutral third party contracted with TennCare.

(g) All denials of Institutional LOC for Katie Beckett Applicants by the neutral third party shall be reviewed by a licensed physician before a denial can be issued.

(h) All Institutional LOC determinations are subject to final review and approval by TennCare.

(5) PreAdmission Evaluation Denials and Appeal Rights.

(a) An Applicant or the legal representative of the Applicant has the right to appeal the denial of a PAE and to request an Administrative Hearing by submitting a written letter of appeal to TennCare, Division of Long-Term Services and Supports, within thirty (30) calendar days of receipt of the notice of denial.

(b) If an Applicant or the legal representative of the Applicant appeals the denial of Institutional LOC, the appellant may request and TennCare will arrange as part of the appeal review, a peer-to-peer review with the child’s treating physician in order to gather any additional information regarding the child’s medical, behavioral, or functional needs. This information shall be reviewed to determine whether the denial should be overturned prior to the case proceeding to hearing.

(c) If TennCare denies a PAE, the Applicant will be notified in the following manner:

1. A written Notice of denial shall be sent to the Applicant and, where applicable, to the Designated Correspondent. This notice shall advise the Applicant of the right to appeal the denial decision within thirty (30) calendar days and the opportunity to request a peer-to-peer review with the child’s treating physician. The notice shall also advise the Applicant of the right to submit within thirty (30) calendar days either the original PAE with additional information for review or a new PAE.

The Notice shall be mailed to the Applicant’s address as it appears upon the PAE.

2. If the PAE is resubmitted with additional information for review or if a new PAE is submitted, and the Bureau continues to deny the PAE, another written notice of denial shall be sent as described in (5)(b)1.

(d) The Applicant has the right to be represented at the hearing by anyone of his/her choice. The hearing will be conducted according to the provisions of the Tennessee Uniform Administrative Procedures Act.

(e) Reasonable accommodations shall be made for Applicants with disabilities who require assistance with an appeal.

(f) Any Notice required pursuant to this section shall be a plain language written Notice.

(g) When a PAE is approved for a fixed period of time with an Expiration Date determined by the Bureau, the Applicant shall be provided with a Notice of appeal rights, including the opportunity to submit an appeal within thirty (30) calendar days of receipt of the notice of denial. Nothing in this section shall preclude the right of the Applicant to submit a new PAE establishing medical necessity of care when the Expiration Date has been reached.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 71-5-105, 71-5-106, 71-5-109, 71-5-110, 71-5-111, 71-5-112, and 71-5-164 and TennCare II/III Section 1115(a) Medicaid Demonstration Waiver Extension.
• Administrative History: Original rule filed June 7, 1982; effective July 22, 1982. Repeal and new rule filed February 23, 1987; effective April 9, 1987. Amendment filed March 22, 1989; effective May 16, 1989. Amendment filed June 8, 1990; effective July 23, 1990. Amendment filed March 18, 1994; effective June 1, 1994. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendments filed May 27, 2010; effective August 25, 2010. Repeal filed February 1, 2013; effective July 29, 2013. Emergency rules filed November 20, 2020; effective through May 19, 2021. Amendments filed February 17, 2021; effective May 18, 2021.

Tenn. Comp. R. & Regs. 1200-13-01-.12 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 14-23-105, 14-23-109, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed March 2, 1983; effective April 4, 1983. Repeal and new rule filed February 4, 1985; effective March 6, 1985. Amendment filed July 5, 1990; effective August 19, 1990. Repeal filed March 18, 1994; effective June 1, 1994.

Tenn. Comp. R. & Regs. 1200-13-01-.30 TENNCARE ICF/MR SERVICES

(1) Definitions. See Rule 1200-13-01-.02.

(2) Eligibility for Medicaid-reimbursed care in an ICF/MR.

(a) The individual must be determined by DHS to be financially and categorically eligible for Medicaid-reimbursed LTC services.

(b) The individual must have a valid, unexpired ICF/MR PAE that has been approved by the Bureau in accordance with Rule 1200-13-01-.15.

(3) Conditions of participation for ICFs/MR.

(a) The ICF/MR must enter into a provider agreement with the Bureau.

(b) The ICF/MR must be certified by the State, showing it has met the standards set out in 42 C.F.R., Part 442, Subpart C and 42 C.F.R., Part 483.

(c) ICFs/MR participating in the State of Tennessee’s TennCare Program shall be terminated as TennCare providers if certification or licensure is canceled by the State.

(d) If the resident has resources to apply toward payment, the payment made by the State will be his current maximum payment per day, charges or per diem cost (whichever is less), minus the available patient resources.

(e) Payments for residents requiring ICF/MR services will not exceed per diem costs or charges, whichever is less.

(f) If an ICF/MR (upon submission of a cost report and audit of its cost), has collected on a per diem basis during the period covered by the cost report and audit, more than cost reimbursement allowed for the ICF/MR patient, the facility shall be required to reimburse the State (through the Bureau and/or the ICF/MR’s Third Party), for that portion of the reimbursement collected in excess of the cost reimbursement allowed.

(g) Regardless of the reimbursement rate established for an ICF/MR, no ICF/MR may charge TennCare Enrollees an amount greater than the amount per day charge to private paying patients for equivalent accommodations and services.

(h) Personal laundry services in an ICF/MR shall be considered a covered service and included in the per diem rate. TennCare Enrollees may not be charged for personal laundry services.

(4) Conditions that ICFs/MR must meet to receive Medicaid reimbursement.

(a) An ICF/MR that has entered into a provider agreement with the Bureau of TennCare is entitled to receive Medicaid reimbursement for covered services provided to an ICF/MR Eligible if 1. The Bureau has received an approvable ICF/MR PAE for the individual within ten (10) calendar days of the ICF/MR PAE Request Date or the physician certification date, whichever is earlier. The PAE Approval Date shall not be more than ten (10) days prior to date of submission of an approvable PAE. An approvable PAE is one in which any deficiencies in the submitted application are cured prior to disposition of the PAE.

2. For the transfer to an ICF/MR of an individual having an approved unexpired ICF/MR PAE, the Bureau has received an approvable Transfer Form within ten (10) calendar days after the date of the transfer. For transfer from ICF/MR services to an HCBS MR Waiver program, the transfer form must be submitted and approved prior to enrollment in the HCBS MR Waiver Program.

3. For a retroactive eligibility determination, the Bureau has received a Notice of Disposition or Change and has received an approvable request to update an approved, unexpired ICF/MR PAE within thirty (30) calendar days of the mailing date of the Notice of Disposition or Change. The effective date of payment for ICF/MR services shall not be earlier than the PAE Approval Date of the original approved, unexpired PAE which has been updated.

(b) Any deficiencies in a submitted PAE application must be cured prior to disposition of the PAE to preserve the PAE submission date for payment purposes.

1. Deficiencies cured after the PAE is denied but within thirty (30) days of the original PAE submission date will be processed as a new application, with reconsideration of the earlier denial based on the record as a whole (including both the original denied application and the additional information submitted). If approved, the effective date of PAE approval can be no earlier than the date of receipt of the information which cured the original deficiencies in the denied PAE.

Payment will not be retroactive back to the date the deficient application was received or to the date requested in the deficient application.

2. Once a PAE has been denied, the original denied PAE application must be resubmitted along with any additional information which cures the deficiencies of the original application. Failure to include the original denied application may delay the availability of Medicaid reimbursement for ICF/MR services.

(c) An ICF/MR that admits a Medicaid Eligible without an approved ICF/MR PreAdmission Evaluation or, where applicable, an approved Transfer Form does so without the assurance of reimbursement from the Bureau.

(5) Reimbursement methodology for ICFs/MR.

(a) Private for-profit and private not-for-profit ICFs/MR shall be reimbursed at the lower of Medicaid cost or charges. An annual inflation factor will be applied to operating costs.

The trending factor shall be computed for facilities that have submitted cost reports covering at least six (6) months of program operations. For facilities that have submitted cost reports covering at least three (3) full years of program participation, the trending factor shall be the average cost increase over the three-year (3-year) period, limited to the seventy-fifth (75th) percentile trending factor of facilities participating for at least three (3) years. Negative averages shall be considered zero (0). For facilities that have not completed three (3) full years in the program, the one-year (1-year) trending factor shall be the fiftieth (50th) percentile trending factor of facilities participating in the program for at least three (3) years. For facilities that have failed to file timely cost reports, the trending factor shall be zero (0). Capital-related costs are not subject to indexing. Capital-related costs are property, depreciation, and amortization expenses included in Section F.18 and F.19 of the Nursing Facility Cost Report Form. All other costs, including home office costs and management fees, are operating costs. Once a per-diem rate is determined from a clean cost report, the rate will not be changed until the next rate determination except for audit adjustments, correction of errors, or termination of a budgeted rate. Reimbursement is not to exceed the amount budgeted by the State for private ICF/MR reimbursement. The Comptroller’s Office shall be authorized to adjust per diem rates up or down as necessary during the year.

(b) Public ICFs/MR that are owned by government shall be reimbursed at one hundred percent (100%) of allowable Medicaid costs with no cost-containment incentive.

Reimbursement shall be based on Medicare principles of retrospective cost reimbursement with year-end cost report settlements. Interim per-diem rates for the fiscal year beginning July 1, 1995 and ending June 30, 1996 shall be established from budgeted cost and patient day information submitted by the government ICF/MR facilities. Thereafter, interim rates shall be based on the providers’ cost reports. There will be a tentative year-end cost settlement within thirty (30) days of submission of the cost reports and a final settlement within twelve (12) months of submission of the cost reports.

(c) Costs for supplies and other items, including any facility staff required to deliver the service, which are billed to Medicare Part B on behalf of all patients must be included as a reduction to reimbursable expenses in Section G of the NF cost report.

(6) Bed holds.

An ICF/MR will be reimbursed in accordance with this Paragraph for the recipient’s bed in that facility during the recipient’s temporary absence from that facility in accordance with the following:

(a) For days not to exceed fifteen (15) days per occasion while the recipient is hospitalized and the following conditions are met:

1. The resident intends to return to the ICF/MR.

2. The hospital provides a discharge plan for the resident.

3. At least eighty-five percent (85%) of all other beds in the ICF/MR certified at the recipient’s designated level of care (i.e., intensive training, high personal care or medical), when computed separately, are occupied at the time of hospital admission. An occupied bed is one that is actually being used by a patient.

Beds being held for other patients while they are hospitalized or otherwise absent from the facility are not considered to be occupied beds, for purposes of this calculation. Computations of occupancy percentages will be rounded to the nearest percentage point.

4. Each period of hospitalization must be physician ordered and so documented in the patient’s medical record in the ICF/MR.

(b) For days not to exceed sixty (60) days per state fiscal year and limited to fourteen (14) days per occasion while the recipient, pursuant to a physician’s order, is absent from the facility on a therapeutic home visit or other therapeutic absence.

(7) Other reimbursement issues.

(a) No change of ownership or controlling interest of an existing Medicaid provider, including ICFs/MR, can occur until monies as may be owed to the Bureau or its contractors are provided for. The purchaser shall notify the Bureau of the purchase at the time of ownership change and is financially liable for the outstanding liabilities to the Bureau or its contractors for one (1) year from the date of purchase or for one (1) year following the Bureau’s receipt of the provider’s Medicare final notice of program reimbursement, whichever is later. The purchaser shall be entitled to use any means available to it by law to secure and recoup these funds from the selling entity. In addition, purchasers of ICFs/MR are responsible for obtaining an accurate accounting and transfer of funds held in trust for Medicaid residents at the time of the change of ownership or controlling interest.

(b) If the Bureau or an MCO has not reimbursed a business for TennCare services provided under the TennCare Program at the time the business is sold, when such an amount is determined, the Bureau or the MCO shall be required to reimburse the person owning the business provided such sale included the sale of such assets.

(c) When a provider was originally paid within a retrospective payment system that is subject to regular adjustments and the provider disputes the proposed adjustment action, the provider must file with the State not later than thirty (30) days after receipt of the notice informing the provider of the proposed adjustment action, a request for hearing. The provider’s right to a hearing shall be deemed waived if a hearing is not requested within thirty (30) days after receipt of the notice.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 71-5-105, and 71-5-109.
• Administrative History: Emergency rule filed March 1, 2010; effective through August 28, 2010. Original rule filed May 27, 2010; effective August 25, 2010. Emergency rule filed December 20, 2011; effective through June 17, 2012. Amendment filed March 14, 2012; effective June 12, 2012.

Tenn. Comp. R. & Regs. 1200-13-01-.31 TENNCARE EMPLOYMENT AND COMMUNITY FIRST CHOICES (ECF CHOICES)

PROGRAM.

(1) Definitions. See Rule 1200-13-01-.02.

(2) Program components. The TennCare ECF CHOICES Program is a managed LTSS program that is administered by specified TennCare MCOs under contract with the Bureau. The specified MCOs are responsible for coordinating all covered physical, behavioral, and LTSS for their Members who qualify for and are enrolled in ECF CHOICES. The program consists of HCBS, as described in this Chapter.

(3) Eligibility for ECF CHOICES.

(a) There are three (3) groups in ECF CHOICES:

1. ECF CHOICES Group 4 (Essential Family Supports).

(i) Participation in ECF CHOICES Group 4 is limited to TennCare Members living at home with family who qualify for and are receiving TennCarereimbursed ECF CHOICES HCBS. “Family” shall mean individual(s) to whom the child or adult with I/DD is legally related, whether the relationship is by blood, by marriage, or by adoption. “Family” shall not include a foster care or paid living arrangement. To be eligible for ECF CHOICES Group 4, Applicants must meet the following criteria:

(I) Be in one of the defined target populations;

(II) Qualify in the specified eligibility categories;

(III) Meet NF LOC or be “At Risk for Institutionalization,” as defined in

Rule 1200-13-01-.02;

(IV) Need and upon enrollment in ECF CHOICES Group 4, receive on an ongoing basis ECF CHOICES HCBS;

(V) Have needs that can be safely and appropriately met in the community and at a cost that does not exceed the Expenditure Cap, as described in Section 1200-13-01-.31(4)(d); and (VI) Qualify in one of the priority categories for which enrollment into ECF CHOICES is currently open and for which a slot is available, or for an available reserve capacity slot.

(ii) Target Populations for ECF CHOICES Group 4. Only persons in one of the target populations below may qualify to enroll in ECF CHOICES Group 4:

(I) Persons who have an intellectual disability as defined in Rule 1200- 13-01-.02.

(II) Persons who have a developmental disability as defined in Rule

Tenn. Comp. R. & Regs. 1200-13-01-.14 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, and 71-5-109 and Public Chapter 358 of the Acts of 1993.
• Administrative History: Original rule filed February 14, 1984; effective March 15, 1984. Amendment filed August 21, 1984; effective September 20, 1984. Repeal filed March 18, 1994; effective June 1, 1994.

Tenn. Comp. R. & Regs. 1200-13-01-.15 MEDICAL (LOC) ELIGIBILITY CRITERIA FOR MEDICAID REIMBURSEMENT OF

CARE IN AN ICF/MR.

(1) Definitions. See Rule 1200-13-01-.02.

(2) ICF/MR PreAdmission Evaluations and Transfer Forms (a) An ICF/MR PreAdmission Evaluation is required to be submitted to the Bureau of TennCare for approval when 1. A Medicaid Eligible is admitted to an ICF/MR.

2. A private-paying resident of an ICF/MR attains Medicaid Eligible status or applies for Medicaid eligibility. A new ICF/MR PreAdmission Evaluation is not required when an individual’s financial status changes from Medicaid Eligible to private pay and then back to Medicaid Eligible within a 90-day time period.

(b) A Transfer Form is required to be submitted to the Bureau of TennCare for approval when an ICF/MR Eligible having an approved unexpired ICF/MR PAE transfers from one ICF/MR to another ICF/MR or from the HCBS MR Waiver Program to an ICF/MR.

A Transfer Form is required to be submitted to the Division of Intellectual Disabilities Services for approval when an ICF/MR Eligible having an approved unexpired ICF/MR PAE transfers from an ICF/MR to the HCBS MR Waiver Program.

(c) An approved ICF/MR PreAdmission Evaluation is valid for ninety (90) calendar days from the ICF/MR PAE Approval Date. An approved ICF/MR PreAdmission Evaluation that has not been used within ninety (90) calendar days of the ICF/MR PAE Approval Date can be updated within 365 calendar days of the ICF/MR PAE Approval Date if the physician certifies that the individual’s current medical condition is consistent with that described in the approved ICF/MR PreAdmission Evaluation. A PAE that is not used within 365 days of the PAE Approval Date is expired and cannot be updated.

(d) An ICF/MR PreAdmission Evaluation must include a recent medical history and physical signed by a physician who is licensed as a doctor of medicine or doctor of osteopathy, or by a licensed nurse practitioner or physician’s assistant. A medical

history and physical performed within 365 calendar days of the ICF/MR PAE Request Date may be used if the individual’s condition has not significantly changed. Additional medical records (progress notes, office records, discharge summaries, etc.) may be used to supplement a history and physical and provide current medical information if changes have occurred since the history and physical was performed.

(e) An ICF/MR PAE must include a psychological evaluation of need for care. Pursuant to 42 C.F.R. § 456.370(b), such evaluation must be performed before admission to the ICF/MR or authorization of payment, but not more than three months before admission.

(3) Medicaid Reimbursement (a) An ICF/MR which has entered into a provider agreement with the Bureau of TennCare is entitled to receive Medicaid reimbursement for covered services provided to an ICF/MR Eligible if:

1. The Bureau of TennCare has received an approvable ICF/MR PreAdmission Evaluation for the individual within ten (10) calendar days of the ICF/MR PAE Request Date or the physician certification date, whichever is earlier. The PAE Approval Date shall not be more than ten (10) days prior to date of submission of an approvable PAE. An approvable PAE is one in which any deficiencies in the submitted application are cured prior to disposition of the PAE.

2. For the transfer to an ICF/MR of an individual having an approved unexpired ICF/MR PreAdmission Evaluation, the Bureau of TennCare has received an approvable Transfer Form within ten (10) calendar days after the date of the transfer. For transfer from ICF/MR services to an HCBS MR Waiver program, the transfer form must be submitted and approved prior to enrollment in the HCBS MR Waiver program.

3. For a retroactive eligibility determination, the Bureau of TennCare has received a Notice of Disposition or Change and has received an approvable request to update an approved, unexpired ICF/MR PreAdmission Evaluation within thirty (30) calendar days of the mailing date of the Notice of Disposition or Change.

The effective date of payment for ICF/MR services shall not be earlier than the PAE Approval Date of the original approved, unexpired PAE which has been updated.

(b) Any deficiencies in a submitted PAE application must be cured prior to disposition of the PAE to preserve the PAE submission date for payment purposes.

1. Deficiencies cured after the PAE is denied but within thirty (30) days of the original PAE submission date will be processed as a new application, with reconsideration of the earlier denial based on the record as a whole (including both the original denied application and the additional information submitted). If approved, the effective date of PAE approval can be no earlier than the date of receipt of the information which cured the original deficiencies in the denied PAE.

Payment will not be retroactive back to the date the deficient application was received or to the date requested in the deficient application.

2. Once a PAE has been denied, the original denied PAE application must be resubmitted along with any additional information which cures the deficiencies of the original application. Failure to include the original denied application may delay the availability of Medicaid reimbursement for ICF/MR services.

(c) An ICF/MR that admits a Medicaid Eligible without an approved ICF/MR PreAdmission Evaluation or, where applicable, an approved Transfer Form does so without the assurance of reimbursement from the Bureau of TennCare.

(4) Criteria for Medicaid-reimbursed Care in an Intermediate Care Facility for the Mentally Retarded (ICF/MR)

(a) Medicaid Eligible Status: The individual must be determined by the Tennessee Department of Human Services to be financially eligible for Medicaid-reimbursed care in an Intermediate Care Facility for the Mentally Retarded.

(b) An individual must meet all of the following criteria in order to be approved for Medicaid-reimbursed care in an Intermediate Care Facility for the Mentally Retarded:

1. Medical Necessity of Care: Care must be expected to enhance the individual’s functional ability or to prevent or delay the deterioration or loss of functional ability. Care in an Intermediate Care Facility for the Mentally Retarded must be ordered and supervised by a physician.

2. Diagnosis of Mental Retardation or Related Conditions.

3. Need for Specialized Services for Mental Retardation or Related Conditions: The individual must require a program of specialized services for mental retardation or related conditions provided under the supervision of a qualified mental retardation professional (QMRP). The individual must also have a significant deficit or impairment in adaptive functioning in one of the following areas: communication, comprehension, behavior, or activities of daily living (e.g., toileting, bathing, eating, dressing/grooming, transfer, mobility).

(c) Individuals with mental retardation or related conditions who were in an Intermediate Care Facility for the Mentally Retarded or who were in community residential placements funded by the Division of Intellectual Disabilities on or prior to the effective date of this rule may be deemed by the Bureau of TennCare to meet the requirements of (4)(b)2. and (4)(b)3.

(d) For continued Medicaid reimbursement of care in an Intermediate Care Facility for the Mentally Retarded, an individual must continue to meet the criteria specified in (4)(a) and (4)(b), unless otherwise exempted by (4)(c).

(5) Grievance process (a) A Medicaid Eligible or the legal representative of the Medicaid Eligible has the right to appeal the denial of an ICF/MR PreAdmission Evaluation and to request a Commissioner’s Administrative Hearing by submitting a written letter of appeal to the Bureau of TennCare within thirty (30) calendar days of receipt of the notice of denial.

(b) If the Bureau of TennCare denies an ICF/MR PreAdmission Evaluation, the individual will be notified in the following manner:

1. A written notice of denial shall be sent to the individual and, where applicable, to the Designated Correspondent. A notice of denial shall also be sent to the ICF/MR. This notice shall advise the individual of the right to appeal the denial decision within thirty (30) calendar days. The notice shall also advise the individual of the right to submit within thirty (30) calendar days either the original ICF/MR PAE with additional information for review or a new ICF/MR PAE. The notice shall be mailed to the individual’s address as it appears upon the ICF/MR PAE. If no address appears on the ICF/MR PAE and supporting documentation, the notice will be mailed to the ICF/MR for forwarding to the individual.

2. If an ICF/MR PreAdmission Evaluation is resubmitted with additional information for review and if the Bureau of TennCare continues to deny the ICF/MR PreAdmission Evaluation, another written notice of denial shall be sent as described in (5)(b)1.

(c) The individual has the right to be represented at the hearing by anyone of their choice.

The hearing will be conducted according to the provisions of the Tennessee Uniform Administrative Procedures Act.

(d) Reasonable accommodations shall be made for individuals with disabilities who require assistance with appeals.

(e) Any notice required pursuant to this section shall be a plain language written notice.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-208, 4-5-209, 71-5-105, and 71-5-109 and Executive Order No. 11.
• Administrative History: Original rule filed June 22, 2000; effective September 5, 2000. Public necessity rule filed July 1, 2009; effective through December 13, 2009. Amendment filed September 11, 2009; effective December 10, 2009. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendments filed May 27, 2010; effective August 25, 2010.

Tenn. Comp. R. & Regs. 1200-13-01-.16 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, and 71-5-109 and Public Chapter 358 of the Acts of 1993.
• Administrative History: Original rule filed September 11, 1987; effective October 31, 1987. Amendment filed March 6, 1991; effective April 20, 1991. Amendment filed September 9, 1991; effective October 24, 1991. Amendment filed November 27, 1991; effective January 11, 1992. Amendment filed October 20, 1992; effective December 4, 1992. Amendment filed December 4, 1992; effective January 19, 1993. Amendment filed March 18, 1994; effective June 1, 1994. Repeal filed January 26, 2007; effective date April 11, 2007. Emergency rule filed March 1, 2010; effective through August 28, 2010.

Tenn. Comp. R. & Regs. 1200-13-01-.22 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, and 71-5-109; Executive Order No. 23; and Public Chapter 358 of the Acts of 1993.
• Administrative History: Original rule filed December 1, 1988; effective January 15, 1989. Amendment filed January 29, 1990; effective March 15, 1990. Amendment filed March 18, 1994; effective June 1, 1994. Repeal filed September 18, 2007; effective December 2, 2007.

Tenn. Comp. R. & Regs. 1200-13-01-.23 NURSING HOME PREADMISSION SCREENINGS FOR MENTAL ILLNESS AND

MENTAL RETARDATION.

(1) Definitions. See Rule 1200-13-01-.02.

(2) Medicaid-certified nursing facilities may not admit individuals applying for admission unless these persons are screened to determine if they have mental illness or mental retardation regardless of method of payment or “known diagnosis.” A Medicaid-certified nursing facility is prohibited from admitting any new resident who has mental illness or mental retardation (or a related condition), unless that individual has been determined by the Tennessee Department of Mental Health and Developmental Disabilities and/or the Division of Intellectual Disabilities Services, as applicable, not to be in need of specialized services and appropriate for placement in a nursing facility. (The individual must also meet the Bureau of TennCare’s preadmission criteria for nursing facility services). The criteria to be used in making determinations will be categorized into two levels: 1) identification screens (Level I) and 2) preadmission screening/resident reviews evaluations (Level II).

(a) Criteria for Identification Screen (Level I)

1. Prior to admission of any person to a nursing facility, it must be determined if:

(i) For Mental Illness:

(I) The individual has a diagnosis of MI. (See definition of MI in Rule

Tenn. Comp. R. & Regs. 1200-13-14-.04 . Any Adult Dental Services received prior to January 1, 2023, shall apply to the maximum amounts allowable for the qualifying time period during which the service was performed as outlined by this rule.

No 2. Assistive Technology, Adaptive Equipment and Supplies Covered with a limit of five thousand dollars ($5,000) per person per calendar year, in combination with Enabling Technology.

Not covered under ECF CHOICES if available under Section 110 of the Rehabilitation Act of 1973, or the IDEA (20 U.S.C. §§ 1401 et seq.).

No Service Benefits for ECF CHOICES Members Benefits for Consumer Direction (“Eligible ECF CHOICES HCBS”)

3. Community Integration Support Services Covered in accordance with limitations specified in Rule 1200-13-01-.02.

Not covered as a separate service for persons receiving CLS or CLS-FM.

For members not working in the community (excludes a facility-based setting) and not receiving any employment services: Up to 20 hours per week of Community Integration Support Services and Independent Living Skills Training combined after completing an Employment Informed Choice process.

For members working in the community or receiving at least one employment service: Up to 30 hours per week of Community Integration Support Services, Independent Living Skills Training, and Individual or Small Group Employment Supports combined.

For members working in individualized integrated employment or selfemployment: Up to 40 hours per week of Community Integration Support Services, Independent Living Skills Training, Job Coaching, Co-Worker Supports and the hours worked without paid supports combined.

For members working in individualized integrated employment or selfemployment at least 30 hours a week:

Up to 50 hours per week of Community Integration Support Services, Independent Living Skills Training, Job Coaching, Co-Worker Supports and the hours worked without paid supports combined.

Payment for attendance and materials and supplies at classes and conferences and club/association dues can be covered, but cannot exceed five hundred dollars ($500) per year for children under age twenty (20) or one thousand dollars ($1,000) for adults age twenty-one (21) or older.

No Service Benefits for ECF CHOICES Members Benefits for Consumer Direction (“Eligible ECF CHOICES HCBS”)

4. Community Living Supports (CLS) and Community Living Supports—Family Model (CLS-FM)

Covered only for adults age 21 and older enrolled in ECF CHOICES Group 5 or 6.

No 5. Community Support Development, Organization and Navigation Covered only for Members enrolled in ECF CHOICES Group 4.

No 6. Community Transportation Covered for transportation to employment and to support participation in community activities when public or other community-based transportation services are not available or when assistance is needed in order to access such benefits.

Shall not supplant NEMT available for medical appointments.

Limited to $225 per month for Members electing to receive this benefit through Consumer Direction.

Yes 7. Decision Making Supports Covered. Limited to five hundred dollars ($500) in one-time assistance per member.

Legal or court fees may be reimbursed only upon completion of counseling services to protect and preserve individual rights and freedoms.

No 8. Enabling Technology Covered with a limit of five thousand dollars ($5,000) per person per calendar year, in combination with Assistive Technology, Adaptive Equipment and Supplies.

Not covered under ECF CHOICES if available under Section 110 of the Rehabilitation Act of 1973, or the IDEA (20 U.S.C. §§ 1401 et seq.).

No 9. Family Caregiver Education and Training Covered only for Members enrolled in ECF CHOICES Group 4 when approved in advance by the Member’s MCO.

Limited to five hundred dollars ($500) per calendar year.

No Service Benefits for ECF CHOICES Members Benefits for Consumer Direction (“Eligible ECF CHOICES HCBS”)

10. Family Caregiver Stipend in lieu of SHC Covered only for Members enrolled in ECF CHOICES Group 4 and only when supports for employment and community integration are provided.

For a child under age eighteen (18), the Family Caregiver Stipend shall be limited to five hundred dollars ($500) per month.

For an adult age eighteen (18) or older, the Family Caregiver Stipend shall be no more than one thousand dollars ($1,000) per month.

No 11. Family-to-Family Support Covered only for Members enrolled in ECF CHOICES Group 4.

No 12. Health Insurance Counseling/Forms Assistance Covered only for Members enrolled in ECF CHOICES Group 4.

Limited to fifteen (15) hours per person per calendar year.

No Service Benefits for ECF CHOICES Members Benefits for Consumer Direction (“Eligible ECF CHOICES HCBS”)

13. Independent Living Skills Training Covered in accordance with limitations specified in Rule 1200-13-01-.02.

Not covered as a separate service for persons receiving CLS or CLS-FM.

For members not working in the community (excludes a facility-based setting) and not receiving any employment services: Up to 20 hours per week of Independent Living Skills Training and Community Integration Support Services combined after completing an Employment Informed Choice process.

For members working in the community or receiving at least one employment service: Up to 30 hours per week of Independent Living Skills Training, Community Integration Support Services, and Individual or Small Group Employment Supports combined.

For members working in individualized integrated employment or selfemployment: Up to 40 hours per week of Independent Living Skills Training, Community Integration Support Services, Job Coaching, Co-Worker Supports and the hours worked without paid supports combined.

For members working in individualized integrated employment or selfemployment at least 30 hours a week:

Up to 50 hours per week of Independent Living Skills Training, Community Integration Support Services, Job Coaching, Co-Worker Supports and the hours worked without paid supports combined.

No 14. Individual Education and Training Services Covered only for Members enrolled in ECF CHOICES Group 5 or 6 when approved in advance by the Member’s MCO.

Limited to five hundred dollars ($500) per Member per calendar year.

No Service Benefits for ECF CHOICES Members Benefits for Consumer Direction (“Eligible ECF CHOICES HCBS”)

15. Integrated Employment Path Services (time limited prevocational training)

Covered for persons age 16 or older in accordance with limitations specified in

Rule 1200-13-01-.02.

Limited to no more than twelve (12) months. One extension of up to twelve (12) months can be allowed only if the individual is actively pursuing individualized employment in an integrated setting and has documentation that a service(s) (e.g.

Job Development or Self-Employment Start-Up funded by Tennessee Rehabilitation Services, this Waiver or another similar source) is concurrently authorized for this purpose.

Limited to 30 hours per week of Integrated Employment Path Services, other Individual or Small Group Employment Supports, Independent Living Skills Training, and Community Integration Support Services combined.

No 16. Minor Home Modifications Covered in accordance with limitations specified in Rule 1200-13-01-.02 and with a limit of $6,000 per project, $10,000 per calendar year, and $20,000 per lifetime.

No 17. Peer-to-Peer Support and Navigation for Person- Centered Planning, Self- Direction, Integrated Employment/Self- Employment and Independent Community Living Covered only for Members enrolled in ECF CHOICES Group 5 or 6.

Limited to one thousand five hundred dollars ($1,500) per person per lifetime.

No 18. Personal Assistance Covered only for ECF CHOICES Members enrolled in Group 5 or 6.

In ECF CHOICES Group 6 (Comprehensive Supports for Employment and Community Living) benefit group, Personal Assistance is limited to two hundred fifteen (215) hours per month.

Yes Service Benefits for ECF CHOICES Members Benefits for Consumer Direction (“Eligible ECF CHOICES HCBS”)

19. Respite Covered with limitations as follows:

Up to thirty (30) days of service per person per calendar year or up to two hundred sixteen (216) hours per person per calendar year, depending on the needs and preferences of the individual as reflected in the PCSP.

The two (2) limits cannot be combined in a calendar year.

Yes for hourly Respite only; daily Respite shall not be available through Consumer Direction 20. Specialized Consultation and Training Covered only for adults age 21 or older enrolled in ECF CHOICES Group 5 or 6.

Limited to five thousand dollars ($5,000) per person per calendar year, except for adults in the Comprehensive Supports for Employment and Community Living benefit group determined to have exceptional medical and/or behavioral support needs pursuant to the Level of Need process described in Rule 1200-13-01-.02.

For adults age 21 and older in ECF CHOICES Group 6 (Comprehensive Supports for Employment and Community Living) determined by TennCare to have exceptional medical and/or behavioral support needs, Specialized Consultation and Training shall be limited to ten thousand dollars ($10,000) per person per calendar year.

No 21. Supportive Home Care (SHC)

Covered only for Members enrolled in ECF CHOICES Group 4.

Yes 22. Supported Employment Individual Employment Support Covered for persons age 16 or older (or age 14 or older, as specified) in accordance with limitations specified in

Rule 1200-13-01-.02, and with the following components:

No Service Benefits for ECF CHOICES Members Benefits for Consumer Direction (“Eligible ECF CHOICES HCBS”)

Exploration – Covered for persons age 14 or older in accordance with limitations specified in Rule 1200-13- 01-.02.

Limited to once per year (with a minimum 365-day interval between services) and only if the person, at the time of re-authorization, is not already engaged in individualized integrated employment or self-employment, or other services to obtain such employment.

No Service Benefits for ECF CHOICES Members Benefits for Consumer Direction (“Eligible ECF CHOICES HCBS”)

Benefits Counseling – Covered for persons age 16 or older in accordance with limitations specified in Rule 1200- 13-01-.02.

Limited to people receiving individual employment supports. Persons receiving small group employment supports are not eligible for this benefit.

Initial Benefits Counseling for someone actively considering or seeking individualized integrated employment or self-employment, or career advancement in these types of employment: up to twenty (20) hours.

This service may be authorized no more than once every two (2) years (with a minimum of two 365-day intervals between services).

Supplementary Benefits Counseling for someone evaluating an individualized integrated job offer/promotion or selfemployment opportunity: up to an additional six (6) hours. This service may be authorized up to three (3) times per year if needed.

PRN problem-solving services for someone to maintain individualized integrated employment or selfemployment: up to eight (8) hours per situation requiring PRN assistance.

This service may be authorized up to four (4) times per year if necessary for the individual to maintain individualized integrated employment or selfemployment.

Service must not be available under

Section 110 of the Rehabilitation Act of 1973, or the IDEA (20 U.S.C. §§ 1401, et seq.). ECF may not fund this service if CWIC Benefits Counseling services funded through the Federal Work Incentives Planning and Assistance (WIPA) program are available.

No Service Benefits for ECF CHOICES Members Benefits for Consumer Direction (“Eligible ECF CHOICES HCBS”)

Discovery – Covered for persons age 14 or older in accordance with limitations specified in Rule 1200-13- 01-.02.

Limited to no more than ninety (90) calendar days from the date of service initiation.

No Situational Observation and Assessment – Covered for persons age 14 or older in accordance with limitations specified in Rule 1200-13- 01-.02.

Limited to once every three years (with a minimum of three 365-day intervals between services), and only if the person, at the time of re-authorization, is not already engaged in individualized integrated employment or selfemployment, or other services to obtain such employment, and the person has a goal to obtain individualized integrated employment or selfemployment within twelve (12) months.

No Job Development Plan or Self- Employment Plan – Covered for persons age 16 or older in accordance with limitations specified in Rule 1200- 13-01-.02.

Limited to once every three years (with a minimum of three 365-day intervals between services), and only if the person, at the time of re-authorization, is not already engaged in individualized integrated employment or selfemployment, or other services to obtain such employment, and the person has a goal to obtain individualized integrated employment or selfemployment within twelve (12) months.

Medicaid funds may not be used to defray the capital expenses associated with starting a business.

No Service Benefits for ECF CHOICES Members Benefits for Consumer Direction (“Eligible ECF CHOICES HCBS”)

Job Development Plan or Self- Employment Start Up – Covered for persons age 16 or older in accordance with limitations specified in Rule 1200- 13-01-.02.

Limited to once per year (with a minimum 365-day interval between services), and only if the person, at the time of re-authorization, is not already engaged in individualized integrated employment or self-employment, or other services to obtain such employment, and the person has a goal to obtain individualized integrated employment or self-employment within nine (9) months.

No Job Coaching – Covered for persons age 16 or older in accordance with limitations specified in Rule 1200-13- 01-.02.

Covered only for members working in individualized integrated employment or self-employment. Limited to 40 hours per week of Job Coaching, Co-Worker Supports, the hours worked without paid supports, Independent Living Skills Training, and Community Integration Support Services combined.

For members working in individualized integrated employment or selfemployment at least 30 hours a week:

Limited to 50 hours per week of Job Coaching, Co-Worker Supports, the hours worked without paid supports, Independent Living Skills Training, and Community Integration Support Services combined.

No Service Benefits for ECF CHOICES Members Benefits for Consumer Direction (“Eligible ECF CHOICES HCBS”)

Co-Worker Supports – Covered for persons age 16 or older in accordance with limitations specified in Rule 1200- 13-01-.02.

Covered only for members working in individualized integrated employment or self-employment. Limited to 40 hours per week of Co-Worker Supports, Job Coaching, the hours worked without paid supports, Independent Living Skills Training, and Community Integration Support Services combined.

For members working in individualized integrated employment or selfemployment at least 30 hours a week.

Limited to 50 hours per week of Co- Worker Supports, Job Coaching, the hours worked without paid supports, Independent Living Skills Training, and Community Integration Support Services combined.

No Career Advancement – Covered for persons age 16 or older in accordance with limitations specified in Rule 1200- 13-01-.02.

This service shall not be authorized retroactive to a promotion or second job being made available to a person.

Supports for Career Advancement may be authorized and paid once every three (3) years (with a minimum of three 365-day intervals between services), if evidence exists that the individual is eligible for promotion or able to present as a strong candidate for employment in a second job (e.g. has strong reference, performance reviews and attendance record from current employer).

No Service Benefits for ECF CHOICES Members Benefits for Consumer Direction (“Eligible ECF CHOICES HCBS”)

23. Supported Employment Small Group Supports Covered for persons age 16 or older in accordance with limitations specified in

Rule 1200-13-01-.02.

Limited to 30 hours per week of Small Group or Individual Employment Supports, Integrated Employment Path Services, Independent Living Skills Training, and Community Integration Support Services combined.

No (8) Consumer Direction (CD).

(a) CD is a model of service delivery that affords ECF CHOICES Members the opportunity to have more choice and control with respect to Eligible ECF CHOICES HCBS that are needed by the Member, in accordance with this Rule. CD is not a service or set of services.

(b) ECF CHOICES HCBS eligible for CD (Eligible ECF CHOICES HCBS).

1. CD shall be limited to the following HCBS:

(i) Personal Assistance.

(ii) Supportive Home Care.

(iii) Hourly Respite. (Daily Respite shall not be available through CD.)

(iv) Community Transportation.

2. ECF CHOICES Members determined to need Eligible ECF CHOICES HCBS may elect to receive one or more of the Eligible ECF CHOICES HCBS through a Contract Provider, or they may participate in CD.

3. ECF CHOICES Members who do not need Eligible ECF CHOICES HCBS shall not be offered the opportunity to enroll in CD.

4. The model of CD that will be implemented in ECF CHOICES is a modified budget

authority model.

5. Each Eligible ECF CHOICES HCBS identified in the Member’s PCSP that the Member elects to receive through CD shall have an individual monthly or annual budget, as specified below.

6. The amount of the budget authorized for each Eligible ECF CHOICES HCBS the Member elects to receive through CD shall be based on a comprehensive needs assessment performed by a Support Coordinator that identifies the Member’s needs, the availability of family and other unpaid caregivers to meet those needs, and the gaps in care for which paid ECF CHOICES may be authorized.

(i) Each Eligible ECF CHOICES HCBS received through CD shall have a separate budget.

(ii) The budget for each Eligible ECF CHOICES HCBS received through CD shall be based on the number of units of that service the member is assessed to need, subject to applicable benefit limits and the Member’s Expenditure Cap.

(iii) Once the budget for each Eligible ECF CHOICES HCBS is determined and authorized, the Member shall have flexibility to determine the rate of reimbursement for that service (subject to any limitations established by TennCare), and to purchase additional units of the service so long as the budget for that service is not exceeded.

(iv) The budget for each Eligible ECF CHOICES HCBS shall be separately maintained. A Member shall not direct money from the budget for one Eligible ECF CHOICES HCBS to purchase a different Eligible ECF CHOICES HCBS, provided however, that a Member’s PCSP (and consequently, the budget for any affected Eligible ECF CHOICES HCBS) may be amended based on the Member’s needs, as appropriate.

(v) Any money remaining in a Member’s monthly budget for Personal Assistance, Supportive Home Care or Community Transportation at the end of a month shall not be carried over to the next month, and cannot be used to purchase units of service in any other month.

(vi) Any money remaining in a Member’s annual budget for hourly Respite at the end of the calendar year shall not be carried over to the next year, and cannot be used to purchase additional units of service in a subsequent calendar year.

7. The amount of the budget for each Eligible ECF CHOICES HCBS shall be authorized as follows:

(i) Personal Assistance for Members enrolled in ECF CHOICES Group 5 or Group 6 and Supportive Home Care for Members enrolled in ECF CHOICES Group 4 shall have a monthly budget if provided through Consumer Direction.

(I) A Member shall only direct CD Workers to provide Personal Assistance or Supportive Home Care, as applicable, up to the amount of the authorized monthly budget for that service.

(II) A Member shall not ask or allow a CD Worker to provide services in excess of the authorized monthly budget for that service.

(III) If a Member exhausts the authorized monthly budget for a service before the month has ended, additional services shall not be authorized for the remainder of the month.

(IV) If a Member (or his Representative for CD) is not able to manage services within the approved budget for the service, the Member may not be able to remain in CD.

(ii) Community Transportation for Members enrolled in ECF CHOICES shall have a monthly budget if provided through CD.

(I) The monthly budget shall be based on the number of days in the month that the Member is expected to need Community Transportation services.

(II) The Member may receive the first month’s budget allotment in advance. The advance monthly budget allotment shall be used to purchase only Community Transportation services as defined in these rules.

(III) A Member may purchase Community Transportation services in the most cost-efficient manner possible, including public transportation (e.g., bus passes), paying a co-worker to share gas expenditures, etc.

(IV) A Member shall not reimburse any person who resides with the Member for Community Transportation.

(V) The Member is obligated to maintain a Community Transportation log and receipts for Community Transportation expenditures as required by TennCare and to submit such information on a monthly

basis to his MCO.

(VI) A Member shall only purchase Community Transportation up to the amount of the authorized monthly budget for that service.

(VII) The Member’s monthly Community Transportation budget shall be reimbursed only for documented purchases of Community Transportation services submitted to the MCO.

(VIII) A Member shall not be reimbursed for Community Transportation services in excess of the authorized monthly budget for that service.

(IX) If a Member exhausts the authorized monthly budget for Community Transportation services before the month has ended, additional services shall not be authorized for the remainder of the month.

(X) If a Member (or his Representative for CD) is not able to manage services within the approved budget for the service, the Member may not be able to remain in CD.

(iii) Respite services for Members enrolled in ECF CHOICES shall have an annual budget if provided through Consumer Direction.

(I) The annual budget shall operate on a calendar year (January 1 through December 31).

(II) A Member who elects to receive Respite through CD shall receive up to 216 hours per year of Respite services. (Daily Respite shall not be available through CD.)

(III) A Member shall only direct CD Workers to provide Respite services, as applicable, up to the amount of the authorized annual budget for that service.

(IV) A Member shall not ask or allow a CD Worker to provide services in excess of the authorized annual budget for that service.

(V) If a Member exhausts the authorized annual budget for Respite services before the calendar year has ended, additional services shall not be authorized for the remainder of the year.

(VI) If a Member (or his Representative for CD) is not able to manage services within the approved budget for the service, the Member may not be able to remain in CD.

8. HH Services, PDN Services, and ECF CHOICES HCBS other than those specified above shall not be available through CD.

(c) Eligibility for CD. To be eligible for CD, an ECF CHOICES Member must meet all of the following criteria:

1. Be a Member of ECF CHOICES.

2. Be determined by a Support Coordinator, based on a comprehensive needs assessment, to need one or more Eligible ECF CHOICES HCBS.

3. Be willing and able to serve as the Employer of Record for his Consumer- Directed Workers and to fulfill all of the required responsibilities for CD, or he must have a qualified Representative who is willing and able to serve as the Employer of Record and to fulfill all of the required responsibilities for CD.

Assistance shall be provided to the Member or his Representative by the FEA.

4. Any additional risks associated with a Member’s decision to participate in CD must be identified and addressed in the PCSP, as applicable, and the MCO must determine that the Member’s needs can be safely and appropriately met in the community while participating in CD.

5. The Member or his Representative for CD and any Workers he employs must agree to use the services of the Bureau’s contracted FEA to perform required Financial Administration and Supports Brokerage functions.

(d) Enrollment in CD.

1. An ECF CHOICES Member assessed to need one or more Eligible ECF CHOICES HCBS may elect to participate in CD at any time.

2. If the Member is unable to make a decision regarding his participation in CD or to communicate his decision, only a legally appointed Representative may make such decision on his behalf. The Member, or a family member or other caregiver, must sign a CD participation form reflecting the decision the Member has made.

3. If the Member is unable to make a decision regarding CD or to communicate his decision and does not have a legally appointed Representative, the Member cannot participate in CD since there is no one with the legal authority to assume and/or delegate the Member’s CD responsibilities.

4. Self-Assessment Tool. If a Member elects to participate in CD, he must complete a self-assessment tool developed by the Bureau to determine whether he requires the assistance of a Representative to perform the responsibilities of CD.

5. Representative. If the Member requires assistance in order to participate in CD, he must designate, or have appointed by a legally appointed Representative, a Representative to assume the CD responsibilities on his behalf.

(i) A Representative for CD must meet all of the following criteria:

(I) Be at least eighteen (18) years of age;

(II) Have a personal relationship with the Member and understand his support needs;

(III) Know the Member’s daily schedule and routine, medical and functional status, medication regimen, likes and dislikes, strengths and weaknesses; and (IV) Be physically present in the Member’s residence on a regular basis or at least at a frequency necessary to supervise and evaluate each Consumer-Directed Worker.

(ii) If a Member requires a Representative but is unwilling or unable to appoint one, the MCO may submit to the Bureau, for review and approval, a request to deny the Member’s participation in CD.

(iii) If a Member’s Support Coordinator believes that the person selected as the Member’s representative for CD does not meet the specified requirements (e.g., the Representative is not physically present in the Member’s residence at a frequency necessary to adequately supervise Workers), the Support Coordinator may request that the Member select a different Representative who meets the specified requirements. If the Member does not select another Representative who meets the specified requirements, the MCO may, in order to help ensure the Member’s health and safety, submit to the Bureau, for review and approval, a request to deny the Member’s participation in CD.

(iv) A Member’s Representative shall not receive payment for serving in this capacity and shall not serve as the Member’s paid Worker for any Consumer-Directed Service.

(v) Representative Agreement. A Representative Agreement must be signed by the Member (or person authorized to sign on the Member’s behalf) and the Representative in the presence of the Support Coordinator. By completing a Representative agreement, the Representative confirms that he agrees to serve as a Member’s representative and that he accepts the responsibilities and will perform the duties associated with being a Representative.

(vi) A Member may change his Representative at any time by notifying his Support Coordinator and his Supports Broker that he intends to change Representative. The Support Coordinator shall verify that the new Representative meets the qualifications as described above. A new Representative Agreement must be completed and signed, in the presence of a Support Coordinator, prior to the new Representative assuming his respective responsibilities.

(e) Employer of Record.

1. If a Member elects to participate in CD, either he or his Representative must serve as the Employer of Record.

2. The Employer of Record is responsible for the following:

(i) Finding, interviewing, hiring and firing Workers;

(ii) Determining Workers’ duties and developing job descriptions;

(iii) Training Workers to provide personalized support based on the Member’s needs and preferences;

(iv) Scheduling Workers;

(v) Ensuring there are enough Workers hired to provide all of the support needed by the Member (including when the Worker scheduled is unable to report to work);

(vi) Ensuring the Worker(s) keep correct time sheets for the services and supports provided;

(vii) Reviewing and approving hours reported by Consumer-Directed Workers;

(viii) Ensuring Workers provide only as much support as assigned to provide and as needed by the Member;

(ix) Ensuring that no Worker provides more than 40 hours of support each week unless the Member or Representative for CD has decided to pay overtime out of the Member’s approved budget;

(x) Managing the services the Member needs within the Member’s approved budget for each service;

(xi) Supervising Workers;

(xii) Evaluating Worker performance and addressing any identified deficiencies or concerns;

(xiii) Setting wages from a range of reimbursement levels established by the Bureau;

(xiv) Reviewing and ensuring proper documentation for services provided; and (xv) Developing and implementing as needed a Back-up Plan to address instances when a scheduled Worker is not available or fails to show up as scheduled.

(f) Denial of Enrollment in CD.

1. Enrollment into CD may be denied by the Bureau when:

(i) The person is not enrolled in TennCare or in ECF CHOICES.

(ii) The Member does not need one or more of the HCBS eligible for CD, as specified in the PCSP.

(iii) The Member is not willing or able to serve as the Employer of Record for his Consumer-Directed Workers and to fulfill all of the required responsibilities for CD, and does not have a qualified Representative who is willing and able to serve as the Employer of Record and to fulfill all of the required responsibilities for CD.

(iv) The Member is unwilling, with the assistance of his Support Coordinator, to identify and address any additional risks associated with the Member’s decision to participate in CD, or the risks associated with the Member’s decision to participate in CD pose too great a threat to the Member’s health, safety and welfare.

(v) The Member does not have an adequate Back-up Plan for CD.

(vi) The Member’s needs cannot be safely and appropriately met in the community while participating in CD.

(vii) The Member or his Representative for CD, or the Consumer-Directed Workers he wants to employ, are unwilling to use the services of the Bureau’s contracted FEA to perform required Financial Administration and Supports Brokerage functions.

(viii) Other significant concerns regarding the Member’s participation in CD which jeopardize the health, safety or welfare of the Member.

2. Denial of enrollment in CD gives rise to notice and due process including the right to a fair hearing, as set forth in this rule.

(g) Fiscal Employer Agent (FEA).

1. The FEA shall perform the following functions on behalf of all Members participating in CD:

(i) Financial Administration functions in the performance of payroll and related tasks; and (ii) Supports Brokerage functions to assist the Member or his Representative with other non-payroll related tasks such as the completion of CD enrollment paperwork and assistance with employer functions as requested.

2. The FEA shall:

(i) Assign a Supports Broker to each ECF CHOICES Member electing to participate in CD of Eligible ECF CHOICES HCBS.

(ii) Provide initial and ongoing training to Members and their Representatives (as applicable) on CD and other relevant issues.

(iii) Verify Worker qualifications, including conducting background checks on Workers, enrolling Workers into TennCare, requesting from TennCare the assignment of Medicaid provider ID numbers, and holding TennCare provider agreements.

(iv) Provide initial and ongoing training to Workers on CD and other relevant issues such as the use of the FEA time keeping system.

(v) Assist the Member and/or Representative in developing and updating Service Agreements.

(vi) Withhold, file and pay applicable federal, state and local income taxes; employment and unemployment taxes; and worker’s compensation.

(vii) Pay Workers for authorized services rendered within authorized timeframes.

(h) Back-up Plan for Consumer-Directed Workers.

1. Each Member participating in CD or his Representative is responsible for the development and implementation of a Back-up Plan that identifies how the Member or Representative will address situations when a scheduled Worker is not available or fails to show up as scheduled.

2. The Member or Representative may not elect, as part of the Back-up Plan, to go without services.

3. The Back-up Plan for CD shall include the names and telephone numbers of contacts (Workers, agency staff, organizations, supports) for alternate care, the order in which each shall be notified and the services to be provided by contacts.

4. Back-up contacts may include paid and unpaid supports; however, it is the responsibility of the Member electing CD and/or his Representative to secure paid (as well as unpaid) back-up contacts who are willing and available to serve in this capacity, and for initiating the back-up plan when needed.

5. The Member’s Back-up Plan for Consumer-Directed Workers shall be integrated into the Member’s Back-up Plan for services provided by Contract Providers, as applicable, and the Member’s PCSP.

6. The Support Coordinator shall review the Back-up Plan developed by the Member and/or his Representative to determine its adequacy to address the Member’s needs. If an adequate Back-up Plan cannot be provided to CD, enrollment into CD may be denied, as set forth in this Rule.

7. The Back-up Plan shall be reviewed and updated at least annually, and as frequently as necessary if there are changes in the type, amount, duration, scope of eligible ECF CHOICES HCBS or the schedule at which such services are needed, changes in Workers (when such Workers also serve as a back-up to other Workers) and changes in the availability of paid or unpaid back-up Workers to deliver needed support.

8. A Member may use Contract Providers to serve as back-up to Consumer Directed Workers only upon prior arrangement by the Member (or Representative for CD) with the Contract Provider, inclusion in the Member’s back-up plan, verification by the Supports Broker, prior approval by the MCO, and subject to the Member’s Expenditure Cap as described in Rule 1200-13-01- .31(4)(d). If the higher cost of services delivered by a Contract Provider would result in a Member’s Expenditure Cap being exceeded, a Member shall not be permitted to use Contract Providers to provide back-up workers. A Member’s MCO shall not be required to maintain Contract Providers on “stand-by” to provide back-up for services delivered through Consumer Direction.

(i) Consumer-Directed Workers (Workers).

1. Hiring Consumer-Directed Workers.

(i) Members shall have the flexibility to hire individuals with whom they have a close personal relationship to serve as Workers, such as neighbors or friends.

(ii) Members may hire family members, excluding spouses, to serve as Workers. However, a family member shall not be reimbursed for a service that he would have otherwise provided without pay. A Member shall not be permitted to employ any person who resides with the Member to deliver Personal Assistance, Supportive Home Care or hourly Respite services. A Member shall not reimburse any person who resides with the Member for Community Transportation.

(iii) Members may elect to have a Worker provide more than one service, have multiple Workers, or have both a Worker and a Contract Provider for a given service, in which case, there must be a set schedule which clearly defines when Contract Providers will be used.

2. Qualifications of Consumer-Directed Workers. Workers must meet the following requirements prior to providing services:

(i) Be at least eighteen (18) years of age or older;

(ii) Complete a background check that includes a criminal background check (including fingerprinting), or, as an alternative, a background check from a licensed private investigation company;

(iii) Verification that the person’s name does not appear on the State abuse registry;

(iv) Verification that the person’s name does not appear on the State and national sexual offender registries and licensure verification, as applicable;

(v) Verification that the person has not been excluded from participation in Medicare, Medicaid, SCHIP, or any Federal health care programs (as defined in Section 128B(f) of the Social Security Act);

(vi) Complete all required training;

(vii) Complete all required applications to become a TennCare provider;

(viii) Sign an abbreviated Medicaid agreement;

(ix) Be assigned a Medicaid provider ID number;

(x) Sign a Service Agreement; and (xi) If the Worker will be transporting the Member as specified in the Service Agreement, a valid driver’s license and proof of insurance must also be provided.

3. Disqualification from Serving as a Consumer-Directed Worker. A Member cannot waive the completion of a background check for a potential Worker. A background check may reveal a potential Worker’s past criminal conduct that may pose an unacceptable risk to the Member. Any of the following findings may place the Member at risk and may disqualify a person from serving as a Worker:

(i) Conviction of an offense involving physical, sexual or emotional abuse, neglect, financial exploitation or misuse of funds, misappropriation of property, theft from any person, violence against any person, or manufacture, sale, possession or distribution of any drug; and/or (ii) Entering of a plea of nolo contendere or when a jury verdict of guilty is rendered but adjudication of guilt is withheld with respect to a crime reasonably related to the nature of the position sought or held.

4. Individualized Assessment of a Consumer-Directed Worker with a Criminal Background.

(i) If a potential Worker’s background check includes past criminal conduct, the Member (or Representative for CD) must review the past criminal conduct with the help of the FEA. The Member (or Representative for CD), with the assistance of the FEA, will consider the following factors:

(I) Whether or not the evidence gathered during the potential Worker’s individualized assessment shows the criminal conduct is related to the job in such a way that could place the Member at risk;

(II) The nature and gravity of the offense or conduct, such as whether the offense is related to physical or sexual or emotional abuse of another person, if the offense involves violence against another person, or the manufacture, sale, or distribution of drugs; and (III) The time that has passed since the offense or conduct and/or completion of the sentence.

(ii) After considering the above factors and any other evidence submitted by the potential Worker, the Member (or Representative for CD) must decide whether to hire the potential Worker.

(iii) If a Member (or Representative for CD) decides to hire the Worker, the FEA shall assist the Member (or Representative for CD) in notifying the Member’s MCO of this decision and shall collaborate with the Member’s MCO to amend the Member’s PCSP to reflect the Member’s (or CD Representative’s) decision to voluntarily assume the risk associated with hiring an individual with a criminal history and that the Member (or Representative for CD) is solely responsible for any negative consequences stemming from that decision. The FEA shall also collaborate with the Member’s MCO on a risk mitigation strategy.

5. Service Agreement.

(i) A Member shall develop a Service Agreement with each Worker, which includes, at a minimum:

(I) The roles and responsibilities of the Worker and the Member;

(II) The Worker’s typical schedule (as developed by the Member and/or Representative), including hours and days;

(III) The scope of each service (i.e., the specific tasks and functions the Worker is to perform);

(IV) The service rate; and (V) The requested start date for services.

(ii) The Service Agreement must be in place for each Worker prior to the Worker providing services.

6. Payments to Consumer-Directed Workers.

(i) Rates. Members participating in CD have the flexibility to set wages for their Workers from a range of reimbursement levels established by TennCare.

(ii) Payments to Consumer-Directed Workers. In order to receive payment for services rendered, all Workers must:

(I) Deliver services in accordance with the services specified in the Member’s PCSP, the monthly or annual budget as approved in the MCO’s service authorization, and in accordance with the schedule set by the Member or the Member’s Representative for CD and Worker assignments determined by the Member or his Representative.

(II) Use the FEA time keeping system to record in and out times for each visit.

(III) Provide detailed documentation of service delivery including but not limited to the specific tasks and functions performed for the Member at each visit, which shall be maintained in the Member’s home.

(IV) Provide no more than forty (40) hours of services within a consecutive seven (7) day period, unless explicitly directed by the Employer of Record who by such direction, agrees to pay the worker over-time pay out of the Member’s budget in accordance with the Fair Labor Standards Act. This shall reduce the amount of services that may be purchased for the Member during that month.

(iii) Termination of Consumer-Directed Workers’ Employment.

(I) A Member may terminate a Worker’s employment at any time.

(II) The MCO may not terminate a Worker’s employment, but may request that a Member be involuntarily withdrawn from CD if it is determined that the health, safety and welfare of the Member may be in jeopardy if the Member continues to employ a Worker but the Member and/or Representative does not want to terminate the Worker.

(j) Withdrawal from Participation in Consumer Direction (CD).

1. General.

(i) Voluntary Withdrawal from CD. Members participating in CD may voluntarily withdraw from participation in CD at any time. The Member’s request must be in writing. Whenever possible, notice of a Member’s decision to withdraw from participation in CD should be provided in advance to permit time to arrange for delivery of services through Contracted Providers.

(ii) Voluntary or involuntary withdrawal of a Member from CD of Eligible ECF CHOICES HCBS shall not affect a Member’s eligibility for LTSS or enrollment in ECF CHOICES, provided the Member continues to meet all requirements for enrollment in ECF CHOICES as defined in this Chapter.

(iii) If a Member voluntarily withdraws or is involuntarily withdrawn from CD, any Eligible ECF CHOICES HCBS he receives shall be provided through Contract Providers, subject to the requirements in this Chapter.

2. Involuntary Withdrawal.

(i) A person may be involuntarily withdrawn from participation in CD of HCBS for any of the following reasons:

(I) The person is no longer enrolled in TennCare.

(II) The person is no longer enrolled in ECF CHOICES.

(III) The Member no longer needs any of the Eligible ECF CHOICES HCBS, as specified in the PCSP.

(IV) The Member is no longer willing or able to serve as the Employer of Record for his Consumer-Directed Workers and to fulfill all of the required responsibilities for CD, and does not have a qualified Representative who is willing and able to serve as the Employer of Record and to fulfill all of the required responsibilities for CD.

(V) The Member is unwilling to work with the Support Coordinator to identify and address any additional risks associated with the Member’s decision to participate in CD, or the risks associated with the Member’s decision to participate in CD pose too great a threat to the Member’s health, safety and welfare.

(VI) The health, safety and welfare of the Member may be in jeopardy if the Member or his Representative continues to employ a Worker but the Member or Representative does not want to terminate the Worker.

(VII) The Member does not have an adequate Back-up Plan for CD.

(VIII) The Member’s needs cannot be safely and appropriately met in the community while participating in CD.

(IX) The Member or his Representative for CD, or Consumer-Directed Workers he wants to employ are unwilling to use the services of the Bureau’s contracted FEA to perform required Financial Administration and Supports Brokerage functions.

(X) The Member or his Representative for CD is unwilling to abide by the requirements of the ECF CHOICES CD program.

(XI) If a Member’s Representative fails to perform in accordance with the terms of the Representative Agreement and the health, safety and welfare of the Member is at risk, and the Member wants to continue to use the Representative.

(XII) If a Member has consistently demonstrated that he is unable to manage, with sufficient supports, including appointment of a Representative, his services and the Support Coordinator or FEA has identified health, safety and/or welfare issues.

(XIII) A Support Coordinator has determined that the health, safety and welfare of the Member may be in jeopardy if the Member continues to employ a Worker but the Member or Representative does not want to terminate the Worker.

(XIV) Other significant concerns regarding the Member’s participation in CD which jeopardize the health, safety or welfare of the Member.

(ii) The Bureau must review and approve all MCO requests for involuntary withdrawal from CD of eligible HCBS before such action may occur. If the Bureau approves the request, written notice shall be given to the Member at least ten (10) days in advance of the withdrawal. The date of withdrawal may be delayed when necessary to allow adequate time to transition the Member to Contract Provider services as seamlessly as possible.

(iii) The Member shall have the right to appeal involuntary withdrawal from CD.

(iv) If a person is no longer enrolled in TennCare or in ECF CHOICES, his participation in CD shall be terminated (9) HCBS Providers in ECF CHOICES.

(a) HCBS providers delivering services under ECF CHOICES must meet specified license, training and background check requirements and shall meet conditions for reimbursement outlined in their provider agreements with the TennCare MCOs.

(b) MCOs may contract with non-participating HCBS providers as needed through a single case agreement and will reimburse the provider at no less than eighty percent (80%) of the lowest rate paid to any contracted HCBS provider in the state for that service.

(10) Appeals.

(a) Appeals related to determinations of eligibility for TennCare Medicaid or TennCare Standard are processed by TennCare, in accordance with Chapters 1200-13-13 and 1200-13-14.

(b) Appeals related to the denial, reduction, suspension, or termination of a covered service are processed by the Bureau in accordance with Rules 1200-13-13-.11 and

Tenn. Comp. R. & Regs. 1200-13-13-.04 and 1200-13-14-.04.

2. Transportation is not provided to HCBS covered by CHOICES, except in the circumstance where a Member requires Adult Day Care that is not available within 30 miles of the Member’s residence.

For CHOICES Members not participating in CD, provider agencies delivering CHOICES HCBS may permit staff to accompany a Member outside the home. In circumstances where the Member is unable to drive, assistance by provider agency staff in performing IADLs (e.g., grocery shopping, picking up prescriptions, banking) specified in the POC may include transporting the Member when such assistance would otherwise be performed for the Member by the provider staff, and subject to the provider agency’s agreement and responsibility to ensure that the Worker has a valid driver’s license and proof of insurance prior to transporting a Member. The decision of whether or not to accompany the Member outside the home (and in the circumstances described above, to transport the Member) is at the discretion of the agency/Worker, taking into account such issues as the ability to safely provide services outside the home setting, the cost involved, and the provider’s willingness to accept and manage potential risk and/or liability. In no case will additional hours of service and/or an increased rate of reimbursement be provided as a result of an agency/Worker decision to accompany or transport a Member outside the home.

3. For CHOICES Members participating in CD, the Member may elect to have his Consumer-Directed Workers (including Companion Care workers) to accompany and/or transport the Member if such an arrangement is agreed to by both the Member and the Workers and specified in the Service Agreement; however, no additional hours or reimbursement will be available. Consumer-Directed Worker(s) must provide to the FEA a valid driver’s license and proof of insurance prior to transporting a Member.

(n) Freedom of Choice.

1. CHOICES Members who meet NF LOC as defined in Rule 1200-13-01-.10 shall be given freedom of choice of NF care or CHOICES HCBS, so long as the Member meets all criteria for enrollment into CHOICES Group 2, as specified in this Chapter and the Member may be enrolled into CHOICES Group 2 in accordance with requirements pertaining to the CHOICES Group 2 Enrollment Target as described in this Chapter.

2. CHOICES Members shall also be permitted to choose providers for CHOICES HCBS specified in the POC from the MCO’s list of participating providers, if the participating provider selected is available and willing to initiate services timely and to deliver services in accordance with the POC. The Member is not entitled to receive services from a particular provider. A Member is not entitled to a fair hearing if he is not able to receive services from the provider of his choice.

(o) Transition Allowance. For CHOICES Members moving from CHOICES 1 to CHOICES 2 or CHOICES 3, the MCO may, at its sole discretion, provide a Transition Allowance not to exceed two thousand dollars ($2,000) per lifetime as a CEA to facilitate transition of the Member from the NF to the community. An MCO shall not be required to provide a Transition Allowance, and Members transitioning out of a NF are not entitled to receive a Transition Allowance, which is not a covered benefit. Items that an MCO may elect to purchase or reimburse are limited to the following:

1. Those items which the Member has no other means to obtain and which are essential in order to establish a community residence when such residence is not already established and to facilitate the person’s safe and timely transition;

2. Rent and/or utility deposits; and 3. Essential kitchen appliances, basic furniture, and essential basic household items, such as towels, linens, and dishes.

(p) Community Based Residential Alternatives (CBRAs).

1. Intent. This subparagraph describes requirements for CBRAs in the CHOICES program necessary to ensure compliance with federal HCBS obligations, including those set forth in 42 C.F.R. §§ 441.301, et seq. These requirements supplement requirements set forth in the licensure rules applicable to the specific CBRA provider, requirements for Managed Care Organizations who administer CBRAs in the CHOICES program, requirements set forth in MCO provider agreements with CBRA providers, and other applicable state laws and regulations, and program policies and protocols applicable to these services and/or providers of these services.

2. Requirements for CBRAs.

(i) Member Choice. A Member shall transition into a specific CBRA setting and receive CBRA services only when such services and setting:

(I) Have been selected by the Member;

(II) The Member has been given the opportunity to meet and to choose to reside with any housemates who will also live in the CBRA setting, as applicable; and (III) The setting has been determined to be appropriate for the Member based on the Member’s needs, interests, and preferences, including (as applicable) the member’s preferred community and/or proximity to family and other natural supports. A CLS or CLS-FM provider shall not admit a Member and CLS or CLS-FM services shall not be authorized for a CHOICES Member unless the CLS or CLS-FM provider is able to safely meet the Member’s needs and ensure the Member’s health, safety and well-being.

(ii) A Member may choose to stop receiving services in a CBRA setting or from a particular CBRA provider at any time, and shall be supported in choosing and transitioning within a reasonable period to a different service, setting, or provider as applicable, that is appropriate based on the Member’s needs and preferences.

(iii) Member Rights. Providers of CBRA services shall ensure that services are delivered in a manner that safeguards the following rights of persons receiving CBRA services:

(I) To be treated with respect and dignity;

(II) To have the same legal rights and responsibilities as any other person unless otherwise limited by law;

(III) To receive services regardless of gender, race, creed, marital status, national origin, disability, sexual orientation, ethnicity or age;

(IV) To be free from abuse, neglect and exploitation;

(V) To receive appropriate, quality services and supports in accordance with a comprehensive, person-centered written plan of care;

(VI) To receive services and supports in the most integrated and least restrictive setting that is appropriate based on the individualized needs of the Member;

(VII) To have access to personal records and to have services, supports and personal records explained so that they are easily understood;

(VIII) To have personal records maintained confidentially;

(IX) To own and have control over personal property, including personal funds, as specified in the plan of care;

(X) To have access to information and records pertaining to expenditures of funds for services provided;

(XI) To have choices and make decisions, and to be supported by family members, an advocate or others, as appropriate, to exercise their legal capacity;

(XII) To have privacy;

(XIII) To be able to associate, publicly or privately, with friends, family and others;

(XIV) To practice the religion or faith of one’s choosing;

(XV) To be free from inappropriate use of physical or chemical restraint;

(XVI) To have access to transportation and environments used by the general public; and (XVII) To seek resolution of rights violations or quality of care issues without retaliation.

(iv) The rights to be safeguarded by providers described in this rule do not limit any other statutory and constitutional rights afforded to all CHOICES Members or their legally authorized representatives, including those rights provided by the HCBS Settings Rule and Person-Centered Planning Rule in 42 C.F.R. § 441.301, and all other rights afforded to residents of CBRAs specific to the licensure authority for that CBRA.

(v) A Member who does not have a legally authorized representative may be supported by family members, an advocate or others as needed to exercise their legal capacity in a supported decision making model.

(vi) A Member may include family members and/or other representatives in the planning and decision-making processes.

(vii) A provider may serve as the Member’s representative payee and assist the Member with personal funds management only as specified in the plan of care. Providers who assist the Member with personal funds management in accordance with the plan of care shall comply with all applicable policies and protocols pertaining to personal funds management, and shall ensure that the Member’s bills have been paid timely and are not overdue, and that there are adequate funds remaining for food, utilities, and any other necessary expenses.

3. CLS Ombudsman.

(i) TennCare shall arrange for all Members choosing to receive CLS or CLS- FM services, including Members identified for transition to CLS or CLS- FM, to have access to a CLS Ombudsman. The CLS Ombudsman shall be employed and/or contracted with an agency that is separate and distinct from the TennCare Bureau.

(ii) The CLS Ombudsman will:

(I) Help to ensure Member choice in the selection of their CLS or CLS- FM benefit, provider, setting, and housemates;

(II) Provide Member education, including rights and responsibilities of Members receiving CLS or CLS-FM, how to handle quality and other concerns, identifying and reporting abuse and neglect, and the role of the CLS Ombudsman and how to contact the CLS Ombudsman;

(III) Provide Member advocacy for individuals receiving CLS or CLS-FM services, including assisting individuals in understanding and exercising personal rights, assisting Members in the resolution of problems and complaints regarding CLS or CLS-FM services, and referral to APS of potential instances of abuse, neglect or financial exploitation; and (IV) Provide systems level advocacy, including recommendations regarding potential program changes or improvements regarding the CLS or CLS-FM benefit, and immediate notification to TennCare of significant quality concerns.

(iii) CLS and CLS-FM providers shall ensure that every CHOICES Member receiving CLS or CLS-FM services knows how to contact the CLS Ombudsman and that contact information for the CLS Ombudsman is available in the residence in a location of the Member’s preference.

(iv) CLS and CLS-FM providers shall ensure access to telephones and/or computers for purposes of communication, and shall respect and safeguard the member’s right to privacy, including the Member’s ability to meet privately with the CLS Ombudsman in the residence.

4. Person-centered Delivery of CLS and CLS-FM Services. A CLS or CLS-FM provider shall be responsible for the following:

(i) A copy of the plan of care for any Member receiving CLS or CLS-FM services shall be accessible in the home to all paid staff;

(ii) Staff shall meet all applicable training requirements as specified in applicable licensure regulations, TennCare regulations, contractor risk agreements with managed care organizations, provider agreements with managed care organizations, or in TennCare policy or protocol. Staff shall be trained on the delivery of person-centered service delivery, and on each Member’s plan of care, including the risk assessment and risk agreement, as applicable, prior to being permitted to provide supports to that Member;

(iii) The CLS or CLS-FM provider shall implement the Member’s plan of care and shall ensure that services are delivered in a manner that is consistent with the Member’s preferences and which supports the Member in achieving his or her goals and desired outcomes;

(iv) The CLS or CLS-FM provider shall support the Member to make his or her own choices and to maintain control of his or her home and living environment;

(v) The Member shall have access to all common living areas within the home with due regard to privacy and personal possessions;

(vi) The Member shall be afforded the freedom to associate with persons of his/her choosing and have visitors at reasonable hours;

(vii) The CLS or CLS-FM provider shall support the Member to participate fully in community life, including faith-based, social, and leisure activities selected by the Member; and (viii) There shall be an adequate food supply (at least 48 hours) for the Member that is consistent with the Member’s dietary needs and preferences.

5. Requirements for Community Living Supports (CLS).

(i) Providers of CLS services in the CHOICES program shall:

(I) Be contracted with the Member’s MCO for the provision of CLS services, and licensed by the DIDD in accordance with T.C.A. Title 33 and TDMHSAS Rules 0940-05-24, 0940-05-28 or 0940-05-32 as applicable;

(II) Maintain an adequate administrative structure necessary to support the provision of CLS services;

(III) Demonstrate financial solvency as it relates to daily operations, including sufficient resources and liquid assets to operate the facility;

(IV) Maintain adequate, trained staff to properly support each CLS resident; the provider must comply with minimum staffing standards specified in licensure regulations, and ensure an adequate number of trained staff to implement each resident’s plan of care, and meet the needs and ensure the health and safety of each resident, including the availability of back-up and emergency staff when scheduled staff cannot report to work;

(V) Comply with all background check requirements specified in T.C.A Title 33;

(VI) Comply with all critical incident reporting and investigation requirements set forth in state law, contractor risk agreements with managed care organizations, provider agreements with managed care organizations, or in TennCare policy or protocol; and (VII) Cooperate with quality monitoring and oversight activities conducted by the DIDD under contract with TennCare to ensure compliance with requirements for the provision of CLS and to monitor the quality of CLS and CLS-FM services received.

(ii) A home where CLS services are provided shall have no more than four (4) residents, or fewer as permitted by the applicable licensure requirements.

(iii) The Member or the Member’s representative (legally authorized or designated by Member) shall have a contributing voice in choosing other individuals who reside in the home where CLS services are provided, and the staff who provide the Member’s services and supports.

(I) The CLS provider shall notify the Member and the Member’s representative (as applicable) of changes of extended or permanent duration in the regularly assigned staff who will provide the Member’s support. Such notification may be verbal or in writing.

When practicable, such notification shall occur in advance of the staffing change.

(II) The CLS provider shall ensure that the Member and/or Member’s representative has the opportunity to help choose new staff who will be regularly assigned to support the Member; however, this may not be possible in the short-term for situations where the change in staffing is of limited duration or is unexpected, e.g., due to illness, termination of employment, or abuse or neglect.

(iv) A CLS provider may deliver CLS services in a home where other CHOICES members receiving CLS reside. A CLS provider may also deliver CLS services in a home where CHOICES members receiving CLS reside along with individuals enrolled in a Section 1915(c) HCBS waiver program operated by the DIDD, when the provider is able and willing to provide supports in a blended residence, comply with all applicable program requirements, and meet the needs and ensure the health, safety and welfare of each resident.

(v) In instances when the CLS provider owns the Member’s place of residence, the provider must sign a written lease/agreement pursuant to the Tennessee Uniform Landlord and Tenant Act (T.C.A. §§ 66-28-101, et seq.) as applicable per the county of residence. If the Tennessee Uniform Landlord and Tenant Act is not applicable to the county of residence, the provider must sign a written lease/agreement with the Member that provides the Member with the same protections as those afforded under the Tennessee Uniform Landlord and Tenant Act.

(vi) Unless the residence is individually licensed or inspected by a public housing agency utilizing the HUD Section 8 safety checklist, the residence shall be inspected, as required by TennCare, prior to the Member’s transition to CLS services; the home where CLS services are provided must have an operable smoke detector and a second means of egress, and all utilities must be working and in proper order.

(vii) The provider shall be responsible for the provision of all assistance and supervision required by program participants. Services shall be provided pursuant to the Member’s person-centered plan of care and may include assistance with the following:

(I) Hands-on assistance with ADLs such as bathing, dressing, personal hygiene, eating, toileting, transfers and ambulation;

(II) Assistance with instrumental activities of daily living necessary to support community living;

(III) Safety monitoring and supervision for Members requiring this type of support as outlined in their person-centered plan of care; and (IV) Managing acute or chronic health conditions, including nurse oversight and monitoring, administration of medications, and skilled nursing services as needed for routine, ongoing health care tasks such as blood sugar monitoring and management, oral suctioning, tube feeding, bowel care, etc., by appropriately licensed nurses practicing within the scope of their licenses, except as delegated in accordance with state law.

(viii) Medication administration shall be performed by appropriately licensed staff or by unlicensed staff who are currently certified in medication administration and employed by an HCBS waiver provider who is both licensed under T.C.A. Title 33 and contracted with DIDD to provide services through an HCBS waiver operated by DIDD, as permitted pursuant to T.C.A. §§ 68-1-904 and 71-5-1414.

(ix) Self -administration of medications is permitted for a person receiving CLS services who is capable of using prescription medication in a manner directed by the prescribing practitioner without assistance or direction. Staff intervention must be limited to verbal reminders as to the time the medication is due. The plan of care must document any training the person needs in order to self-administer medications and how it will be provided; storage, labeling and documentation of administration; oversight to ensure safe administration; and how medication will be administered during any time the person is incapable of self-administration.

(x) Services and supports for a Member receiving CLS shall be provided up to 24 hours per day based on the Member’s assessed level of need as specified in the plan of care and approved level of CLS reimbursement.

Members approved for 24 hours per day of CLS are not prohibited from engaging in independent activities.

(xi) Members approved for 24 hour support who are assessed to be capable of independent functioning may participate in activities of their choosing without the support of staff as specified in the plan of care and risk assessment and risk agreement.

(xii) Regardless of the level of CLS reimbursement a Member is authorized to receive, a Member may choose to be away from home without support of staff, e.g., for overnight visits, vacations, etc. with family or friends.

(xiii) The CLS provider shall be responsible for community transportation needed by the Member. The CLS provider shall transport the Member into the community or assist the Member in identifying and arranging transportation into the community to participate in activities of his choosing.

(xi v) The provider shall be responsible for assisting the Member in scheduling medical appointments and obtaining medical services, including accompanying the Member to medical appointments, as needed, and shall either provide transportation to medical services and appointments for the Member or assist the Member in arranging and utilizing NEMT, as covered under the TennCare program.

6. Requirements for Community Living Supports Family Model (CLS-FM) Services.

(i) Providers of CLS-FM services in the CHOICES program shall:

(I) Be contracted with the Member’s MCO for the provision of CLS-FM services, and licensed by the DIDD in accordance with T.C.A. Title 33 and TDMHSAS Rule 0940-05-26;

(II) Maintain an adequate administrative structure necessary to support the provision of CLS-FM services;

(III) Demonstrate financial solvency as it relates to daily operations, including sufficient resources and liquid assets to operate the facility;

(IV) Ensure CLS-FM family caregivers are adequately trained to properly support each CLS resident; the provider must comply with minimum staffing standards specified in licensure regulations, and ensure an adequate number of family caregivers and trained staff as needed to implement each resident’s plan of care, and meet the needs and ensure the health and safety of each resident, including the availability of back-up and emergency staff when scheduled staff cannot report to work;

(V) Comply with all background check requirements specified in T.C.A.

Title 33;

(VI) Comply with all critical incident reporting and investigation requirements set forth in state law, contractor risk agreements with managed care organizations, provider agreements with managed care organizations, or in TennCare policy or protocol; and (VII) Cooperate with quality monitoring and oversight activities conducted by the DIDD under contract with TennCare to ensure compliance with requirements for the provision of CLS and to monitor the quality of CLS and CLS-FM services received.

(ii) A home where CLS-FM services are provided shall serve no more than three (3) individuals, including individuals receiving CLS-FM services and individuals receiving Family Model Residential services, and must be physically adequate to allow each participant to have private bedroom and bathroom space unless otherwise agreed upon with residents to share, in which case each participant must have equal domain over shared spaces.

(iii) The Member or the Member’s representative (legally authorized or designated by Member) shall have a contributing voice in choosing other individuals who reside in the home where CLS-FM services are provided, caregivers whose home the Member will move into, and any staff hired by the CLS-FM provider to assist in providing the Member’s services and supports.

(iv) A CLS-FM provider may deliver CLS-FM services in a home where other CHOICES Members receiving CLS-FM reside. A CLS-FM provider may also deliver CLS services in a home where CHOICES Members receiving CLS-FM reside along with individuals enrolled in a Section 1915(c) HCBS waiver program operated by the DIDD, when the provider is able and willing to provide supports in a blended residence, comply with all applicable program requirements, and meet the needs and ensure the health, safety and welfare of each resident. In instances of blended homes, there shall be no more than three (3) service recipients residing in the home, regardless of the program or funding source.

(v) The family caregiver and Member must sign a written lease/agreement pursuant to the Tennessee Uniform Landlord and Tenant Act (T.C.A. §§ 66-28-101, et seq.) as applicable per the county of residence. If the Tennessee Uniform Landlord and Tenant Act is not applicable to the county of residence, the provider must sign a written lease/agreement with the Member that provides the Member with the same protections as those afforded under the Tennessee Uniform Landlord and Tenant Act.

(vi) Unless the residence is individually licensed or inspected by a public housing agency utilizing the HUD Section 8 safety checklist, the residence shall be inspected, as required by TennCare, prior to the Member’s transition to CLS services; the home where CLS-FM services are provided must have an operable smoke detector and a second means of egress.

(vii) The CLS-FM provider shall be responsible for the provision of all assistance and supervision required by program participants. Services shall be provided pursuant to the Member’s person-centered plan of care and may include assistance with the following:

(I) Hands-on assistance with ADLs such as bathing, dressing, personal hygiene, eating, toileting, transfers and ambulation;

(II) Assistance with instrumental activities of daily living necessary to support community living;

(III) Safety monitoring and supervision for Members requiring this type of support as outlined in their person-centered plan of care; and (IV) Managing acute or chronic health conditions, including nurse oversight and monitoring, administration of medications, and skilled nursing services as needed for routine, ongoing health care tasks such as blood sugar monitoring and management, oral suctioning, tube feeding, bowel care, etc., by appropriately licensed nurses practicing within the scope of their licenses, except as delegated in accordance with state law.

(viii) Medication administration shall be performed by appropriately licensed staff or by unlicensed staff who are currently certified in medication administration and employed by an HCBS waiver provider who is both licensed under T.C.A. Title 33 and contracted with DIDD to provide services through an HCBS waiver operated by DIDD, as permitted pursuant to T.C.A. §§ 68-1-904 and 71-5-1414.

(ix) Self-administration of medications is permitted for a person receiving CLS- FM services who is capable of using prescription medication in a manner directed by the prescribing practitioner without assistance or direction. Staff intervention must be limited to verbal reminders as to the time the medication is due. The plan of care must document any training the person needs in order to self-administer medications and how it will be provided; storage, labeling and documentation of administration; oversight to ensure safe administration; and how medication will be administered during any time the person is incapable of self-administration.

(x) Services and supports for a Member receiving CLS-FM shall be provided up to 24 hours per day based on the Member’s assessed level of need as specified in the plan of care and approved level of CLS reimbursement.

Members approved for 24 hours per day of CLS-FM are not prohibited from engaging in independent activities.

(xi) Members approved for 24 hour support who are assessed to be capable of independent functioning may participate in activities of their choosing without the support of staff as specified in the plan of care and risk assessment and risk agreement.

(xii) Regardless of the level of CLS-FM reimbursement a Member is authorized to receive, a Member may choose to be away from home without support of staff, e.g., for overnight visits, vacations, etc. with family or friends.

(xiii) The CLS provider shall be responsible for community transportation needed by the Member. The CLS provider shall transport the Member into the community or assist the Member in identifying and arranging transportation into the community to participate in activities of his choosing.

(xiv) The provider shall be responsible for assisting the Member in scheduling medical appointments and obtaining medical services, including accompanying the Member to medical appointments, as needed, and shall either provide transportation to medical services and appointments for the Member or assist the Member in arranging and utilizing non-emergency transportation services (NEMT), as covered under the TennCare program.

7. Reimbursement of CLS and CLS-FM Services.

(i) Reimbursement for CLS and CLS-FM services shall be made to a contracted CLS or CLS-FM provider by the Member’s MCO in accordance with the Member’s plan of care and service authorizations, and contingent upon the Member’s eligibility for and enrollment in TennCare and CHOICES.

(ii) Reimbursement for CLS and CLS-FM services shall be made only for dates of service that the member actually receives CLS and CLS-FM services. CLS and CLS-FM services shall not be reimbursed for any date on which the member does not receive any CLS or CLS-FM services because the member is in a hospital or other inpatient setting, or for therapeutic leave, e.g., overnight visits, vacations, etc. with family or friends when the Member is not accompanied by staff.

(iii) Rates of reimbursement for CLS and CLS-FM services shall be established by TennCare.

(iv) Rates of reimbursement for CLS and CLS-FM services may take into account the level of care the person qualifies to receive (Nursing Facility or At-Risk as determined by TennCare), and the person’s support needs, including skilled nursing needs for ongoing health care tasks.

(v) The rate of reimbursement for CLS or CLS-FM, as applicable, shall not vary based on the number of people receiving CLS, CLS-FM or HCBS Waiver services who live in the home.

(vi) A licensed and contracted CLS or CLS-FM provider selected by a person to provide CLS or CLS-FM services shall determine whether the provider is able to safely provide the requested service and meet the person’s needs, and may take into consideration the rate of reimbursement authorized.

(vii) Neither a Member nor a CLS or CLS-FM provider may file a medical appeal or receive a fair hearing regarding the rate of reimbursement a provider will receive for CLS or CLS-FM services.

(viii) The rate of reimbursement for CLS or CLS-FM services is inclusive of all applicable transportation services needed by the Member, except for transportation authorized and obtained under the TennCare NEMT benefit.

(ix) Reimbursement for CLS or CLS-FM services shall not be made for room and board. Residential expenses (e.g., rent, utilities, phone, cable TV, food, etc.) shall be apportioned as appropriate between the Member and other residents in the home.

(x) Family members of the individual receiving services are not prohibited from helping pay a resident’s Room and Board expenses.

(xi) Reimbursement for CLS or CLS-FM services shall not include the cost of maintenance of the dwelling.

(xii) Reimbursement for CLS or CLS-FM services shall not include payment made to the Member’s conservator, unless so permitted in the Order for Conservatorship.

(xiii) Except as permitted pursuant to Rule 1200-13-01-.05(8)(l), Personal Care Visits, Attendant Care, and Home-Delivered Meals shall not be authorized or reimbursed for a Member receiving CLS or CLS-FM services.

(xiv) In-home Respite shall not be authorized or reimbursed for a Member receiving CLS or CLS-FM services.

(xv) CLS and CLS-FM services shall not be provided or reimbursed in nursing facilities, ACLFs, hospitals or ICFs/IID.

(9) Consumer-Direction (CD).

(a) CD is a model of service delivery that affords CHOICES Group 2 and CHOICES Group 3 Members the opportunity to have more choice and control with respect to Eligible CHOICES HCBS that are needed by the Member, in accordance with this Rule. CD is not a service or set of services.

1. The model of CD that will be implemented in CHOICES is an employer authority model.

2. The determination regarding the services a Member will receive shall be based on a comprehensive needs assessment performed by a Care Coordinator that identifies the Member’s needs, the availability of family and other caregivers to meet those needs, and the gaps in care for which paid services may be authorized.

3. Upon completion of the comprehensive needs assessment, CHOICES Members determined to need Eligible CHOICES HCBS may elect to receive one or more of the Eligible CHOICES HCBS through a Contract Provider, or they may participate in CD. Companion Care is available only through CD.

4. CHOICES Members who do not need Eligible CHOICES HCBS shall not be offered the opportunity to enroll in CD.

(b) CHOICES HCBS eligible for CD (Eligible CHOICES HCBS).

1. CD is limited to the following HCBS:

(i) Attendant Care.

(ii) Companion Care (available only to Members electing CD and in CHOICES Group 2; not available to CHOICES Group 3 members).

(iii) In-Home Respite Care.

(iv) Personal Care Visits.

2. CHOICES Members do not have budget authority. The amount of a covered benefit available to the Member shall not increase as a result of his decision to participate in CD, even if the rate of reimbursement for the service is lower in CD.

The amount of each covered benefit to be provided to the Member is specified in the approved POC.

3. HH Services, PDN Services, and CHOICES HCBS other than those specified above shall not be available through CD.

(c) Eligibility for CD. To be eligible for CD, a CHOICES Member must meet all of the following criteria:

1. Be a Member of CHOICES Group 2 or CHOICES Group 3.

2. Be determined by a Care Coordinator, based on a comprehensive needs assessment, to need one or more Eligible CHOICES HCBS.

3. Be willing and able to serve as the Employer of Record for his Consumer- Directed Workers and to fulfill all of the required responsibilities for CD, or he must have a qualified Representative who is willing and able to serve as the Employer of Record and to fulfill all of the required responsibilities for CD.

Assistance shall be provided to the Member or his Representative by the FEA.

4. Any additional risks associated with a Member’s decision to participate in CD must be identified and addressed in a signed Risk Agreement, as applicable, and the MCO must determine that the Member’s needs can be safely and appropriately met in the community while participating in CD.

5. The Member or his Representative for CD and any Workers he employs must agree to use the services of the Bureau’s contracted FEA to perform required Financial Administration and Supports Brokerage functions.

(d) Enrollment in CD.

1. A CHOICES Group 2 or CHOICES Group 3 Member assessed to need one or more Eligible CHOICES HCBS may elect to participate in CD at any time.

2. If the Member is unable to make a decision regarding his participation in CD or to communicate his decision, only a legally appointed Representative may make such decision on his behalf. The Member, or a family member or other caregiver, must sign a CD participation form reflecting the decision the Member has made.

3. If the Member is unable to make a decision regarding CD or to communicate his decision and does not have a legally appointed Representative, the Member cannot participate in CD since there is no one with the legal authority to assume and/or delegate the Member’s CD responsibilities.

4. Self-Assessment Tool. If a Member elects to participate in CD, he must complete a self-assessment tool developed by the Bureau to determine whether he requires the assistance of a Representative to perform the responsibilities of CD.

5. Representative. If the Member requires assistance in order to participate in CD, he must designate, or have appointed by a legally appointed Representative, a Representative to assume the CD responsibilities on his behalf.

(i) A Representative must meet all of the following criteria:

(I) Be at least eighteen (18) years of age;

(II) Have a personal relationship with the Member and understand his support needs;

(III) Know the Member’s daily schedule and routine, medical and functional status, medication regimen, likes and dislikes, strengths and weaknesses; and (IV) Be physically present in the Member’s residence on a regular basis or at least at a frequency necessary to supervise and evaluate each Consumer-Directed Worker.

(ii) If a Member requires a Representative but is unwilling or unable to appoint one, the MCO may submit to the Bureau, for review and approval, a request to deny the Member’s participation in CD.

(iii) If a Member’s Care Coordinator believes that the person selected as the Member’s representative for CD does not meet the specified requirements (e.g., the Representative is not physically present in the Member’s residence at a frequency necessary to adequately supervise Workers), the Care Coordinator may request that the Member select a different Representative who meets the specified requirements. If the Member does not select another Representative who meets the specified requirements, the MCO may, in order to help ensure the Member’s health and safety, submit to the Bureau, for review and approval, a request to deny the Member’s participation in CD.

(iv) A Member’s Representative shall not receive payment for serving in this capacity and shall not serve as the Member’s Worker for any Consumer- Directed Service.

(v) Representative Agreement. A Representative Agreement must be signed by the Member (or person authorized to sign on the Member’s behalf) and the Representative in the presence of the Care Coordinator. By completing a Representative agreement, the Representative confirms that he agrees to serve as a Member’s representative and that he accepts the responsibilities and will perform the duties associated with being a Representative.

(vi) A Member may change his Representative at any time by notifying his Care Coordinator and his Supports Broker that he intends to change Representatives. The Care Coordinator shall verify that the new Representative meets the qualifications as described above. A new Representative Agreement must be completed and signed, in the presence of a Care Coordinator, prior to the new Representative assuming his respective responsibilities.

(e) Employer of Record.

1. If a Member elects to participate in CD, either he or his Representative must serve as the Employer of Record.

2. The Employer of Record is responsible for the following:

(i) Recruiting, hiring and firing Workers;

(ii) Determining Workers’ duties and developing job descriptions;

(iii) Scheduling Workers;

(iv) Supervising Workers;

(v) Evaluating Worker performance and addressing any identified deficiencies or concerns;

(vi) Setting wages from a range of reimbursement levels established by the Bureau;

(vii) Training Workers to provide personalized care based on the Member’s needs and preferences;

(viii) Ensuring that Workers deliver only those services authorized, and reviewing and approving hours worked by Consumer-Directed Workers;

(ix) Reviewing and ensuring proper documentation for services provided; and (x) Developing and implementing as needed a Back-up Plan to address instances when a scheduled Worker is not available or fails to show up as scheduled.

(f) Denial of Enrollment in CD.

1. Enrollment into CD may be denied by the Bureau when:

(i) The person is not enrolled in TennCare or in CHOICES Group 2 or CHOICES Group 3.

(ii) The Member does not need one or more of the HCBS eligible for CD, as specified in the POC.

(iii) The Member is not willing or able to serve as the Employer of Record for his Consumer-Directed Workers and to fulfill all of the required responsibilities for CD, and does not have a qualified Representative who is willing and able to serve as the Employer of Record and to fulfill all of the required responsibilities for CD.

(iv) The Member is unwilling to sign a Risk Agreement which identifies and addresses any additional risks associated with the Member’s decision to participate in CD, or the risks associated with the Member’s decision to participate in CD pose too great a threat to the Member’s health, safety and welfare.

(v) The Member does not have an adequate Back-up Plan for CD.

(vi) The Member’s needs cannot be safely and appropriately met in the community while participating in CD.

(vii) The Member or his Representative for CD, or the Consumer-Directed Workers he wants to employ are unwilling to use the services of the Bureau’s contracted FEA to perform required Financial Administration and Supports Brokerage functions.

(viii) Other significant concerns regarding the Member’s participation in CD which jeopardize the health, safety or welfare of the Member.

2. Denial of enrollment in CD gives rise to notice and due process including the right to a fair hearing, as set forth in this rule.

(g) Fiscal Employer Agent (FEA).

1. The FEA shall perform the following functions on behalf of all Members participating in CD:

(i) Financial Administration functions in the performance of payroll and related tasks; and (ii) Supports Brokerage functions to assist the Member or his Representative with other non-payroll related tasks such as recruiting and training workers.

2. The FEA shall:

(i) Assign a Supports Broker to each CHOICES Member electing to participate in CD of HCBS.

(ii) Provide initial and ongoing training to Members and their Representatives (as applicable) on CD and other relevant issues.

(iii) Verify Worker qualifications, including conducting background checks on Workers, enrolling Workers into TennCare, assigning Medicaid provider ID numbers, and holding TennCare provider agreements.

(iv) Provide initial and ongoing training to workers on CD and other relevant issues.

(v) Assist the Member and/or Representative in developing and updating Service Agreements.

(vi) Withhold, file and pay applicable federal, state and local income taxes; employment and unemployment taxes; and worker’s compensation.

(vii) Pay Workers for authorized services rendered within authorized timeframes.

(h) Back-up Plan for Consumer-Directed Workers.

1. Each Member participating in CD or his Representative is responsible for the development and implementation of a Back-up Plan that identifies how the Member or Representative will address situations when a scheduled Worker is not available or fails to show up as scheduled.

2. The Member or Representative may not elect, as part of the Back-up Plan, to go without services.

3. The Back-up Plan for CD shall include the names and telephone numbers of contacts (Workers, agency staff, organizations, supports) for alternate care, the order in which each shall be notified and the services to be provided by contacts.

4. Back-up contacts may include paid and unpaid supports; however, it is the responsibility of the Member electing CD and/or his Representative to secure paid (as well as unpaid) back-up contacts who are willing and available to serve in this capacity, and for initiating the back-up plan when needed.

5. The Member’s Back-up Plan for Consumer-Directed Workers shall be integrated into the Member’s Back-up Plan for services provided by Contract Providers, as applicable, and the Member’s POC.

6. The Care Coordinator shall review the Back-up Plan developed by the Member and/or his Representative to determine its adequacy to address the Member’s needs. If an adequate Back-up Plan cannot be provided to CD, enrollment into CD may be denied, as set forth in this Rule.

7. The Back-up Plan shall be reviewed and updated at least annually, and as frequently as necessary if there are changes in the type, amount, duration, scope of eligible CHOICES HCBS or the schedule at which such services are needed, changes in Workers (when such Workers also serve as a back-up to other Workers) and changes in the availability of paid or unpaid back-up Workers to deliver needed care.

8. A Member may use Contract Providers to serve as back-up to Consumer Directed Workers only upon prior arrangement by the Member (or Representative for CD) with the Contract Provider, inclusion in the Member’s back-up plan, verification by the Supports Broker, prior approval by the MCO and subject to the Member’s Individual Cost Neutrality Cap as described in Rule 1200-13-01-.05(4)(c). If the higher cost of services delivered by a Contract Provider would result in a Member’s Cost Neutrality Cap being exceeded, a Member shall not be permitted to use Contract Providers to provide back-up workers. A Member’s MCO shall not be required to maintain Contract Providers on “stand-by” to provide back-up for services delivered through Consumer Direction.

(i) Consumer-Directed Workers (Workers).

1. Hiring Consumer-Directed Workers.

(i) Members shall have the flexibility to hire individuals with whom they have a close personal relationship to serve as Workers, such as neighbors or friends.

(ii) Members may hire family members, excluding spouses, to serve as Workers. However, a family member shall not be reimbursed for a service that he would have otherwise provided without pay. A Member shall not be permitted to employ any person who resides with the Member to deliver Personal Care Visits, Attendant Care, or In-Home Respite Care. A Member or his Representative for CD shall not be permitted to employ either of the following to deliver Companion Care services:

(I) An Immediate Family Member as defined in Rule 1200-13-01-.02.

(II) Any person with whom the Member currently resides, or with whom the Member has resided in the last five (5) years.

(iii) Members may elect to have a Worker provide more than one service, have multiple Workers, or have both a Worker and a Contract Provider for a given service, in which case, there must be a set schedule which clearly defines when Contract Providers will be used.

2. Qualifications of Consumer-Directed Workers. Workers must meet the following requirements prior to providing services:

(i) Be at least eighteen (18) years of age or older;

(ii) Complete a background check that includes a criminal background check (including fingerprinting), or, as an alternative, a background check from a licensed private investigation company;

(iii) Verification that the person’s name does not appear on the State abuse registry;

(iv) Verification that the person’s name does not appear on the State and national sexual offender registries and licensure verification, as applicable;

(v) Verification that the person has not been excluded from participation in Medicare, Medicaid, SCHIP, or any Federal health care programs (as defined in Section 128B(f) of the Social Security Act);

(vi) Complete all required training;

(vii) Complete all required applications to become a TennCare provider;

(viii) Sign an abbreviated Medicaid agreement;

(ix) Be assigned a Medicaid provider ID number;

(x) Sign a Service Agreement; and (xi) If the Worker will be transporting the Member as specified in the Service Agreement, a valid driver’s license and proof of insurance must also be provided.

3. Disqualification from Serving as a Consumer-Directed Worker. A Member (or Representative for CD) cannot waive a background check for a potential Worker.

A background check may reveal a potential Worker’s past criminal conduct that may pose an unacceptable risk to the Member. Any of the following findings may place the Member at risk and may disqualify a person from serving as a Worker:

(i) Conviction of an offense involving physical, sexual or emotional abuse, neglect, financial exploitation or misuse of funds, misappropriation of property, theft from any person, violence against any person, or manufacture, sale, possession or distribution of any drug; and/or (ii) Entering of a plea of nolo contendere or when a jury verdict of guilty is rendered but adjudication of guilt is withheld with respect to a crime reasonably related to the nature of the position sought or held.

4. Individualized Assessment of a Consumer-Directed Worker with a Criminal Background.

(i) If a potential Worker’s background check includes past criminal conduct, the Member (or Representative for CD) must review the past criminal conduct with the help of the FEA. The Member (or Representative for CD), with the assistance of the FEA, will consider the following factors:

(I) Whether or not the evidence gathered during the potential Worker’s individualized assessment shows the criminal conduct is related to the job in such a way that could place the Member at risk;

(II) The nature and gravity of the offense or conduct, such as whether the offense is related to physical or sexual or emotional abuse of another person, if the offense involves violence against another person, or the manufacture, sale, or distribution of drugs; and (III) The time that has passed since the offense or conduct and/or completion of the sentence.

(ii) After considering the above factors and any other evidence submitted by the potential Worker, the Member (or Representative for CD) must decide whether to hire the potential Worker.

(iii) If a Member (or Representative for CD) decides to hire the Worker, the FEA shall assist the Member (or Representative for CD) in notifying the Member’s MCO of this decision and shall collaborate with the Member’s MCO to amend the Member’s risk agreement to reflect the Member’s (or CD Representative’s) decision to voluntarily assume risk associated with hiring an individual with a criminal history and that the Member (or Representative for CD) is solely responsible for any negative consequences stemming from that decision.

5. Service Agreement.

(i) A Member shall develop a Service Agreement with each Worker, which includes, at a minimum:

(I) The roles and responsibilities of the Worker and the Member;

(II) The Worker’s schedule (as developed by the Member and/or Representative), including hours and days;

(III) The scope of each service (i.e., the specific tasks and functions the Worker is to perform);

(IV) The service rate; and (V) The requested start date for services.

(ii) The Service Agreement must be in place for each Worker prior to the Worker providing services.

(iii) The Service Agreement shall also stipulate if a Worker will provide one or more Self-Directed Health Care Tasks, the specific task(s) to be performed, and the frequency of each Self-Directed Health Care Task.

6. Payments to Consumer-Directed Workers.

(i) Rates.

With the exception of Companion Care Services, Members participating in CD have the flexibility to set wages for their Workers from a range of reimbursement levels established by TennCare.

(I) Monthly Companion Care rates are only available for a full month of service delivery and will be pro-rated when a lesser number of days are actually delivered.

(II) The back-up per diem rate is available only when a regularly scheduled companion is ill or unexpectedly unable to deliver services, and shall not be authorized as a component of ongoing Companion Care Services.

(ii) Payments to Consumer-Directed Workers. In order to receive payment for services rendered, all Workers must:

(I) Deliver services in accordance with the schedule of services specified in the Member’s POC and in the MCO’s service authorization, and in accordance with Worker assignments determined by the Member or his Representative.

(II) Use the EVV system to log in and out at each visit.

(III) Provide detailed documentation of service delivery including but not limited to the specific tasks and functions performed for the Member at each visit, which shall be maintained in the Member’s home.

(IV) Provide no more than forty (40) hours of services within a consecutive seven (7) day period, unless explicitly permitted by program guidelines and in accordance with service authorizations.

(iii) Termination of Consumer-Directed Workers’ Employment.

(I) A Member may terminate a Worker’s employment at any time.

(II) The MCO may not terminate a Worker’s employment, but may request that a Member be involuntarily withdrawn from CD if it is determined that the health, safety and welfare of the Member may be in jeopardy if the Member continues to employ a Worker but the Member and/or Representative does not want to terminate the Worker.

(j) Self-Direction of Health Care Tasks.

1. A Competent Adult, as defined in this Chapter, with a functional disability living in his own home, enrolled in CHOICES Group 2 or CHOICES Group 3, and participating in CD, or his Representative for CD, may choose to direct and supervise a Consumer-Directed Worker in the performance of a Health Care Task as defined in this Chapter.

2. For purposes of this rule, home does not include a NF or ACLF.

3. A Member shall not receive additional amounts of any service as a result of his decision to self-direct health care tasks. Rather, the Health Care Tasks shall be performed by the Worker in the course of delivering Eligible CHOICES HCBS already determined to be needed, as specified in the POC.

4. The Member or Representative who chooses to self-direct a health care task is responsible for initiating self-direction by informing the health care professional who has ordered the treatment which involves the Health Care Task of the individual or caregiver’s intent to perform that task through self-direction. The provider shall not be required to prescribe self-direction of the health care task.

5. When a licensed health care provider orders treatment involving a Health Care Task to be performed through self-directed care, the responsibility to ascertain that the Member or caregiver understands the treatment and will be able to follow through on the Self-Directed Health Care Task is the same as it would be for a Member or caregiver who performs the Health Care Task for himself, and the licensed health care provider incurs no additional liability when ordering a Health Care Task which is to be performed through self-directed care.

6. The Member or his Representative for CD will identify one or more Consumer- Directed Workers who will perform the task in the course of delivery of Eligible CHOICES HCBS. If a Worker agrees to perform the Health Care Tasks, the tasks to be performed must be specified in the Service Agreement. The Member or his Representative for CD is solely responsible for identifying a Worker who is willing to perform Health Care Tasks, and for instructing the paid personal aide on the task(s) to be performed.

7. The Member or his Representative for CD must also identify in his Back-up Plan for CD who will perform the Health Care Task if the Worker is unavailable, or stops performing the task for any reason.

8. Ongoing monitoring of the Worker performing self-directed Health Care Tasks is the responsibility of the Member or his Representative. Members are encouraged to use a home medication log as a tool to document medication administration.

Medications should be kept in original containers, with labels intact and legible.

(k) Withdrawal from Participation in Consumer Direction (CD).

1. General.

(i) Voluntary Withdrawal from CD. Members participating in CD may voluntarily withdraw from participation in CD at any time. The Member’s request must be in writing. Whenever possible, notice of a Member’s decision to withdraw from participation in CD should be provided in advance to permit time to arrange for delivery of services through Contracted Providers.

(ii) Voluntary or involuntary withdrawal of a Member from CD of Eligible CHOICES HCBS shall not affect a Member’s eligibility for LTSS or enrollment in CHOICES, provided the Member continues to meet all requirements for enrollment in CHOICES as defined in this Chapter.

(iii) If a Member voluntarily withdraws or is involuntarily withdrawn from CD, any Eligible CHOICES HCBS he receives, with the exception of Companion Care, shall be provided through Contract Providers, subject to the requirements in this Chapter. Companion Care is only available through CD.

2. Involuntary Withdrawal.

(i) A person may be involuntarily withdrawn from participation in CD of HCBS for any of the following reasons:

(I) The person is no longer enrolled in TennCare.

(II) The person is no longer enrolled in either CHOICES Group 2 or CHOICES Group 3.

(III) The Member no longer needs any of the Eligible CHOICES HCBS, as specified in the POC.

(IV) The Member is no longer willing or able to serve as the Employer of Record for his Consumer-Directed Workers and to fulfill all of the required responsibilities for CD, and does not have a qualified Representative who is willing and able to serve as the Employer of Record and to fulfill all of the required responsibilities for CD.

(V) The Member is unwilling to sign a Risk Agreement, as applicable, which identifies and addresses any additional risks associated with the Member’s decision to participate in CD, or the risks associated with the Member’s decision to participate in CD pose too great a threat to the Member’s health, safety and welfare.

(VI) The health, safety and welfare of the Member may be in jeopardy if the Member or his Representative continues to employ a Worker but the Member or Representative does not want to terminate the Worker.

(VII) The Member does not have an adequate Back-up Plan for CD.

(VIII) The Member’s needs cannot be safely and appropriately met in the community while participating in CD.

(IX) The Member or his Representative for CD, or Consumer-Directed Workers he wants to employ are unwilling to use the services of the Bureau’s contracted FEA to perform required Financial Administration and Supports Brokerage functions.

(X) The Member or his Representative for CD is unwilling to abide by the requirements of the CHOICES CD program.

(XI) If a Member’s Representative fails to perform in accordance with the terms of the Representative Agreement and the health, safety and welfare of the Member is at risk, and the Member wants to continue to use the Representative.

(XII) If a Member has consistently demonstrated that he is unable to manage, with sufficient supports, including appointment of a Representative, his services and the Care Coordinator or FEA has identified health, safety and/or welfare issues.

(XIII) A Care Coordinator has determined that the health, safety and welfare of the Member may be in jeopardy if the Member continues to employ a Worker but the Member or Representative does not want to terminate the Worker.

(XIV) Other significant concerns regarding the Member’s participation in CD which jeopardize the health, safety or welfare of the Member.

(ii) The Bureau must review and approve all MCO requests for involuntary withdrawal from CD of HCBS before such action may occur. If the Bureau approves the request, written notice shall be given to the Member at least ten (10) days in advance of the withdrawal. The date of withdrawal may be delayed when necessary to allow adequate time to transition the Member to Contract Provider services as seamlessly as possible.

(iii) The Member shall have the right to appeal involuntary withdrawal from CD.

(iv) If a person is no longer enrolled in TennCare or in CHOICES, his participation in CD shall be terminated automatically.

(10) Nursing Facilities (NFs) in CHOICES.

(a) Conditions of participation. NFs participating in CHOICES must meet all of the conditions of participation and conditions for reimbursement outlined in their provider agreements with the TennCare MCOs.

(b) Level 1 reimbursement methodology for NF care: See Rule 1200-13-01-.03(6).

(c) Level 2 reimbursement methodology for NF care: See Rule 1200-13-01-.03(7).

(d) Enhanced Respiratory Care reimbursement methodology for NF care: See Rule 1200- 13-01.03(8).

(e) Non-participating providers. NFs that wish to continue serving existing residents without entering into provider agreements with TennCare MCOs will be considered non-participating providers.

1. Non-participating NF providers must comply with Rules 1200-13-01-.03, 1200- 13-01-.06, and 1200-13-01-.09.

2. Non-participating providers must sign a modified contract (called a case agreement) with the MCO to continue receiving reimbursement for existing residents, including residents who may become Medicaid eligible.

3. Non-participating NF providers will be reimbursed eighty percent (80%) of the lowest rate paid to any participating NF provider in Tennessee for the applicable level of NF services.

(f) Bed holds. See Rule 1200-13-01-.03(9).

(g) Other reimbursement issues. See Rule 1200-13-01-.03(10).

(11) HCBS Providers in CHOICES.

(a) HCBS providers delivering care under CHOICES must meet specified license requirements and shall meet conditions for reimbursement outlined in their provider agreements with the TennCare MCOs.

(b) Non-participating HCBS providers will be reimbursed by the Member’s MCO at eighty percent (80%) of the lowest rate paid to any HCBS provider in the state for that service.

(12) Appeals.

(a) Appeals related to determinations of eligibility for TennCare Medicaid or TennCare Standard are processed by DHS, in accordance with Chapters 1200-13-13 and 1200- 13-14.

(b) Appeals related to the denial, reduction, suspension, or termination of a covered service are processed by the Bureau in accordance with Rules 1200-13-13-.11 and

Tenn. Comp. R. & Regs. 1200-13-14-.11 , provided however that notice and continuation of benefits shall not be provided for ECF CHOICES HCBS identified in the Initial SP that are needed by the ECF CHOICES member immediately upon enrollment in ECF CHOICES while the Support Coordinator develops the comprehensive PCSP. A member may request a fair hearing regarding any covered benefit not approved in the PCSP that he believes is needed.

(c) Appeals related to the PAE process (including decisions pertaining to the PASRR process) are processed by the Bureau’s Division of Long-Term Services and Supports in accordance with Rule 1200-13-01-.10(7).

(d) Appeals related to the enrollment or disenrollment of an individual in ECF CHOICES or to denial or involuntary withdrawal from participation in CD are processed by the Division of Long-Term Services and Supports in the Bureau, in accordance with the following procedures:

1. If enrollment into ECF CHOICES or if participation in CD is denied, notice containing an explanation of the reason for such denial shall be provided. The notice shall include the person’s right to request a fair hearing within thirty (30) days from receipt of the written notice regarding valid factual disputes pertaining to the enrollment denial decision.

2. If a Member is involuntarily disenrolled from ECF CHOICES, or if participation in CD is involuntarily withdrawn, advance notice of involuntary disenrollment or withdrawal shall be issued. The notice shall include a statement of the Member’s right to request a fair hearing within thirty (30) days from receipt of the written notice regarding valid factual disputes pertaining to the decision.

3. Appeals regarding denial of enrollment into ECF CHOICES, involuntary disenrollment from ECF CHOICES, or denial or involuntary withdrawal from participation in CD must be filed in writing with the TennCare Division of Long- Term Services and Supports within thirty-five (35) days of issuance of the written notice if the appeal is filed with the Bureau by fax, and within forty (40) days of issuance of the written notice if the appeal is mailed to the Bureau. This allows five (5) days mail time for receipt of the written notice and when applicable, five (5) days mail time for receipt of the written appeal.

4. In the case of involuntary disenrollment from ECF CHOICES only, if the appeal is received prior to the date of action, continuation of ECF CHOICES benefits shall be provided, pending resolution of the disenrollment appeal.

5. In the case of involuntary withdrawal from participation in CD, if the appeal is received prior to the date of action, continuation of participation in CD shall be provided, unless such continuation would pose a serious risk to the Member’s health, safety and welfare, in which case, services specified in the PCSP shall be made available through Contract Providers pending resolution of the appeal.

(e) A member may present all relevant and material evidence pertaining to the adverse action.

(11) Management of the Referral List for ECF CHOICES.

(a) A new referral list shall be established for ECF CHOICES.

(b) The referral list shall be managed by TennCare on a statewide basis.

1. The ECF CHOICES referral list management process generally includes three (3) steps: screening, intake and enrollment. The referral management process shall be used to help manage Potential Applicants and Applicants for ECF CHOICES in accordance with established prioritization and enrollment criteria.

2. Intake and enrollment into ECF CHOICES from the referral list shall proceed in accordance with these Rules and with TennCare policies and protocols.

3. Potential Applicants for ECF CHOICES shall be categorized on the ECF CHOICES referral list as follows:

(i) Category 1 - Any age or level of disability, employed and in need of supports to maintain employment that are not otherwise available as vocational rehabilitation services funded under Section 110 of the Rehabilitation Act of 1973, 29 U.S.C. § 730, or as special education or related services as those terms are defined in Section 602 of the Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. § 1401.

(I) Includes youth age 18–22 transitioning from school and young adults completing post-secondary education or training who are employed and in need of supports to maintain employment.

(II) If employment is lost after enrollment into ECF CHOICES occurs, the person shall not be disenrolled if other ECF CHOICES HCBS are needed on an ongoing basis, which may include supports to obtain and maintain new employment.

(ii) Category 2 – 18–22 years old, regardless of the level of disability, transitioning from school and young adults completing post-secondary education or training who are employed or who have the commitment of employment from an employer and are in need of employment supports that are not otherwise available as vocational rehabilitation services funded under Section 110 of the Rehabilitation Act of 1973, 29 U.S.C. § 730.

Includes individuals age 18–22 and young adults completing postsecondary education or training who are participating in paid or unpaid internships with the commitment of employment and individuals with more significant needs who may require employment customization.

(iii) Category 3 - Any age or level of disability, recently unemployed and in need of supports to obtain and/or maintain new employment that are not otherwise available as vocational rehabilitation services funded under

Section 110 of the Rehabilitation Act of 1973, 29 U.S.C. § 730 (iv) Category 4 – 18–22 years old, regardless of the level of disability, transitioning from school with expressed desire for employment.

(v) Category 5 - Unemployed, regardless of the level of disability, with desire and commitment to work.

(vi) Category 6 - Youth of transition age, regardless of the level of disability, living at home with family caregivers, who are actively planning for employment as part of the transition process and in need of supports provided in ECF CHOICES, including for individuals with more significant needs, employment customization, in order to achieve and maintain employment that are not otherwise available as vocational rehabilitation services funded under Section 110 of the Rehabilitation Act of 1973, 29 U.S.C. § 730, or as special education or related services as those terms are defined in Section 602 of the Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. § 1401.

Category 6 shall be applicable only to enrollment into ECF CHOICES Group 4 (Essential Family Supports).

4. ECF CHOICES referral list categories are listed in the order of prioritization.

These categories shall be applicable for all non-reserve capacity slots for Potential Applicants of all ages and levels of disability, and for all ECF CHOICES benefit groups.

5. Potential Applicants on the ECF CHOICES referral list shall have the opportunity to apply for enrollment into ECF CHOICES when the category in which they are placed on the ECF CHOICES referral list is open for enrollment, and when there is an available slot in which the Potential Applicant can be enrolled, if all applicable eligibility and enrollment criteria are met.

6. ECF CHOICES referral list categories shall apply only to prioritization for enrollment into ECF CHOICES.

7. Employment shall not be a condition or requirement for enrollment in ECF CHOICES.

(i) Potential Applicants who are not employed and not interested in employment may be enrolled in ECF CHOICES in accordance with these rules and with TennCare policies and protocols for management of the statewide ECF CHOICES referral list, including prioritization criteria.

(ii) Criteria applicable to ECF CHOICES referral list categories shall apply only to prioritization for enrollment into ECF CHOICES.

(iii) Persons prioritized for enrollment in ECF CHOICES on the basis of employment who are enrolled in ECF CHOICES and subsequently lose their job shall not be disenrolled from ECF CHOICES because they are no longer employed, so long as other ECF CHOICES HCBS are needed on an ongoing basis, which may include supports to obtain and maintain new employment.

8. A person who does not meet the conditions for any of the Categories specified above shall be placed on the ECF CHOICES referral list in an “Other Active” category if ECF CHOICES HCBS are requested at time of referral or in a “Deferred” category if ECF CHOICES HCBS are not requested at time of referral.

9. Reserve Capacity Slots.

In addition to the categories identified above, a specified number of slots shall be held in reserve capacity for individuals who meet one or more of the following criteria:

(i) One or more emergent circumstances as follows:

(I) The person’s primary caregiver is recently deceased and there is no other caregiver available to provide needed long-term supports.

(II) The person’s primary caregiver is permanently incapacitated and there is no other caregiver available to provide needed long-term supports.

(III) There is clear evidence of serious abuse, neglect, or exploitation in the current living arrangement. The person must move from the living arrangement to prevent further abuse, neglect or exploitation, and there is no alternative living arrangement available.

(IV) Enrollment into ECF CHOICES is necessary in order to facilitate transition out of a long-term care institution, i.e., a NF or a private or public ICF/IID into a more integrated community-based setting.

(V) The person is an adult age 21 or older enrolled in ECF CHOICES Group 4 (Essential Family Supports) or ECF CHOICES Group 5 (Essential Support for Employment and Independent Living) and has recently experienced a significant change in needs or circumstances.

TennCare has determined via a Safety Determination that the person can no longer be safely served within the array of benefits available in ECF CHOICES Group 4 (Essential Family Supports) or 5 (Essential Supports for Employment and Independent Living), as applicable, the person meets NF level of care, and must be transitioned to ECF CHOICES Group 6 in order to sustain community living in the most integrated setting.

(VI) The health, safety or welfare of the person or others is in immediate and ongoing risk of serious harm or danger. Other interventions including Behavioral Health Crisis Prevention, Intervention and Stabilization services, where applicable, have been tried but were not successful in minimizing the risk of serious harm to the person or others without additional services available in ECF CHOICES, and the situation cannot be resolved absent the provision of such services available in ECF CHOICES.

(ii) The Potential Applicant has multiple complex chronic or acquired health conditions that prevent the person from being able to work, and the Potential Applicant is in urgent need of supports in order to maintain the current living arrangement and delay or prevent the need for more expensive services (applicable only to individuals of working age).

(iii) A Potential Applicant may apply for enrollment into a reserve capacity slot for persons in emergent circumstances or who have multiple complex health conditions only if determined through an Interagency Committee review process, including both TennCare and DIDD, that enrollment into ECF CHOICES is the most appropriate way to provide needed supports.

Such review shall include consideration of other options, including the relative costs of such options.

(iv) Discharge from another service system (DCS, DMHSAS, etc.) shall not be deemed an emergent situation unless specified emergent criteria are met and unless diligent and timely efforts to plan and prepare for discharge and to facilitate transition to community living without long-term services and supports available in ECF CHOICES have been made, and it is determined through the Interagency Committee review process that enrollment in ECF CHOICES is the most appropriate way to provide needed supports.

10. The waiting list maintained by DIDD for the 1915(c) HCBS Waivers shall be one source of referrals for ECF CHOICES. Persons on the DIDD waiting list for the 1915(c) HCBS Waivers as of June 30, 2016:

(i) Shall be automatically referred for the ECF CHOICES program and placed on the ECF CHOICES referral list.

(ii) May submit documentation regarding employment that shall be reviewed in determining their category on the ECF CHOICES referral list, or if they may meet criteria for a reserve capacity slot based on emergent circumstances or multiple complex health conditions.

(iii) Who do not submit information regarding employment or indicating that they may meet criteria for enrollment in a reserve capacity slot based on emergent circumstances or multiple complex health conditions shall be placed on the ECF CHOICES referral list in the “Other Active” category, unless they are currently on the HCBS Waiver waiting list in a “Deferred” category, in which case they shall be automatically placed on the ECF CHOICES referral list in the “Deferred” category.

11. A Potential Applicant may request an administrative review of his or her category on the ECF CHOICES referral list at any time. This request should be submitted to TennCare in writing.

12. A Potential Applicant may submit additional information at any time that may affect his or her category on the ECF CHOICES referral list. The additional information should be submitted to the Potential Applicant’s MCO (if the Potential Applicant is assigned to an MCO participating in ECF CHOICES), or to DIDD (if the Potential Applicant is assigned to an MCO not participating in ECF CHOICES or is not currently enrolled in TennCare).

13. A Potential Applicant shall not be granted a fair hearing regarding the category in which he has been placed on the ECF CHOICES referral list.

14. A Potential Applicant shall be entitled to a determination regarding his or her eligibility to enroll in the ECF CHOICES program and, if the application is denied, to due process, including notice and the right to request a fair hearing only when the Potential Applicant is determined to meet criteria for an available reserve capacity slot or meets prioritization criteria for an available program slot for which enrollment is currently open and will be enrolled into the program if all applicable eligibility and enrollment criteria are met.

(12) Safety Determination Requests. (See Rule 1200-13-01-.05(6)).

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-208, 71-5-102, 71-5-105, 71-5-106, 71-5-107, 71-5-109, 71-5- 110, 71-5-111, 71-5-112, 71-5-134, 71-5-164, and 71-5-1404 and TennCare II/III Section 1115(a) Medicaid Demonstration Waiver Extension.
• Administrative History: Emergency rules filed July 1, 2016; effective through December 28, 2016. Amendments filed September 30, 2016; effective December 29, 2016. Emergency rules filed November 20, 2020; effective through May 19, 2021. Amendments filed February 17, 2021; effective May 18, 2021. Emergency rules filed December 27, 2022 to become effective January 1, 2023; effective through June 30, 2023. Amendments filed November 1, 2022; effective January 30, 2023. Amendments filed January 19, 2023; effective April 19, 2023. Amendments filed July 7, 2025; effective October 5, 2025.

Tenn. Comp. R. & Regs. 1200-13-01-.13 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, and 71-5-109 and Executive Order No. 11.
• Administrative History: Original rule filed June 23, 1983; effective July 25, 1983. Amendment filed March 30, 1995; effective June 15, 1995. Repeal filed June 29, 2000; effective September 12, 2000.

Tenn. Comp. R. & Regs. 1200-13-01-.17 REPEALED

History

• Authority: T.C.A. §§ 4-5-202 and 71-5-105.
• Administrative History: Original rule filed February 12, 1986; effective March 14, 1986. Amendment filed March 1, 1988; effective April 15, 1988. Amendment filed July 28, 2004; effective October 11, 2004. Public necessity rule filed July 1, 2009; effective through December 13, 2009. Amendments filed September 11, 2009; effective December 10, 2009. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendments filed May 27, 2010; effective August 25, 2010. Repeal filed February 1, 2013; effective July 29, 2013.

Tenn. Comp. R. & Regs. 1200-13-01-.18 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, and 71-5-109; Executive Order No. 23; and Public Chapter 358 of the Acts of 1993.
• Administrative History: Original rule filed May 1985; effective June 23, 1985. Amendment filed November 5, 1990; effective December 20, 1990. Amendment filed March 18, 1994; effective June 1, 1994. Amendment filed September 18, 2007; effective December 2, 2007.

Tenn. Comp. R. & Regs. 1200-13-01-.19 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, and 71-5-109 and Public Chapter 358 of the Acts of 1993.
• Administrative History: Original rule filed September 10, 1985; effective October 10, 1985. Amendment filed March 18, 1994; effective June 1, 1994. Repeal filed January 26, 2007; effective April 11, 2007.

Tenn. Comp. R. & Regs. 1200-13-01-.20 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, and 71-5-109 and Public Chapter 358 of the Acts of 1994.
• Administrative History: Original rule filed June 2, 1988; effective July 17, 1988. Amendment filed April 19, 1990; effective June 3, 1990. Amendment filed April 30, 1992; effective June 14, 1992. Amendment filed March 18, 1994; effective June 1, 1994. Repeal filed January 26, 2007; effective April 11, 2007.

Tenn. Comp. R. & Regs. 1200-13-01-.21 REPEALED

History

• Authority: T.C.A. §§ 4-5-202 and 71-5-105.
• Administrative History: Original rule filed January 29, 1990; effective March 15, 1990. Amendment filed October 24, 1991; effective December 8, 1991. Amendment filed November 27, 1991; effective January 11, 1992. Amendment filed March 10, 1992; effective April 24, 1992. Amendment filed August 4, 1992; effective September 18, 1992. Amendment filed December 4, 1992; effective January 19, 1993. Amendment filed March 18, 1994; effective June 1, 1994. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendments filed May 27, 2010; effective August 25, 2010. Repeal filed February 1, 2013; effective July 29, 2013.

Tenn. Comp. R. & Regs. 1200-13-01-.24 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed October 21, 1991; effective December 5, 1991. Amendment filed March 18, 1994; effective June 1, 1994. Repeal filed May 5, 2009; effective July 19, 2009.

Tenn. Comp. R. & Regs. 1200-13-01-.25 TENNESSEE’S HOME AND COMMUNITY BASED SERVICES WAIVER FOR THE

MENTALLY RETARDED AND DEVELOPMENTALLY DISABLED UNDER SECTION 1915(c) OF THE SOCIAL SECURITY ACT (STATEWIDE MR WAIVER).

(1) Definitions: The following definitions shall apply for interpretation of this rule:

(a) Adult Dental Services. See definition in 1200-13-01-.02.

(b) Behavioral Respite Services - services that provide Respite for an Enrollee who is experiencing a behavioral crisis that necessitates removal from the current residential setting in order to resolve the behavioral crisis.

(c) Behavior Services - assessment and amelioration of Enrollee behavior that presents a health or safety risk to the Enrollee or others or that significantly interferes with home or community activities; determination of the settings in which such behaviors occur and the events which precipitate the behaviors; development, monitoring, and revision of crisis prevention and behavior intervention strategies; and training of caregivers who are responsible for direct care of the Enrollee in prevention and intervention strategies.

(d) Bureau of TennCare - the bureau in the Tennessee Department of Finance and Administration which is the State Medicaid Agency and is responsible for administration of the Medicaid program in Tennessee.

(e) Certification - the process by which a physician, who is licensed as a doctor of medicine or doctor of osteopathy, signs and dates a Pre-Admission Evaluation signifying that the named individual requires services provided through the Home and Community Based Services Waiver for the Mentally Retarded and Developmentally Disabled as an alternative to care in an Intermediate Care Facility for the Mentally Retarded.

(f) Covered Services or Covered Waiver Services - The services which are available through Tennessee’s Home and Community Based Services Waiver for the Mentally Retarded and Developmentally Disabled when medically necessary and when provided in accordance with the Waiver as approved by the Centers for Medicare and Medicaid Services.

(g) Day Services - individualized services and supports that enable an Enrollee to acquire, retain, or improve skills necessary to reside in a community-based setting; to participate in community activities and utilize community resources; to acquire and maintain employment; and to participate in retirement activities.

(h) Denial - as used in regard to Waiver Services, the term shall mean the termination, suspension, or reduction in amount, scope, and duration of a Waiver Service or a refusal or failure to provide such service.

(i) Disenrollment - the voluntary or involuntary termination of enrollment of an individual receiving services through the Home and Community Based Services Waiver for the Mentally Retarded and Developmentally Disabled.

(j) Enrollee - a Medicaid Eligible who is enrolled in the Home and Community Based Services Waiver for the Mentally Retarded and Developmentally Disabled.

(k) Environmental Accessibility Modifications - only those interior or exterior physical modifications to the Enrollee’s place of residence which are required to ensure the health, welfare and safety of the Enrollee or which are necessary to enable the Enrollee to function with greater independence.

(l) Family Model Residential Support - a type of residential service having individualized services and supports that enable an Enrollee to acquire, retain, or improve skills necessary to reside successfully in a family environment in the home of trained caregivers other than the family of origin. The service includes direct assistance as needed with activities of daily living, household chores essential to the health and safety of the enrollee, budget management, attending appointments, and interpersonal and social skills building to enable the Enrollee to live in a home in the community. It also may include medication administration as permitted under Tennessee’s Nurse Practice Act.

(m) Home (of an Enrollee) - the residence or dwelling in which the Enrollee resides, excluding hospitals, nursing facilities, Intermediate Care Facilities for the Mentally Retarded, Assisted Living Facilities and Homes for the Aged.

(n) Home and Community Based Services Waiver for the Mentally Retarded and Developmentally Disabled or “Waiver” - the Home and Community Based Services waiver program approved for Tennessee by the Centers for Medicare and Medicaid Services to provide services to a specified number of Medicaid-eligible individuals who have mental retardation and who meet the criteria for Medicaid reimbursement of care in an Intermediate Care Facility for the Mentally Retarded.

(o) ICF/MR Pre-Admission Evaluation (ICF/MR PAE) - the assessment form used by the State Medicaid Agency to document the current medical and habilitative needs of an individual with mental retardation and to document that the individual meets the Medicaid level of care eligibility criteria for care in an ICF/MR.

(p) Individual Support Plan - the individualized written Plan of Care.

(q) Individual Transportation Services - non-emergency transport of an Enrollee to and from approved activities specified in the Plan of Care.

(r) Intermediate Care Facility for the Mentally Retarded (ICF/MR) - a licensed facility approved for Medicaid vendor reimbursement that provides specialized services for individuals with mental retardation or related conditions and that complies with current federal standards and certification requirements for an ICF/MR.

(s) Medicaid Eligible - an individual who has been determined by the Tennessee Department of Human Services to be financially eligible to have the State Medicaid Agency make reimbursement for covered services.

(t) Medicaid State Plan - the plan approved by the Center for Medicare and Medicaid Services which specifies the covered benefits for the Medicaid program in Tennessee.

(u) Medical Residential Services - a type of residential service provided in a residence where all residents require direct skilled nursing services and habilitative services and supports that enable an Enrollee to acquire, retain, or improve skills necessary to reside in a community-based setting. Medical Residential Services must be ordered by the Enrollee’s physician, physician assistant, or nurse practitioner, who shall document the medical necessity of the services and specify the nature and frequency of the nursing services. The enrollee who receives Medical Residential Services shall require direct skilled nursing services on a daily basis and at a level which cannot for practical purposes be provided through two or fewer daily skilled nursing visits. The service includes direct assistance as needed with activities of daily living, household chores essential to the health and safety of the enrollee, budget management, attending appointments, and interpersonal and social skills building to enable the enrollee to live in a home in the community. It also may include medication administration as permitted under Tennessee’s Nurse Practice Act.

(v) Nursing Services - skilled nursing services that fall within the scope of Tennessee’s Nurse Practice Act and that are directly provided to the Enrollee in accordance with a plan of care. Nursing Services shall be ordered by the Enrollee’s physician, physician assistant, or nurse practitioner, who shall document the medical necessity of the services and specify the nature and frequency of the nursing services.

(w) Nutrition Services - assessment of nutritional needs, nutritional counseling, and education of the Enrollee and of caregivers responsible for food purchase, food preparation, or assisting the Enrollee to eat. Nutrition Services are intended to promote healthy eating practices and to enable the Enrollee and direct support professionals to follow special diets ordered by a physician, physician assistant, or nurse practitioner.

(x) Occupational Therapy Services - diagnostic, therapeutic, and corrective services which are within the scope of state licensure. Occupational Therapy Services provided to improve or maintain current functional abilities as well as prevent or minimize deterioration of chronic conditions leading to a further loss of function are also included within this definition.

(y) Operational Administrative Agency - the approved agency with which the State Medicaid Agency contracts for the administration of the day-to-day operations of the Home and Community Based Services Waiver for the Mentally Retarded and Developmentally Disabled.

(z) Orientation and Mobility Training - assessment of the ability of an Enrollee who is legally blind to move independently, safely, and purposefully in the home and community environment; orientation and mobility counseling; and training and education of the Enrollee and of caregivers responsible for assisting in the mobility of the Enrollee.

(aa) Personal Assistance - the provision of direct assistance with activities of daily living (e.g., bathing, dressing, personal hygiene, eating, meal preparation excluding cost of food), household chores essential to the health and safety of the enrollee, budget management, attending appointments, and interpersonal and social skills building to enable the Enrollee to live in a home in the community. It also may include medication administration as permitted under Tennessee’s Nurse Practice Act.

(bb) Personal Emergency Response System - a stationary or portable electronic device used in the Enrollee’s place of residence which enables the Enrollee to secure help in an emergency. The system shall be connected to a response center staffed by trained professionals who respond upon activation of the electronic device.

(cc) Physical Therapy Services - diagnostic, therapeutic, and corrective services which are within the scope of state licensure. Physical Therapy Services provided to improve or maintain current functional abilities as well as prevent or minimize deterioration of chronic conditions leading to a further loss of function are also included within this definition.

(dd) Plan of Care - an individualized written Plan of Care which describes the medical and other services (regardless of funding source) to be furnished to the Enrollee, the Waiver Service frequency, and the type of provider who will furnish each Waiver Service and which serves as the fundamental tool by which the State ensures the health and welfare of Enrollees.

(ee) Qualified Mental Retardation Professional (QMRP) - an individual who meets current federal standards, as published in the Code of Federal Regulations, for a qualified mental retardation professional.

(ff) Re-evaluation - the annual process approved by the State Medicaid Agency by which a licensed physician or registered nurse or a Qualified Mental Retardation Professional assesses the Enrollee’s need for continued Waiver Services and certifies in writing that the Enrollee continues to require Waiver Services.

(gg) Residential Habilitation - a type of residential service having individualized services and supports that enable an Enrollee to acquire, retain, or improve skills necessary to reside in a community-based setting including direct assistance with activities of daily living essential to the health and safety of the Enrollee, budget management, attending appointments, and interpersonal and social skills building to enable the Enrollee to live in a home in the community. It also may include medication administration as permitted under Tennessee’s Nurse Practice Act.

(hh) Respite - services provided to an Enrollee when unpaid caregivers are absent or incapacitated due to death, hospitalization, illness or injury, or when unpaid caregivers need relief from routine caregiving responsibilities.

(ii) Safety Plan - an individualized plan by which the Operational Administrative Agency ensures the health, safety and welfare of Enrollees who do not have 24-hour direct care services.

(jj) Specialized Medical Equipment and Supplies and Assistive Technology - assistive devices, adaptive aids, controls or appliances which enable an Enrollee to increase the ability to perform activities of daily living, or to perceive, control or communicate with the environment, and supplies for the proper functioning of such items. Specialized Medical Equipment, Supplies, and Assistive Technology shall be recommended by a qualified health care professional (e.g., occupational therapist, physical therapist, speech language pathologist, physician or nurse practitioner) based on an assessment of the Enrollee’s needs and capabilities and shall be furnished as specified in the Plan of Care. Specialized Medical Equipment and Supplies and Assistive Technology may also include a face-to-face consultative assessment by a physical therapist, occupational therapist, or speech therapist to assure that Specialized Medical Equipment and Assistive Technology which requires custom fitting meets the needs of the Enrollee and may include training of the Enrollee by a physical therapist, occupational therapist or speech therapist to effectively utilize such customized equipment.

(kk) Speech, Language and Hearing Services - diagnostic, therapeutic and corrective services which are within the scope of state licensure which enable an Enrollee to improve or maintain current functional abilities and to prevent or minimize deterioration of chronic conditions leading to a further loss of function.

(ll) State Medicaid Agency - the bureau in the Tennessee Department of Finance and Administration which is responsible for administration of the Title XIX Medicaid program in Tennessee.

(mm) Subcontractor - an individual, organized partnership, professional corporation, or other legal association or entity which enters into a written contract with the Operational Administrative Agency to provide Waiver Services to an Enrollee.

(nn) Support Coordination - case management services that assist the Enrollee in identifying, selecting, obtaining, coordinating and using both paid services and natural supports to enhance the Enrollee’s independence, integration in the community and productivity as specified in the Enrollee’s Plan of Care. Support Coordination shall be person-centered and shall include, but is not limited to, ongoing assessment of the Enrollee’s strengths and needs; development, evaluation and revision of the Plan of Care; assistance with the selection of service providers; provision of general education about the Waiver program, including Enrollee rights and responsibilities; and monitoring implementation of the plan of care and initiating individualized corrective actions as necessary (e.g., reporting, referring, or appealing to appropriate entities).

(oo) Support Coordinator - the person who is responsible for developing the Individual Support Plan and participating in the development of, monitoring and assuring the implementation of the Plan of Care; who provides Support Coordination services to an Enrollee; and who meets the qualifications for a Support Coordinator as specified in the Home and Community Based Services Waiver for the Mentally Retarded and Developmentally Disabled.

(pp) Supported Living - a type of residential service having individualized services and supports that enable an Enrollee to acquire, retain or improve skills necessary to reside in a home that is under the control and responsibility of the Enrollee. The service includes direct assistance as needed with activities of daily living, household chores essential to the health and safety of the Enrollee, budget management, attending appointments, and interpersonal and social skills building to enable the Enrollee to live in a home in the community. It also may include medication administration as permitted under Tennessee’s Nurse Practice Act.

(qq) Transfer Form - the form approved by the State Medicaid Agency and used to document the transfer of an Enrollee having an approved unexpired ICF/MR Pre- Admission Evaluation from the Waiver to an ICF/MR, from an ICF/MR to the Waiver or from one MR Waiver program to another MR Waiver program. For purposes of transfer to an MR Waiver program, whether from an ICF/MR or from another MR Waiver program, such Transfer Form shall be processed by TennCare only if submitted by the Division of Intellectual Disabilities Services (DIDS). DIDS shall submit a Transfer Form only after verifying that the person otherwise meets all applicable admission criteria for the applicable MR Waiver program, as the Transfer Form accomplishes only the transfer of the level of care eligibility.

(rr) Vehicle Accessibility Modifications - interior or exterior physical modifications to a vehicle owned by the Enrollee or to a vehicle which is owned by the guardian or conservator of the Enrollee and which is routinely available for transport of the Enrollee. Such modifications must be intended to ensure the transport of the Enrollee in a safe manner.

(2) Covered Services and Limitations.

(a) Adult Dental Services.

1. Adult Dental Services shall not include hospital outpatient or inpatient facility services or related anesthesiology, radiology, pathology, or other medical services in such setting.

2. Adult Dental Services shall exclude orthodontic services.

3. Adult Dental Services shall be limited to adults age twenty-one (21) years or older who are enrolled in the Waiver.

4. Adult Dental Services for adults age 21 or older enrolled in the Waiver shall be limited to a maximum of $5,000 per member per calendar year, and a maximum of $7,500 per member across three (3) consecutive calendar years. Adult Dental Services that are received on or after January 1, 2023, shall apply to the maximum amount allowable under this rule only if the service is not covered as

part of the Dental Services benefit outlined in 1200-13-13-.04 and 1200-13-14- .04. Any Adult Dental Services received prior to January 1, 2023, shall apply to the maximum amounts allowable for the qualifying time period during which the service was performed as outlined by this rule.

(b) Behavioral Respite Services.

1. Behavioral Respite Services may be provided in a Medicaid-certified ICF/MR, in a licensed respite care facility, or in a home operated by a licensed residential provider.

2. Reimbursement shall not be made for the cost of room and board except when provided as part of Behavioral Respite Services furnished in a facility approved by the State that is not a private residence.

3. Behavioral Respite Services shall be limited to a maximum of sixty (60) days per Enrollee per year.

4. Enrollees who receive Behavioral Respite Services shall be eligible to receive Individual Transportation Services only to the extent necessary during the time period when Behavioral Respite Services is being provided.

(c) Behavior Services.

1. Behavior Services shall not be billed when provided during the same time period as Physical Therapy; Occupational Therapy; Nutrition Services; Orientation and Mobility Training; or Speech, Language and Hearing Services, unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently.

2. Behavior Services shall be provided face to face with the Enrollee except for Enrollee-specific training of staff; behavior assessment and plan development; and presentation of Enrollee behavior information at human rights committee meetings, behavior support committee meetings, and Enrollee planning meetings.

3. Reimbursement for presentation of Enrollee behavior information at meetings shall be limited to a maximum of five (5) hours per Enrollee per year per provider.

Reimbursement for behavior assessments shall be limited to a maximum of eight (8) hours per assessment with a maximum of two (2) assessments per year.

Reimbursement for behavior plan development resulting from such a behavior assessment and the training of staff on the plan during the first thirty (30) days following its approval for use shall be limited to a maximum of six (6) hours.

(d) Day Services.

1. Day Services may be provided in settings such as specialized facilities licensed to provide Day Services, community centers or other community sites, or job sites. Services may also be provided in the Enrollee’s place of residence if there is a health, behavioral, or other medical reason or if the Enrollee has chosen retirement. This service shall not be provided in inpatient hospitals, nursing facilities, and Intermediate Care Facilities for the Mentally Retarded (ICF/MR’s).

2. With the exception of employment that is staff supported, Day Services shall be provided only on weekdays during the day (i.e., between the hours of 7:30 a.m. and 6:00 p.m.), as specified in the Plan of Care.

3. Day Services shall be limited to a maximum of six (6) hours per day and five (5) days per week up to a maximum of 243 days per Enrollee per year.

4. Transportation to and from the Enrollee’s place of residence to Day Services and transportation that is needed during the time that the Enrollee is receiving Day Services shall be a component of Day Services and shall be included in the Day Services reimbursement rate (i.e., it shall not be billed as a separate Waiver service) with the following exceptions:

(i) Transportation to and from medical services covered through the Medicaid State Plan, which shall not be billed as a Waiver service; or (ii) Transportation necessary for Orientation and Mobility Training.

5. Day Services shall not replace services available under a program funded by the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act.

6. For an Enrollee receiving employment supports, reimbursement shall not be made for incentive payments, subsidies or unrelated vocational training expenses such as the following:

(i) Incentive payments made to an employer to encourage or subsidize the employer’s participation in a supported employment program;

(ii) Payments that are passed through to users of supported employment programs; or (iii) Payments for vocational training that is not directly related to an Enrollee’s supported employment program.

(e) Environmental Accessibility Modifications.

1. Environmental Accessibility Modifications which are considered improvements to the home (e.g., roof or flooring repair, installing carpet, installation of central air conditioning, construction of an additional room) are excluded from coverage.

2. Any modification which is not of direct medical or remedial benefit to the Enrollee is excluded from coverage.

3. Modification of an existing room which increases the total square footage of the home is also excluded unless the modification is necessary to improve the accessibility of an Enrollee having limited mobility, in which case the modification shall be limited to the minimal amount of square footage necessary to accomplish the increased accessibility.

4. Environmental Accessibility Modifications shall be limited to a maximum of $15,000 per Enrollee per two (2) year period.

(f) Family Model Residential Support.

1. With the exception of homes that were already providing services to three (3) residents prior to January 1, 2004, a Family Model Residential Support home shall have no more than two (2) residents who receive services and supports.

2. The Family Model Residential Support provider shall be responsible for providing an appropriate level of services and supports twenty-four (24) hours per day during the hours the Enrollee is not receiving Day Services or is not at school or work.

3. Transportation shall be a component of Family Model Residential Support and shall be included in the reimbursement rate for such (i.e., it shall not be billed as a separate Waiver service) with the following exceptions:

(i) Transportation to and from medical services covered through the Medicaid State Plan, which shall not be billed as a Waiver service;

(ii) Transportation necessary for Behavioral Respite Services; or (iii) Transportation necessary for Orientation and Mobility Training.

4. This service shall not be provided in inpatient hospitals, nursing facilities, and Intermediate Care Facilities for the Mentally Retarded (ICF/MR’s).

5. Reimbursement for Family Model Residential Support shall not be made for room and board or for the cost of maintenance of the dwelling, and reimbursement shall not include payment made to the Enrollee’s parent, step-parent, spouse, child, or sibling or to any other individual who is a conservator unless so permitted in the Order for Conservatorship.

(g) Individual Transportation Services.

Individual Transportation Services shall not be used for:

1. Transportation to and from Day Services;

2. Transportation to and from supported or competitive employment;

3. Transportation of school aged children to and from school;

4. Transportation to and from medical services covered by the Medicaid State Plan; or 5. Transportation of an Enrollee receiving a residential service, except as described herein for Orientation and Mobility Training or Behavioral Respite Services.

(h) Medical Residential Services.

1. The Medical Residential Services provider shall be responsible for providing an appropriate level of services and supports twenty-four (24) hours per day when the Enrollee is not at school and shall be responsible for the cost of Day Services needed by the Enrollee.

2. Transportation shall be a component of Medical Residential Services and shall be included in the reimbursement rate for such (i.e., it shall not be billed as a separate Waiver service) with the following exceptions:

(i) Transportation to and from medical services covered through the Medicaid State Plan, which shall not be billed as a Waiver service;

(ii) Transportation necessary for Behavioral Respite Services; or (iii) Transportation necessary for Orientation and Mobility Training.

3. Reimbursement for Medical Residential Services shall not include the cost of maintenance of the dwelling, and reimbursement shall not include payment made to members of the Enrollee’s immediate family or to the Enrollee’s conservator.

Reimbursement shall not be made for room and board if the home is rented, leased, or owned by the provider. If the home is rented, leased, or owned by the Enrollee, reimbursement shall not be made for room and board with the exception of a reasonable portion that is attributed to a live-in caregiver who is unrelated to the Enrollee and who provides services to the Enrollee in the Enrollee’s place of residence. If an Enrollee owns or leases the place of residence, residential expenses (e.g., phone, cable TV, food, rent) shall be apportioned between the Enrollee, other residents in the home, and (as applicable) live-in or other caregivers.

4. This service shall not be provided in inpatient hospitals, nursing facilities, and Intermediate Care Facilities for the Mentally Retarded (ICF/MR’s).

5. Medical Residential Services providers must be licensed by the Department of Mental Health and Developmental Disabilities as a Mental Retardation Residential Habilitation Facility provider or a Supported Living Service provider and ensure that employed nurses are licensed to practice in the state of Tennessee.

(i) Nursing Services.

1. Nursing Services shall be provided face to face with the Enrollee by a licensed registered nurse or licensed practical nurse under the supervision of a registered nurse.

2. Nursing assessment and/or nursing oversight shall not be a separate billable service under this definition.

3. This service shall be provided in home and community settings, as specified in the Plan of Care, excluding inpatient hospitals, nursing facilities, and Intermediate Care Facilities for the Mentally Retarded (ICF/MR’s).

4. An Enrollee who is receiving Medical Residential Services shall not be eligible to receive Nursing Services during the hours Medical Residential Services are being provided.

5. Nursing Services shall not be billed when provided during the same time period as other therapies unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently.

6. Nursing Services are not intended to replace services available through the Medicaid State Plan or services available under the Rehabilitation Act of 1973 or Individuals with Disabilities Education Act.

(j) Nutrition Services.

1. Nutrition Services must be provided face to face with the Enrollee except for Enrollee-specific training of caregivers responsible for food purchase, food preparation, or assisting the Enrollee to eat and except for that portion of the assessment involving development of the POC.

2. Nutrition Services shall not be billed when provided during the same time period as Physical Therapy; Occupational Therapy; Speech, Language and Hearing Services; Orientation and Mobility Training; or Behavior Services, unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently.

3. Reimbursement for a Nutrition Services assessment visit, which includes the Nutritional Services plan development resulting from such an assessment, shall be limited to one (1) assessment visit per month with a maximum of three (3) assessment visits per year per Enrollee per provider Nutrition Services other than such assessments (e.g., Enrollee-specific training of caregivers; monitoring dietary compliance and food preparation) shall be limited to a maximum of one (1) visit per day. Nutrition Services assessments shall not be billed on the same day with other Nutrition Services.

(k) Occupational Therapy Services.

1. Services must be provided by a licensed occupational therapist or by a licensed occupational therapist assistant working under the supervision of a licensed occupational therapist.

2. Occupational Therapy must be provided face to face with the Enrollee except for that portion of the assessment involving development of the POC.

3. Occupational Therapy therapeutic and corrective services shall not be ordered concurrently with Occupational Therapy assessments (i.e., assess and treat orders are not accepted).

4. Occupational Therapy assessments shall not be billed on the same day with other Occupational Therapy services.

5. Occupational Therapy shall not be billed when provided during the same time period as Physical Therapy; Speech, Language and Hearing Services; Nutrition Services; Orientation and Mobility Training; or Behavior Services, unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently. Occupational Therapy shall not be billed with Day Services if the Day Services are reimbursed on a per hour basis.

6. Occupational Therapy services are not intended to replace services available through the Medicaid State Plan or services available under the Rehabilitation Act of 1973 or Individuals with Disabilities Education Act.

7. Reimbursement for an Occupational Therapy assessment with development of an Occupational Therapy plan based on such an assessment shall be limited to a maximum of one (1) assessment with plan development per month with a maximum of three (3) assessments per year per Enrollee per provider.

Occupational Therapy services other than such assessments (e.g., Enrolleespecific training of caregivers; provision of therapeutic services; monitoring progress) shall be limited to a maximum of one and one-half (1.5) hours per Enrollee per day.

(l) Orientation and Mobility Training.

1. Orientation and Mobility Training shall not be billed when provided during the same time period as Physical Therapy; Occupational Therapy; Nutrition Services; Behavior Services; or Speech, Language and Hearing Services, unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently.

2. Orientation and Mobility Training shall not replace services available under a program funded by the Rehabilitation Act of 1973 or Individuals with Disabilities Education Act.

3. Reimbursement for an Orientation and Mobility Training assessment with development of the Orientation and Mobility Training plan based on such an assessment shall be limited to a maximum of one (1) assessment with plan development per month with a maximum of three (3) assessments per year per Enrollee per provider. Orientation and Mobility Training assessments shall not be billed on the same day with other Orientation and Mobility Training services.

Orientation and Mobility Training services other than such assessments (e.g., Enrollee training; Enrollee-specific training of caregivers), which shall be reimbursed on a per diem basis, shall be limited to a maximum of fifty-two (52) hours of services per Enrollee per year.

4. Enrollees receiving Orientation and Mobility Training shall be eligible to receive Individual Transportation Services to the extent necessary for participation in Orientation and Mobility Training.

(m) Personal Assistance.

1. Personal Assistance may be provided in the home or community; however, it shall not be provided in school settings and shall not be provided to replace personal assistance services required to be covered by schools or services available through the Medicaid State Plan.

2. An Enrollee who is receiving a residential service (i.e., Supported Living, Residential Habilitation, Medical Residential Services, or Family Model Residential Support) shall not be eligible to receive Personal Assistance.

Personal Assistance shall not be provided during the same time period when the Enrollee is receiving Day Services.

3. This service shall not be provided in inpatient hospitals, nursing facilities, and Intermediate Care Facilities for the Mentally Retarded (ICF/MR’s).

4. Family members who provide Personal Assistance must meet the same standards as providers who are unrelated to the Enrollee. The Personal Assistance provider shall not be the spouse and shall not be the Enrollee’s parent if the Enrollee is a minor. Reimbursement shall not be made to any other individual who is a conservator unless so permitted in the Order for Conservatorship.

(n) Personal Emergency Response System. The system shall be limited to those who are alone for parts of the day and who have demonstrated mental and physical capability to utilize such a system effectively.

(o) Physical Therapy Services.

1. Services must be provided by a licensed physical therapist or by a licensed physical therapist assistant working under the supervision of a licensed physical therapist.

2. Physical Therapy must be provided face to face with the Enrollee except for that portion of the assessment involving development of the POC.

3. Physical Therapy therapeutic and corrective services shall not be ordered concurrently with Physical Therapy assessments (i.e., assess and treat orders are not accepted).

4. Physical Therapy assessments shall not be billed on the same day with other Physical Therapy services.

5. Physical Therapy shall not be billed when provided during the same time period as Occupational Therapy; Speech, Language and Hearing Services; Nutrition Services; Orientation and Mobility Training; or Behavior Services, unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently. Physical Therapy shall not be billed with Day Services if the Day Services are reimbursed on a per hour basis.

6. Physical Therapy services are not intended to replace services available through the Medicaid State Plan or services available under the Rehabilitation Act of 1973 or Individuals with Disabilities Education Act.

7. Reimbursement for a Physical Therapy assessment with development of a Physical Therapy plan based on such an assessment shall be limited to a maximum of one (1) assessment with plan development per month with a maximum of three (3) assessments per year per Enrollee per provider. Physical Therapy services other than such assessments (e.g., Enrollee-specific training of caregivers; provision of therapeutic services; monitoring progress) shall be limited to a maximum of one and one-half (1.5) hours per Enrollee per day.

(p) Residential Habilitation.

1. A Residential Habilitation home shall have no more than 4 residents with the exception that homes which were already providing services to more than 4 residents prior to July 1, 2000, may continue to do so.

2. The Residential Habilitation provider shall be responsible for providing an appropriate level of services and supports twenty-four (24) hours per day during the hours the Enrollee is not receiving Day Services or is not at school or work.

3. Transportation shall be a component of Residential Habilitation and shall be included in the reimbursement rate for such (i.e., it shall not be billed as a separate Waiver service) with the following exceptions:

(i) Transportation to and from medical services covered through the Medicaid State Plan, which shall not be billed as a Waiver service;

(ii) Transportation necessary for Behavioral Respite Services; or (iii) Transportation necessary for Orientation and Mobility Training.

4. Reimbursement for Residential Habilitation shall not be made for room and board or for the cost of maintenance of the dwelling, and reimbursement shall not include payment made to members of the Enrollee’s immediate family or to the Enrollee’s conservator.

5. This service shall not be provided in inpatient hospitals, nursing facilities, and Intermediate Care Facilities for the Mentally Retarded (ICF/MR’s).

(q) Respite.

1. Respite may be provided in the Enrollee’s place of residence, in a Family Model Residential Support home, in a Medicaid-certified ICF/MR, in a home operated by a licensed residential provider, or in the home of an approved respite provider.

2. An Enrollee receiving a residential service (i.e., Supported Living, Residential Habilitation, Medical Residential Services, or Family Model Residential Support) shall not be eligible to receive Respite as a service.

3. The cost of room and board shall be excluded from Respite reimbursement if Respite is provided in a private residence.

4. Respite shall be limited to a maximum of thirty (30) days per Enrollee per year.

5. Enrollees who receive Respite shall be eligible to receive Individual Transportation Services only to the extent necessary during the time period when Respite is being provided.

(r) Specialized Medical Equipment and Supplies and Assistive Technology.

1. Face-to-face consultative assessment by a physical therapist, occupational therapist, or speech therapist to assure that specialized medical equipment and assistive technology which requires custom fitting meets the needs of the Enrollee and training of the Enrollee by a physical therapist, occupational therapist, or speech therapist to effectively utilize such customized equipment shall be limited to a maximum of three (3) hours per Enrollee per day.

2. Items not of direct medical or remedial benefit to the Enrollee shall be excluded.

Items that would be covered by the Medicaid State Plan shall be excluded from coverage. Swimming pools, hot tubs, health club memberships, and recreational equipment are excluded. Prescription and over-the-counter medications, food and food supplements, and diapers and other incontinence supplies are excluded.

3. When medically necessary and not covered by warranty, repair of equipment may be covered when it is substantially less expensive to repair the equipment rather than to replace it.

4. The purchase price for waiver-reimbursed Specialized Medical Equipment, Supplies and Assistive Technology shall be considered to include the cost of the item as well as basic training on operation and maintenance of the item.

5. Specialized Medical Equipment and Supplies and Assistive Technology as defined by 1200-13-01-.25, and Enabling Technology, as defined by 1200-13-01- .02, shall be limited to a combined maximum benefit of $10,000 per person supported per two (2) consecutive calendar years.

(s) Speech, Language and Hearing Services.

1. Services must be provided by a licensed speech language pathologist or by a licensed audiologist.

2. Speech, Language and Hearing Services must be provided face to face with the Enrollee except for that portion of the assessment involving development of the POC.

3. Speech, Language and Hearing therapeutic and corrective services shall not be ordered concurrently with Speech, Language and Hearing assessments (i.e., assess and treat orders are not accepted).

4. Speech, Language and Hearing Services assessments shall not be billed on the same day with other Speech, Language and Hearing Services 5. Speech, Language and Hearing Services shall not be billed when provided during the same time period as Physical Therapy; Occupational Therapy;

Nutrition Services; Orientation and Mobility Training; or Behavior Services, unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently. Speech, Language and Hearing Services shall not be billed with Day Services if the Day Services are reimbursed on a per hour basis.

6. Reimbursement for a Speech, Language, and Hearing Services assessment with development of a Speech, Language, and Hearing Services plan based on such an assessment shall be limited to a maximum of one (1) assessment with plan development per month with a maximum of three (3) assessments per year per Enrollee per provider. Speech, Language, and Hearing Services other than such assessments (e.g., Enrollee-specific training of caregivers; provision of therapeutic services; monitoring progress) shall be limited to a maximum of one and one-half (1.5) hours per Enrollee per day.

(t) Support Coordination. There must be at least one face-to-face contact with the Enrollee per calendar month. If the Enrollee receives a residential service, the Support Coordinator shall have at least one face-to-face contact with the Enrollee in the Enrollee’s place of residence each quarter.

(u) Supported Living.

1. The Supported Living provider shall not own the Enrollee’s place of residence or be a co-signer of a lease on the Enrollee’s place of residence unless the Supported Living provider signs a written agreement with the Enrollee that states that the Enrollee will not be required to move if the primary reason is because the Enrollee desires to change to a different Supported Living provider. A Supported Living provider shall not own, be owned by, or be affiliated with any entity that leases or rents a place of residence to an Enrollee if such entity requires, as a condition of renting or leasing, the Enrollee to move if the Supported Living provider changes.

2. The Supported Living home shall have no more than three (3) residents including the Enrollee.

3. Unless the residence is individually licensed or inspected by a public housing agency utilizing the HUD Section 8 safety checklist, the residence must have an operable smoke detector and a second means of egress.

4. The Supported Living provider shall be responsible for providing an appropriate level of services and supports twenty-four (24) hours per day during the hours the Enrollee is not receiving Day Services or is not at school or work.

5. Transportation shall be a component of Supported Living and shall be included in the reimbursement rate for such (i.e., it shall not be billed as a separate Waiver service) with the following exceptions:

(i) Transportation to and from medical services covered through the Medicaid State Plan, which shall not be billed as a Waiver service;

(ii) Transportation necessary for Behavioral Respite Services; or (iii) Transportation necessary for Orientation and Mobility Training.

6. Reimbursement for Supported Living shall not be made for room and board with the exception of a reasonable portion that is attributed to a live-in caregiver who is unrelated to the Enrollee and who provides services to the Enrollee in the Enrollee’s home. Reimbursement for Supported Living shall not include the cost of maintenance of the dwelling. Residential expenses (e.g., phone, cable TV, food, rent) shall be apportioned between the Enrollee, other residents in the home, and (as applicable) live-in or other caregivers.

7. This service shall not be provided in inpatient hospitals, nursing facilities, and Intermediate Care Facilities for the Mentally Retarded (ICF/MR’s).

8. The Enrollee or the Enrollee’s guardian or conservator shall have a voice in choosing the individuals who reside in the Supported Living residence and the staff who provide services and supports.

9. The Enrollee shall have the right to manage personal funds as specified in the Individual Support Plan.

(v) Vehicle Accessibility Modifications.

1. Replacement of tires or brakes, oil changes, and other vehicle maintenance procedures shall be excluded from coverage.

2. Vehicle Accessibility Modifications shall be limited to a maximum of $20,000 per Enrollee per five (5) year period.

(w) Out-of-State Services. A provider of Personal Assistance, Residential Habilitation, Supported Living, Medical Residential Services, and Family Model Residential Services may provide such Covered Service outside the State of Tennessee and be reimbursed only when provided in accordance with the following:

1. Covered Services provided out of state shall be for the purpose of visiting relatives or for vacations and shall be included in the Enrollee’s Plan of Care.

Trips to casinos or other gambling establishments shall be excluded from coverage.

2. Covered Services provided out of state shall be limited to a maximum of fourteen (14) days per Enrollee per year.

3. The waiver service provider agency must be able to assure the health and safety of the Enrollee during the period when Covered Services will be provided out of state and must be willing to assume the additional risk and liability of provision of Covered Services out of state.

4. During the period when Covered Services are being provided out of state, the waiver service provider agency shall maintain an adequate amount of staffing to meet the needs of the Enrollee and must ensure that staff meet the applicable provider qualifications.

5. The provider agency which provides Covered Services out of state shall not receive any additional reimbursement for provision of services out-of-state. The costs of travel, lodging, food, and other expenses incurred by staff during the provision of out-of-state services shall not be reimbursed through the Waiver.

The costs of travel, lodging, food, and other expenses incurred by the Enrollee while receiving out-of-state services shall be the responsibility of the Enrollee and shall not be reimbursed through the waiver.

(x) All Covered Services to be provided prior to the development of the initial Individual Support Plan must be included in the physician’s plan of care section of the Pre- Admission Evaluation application.

(3) Eligibility.

(a) To be eligible for enrollment in the Waiver, an individual must meet all of the following criteria:

1. The individual must be a resident of the State of Tennessee.

2. The individual must, but for the provision of Waiver Services, require the LOC provided in an ICF/MR, and must meet the ICF/MR eligibility criteria specified in TennCare Rule 1200-13-01-.15, except that requirements pertaining to a psychological evaluation shall be in accordance with Rule 1200-13-01-.25(3)(a)5.

3. The individual’s habilitative, medical, and specialized services needs must be such that they can be effectively and safely met through the Waiver, as determined by the Operational Administrative Agency based on a pre-enrollment assessment.

4. The individual must have an unexpired ICF/MR Pre-Admission Evaluation which has been approved by the State Medicaid Agency or by its designee and which lists the Enrollee’s specific Waiver Services with the amount, scope, and duration of the services.

5. The individual must have a psychological evaluation included as part of the approved Pre-Admission Evaluation which meets the following:

(i) The psychological evaluation shall document that the individual:

(I) Has mental retardation manifested before eighteen (18) years of age and has an IQ test score of seventy (70) or below; or (II) Is a child five (5) years of age or younger who has a developmental disability with a high probability of resulting in mental retardation (i.e., a condition of substantial developmental delay or specific congenital or acquired condition with a high probability of resulting in mental retardation); and (ii) There is no time limit for when the psychological evaluation is conducted as long as it is completed prior to the submission of the PAE, and as long as the evaluation meets the requirements specified in 1200-13-01- .25(3)(a)5.(i) above, and the person’s current medical, social, developmental and psycho-social history continues to support the evaluation.

(iii) A new psychological evaluation performed within ninety (90) calendar days preceding the date of admission into the waiver shall be required if the person’s condition has significantly changed, or the original evaluation is not otherwise consistent with the person’s current medical, social, developmental and psycho-social history.

6. The individual shall have one or more designated adults who shall be present in the individual’s home to observe, evaluate, and provide an adequate level of direct care services to ensure the health and safety of the individual.

(i) An individual who does not have 24-hour-per-day direct care services shall:

(I) Have an individualized Safety Plan that:

I. Is based on a written assessment of the individual’s functional capabilities and habilitative, medical, and specialized services needs by the Independent Support Coordinator in consultation with individuals who are knowledgeable of the individual’s capability of functioning without direct care services twentyfour (24) hours per day;

II. Addresses the individual’s capability of functioning when direct care staff are not present;

III. Addresses the ability of the individual to self-administer medications when direct care staff are not present;

IV. Specifies whether a Personal Emergency Response System will be used by the individual to secure help in an emergency;

V. Is updated as needed, but no less frequently than annually, by the Operational Administrative Agency to ensure the health and safety of the individual; and VI. Is an attachment to the ICF/MR PAE or, if applicable, to the Transfer Form.

(II) Have one or more designated adults who shall be present in the individual’s home to observe, evaluate, and provide an adequate level of direct care services to ensure the health and safety of the individual as needed but no less frequently than one day each week.

7. An individual must have a place of residence with an environment that is adequate to reasonably ensure health, safety and welfare. Any licensed facility in which the individual resides must meet all applicable fire and safety codes.

(b) A Transfer Form approved by the State Medicaid Agency:

1. May be used to transfer an Enrollee having an approved unexpired ICF/MR PAE from the Waiver to an ICF/MR;

2. May be used to transfer an individual having an approved unexpired ICF/MR PAE from an ICF/MR to the Waiver;

3. May be used to transfer an individual from one MR Waiver to a different Home and Community Based Services MR Waiver Program as specified in 1200-13-01- .25(1)(qq) above; and 4. Shall include an initial plan of care that lists the Enrollee’s specific Waiver Services with the amount, scope, and duration of the services.

(4) Intake and Enrollment.

(a) When an individual is determined to be likely to require the level of care provided by an ICF/MR, the Operational Administrative Agency shall inform the individual or the individual’s legal representative of any feasible alternatives available under the Waiver and shall offer the choice of available institutional services or Waiver program services.

Notice to the individual shall contain:

1. A simple explanation of the Waiver and Covered Services;

2. Notification of the opportunity to apply for enrollment in the Waiver and an explanation of the procedures for enrollment; and 3. A statement that participation in the Waiver is voluntary.

(b) Enrollment in the Waiver shall be voluntary, but shall be restricted to the maximum number of individuals specified in the Waiver, as approved by the Centers for Medicare and Medicaid Services for the State of Tennessee.

(c) Enrollment of new Enrollees into the Waiver may be suspended when the average per capita fiscal year expenditure under the Waiver exceeds or is reasonably anticipated to exceed 100% of the average per capita expenditure that would have been made in the fiscal year if the care was provided in an ICF/MR.

(d) Upon implementation of the ECF CHOICES program, all new enrollment into the Statewide Waiver shall be closed; provided, however, that a child age 18-21 who has an Intellectual Disability and is aging out of State custody or is determined by TennCare to no longer be able to safely continue living with their family may be enrolled into the Statewide Waiver subject to (b) above if all eligibility and enrollment criteria are met, only until such time that the State has authority under the terms and conditions of the 1115 Waiver to provide for enrollment of such child into ECF CHOICES, when appropriate..

(5) Certification and Re-evaluation.

(a) The ICF/MR Pre-Admission Evaluation shall include a signed and dated certification by the individual’s physician that the individual requires Waiver Services.

(b) The Operational Administrative Agency shall perform a re-evaluation of the Enrollee’s need for continued stay in the Waiver within twelve (12) calendar months of the date of enrollment and at least every twelve (12) months thereafter. The re-evaluation shall be documented in a format approved by the State Medicaid Agency and shall be performed by a licensed physician or registered nurse or a Qualified Mental Retardation Professional.

(c) The Operational Administrative Agency shall maintain in its files for a minimum period of three (3) years a copy of the re-evaluations of need for continued stay.

(6) Disenrollment.

(a) Voluntary disenrollment of an Enrollee from the Waiver may occur at any time upon written notice from the Enrollee or the Enrollee’s guardian or conservator to the Operational Administrative Agency. Prior to disenrollment the Operational Administrative Agency shall provide reasonable assistance to the Enrollee in locating appropriate alternative placement.

(b) An Enrollee may be involuntarily disenrolled from the Waiver for any of the following reasons:

1. The Home and Community Based Services Waiver for the Mentally Retarded and Developmentally Disabled is terminated.

2. An Enrollee becomes ineligible for Medicaid or is found to be erroneously enrolled in the Waiver.

3. An Enrollee moves out of the State of Tennessee; provided however, that when the Enrollee is the dependent of a military service member who is a legal resident of the state, but has left the state temporarily due to the military service member’s military assignment out of state, such dependent may re-enroll in the Waiver upon return to the State, so long as all conditions of eligibility are met.

4. The condition of the Enrollee improves such that the Enrollee no longer requires the level of care provided by the Waiver.

5. The Enrollee’s medical or behavioral needs become such that the health, safety, and welfare of the Enrollee cannot be assured through the provision of Waiver Services.

6. The home or home environment of the Enrollee becomes unsafe to the extent that it would reasonably be expected that Waiver Services could not be provided without significant risk of harm or injury to the Enrollee or to individuals who provide covered services to the Enrollee.

7. The Enrollee or the Enrollee’s guardian or conservator refuses to abide by the Plan of Care or related Waiver policies, resulting in the inability of the Operational Administrative Agency to ensure quality care or the health and safety of the Enrollee.

8. The health, safety, and welfare of the Enrollee cannot be assured due to the lack of an approved Safety Plan.

9. The Enrollee was transferred to a hospital, NF, ICF/MR, Assisted Living Facility, and/or Home for the Aged and has resided there for a continuous period exceeding one hundred twenty (120) days, if such period began prior to March 1, 2010, or a period exceeding ninety (90) days if such period begins on or after March 1, 2010.

(c) The Operational Administrative Agency shall notify the State Medicaid Agency in writing prior to involuntary disenrollment of an Enrollee and shall give advance notice to the Enrollee of the intended involuntary disenrollment and of the Enrollee’s right to appeal and have a fair hearing.

(d) If an Enrollee has been involuntarily disenrolled from the Waiver, the Operational Administrative Agency shall provide reasonable assistance to the Enrollee in locating appropriate alternative placement.

(7) Plan of Care.

(a) All Waiver Services for the Enrollee shall be provided in accordance with an approved Plan of Care.

1. Prior to the development of the initial Individual Support Plan, Covered Services shall be provided in accordance with the physician’s initial plan of care included in the approved ICF/MR Pre-Admission Evaluation.

2. Each Enrollee shall have a comprehensive individualized written Plan of Care (the Individual Support Plan) that shall be developed for the Enrollee within sixty (60) calendar days of admission into the Waiver.

3. A Safety Plan for Enrollees who do not have 24-hour direct care services shall be maintained with the Plan of Care.

(b) To ensure that Waiver Services and other services are being appropriately provided to meet the Enrollee’s needs, the Plan of Care shall be reviewed on an ongoing basis and shall be updated and signed in accordance with the following:

1. The Support Coordinator shall review the Plan of Care when needed, but no less frequently than once each calendar month, and shall document such review by a dated signature.

2. A team consisting of the Support Coordinator and other appropriate participants in the development of the Plan of Care shall review the Plan of Care when needed, but no less frequently than every twelve (12) calendar months, and shall document such review by dated signatures. Such annual review shall include, but not be limited to, reviewing outcomes and determining if progress is being made in accordance with the Plan of Care; reviewing the appropriateness of supports and services being provided and determining further needs of the Enrollee.

(8) Physician Services.

(a) The Operational Administrative Agency shall ensure that each Enrollee receives physician services as needed and that each Enrollee has a medical examination, documented in the Enrollee’s record, in accordance with the following schedule:

Age Minimum frequency of medical examinations Up to age 21 In accordance with Medicaid EPSDT periodicity standards 21-64 Every one (1) to three (3) years, as determined by the Enrollee’s physician Over age 65 Annually (b) All Covered Services to be provided prior to the development of the initial Individual Support Plan shall be physician ordered and shall be included in the physician’s plan of care section of the Pre-Admission Evaluation application.

(c) When required by state law, Covered Services shall be ordered or reordered, by a licensed physician, licensed nurse practitioner, physician assistant, a licensed dentist, or other appropriate health care provider.

(9) Waiver Administration. The Operational Administrative Agency shall be responsible for the administration of the day-to-day operations of the Waiver under the oversight of the State Medicaid Agency and shall ensure that Covered Services are provided in accordance with state and federal laws, rules, regulations and policies established by the State Medicaid Agency. The Operational Administrative Agency shall be responsible for the following activities, whether provided directly or through subcontract:

(a) Marketing of the Waiver to potential Enrollees;

(b) Intake and pre-enrollment assessment of the applicant’s habilitative, medical and specialized services needs; and appropriateness for enrollment in the Waiver;

(c) Assisting the applicant with the submission of a properly completed ICF/MR Pre- Admission Evaluation;

(d) Enrollment of eligible individuals into the Waiver;

(e) Provision of a plain language explanation of appeal rights to each Enrollee upon enrollment in the Waiver;

(f) Review and approval of Plans of Care (Individual Support Plans) to ensure that Waiver Services have been authorized prior to payment;

(g) Ensuring that annual level of care re-evaluations have been performed to document the need for continuation of Waiver Services for the Enrollee;

(h) Notification of the State Medicaid Agency in writing prior to involuntary disenrollment of any Enrollee;

(i) Ensuring that Waiver providers maintain comprehensive Enrollee records and documentation of services provided to Enrollees in accordance with state and federal laws, rules, regulations and State Medicaid Agency policies;

(j) Obtaining approval from the State Medicaid Agency prior to distributing policies and procedures to Waiver providers or Waiver information to Enrollees;

(k) Compliance with reporting and record-keeping requirements established by the State Medicaid Agency;

(l) Maintaining in its files the original ICF/MR Pre-Admission Evaluation and, where applicable, the original Transfer Form;

(m) Assurance of a statewide provider network adequate to meet the needs of Enrollees;

(n) Ensuring that Waiver Services providers and subcontractors meet the Waiver provider qualifications approved by the Centers for Medicare and Medicaid Services;

(o) Ensuring that Waiver Services providers have a signed provider agreement which includes a requirement for compliance with the Division of Mental Retardation Services Provider Manual in the delivery of waiver services;

(p) Assurance of the health and safety of Enrollees through the implementation of a comprehensive quality monitoring program;

(q) Reporting instances of abuse, neglect, mistreatment or exploitation to appropriate state agencies;

(r) Assurance that Covered Services are provided in accordance with the approved Waiver definitions and in accordance with the State Medicaid Agency guidelines;

(s) Compliance with the appeals process specified in TennCare rule 1200-13-13-.11 to ensure that Enrollees are afforded advance notice and the right to appeal an adverse decision and have a fair hearing;

(t) Ensuring that providers and subcontractors comply with the quality monitoring guidelines and requirements established by the State Medicaid Agency, by the Operational Administrative Agency, and by the Centers for Medicare and Medicaid Services, and with other state and federal laws, rules, and regulations affecting the provision of Waiver Services;

(u) Collection of applicable patient liability from Enrollees;

(v) Reimbursement of Waiver providers in accordance with policies established by the State Medicaid Agency;

(w) Recoupment of payments made to Waiver providers when there is lack of documentation to support that services were provided or there is a lack of medical necessity of services, or when inappropriate payments have been made due to erroneous or fraudulent billing; and (x) Expenditure and revenue reporting in accordance with state and federal requirements.

(10) Reimbursement.

(a) The average per capita fiscal year expenditure under the Waiver shall not exceed 100% of the average per capita expenditure that would have been made in the fiscal year if care had been provided in an ICF/MR. The total Medicaid expenditure for Waiver Services and other Medicaid services provided to Enrollees shall not exceed 100% of the amount that would have been incurred in the fiscal year if care was provided in an ICF/MR.

(b) The Operational Administrative Agency shall be reimbursed for Waiver Services at the rate per unit of service actually paid by the Operational Administrative Agency to the Waiver service provider or at the maximum rate per unit of service established by the State Medicaid Agency, whichever is less.

(c) In accordance with 42 CFR § 435.726, the Operational Administrative Agency shall make a diligent effort to collect patient liability if it applies to the Enrollee. The Operational Administrative Agency or its designee shall complete appropriate forms showing the individual’s amount of monthly income and shall submit them to the Tennessee Department of Human Services. The Tennessee Department of Human Services shall issue the appropriate forms to the Operational Administrative Agency and to the State Medicaid Agency’s fiscal agent that processes and pays vendor claims, specifying the amount of patient liability to be applied toward the cost of care for the Enrollee.

(d) The Operational Administrative Agency shall submit bills for services to the State Medicaid Agency’s fiscal agent using a claim form approved by the State Medicaid Agency. On claim forms, the Operational Administrative Agency shall use a provider number assigned by the State Medicaid Agency.

(e) Reimbursement shall not be made to the Operational Administrative Agency for therapeutic leave or hospital leave for Enrollees in the Waiver.

(f) Medicaid benefits other than those specified in the Waiver’s scope of Covered Services shall be reimbursed by the State Medicaid Agency as otherwise provided for by federal and state rules and regulations.

(g) The Operational Administrative Agency shall be responsible for obtaining the physician’s initial certification and subsequent Enrollee re-evaluations. Failure to perform re-evaluations in a timely manner and in the format approved by the State Medicaid Agency shall require a corrective action plan and shall result in partial or full recoupment of all amounts paid by the State Medicaid Agency during the time period when a re-evaluation had lapsed.

(h) The State Medicaid Agency shall be responsible for defining and establishing the billing units to be used by the Operational Administrative Agency in billing for Waiver Services.

(i) An Operational Administrative Agency that enrolls an individual without an approved ICF/MR Pre-Admission Evaluation or, where applicable, an approved Transfer Form does so without the assurance of reimbursement. An Operational Administrative Agency that enrolls an individual who has not been determined by the Tennessee Department of Human Services to be financially eligible to have Medicaid make reimbursement for covered services does so without the assurance of reimbursement.

(11) Appeals. An Enrollee shall have the right to appeal an adverse action in accordance with TennCare rule 1200-13-13-.11.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 4-5-209, 71-5-105, 71-5-107, and 71-5-109 and Executive Order No. 23.
• Administrative History: Original rule filed July 6, 2001; effective September 19, 2001. Amendment filed June 20, 2007; effective September 3, 2007. Public necessity rule filed July 1, 2009; effective through December 13, 2009. Amendments filed September 11, 2009; effective December 10, 2009. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendments filed May 27, 2010; effective August 25, 2010. Amendments filed June 26, 2015; effective September 24, 2015. Amendments filed September 30, 2016; effective December 29, 2016. Emergency rules filed December 27, 2022 to become effective January 1, 2023; effective through June 30, 2023. Amendments filed November 1, 2022; effective January 30, 2023. Amendments filed January 19, 2023; effective April 19, 2023.

Tenn. Comp. R. & Regs. 1200-13-01-.26 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-209, 71-5-105, and 71-5-109 and Executive Order No. 23.
• Administrative History: Original rule filed July 28, 2004; effective October 11, 2004. Public necessity rule filed August 30, 2007; effective through February 11, 2008. Repeal filed November 30, 2007; effective February 13, 2008.

Tenn. Comp. R. & Regs. 1200-13-01-.27 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-209, 71-5-105, and 71-5-109 and Executive Order No. 23.
• Administrative History: Original rule filed July 28, 2004; effective October 11, 2004. Public necessity rule filed December 28, 2007; effective through June 10, 2008. Repeal of rule filed March 27, 2008; effective June 10, 2008.

Tenn. Comp. R. & Regs. 1200-13-01-.28 HOME AND COMMUNITY BASED SERVICES WAIVER FOR PERSONS WITH

MENTAL RETARDATION UNDER SECTION 1915(c) OF THE SOCIAL SECURITY ACT (ARLINGTON MR WAIVER).

(1) Definitions: The following definitions shall apply for interpretation of this rule:

(a) Adult Dental Services. See definition in 1200-13-01-.02.

(b) Behavioral Respite Services - services that provide Respite for an Enrollee who is experiencing a behavioral crisis that necessitates removal from the current residential setting in order to resolve the behavioral crisis.

(c) Behavior Services - assessment and amelioration of Enrollee behavior that presents a health or safety risk to the Enrollee or others or that significantly interferes with home or community activities; determination of the settings in which such behaviors occur and the events which precipitate the behaviors; development, monitoring, and revision of crisis prevention and behavior intervention strategies; and training of caregivers who are responsible for direct care of the Enrollee in prevention and intervention strategies.

(d) Bureau of TennCare - the bureau in the Tennessee Department of Finance and Administration which is the State Medicaid Agency and is responsible for administration of the Medicaid program in Tennessee.

(e) Certification - the process by which a physician, who is licensed as a doctor of medicine or doctor of osteopathy, signs and dates a Pre-Admission Evaluation signifying that the named individual requires services provided through the Home and Community Based Services Waiver for Persons with Mental Retardation as an alternative to care in an Intermediate Care Facility for the Mentally Retarded.

(f) Covered Services or Covered Waiver Services - the services which are available through Tennessee’s Home and Community Based Services Waiver for Persons with Mental Retardation when medically necessary and when provided in accordance with the Waiver as approved by the Centers for Medicare and Medicaid Services.

(g) Day Services - individualized services and supports that enable an Enrollee to acquire, retain, or improve skills necessary to reside in a community-based setting; to participate in community activities and utilize community resources; to acquire and maintain employment; and to participate in retirement activities.

(h) Denial - as used in regard to Waiver Services, the term shall mean the termination, suspension, or reduction in amount, scope, and duration of a Waiver Service or a refusal or failure to provide such service.

(i) Disenrollment - the voluntary or involuntary termination of enrollment of an individual receiving services through the Home and Community Based Services Waiver for Persons with Mental Retardation.

(j) Enrollee - a Medicaid Eligible who is enrolled in the Home and Community Based Services Waiver for Persons with Mental Retardation.

(k) Environmental Accessibility Modifications - only those interior or exterior physical modifications to the Enrollee’s place of residence which are required to ensure the health, welfare and safety of the Enrollee or which are necessary to enable the Enrollee to function with greater independence.

(l) Family Model Residential Support - a type of residential service having individualized services and supports that enable an Enrollee to acquire, retain, or improve skills necessary to reside successfully in a family environment in the home of trained caregivers other than the family of origin. The service includes direct assistance as needed with activities of daily living, household chores essential to the health and safety of the enrollee, budget management, attending appointments, and interpersonal and social skills building to enable the Enrollee to live in a home in the community. It also may include medication administration as permitted under Tennessee’s Nurse Practice Act.

(m) Home (of an Enrollee) - the residence or dwelling in which the Enrollee resides, excluding hospitals, nursing facilities, Intermediate Care Facilities for the Mentally Retarded, Assisted Living Facilities and Homes for the Aged.

(n) Home and Community Based Services Waiver for Persons with Mental Retardation or “Waiver” - the Home and Community Based Services waiver program approved for Tennessee by the Centers for Medicare and Medicaid Services to provide services to a specified number of Medicaid-eligible individuals who have mental retardation and who meet the criteria for Medicaid reimbursement of care in an Intermediate Care Facility for the Mentally Retarded.

(o) ICF/MR Pre-Admission Evaluation (ICF/MR PAE) - the assessment form used by the State Medicaid Agency to document the current medical and habilitative needs of an individual with mental retardation and to document that the individual meets the Medicaid level of care eligibility criteria for care in an ICF/MR.

(p) Individual Support Plan - the individualized written Plan of Care.

(q) Individual Transportation Services - non-emergency transport of an Enrollee to and from approved activities specified in the Plan of Care.

(r) Intermediate Care Facility for the Mentally Retarded (ICF/MR) - a licensed facility approved for Medicaid vendor reimbursement that provides specialized services for individuals with mental retardation or related conditions and that complies with current federal standards and certification requirements for an ICF/MR.

(s) Medicaid Eligible - an individual who has been determined by the Tennessee Department of Human Services to be financially eligible to have the State Medicaid Agency make reimbursement for covered services.

(t) Medicaid State Plan - the plan approved by the Centers for Medicare and Medicaid Services which specifies the covered benefits for the Medicaid program in Tennessee.

(u) Medical Residential Services - a type of residential service provided in a residence where all residents require direct skilled nursing services and habilitative services and supports that enable an Enrollee to acquire, retain, or improve skills necessary to reside in a community-based setting. Medical Residential Services must be ordered by the Enrollee’s physician, physician assistant, or nurse practitioner, who shall document the medical necessity of the services and specify the nature and frequency of the nursing services. The enrollee who receives Medical Residential Services shall require direct skilled nursing services on a daily basis and at a level which cannot for practical purposes be provided through two or fewer daily skilled nursing visits. The service includes direct assistance as needed with activities of daily living, household chores essential to the health and safety of the enrollee, budget management, attending appointments, and interpersonal and social skills building to enable the enrollee to live in a home in the community. It also may include medication administration as permitted under Tennessee’s Nurse Practice Act.

(v) Nursing Services - skilled nursing services that fall within the scope of Tennessee’s Nurse Practice Act and that are directly provided to the Enrollee in accordance with a plan of care. Nursing Services shall be ordered by the Enrollee’s physician, physician assistant, or nurse practitioner, who shall document the medical necessity of the services and specify the nature and frequency of the nursing services.

(w) Nutrition Services - assessment of nutritional needs, nutritional counseling, and education of the Enrollee and of caregivers responsible for food purchase, food preparation, or assisting the Enrollee to eat. Nutrition Services are intended to promote healthy eating practices and to enable the Enrollee and direct support professionals to follow special diets ordered by a physician, physician assistant, or nurse practitioner.

(x) Occupational Therapy Services - diagnostic, therapeutic, and corrective services which are within the scope of state licensure. Occupational Therapy Services provided to improve or maintain current functional abilities as well as prevent or minimize deterioration of chronic conditions leading to a further loss of function are also included within this definition.

(y) Operational Administrative Agency - the approved agency with which the State Medicaid Agency contracts for the administration of the day-to-day operations of the Home and Community Based Services Waiver for Persons with Mental Retardation.

(z) Orientation and Mobility Training - assessment of the ability of an Enrollee who is legally blind to move independently, safely, and purposefully in the home and community environment; orientation and mobility counseling; and training and education of the Enrollee and of caregivers responsible for assisting in the mobility of the Enrollee.

(aa) Personal Assistance - the provision of direct assistance with activities of daily living (e.g., bathing, dressing, personal hygiene, eating, meal preparation excluding cost of food), household chores essential to the health and safety of the enrollee, budget management, attending appointments, and interpersonal and social skills building to enable the Enrollee to live in a home in the community. It also may include medication administration as permitted under Tennessee’s Nurse Practice Act.

(bb) Personal Emergency Response System - a stationary or portable electronic device used in the Enrollee’s place of residence which enables the Enrollee to secure help in an emergency. The system shall be connected to a response center staffed by trained professionals who respond upon activation of the electronic device.

(cc) Physical Therapy Services - diagnostic, therapeutic, and corrective services which are within the scope of state licensure. Physical Therapy Services provided to improve or maintain current functional abilities as well as prevent or minimize deterioration of chronic conditions leading to a further loss of function are also included within this definition.

(dd) Plan of Care - an individualized written Plan of Care which describes the medical and other services (regardless of funding source) to be furnished to the Enrollee, the Waiver Service frequency, and the type of provider who will furnish each Waiver Service and which serves as the fundamental tool by which the State ensures the health and welfare of Enrollees.

(ee) Qualified Mental Retardation Professional (QMRP) - an individual who meets current federal standards, as published in the Code of Federal Regulations, for a qualified mental retardation professional.

(ff) Re-evaluation - the annual process approved by the State Medicaid Agency by which a licensed physician or registered nurse or a Qualified Mental Retardation Professional assesses the Enrollee’s need for continued Waiver Services and certifies in writing that the Enrollee continues to require Waiver Services.

(gg) Residential Habilitation - a type of residential service having individualized services and supports that enable an Enrollee to acquire, retain, or improve skills necessary to reside in a community-based setting including direct assistance with activities of daily living essential to the health and safety of the Enrollee, budget management, attending appointments, and interpersonal and social skills building to enable the Enrollee to live in a home in the community. It also may include medication administration as permitted under Tennessee’s Nurse Practice Act.

(hh) Respite - services provided to an Enrollee when unpaid caregivers are absent or incapacitated due to death, hospitalization, illness or injury, or when unpaid caregivers need relief from routine caregiving responsibilities.

(ii) Safety Plan - an individualized plan by which the Operational Administrative Agency ensures the health, safety and welfare of Enrollees who do not have 24-hour direct care services.

(jj) Specialized Medical Equipment and Supplies and Assistive Technology - assistive devices, adaptive aids, controls or appliances which enable an Enrollee to increase the ability to perform activities of daily living, or to perceive, control or communicate with the environment, and supplies for the proper functioning of such items. Specialized Medical Equipment, Supplies and Assistive Technology shall be recommended by a qualified health care professional (e.g., occupational therapist, physical therapist, speech language pathologist, physician or nurse practitioner) based on an assessment of the Enrollee’s needs and capabilities and shall be furnished as specified in the Plan of Care. Specialized Medical Equipment and Supplies and Assistive Technology may also include a face-to-face consultative assessment by a physical therapist, occupational therapist or speech therapist to assure that Specialized Medical Equipment and Assistive Technology which requires custom fitting meets the needs of the Enrollee and may include training of the Enrollee by a physical therapist, occupational therapist or speech therapist to effectively utilize such customized equipment.

(kk) Speech, Language and Hearing Services - diagnostic, therapeutic and corrective services which are within the scope of state licensure which enable an Enrollee to improve or maintain current functional abilities and to prevent or minimize deterioration of chronic conditions leading to a further loss of function.

(ll) State Medicaid Agency - the bureau in the Tennessee Department of Finance and Administration which is responsible for administration of the Title XIX Medicaid program in Tennessee.

(mm) Subcontractor - an individual, organized partnership, professional corporation, or other legal association or entity which enters into a written contract with the Operational Administrative Agency to provide Waiver Services to an Enrollee.

(nn) Support Coordination - case management services that assist the Enrollee in identifying, selecting, obtaining, coordinating and using both paid services and natural supports to enhance the Enrollee’s independence, integration in the community and productivity as specified in the Enrollee’s Plan of Care. Support Coordination shall be person-centered and shall include, but is not limited to, ongoing assessment of the Enrollee’s strengths and needs; development, evaluation and revision of the Plan of Care; assistance with the selection of service providers; provision of general education about the Waiver program, including Enrollee rights and responsibilities; and monitoring implementation of the plan of care and initiating individualized corrective actions as necessary (e.g., reporting, referring, or appealing to appropriate entities).

(oo) Support Coordinator - the person who is responsible for developing the Individual Support Plan and participating in the development of, monitoring and assuring the implementation of the Plan of Care; who provides Support Coordination services to an Enrollee; and who meets the qualifications for a Support Coordinator as specified in the Home and Community Based Services Waiver for Persons with Mental Retardation.

(pp) Supported Living - a type of residential service having individualized services and supports that enable an Enrollee to acquire, retain or improve skills necessary to reside in a home that is under the control and responsibility of the Enrollee. The service includes direct assistance as needed with activities of daily living, household chores essential to the health and safety of the Enrollee, budget management, attending appointments, and interpersonal and social skills building to enable the Enrollee to live in a home in the community. It also may include medication administration as permitted under Tennessee’s Nurse Practice Act.

(qq) Transfer Form - the form approved by the State Medicaid Agency and used to document the transfer of an Enrollee having an approved unexpired ICF/MR Pre- Admission Evaluation from the Waiver to an ICF/MR, from an ICF/MR to the Waiver or from one MR Waiver program to another MR Waiver program. For purposes of transfer to an MR Waiver program, whether from an ICF/MR or from another MR Waiver program, such Transfer Form shall be processed by TennCare only if submitted by the Division of Intellectual Disabilities Services (DIDS). DIDS shall submit a Transfer Form only after verifying that the person otherwise meets all applicable admission criteria for the applicable MR Waiver program, as the Transfer Form accomplishes only the transfer of the level of care eligibility.

(rr) Vehicle Accessibility Modifications - interior or exterior physical modifications to a vehicle owned by the Enrollee or to a vehicle which is owned by the guardian or conservator of the Enrollee and which is routinely available for transport of the Enrollee. Such modifications must be intended to ensure the transport of the Enrollee in a safe manner.

(ss) Vision Services - routine eye examinations and refraction; standard or special frames for eyeglasses; standard, bifocal, multifocal or special lenses for eyeglasses; contact lenses; and dispensing fees for ophthalmologists, optometrists, and opticians.

(2) Covered Services and Limitations.

(a) Adult Dental Services.

1. Adult Dental Services shall not include hospital outpatient or inpatient facility services or related anesthesiology, radiology, pathology, or other medical services in such setting.

2. Adult Dental Services shall exclude orthodontic services.

3. Adult Dental Services shall be limited to adults age twenty-one (21) years or older who are enrolled in the waiver.

4. Adult Dental Services for adults age 21 or older enrolled in the Waiver shall be limited to a maximum of $5,000 per member per calendar year, and a maximum of $7,500 per member across three (3) consecutive calendar years. Adult Dental Services that are received on or after January 1, 2023, shall apply to the maximum amount allowable under this rule only if the service is not covered as

part of the Dental Services benefit outlined in 1200-13-13-.04 and 1200-13-14- .04. Any Adult Dental Services received prior to January 1, 2023, shall apply to the maximum amounts allowable for the qualifying time period during which the service was performed as outlined by this rule.

(b) Behavioral Respite Services.

1. Behavioral Respite Services may be provided in a Medicaid-certified ICF/MR, in a licensed respite care facility, or in a home operated by a licensed residential provider.

2. Reimbursement shall not be made for the cost of room and board except when provided as part of Behavioral Respite Services furnished in a facility approved by the State that is not a private residence.

3. Behavioral Respite Services shall be limited to a maximum of sixty (60) days per Enrollee per year.

4. Enrollees who receive Behavioral Respite Services shall be eligible to receive Individual Transportation Services only to the extent necessary during the time period when Behavioral Respite Services is being provided.

(c) Behavior Services.

1. Behavior Services shall not be billed when provided during the same time period as Physical Therapy; Occupational Therapy; Nutrition Services; Orientation and Mobility Training; or Speech, Language and Hearing Services, unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently.

2. Behavior Services shall be provided face to face with the Enrollee except for Enrollee-specific training of staff; behavior assessment and plan development; and presentation of Enrollee behavior information at human rights committee meetings, behavior support committee meetings, and Enrollee planning meetings.

3. Reimbursement for presentation of Enrollee behavior information at meetings shall be limited to a maximum of five (5) hours per Enrollee per year per provider.

Reimbursement for behavior assessments shall be limited to a maximum of eight (8) hours per assessment with a maximum of two (2) assessments per year.

Reimbursement for behavior plan development resulting from such a behavior assessment and the training of staff on the plan during the first thirty (30) days following its approval for use shall be limited to a maximum of six (6) hours.

(d) Day Services.

1. Day Services may be provided in settings such as specialized facilities licensed to provide Day Services, community centers or other community sites, or job sites. Services may also be provided in the Enrollee’s place of residence if there is a health, behavioral, or other medical reason or if the Enrollee has chosen retirement. This service shall not be provided in inpatient hospitals, nursing facilities, and Intermediate Care Facilities for the Mentally Retarded (ICF/MR’s).

2. With the exception of employment that is staff supported, Day Services shall be provided only on weekdays during the day (i.e., between the hours of 7:30 a.m. and 6:00 p.m.), as specified in the Plan of Care.

3. Day Services shall be limited to a maximum of six (6) hours per day and five (5) days per week up to a maximum of 243 days per Enrollee per year.

4. Transportation to and from the Enrollee’s place of residence to Day Services and transportation that is needed during the time that the Enrollee is receiving Day Services shall be a component of Day Services and shall be included in the Day Services reimbursement rate (i.e., it shall not be billed as a separate Waiver service) with the following exceptions:

(i) Transportation to and from medical services covered through the Medicaid State Plan, which shall not be billed as a Waiver service; or (ii) Transportation necessary for Orientation and Mobility Training.

5. Day Services shall not replace services available under a program funded by the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act.

6. For an Enrollee receiving employment supports, reimbursement shall not be made for incentive payments, subsidies or unrelated vocational training expenses such as the following:

(i) Incentive payments made to an employer to encourage or subsidize the employer’s participation in a supported employment program;

(ii) Payments that are passed through to users of supported employment programs; or (iii) Payments for vocational training that is not directly related to an Enrollee’s supported employment program.

(e) Environmental Accessibility Modifications.

1. Environmental Accessibility Modifications which are considered improvements to the home (e.g., roof or flooring repair, installing carpet, installation of central air conditioning, construction of an additional room) are excluded from coverage.

2. Any modification which is not of direct medical or remedial benefit to the Enrollee is excluded from coverage.

3. Modification of an existing room which increases the total square footage of the home is also excluded unless the modification is necessary to improve the accessibility of an Enrollee having limited mobility, in which case the modification shall be limited to the minimal amount of square footage necessary to accomplish the increased accessibility.

4. Environmental Accessibility Modifications shall be limited to a maximum of $15,000 per Enrollee per two (2) year period.

(f) Family Model Residential Support.

1. With the exception of homes that were already providing services to three (3) residents prior to January 1, 2004, a Family Model Residential Support home shall have no more than two (2) residents who receive services and supports.

2. The Family Model Residential Support provider shall be responsible for providing an appropriate level of services and supports twenty-four (24) hours per day during the hours the Enrollee is not receiving Day Services or is not at school or work.

3. Transportation shall be a component of Family Model Residential Support and shall be included in the reimbursement rate for such (i.e., it shall not be billed as a separate Waiver service) with the following exceptions:

(i) Transportation to and from medical services covered through the Medicaid State Plan, which shall not be billed as a Waiver service;

(ii) Transportation necessary for Behavioral Respite Services; or (iii) Transportation necessary for Orientation and Mobility Training.

4. This service shall not be provided in inpatient hospitals, nursing facilities, and Intermediate Care Facilities for the Mentally Retarded (ICF/MR’s).

5. Reimbursement for Family Model Residential Support shall not be made for room and board or for the cost of maintenance of the dwelling, and reimbursement shall not include payment made to the Enrollee’s parent, step-parent, spouse, child, or sibling or to any other individual who is a conservator unless so permitted in the Order for Conservatorship.

(g) Individual Transportation Services.

Individual Transportation Services shall not be used for:

1. Transportation to and from Day Services;

2. Transportation to and from supported or competitive employment;

3. Transportation of school aged children to and from school;

4. Transportation to and from medical services covered by the Medicaid State Plan; or 5. Transportation of an Enrollee receiving a residential service, except as described herein for Orientation and Mobility Training or Behavioral Respite Services.

(h) Medical Residential Services.

1. The Medical Residential Services provider shall be responsible for providing an appropriate level of services and supports twenty-four (24) hours per day when the Enrollee is not at school and shall be responsible for the cost of Day Services needed by the Enrollee.

2. Transportation shall be a component of Medical Residential Services and shall be included in the reimbursement rate for such (i.e., it shall not be billed as a separate Waiver service) with the following exceptions:

(i) Transportation to and from medical services covered through the Medicaid State Plan, which shall not be billed as a Waiver service;

(ii) Transportation necessary for Behavioral Respite Services; or (iii) Transportation necessary for Orientation and Mobility Training.

3. Reimbursement for Medical Residential Services shall not include the cost of maintenance of the dwelling, and reimbursement shall not include payment made to members of the Enrollee’s immediate family or to the Enrollee’s conservator.

Reimbursement shall not be made for room and board if the home is rented, leased, or owned by the provider. If the home is rented, leased, or owned by the Enrollee, reimbursement shall not be made for room and board with the exception of a reasonable portion that is attributed to a live-in caregiver who is unrelated to the Enrollee and who provides services to the Enrollee in the Enrollee’s place of residence. If an Enrollee owns or leases the place of residence, residential expenses (e.g., phone, cable TV, food, rent) shall be apportioned between the Enrollee, other residents in the home, and (as applicable) live-in or other caregivers.

4. This service shall not be provided in inpatient hospitals, nursing facilities, and Intermediate Care Facilities for the Mentally Retarded (ICF/MR’s).

5. Medical Residential Services providers must be licensed by the Department of Mental Health and Developmental Disabilities as a Mental Retardation Residential Habilitation Facility provider or a Supported Living Service provider and ensure that employed nurses are licensed to practice in the state of Tennessee.

(i) Nursing Services.

1. Nursing Services shall be provided face to face with the Enrollee by a licensed registered nurse or licensed practical nurse under the supervision of a registered nurse.

2. Nursing assessment and/or nursing oversight shall not be a separate billable service under this definition.

3. This service shall be provided in home and community settings, as specified in the Plan of Care, excluding inpatient hospitals, nursing facilities, and Intermediate Care Facilities for the Mentally Retarded (ICF/MR’s).

4. An Enrollee who is receiving Medical Residential Services shall not be eligible to receive Nursing Services during the hours Medical Residential Services are being provided.

5. Nursing Services shall not be billed when provided during the same time period as other therapies unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently.

6. Nursing Services are not intended to replace services available through the Medicaid State Plan or services available under the Rehabilitation Act of 1973 or Individuals with Disabilities Education Act.

(j) Nutrition Services.

1. Nutrition Services must be provided face to face with the Enrollee except for Enrollee-specific training of caregivers responsible for food purchase, food preparation, or assisting the Enrollee to eat and except for that portion of the assessment involving development of the POC.

2. Nutrition Services shall not be billed when provided during the same time period as Physical Therapy; Occupational Therapy; Speech, Language and Hearing Services; Orientation and Mobility Training; or Behavior Services, unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently.

3. Reimbursement for a Nutrition Services assessment visit, which includes the Nutritional Services plan development resulting from such an assessment, shall be limited to one (1) assessment visit per month with a maximum of three (3) assessment visits per year per Enrollee per provider Nutrition Services other than such assessments (e.g., Enrollee-specific training of caregivers; monitoring dietary compliance and food preparation) shall be limited to a maximum of one (1) visit per day. Nutrition Services assessments shall not be billed on the same day with other Nutrition Services.

(k) Occupational Therapy Services.

1. Services must be provided by a licensed occupational therapist or by a licensed occupational therapist assistant working under the supervision of a licensed occupational therapist.

2. Occupational Therapy must be provided face to face with the Enrollee except for that portion of the assessment involving development of the POC.

3. Occupational Therapy therapeutic and corrective services shall not be ordered concurrently with Occupational Therapy assessments (i.e., assess and treat orders are not accepted).

4. Occupational Therapy assessments shall not be billed on the same day with other Occupational Therapy services.

5. Occupational Therapy shall not be billed when provided during the same time period as Physical Therapy; Speech, Language and Hearing Services; Nutrition Services; Orientation and Mobility Training; or Behavior Services, unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently. Occupational Therapy shall not be billed with Day Services if the Day Services are reimbursed on a per hour basis.

6. Occupational Therapy services are not intended to replace services available through the Medicaid State Plan or services available under the Rehabilitation Act of 1973 or Individuals with Disabilities Education Act.

7. Reimbursement for an Occupational Therapy assessment with development of an Occupational Therapy plan based on such an assessment shall be limited to a maximum of one (1) assessment with plan development per month with a maximum of three (30 assessments per year per Enrollee per provider.

Occupational Therapy services other than such assessments (e.g., Enrolleespecific training of caregivers; provision of therapeutic services; monitoring progress) shall be limited to a maximum of one and one-half (1.5) hours per Enrollee per day.

(l) Orientation and Mobility Training.

1. Orientation and Mobility Training shall not be billed when provided during the same time period as Physical Therapy; Occupational Therapy; Nutrition Services; Behavior Services; or Speech, Language and Hearing Services, unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently.

2. Orientation and Mobility Training shall not replace services available under a program funded by the Rehabilitation Act of 1973 or Individuals with Disabilities Education Act.

3. Reimbursement for an Orientation and Mobility Training assessment with development of the Orientation and Mobility Training plan based on such an assessment shall be limited to a maximum of one (1) assessment with plan development per month with a maximum of three (3) assessments per year per Enrollee per provider. Orientation and Mobility Training assessments shall not be billed on the same day with other Orientation and Mobility Training services.

Orientation and Mobility Training services other than such assessments (e.g., Enrollee training; Enrollee-specific training of caregivers), which shall be reimbursed on a per diem basis, shall be limited to a maximum of fifty-two (52) hours of services per Enrollee per year.

4. Enrollees receiving Orientation and Mobility Training shall be eligible to receive Individual Transportation Services to the extent necessary for participation in Orientation and Mobility Training.

(m) Personal Assistance.

1. Personal Assistance may be provided in the home or community; however, it shall not be provided in school settings and shall not be provided to replace personal assistance services required to be covered by schools or services available through the Medicaid State Plan.

2. An Enrollee who is receiving a residential service (i.e., Supported Living, Residential Habilitation, Medical Residential Services, or Family Model Residential Support) shall not be eligible to receive Personal Assistance.

Personal Assistance shall not be provided during the same time period when the Enrollee is receiving Day Services.

3. This service shall not be provided in inpatient hospitals, nursing facilities, and Intermediate Care Facilities for the Mentally Retarded (ICF/MR’s).

4. Family members who provide Personal Assistance must meet the same standards as providers who are unrelated to the Enrollee. The Personal Assistance provider shall not be the spouse and shall not be the Enrollee’s parent if the Enrollee is a minor. Reimbursement shall not be made to any other individual who is a conservator unless so permitted in the Order for Conservatorship.

(n) Personal Emergency Response System. The system shall be limited to those who are alone for parts of the day and who have demonstrated mental and physical capability to utilize such a system effectively.

(o) Physical Therapy Services.

1. Services must be provided by a licensed physical therapist or by a licensed physical therapist assistant working under the supervision of a licensed physical therapist.

2. Physical Therapy must be provided face to face with the Enrollee except for that portion of the assessment involving development of the POC.

3. Physical Therapy therapeutic and corrective services shall not be ordered concurrently with Physical Therapy assessments (i.e., assess and treat orders are not accepted).

4. Physical Therapy assessments shall not be billed on the same day with other Physical Therapy services.

5. Physical Therapy shall not be billed when provided during the same time period as Occupational Therapy; Speech, Language and Hearing Services; Nutrition Services; Orientation and Mobility Training; or Behavior Services, unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently. Physical Therapy shall not be billed with Day Services if the Day Services are reimbursed on a per hour basis.

6. Physical Therapy services are not intended to replace services available through the Medicaid State Plan or services available under the Rehabilitation Act of 1973 or Individuals with Disabilities Education Act.

7. Reimbursement for a Physical Therapy assessment with development of a Physical Therapy plan based on such an assessment shall be limited to a maximum of one (1) assessment with plan development per month with a maximum of three (3) assessments per year per Enrollee per provider. Physical Therapy services other than such assessments (e.g., Enrollee-specific training of caregivers; provision of therapeutic services; monitoring progress) shall be limited to a maximum of one and one-half (1.5) hours per Enrollee per day.

(p) Residential Habilitation.

1. A Residential Habilitation home shall have no more than four (4) residents with the exception that homes which were already providing services to more than 4 residents prior to July 1, 2000, may continue to do so.

2. The Residential Habilitation provider shall be responsible for providing an appropriate level of services and supports twenty-four (24) hours per day during the hours the Enrollee is not receiving Day Services or is not at school or work.

3. Transportation shall be a component of Residential Habilitation and shall be included in the reimbursement rate for such (i.e., it shall not be billed as a separate Waiver service) with the following exceptions:

(i) Transportation to and from medical services covered through the Medicaid State Plan, which shall not be billed as a Waiver service;

(ii) Transportation necessary for Behavioral Respite Services; or (iii) Transportation necessary for Orientation and Mobility Training.

4. Reimbursement for Residential Habilitation shall not be made for room and board or for the cost of maintenance of the dwelling, and reimbursement shall not include payment made to members of the Enrollee’s immediate family or to the Enrollee’s conservator.

5. This service shall not be provided in inpatient hospitals, nursing facilities, and Intermediate Care Facilities for the Mentally Retarded (ICF/MR’s).

(q) Respite.

1. Respite may be provided in the Enrollee’s place of residence, in a Family Model Residential Support home, in a Medicaid-certified ICF/MR, in a home operated by a licensed residential provider, or in the home of an approved respite provider.

2. An Enrollee receiving a residential service (i.e., Supported Living, Residential Habilitation, Medical Residential Services, or Family Model Residential Support) shall not be eligible to receive Respite as a service.

3. The cost of room and board shall be excluded from Respite reimbursement if Respite is provided in a private residence.

4. Respite shall be limited to a maximum of thirty (30) days per Enrollee per year.

5. Enrollees who receive Respite shall be eligible to receive Individual Transportation Services only to the extent necessary during the time period when Respite is being provided.

(r) Specialized Medical Equipment and Supplies and Assistive Technology.

1. Face-to-face consultative assessment by a physical therapist, occupational therapist, or speech therapist to assure that specialized medical equipment and assistive technology which requires custom fitting meets the needs of the Enrollee and training of the Enrollee by a physical therapist, occupational therapist, or speech therapist to effectively utilize such customized equipment shall be limited to a maximum of three (3) hours per Enrollee per day.

2. Items not of direct medical or remedial benefit to the Enrollee shall be excluded.

Items that would be covered by the Medicaid State Plan shall be excluded from coverage. Swimming pools, hot tubs, health club memberships, and recreational equipment are excluded. Prescription and over-the-counter medications, food and food supplements, and diapers and other incontinence supplies are excluded.

3. When medically necessary and not covered by warranty, repair of equipment may be covered when it is substantially less expensive to repair the equipment rather than to replace it.

4. The purchase price for waiver-reimbursed Specialized Medical Equipment, Supplies and Assistive Technology shall be considered to include the cost of the item as well as basic training on operation and maintenance of the item.

5. Specialized Medical Equipment and Supplies and Assistive Technology, as defined by 1200-13-01-.28, and Enabling Technology, as defined by 1200-13-01- .02, shall be limited to a combined maximum benefit of $10,000 per person supported per two (2) consecutive calendar years.

(s) Speech, Language and Hearing Services.

1. Services must be provided by a licensed speech language pathologist or by a licensed audiologist.

2. Speech, Language and Hearing Services must be provided face to face with the Enrollee except for that portion of the assessment involving development of the POC.

3. Speech, Language and Hearing therapeutic and corrective services shall not be ordered concurrently with Speech, Language and Hearing assessments (i.e., assess and treat orders are not accepted).

4. Speech, Language and Hearing Services assessments shall not be billed on the same day with other Speech, Language and Hearing Services.

5. Speech, Language and Hearing Services shall not be billed when provided during the same time period as Physical Therapy; Occupational Therapy;

Nutrition Services; Orientation and Mobility Training; or Behavior Services, unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently. Speech, Language and Hearing Services shall not be billed with Day Services if the Day Services are reimbursed on a per hour basis.

6. Reimbursement for a Speech, Language, and Hearing Services assessment with development of a Speech, Language, and Hearing Services plan based on such an assessment shall be limited to a maximum of one (1) assessment with plan development per month with a maximum of three (3) assessments per year per Enrollee per provider. Speech, Language, and Hearing Services other than such assessments (e.g., Enrollee-specific training of caregivers; provision of therapeutic services; monitoring progress) shall be limited to a maximum of one and one-half (1.5) hours per Enrollee per day.

(t) Support Coordination. There must be at least one face-to-face contact with the Enrollee per calendar month. If the Enrollee receives a residential service, the Support Coordinator shall have at least one face-to-face contact with the Enrollee in the Enrollee’s place of residence each quarter.

(u) Supported Living.

1. The Supported Living provider shall not own the Enrollee’s place of residence or be a co-signer of a lease on the Enrollee’s place of residence unless the Supported Living provider signs a written agreement with the Enrollee that states that the Enrollee will not be required to move if the primary reason is because the Enrollee desires to change to a different Supported Living provider. A Supported Living provider shall not own, be owned by, or be affiliated with any entity that leases or rents a place of residence to an Enrollee if such entity requires, as a condition of renting or leasing, the Enrollee to move if the Supported Living provider changes.

2. The Supported Living home shall have no more than three (3) residents including the Enrollee.

3. Unless the residence is individually licensed or inspected by a public housing agency utilizing the HUD Section 8 safety checklist, the residence must have an operable smoke detector and a second means of egress.

4. The Supported Living provider shall be responsible for providing an appropriate level of services and supports twenty-four (24) hours per day during the hours the Enrollee is not receiving Day Services or is not at school or work.

5. Transportation shall be a component of Supported Living and shall be included in the reimbursement rate for such (i.e., it shall not be billed as a separate Waiver service) with the following exceptions:

(i) Transportation to and from medical services covered through the Medicaid State Plan, which shall not be billed as a Waiver service;

(ii) Transportation necessary for Behavioral Respite Services; or (iii) Transportation necessary for Orientation and Mobility Training.

6. Reimbursement for Supported Living shall not be made for room and board with the exception of a reasonable portion that is attributed to a live-in caregiver who is unrelated to the Enrollee and who provides services to the Enrollee in the Enrollee’s home. Reimbursement for Supported Living shall not include the cost of maintenance of the dwelling. Residential expenses (e.g., phone, cable TV, food, rent) shall be apportioned between the Enrollee, other residents in the home, and (as applicable) live-in or other caregivers.

7. This service shall not be provided in inpatient hospitals, nursing facilities, and Intermediate Care Facilities for the Mentally Retarded (ICF/MR’s).

8. The Enrollee or the Enrollee’s guardian or conservator shall have a voice in choosing the individuals who reside in the Supported Living residence and the staff who provide services and supports.

9. The Enrollee shall have the right to manage personal funds as specified in the Individual Support Plan.

(v) Vehicle Accessibility Modifications.

1. Replacement of tires or brakes, oil changes, and other vehicle maintenance procedures shall be excluded from coverage.

2. Vehicle Accessibility Modifications shall be limited to a maximum of $20,000 per Enrollee per five (5) year period.

(w) Vision Services. Vision Services shall be limited to adults age twenty-one (21) years or older who are enrolled in the Waiver.

(x) Out-of-State Services. A provider of Personal Assistance, Residential Habilitation, Supported Living, Medical Residential Services, and Family Model Residential Services may provide such Covered Service outside the State of Tennessee and be reimbursed only when provided in accordance with the following:

1. Covered Services provided out of state shall be for the purpose of visiting relatives or for vacations and shall be included in the Enrollee’s Plan of Care.

Trips to casinos or other gambling establishments shall be excluded from coverage.

2. Covered Services provided out of state shall be limited to a maximum of fourteen (14) days per Enrollee per year.

3. The waiver service provider agency must be able to assure the health and safety of the Enrollee during the period when Covered Services will be provided out of state and must be willing to assume the additional risk and liability of provision of Covered Services out of state.

4. During the period when Covered Services are being provided out of state, the waiver service provider agency shall maintain an adequate amount of staffing to meet the needs of the Enrollee and must ensure that staff meet the applicable provider qualifications.

5. The provider agency which provides Covered Services out of state shall not receive any additional reimbursement for provision of services out-of-state. The costs of travel, lodging, food, and other expenses incurred by staff during the provision of out-of-state services shall not be reimbursed through the Waiver.

The costs of travel, lodging, food, and other expenses incurred by the Enrollee while receiving out-of-state services shall be the responsibility of the Enrollee and shall not be reimbursed through the waiver.

(y) All Covered Services to be provided prior to the development of the initial Individual Support Plan must be included in the physician’s plan of care section of the Pre- Admission Evaluation application.

(3) Eligibility.

(a) To be eligible for enrollment in the Waiver, an individual must meet all of the following criteria:

1. The individual must be a resident of the State of Tennessee.

2. The individual must be a class member certified in United States vs. State of Tennessee, et. al. (Arlington Developmental Center).

3. The individual must, but for the provision of Waiver Services, require the level of care provided in an ICF/MR, and must meet the ICF/MR eligibility criteria specified in Rule 1200-13-01-.15, except that requirements pertaining to a psychological evaluation shall be in accordance with Rule 1200-13-01-.28(3)(a)6.

4. The individual’s habilitative, medical, and specialized services needs must be such that they can be effectively and safely met through the Waiver, as determined by the Operational Administrative Agency based on a pre-enrollment assessment.

5. The individual must have an unexpired ICF/MR Pre-Admission Evaluation which has been approved by the State Medicaid Agency or by its designee and which lists the Enrollee’s specific Waiver Services with the amount, scope, and duration of the services.

6. The individual must have a psychological evaluation included as part of the approved Pre-Admission Evaluation which meets the following:

(i) The psychological evaluation shall document that the individual has mental retardation manifested before eighteen (18) years of age and has an IQ test score of seventy (70) or below; and (ii) There is no time limit for when the psychological evaluation is conducted as long as it is completed prior to the submission of the PAE, and as long as the evaluation meets the requirements specified in 1200-13-01- .28(3)(a)6.(i) above, and the person’s current medical, social, developmental and psycho-social history continues to support the evaluation.

(iii) A new psychological evaluation performed within ninety (90) calendar days preceding the date of admission into the waiver shall be required if the person’s condition has significantly changed, or the original evaluation is not otherwise consistent with the person’s current medical, social, developmental and psycho-social history.

7. The individual shall have one or more designated adults who shall be present in the individual’s home to observe, evaluate, and provide an adequate level of direct care services to ensure the health and safety of the individual.

(i) An individual who does not have 24-hour-per-day direct care services shall:

(I) Have an individualized Safety Plan that:

I. Is based on a written assessment of the individual’s functional capabilities and habilitative, medical, and specialized services needs by the Independent Support Coordinator in consultation with individuals who are knowledgeable of the individual’s capability of functioning without direct care services twentyfour (24) hours per day;

II. Addresses the individual’s capability of functioning when direct care staff are not present;

III. Addresses the ability of the individual to self-administer medications when direct care staff are not present;

IV. Specifies whether a Personal Emergency Response System will be used by the individual to secure help in an emergency;

V. Is updated as needed, but no less frequently than annually, by the Operational Administrative Agency to ensure the health and safety of the individual; and VI. Is an attachment to the ICF/MR PAE or, if applicable, to the Transfer Form.

(II) Have one or more designated adults who shall be present in the individual’s home to observe, evaluate, and provide an adequate level of direct care services to ensure the health and safety of the individual as needed but no less frequently than one day each week.

8. An individual must have a place of residence with an environment that is adequate to reasonably ensure health, safety and welfare. Any licensed facility in which the individual resides must meet all applicable fire and safety codes.

(b) A Transfer Form approved by the State Medicaid Agency:

1. May be used to transfer an Enrollee having an approved unexpired ICF/MR PAE from the Waiver to an ICF/MR;

2. May be used to transfer an individual having an approved unexpired ICF/MR PAE from an ICF/MR to the Waiver;

3. May be used to transfer an individual from one MR Waiver to a different Home and Community Based Services MR Waiver Program as specified in 1200-13-01- .28(1)(qq) above; and 4. Shall include an initial plan of care that lists the Enrollee’s specific Waiver Services with the amount, scope, and duration of the services.

(4) Intake and Enrollment.

(a) When an individual is determined to be likely to require the level of care provided by an ICF/MR, the Operational Administrative Agency shall inform the individual or the individual’s legal representative of any feasible alternatives available under the Waiver and shall offer the choice of available institutional services or Waiver program services.

Notice to the individual shall contain:

1. A simple explanation of the Waiver and Covered Services;

2. Notification of the opportunity to apply for enrollment in the Waiver and an explanation of the procedures for enrollment; and 3. A statement that participation in the Waiver is voluntary.

(b) Enrollment in the Waiver shall be voluntary, but shall be restricted to the maximum number of individuals specified in the Waiver, as approved by the Centers for Medicare and Medicaid Services for the State of Tennessee.

(c) Enrollment of new Enrollees into the Waiver may be suspended when the average per capita fiscal year expenditure under the Waiver exceeds or is reasonably anticipated to exceed 100% of the average per capita expenditure that would have been made in the fiscal year if the care was provided in an ICF/MR.

(d) Upon implementation of the ECF CHOICES program, all new enrollment into the Arlington Waiver (effective upon its renewal on January 1, 2015, the Comprehensive Aggregate Cap Waiver) shall be limited to individuals who have been identified by the state as a former member of the certified class in the United States vs. State of Tennessee, et al. (Arlington Developmental Center), a current or former member of the certified class in the United States vs. the State of Tennessee, et al. (Clover Bottom Developmental Center), or a person discharged from a State Developmental Center (Clover Bottom or Greene Valley) or the Harold Jordan Center following a stay of at least 90 days.

(5) Certification and Re-evaluation.

(a) The ICF/MR Pre-Admission Evaluation shall include a signed and dated certification by the individual’s physician that the individual requires Waiver Services.

(b) The Operational Administrative Agency shall perform a re-evaluation of the Enrollee’s need for continued stay in the Waiver within twelve (12) calendar months of the date of enrollment and at least every twelve (12) months thereafter. The re-evaluation shall be documented in a format approved by the State Medicaid Agency and shall be performed by a licensed physician or registered nurse or a Qualified Mental Retardation Professional.

(c) The Operational Administrative Agency shall maintain in its files for a minimum period of three (3) years a copy of the re-evaluations of need for continued stay.

(6) Disenrollment.

(a) Voluntary disenrollment of an Enrollee from the Waiver may occur at any time upon written notice from the Enrollee or the Enrollee’s guardian or conservator to the Operational Administrative Agency. Prior to disenrollment the Operational Administrative Agency shall provide reasonable assistance to the Enrollee in locating appropriate alternative placement.

(b) An Enrollee may be involuntarily disenrolled from the Waiver for any of the following reasons:

1. The Home and Community Based Services Waiver for Persons with Mental Retardation is terminated.

2. An Enrollee becomes ineligible for Medicaid or is found to be erroneously enrolled in the Waiver.

3. An Enrollee moves out of the State of Tennessee; provided however, that when the Enrollee is the dependent of a military service member who is a legal resident of the state, but has left the state temporarily due to the military service member’s military assignment out of state, such dependent may re-enroll in the Waiver upon return to the State, so long as all conditions of eligibility are met.

4. The condition of the Enrollee improves such that the Enrollee no longer requires the level of care provided by the Waiver.

5. The Enrollee’s medical or behavioral needs become such that the health, safety, and welfare of the Enrollee cannot be assured through the provision of Waiver Services.

6. The home or home environment of the Enrollee becomes unsafe to the extent that it would reasonably be expected that Waiver Services could not be provided without significant risk of harm or injury to the Enrollee or to individuals who provide covered services to the Enrollee.

7. The Enrollee or the Enrollee’s guardian or conservator refuses to abide by the Plan of Care or related Waiver policies, resulting in the inability of the Operational Administrative Agency to ensure quality care or the health and safety of the Enrollee.

8. The health, safety and welfare of the Enrollee cannot be assured due to the lack of an approved Safety Plan.

9. The Enrollee was transferred to a hospital, NF, ICF/MR, Assisted Living Facility, and/or Home for the Aged and has resided there for a continuous period exceeding one hundred twenty (120) days, if such period began prior to March 1, 2010, or a period exceeding ninety (90) days if such period begins on or after March 1, 2010.

(c) The Operational Administrative Agency shall notify the State Medicaid Agency in writing prior to involuntary disenrollment of an Enrollee and shall give advance notice to the Enrollee of the intended involuntary disenrollment and of the Enrollee’s right to appeal and have a fair hearing.

(d) If an Enrollee has been involuntarily disenrolled from the Waiver, the Operational Administrative Agency shall provide reasonable assistance to the Enrollee in locating appropriate alternative placement.

(7) Plan of Care.

(a) All Waiver Services for the Enrollee shall be provided in accordance with an approved Plan of Care.

1. Prior to the development of the initial Individual Support Plan, Covered Services shall be provided in accordance with the physician’s initial plan of care included in the approved ICF/MR Pre-Admission Evaluation.

2. Each Enrollee shall have a comprehensive individualized written Plan of Care (the Individual Support Plan) that shall be developed for an Enrollee within sixty (60) calendar days of admission into the Waiver.

3. A Safety Plan for Enrollees who do not have 24-hour direct care services shall be maintained with the Plan of Care.

(b) To ensure that Waiver Services and other services are being appropriately provided to meet the Enrollee’s needs, the Plan of Care shall be reviewed on an ongoing basis and shall be updated and signed in accordance with the following:

1. The Support Coordinator shall review the Plan of Care when needed, but no less frequently than once each calendar month, and shall document such review by a dated signature.

2. A team consisting of the Support Coordinator and other appropriate participants in the development of the Plan of Care shall review the Plan of Care when needed, but no less frequently than every twelve (12) calendar months, and shall document such review by dated signatures. Such annual review shall include, but not be limited to, reviewing outcomes and determining if progress is being made in accordance with the Plan of Care; reviewing the appropriateness of supports and services being provided and determining further needs of the Enrollee.

(8) Physician Services.

(a) The Operational Administrative Agency shall ensure that each Enrollee receives physician services as needed and that each Enrollee has a medical examination, documented in the Enrollee’s record, in accordance with the following schedule:

Age Minimum frequency of medical examinations Up to age 21 In accordance with Medicaid EPSDT periodicity standards 21-64 Every one (1) to three (3) years, as determined by the Enrollee’s physician Over age 65 Annually (b) All Covered Services to be provided prior to the development of the initial Individual Support Plan shall be physician ordered and shall be included in the physician’s plan of care section of the Pre-Admission Evaluation application.

(c) When required by state law, Covered Services shall be ordered or reordered, by a licensed physician, licensed nurse practitioner, physician assistant, a licensed dentist, or other appropriate health care provider.

(9) Waiver Administration. The Operational Administrative Agency shall be responsible for the administration of the day-to-day operations of the Waiver under the oversight of the State Medicaid Agency and shall ensure that Covered Services are provided in accordance with state and federal laws, rules, regulations and policies established by the State Medicaid Agency. The Operational Administrative Agency shall be responsible for the following activities, whether provided directly or through subcontract:

(a) Marketing of the Waiver to potential Enrollees;

(b) Intake and pre-enrollment assessment of the applicant’s habilitative, medical and specialized services needs; and appropriateness for enrollment in the Waiver;

(c) Assisting the applicant with the submission of a properly completed ICF/MR Pre- Admission Evaluation;

(d) Enrollment of eligible individuals into the Waiver;

(e) Provision of a plain language explanation of appeal rights to each Enrollee upon enrollment in the Waiver;

(f) Review and approval of Plans of Care (Individual Support Plans) to ensure that Waiver Services have been authorized prior to payment;

(g) Ensuring that annual level of care re-evaluations have been performed to document the need for continuation of Waiver Services for the Enrollee;

(h) Notification of the State Medicaid Agency in writing prior to involuntary disenrollment of any Enrollee;

(i) Ensuring that Waiver providers maintain comprehensive Enrollee records and documentation of services provided to Enrollees in accordance with state and federal laws, rules, regulations and State Medicaid Agency policies;

(j) Obtaining approval from the State Medicaid Agency prior to distributing policies and procedures to Waiver providers or Waiver information to Enrollees;

(k) Compliance with reporting and record-keeping requirements established by the State Medicaid Agency;

(l) Maintaining in its files the original ICF/MR Pre-Admission Evaluation and, where applicable, the original Transfer Form;

(m) Assurance of a statewide provider network adequate to meet the needs of Enrollees;

(n) Ensuring that Waiver Services providers and subcontractors meet the Waiver provider qualifications approved by the Centers for Medicare and Medicaid Services;

(o) Ensuring that Waiver Services providers have a signed provider agreement which includes a requirement for compliance with the Division of Mental Retardation Services Provider Manual in the delivery of waiver services;

(p) Assurance of the health and safety of Enrollees through the implementation of a comprehensive quality monitoring program;

(q) Reporting instances of abuse, neglect, mistreatment or exploitation to appropriate state agencies;

(r) Assurance that Covered Services are provided in accordance with the approved Waiver definitions and in accordance with the State Medicaid Agency guidelines;

(s) Compliance with the appeals process specified in TennCare rule 1200-13-13-.11 to ensure that Enrollees are afforded advance notice and the right to appeal an adverse decision and have a fair hearing;

(t) Ensuring that providers and subcontractors comply with the quality monitoring guidelines and requirements established by the State Medicaid Agency, by the Operational Administrative Agency, and by the Centers for Medicare and Medicaid Services, and with other state and federal laws, rules, and regulations affecting the provision of Waiver Services;

(u) Collection of applicable patient liability from Enrollees;

(v) Reimbursement of Waiver providers in accordance with policies established by the State Medicaid Agency;

(w) Recoupment of payments made to Waiver providers when there is lack of documentation to support that services were provided or there is a lack of medical necessity of services, or when inappropriate payments have been made due to erroneous or fraudulent billing; and (x) Expenditure and revenue reporting in accordance with state and federal requirements.

(10) Reimbursement.

(a) The average per capita fiscal year expenditure under the Waiver shall not exceed 100% of the average per capita expenditure that would have been made in the fiscal year if care had been provided in an ICF/MR. The total Medicaid expenditure for Waiver Services and other Medicaid services provided to Enrollees shall not exceed 100% of the amount that would have been incurred in the fiscal year if care was provided in an ICF/MR.

(b) The Operational Administrative Agency shall be reimbursed for Waiver Services at the rate per unit of service actually paid by the Operational Administrative Agency to the Waiver service provider or at the maximum rate per unit of service established by the State Medicaid Agency, whichever is less.

(c) In accordance with 42 CFR § 435.726, the Operational Administrative Agency shall make a diligent effort to collect patient liability if it applies to the Enrollee. The Operational Administrative Agency or its designee shall complete appropriate forms showing the individual’s amount of monthly income and shall submit them to the Tennessee Department of Human Services. The Tennessee Department of Human Services shall issue the appropriate forms to the Operational Administrative Agency and to the State Medicaid Agency’s fiscal agent that processes and pays vendor claims, specifying the amount of patient liability to be applied toward the cost of care for the Enrollee.

(d) The Operational Administrative Agency shall submit bills for services to the State Medicaid Agency’s fiscal agent using a claim form approved by the State Medicaid Agency. On claim forms, the Operational Administrative Agency shall use a provider number assigned by the State Medicaid Agency.

(e) Reimbursement shall not be made to the Operational Administrative Agency for therapeutic leave or hospital leave for Enrollees in the Waiver.

(f) Medicaid benefits other than those specified in the Waiver’s scope of Covered Services shall be reimbursed by the State Medicaid Agency as otherwise provided for by federal and state rules and regulations.

(g) The Operational Administrative Agency shall be responsible for obtaining the physician’s initial certification and subsequent Enrollee re-evaluations. Failure to perform re-evaluations in a timely manner and in the format approved by the State Medicaid Agency shall require a corrective action plan and shall result in partial or full recoupment of all amounts paid by the State Medicaid Agency during the time period when a re-evaluation had lapsed.

(h) The State Medicaid Agency shall be responsible for defining and establishing the billing units to be used by the Operational Administrative Agency in billing for Waiver Services.

(i) An Operational Administrative Agency that enrolls an individual without an approved ICF/MR Pre-Admission Evaluation or, where applicable, an approved Transfer Form does so without the assurance of reimbursement. An Operational Administrative Agency that enrolls an individual who has not been determined by the Tennessee Department of Human Services to be financially eligible to have Medicaid make reimbursement for covered services does so without the assurance of reimbursement.

(11) Appeals. An Enrollee shall have the right to appeal an adverse action in accordance with TennCare rule 1200-13-13-.11.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 4-5-209, 71-5-105, 71-5-107, and 71-5-109 and Executive Order No. 23.
• Administrative History: Original rule filed June 20, 2007; effective September 3, 2007. Public necessity rules filed July 1, 2009; effective through December 13, 2009. Amendments filed September 11, 2009; effective December 10, 2009. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendments filed May 27, 2010; effective August 25, 2010. Amendments filed June 26, 2015; effective September 24, 2015. Amendments filed September 30, 2016; effective December 29, 2016. Emergency rules filed December 27, 2022 to become effective January 1, 2023; effective through June 30, 2023. Amendments filed November 1, 2022; effective January 30, 2023. Amendments filed January 19, 2023; effective April 19, 2023.

Tenn. Comp. R. & Regs. 1200-13-01-.29 TENNESSEE’S SELF-DETERMINATION WAIVER UNDER SECTION 1915(c) OF THE SOCIAL SECURITY ACT (SELF-DETERMINATION MR WAIVER PROGRAM).

(1) Definitions: The following definitions shall apply for interpretation of this rule:

(a) Adult Dental Services. See definition in 1200-13-01-.02.

(b) Behavioral Respite Services - services that provide Respite for an Enrollee who is experiencing a behavioral crisis that necessitates removal from the current residential setting in order to resolve the behavioral crisis.

(c) Behavior Services - assessment and amelioration of Enrollee behavior that presents a health or safety risk to the Enrollee or others or that significantly interferes with home or community activities; determination of the settings in which such behaviors occur and the events which precipitate the behaviors; development, monitoring, and revision of crisis prevention and behavior intervention strategies; and training of caregivers who are responsible for direct care of the Enrollee in prevention and intervention strategies.

(d) Bureau of TennCare - the bureau in the Tennessee Department of Finance and Administration which is the State Medicaid Agency and is responsible for administration of the Medicaid program in Tennessee.

(e) Case Manager - an individual who assists the Enrollee or potential Enrollee in gaining access to needed Waiver and other Medicaid State Plan services as well as other needed services regardless of the funding source; develops the initial interim Plan of Care and facilitates the development of the Enrollee’s Plan of Care; monitors the Enrollee’s needs and the provision of services included in the Plan of Care; monitors the Enrollee’s budget, and authorizes alternative emergency back-up services for the Enrollee if necessary.

(f) Certification - the process by which a physician, who is licensed as a doctor of medicine or doctor of osteopathy, signs and dates a Pre-Admission Evaluation signifying that the named individual requires services provided through the Tennessee Self-Determination Waiver Program as an alternative to care in an Intermediate Care Facility for the Mentally Retarded.

(g) Covered Services or Covered Waiver Services - The services which are available through the Tennessee Self-Determination Waiver Program when medically necessary and when provided in accordance with the Waiver as approved by the Centers for Medicare and Medicaid Services.

(h) Day Services - individualized services and supports that enable an Enrollee to acquire, retain, or improve skills necessary to reside in a community-based setting; to participate in community activities and utilize community resources; to acquire and maintain employment; and to participate in retirement activities.

(i) Denial - as used in regard to Waiver Services, the term shall mean the termination, suspension, or reduction in amount, scope, and duration of a Waiver Service or a refusal or failure to provide such service.

(j) Disenrollment - the voluntary or involuntary termination of enrollment of an individual receiving services through the Tennessee Self-Determination Waiver Program.

(k) Emergency Assistance - a supplementary increase in the amount of approved Covered Waiver Services for the purpose of preventing the permanent out of home placement of the Enrollee which is provided in one of the following emergency situations:

1. Permanent or temporary involuntary loss of the Enrollee’s present residence;

2. Loss of the Enrollee’s present caregiver for any reason, including death of a caregiver or changes in the caregiver’s mental or physical status resulting in the caregiver’s inability to perform effectively for the Enrollee; or 3. Significant changes in the behavioral, medical or physical condition of the Enrollee that necessitate substantially expanded services.

(l) Enrollee - a Medicaid Eligible who is enrolled in the Tennessee Self-Determination Waiver Program.

(m) Environmental Accessibility Modifications - only those interior or exterior physical modifications to the Enrollee’s place of residence which are required to ensure the health, welfare and safety of the Enrollee or which are necessary to enable the Enrollee to function with greater independence.

(n) Financial Administration - a service which facilitates the employment of Waiver Service providers by the Enrollee and the management of the Enrollee’s self-directed budget and is provided to assure that Enrollee-managed funds specified in the Plan of Care are managed and distributed as intended. Financial Administration includes filing claims for Enrollee-managed services and reimbursing individual Covered Waiver Service providers; deducting all required federal, state and local taxes, including unemployment fees, prior to issuing reimbursement or paychecks; making Workers Compensation premium payments for Waiver Service providers employed by the Enrollee; verifying that goods and services for which reimbursement is requested have been authorized in the Plan of Care; ensuring that requests for payment are properly documented and have been approved by the Enrollee or the Enrollee’s guardian or conservator; and assisting the Enrollee in meeting applicable employer-of-record requirements. It also includes maintaining a separate account for each Enrollee’s selfdetermination budget; preparation of required monthly reports detailing disbursements of self-determination budget funds, the status of the expenditure of self-determination budget funds in comparison to the budget, and expenditures for standard method services made by the state on the Enrollee’s behalf; and notification of the Operational Administrative Agency when expenditure patterns potentially will result in the premature exhaustion of the Enrollee’s self-determination budget. It includes, in addition, verification that self-managed Waiver Service providers meet the State Medicaid Agency provider qualification requirements.

(o) Financial Administration Entity - an entity which meets the State Medicaid Agency requirements to provide Financial Administration services and which has been approved by the OAA to provide Financial Administration services.

(p) Home (of an Enrollee) - the residence or dwelling in which the Enrollee resides, excluding hospitals, nursing facilities, Intermediate Care Facilities for the Mentally Retarded, Assisted Living Facilities and Homes for the Aged (q) ICF/MR Pre-Admission Evaluation (ICF/MR PAE) - the assessment form used by the State Medicaid Agency to document the current medical and habilitative needs of an individual with mental retardation and to document that the individual meets the Medicaid level of care eligibility criteria for care in an ICF/MR.

(r) Individual Support Plan - the individualized written Plan of Care.

(s) Individual Transportation Services - non-emergency transport of an Enrollee to and from approved activities specified in the Pan of Care.

(t) Intermediate Care Facility for the Mentally Retarded (ICF/MR) - a licensed facility approved for Medicaid vendor reimbursement that provides specialized services for individuals with mental retardation or related conditions and that complies with current federal standards and certification requirements for an ICF/MR.

(u) Medicaid Eligible - an individual who has been determined by the Tennessee Department of Human Services to be financially eligible to have the State Medicaid Agency make reimbursement for covered services.

(v) Medicaid State Plan - the plan approved by the Centers for Medicare and Medicaid Services which specifies the covered benefits for the Medicaid program in Tennessee.

(w) Nursing Services - skilled nursing services that fall within the scope of Tennessee’s Nurse Practice Act and that are directly provided to the Enrollee in accordance with a plan of care. Nursing Services shall be ordered by the Enrollee’s physician, physician assistant, or nurse practitioner, who shall document the medical necessity of the services and specify the nature and frequency of the nursing services.

(x) Nutrition Services - assessment of nutritional needs, nutritional counseling, and education of the Enrollee and of caregivers responsible for food purchase, food preparation, or assisting the Enrollee to eat. Nutrition Services are intended to promote healthy eating practices and to enable the Enrollee and direct support professionals to follow special diets ordered by a physician, physician assistant, or nurse practitioner.

(y) Occupational Therapy Services - diagnostic, therapeutic, and corrective services which are within the scope of state licensure. Occupational Therapy Services provided to improve or maintain current functional abilities as well as prevent or minimize deterioration of chronic conditions leading to a further loss of function are also included within this definition.

(z) Operational Administrative Agency - the approved agency with which the State Medicaid Agency contracts for the administration of the day-to-day operations of the Tennessee Self-Determination Waiver Program.

(aa) Orientation and Mobility Services for Impaired Vision assessment of the ability of an Enrollee who is legally blind to move independently, safely, and purposefully in the home and community environment; orientation and mobility counseling; and training and education of the Enrollee and of caregivers responsible for assisting in the mobility of the Enrollee.

(bb) Personal Assistance - the provision of direct assistance with activities of daily living (e.g., bathing, dressing, personal hygiene, eating, meal preparation excluding cost of food), household chores essential to the health and safety of the enrollee, budget management, attending appointments, and interpersonal and social skills building to enable the Enrollee to live in a home in the community. It also may include medication administration as permitted under Tennessee’s Nurse Practice Act.

(cc) Personal Emergency Response System - a stationary or portable electronic device used in the Enrollee’s place of residence which enables the Enrollee to secure help in an emergency. The system shall be connected to a response center staffed by trained professionals who respond upon activation of the electronic device.

(dd) Physical Therapy Services - diagnostic, therapeutic, and corrective services which are within the scope of state licensure. Physical Therapy Services provided to improve or maintain current functional abilities as well as prevent or minimize deterioration of chronic conditions leading to a further loss of function are also included within this definition.

(ee) Plan of Care - an individualized written Plan of Care which describes the medical and other services (regardless of funding source) to be furnished to the Enrollee, the Waiver Service frequency, and the type of provider who will furnish each Waiver Service and which serves as the fundamental tool by which the State ensures the health and welfare of Enrollees.

(ff) Qualified Mental Retardation Professional (QMRP) - an individual who meets current federal standards, as published in the Code of Federal Regulations, for a qualified mental retardation professional.

(gg) Re-evaluation - the annual process approved by the State Medicaid Agency by which a licensed physician or registered nurse or a Qualified Mental Retardation Professional assesses the Enrollee’s need for continued Waiver Services and certifies in writing that the Enrollee continues to require Waiver Services.

(hh) Respite - services provided to an Enrollee when unpaid caregivers are absent or incapacitated due to death, hospitalization, illness or injury, or when unpaid caregivers need relief from routine caregiving responsibilities.

(ii) Safety Plan - an individualized plan by which the Operational Administrative Agency ensures the health, safety and welfare of Enrollees who do not have 24-hour direct care services.

(jj) Self-Directed or Self-Determined or Self-Managed - the direct management of one or more Covered Services specified in subparagraph (2)(b) with the assistance of a Financial Administration Entity which pays the Enrollee’s service providers, handles taxes and other payroll or benefits related to the employment of the service providers, and provides other financial administration services as specified in subparagraph (1)(o).

(kk) Self-Direction or Self-Determination or Self-Management - the process whereby an Enrollee or the Enrollee’s guardian or conservator directly manages one or more Covered Services specified in subparagraph (2)(b) with the assistance of a Financial Administration Entity which pays the Enrollee’s service providers, handles taxes and other payroll or benefits related to the employment of the service providers, and provides other financial administration services as specified in subparagraph (1)(o).

(ll) Specialized Medical Equipment and Supplies and Assistive Technology - assistive devices, adaptive aids, controls or appliances which enable an Enrollee to increase the ability to perform activities of daily living, or to perceive, control or communicate with the environment, and supplies for the proper functioning of such items. Specialized Medical Equipment, Supplies and Assistive Technology shall be recommended by a qualified health care professional (e.g., occupational therapist, physical therapist, speech language pathologist, physician or nurse practitioner) based on an assessment of the Enrollee’s needs and capabilities and shall be furnished as specified in the Plan of Care. Specialized Medical Equipment and Supplies and Assistive Technology may also include a face-to-face consultative assessment by a physical therapist, occupational therapist or speech therapist to assure that Specialized Medical Equipment and Assistive Technology which requires custom fitting meets the needs of the Enrollee and may include training of the Enrollee by a physical therapist, occupational therapist or speech therapist to effectively utilize such customized equipment.

(mm) Speech, Language and Hearing Services - diagnostic, therapeutic and corrective services which are within the scope of state licensure which enable an Enrollee to improve or maintain current functional abilities and to prevent or minimize deterioration of chronic conditions leading to a further loss of function.

(nn) State Medicaid Agency - the Bureau in the Tennessee Department of Finance and Administration which is responsible for administration of the Title XIX Medicaid program in Tennessee.

(oo) Subcontractor - an individual, organized partnership, professional corporation, or other legal association or entity which enters into a written contract with the Operational Administrative Agency to provide Waiver Services to an Enrollee.

(pp) Supports Broker - the person or entity that provides Supports Brokerage services to an Enrollee.

(qq) Supports Brokerage - an activity designed to enable an Enrollee to manage selfdirected services and provide assistance to the Enrollee to locate, access and coordinate needed services. It includes provision of training to the Enrollee in Enrolleemanaged services; assistance in the recruitment of individual providers of Enrolleemanaged services and negotiation of payment rates; assistance in the scheduling, training and supervision of individual providers; assistance in managing and monitoring the Enrollee’s budget; and assistance in monitoring and evaluating the performance of individual providers. It may also include assistance in locating and securing services and supports and other community resources that promote community integration, community membership and independence.

(rr) Tennessee Self-Determination Waiver Program or “Waiver” - the Home and Community Based Services waiver program approved for Tennessee by the Centers for Medicare and Medicaid Services to provide services to a specified number of Medicaid-eligible individuals on the Waiting List who have mental retardation and who meet the criteria for Medicaid reimbursement of care in an Intermediate Care Facility for the Mentally Retarded.

(ss) Transfer Form - the form approved by the State Medicaid Agency and used to document the transfer of an Enrollee having an approved unexpired ICF/MR Pre- Admission Evaluation from the Waiver to an ICF/MR, from an ICF/MR to the Waiver or from one MR Waiver program to another MR Waiver program. For purposes of transfer to an MR Waiver program, whether from an ICF/MR or from another MR Waiver program, such Transfer Form shall be processed by TennCare only if submitted by the Division of Intellectual Disabilities Services (DIDS). DIDS shall submit a Transfer Form only after verifying that the person otherwise meets all applicable admission criteria for the applicable MR Waiver program, as the Transfer Form accomplishes only the transfer of the level of care eligibility.

(tt) Vehicle Accessibility Modifications - interior or exterior physical modifications to a vehicle owned by the Enrollee or to a vehicle which is owned by the guardian or conservator of the Enrollee and which is routinely available for transport of the Enrollee. Such modifications must be intended to ensure the transport of the Enrollee in a safe manner.

(uu) Waiting List - a document prepared and updated by the Operational Administrative Agency which lists persons who are seeking home and community-based mental retardation services in Tennessee.

(2) Self-Direction of Covered Services.

(a) Self-Directed Services.

1. The Covered Services specified in subparagraph (2)(b) may be Self-Directed or Self-Managed by the Enrollee or the Enrollee’s guardian or conservator in accordance with State Medicaid Agency guidelines.

2. The Enrollee or the Enrollee’s guardian or conservator shall have the right to decide whether to Self-Direct the Covered Services specified in subparagraph (2)(b) or to receive them through the provider-directed service delivery method.

When the Enrollee or the Enrollee’s guardian or conservator does not choose to Self-Direct a Covered Service, such service shall be furnished through the provider-directed service delivery method.

3. When the Enrollee or the Enrollee’s guardian or conservator elects to Self-Direct one or more of the Covered Services specified in Subparagraph (2)(b), a Financial Administration Entity must provide Financial Administration services .

(b) The following Covered Services may be Self-Directed:

1. Day Services which are not facility-based.

2. Individual Transportation Services.

3. Personal Assistance.

4. Respite Services when provided by an approved respite provider who serves only one (1) Enrollee.

(c) The following Covered Services shall not be Self-Directed:

1. Adult Dental Services.

2. Behavioral Respite Services.

3. Behavior Services.

4. Day Services which are facility-based.

5. Emergency Assistance.

6. Nursing Services.

7. Nutrition Services.

8. Occupational Therapy Services.

9. Orientation and Mobility Training.

10. Personal Emergency Response Systems.

11. Physical Therapy Services.

12. Respite Services when provided by an approved respite provider who serves more than one (1) Enrollee.

13. Specialized Medical Equipment and Supplies and Assistive Technology.

14. Speech, Language and Hearing Services.

(d) Termination of Self-Direction of Covered Services.

1. Self-Direction of Covered Services by the Enrollee may be voluntarily terminated by the Enrollee or the Enrollee’s guardian or conservator at any time.

2. Self-Direction of Covered Services by the Enrollee may be involuntarily terminated for any of the following reasons:

(i) The Enrollee or the Enrollee’s guardian or conservator does not carry out the responsibilities required for the Self-Direction of Covered Services; or (ii) Continued use of Self-Direction as the method of service management would result in the inability of the Operational Administrative Agency to ensure the health and safety of the Enrollee.

3. Termination of Self-Direction of Covered Services shall not affect the Enrollee’s receipt of Covered Services. Covered Services shall continue to be provided through the provider-directed method of service delivery.

(e) Changing the Amount of Self-Directed Services by the Enrollee.

1. The Enrollee shall have the flexibility to change the amount of those Self- Directed Covered Services specified in subparagraph (2)(b) that have been approved in the Individual Support Plan if:

(i) The change is consistent with the needs, goals, and objectives identified in the Individual Support Plan;

(ii) The change does not affect the total amount of the Enrollee’s selfdetermination budget; and (iii) The Enrollee notifies the Financial Administration Entity, the Supports Broker (if applicable) and the Case Manager.

2. The Case Manager and the Financial Administration Entity shall maintain documentation of such changes by the Enrollee in the amount of the Self- Directed Covered Services for audit purposes.

(3) Covered Services and Limitations.

(a) Adult Dental Services.

1. Adult Dental Services shall not include hospital outpatient or inpatient facility services or related anesthesiology, radiology, pathology, or other medical services in such setting.

2. Adult Dental Services shall exclude orthodontic services.

3. Adult Dental Services shall be limited to adults age twenty-one (21) years or older who are enrolled in the Waiver.

4. Adult Dental Services for adults age 21 or older enrolled in the Waiver shall be limited to a maximum of $5,000 per member per calendar year, and a maximum of $7,500 per member across three (3) consecutive calendar years. Adult Dental Services that are received on or after January 1, 2023, shall apply to the maximum amount allowable under this rule only if the service is not covered as

part of the Dental Services benefit outlined in 1200-13-13-.04 and 1200-13-14- .04. Any Adult Dental Services received prior to January 1, 2023, shall apply to the maximum amounts allowable for the qualifying time period during which the service was performed as outlined by this rule.

(b) Behavioral Respite Services.

1. Behavioral Respite Services may be provided in a Medicaid-certified ICF/MR, in a licensed respite care facility, or in a home operated by a licensed residential provider.

2. Reimbursement shall not be made for the cost of room and board except when provided as part of Behavioral Respite Services furnished in a facility approved by the State that is not a private residence.

3. Enrollees who receive Behavioral Respite Services shall be eligible to receive Individual Transportation Services only to the extent necessary during the time period when Behavioral Respite Services is being provided.

(c) Behavior Services.

1. Behavior Services shall not be billed when provided during the same time period as Physical Therapy; Occupational Therapy; Nutrition Services; Orientation and Mobility Training; or Speech, Language and Hearing Services, unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently.

2. Behavior Services shall be provided face to face with the Enrollee except Enrollee-specific training of staff; behavior assessment and plan development; and presentation of Enrollee behavior information at human rights committee meetings, behavior support committee meetings, and Enrollee planning meetings.

3. Reimbursement for presentation of Enrollee behavior information at meetings shall be limited to a maximum of five (5) hours per Enrollee per year per provider.

Reimbursement for behavior assessments shall be limited to a maximum of eight (8) hours per assessment with a maximum of two (2) assessments per year.

Reimbursement for behavior plan development resulting from such a behavior assessment and the training of staff on the plan during the first thirty (30) days following its approval for use shall be limited to a maximum of six (6) hours.

(d) Day Services.

1. Day Services may be provided in settings such as specialized facilities licensed to provide Day Services, community centers or other community sites, or job sites. Services may also be provided in the Enrollee’s place of residence if there is a health, behavioral, or other medical reason or if the Enrollee has chosen retirement. This service shall not be provided in inpatient hospitals, nursing facilities, and Intermediate Care Facilities for the Mentally Retarded (ICF/MR’s).

2. Day Services provided in a provider’s day habilitation facility shall be provided during the provider agency’s normal business hours.

3. Transportation to and from the Enrollee’s place of residence to Day Services and transportation that is needed during the time that the Enrollee is receiving Day Services shall be a component of Day Services and shall be included in the Day Services reimbursement rate (i.e., it shall not be billed as a separate Waiver service) with the following exceptions:

(i) Transportation to and from medical services covered through the Medicaid State Plan, which shall not be billed as a Waiver service; or (ii) Transportation necessary for Orientation and Mobility Training.

4. Day Services shall not replace services available under a program funded by the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act.

5. For an Enrollee receiving employment supports, reimbursement shall not be made for incentive payments, subsidies or unrelated vocational training expenses such as the following:

(i) Incentive payments made to an employer to encourage or subsidize the employer’s participation in a supported employment program;

(ii) Payments that are passed through to users of supported employment programs; or (iii) Payments for vocational training that is not directly related to an Enrollee’s supported employment program.

(e) Environmental Accessibility Modifications.

1. Environmental Accessibility Modifications which are considered improvements to the home (e.g., roof or flooring repair, installing carpet, installation of central air conditioning, construction of an additional room) are excluded from coverage.

2. Any modification which is not of direct medical or remedial benefit to the Enrollee is excluded from coverage.

3. Modification of an existing room which increases the total square footage of the home is also excluded unless the modification is necessary to improve the accessibility of an Enrollee having limited mobility, in which case the modification shall be limited to the minimal amount of square footage necessary to accomplish the increased accessibility.

(f) Individual Transportation Services.

Individual Transportation Services shall not be used for:

1. Transportation to and from Day Services;

2. Transportation to and from supported or competitive employment;

3. Transportation of school aged children to and from school; or 4. Transportation to and from medical services covered by the Medicaid State Plan.

(g) Reserved.

(h) Nursing Services.

1. Nursing Services shall be provided face to face with the Enrollee by a licensed registered nurse or licensed practical nurse under the supervision of a registered nurse.

2. Nursing assessment and/or nursing oversight shall not be a separate billable service under this definition.

3. This service shall be provided in home and community settings, as specified in the Plan of Care, excluding inpatient hospitals, nursing facilities, and Intermediate Care Facilities for the Mentally Retarded (ICF/MR’s).

4. Nursing Services shall not be billed when provided during the same time period as other therapies unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently.

5. Nursing Services are not intended to replace services available through the Medicaid State Plan or services available under the Rehabilitation Act of 1973 or Individuals with Disabilities Education Act.

(i) Nutrition Services.

1. Nutrition Services must be provided face to face with the Enrollee except for Enrollee-specific training of caregivers responsible for food purchase, food preparation, or assisting the Enrollee to eat and except for that portion of the assessment involving development of the POC.

2. Nutrition Services shall not be billed when provided during the same time period as Physical Therapy; Occupational Therapy; Speech, Language and Hearing Services; Orientation and Mobility Training; or Behavior Services, unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently.

3. Reimbursement for a Nutrition Services assessment visit, which includes the Nutritional Services plan development resulting from such an assessment, shall be limited to one (1) assessment visit per month with a maximum of three (3) assessment visits per year per Enrollee per provider Nutrition Services other than such assessments (e.g., Enrollee-specific training of caregivers; monitoring dietary compliance and food preparation) shall be limited to a maximum of one (1) visit per day. Nutrition Services assessments shall not be billed on the same day with other Nutrition Services.

(j) Occupational Therapy Services.

1. Services must be provided by a licensed occupational therapist or by a licensed occupational therapist assistant working under the supervision of a licensed occupational therapist.

2. Occupational Therapy must be provided face to face with the Enrollee except for that portion of the assessment involving development of the POC.

3. Occupational Therapy therapeutic and corrective services shall not be ordered concurrently with Occupational Therapy assessments (i.e., assess and treat orders are not accepted).

4. Occupational Therapy assessments shall not be billed on the same day with other Occupational Therapy services.

5. Occupational Therapy shall not be billed when provided during the same time period as Physical Therapy; Speech, Language and Hearing Services; Nutrition Services; Orientation and Mobility Training; or Behavior Services, unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently. Occupational Therapy shall not be billed with Day Services if the Day Services are reimbursed on a per hour basis.

6. Occupational Therapy services are not intended to replace services available through the Medicaid State Plan or services available under the Rehabilitation Act of 1973 or Individuals with Disabilities Education Act.

7. Reimbursement for an Occupational Therapy assessment with development of an Occupational Therapy plan based on such an assessment shall be limited to a maximum of one (1) assessment with plan development per month with a maximum of three (3) assessments per year per Enrollee per provider.

Occupational Therapy services other than such assessments (e.g., Enrolleespecific training of caregivers; provision of therapeutic services; monitoring progress) shall be limited to a maximum of one and one-half (1.5) hours per Enrollee per day.

(k) Orientation and Mobility Services for Impaired Vision.

1. Orientation and Mobility Services for Impaired Vision shall not be billed when provided during the same time period as Physical Therapy; Occupational Therapy; Nutrition Services; Behavior Services; or Speech, Language and Hearing Services, unless there is documentation in the Enrollee’s record of medical justification for the two (2) services to be provided concurrently.

2. Orientation and Mobility Services for Impaired Vision shall not replace services available under a program funded by the Rehabilitation Act of 1973 or Individuals with Disabilities Education Act.

3. Reimbursement for an Orientation and Mobility Services for Impaired Vision assessment with development of the Orientation and Mobility Services for Impaired Vision plan based on such an assessment shall be limited to a maximum of one (1) assessment with plan development per month with a maximum of three (3) assessments per year per Enrollee per provider.

Orientation and Mobility Services for Impaired Vision assessments shall not be billed on the same day with other Orientation and Mobility services. Orientation and Mobility Services for Impaired Vision other than such assessments (e.g., Enrollee training; Enrollee-specific training of caregivers), which shall be reimbursed on a per diem basis, shall be limited to a maximum of fifty-two (52) hours of services per Enrollee per year.

(l) Personal Assistance.

1. Personal Assistance may be provided in the home or community; however, it shall not be provided in school settings and shall not be provided to replace personal assistance services required to be covered by schools or services available through the Medicaid State Plan.

2. Personal Assistance shall not be provided during the same time period when the Enrollee is receiving Day Services.

3. This service shall not be provided in inpatient hospitals, nursing facilities, and Intermediate Care Facilities for the Mentally Retarded (ICF/MR’s).

4. Family members who provide Personal Assistance must meet the same standards as providers who are unrelated to the Enrollee. The Personal Assistance provider shall not be the spouse and shall not be the Enrollee’s parent if the Enrollee is a minor. Reimbursement shall not be made to any other individual who is a conservator unless so permitted in the Order for Conservatorship.

(m) Personal Emergency Response System. The system shall be limited to those who are alone for parts of the day and who have demonstrated mental and physical capability to utilize such a system effectively.

(n) Physical Therapy Services.

1. Services must be provided by a licensed physical therapist or by a licensed physical therapist assistant working under the supervision of a licensed physical therapist.

2. Physical Therapy must be provided face to face with the Enrollee except for that portion of the assessment involving development of the POC.

3. Physical Therapy therapeutic and corrective services shall not be ordered concurrently with Physical Therapy assessments (i.e., assess and treat orders are not accepted).

4. Physical Therapy assessments shall not be billed on the same day with other Physical Therapy services.

5. Physical Therapy shall not be billed when provided during the same time period as Occupational Therapy; Speech, Language and Hearing Services; Nutrition Services; Orientation and Mobility Training; or Behavior Services, unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently. Physical Therapy shall not be billed with Day Services if the Day Services are reimbursed on a per hour basis.

6. Physical Therapy services are not intended to replace services available through the Medicaid State Plan or services available under the Rehabilitation Act of 1973 or Individuals with Disabilities Education Act.

7. Reimbursement for a Physical Therapy assessment with development of a Physical Therapy plan based on such an assessment shall be limited to a maximum of one (1) assessment with plan development per month with a maximum of three (3) assessments per year per Enrollee per provider. Physical Therapy services other than such assessments (e.g., Enrollee-specific training of caregivers; provision of therapeutic services; monitoring progress) shall be limited to a maximum of one and one-half (1.5) hours per Enrollee per day.

(o) Respite.

1. Respite may be provided in the Enrollee’s place of residence, in a Family Model Residential Support home, in a Medicaid-certified ICF/MR, in a home operated by a licensed residential provider, or in the home of an approved respite provider.

2. The cost of room and board shall be excluded from Respite reimbursement if Respite is provided in a private residence.

3. Enrollees who receive Respite shall be eligible to receive Individual Transportation Services only to the extent necessary during the time period when Respite is being provided.

(p) Specialized Medical Equipment and Supplies and Assistive Technology.

1. Items not of direct medical or remedial benefit to the Enrollee shall be excluded.

Items that would be covered by the Medicaid State Plan shall be excluded from coverage. Swimming pools, hot tubs, health club memberships, and recreational equipment are excluded. Prescription and over-the-counter medications, food and food supplements, and diapers and other incontinence supplies are excluded.

2. When medically necessary and not covered by warranty, repair of equipment may be covered when it is substantially less expensive to repair the equipment rather than to replace it.

3. The purchase price for waiver-reimbursed Specialized Medical Equipment, Supplies and Assistive Technology shall be considered to include the cost of the item as well as basic training on operation and maintenance of the item.

4. Specialized Medical Equipment and Supplies and Assistive Technology, as defined by 1200-13-01-.29, and Enabling Technology, as defined by 1200-13-01- .02, shall be limited to a combined maximum benefit of $10,000 per person supported per two (2) consecutive calendar years.

(q) Speech, Language and Hearing Services.

1. Services must be provided by a licensed speech language pathologist or by a licensed audiologist.

2. Speech, Language and Hearing Services must be provided face to face with the Enrollee except for that portion of the assessment involving development of the POC.

3. Speech, Language and Hearing therapeutic and corrective services shall not be ordered concurrently with Speech, Language and Hearing assessments (i.e., assess and treat orders are not accepted).

4. Speech, Language and Hearing Services assessments shall not be billed on the same day with other Speech, Language and Hearing Services.

5. Speech, Language and Hearing Services shall not be billed when provided during the same time period as Physical Therapy; Occupational Therapy;

Nutrition Services; Orientation and Mobility Training; or Behavior Services, unless there is documentation in the Enrollee’s record of medical justification for the two services to be provided concurrently. Speech, Language and Hearing Services shall not be billed with Day Services if the Day Services are reimbursed on a per hour basis.

6. Reimbursement for a Speech, Language, and Hearing Services assessment with development of a Speech, Language, and Hearing Services plan based on such an assessment shall be limited to a maximum of one (1) assessment with plan development per month with a maximum of three (3) assessments per year per Enrollee per provider. Speech, Language, and Hearing Services other than such assessments (e.g., Enrollee-specific training of caregivers; provision of therapeutic services; monitoring progress) shall be limited to a maximum of one and one-half (1.5) hours per Enrollee per day.

(r) Vehicle Accessibility Modifications. Replacement of tires or brakes, oil changes, and other vehicle maintenance procedures shall be excluded from coverage.

(s) Out-of-State Services. A provider of Personal Assistance may provide Personal Assistance outside the State of Tennessee and be reimbursed only when provided in accordance with the following:

1. Personal Assistance provided out of state shall be for the purpose of visiting relatives or for vacations and shall be included in the Enrollee’s Plan of Care.

Trips to casinos or other gambling establishments shall be excluded from coverage.

2. Personal Assistance provided out of state shall be limited to a maximum of fourteen (14) days per Enrollee per year.

3. The Personal Assistance provider must be able to assure the health and safety of the Enrollee during the period when Personal Assistance will be provided out of state and must be willing to assume the additional risk and liability of provision of Personal Assistance out of state.

4. During the period when Personal Assistance is being provided out of state, staffing by qualified Personal Assistance staff shall be maintained in accordance with the Individual Support Plan to meet the needs of the Enrollee.

5. The Personal Assistance provider or provider agency which provides Personal Assistance out of state shall not receive any additional reimbursement for provision of services out-of-state. The costs of travel, lodging, food, and other expenses incurred by Personal Assistance staff during the provision of out-ofstate Personal Assistance shall not be reimbursed through the Waiver. The costs of travel, lodging, food, and other expenses incurred by the Enrollee while receiving out-of-state Personal Assistance shall be the responsibility of the Enrollee and shall not be reimbursed through the waiver.

(t) Emergency Assistance.

1. Emergency Assistance shall be provided only in one of the following emergency situations:

(i) Permanent or temporary involuntary loss of the Enrollee’s present residence;

(ii) Loss of the Enrollee’s present caregiver for any reason, including death of a caregiver or changes in the caregiver’s mental or physical status resulting in the caregiver’s inability to perform effectively for the Enrollee; or (iii) Significant changes in the behavioral, medical or physical condition of the Enrollee that necessitate substantially expanded services.

2. Emergency Assistance shall be available only to Enrollees whose needs cannot be accommodated within the $30,000 budget limitation on Covered Waiver Services.

3. The amount of Emergency Assistance shall be limited to $6,000 per Enrollee per year. Prior authorization by the Enrollee’s Case Manager shall be required and shall be renewed every thirty (30) calendar days.

4. Emergency Assistance shall only be used to provide a supplementary increase in the amount of other Covered Waiver Services.

(u) The cost of all Covered Services, including any Emergency Assistance, shall not exceed $42,000 per year per Enrollee.

(v) All Covered Services to be provided prior to the development of the initial Individual Support Plan must be included in the physician’s plan of care section of the Pre- Admission Evaluation application.

(4) Eligibility.

(a) To be eligible for enrollment in the Waiver, an individual must meet all of the following criteria:

1. The individual must be a resident of the State of Tennessee.

2. The individual shall have an established non-institutional place of residence and shall not require staff-supported residential services provided through a Home and Community Based Services Waiver (e.g., Residential Habilitation and Supported Living as defined in TennCare rule 1200-13-01-.25).

3. The individual must, but for the provision of Waiver Services, require the level of care provided in an ICF/MR, and must meet the ICF/MR eligibility criteria specified in TennCare Rule 1200-13-01-.15, except that requirements pertaining to a psychological evaluation shall be in accordance with Rule 1200-13-01- .29(4)(a)6.

4. The individual’s habilitative, medical, and specialized services needs must be such that they can be effectively and safely met through the Waiver, as determined by the Operational Administrative Agency based on a pre-enrollment assessment.

5. The individual must have an unexpired ICF/MR Pre-Admission Evaluation which has been approved by the State Medicaid Agency or by its designee and which lists the Enrollee’s specific Waiver Services with the amount, scope, and duration of the services.

6. The individual must have a psychological evaluation included as part of the approved Pre-Admission Evaluation which meets the following:

(i) The psychological evaluation shall document that the individual:

(I) Has mental retardation manifested before eighteen (18) years of age and has an IQ test score of seventy (70) or below; or (II) Is a child five (5) years of age or younger who has a developmental disability with a high probability of resulting in mental retardation (i.e., a condition of substantial developmental delay or specific congenital or acquired condition with a high probability of resulting in mental retardation); and (ii) There is no time limit for when the psychological evaluation is conducted as long as it is completed prior to the submission of the PAE, and as long as the evaluation meets the requirements specified in 1200-13-01- .29(4)(a)6.(i) above, and the person’s current medical, social, developmental and psycho-social history continues to support the evaluation.

(iii) A new psychological evaluation performed within ninety (90) calendar days preceding the date of admission into the waiver shall be required if the person’s condition has significantly changed, or the original evaluation is not otherwise consistent with the person’s current medical, social, developmental and psycho-social history.

7. The individual shall have one or more designated adults who shall be present in the individual’s home to observe, evaluate, and provide an adequate level of direct care services to ensure the health and safety of the individual.

(i) An individual who does not have 24-hour-per-day direct care services shall:

(I) Have an individualized Safety Plan that:

I. Is based on a written assessment of the individual’s functional capabilities and habilitative, medical, and specialized services needs by the Case Manager in consultation with individuals who are knowledgeable of the individual’s capability of functioning without direct care services twenty-four (24) hours per day;

II. Addresses the individual’s capability of functioning when direct care staff are not present;

III. Addresses the ability of the individual to self-administer medications when direct care staff are not present;

IV. Specifies whether a Personal Emergency Response System will be used by the individual to secure help in an emergency;

V. Is updated as needed, but no less frequently than annually, by the Operational Administrative Agency to ensure the health and safety of the individual; and VI. Is an attachment to the ICF/MR PAE or, if applicable, to the Transfer Form.

(II) Have one or more designated adults who shall be present in the individual’s home to observe, evaluate, and provide an adequate level of direct care services to ensure the health and safety of the individual as needed but no less frequently than one day each week.

8. The individual shall have a place of residence with an environment that is adequate to reasonably ensure health, safety and welfare.

(b) A Transfer Form approved by the State Medicaid Agency:

1. May be used to transfer an Enrollee having an approved unexpired ICF/MR PAE from the Waiver to an ICF/MR;

2. May be used to transfer an individual having an approved unexpired ICF/MR PAE from an ICF/MR to the Waiver;

3. May be used to transfer an individual from one MR Waiver to a different Home and Community Based Services MR Waiver Program as specified in 1200-13-01- .29(1)(ss) above; and 4. Shall include an initial plan of care that lists the Enrollee’s specific Waiver Services with the amount, scope, and duration of the services.

(5) Intake and Enrollment.

(a) When an individual is determined to be likely to require the level of care provided by an ICF/MR, the Operational Administrative Agency shall inform the individual or the individual’s legal representative of any feasible alternatives available under the Waiver and shall offer the choice of available institutional services or Waiver program services.

Notice to the individual shall contain:

1. A simple explanation of the Waiver and Covered Services;

2. Notification of the opportunity to apply for enrollment in the Waiver and an explanation of the procedures for enrollment; and 3. A statement that participation in the Waiver is voluntary.

(b) Enrollment in the Waiver shall be voluntary, but shall be restricted to the maximum number of individuals specified in the Waiver, as approved by the Centers for Medicare and Medicaid Services for the State of Tennessee.

(c) Upon implementation of the ECF CHOICES program, all new enrollment into the Self- Determination Waiver shall be closed; provided, however, that a child age 18–21 who has an Intellectual Disability and is aging out of State custody or is determined by TennCare to no longer be able to safely continue living with their family may be enrolled into the Self-Determination Waiver subject to (b) above if all eligibility and enrollment criteria are met, only until such time that the State has authority under the terms and conditions of the 1115 Waiver to provide for enrollment of such child into ECF CHOICES, when appropriate.

(6) Certification and Re-evaluation.

(a) The ICF/MR Pre-Admission Evaluation shall include a signed and dated certification by the individual’s physician that the individual requires Waiver Services.

(b) The Operational Administrative Agency shall perform a re-evaluation of the Enrollee’s need for continued stay in the Waiver within twelve (12) calendar months of the date of enrollment and at least every twelve (12) months thereafter. The re-evaluation shall be documented in a format approved by the State Medicaid Agency and shall be performed by a licensed physician or registered nurse or a Qualified Mental Retardation Professional.

(c) The Operational Administrative Agency shall maintain in its files for a minimum period of three (3) years a copy of the re-evaluations of need for continued stay.

(7) Disenrollment.

(a) Voluntary disenrollment of an Enrollee from the Waiver may occur at any time upon written notice from the Enrollee or the Enrollee’s guardian or conservator to the Operational Administrative Agency. Prior to disenrollment the Operational Administrative Agency shall provide reasonable assistance to the Enrollee in locating appropriate alternative placement.

(b) An Enrollee may be involuntarily disenrolled from the Waiver for any of the following reasons:

1. The Tennessee Self-Determination Waiver Program is terminated.

2. An Enrollee becomes ineligible for Medicaid or is found to be erroneously enrolled in the Waiver.

3. An Enrollee moves out of the State of Tennessee; provided however, that when the Enrollee is the dependent of a military service member who is a legal resident of the state, but has left the state temporarily due to the military service member’s military assignment out of state, such dependent may re-enroll in the Waiver upon return to the State, so long as all conditions of eligibility are met.

4. The condition of the Enrollee improves such that the Enrollee no longer requires the level of care provided by the Waiver.

5. The Enrollee’s medical or behavioral needs become such that the health, safety and welfare of the Enrollee cannot be assured through the provision of Waiver Services.

6. The home or home environment of the Enrollee becomes unsafe to the extent that it would reasonably be expected that Waiver Services could not be provided without significant risk of harm or injury to the Enrollee or to individuals who provide covered services to the Enrollee.

7. The Enrollee or the Enrollee’s guardian or conservator refuses to abide by the Plan of Care or related Waiver policies, resulting in the inability of the Operational Administrative Agency to ensure quality care or the health and safety of the Enrollee.

8. The health, safety and welfare of the Enrollee cannot be assured due to the lack of an approved Safety Plan.

9. The Enrollee was transferred to a hospital, NF, ICF/MR, Assisted Living Facility, and/or Home for the Aged and has resided there for a continuous period exceeding one hundred twenty (120) days, if such period began prior to March 1, 2010, or a period exceeding ninety (90) days if such period begins on or after March 1, 2010.

10. The cost for all Covered Waiver services, including Emergency Assistance services, has reached the Waiver limit of $36,000 per year per Enrollee and the State cannot assure the health and safety of the Enrollee.

(c) The Operational Administrative Agency shall notify the State Medicaid Agency in writing prior to involuntary disenrollment of an Enrollee and shall give advance notice to the Enrollee of the intended involuntary disenrollment and of the Enrollee’s right to appeal and have a fair hearing.

(d) If an Enrollee has been involuntarily disenrolled from the Waiver, the Operational Administrative Agency shall provide reasonable assistance to the Enrollee in locating appropriate alternative placement.

(8) Plan of Care.

(a) All Waiver Services for the Enrollee shall be provided in accordance with an approved Plan of Care.

1. Prior to the development of the initial Individual Support Plan, Covered Services shall be provided in accordance with the physician’s initial plan of care included in the approved ICF/MR Pre-Admission Evaluation.

2. Each Enrollee shall have an individualized written Plan of Care (the Individual Support Plan) that shall be developed for an Enrollee within sixty (60) calendar days of admission into the Waiver.

3. A Safety Plan for Enrollees who do not have 24-hour direct care services shall be maintained with the Plan of Care.

(b) To ensure that Waiver Services and other services are being appropriately provided to meet the Enrollee’s needs, the Plan of Care shall be reviewed on an ongoing basis and shall be updated and signed in accordance with the following:

1. The Case Manager shall review the Plan of Care when needed, but no less frequently than once each calendar month, and shall document such review by a dated signature.

2. A team consisting of the Case Manager and other appropriate participants in the development of the Plan of Care shall review the Plan of Care when needed, but no less frequently than every twelve (12) calendar months, and shall document such review by dated signatures. Such annual review shall include, but not be limited to, reviewing outcomes and determining if progress is being made in accordance with the Plan of Care; reviewing the appropriateness of supports and services being provided and determining further needs of the Enrollee.

(9) Physician Services.

(a) The Operational Administrative Agency shall ensure that each Enrollee receives physician services as needed and that each Enrollee has a medical examination, documented in the Enrollee’s record, in accordance with the following schedule:

Age Minimum frequency of medical examinations Up to age 21 In accordance with Medicaid EPSDT periodicity standards 21-64 Every one (1) to three (3) years, as determined by the Enrollee’s physician Over age 65 Annually (b) All Covered Services to be provided prior to the development of the initial Individual Support Plan shall be physician ordered and shall be included in the physician’s plan of care section of the Pre-Admission Evaluation application.

(c) When required by state law, Covered Services shall be ordered or reordered, by a licensed physician, licensed nurse practitioner, physician assistant, a licensed dentist, or other appropriate health care provider.

(10) Waiver Administration. The Operational Administrative Agency shall be responsible for the administration of the day-to-day operations of the Waiver under the oversight of the State Medicaid Agency and shall ensure that Covered Services are provided in accordance with state and federal laws, rules, regulations and policies established by the State Medicaid Agency. The Operational Administrative Agency shall be responsible for the following activities, whether provided directly or through subcontract:

(a) Marketing of the Waiver to potential Enrollees;

(b) Intake and pre-enrollment assessment of the applicant’s habilitative, medical and specialized services needs; and appropriateness for enrollment in the Waiver;

(c) Assisting the applicant with the submission of a properly completed ICF/MR Pre- Admission Evaluation;

(d) Enrollment of eligible individuals into the Waiver;

(e) Provision of a plain language explanation of appeal rights to each Enrollee upon enrollment in the Waiver;

(f) Review and approval of Plans of Care (Individual Support Plans) to ensure that Waiver Services have been authorized prior to payment;

(g) Ensuring that annual level of care re-evaluations have been performed to document the need for continuation of Waiver Services for the Enrollee;

(h) Notification of the State Medicaid Agency in writing prior to involuntary disenrollment of any Enrollee;

(i) Ensuring that Waiver providers maintain comprehensive Enrollee records and documentation of services provided to Enrollees in accordance with state and federal laws, rules, regulations and State Medicaid Agency policies;

(j) Obtaining approval from the State Medicaid Agency prior to distributing policies and procedures to Waiver providers or Waiver information to Enrollees;

(k) Compliance with reporting and record-keeping requirements established by the State Medicaid Agency;

(l) Maintaining in its files the original ICF/MR Pre-Admission Evaluation and, where applicable, the original Transfer Form;

(m) Assurance of a statewide provider network adequate to meet the needs of Enrollees;

(n) Ensuring that Waiver Services providers and subcontractors meet the Waiver provider qualifications approved by the Centers for Medicare and Medicaid Services;

(o) Ensuring that Waiver Services providers have a signed provider agreement which includes a requirement for compliance with the Division of Mental Retardation Services Provider Manual in the delivery of waiver services;

(p) Assurance of the health and safety of Enrollees through the implementation of a comprehensive quality monitoring program;

(q) Reporting instances of abuse, neglect, mistreatment or exploitation to appropriate state agencies;

(r) Assurance that Covered Services are provided in accordance with the approved Waiver definitions and in accordance with the State Medicaid Agency guidelines;

(s) Compliance with the appeals process specified in TennCare rule 1200-13-13-.11 to ensure that Enrollees are afforded advance notice and the right to appeal an adverse decision and have a fair hearing;

(t) Ensuring that providers and subcontractors comply with the quality monitoring guidelines and requirements established by the State Medicaid Agency, by the Operational Administrative Agency, and by the Centers for Medicare and Medicaid Services, and with other state and federal laws, rules, and regulations affecting the provision of Waiver Services;

(u) Oversight and monitoring of the Financial Administration entity;

(v) Collection of applicable patient liability from Enrollees;

(w) Reimbursement of Waiver providers in accordance with policies established by the State Medicaid Agency;

(x) Recoupment of payments made to Waiver providers when there is lack of documentation to support that services were provided or there is a lack of medical necessity of services, or when inappropriate payments have been made due to erroneous or fraudulent billing; and (y) Expenditure and revenue reporting in accordance with state and federal requirements.

(11) Reimbursement.

(a) The average per capita fiscal year expenditure under the Waiver shall not exceed 100% of the average per capita expenditure that would have been made in the fiscal year if care had been provided in an ICF/MR. The total Medicaid expenditure for Waiver Services and other Medicaid services provided to Enrollees shall not exceed 100% of the amount that would have been incurred in the fiscal year if care was provided in an ICF/MR. Reimbursement for the cost of all Covered Services, including any Emergency Assistance, shall not exceed $42,000 per year per Enrollee.

(b) The Operational Administrative Agency shall be reimbursed for Waiver Services at the rate per unit of service actually paid by the Operational Administrative Agency to the Waiver service provider or at the maximum rate per unit of service established by the State Medicaid Agency, whichever is less.

(c) In accordance with 42 CFR § 435.726, the Operational Administrative Agency shall make a diligent effort to collect patient liability if it applies to the Enrollee. The Operational Administrative Agency or its designee shall complete appropriate forms showing the individual’s amount of monthly income and shall submit them to the Tennessee Department of Human Services. The Tennessee Department of Human Services shall issue the appropriate forms to the Operational Administrative Agency and to the State Medicaid Agency’s fiscal agent that processes and pays vendor claims, specifying the amount of patient liability to be applied toward the cost of care for the Enrollee.

(d) The Operational Administrative Agency shall submit bills for services to the State Medicaid Agency’s fiscal agent using a claim form approved by the State Medicaid Agency. On claim forms, the Operational Administrative Agency shall use a provider number assigned by the State Medicaid Agency.

(e) Reimbursement shall not be made to the Operational Administrative Agency for therapeutic leave or hospital leave for Enrollees in the Waiver.

(f) Medicaid benefits other than those specified in the Waiver’s scope of Covered Services shall be reimbursed by the State Medicaid Agency as otherwise provided for by federal and state rules and regulations.

(g) The Operational Administrative Agency shall be responsible for obtaining the physician’s initial certification and subsequent Enrollee re-evaluations. Failure to perform re-evaluations in a timely manner and in the format approved by the State Medicaid Agency shall require a corrective action plan and shall result in partial or full recoupment of all amounts paid by the State Medicaid Agency during the time period when a re-evaluation had lapsed.

(h) The Operational Administrative Agency shall be responsible for ensuring that the Financial Administration entity fulfills its financial, ministerial, and clerical responsibilities associated with the provision of Financial Administration services to an Enrollee who Self-Directs one or more Covered Services. Examples of such responsibilities include the hiring and employment of service providers by the Enrollee or the Enrollee’s guardian or conservator; management of Enrollee accounts; disbursement of funds to Waiver service providers while withholding appropriate deductions; reviewing documentation of Covered Services to assure Enrollee approval prior to payment; ensuring that Waiver service providers possess the necessary qualifications established by the State Medicaid Agency.

(i) The State Medicaid Agency shall be responsible for defining and establishing the billing units to be used by the Operational Administrative Agency in billing for Waiver Services.

(j) An Operational Administrative Agency that enrolls an individual without an approved ICF/MR Pre-Admission Evaluation or, where applicable, an approved Transfer Form does so without the assurance of reimbursement. An Operational Administrative Agency that enrolls an individual who has not been determined by the Tennessee Department of Human Services to be financially eligible to have Medicaid make reimbursement for covered services does so without the assurance of reimbursement.

(12) Appeals. An Enrollee shall have the right to appeal an adverse action in accordance with TennCare rule 1200-13-13-.11.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 4-5-209, 71-5-105, 71-5-107, and 71-5-109 and Executive Order No. 23.
• Administrative History: Original rule filed June 20, 2007; effective September 3, 2007. Public necessity rules filed July 1, 2009; effective through December 13, 2009. Amendments filed September 11, 2009; effective December 10, 2009. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendments filed May 27, 2010; effective August 25, 2010. Amendments filed June 26, 2015; effective September 24, 2015. Amendments filed September 30, 2016; effective December 29, 2016. Emergency rules filed December 27, 2022 to become effective January 1, 2023; effective through June 30, 2023. Amendments filed November 1, 2022; effective January 30, 2023. Amendments filed January 19, 2023; effective April 19, 2023.

Tenn. Comp. R. & Regs. 1200-13-13-.01 and shall give rise to notice of action and due process rights to request a fair hearing in accordance with Rule 1200-13-13-.11.

(9) Consumer Direction (CD).

(a) CD is a model of service delivery that affords the parent or legal guardian of a child enrolled in Katie Beckett Group Part A or Medicaid Diversion Group Part B the opportunity to have more choice and control with respect to Eligible Katie Beckett HCBS that are needed by the child, in accordance with this Rule. CD is not a service or set of services.

(b) Katie Beckett HCBS eligible for CD (Eligible Katie Beckett HCBS).

1. CD shall be limited to the following HCBS:

(i) Supportive Home Care.

(ii) Hourly Respite. (Daily Respite shall not be available through CD.)

(iii) Community Transportation.

2. Katie Beckett Group Part A or Medicaid Diversion Group Part B Members determined to need Eligible Katie Beckett HCBS may elect to receive one or more of the Eligible Katie Beckett HCBS through a Contract Provider, or they may participate in CD.

3. Katie Beckett Members who do not need Eligible Katie Beckett HCBS shall not be offered the opportunity to enroll in CD.

4. The model of CD that will be implemented in Katie Beckett is a modified budget

authority model.

5. Each Eligible Katie Beckett HCBS identified in the child’s PCSP/ISP, that the child’s parent or legal guardian elects to receive through CD shall have an individual monthly or annual budget, as specified below.

6. The amount of the budget authorized for each Eligible Katie Beckett HCBS the child’s parent or legal guardian elects to receive through CD shall be based on a comprehensive needs assessment performed by the MCO Nurse Care Manager or DIDD Case Manager that identifies the child’s needs, the availability of family and other unpaid caregivers to meet those needs, and the gaps in care for which paid Katie Beckett HCBS may be authorized.

(i) Each Eligible Katie Beckett HCBS received through CD shall have a separate budget.

(ii) The budget for each Eligible Katie Beckett HCBS received through CD shall be based on the number of units of that service the child is assessed to need, subject to applicable benefit limits and the child’s Expenditure Cap.

(iii) Once the budget for each Eligible Katie Beckett HCBS is determined and authorized, the child’s parent or legal guardian shall have flexibility to determine the rate of reimbursement for that service (subject to any limitations established by TennCare), and to purchase additional units of the service so long as the budget for that service is not exceeded.

(iv) The budget for each Eligible Katie Beckett HCBS shall be separately maintained. A child’s parent or legal guardian shall not direct money from the budget for one Eligible Katie Beckett HCBS to purchase a different Eligible Katie Beckett HCBS, provided however, that a child’s PCSP/ISP (and consequently, the budget for any affected Eligible Katie Beckett HCBS) may be amended based on the child’s needs, as appropriate.

(v) Any money remaining in a child’s monthly budget for Supportive Home Care or Community Transportation at the end of a month shall not be carried over to the next month, and cannot be used to purchase units of service in any other month.

(vi) Any money remaining in a child’s annual budget for hourly Respite at the end of the calendar year shall not be carried over to the next year, and cannot be used to purchase additional units of service in a subsequent calendar year.

7. The amount of the budget for each Eligible Katie Beckett HCBS shall be authorized as follows:

(i) Supportive Home Care shall have a monthly budget if provided through Consumer Direction.

(I) A child’s parent or legal guardian shall only direct CD Workers to provide Supportive Home Care up to the amount of the authorized monthly budget for that service.

(II) A child’s parent or legal guardian shall not ask or allow a CD Worker to provide services in excess of the authorized monthly budget for that service.

(III) If a child’s parent or legal guardian exhausts the child’s authorized monthly budget for a service before the month has ended, additional services shall not be authorized for the remainder of the month.

(IV) If a child’s parent or legal guardian is not able to manage services within the approved budget for the service, the child may not be able to remain in CD.

(ii) Community Transportation for children enrolled in Katie Beckett Group Part A or Medicaid Diversion Group Part B shall have a monthly budget if provided through CD.

(I) The monthly budget shall be based on the number of days in the month that the child is expected to need Community Transportation services.

(II) The child’s parent or legal guardian may receive the first month’s budget allotment in advance. The advance monthly budget allotment shall be used to purchase only Community Transportation services as defined in this Rule Chapter.

(III) A child’s parent or legal guardian may purchase Community Transportation services in the most cost-efficient manner possible, including public transportation (e.g., bus passes), paying a co-worker to share gas expenditures, etc.

(IV) A child’s parent or legal guardian shall not reimburse any person who resides with the child for Community Transportation.

(V) The child’s parent or legal guardian is obligated to maintain a Community Transportation log and receipts for Community Transportation expenditures as required by TennCare and to submit such information on a monthly basis to his MCO.

(VI) A child’s parent or legal guardian shall only purchase Community Transportation up to the amount of the authorized monthly budget for that service.

(VII) The child’s parent or legal guardian shall be reimbursed only for documented purchases of Community Transportation services submitted to the MCO.

(VIII) A child’s parent or legal guardian shall not be reimbursed for Community Transportation services in excess of the authorized monthly budget for that service.

(IX) If a child’s parent or legal guardian exhausts the child’s authorized monthly budget for Community Transportation services before the month has ended, additional services shall not be authorized for the remainder of the month.

(X) If a child’s parent or legal guardian is not able to manage services within the approved budget for the service, the child may not be able to remain in CD.

(iii) Respite services for children enrolled in Katie Beckett Group Part A or Medicaid Diversion Group Part B shall have an annual budget if provided through Consumer Direction.

(I) The annual budget shall operate on a calendar year (January 1 through December 31).

(II) A child’s parent or legal guardian who elects to receive the child’s Respite through CD shall receive up to 216 hours per year of Respite services. (Daily Respite shall not be available through CD.)

(III) A child’s parent or legal guardian shall only direct CD Workers to provide Respite services up to the amount of the authorized annual budget for that service.

(IV) A child’s parent or legal guardian shall not ask or allow a CD Worker to provide services in excess of the authorized annual budget for that service.

(V) If a child’s parent or legal guardian exhausts the child’s authorized annual budget for Respite services before the calendar year has ended, additional services shall not be authorized for the remainder of the year.

(VI) If a child’s parent or legal guardian is not able to manage services within the child’s approved budget for the service, the child may not be able to remain in CD.

8. HH Services, PDN Services, and Katie Beckett HCBS other than those specified above shall not be available through CD.

(c) Eligibility for CD. To be eligible for CD, a child must meet all of the following criteria:

1. Be a Member of Katie Beckett Group Part A or Medicaid Diversion Group Part B.

2. Be determined by an MCO Nurse Care Manager or DIDD Case Manager, based on a comprehensive needs assessment, to need one or more Eligible Katie Beckett HCBS.

3. The child’s parent or legal guardian must be willing and able to serve as the Employer of Record for the child’s Consumer-Directed Workers and to fulfill all of the required responsibilities for CD. In limited exceptional circumstances, TennCare may permit the child’s parent or legal guardian to designate a qualified Representative who is willing and able to serve as the Employer of Record and to fulfill all of the required responsibilities for CD. Assistance shall be provided to the child’s parent or legal guardian or in limited exceptional circumstances, the Representative for CD by the FEA.

4. The child’s parent or legal guardian or in limited exceptional circumstances, the Representative for CD and any Workers employed to provide services through CD must agree to use the services of TennCare’s contracted FEA to perform required Financial Administration and Supports Brokerage functions.

(d) Enrollment in CD.

1. The parent or legal guardian of a child enrolled in Katie Beckett Group Part A or Medicaid Diversion Group Part B assessed to need one or more Eligible Katie Beckett HCBS may elect to participate in CD at any time.

2. Only the child’s parent or legal guardian may make the decision whether the child will participate in CD. The child’s parent or legal guardian must sign a CD participation form reflecting the decision.

3. Representative. In limited exceptional circumstances, TennCare may permit the child’s parent or legal guardian to designate a Representative for CD.

(i) A Representative for CD must meet all of the following criteria:

(I) Be at least eighteen (18) years of age;

(II) Have a personal relationship with the child and understand the child’s support needs;

(III) Know the child’s daily schedule and routine, medical and functional status, medication regimen, likes and dislikes, strengths and weaknesses; and (IV) Be physically present in the child’s residence on a regular basis or at least at a frequency necessary to supervise and evaluate each Consumer-Directed Worker.

(ii) If a child’s MCO Nurse Care Manager or DIDD Case Manager believes that the person selected as the Representative for CD does not meet the specified requirements (e.g., the Representative is not physically present in the child’s residence at a frequency necessary to adequately supervise Workers), the MCO Nurse Care Manager or DIDD Case Manager may request that the child’s parent or legal guardian select a different Representative who meets the specified requirements. If the child’s parent or legal guardian does not select another Representative who meets the specified requirements, the MCO or DIDD may, in order to help ensure the child’s health and safety, submit to TennCare, for review and approval, a request to deny the child’s participation in CD.

(iii) A Representative for CD shall not receive payment for serving in this capacity and shall not serve as the child’s paid Worker for any Consumer- Directed Service.

(iv) Representative Agreement. A Representative Agreement must be signed by the child’s parent or legal guardian and the Representative in the presence of the MCO Nurse Care Manager or DIDD Case Manager. By completing a Representative agreement, the Representative confirms that he agrees to serve as the Representative for CD and that he accepts the responsibilities and will perform the duties associated with being a Representative for CD.

(v) A child’s parent or legal guardian may change the Representative at any time by notifying the child’s MCO Nurse Care Manager or DIDD Case Manager and the child’s Supports Broker that he intends to change Representative. The child’s MCO Nurse Care Manager or DIDD Case Manager shall verify that the new Representative meets the qualifications as described above. A new Representative Agreement must be completed and signed, in the presence of the child’s MCO Nurse Care Manager or DIDD Case Manager, prior to the new Representative assuming his respective responsibilities.

(e) Employer of Record.

1. If a child’s parent or legal guardian elects to participate in CD, he must serve as the Employer of Record. In limited exceptional circumstances where TennCare permits the parent or legal guardian to designate a Representative for CD, the Representative must serve as the Employer of Record.

2. The Employer of Record is responsible for the following:

(i) Finding, interviewing, hiring and firing Workers;

(ii) Determining Workers’ duties and developing job descriptions;

(iii) Training Workers to provide personalized support based on the Member’s needs and preferences;

(iv) Scheduling Workers;

(v) Ensuring there are enough Workers hired to provide all of the support needed by the child (including when the Worker scheduled is unable to report to work);

(vi) Ensuring the Worker(s) keep correct time sheets for the services and supports provided;

(vii) Reviewing and approving hours reported by Consumer-Directed Workers;

(viii) Ensuring Workers provide only as much support as assigned to provide and as needed by the child;

(ix) Ensuring that no Worker provides more than 40 hours of support each week unless the parent or legal guardian of a child enrolled in Katie Beckett Group Part A or the Representative for CD has decided to pay overtime out of the child’s approved budget (a Worker delivering services to a child enrolled in Medicaid Diversion Group Part B shall not be permitted to provide more than 40 hours of support each week);

(x) Managing the services the child needs within the child’s approved budget for each service;

(xi) Supervising Workers;

(xii) Evaluating Worker performance and addressing any identified deficiencies or concerns;

(xiii) Setting wages from a range of reimbursement levels established by TennCare;

(xiv) Reviewing and ensuring proper documentation for services provided; and (xv) Developing and implementing as needed a Back-up Plan to address instances when a scheduled Worker is not available or fails to show up as scheduled.

(f) Denial of Enrollment in CD.

1. Enrollment into CD may be denied by TennCare when:

(i) The child is not enrolled in TennCare or in Katie Beckett Group Part A or Medicaid Diversion Group Part B.

(ii) The child does not need one or more of the HCBS eligible for CD, as specified in the PCSP/ISP.

(iii) The child’s parent or legal guardian is not willing or able to serve as the Employer of Record for the child’s Consumer-Directed Workers and to fulfill all of the required responsibilities for CD, and does not meet limited exceptional circumstances as determined by TennCare or have a qualified Representative who is willing and able to serve as the Employer of Record and to fulfill all of the required responsibilities for CD.

(iv) The child does not have an adequate Back-up Plan for CD.

(v) The child’s parent or legal guardian or in limited exceptional circumstances, the Representative for CD, or the Consumer-Directed Workers he wants to employ, are unwilling to use the services of TennCare’s contracted FEA to perform required Financial Administration and Supports Brokerage functions.

(vi) Other significant concerns regarding the child’s participation in CD which jeopardize the health, safety or welfare of the child.

2. Denial of enrollment in CD gives rise to notice and due process including the right to a fair hearing, as set forth in this rule.

(g) Fiscal Employer Agent (FEA).

1. The FEA shall perform the following functions on behalf of all Katie Beckett Group Part A or Medicaid Diversion Group Part B enrollees participating in CD:

(i) Financial Administration functions in the performance of payroll and related tasks; and (ii) Supports Brokerage functions to assist the child’s parent or legal guardian (or the Representative for CD) with other non-payroll related tasks such as the completion of CD enrollment paperwork and assistance with employer functions as requested.

2. The FEA shall:

(i) Assign a Supports Broker to each Katie Beckett Member electing to participate in CD of Eligible Katie Beckett HCBS.

(ii) Provide initial and ongoing training to the child’s parent or legal guardian (or the Representative for CD) on CD and other relevant issues.

(iii) Verify Worker qualifications, including conducting background checks on Workers, enrolling Workers into TennCare, requesting from TennCare the assignment of Medicaid provider ID numbers, and holding TennCare provider agreements.

(iv) Provide initial and ongoing training to Workers on CD and other relevant issues such as the use of the FEA time keeping system.

(v) Assist the child’s parent or legal guardian (or the Representative for CD) in developing and updating Service Agreements.

(vi) Withhold, file and pay applicable federal, state and local income taxes; employment and unemployment taxes; and worker’s compensation.

(vii) Pay Workers for authorized services rendered within authorized timeframes.

(h) Back-up Plan for Consumer-Directed Workers.

1. The parent or legal guardian of each child participating in CD is responsible for the development and implementation of a Back-up Plan that identifies how the parent or legal guardian or the Representative for CD will address situations when a scheduled Worker is not available or fails to show up as scheduled.

2. The child’s parent or legal guardian may not elect, as part of the Back-up Plan, to allow the child to go without services.

3. The Back-up Plan for CD shall include the names and telephone numbers of contacts (Workers, agency staff, organizations, supports) for alternate care, the order in which each shall be notified and the services to be provided by contacts.

4. Back-up contacts may include paid and unpaid supports; however, it is the responsibility of the child’s parent or legal guardian or his Representative for CD to secure paid (as well as unpaid) back-up contacts who are willing and available to serve in this capacity, and for initiating the back-up plan when needed.

5. The child’s Back-up Plan for Consumer-Directed Workers shall be integrated into the child’s Back-up Plan for services provided by Contract Providers and the child’s PCSP/ISP.

6. The MCO Nurse Care Manager or DIDD Case Manager shall review the Back-up Plan developed by the child’s parent or legal guardian or his Representative for CD to determine its adequacy to address the child’s needs. If an adequate Backup Plan cannot be provided to CD, enrollment into CD may be denied, as set forth in this Rule.

7. The Back-up Plan shall be reviewed and updated at least annually, and as frequently as necessary if there are changes in the type, amount, duration, scope of eligible Katie Beckett HCBS or the schedule at which such services are needed, changes in Workers (when such Workers also serve as a back-up to other Workers) and changes in the availability of paid or unpaid back-up Workers to deliver needed support.

8. A child’s parent or legal guardian may use Contract Providers to serve as backup to Consumer Directed Workers only upon prior arrangement by the child’s parent or legal guardian or Representative for CD with the Contract Provider, inclusion in the child’s back-up plan, verification by the MCO Nurse Care Manager or DIDD Case Manager, prior approval by the MCO or DIDD, and subject to the child’s Expenditure Cap as described in Paragraph (8). If the higher cost of services delivered by a Contract Provider would result in a child’s Expenditure Cap being exceeded, the child’s parent or legal guardian shall not be permitted to use Contract Providers to provide back-up workers. A child’s MCO or DIDD shall not be required to maintain Contract Providers on “stand-by” to provide back-up for services delivered through Consumer Direction.

(i) Consumer-Directed Workers (Workers).

1. Hiring Consumer-Directed Workers.

(i) A child’s parent or legal guardian shall have the flexibility to hire individuals with whom they have a close personal relationship to serve as Workers, such as neighbors or friends.

(ii) A child’s parent or legal guardian may hire family members, excluding spouses, to serve as Workers. However, a family member shall not be reimbursed for a service that he would have otherwise provided without pay. A child’s parent or legal guardian shall not be permitted to employ any person who resides with the child enrolled in Katie Beckett to deliver Supportive Home Care or hourly Respite services. A child’s parent or legal guardian shall not reimburse any person who resides with the child for Community Transportation.

(iii) The child’s parent or legal guardian may elect to have a Worker provide more than one service, have multiple Workers, or have both a Worker and a Contract Provider for a given service, in which case, there must be a set schedule which clearly defines when Contract Providers will be used.

2. Qualifications of Consumer-Directed Workers. Workers must meet the following requirements prior to providing services:

(i) Be at least eighteen (18) years of age or older;

(ii) Complete a background check that includes a criminal background check (including fingerprinting), or, as an alternative, a background check from a licensed private investigation company;

(iii) Verification that the person’s name does not appear on the State abuse registry;

(iv) Verification that the person’s name does not appear on the State and national sexual offender registries;

(v) Licensure verification, as applicable;

(vi) Verification that the person has not been excluded from participation in Medicare, Medicaid, SCHIP, or any Federal health care programs (as defined in Section 128B(f) of the Social Security Act);

(vii) Complete all required training;

(viii) Complete all required applications to become a TennCare provider;

(ix) Sign an abbreviated Medicaid agreement;

(x) Be assigned a Medicaid provider ID number;

(xi) Sign a Service Agreement; and (xii) If the Worker will be transporting the child as specified in the Service Agreement, a valid driver’s license and proof of insurance must also be provided.

3. Disqualification from Serving as a Consumer-Directed Worker. A child’s parent or legal guardian cannot waive the completion of a background check for a potential Worker. A background check may reveal a potential Worker’s past criminal conduct that may pose an unacceptable risk to the child. Any of the following findings may place the child at risk and may disqualify a person from serving as a Worker:

(i) Conviction of an offense involving physical, sexual or emotional abuse, neglect, financial exploitation or misuse of funds, misappropriation of property, theft from any person, violence against any person, or manufacture, sale, possession or distribution of any drug; and/or (ii) Entering of a plea of nolo contendere or when a jury verdict of guilty is rendered but adjudication of guilt is withheld with respect to a crime reasonably related to the nature of the position sought or held.

4. Individualized Assessment of a Consumer-Directed Worker with a Criminal Background.

(i) If a potential Worker’s background check includes past criminal conduct, the child’s parent or legal guardian or Representative for CD must review the past criminal conduct with the help of the FEA. The child’s parent or legal guardian or Representative for CD, with the assistance of the FEA, will consider the following factors:

(I) Whether or not the evidence gathered during the potential Worker’s individualized assessment shows the criminal conduct is related to the job in such a way that could place the child at risk;

(II) The nature and gravity of the offense or conduct, such as whether the offense is related to physical or sexual or emotional abuse of another person, if the offense involves violence against another person, or the manufacture, sale, or distribution of drugs; and (III) The time that has passed since the offense or conduct and/or completion of the sentence.

(ii) After considering the above factors and any other evidence submitted by the potential Worker, the child’s parent or legal guardian or Representative for CD must decide whether to hire the potential Worker.

(iii) If a child’s parent or legal guardian or Representative for CD decides to hire the Worker, the FEA shall assist the child’s parent or legal guardian or Representative for CD in notifying the child’s MCO or DIDD of this decision and shall collaborate with the child’s MCO or DIDD to amend the child’s PCSP/ISP to reflect the parent’s or legal guardian’s or CD Representative’s decision to voluntarily assume the risk associated with hiring an individual with a criminal history and that the child’s parent or legal guardian or Representative for CD is solely responsible for any negative consequences stemming from that decision. The FEA shall also collaborate with the child’s MCO or DIDD, as applicable, on a risk mitigation strategy.

5. Service Agreement.

(i) The child’s parent or legal guardian or Representative for CD shall develop a Service Agreement with each Worker which includes, at a minimum:

(I) The roles and responsibilities of the Worker and the Employer of Record;

(II) The Worker’s typical schedule, as developed by the parent or legal guardian or Representative for CD, including hours and days;

(III) The scope of each service, i.e., the specific tasks and functions the Worker is to perform;

(IV) The service rate; and (V) The requested start date for services.

(ii) The Service Agreement must be in place for each Worker prior to the Worker providing services.

6. Payments to Consumer-Directed Workers.

(i) Rates. The parent or legal guardian of children participating in CD have the flexibility to set wages for the child’s Workers from a range of reimbursement levels established by TennCare.

(ii) Payments to Consumer-Directed Workers. In order to receive payment for services rendered, all Workers must:

(I) Deliver services in accordance with the services specified in the child’s PCSP or DIDD-approved ISP, the monthly or annual budget as approved in the MCO’s or DIDD’s service authorization, and in accordance with the schedule set by the child’s parent or legal guardian or the Representative for CD and Worker assignments determined by the parent or legal guardian or the Representative for CD.

(II) Use the FEA time keeping system to record in and out times for each visit in a manner compliant with the 21st Century Cures Act.

(III) Provide detailed documentation of service delivery including but not limited to the specific tasks and functions performed for the child at each visit, which shall be maintained in the child’s home.

(IV) Provide no more than forty (40) hours of services within a consecutive seven (7) day period, unless explicitly directed by the Employer of Record who by such direction, agrees to pay the worker over-time pay out of the child’s budget in accordance with the Fair Labor Standards Act. This shall reduce the amount of services that may be purchased for the child during that month.

(iii) Termination of Consumer-Directed Workers’ Employment.

(I) The Employer of Record may terminate a Worker’s employment at any time.

(II) The MCO or DIDD may not terminate a Worker’s employment, but may request that a child be involuntarily withdrawn from CD if it is determined that the health, safety and welfare of the child may be in jeopardy if the child’s parent or legal guardian or the Representative for CD continues to employ a Worker but the Employer of Record does not want to terminate the Worker.

(j) Withdrawal from Participation in Consumer Direction (CD).

1. General.

(i) Voluntary Withdrawal from CD. The parent or legal guardian of a child participating in CD may voluntarily withdraw the child from participation in CD at any time. The request must be in writing. Whenever possible, notice of the parent’s or legal guardian’s decision to withdraw the child from participation in CD should be provided in advance to permit time to arrange for delivery of services through Contracted Providers.

(ii) Voluntary or involuntary withdrawal of a child from CD of Eligible Katie Beckett HCBS shall not affect the child’s eligibility for Katie Beckett HCBS or enrollment in Katie Beckett Group Part A or Medicaid Diversion Group

Part B, provided the child continues to meet all requirements for enrollment in Katie Beckett as defined in this Chapter.

(iii) If a child is voluntarily or involuntarily withdrawn from CD, any Eligible Katie Beckett HCBS he receives shall be provided through Contract Providers, subject to the requirements in this Chapter.

2. Involuntary Withdrawal.

(i) A child may be involuntarily withdrawn from participation in CD of HCBS for any of the following reasons:

(I) The child is no longer enrolled in TennCare.

(II) The child is no longer enrolled in Katie Beckett Group Part A or Medicaid Diversion Group Part B.

(III) The child no longer needs any of the Eligible Katie Beckett HCBS, as specified in the PCSP or DIDD-approved ISP.

(IV) The child’s parent or legal guardian is no longer willing or able to serve as the Employer of Record for the child’s Consumer-Directed Workers and to fulfill all of the required responsibilities for CD, and does not meet limited exceptional circumstances or have a qualified Representative who is willing and able to serve as the Employer of Record and to fulfill all of the required responsibilities for CD.

(V) The child’s parent or legal guardian is unwilling to work with the MCO Nurse Care Manager or DIDD Case Manager to identify and address any additional risks associated with the decision to participate in CD, or the risks associated with the decision to participate in CD pose too great a threat to the child’s health, safety and welfare.

(VI) The health, safety and welfare of the child may be in jeopardy if the child’s parent or legal guardian or the Representative for CD continues to employ a Worker but the child’s parent or legal guardian or the Representative for CD does not want to terminate the Worker.

(VII) The child does not have an adequate Back-up Plan for CD.

(VIII) The child’s needs cannot be safely and appropriately met in the community while participating in CD.

(IX) The child’s parent or legal guardian or the Representative for CD, or Consumer-Directed Workers he wants to employ are unwilling to use the services of TennCare’s contracted FEA to perform required Financial Administration and Supports Brokerage functions.

(X) The child’s parent or legal guardian or the Representative for CD is unwilling to abide by the requirements of the Katie Beckett CD program.

(XI) If the Representative for CD fails to perform in accordance with the terms of the Representative Agreement and the health, safety and welfare of the child is at risk, and the child’s parent or legal guardian wants to continue to use the Representative.

(XII) A Support Coordinator has determined that the health, safety and welfare of the child may be in jeopardy if the child’s parent or legal guardian or the Representative for CD continues to employ a Worker but the Employer of Record does not want to terminate the Worker.

(XIII) Other significant concerns regarding the child’s participation in CD which jeopardize the health, safety or welfare of the child.

(ii) TennCare must review and approve all MCO requests for involuntary withdrawal from CD of eligible Katie Beckett HCBS before such action may occur. If TennCare approves the request, written notice shall be given to the child and parent or legal guardian at least ten (10) days in advance of the withdrawal. The date of withdrawal may be delayed when necessary to allow adequate time to transition the child to Contract Provider services as seamlessly as possible.

(iii) The child and parent or legal guardian shall have the right to appeal involuntary withdrawal from CD.

(iv) If a child is no longer enrolled in TennCare or in Katie Beckett Group Part A or Medicaid Diversion Group Part B, participation in CD shall be terminated.

(10) Appeals.

(a) Appeals related to determinations of financial eligibility for TennCare Medicaid (including financial eligibility via the Katie Beckett program) are processed by TennCare, in accordance with Chapter 1200-13-19.

(b) Appeals related to the denial, reduction, suspension, or termination of a covered service are processed by TennCare in accordance with Rule 1200-13-13-.11 provided however that medical necessity for Katie Beckett Group Part A and Medicaid Diversion Group Part B HCBS shall be determined as provided in Paragraph (7). A child’s parent or legal guardian may request a fair hearing regarding any covered benefit not approved in the PCSP or DIDD-approved ISP that he believes the child needs.

(c) Appeals related to determinations of medical (or level of care) eligibility are processed by TennCare’s Division of Long-Term Services and Supports in accordance with Rule .11.

(d) Appeals related to a child’s enrollment or disenrollment of an individual in Katie Beckett or to denial or involuntary withdrawal from participation in CD are processed by the TennCare Division of Long-Term Services and Supports in accordance with the following procedures:

1. If enrollment into Katie Beckett or if participation in CD is denied, notice containing an explanation of the reason for such denial shall be provided. The notice shall include the person’s right to request a fair hearing within thirty (30) days from receipt of the written notice regarding valid factual disputes pertaining to the enrollment denial decision.

2. If a Member is involuntarily disenrolled from Katie Beckett, or if participation in CD is involuntarily withdrawn, advance notice of involuntary disenrollment or withdrawal shall be issued. The notice shall include a statement of the Member’s right to request a fair hearing within thirty (30) days from receipt of the written notice regarding valid factual disputes pertaining to the decision.

3. Appeals regarding denial of enrollment into Katie Beckett, involuntary disenrollment from Katie Beckett, or denial or involuntary withdrawal from participation in CD must be filed in writing with the TennCare Division of Long- Term Services and Supports within thirty-five (35) days of issuance of the written notice if the appeal is filed with TennCare by fax, and within forty (40) days of issuance of the written notice if the appeal is mailed to TennCare. This allows five (5) days mail time for receipt of the written notice and when applicable, five (5) days mail time for receipt of the written appeal.

4. In the case of involuntary disenrollment from Katie Beckett only, if the appeal is received prior to the date of action, continuation of Katie Beckett benefits shall be provided, pending resolution of the disenrollment appeal.

5. In the case of involuntary withdrawal from participation in CD, if the appeal is received prior to the date of action, continuation of participation in CD shall be provided, unless such continuation would pose a serious risk to the child’s health, safety and welfare, in which case, services specified in the PCSP or DIDD-approved ISP shall be made available through Contract Providers pending resolution of the appeal.

(e) A member may present all relevant and material evidence pertaining to the adverse action.

History

• Authority: T.C.A. §§ 4-5-208, 71-5-105, 71-5-106, 71-5-109, 71-5-110, 71-5-111, 71-5-112, and 71-5- 164 and TennCare II/III Section 1115(a) Medicaid Demonstration Waiver Extension.
• Administrative History: Emergency rules filed November 20, 2020; effective through May 19, 2021. Amendments filed February 17, 2021; effective May 18, 2021.

Tenn. Comp. R. & Regs. 1200-13-13-.11 and 1200-13-14-.11.

(iv) Denial of enrollment and/or involuntary disenrollment because a person’s Expenditure Cap will be exceeded shall constitute an eligibility/enrollment action, and shall give rise to notice of action and due process rights to request a fair hearing in accordance with this rule.

(5) Disenrollment from ECF CHOICES. A Member may be disenrolled from ECF CHOICES voluntarily or involuntarily.

(a) Voluntary disenrollment from ECF CHOICES means the Member has chosen to disenroll, and no notice of action shall be issued regarding a Member’s decision to voluntarily disenroll from ECF CHOICES. However, notice shall be provided regarding any subsequent adverse action that may occur as a result of the Member’s decision, including any change in benefits, cost-sharing responsibility, or continued eligibility for TennCare when the Member’s eligibility was conditioned on receipt of LTSS. Voluntary disenrollment shall proceed only upon:

1. Election by the Member to receive institutional services (e.g., NF or ICF/IID services), including hospice services in a NF, which is not a LTSS, provided however, that a Member shall not be disenrolled from ECF CHOICES in order to receive Short-Term NF care as defined in 1200-13-01-.02;

2. Election by the Member to enroll in an MCO that does not administer the ECF CHOICES program (i.e., United Healthcare Community Plan until such time as specified by TennCare or TennCare Select, including Select Community); or 3. Receipt of a statement signed by the Member or his authorized Representative voluntarily requesting disenrollment.

(b) A Member may be involuntarily disenrolled from ECF CHOICES only by the Bureau, although such process may be initiated by a Member’s MCO. Reasons for involuntary disenrollment include but are not limited to:

1. The Member no longer meets one or more criteria for eligibility and/or enrollment as specified in this Rule.

2. The Member’s needs can no longer be safely met in the community. This may include but is not limited to the following instances:

(i) The home or home environment of the Member becomes unsafe to the extent that it would reasonably be expected that HCBS could not be provided without significant risk of harm or injury to the Member or to individuals who provide covered services to the Member.

(ii) The Member or his representative/conservator or caregiver refuses to abide by the PCSP.

(iii) Even though an adequate provider network is in place, there are no providers who are willing to provide necessary services to the Member.

(iv) The Member’s decision to continue receiving services in the home or community poses an unacceptable level of risk.

3. The Member’s needs can no longer be safely met in the community at a cost that does not exceed the Member’s Expenditure Cap as described in this Rule.

4. The Member no longer needs or is no longer receiving LTSS.

5. The Member has refused to pay his or her Patient Liability. The MCO and/or its participating providers are unwilling to serve the Member in ECF CHOICES because he has not paid his or her Patient Liability, and/or no other MCO is willing to serve the Member in ECF CHOICES.

(6) Transitioning To and From ECF CHOICES.

(a) Transition from CHOICES Group 1 to ECF CHOICES.

1. A member may request to transition from CHOICES Group 1 to ECF CHOICES at any time. The member’s MCO is responsible for assessing the member’s services and supports needs in the community, developing and implementing a transition plan, as appropriate, and submitting the transition request to TennCare. Only an MCO may submit to TennCare a request to transition a Member from CHOICES Group 1 to ECF CHOICES. An MCO may request to transition a Member from CHOICES Group 1 to ECF CHOICES only when the Member chooses to transition from the NF to an HCBS setting and meets eligibility criteria to enroll in that group, as specified in Rule 1200-13-01-.31(3).

Members shall not be required to transition from CHOICES Group 1 to ECF CHOICES.

2. A Member that has already been discharged from the NF shall not be transitioned to ECF CHOICES. Once a Member has discharged from the NF, the Member has voluntarily disenrolled from CHOICES Group 1 and must be newly enrolled into ECF CHOICES, in accordance with these rules. A new PAE shall be required for enrollment into ECF CHOICES.

3. When Members move from CHOICES Group 1 to ECF CHOICES, TennCare must recalculate the Member’s Patient Liability based on the Community PNA.

(b) Transition from ECF CHOICES to CHOICES Group 1.

1. An MCO may request to transition a Member from ECF CHOICES to CHOICES Group 1 only under the following circumstances:

(i) The MCO provides advance notification to TennCare, which shall include documentation of thoroughly exploring and exhausting all attempts to provide services in a more integrated community setting.

(ii) The member must meet the nursing facility level of care in place at the time of admission and make an informed choice to transition to a nursing facility and enroll in CHOICES Group 1. Informed choice requires thorough exploration and exhaustion of all integrated community setting options.

(iii) A PASRR shall be completed prior to admission, the member must be determined appropriate for placement in a nursing facility, and all identified specialized services must be coordinated by the MCO immediately upon admission.

2. When Members transition from ECF CHOICES to CHOICES Group 1, TennCare must recalculate the Member’s Patient Liability based on the Institutional PNA.

3. At such time as a transition between ECF CHOICES and CHOICES Group 1 is made, the MCO shall issue notice of transition to the Member. Because the Member has elected the transition, such transition shall not constitute an adverse action. Thus, the notice will not include the right to appeal or request a fair hearing regarding the Member’s decision.

(c) Individuals enrolled in a Section 1915(c) Waiver shall not be permitted to transition into ECF CHOICES, even if they meet applicable eligibility and enrollment criteria for ECF CHOICES, until such time that the State determines that such transitions can be permitted and in accordance with timeframes and procedures established by TennCare.

(d) Individuals enrolled in CHOICES Group 2 or 3 shall not be permitted to transition into ECF CHOICES, even if they meet applicable eligibility and enrollment criteria for ECF CHOICES, unless the State determines that the individual qualifies for ECF CHOICES, the individual’s needs can be more appropriately met in ECF CHOICES, and in accordance with timeframes and procedures established by TennCare.

(7) Benefits in the TennCare ECF CHOICES Program.

(a) Members of ECF CHOICES receive HCBS as specified in an approved Initial Support Plan or PCSP, as applicable, in addition to medically necessary covered benefits available for TennCare Medicaid and TennCare Standard recipients, as specified in Rules 1200-13-13-.04 and 1200-13-14-.04. While receiving ECF CHOICES HCBS, Members are not eligible for NF care, except for Short-Term NF care, as described in this Chapter.

(b) Members are not eligible to receive any other HCBS during the time that Short-Term NF services are provided. ECF CHOICES HCBS such as Minor Home Modifications which are required to facilitate transition from the NF back to the home or community may be provided during the NF stay and billed with date of service being on or after discharge from the NF.

(c) All ECF CHOICES HCBS must be authorized by the MCO in order for MCO payment to be made for the services. ECF CHOICES HCBS must be specified in an approved Initial Support Plan or PCSP, as applicable, and authorized by the MCO prior to delivery of the service in order for MCO payment to be made for the service.

(d) ECF CHOICES HCBS covered under the ECF CHOICES Program and applicable limits are specified below. The benefit limits are applied across all services received by the Member regardless of whether the services are received through CD and/or a traditional provider agency. Corresponding limitations regarding the scope of each service are defined in Rule 1200-13-01-.02 and in Subparagraphs (a) through (c) above.

(e) Community Based Residential Alternatives (CBRAs). CBRAs in the ECF CHOICES program, including CLS and CLS-FM, are subject to the same requirements as CBRAs in the CHOICES program. See Rule .05(8)(p) for requirements applicable to CBRAs in CHOICES and ECF CHOICES.

Service Benefits for ECF CHOICES Members Benefits for Consumer Direction (“Eligible ECF CHOICES HCBS”)

1. Adult Dental Services Covered for adults age 21 and older in accordance with limitations specified in

Rule 1200-13-01-.02.

Orthodontic services are excluded from coverage.

Limited to a maximum of five thousand dollars ($5,000) per person per calendar year, and a maximum of seven thousand five hundred dollars ($7,500) per person across three (3) consecutive calendar years.

Adult Dental Services that are received on or after January 1, 2023, shall apply to the maximum amount allowable under this rule only if the service is not covered as part of the Dental Services benefit outlined in 1200-13-13-.04 and

Tenn. Comp. R. & Regs. 1200-13-01-.32 TENNCARE KATIE BECKETT PROGRAM

(1) Definitions. See Rule .02.

(2) Program components. The TennCare Katie Beckett Program offers services and supports to children under age 18 with disabilities and/or complex medical needs who are not Medicaid eligible because of their parents’ income or assets. The program has two primary components:

(a) Katie Beckett Group Part A is a “traditional” Katie Beckett model, providing full Medicaid eligibility by waiving the deeming of the parents’ income and assets to the child, as well as wraparound HCBS to children with the most significant disabilities or complex medical needs who meet institutional level of care, and for whom the estimated amount that would be expended by the Medicaid program for care outside an institution is not greater than the estimated amount that would otherwise be expended by the Medicaid program to provide the child’s care within an appropriate institution. The program is designed to supplement a child’s primary insurance coverage in order to help fill gaps between the child’s needs and what private insurance will cover, including essential wraparound services not typically covered by insurers, including Medicaid. Children in Katie Beckett Group Part A are enrolled in a special component of TennCare Select called Select Community, developed specifically for people with I/DD. TennCare Select is responsible for coordinating all medically necessary, covered physical and behavioral health services, including EPSDT benefits, and wraparound HCBS for children who qualify for and are enrolled in Katie Beckett Group Part A.

(b) Medicaid Diversion Group Part B is a Medicaid diversion program, offering a capped package of essential wraparound services and supports, as well as premium assistance on a sliding fee scale to a broader group of children with disabilities, including those “at risk” of institutionalization. These children do not qualify for Medicaid state plan benefits and are not assigned to a TennCare MCO. DIDD is responsible for coordinating all covered wraparound services and supports for children who qualify for and are enrolled in Medicaid Diversion Group Part B.

(c) In addition to the two primary components of the Katie Beckett program, a demonstration population category, called the Continued Eligibility Group Part C, provides continuity of coverage, benefits, and providers, by allowing a child to continue receiving TennCare state plan services upon being determined to no longer qualify for Medicaid in any other eligibility category if the child meets the Katie Beckett Group Part A group eligibility criteria, but a slot is not available for the child at the time Medicaid financial eligibility would otherwise end. The child may only remain in this Group until a slot is available in Katie Beckett Group Part A. For a child who qualifies for and is enrolled in the Continued Eligibility group Part C, the child’s MCO is responsible for coordinating all covered physical and behavioral health services, including EPSDT benefits.

(3) Eligibility for Katie Beckett. There are three (3) groups in the Katie Beckett Program:

(a) Katie Beckett Group Part A, a “traditional” Katie Beckett program. To be eligible for Katie Beckett Group Part A, an Applicant must meet all of the following criteria:

1. Must be under age 18;

2. Have medical needs that are likely to last at least 12 months or result in death and which result in severe functional limitations;

3. Qualify for the level of care provided in a medical institution according to criteria established by TennCare for children, as described in Rule .11;

4. A licensed physician must agree and certify that in-home care will meet the child’s needs;

5. Would qualify for SSI on the basis of the child’s disability, except for the parents’ income and/or assets;

6. Is not otherwise Medicaid eligible or receiving LTSS in another Medicaid program;

7. Qualify financially in the Katie Beckett Group Part A demonstration population category;

8. The estimated amount that would be expended by the Medicaid program for the child’s care outside an institution is not greater than the estimated amount that would otherwise be expended by the Medicaid program for the child’s care within an appropriate institution, as described in Paragraph (4)(d);

9. Purchase and maintain minimum essential coverage private or employersponsored insurance; however, TennCare may choose to offer Assistance with Premium Payments for such coverage if the child requests and qualifies for a hardship exception;

10. Pay premiums as described in Rule Chapter 1200-13-20, if family income is above 150% FPL; and 11. Have the most significant disabilities and/or complex medical needs and be prioritized for enrollment into an available slot in Katie Beckett Group Part A in accordance with prioritization criteria described in Paragraph (4)(c).

(b) Medicaid Diversion Group Part B, a Medicaid Diversion program. To be eligible for enrollment in Medicaid Diversion Group Part B, Applicants must meet the following criteria:

1. Must be under age 18;

2. Have medical needs that are likely to last at least 12 months or result in death and which result in severe, functional limitations;

3. Qualify for the level of care provided in a medical institution or be at risk of institutionalization, according to criteria established by TennCare for children, as described in Rule .11;

4. Not otherwise Medicaid eligible or receiving LTSS in another Medicaid program;

5. Qualify financially in the Medicaid Diversion Group Part B demonstration population category;

6. Not eligible for Katie Beckett Group Part A or not enrolled in Katie Beckett Group

Part A due to program enrollment targets; and 7. Next in line for enrollment into an available slot in Medicaid Diversion Group Part B based on date of referral or once a Medicaid Diversion Group Part B waiting list is established, the date of placement on the Medicaid Diversion Group Part B waiting list.

(c) Continued Eligibility Group Part C. To be eligible for enrollment in the Continued Eligibility Group Part C, Applicants must meet the following criteria:

1. All of the criteria specified in (3)(a)1.–8. above;

2. Enrolled in Medicaid, but determined by TennCare to no longer qualify in any other Medicaid category; and 3. Cannot be enrolled into Katie Beckett Group Part A, because there is not a Katie Beckett Group Part A program slot available based on program funding or the state’s prioritization criteria. Once a Katie Beckett Group Part A slot is available for which the child is prioritized for enrollment, the child must transition to Katie Beckett Group Part A or be disenrolled from Medicaid unless eligible in another open Medicaid category, and shall no longer qualify in the Continued Eligibility Group Part C.

(d) Level of Care (LOC). All Enrollees in Katie Beckett must meet the applicable LOC criteria, as determined by Rule .11.

(4) Enrollment in Katie Beckett. Enrollment into the Katie Beckett Program shall be processed by TennCare as follows:

(a) Enrollment Targets. There shall be separate Enrollment Targets for Katie Beckett Group Part A and Medicaid Diversion Group Part B. The Enrollment Target for each

Part shall function as a cap on the total number of children who can be enrolled into that Part at any given time.

1. TennCare shall set the Enrollment Target for each Part (Katie Beckett Group Part A and Medicaid Diversion Group Part B) based on the funding appropriated for the Katie Beckett program. The Enrollment Target for each Part shall be limited as necessary to ensure that program spending does not exceed the funding appropriated for the program.

2. TennCare shall post the Enrollment Target for each Part publicly on the TennCare website. DIDD shall also post the Enrollment Target for each Part publicly on the DIDD website.

3. There shall be no Enrollment Target for the Continued Eligibility Group Part C.

4. In order to enroll in Katie Beckett Group Part A or Medicaid Diversion Group Part B, there must be capacity within the established Enrollment Target to enroll the Applicant in accordance with this Rule which may include satisfaction of criteria for Reserve Capacity.

5. Once the Enrollment Target, including Reserve Capacity as described in this

Rule, is reached for a particular Katie Beckett Part, Applicants shall not be enrolled into that Part or qualify in the Katie Beckett Group Part A demonstration population or the Medicaid Diversion Group Part B demonstration population, until such time that capacity within the Enrollment Target is available, and the person is prioritized for enrollment into an available slot, as described in Subparagraph (c).

(i) There are no exceptions to this Rule.

(ii) If an Applicant is not permitted to proceed with enrollment into Katie Beckett Group Part A or Medicaid Diversion Group Part B because the applicable Enrollment Target has been reached, the Applicant shall remain on the Waiting List for the applicable Katie Beckett Part(s).

(b) Reserve Capacity.

1. At program implementation, TennCare shall reserve all available slots within the Katie Beckett Group Part A Enrollment Target. These slots will be available only to children who have a level of care prioritization criteria of one (1) through four (4), as described below in Subparagraph (c). The purpose of these reserve capacity slots shall be to ensure that children with the most significant medical needs and disabilities are enrolled into Katie Beckett Group Part A.

2. Only Applicants who meet specified reserve capacity criteria may be enrolled into reserve capacity slots.

3. Once all reserve capacity slots set aside have been filled, persons who meet such criteria shall not proceed with the enrollment process, but shall remain on the Waiting List for Katie Beckett Group Part A.

4. If an Applicant determined to meet medical eligibility for Katie Beckett Group Part A does not meet criteria for a Reserve Capacity slot, the Applicant shall not proceed with the enrollment process, but shall remain on the Waiting List for Katie Beckett Group Part A.

(c) Prioritization.

1. Katie Beckett Group Part A (i) Each child who meets any institutional level of care for enrollment into Katie Beckett Group Part A shall be prioritized for an available slot.

(ii) Each child shall have two (2) prioritization scores.

(I) Level of Care Prioritization.

I. The first prioritization score shall be based solely on the child’s level of care eligibility, as follows:

A. A LOC prioritization score of one (1) shall be assigned to any child who meets Tier 1 – Medical Institutional LOC and requires ventilator care or non-invasive positive pressure ventilation for at least eight (8) hours per day as a life-sustaining measure for chronic respiratory failure.

B. A LOC prioritization score of two (2) shall be assigned to a child who meets Tier 1 – Medical Institutional LOC based on other complex skilled medical interventions.

C. A LOC prioritization score of three (3) shall be assigned to a child who meets Tier 1 – Behavioral Institutional LOC based on both self-injurious behaviors and physically aggressive behavior toward others.

D. A LOC prioritization score of four (4) shall be assigned to a child who meets Tier 1 – Behavioral Institutional LOC based on either self-injurious behaviors or physically aggressive behavior toward others.

E. A LOC prioritization score of five (5) shall be assigned to a child who meets Tier 2 Institutional LOC - Standard 1:

Medical.

F. A LOC prioritization score of six (6) shall be assigned to a child who meets Tier 2 Institutional LOC - Standard 2:

Behavioral.

G. A LOC prioritization score of seven (7) shall be assigned to a child who meets Tier 2 Institutional LOC - Standard 3: Functional.

II. Children will be enrolled into an available Katie Beckett Group

Part A program slot in numerical order in accordance with their LOC prioritization score. (For example, a child with a LOC prioritization score of 1 would be enrolled first; then a child with a LOC prioritization score of 2, then 3, etc.)

(II) Other Prioritization Criteria.

I. The second prioritization score shall be based solely on other prioritization criteria, as follows:

A. Prognosis of the child’s medical condition;

B. Intensive interventions;

C. Transportation and primary/specialty care needs;

D. Non-febrile seizures;

E. Nutrition/feeding;

F. Medications;

G. Caregiving; and H. Additional caregiver burden.

II. Items considered within each domain, the value of the items, and the maximum scores and weightings of each domain shall be determined with input from a Technical Advisory Group comprised of clinical experts in treating children with complex medical needs and disabilities, parents of children with complex medical needs and disabilities; and advocacy representatives.

III. Each child determined eligible for Katie Beckett Group Part A shall have an other prioritization score between 0 and 100.

IV. The other prioritization score shall be taken into account only when two or more children have the same LOC prioritization score, it is the highest LOC prioritization score for an available program slot, and there are insufficient slots available to enroll all children with that LOC prioritization score. In that case, enrollment shall be based on the other prioritization criteria score for each child. The child with the highest other prioritization score would be enrolled first.

(III) In the event that two or more children have the same LOC prioritization scores, it is the highest LOC prioritization score for an available program slot, there are insufficient slots available to enroll all children with that LOC prioritization score, and two or more of the children also have the same other prioritization score, enrollment shall proceed in order based on the date each child was placed on the Katie Beckett Group Part A Waiting List.

2. Prioritization for Medicaid Diversion Group Part B shall be on a first come, first serve basis.

3. An Applicant or the Applicant’s legal representative may request an administrative review of the Katie Beckett Group Part A prioritization score(s) at any time. This request shall be submitted to TennCare in writing.

4. An Applicant may submit additional information that may affect the Katie Beckett Group Part A prioritization score(s) to DIDD at any time.

5. An Applicant shall not be granted a fair hearing regarding his or her prioritization score(s).

6. An Applicant shall be entitled to a determination regarding his or her eligibility to enroll in the Katie Beckett program. If the application is denied, the Applicant is entitled to due process, including notice and the right to request a fair hearing, only when the Applicant is determined to meet prioritization criteria for an available program slot and will be enrolled into the program if all applicable eligibility and enrollment criteria are met.

(d) Comparable Cost of Institutional Care.

1. To qualify for enrollment in Katie Beckett Group Part A or in the Continued Eligibility Group Part C, the estimated amount that would be expended by the Medicaid program for the child’s care outside an institution cannot be greater than the estimated amount that would otherwise be expended by the Medicaid program for the child’s care within an appropriate institution. This shall be called the “Comparable Cost of Institutional Care Requirement.”

2. The appropriate institution depends on the institutional level of care the child would otherwise qualify to receive, as determined by LOC eligibility criteria in

Rule .11. For a child who meets either Tier 1 – Medical Institutional LOC or Tier 1 – Behavioral Institutional LOC, the appropriate institution shall be based on the level of care the child is at imminent risk of needing if medical assistance is not provided in the child’s home.

(i) For a child determined to meet Tier 1 – Medical Institutional LOC, the comparable cost of institutional care shall be based on the average cost of pediatric inpatient medical hospitalization as determined by TennCare. The

basis of such cost shall be for non-critical care (i.e., outside the intensive care unit).

(ii) For a child determined to meet Tier 1 – Behavioral Institutional LOC, the comparable cost of institutional care shall be based on the average cost of pediatric inpatient psychiatric hospitalization as determined by TennCare.

(iii) For a child determined to meet Tier 2 – Institutional LOC, the comparable cost of institutional care shall be based on the average cost of services in a private Intermediate Care Facility for Individuals with Intellectual Disabilities, as determined by TennCare.

(iv) The comparable cost of institutional care for each applicable type of medical institution specified above may be adjusted annually as determined by TennCare.

3. Application of the Comparable Cost of Institutional Care Requirement.

(i) As part of the LOC eligibility determination process, TennCare or its third party contractor shall gather information regarding the Medicaid services expected to be needed upon enrollment in Katie Beckett. This may include but is not limited to review of medical records, recommendations of the child’s treating physician, or information provided by the child’s parent or legal guardian.

(ii) For children enrolled in Medicaid but determined to no longer qualify in any other open Medicaid category that are seeking enrollment in Katie Beckett Group Part A or the Continued Eligibility Group Part C, actual Medicaid utilization and expenditures shall be considered in estimating the cost of providing care in the home and community.

(iii) In order to qualify for enrollment in Katie Beckett Group Part A or the Continued Eligibility Group Part C, the child’s parent or legal guardian must sign a form confirming understanding of the Comparable Cost of Institutional Care Requirement and acknowledging that the child’s eligibility for initial and continued enrollment in Katie Beckett Group Part A or the Continued Eligibility Group Part C is dependent on the child meeting and continuing to meet the Comparable Cost of Institutional Care Requirement as described in this rule.

(iv) If the actual cost of a child’s Medicaid services exceeds the comparable cost of institutional care (prior to or during enrollment in the Katie Beckett Program), TennCare may reasonably expect that the estimated cost of services Medicaid would provide is greater than the comparable cost of institutional care, unless the child’s needs have changed significantly such that the same level of services will no longer be required going forward.

(v) The estimated cost of Medicaid services outside an institution shall include at least the following:

(I) The estimated cost of pediatric home health or private duty nursing services that would be provided by TennCare;

(II) The estimated cost of physical, occupational, speech, language and hearing services that would be provided by TennCare;

(III) The estimated cost of community-based behavioral health services that would be provided by TennCare (i.e., all non-hospital services, including community-based residential treatment, when applicable);

(IV) The estimated cost of durable medical equipment;

(V) For children who will be enrolled in Katie Beckett Group Part A only, the estimated cost of any wraparound HCBS the child will receive.

(vi) Services for a child enrolled in Katie Beckett Group Part A or the Continued Eligibility Group Part C shall not be denied on the basis that the comparable cost of institutional care would be exceeded.

(vii) TennCare shall take action as appropriate to deny enrollment or to disenroll a child who no longer qualifies for enrollment in Katie Beckett Group Part A or the Continued Eligibility Group Part C because the Comparable Cost of Institutional Care Requirement is not met.

(viii) The Comparable Cost of Institutional Care Requirement shall be applied on a calendar year basis. For children enrolled in Katie Beckett Group Part A and the Continued Eligibility Group Part C, TennCare and the child’s MCO shall estimate and track actual cost of services as provided in

subpart (v) across each calendar year.

(ix) The Comparable Cost of Institutional Care Requirement shall also be applied prospectively on a twelve (12) month basis. This is to ensure that a child’s PCSP does not establish a threshold level of supports that cannot be sustained over the course of time. This means that, for purposes of person and family-centered support planning, the child’s MCO will always estimate the actual cost of services forward for twelve (12) months in order to determine whether the Comparable Cost of Institutional Care Requirement will continue to be met based on the most current PCSP that has been developed. The cost of one-time services such as short-term services or short-term increases in services must be counted as part of the total cost of services for a full twelve (12) month period following the date of service delivery.

(x) If it can be reasonably anticipated, based on the services actually received or determined to be needed that the cost of Medicaid services in the community will exceed the comparable cost of Medicaid services in the appropriate institution, the child does not qualify to enroll in or to remain enrolled in Katie Beckett Group Part A or the Continued Eligibility Group

Part C.

(xi) As the setting of a child’s Comparable Cost of Institutional Care does not, in and of itself, result in any increase or decrease in a child’s services, it is not considered an adverse action or give rise to appeal rights unless it will result in an adverse enrollment action.

(xii) Denial of enrollment and/or involuntary disenrollment because a child’s comparable cost of institutional care will be exceeded shall constitute an eligibility/enrollment action, and shall give rise to notice of action and due process rights to request a fair hearing in accordance with this rule.

(5) Disenrollment from Katie Beckett. A Member may be disenrolled from Katie Beckett voluntarily or involuntarily.

(a) Voluntary disenrollment from Katie Beckett means the child’s parent or legal guardian has chosen to disenroll the child from the program, including all applicable benefits the child is receiving (see Paragraph (6)). Voluntary disenrollment from Katie Beckett Group Part A or the Continued Eligibility Group Part C includes voluntary disenrollment from Medicaid. No notice of action shall be issued regarding a parent or legal guardian’s decision to voluntarily disenroll the child from Katie Beckett. Voluntary disenrollment shall proceed only upon one of the following:

1. Receipt of a statement signed by the child’s parent or legal guardian voluntarily requesting disenrollment;

2. The child’s admission to a medical institution for a period of at least thirty (30) days unless the child is reasonably expected to discharge home soon, and upon determination of Medicaid eligibility in another category; or 3. Election by the parent or legal guardian to enroll a child in Katie Beckett Group

Part A in an MCO that does not administer Part A of the Katie Beckett program (i.e., any MCO other than TennCare Select).

(b) A child may be involuntarily disenrolled from Katie Beckett only by TennCare, although such process may be initiated by DIDD or TennCare’s Contracted MCO. Reasons for involuntary disenrollment include but are not limited to:

1. The child no longer meets one or more criteria for eligibility and/or enrollment as specified in this Rule.

2. The child is deceased.

3. The child is no longer a resident of Tennessee.

(6) Benefits in the Katie Beckett Program.

(a) Katie Beckett Group Part A 1. Children enrolled in Katie Beckett Group Part A are eligible to receive all medically necessary covered benefits available for children enrolled in TennCare Medicaid, as specified in Rule 1200-13-13-.04, including EPSDT, and medically necessary covered wraparound HCBS as specified below.

2. All Katie Beckett Group Part A HCBS must be specified in an approved Person- Centered Support Plan and authorized by the MCO prior to delivery of the service in order for MCO payment to be made for the service.

3. Katie Beckett Group Part A HCBS shall be limited to a maximum of $15,000 per child per calendar year. There are no exceptions to this limit.

(b) Medicaid Diversion Group Part B 1. Children enrolled in Medicaid Diversion Group Part B are not eligible to receive Medicaid State Plan services or EPSDT.

2. Children enrolled in Medicaid Diversion Group Part B are eligible to receive a capped package of HCBS only, as specified below.

3. Medicaid Diversion Group Part B HCBS shall be limited to a maximum of $10,000 per child per calendar year. There are no exceptions to this limit.

4. All Medicaid Diversion Group Part B HCBS must be specified in an approved ISP and authorized by DIDD prior to delivery of the service in order for payment to be made for the service.

(c) Continued Eligibility Group Part C 1. Children enrolled in the Continued Eligibility Group Part C are eligible to receive all medically necessary covered benefits available for children enrolled in TennCare Medicaid, as specified in Rule 1200-13-13-.04, including EPSDT.

2. Children enrolled in the Continued Eligibility Group Part C are not eligible to receive any wraparound HCBS.

(d) Katie Beckett Group Part A (“Part A”) wraparound HCBS and Medicaid Diversion Group Part B (“Part B”) HCBS covered under the Katie Beckett Program and applicable individual benefit limits are specified below. The benefit limits are applied across all services received by the child regardless of whether the services are received through CD and/or a traditional provider agency. Corresponding limitations regarding the scope of each service are defined in Rule .02. Limitations on the total of all HCBS that can be received in a calendar year are specified in (a) and (b) above.

Katie Beckett HCBS Benefits Katie Beckett Coverage Available through Consumer Direction?

(“Eligible Katie Beckett HCBS”)

Respite Covered as medically necessary in Part A and Part B with limitations as follows:

Up to thirty (30) days of service per person per calendar year or up to two hundred sixteen (216) hours per person per calendar year, depending on needs and preferences as reflected in the PCSP, or in the DIDD-approved ISP for Part B members.

The two (2) limits cannot be combined in a calendar year.

Yes, hourly only.

Daily respite is not available in Consumer Direction.

Supportive Home Care Covered as medically necessary in Part A and Part B. Yes Assistive Technology, Adaptive Equipment and Supplies Covered as medically necessary in Part A and Part B with a limit of five thousand dollars ($5,000) per child per calendar year.

Not covered under Katie Beckett if available under

Section 110 of the Rehabilitation Act of 1973, or the IDEA (20 U.S.C. §§ 1401 et seq.).

No Minor Home Modifications Covered as medically necessary in Part A and Part B in accordance with limitations specified in Rule .02 and with limits of $6,000 per project, $10,000 per calendar year, and $20,000 per lifetime.

No Vehicle Modifications Covered as medically necessary in Part A and Part B in accordance with limitations specified in Rule .02 and with limits of $10,000 per calendar year and $20,000 per lifetime.

No Community Integration Support Services Covered as medically necessary in Part A and Part B in accordance with limitations specified in Rule .02.

Payment for attendance and materials and supplies at classes and conferences and club/association dues can be covered, but cannot exceed five hundred dollars ($500) per year.

No Community Transportation Covered as medically necessary in Part A and Part B for transportation to support participation in community activities when family, public or other community-based transportation services are not available or when assistance is needed in order to access such benefits.

Shall not supplant NEMT available for medical appointments.

Limited to $225 per month for a child whose parent or legal guardian elects to receive this benefit through Consumer Direction.

Yes Family Caregiver Education and Training Covered as medically necessary in Part A and Part B only when approved in advance by the child’s MCO.

Limited to five hundred dollars ($500) per calendar year.

No Decision Making Supports Covered as medically necessary in Part A and Part B.

Limited to five hundred dollars ($500) in one-time assistance per child.

Legal fees may be reimbursed only upon completion of counseling services to protect and preserve the child’s rights and freedoms upon attaining age 18.

No Family-to-Family Support Covered as medically necessary in Part A and Part B. No Community Support Development, Organization and Navigation Covered as medically necessary in Part A and Part B. No Health Insurance Counseling/Forms Assistance Covered as medically necessary in Part A and Part B.

Limited to fifteen (15) hours per child per calendar year.

No Assistance with Premium Payments Covered as medically necessary in Part B.

Limited to the amount determined to be the child’s portion of third party liability (TPL) coverage premiums, when other family members are also covered by the same premium.

Assistance with Premium Payments may be offered to a child upon enrollment in Part A only if the child does not have TPL at the time of enrollment and a hardship exception to the requirement to obtain/maintain TPL is requested and would otherwise be approved. In such cases, the Assistance with Premium Payments shall be limited to the lesser of the amount by which the child’s portion of the family’s monthly TPL premium exceeds the child’s Katie Beckett Group Part A premiums, or the lowest cost silver level child only plan in the highest rating region in Tennessee offered through the Federally Facilitated Marketplace, and shall not count against the $15,000 per calendar year expenditure cap for Part A wraparound HCBS.

Assistance with Premium Payments shall not be covered for a child who already has private insurance upon enrollment into Katie Beckett Group Part A, even if such coverage is later lost and new coverage must be obtained.

No Automated health care and related expenses reimbursement Covered as medically necessary in Part B only.

Limited to medical and dental expenses determined by the IRS to be qualified for reimbursement under a Healthcare Reimbursement Account or that would qualify for the medical and dental expenses income tax deduction, except that health insurance premiums shall be covered only as described above as part of the Health Insurance Premium Assistance benefit (and not as part of this benefit).

Acceptable documentation must be provided to the contracted entity administering the benefit in order for the benefit to be covered and reimbursement approved. The child’s parent or legal guardian shall comply with all applicable requirements of the administering entity in order to receive this benefit.

No Individualized therapeutic support reimbursement Covered in Part B only for items determined to be medically necessary for the child but not eligible for reimbursement as part of the automated health care and related expenses reimbursement benefit above (i.e., does not meet IRS guidelines).

No (7) Medical Necessity for Covered Katie Beckett Services.

(a) State Plan and EPSDT benefits. Medical necessity for all covered State Plan and EPSDT benefits, including physical and behavioral health, pharmacy, and dental services, for children enrolled in Katie Beckett shall be determined in accordance with

Rule Chapter 1200-13-16. This includes all benefits for children eligible for Medicaid in the Continued Eligibility Group Part C.

(b) Katie Beckett Group Part A wraparound HCBS and Medicaid Diversion Group Part B Benefits. For Katie Beckett Group Part A wraparound HCBS and all Medicaid Diversion Group Part B Benefits, pursuant to Rule 1200-13-16-.05(8), the following guidelines shall apply:

(c) In order to be medically necessary and therefore reimbursable as a covered Katie Beckett HCBS benefit, all of the following criteria must be met.

1. The service, including the type, amount, frequency and duration, must be specified in an approved PCSP, or for Medicaid Diversion Group Part B members, in the ISP approved by DIDD.

2. The service must be authorized by the appropriate entity, which shall be as follows:

(i) For Katie Beckett Group Part A wraparound HCBS, the person’s MCO;

(ii) For Medicaid Diversion Group Part B benefits, the Department of Intellectual and Developmental Disabilities;

3. The service, including the type, amount, frequency and duration, must meet one or more of the following:

(i) Be of direct therapeutic or ameliorative benefit to the child’s medical needs or disabilities;

(ii) Support the child’s full integration and participation in the community;

(iii) Help to prepare the child for transition to employment and community living, with as much independence as possible; or (iv) Support and sustain the family’s ability to meet the child’s medical, physical, behavioral, functional and other support needs and reduce or prevent the risk of out-of-home placement.

4. The service must be the most cost-effective way of safely and effectively meeting the child’s needs in the home or community setting. If a less costly service or support or mix of services and supports that is available would safely meet the child’s needs in the community, the more expensive service requested is therefore not medically necessary and will not be provided.

5. The service must not supplant assistance that family members, friends, or others are able and willing to provide or that is available through other paid or unpaid supports. This includes services available under the Rehabilitation Act of 1973 or Individuals with Disabilities Education Act, regardless of whether the family chooses to receive such services.

(d) TennCare or the entity responsible for authorizing HCBS may develop and implement guidelines which can be used to further clarify how these decisions are made with respect to a particular benefit.

(e) Notwithstanding (c)1.–5. above, any medical or related item or service purchased for a child enrolled in Medicaid Diversion Group Part B and determined by the IRS to be eligible as an itemized deduction on Schedule A (Form 1040 or 1040-SR), or eligible for payment or reimbursement through a Health Reimbursement Account, Health Savings Account or Flexible Spending Account shall meet medical necessity requirements.

(8) Each child enrolling or enrolled in Katie Beckett Group Part A or Medicaid Diversion Group

Part B shall be subject to an Expenditure Cap on the HCBS benefit package the child is eligible to receive. Each benefit package has a distinct Expenditure Cap, outlined below:

(a) For a child enrolled in Katie Beckett Group Part A, the expenditure cap shall be fifteen thousand dollars ($15,000) per calendar year. The Expenditure Cap shall apply to Katie Beckett wraparound HCBS only (not other Medicaid services). All Katie Beckett Group

Part A wraparound HCBS shall be counted against the Expenditure Cap, including the cost of minor home modifications.

(b) For a child enrolled in Medicaid Diversion Group Part B, the Expenditure Cap shall be ten thousand dollars ($10,000) per calendar year. The Expenditure Cap shall apply to Medicaid Diversion Group Part B HCBS only (these are the only benefits the child is eligible to receive). All Medicaid Diversion Group Part B HCBS shall be counted against the Expenditure Cap, including the cost of minor home modifications.

1. The Expenditure Cap shall be used to determine the total cost of Katie Beckett HCBS a child can receive while enrolled in Katie Beckett Group Part A or Medicaid Diversion Group Part B. The Expenditure Cap functions as a limit on the total cost of Katie Beckett Group Part A or Medicaid Diversion Group Part B HCBS that can be provided by the MCO or DIDD to the child in the home or community setting. Katie Beckett HCBS in excess of a child’s Expenditure Cap are non-covered benefits.

2. For a child in Katie Beckett Group Part A, the total cost of Katie Beckett wraparound HCBS shall also be counted in applying the Comparable Cost of Institutional Care Requirement.

3. A child shall not be entitled to receive services up to the amount of the Expenditure Cap. A child shall receive only those services that are medically necessary, as described in this Rule. Determination of the services that are medically necessary shall be based on a comprehensive assessment of the child’s needs and the availability of Natural Supports and other (non-TennCare reimbursed) services to meet identified needs, which shall be conducted by the child’s Nurse Care Manager or DIDD Case Manager and subject to any applicable utilization management review and approval processes.

4. Application of the Expenditure Cap.

(i) For a child enrolled in Katie Beckett Group Part A, TennCare State Plan services shall not be counted against the child’s Expenditure Cap for Katie Beckett Group Part A wraparound HCBS.

(ii) The annual HCBS Expenditure Cap shall be applied on a calendar year

basis. TennCare and the child’s MCO or DIDD will track utilization of HCBS across each calendar year.

(iii) The HCBS Expenditure Cap shall also be applied prospectively on a twelve (12) month basis. This is to ensure that a child’s PCSP/ISP does not establish a threshold level of supports that cannot be sustained over the course of time. This means that, for purposes of person and familycentered support planning, the child’s MCO or DIDD will always estimate the actual cost of services forward for twelve (12) months in order to determine whether the Expenditure Cap will continue be met based on the most current PCSP/ISP that has been developed. The cost of one-time services such as short-term services or short-term increases in services must be counted as part of the total cost of services for a full twelve (12) month period following the date of service delivery.

(iv) Denial of or reductions of Katie Beckett HCBS based on a child’s Expenditure Cap shall constitute an adverse action, as defined in Rule

Tenn. Comp. R. & Regs. 1200-13-01-.33 TEMPORARY BENEFITS UNDER THE AMERICAN RESCUE PLAN ACT

ENHANCED HCBS FMAP SPENDING PLAN.

(1) Definitions. See Rule 1200-13-01-.02, unless otherwise noted.

(2) Notwithstanding any other rule related to a benefit limit, Expenditure Cap, Individual Cost Neutrality Cap, or Individual Cost Limit, from November 2, 2021, through March 31, 2025, TennCare Enrollees receiving HCBS in CHOICES Groups 2 or 3; ECF CHOICES Groups 4, 5, 6, or 7; or a Section 1915(c) waiver who meet the criteria outlined in this rule may receive an additional one-time increase of up to $3,000 in eligible Family Caregiver Supports (“FCS”), as defined in 1200-13-01-.02.

(3) Eligibility criteria. Services in (4) below will only be approved if they further enable the individual’s independence or support and sustain unpaid family caregivers. To be eligible for FCS, an individual must:

(a) Receive HCBS in CHOICES Group 2 or 3; ECF CHOICES Group 4, 5, 6, or 7; or a

Section 1915(c) waiver as of July 12, 2021;

(b) Live with a family member or family members who routinely provide(s) unpaid support and assistance or have an unpaid family caregiver(s) who routinely provide(s) unpaid support and assistance; and (c) Individuals receiving residential services are not eligible for FCS.

(4) Eligible FCS.

(a) Enrollees in CHOICES Groups 2 and 3 who meet the eligibility criteria in (3) above may utilize FCS for the following services:

1. Respite;

2. Adult Day Care;

3. Assistive Technology;

4. Enabling Technology; and 5. Minor Home Modifications.

(b) Enrollees in ECF CHOICES Groups 4, 5, 6, and 7 who meet the eligibility criteria in (3) above may utilize FCS for the following services:

1. Respite;

2. Assistive Technology;

3. Enabling Technology; and 4. Minor Home Modifications.

(c) Enrollees in one of the 1915(c) Waiver programs who meet the eligibility criteria in (3) above may utilize FCS for the following services as defined in 1200-13-01-.25, unless otherwise indicated:

1. Respite;

2. Specialized Medical Equipment and Supplies and Assistive Technology;

3. Enabling Technology as defined in 1200-13-01-.02; and 4. Environmental Accessibility Modifications.

(5) Use of FCS.

(a) For each program, the $3,000 for FCS is a one-time increase that may be utilized anytime between November 2, 2021, and March 31, 2025.

(b) An individual may elect to receive additional units of one service or multiple services; however, the overall limitation on FCS is $3,000 per person.

(c) This assistance is provided in addition to existing service limitations and without regard for an Expenditure Cap, Individual Cost Neutrality Cap, or Individual Cost Limit specified in the approved waiver. However, Enrollees must use all currently available benefits within the benefit limit or Expenditure Cap, Individual Cost Neutrality Cap, or Individual Cost Limit before accessing FCS through this rule.

(d) If an individual has already reached an Expenditure Cap, Individual Cost Neutrality Cap, or Individual Cost Limit, as applicable, these services may be utilized without respect to whether the maximum benefit has already been utilized.

(e) An individual’s PCSP shall be modified to reflect any FCS requested and approved pursuant to this rule.

(6) Appeals. Appeals related to the denial, reduction, suspension, or termination of FCS are processed by the Division in accordance with Rules 1200-13-13-.11 and 1200-13-14-.11.

Continuation of the FCS approved pursuant to this rule shall not be provided after the exhaustion of the $3,000 limit or after March 31, 2025, whichever comes first.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, and 71-5-109.
• Administrative History: New rule filed November 1, 2022; effective January 30, 2023.

Chapter 1200-13-02 Nursing Facility Provider Reimbursement

Tenn. Comp. R. & Regs. 1200-13-02-.01 DEFINITIONS

The following definitions apply to nursing facility (NF) provider reimbursement. Additional definitions are contained in Chapter 1200-13-01.

(1) Acceptable Cost Report – The skilled nursing facility (SNF) cost report (Medicare form 2540- 10), or hospital health care complex cost report (Medicare form 2552-10), Medicaid supplemental cost report form, and required additional information. To be acceptable, the appropriate forms and required additional information must be filed with the Comptroller by the required due date, and meet the acceptance criteria on the acceptance check list. The Medicaid supplemental cost report form and acceptance check list are available on TennCare’s main website under the LTSS subsection.

(2) Active MDS Assessment – A resident’s MDS assessment is considered active when it has been accepted by CMS. The assessment will remain active until a subsequent MDS assessment for the same resident is received by CMS, or the assessment becomes a Delinquent MDS Resident Assessment.

(3) Administrative and Operating Cost Component – The portion of the Medicaid daily NF rate that is attributable to the general administration and operation of the NF. These costs include the allowable and reimbursable SNF/NF costs that are not included in the Direct Care Case Mix Adjusted, Direct Care Non-Case Mix Adjusted, Capital, Cost-Based, or Excluded cost components.

(4) Annualized Medicaid Resident Day-Weighted Median Cost – A numerical value determined by arraying the per diem costs and total annualized Medicaid resident days of each NF provider from low to high and identifying the point in the array at which the cumulative total of all annualized Medicaid resident days first equals or exceeds half the number of the total annual Medicaid resident days for all Medicaid participating NF providers. The per diem cost at this point is the annualized Medicaid resident day-weighted median cost.

(5) Appraisal Value – The most current depreciated NF appraised value as determined by the certified appraisal firm designated by TennCare. TennCare’s certified appraisal contractor must be selected through a formal procurement process for a single statewide contract.

(6) Capital Cost Component – The portion of the NF rate that is designed to compensate providers for their capital costs. These cost centers include the SNF/NF portion of: 1) Capital Related Costs – Building and Fixtures cost center (and applicable subscripted cost centers);

2. The Capital Related Costs – Moveable Equipment (and applicable subscripted cost centers); and 3) Other Capital Related Costs (and applicable subscripted cost centers). If real estate tax cost related to the SNF/NF is reported in one of these cost centers, then real estate tax cost will be excluded from the capital cost component, and included in the costbased component.

(7) Case Mix – A measure of the intensity of care a resident required, as documented on the MDS and measured using the RUG-IV 48 resident classification system through rate periods ending 6/30/2024, or using the PDPM resident classification system, or its successor, for rate periods after 6/30/2024. CMS nursing-only RUG or PDPM weights will be utilized.

(8) Comptroller – The Tennessee Office of the Comptroller of the Treasury, or its successor, and the associated work product of its contractors and agents.

(9) CMS – The Centers for Medicare and Medicaid Services.

(10) Cost-Based Component – The portion of the per diem rate attributable to real estate taxes related to NF services, and NF provider assessment costs.

(11) Delinquent MDS Resident Assessment – An MDS assessment that is more than 113 days old as of the end date of the MDS assessment collection period for each semi-annual rate period, as measured from the Assessment Reference Date (ARD) field on the MDS.

(12) Direct Care Case Mix Adjusted Cost Component – The portion of the Medicaid daily NF rate that is attributable to salaries, contract labor, and direct/apportioned payroll tax and employee benefit expense for registered nurses (RN), licensed practical/vocational nurses (LPN/LVN), and certified nurse aides (CNA) or orderlies that are providing direct SNF/NF patient care services. Costs associated with SNF/NF administrative nursing functions (Director of Nursing (DON), Assistant Director of Nursing (ADON), Minimum Data Set (MDS) coordinator, Quality Assurance (QA) coordinator, In-service/training coordinator) are not included in this cost component. Direct care case mix adjusted cost also includes a proportionate allocation of pooled payroll taxes and employee benefits expenses. Pooled payroll taxes and employee benefits will be apportioned to this cost component using Medicare cost report cost apportionment mechanics. All cost component costs are subject to the methods of apportionment in the Medicare cost report. Any portion of cost component expenses that are allocated to non-reimbursable cost centers or non-nursing facility (SNF/NF) cost centers, as designated by TennCare, will be excluded from cost component totals.

(13) Direct Care Non-Case Mix Adjusted Cost Component – The portion of the Medicaid daily NF rate that is attributable to salaries, contract labor, and direct/apportioned payroll tax and employee benefit expense associated with NF DON and ADON duties, the cost of raw food and special dietary supplements reported on the Medicaid supplemental cost report (includes those dietary supplements used for tube feeding or oral feeding, such as elemental high nitrogen diet, even when prescribed by a physician as defined by CMS Publication 15-1, The Provider Reimbursement Manual – Part I, section 2203.1), and staff associated with the provision of social services and recreational activities to NF residents. Direct care non-case mix adjusted cost also includes a proportionate allocation of pooled payroll taxes and employee benefits expenses. Pooled payroll taxes and employee benefits will be apportioned to this cost component using Medicare cost report cost apportionment mechanics. All cost component costs are subject to the methods of apportionment in the Medicare cost report.

Any portion of cost component costs that are allocated to non-reimbursable cost centers or non-nursing facility (SNF/NF) cost centers, as designated by TennCare, will be excluded from cost component totals.

(14) Excluded Cost Component – The portion of NF provider expense that will be excluded from allowable cost and not included in rate determination:

(a) The Nursing and Allied Health cost center (and applicable subscripted cost centers).

(b) The Interns and Residents cost centers (and applicable subscripted cost centers).

(c) The ParaMed Program cost center (and applicable subscripted cost centers).

(d) The direct costs of all non-overhead (general services) and non-routine SNF/NF cost centers.

(e) Overhead (general service) cost center expense allocations to non-SNF/NF routine cost centers, outpatient cost centers, and non-reimbursable cost centers, as determined by TennCare.

(f) For hospital-based NF overhead (general services), cost allocations to cost centers other than the SNF/NF routine cost centers, are excluded from rate setting allowable costs.

(15) Fair Rental Value (FRV) – The methodology used to calculate the capital reimbursement per diem rate for Medicaid participating NF.

(16) Final Case Mix Index Report (FCIR) – A semi-annual report reflecting the Medicaid and facility-wide case mix index for each NF using the time-weighted acuity measurement system.

(17) Fixed Assets – Buildings and building equipment, as described by CMS Publication 15-1, The Provider Reimbursement Manual – Part 1, sections 104.2 and 104.3.

(18) Index Factor – The most recently published Skilled Nursing Facility without Capital Market Basket Index, as produced for subscribers by IHS Global Insight (IHS Economics), or a comparable index, if this index ceases to be produced.

(19) Long-Stay Resident – A nursing facility resident who has been in the nursing facility for greater than one hundred (100) days.

(20) Major Movable Equipment – Capitalized assets as defined by CMS Publication 15-1, The Provider Reimbursement Manual – Part 1, section 104.4.

(21) Medicare Cost Report – CMS Forms 2540-10 and 2552-10, or subsequent versions of these forms.

(22) Medicaid Supplemental Cost Report – The supplemental cost reporting schedules designated by TennCare. The Medicaid supplemental cost report form is available on TennCare’s main website under the LTSS subsection.

(23) Medicaid Nursing Facility-Wide Semi-Annual Average Case Mix Index – The calendar day weighted average, carried to four (4) decimal places, of all indices for each resident MDS assessment transmitted and accepted by CMS that is considered active within a given semiannual rate period and where Medicaid is determined to be the primary per diem payer source. The resident case mix indices are calculated utilizing the time-weighted acuity measurement system. Any MDS assessments or MDS assessment periods which coincide with a federally or state declared public health emergency period may be excluded from or have BC1-Delinquent records removed from the calculation of the Medicaid Nursing Facility- Wide Semi-Annual Average Case Mix Index. In the event that less than three (3) months of MDS assessment information is available for the semi-annual case mix index calculation after exclusion, the most recently preceding Medicaid Nursing Facility-Wide Semi-Annual Average Case Mix Index which contains three (3) or more months of MDS assessment information will be utilized for rate setting.

(24) Minimum Data Set (MDS) – A core set of screening and assessment data, including common definitions and coding categories that form the foundation of the comprehensive assessment for all residents of long-term care NF providers certified to participate in the Medicaid program. The Tennessee reimbursement system will employ the current MDS assessment as approved by CMS.

(25) Minimum Data Set (MDS) Case-Mix Review – A review of original legal medical record documentation and other documentation as designated by TennCare in the MDS Supportive Documentation Requirements User Guide, supplied by nursing facility provider to support certain reported values that resulted in a specific case mix classification on a randomly selected MDS assessment sample. The review of the documentation supplied by the nursing facility provider will result in the case mix classification being supported or unsupported.

(26) MDS Supportive Documentation Requirements – The minimum documentation and review standard requirements for the MDS items associated with the current case mix classification system. These requirements shall be maintained by TennCare in the Supportive Documentation Requirements User Guide, which shall be updated and published as necessary on TennCare’s website, or if not published on TennCare’s website, then a link to the Guide will be on TennCare’s website. The information in these requirements serves to further clarify and provide guidance related to the requirements contained in the Long-Term Care Facility Resident Assessment User’s Manual (RAI Manual), instructions that are printed on the MDS form itself, and the Data Submission Specifications for MDS 3.0,or its successor.

(27) Neutralized – The process of removing cost variations associated with case mix. Neutralized cost is determined by dividing a provider’s inflated per diem direct care case mix adjusted costs by its cost report period average case mix index (CMI).

(28) New Nursing Facility Provider – A provider whose licensed beds have not previously been certified for participation by the Medicaid program for NF level of care.

(29) Nursing Facility Cost Report Period Case Mix Index – The calendar day weighted average of all applicable NF-wide quarterly case mix indices, carried to four (4) decimal places. The case mix index periods used in this weighted average will be the periods that most closely coincide with the NF provider’s cost reporting period that is used for rate setting. The average will be determined by weighting the applicable quarterly case mix index periods by the number of days the MDS assessments were active during the cost reporting period. The quarterly case mix index averages will be calculated using the time-weighted acuity measurement system and be inclusive of MDS assessments available as of the date of the applicable FCIRs. Any MDS assessments, BC1-Delinquent records, or MDS assessment periods excluded from the semi-annual rate setting process will also be excluded from the calculation of the Nursing Facility Cost Report Period Case Mix Index.

For example, a NF provider with a 1/1/2022 to 12/31/2022 cost reporting period would have a nursing facility cost report period case mix index calculated by the following:

Portion of Cost Report Year Case Mix Index Period Days for Weighted Calculation 1/1/2022 through 2/28/2022 12/1/2021 through 2/28/2022 3/1/2022 through 3/1/2022 through 92 5/31/2022 5/31/2022 6/1/2022 through 8/31/2022 6/1/2022 through 8/31/2022 9/1/2022 through 11/30/2022 9/1/2022 through 11/30/2022 12/1/2022 through 12/31/2022 12/1/2022 through 2/28/2023 (30) Nursing Facility-Wide Semi-Annual Average Case Mix Index – The calendar day weighted average, carried to four (4) decimal places, of all indices for all resident MDS assessments transmitted and accepted by CMS that are considered active within a given semi-annual rate period. The resident case mix indices are calculated utilizing the time-weighted acuity measurement system. Any MDS assessments or MDS assessment periods which coincide with a federally or state declared public health emergency period may be excluded from or have BC1-Delinquent records removed from the calculation of the Nursing Facility-Wide Semi-Annual Average Case Mix Index. In the event that less than three (3) months of MDS assessment information is available for the semi-annual case mix index calculation after exclusion, the most recently preceding Nursing Facility-Wide Semi-Annual Average Case Mix Index which contains three (3) or more months of MDS assessment information will be utilized for rate setting.

(31) Patient Driven Payment Model (PDPM) – The system for grouping a nursing facility’s residents according to their clinical and functional status identified from MDS data.

(a) Components. This classification system uses certain MDS data elements to place assessments into one of the Case Mix groups across five (5) components based on similar resource needs. The 5 PDPM components are:

1. Physical Therapy, 2. Occupational Therapy, 3. Speech Language Pathology, 4. Nursing, and 5. Non-Therapy Ancillary.

(b) Nursing Classification. A hierarchical methodology is used to determine the individual case mix index for the PDPM nursing component classifications. The hierarchical classification system will work through the PDPM nursing classifications in order and select the first group for which the patient qualifies. The first of the twenty-five (25) individual PDPM nursing groups for which the patient qualifies is the assigned PDPM nursing classification. The nursing classification hierarchical order includes:

1. Extensive Services, 2. Special Care High, 3. Special Care Low, 4. Clinically Complex, 5. Behavioral Symptoms and Cognitive Performance, and 6. Reduced Physical Function.

(32) Preliminary Case Mix Index Report (PCIR) – The preliminary report that reflects the acuity of the residents in the NF. Resident acuity will be measured for each semi-annual rate period, utilizing the time-weighted acuity measurement system.

(33) Quality Informed – A descriptor of any component of the NF reimbursement methodology that is adjusted based on the NF provider’s Quality Tier (e.g., Direct Care Case Mix Adjusted Cost Component and Direct Care Non-Case Mix Adjusted Cost Component) or other specified performance measures (e.g., Fair Rental Value).

(34) Quality Tier – The NF provider’s classification within a specified range of scores on quality outcome measures.

(35) Rate Year – A one-year period from July 1 through June 30 during which a particular set of rates are in effect, corresponding to a state fiscal year.

(36) Rebase – The process of reestablishing cost component medians and reimbursement rates by incorporating the most recently audited or reviewed qualifying cost reports.

(37) Resource Utilization Group-IV (RUG-IV) Resident Classification System – The resource utilization group used to classify residents. When a resident classifies into more than one RUG-IV group, or RUG-IV successor group, the RUG with the greatest case mix index will be utilized to calculate the NF provider’s all residents average case mix index and Medicaid residents average case mix index. The nursing-only weights RUG-IV Version 1.03 Grouper will be utilized for rate determination purposes through rate periods ending June 30, 2024.

(38) Sales Comparison Approach – Based upon the principle of substitution, when a property is replaceable in the market its value tends to be set at the cost of acquiring an equally desirable substitute property, assuming no costly delay in making the substitution. Since two (2) properties are rarely identical, the necessary adjustments for differences in quality, location, size, services, and market appeal are a function of appraisal experience and judgment. Land is valued via the sales comparison approach.

(39) Semi-Annual Rate Period – A six (6) month period beginning July 1 or January 1 for which new reimbursement rates will be calculated. The semi-annual rate period will use all active MDS assessments for the time period beginning ten (10) months prior and ending four (4) months prior to the begin date of the semi-annual rate period. Any active MDS assessments or active MDS assessment periods which coincide with a federally or state declared public health emergency period may be excluded from or have BC1-Delinquent records removed from the calculation of the applicable case mix index averages. In the event that less than three (3) months of active MDS assessment information is available for use in the semiannual rate period calculation after exclusion, the most recently preceding applicable case mix index averages which contain three (3) or more months of MDS assessment information will be utilized for rate setting.

For example, the July 1, 2018, semi-annual rate period will use active MDS assessment records from September 1, 2017, through February 28, 2018.

(40) Short-Stay Resident – A nursing facility resident who has been in the nursing facility for no more than one hundred (100) days.

(41) TennCare – The program administered by the Single State Agency as designated by the State and CMS pursuant to Title XIX of the Social Security Act and the Section 1115 Research and Demonstration Waiver granted to the State of Tennessee; the name of the Division within the Tennessee Department of Finance and Administration encompassing all the health care related agencies located within F&A; and, the name of the Bureau which directly administers the program.

(42) Time-Weighted Acuity Measurement System (TW) – The case mix index calculation methodology that is compiled from the collection of all resident MDS assessments transmitted and accepted by CMS that are considered active within a given semi-annual rate period. The resident MDS assessments will be weighted based on the number of calendar days that the assessment is considered an active assessment within a given semi-annual rate period.

(43) Unsupported MDS Resident Assessment – An assessment where one or more data items that are used to classify a resident pursuant to the current resident classification system is not supported according to the MDS Supportive Documentation Requirements User Guide and a different classification would result; therefore, the MDS assessment would be considered “unsupported.”

(44) Weighted Construction Year Age – The construction age is determined by subtracting the year the building or building addition was constructed as denoted in the appraisal report from the year the appraisal was performed by TennCare’s certified appraisal firm. The average of the construction year is weighted by the finished square footage associated with each separate building or addition as denoted in the appraisal report produced by TennCare’s certified appraisal firm.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 14-23-105, 14-23-109, 71-5-105, 71-5-109, 71-5-134, and 71-5- 1413.
• Administrative History: Original rule filed January 18, 1979; effective March 5, 1979. Amendment filed March 8, 1983; effective April 7, 1983. Amendment filed June 23, 1983; effective July 25, 1983. Amendment filed March 8, 1984; effective June 12, 1984. Amendment filed June 2, 1988; effective July 17, 1988. Repeal filed May 5, 2009; effective July 19, 2009. New rules filed May 1, 2018; effective July 30, 2018. Amendments filed January 28, 2021; effective April 28, 2021. Amendments filed March 31, 2026; effective June 29, 2026.

Tenn. Comp. R. & Regs. 1200-13-02-.02 DETERMINATION OF PAYMENT

TennCare, in consultation with the Comptroller and the Tennessee Health Care Association (THCA), shall establish the rules for the determination of payment for services provided to Medicaid recipients as part of the NF program. Payment determination components shall include acuity adjusted direct care, non-acuity adjusted direct care, quality, administration, fair market value capital, and a cost-based component. Other NF stakeholders shall have input into the quality component of the rate.

History

• Authority: T. C.A. §§ 4-5-202, 14-1905, 71-5-105, 71-5-109, and 71-5-1413.
• Administrative History: Original rule filed January 18, 1979; effective March 5, 1979. Repeal filed May 5, 2009; effective July 19, 2009. New rules filed May 1, 2018; effective July 30, 2018.

Tenn. Comp. R. & Regs. 1200-13-02-.03 CONDITIONS FOR REIMBURSEMENT OF NURSING FACILITY CARE

(1) A NF must enter into a provider agreement with one (1) or more TennCare MCOs, for reimbursement of NF services.

(2) A NF must be certified by the Tennessee Department of Health, showing that it has met the standards set out in 42 C.F.R. Part 442.

(3) A NF participating in TennCare shall be terminated as a TennCare provider if certification or licensure is canceled by CMS or the State. A NF whose certification was terminated may be recertified to provide Medicaid services and may be contracted to provide Medicaid services at the discretion of the MCOs.

(4) If a resident has resources to apply toward payment, including Patient Liability as determined by TennCare, or TPL, which may include LTC insurance benefits, the payment for NF services shall be the NF’s per diem rate for the applicable level of NF reimbursement authorized minus the resident’s available resources.

(5) Regardless of the Medicaid reimbursement rate established, a NF may not charge TennCare Enrollees an amount greater than the amount per day charged to Non-Medicaid payer patients for equivalent accommodations and services.

(6) The specific items and services covered by the NF program shall be those defined and approved by TennCare. A NF shall not charge a TennCare enrollee for a covered service.

Non-covered services may be charged directly to the resident, upon prior notification by the NF to the resident that the service is not covered. Rule 1200-13-13-.08(5).

History

• Authority: T. C.A. §§ 4-5-202, 14-23-105, 14-23-109, 71-5-105, 71-5-109, and 71-5-1413.
• Administrative History: Original rule filed January 18, 1979; effective March 5, 1979. Amendment filed March 8, 1983; effective April 7, 1983. Amendment filed June 23, 1983; effective July 25, 1983. Repeal filed May 5, 2009; effective July 19, 2009. New rules filed May 1, 2018; effective July 30, 2018.

Tenn. Comp. R. & Regs. 1200-13-02-.04 CONDITIONS FOR REIMBURSEMENT OF ENHANCED RESPIRATORY CARE

(1) The NF must enter into a provider agreement with one (1) or more TennCare MCOs for the provision and reimbursement of Enhanced Respiratory Care (ERC) in a dual certified and licensed SNF/NF.

(a) A TennCare MCO shall, pursuant to T.C.A. § 71-5-1412, contract with any NF for the provision of Medicaid NF services, but shall not be obligated to reimburse any NF for ERC.

(b) Unless an exception is granted, a TennCare MCO shall not reimburse any NF for ERC unless such NF was contracted by the MCO for ERC Reimbursement as of July 1, 2016. An MCO may request an exception from TennCare to the moratorium on reimbursement for ERC upon the MCO’s demonstration of the need for additional capacity or improved quality in the geographic area in which the NF is located, and the NF’s compliance with all applicable conditions of ERC Reimbursement specified in this

rule.

(2) The SNF/NF providing ERC services must be dual certified for the provision of Medicare SNF and Medicaid NF services, showing it has met the federal certification standards. Any NF providing ERC services in the TennCare Program shall be terminated by all TennCare MCOs as a TennCare provider if certification or licensure is canceled by CMS or the State.

(3) NFs providing Ventilator Weaning or chronic ventilator services and NFs receiving short-term reimbursement at the Sub-Acute Tracheal Suctioning Rate for a person who has just been weaned from the ventilator, but who still requires short-term intensive respiratory intervention, shall also meet or exceed the following minimum standards:

(a) The NF shall ensure that medical direction of all Ventilator Weaning, Chronic Ventilator Care, and Sub-Acute Tracheal Suctioning services is provided by a physician licensed to practice in the State of Tennessee and board certified in pulmonary disease or critical care medicine as recognized by either the American Board of Medical Specialties or American Osteopathic Association, as applicable.

(b) A licensed respiratory care practitioner, as defined by T.C.A. § 63-27-102, shall be on site in the ventilator care unit twenty-four (24) hours per day, seven (7) days per week to provide:

1. Ventilator care;

2. Administration of medical gases;

3. Administration of aerosol medications; and 4. Diagnostic testing and monitoring of life support systems.

(c) The NF shall ensure that an appropriate individualized Plan of Care (POC) is prepared for each resident receiving Ventilator Weaning, Chronic Ventilator Care, or Sub-Acute Tracheal Suctioning. The POC shall be developed with input and participation from the medical director of the NF’s ERC program as described in Subparagraph (a).

(d) The NF shall establish admissions criteria to ensure the medical stability of ventilatordependent residents prior to transfer from an acute care setting. The NF shall maintain documentation regarding the clinical evaluation of each resident who will receive ERC for appropriateness of placement in the facility prior to admission.

(e) End tidal carbon dioxide (etCO2) or transcutaneous monitoring of carbon dioxide and oxygen (tcCO2) and continuous pulse oximetry measurements shall be available for all residents receiving Chronic Ventilator Care and provided based on the needs of each resident. For residents receiving Ventilator Weaning or Sub-Acute Tracheal Suctioning, continuous pulse oximetry shall be provided, and end tidal Carbon Dioxide (etCO2) measurements shall be provided no less than every four (4) hours, and within one (1) hour following all vent parameter changes, or for residents receiving Sub-Acute Tracheal Suctioning, after all tracheostomy tube changes, tracheostomy capping trials, or the use of speaking devices.

(f) An audible, redundant external alarm system shall be connected to emergency power and/or battery back-up and located outside the room of each resident who is ventilatordependent for the purpose of alerting staff of resident ventilator disconnection or ventilator failure.

(g) Ventilator equipment (and ideally physiologic monitoring equipment) shall be connected to back-up generator power via clearly marked wall outlets.

(h) Ventilators shall be equipped with adequate back-up provisions, including:

1. Internal and/or external battery back-up systems to provide a minimum of eight (8) hours of power;

2. Sufficient emergency oxygen delivery devices (i.e., compressed gas or battery operated concentrators);

3. At least one (1) battery operated suction device available per every eight (8) residents on mechanical ventilator or with a tracheostomy; and 4. A minimum of one (1) patient-ready back-up ventilator which shall be available in the facility at all times.

(i) The NF shall be equipped with current ventilator technology to encourage and enable maximum mobility and comfort, ideally weighing less than fifteen (15) pounds with various mounting options for portability (e.g., wheelchair, bedside table, or backpack).

(j) The facility shall have an emergency preparedness plan specific to residents receiving ERC (i.e., Ventilator Weaning, Chronic Ventilator Care, or Sub-Acute Tracheal Suctioning) which shall specifically address total power failures (loss of power and generator), as well as other emergency circumstances.

(k) The facility shall have a written training program, including an annual demonstration of competencies, for all staff caring for residents receiving ERC (i.e., Ventilator Weaning, Chronic Ventilator Care, or Sub-Acute Tracheal Suctioning), which shall include alarm response, positioning and transfers, care within licensure scope, and rescue breathing.

(4) A NF must be operating in compliance with all of the conditions specified in Paragraph (3) in order to be eligible for Ventilator Weaning, Chronic Ventilator Care, or Sub-Acute Tracheal Suctioning Reimbursement.

(5) The standards set forth in Paragraph (3) are not applicable for Secretion Management Tracheal Suctioning Reimbursement; however, the NF must meet standards specified in Paragraph (6) below for Secretion Management Tracheal Suctioning Reimbursement.

(6) A NF contracted with one or more TennCare MCOs to receive only Secretion Management Tracheal Suctioning Reimbursement shall meet or exceed the following minimum standards:

(a) A licensed respiratory care practitioner as defined by T.C.A. § 63-27-102, shall be on site a minimum of weekly to provide:

1. Clinical Assessment of each resident receiving Secretion Management Tracheal Suctioning (including Pulse Oximetry measurements);

2. Evaluation of appropriate humidification;

3. Tracheostomy site and neck skin assessment;

4. Care plan updates; and 5. Ongoing education and training on patient assessment, equipment and treatment.

(b) The NF shall ensure that an appropriate individualized POC is prepared for each resident receiving Secretion Management Tracheal Suctioning. The POC shall be developed with input and participation from a licensed respiratory care practitioner as defined by T.C.A. § 63-27-102. Medical direction, including POC development and oversight for persons receiving Sub-Acute Tracheal Suctioning shall be conducted according to Paragraph (3).

(c) The NF shall establish admissions criteria which meet the standard of care to ensure the medical stability of residents who will receive Secretion Management Tracheal Suctioning prior to transfer from an acute care setting. The NF shall maintain preadmission documentation regarding the clinical evaluation of each resident who will receive Secretion Management Tracheal Suctioning for appropriateness of placement in the facility.

(d) Pulse oximetry measurements shall be provided at least daily with continuous monitoring available, based on the needs of each resident. For any resident being weaned from the tracheostomy, the following shall be provided:

1. Continuous pulse oximetry monitoring; and 2. End tidal Carbon Dioxide (etCO2) measurements at least every four (4) hours and within one (1) hour following tracheostomy tube changes, tracheostomy capping trials, or the use of speaking devices. Transcutaneous (tcCO2) shall not be appropriate for intermittent monitoring.

(e) Mechanical airway clearance devices and/or heated high flow molecular humidification via the tracheostomy shall also be available for secretion management, as appropriate for the needs of each resident.

(f) Oxygen equipment shall be connected to back-up generator power via clearly marked wall outlets.

(g) Adequate back-up provisions shall be in place including:

1. Sufficient emergency oxygen delivery devices (i.e., compressed gas or battery operated concentrators); and 2. At least one (1) battery operated suction device available per every eight (8) residents on mechanical ventilation or with a tracheostomy.

(h) The facility shall have an emergency preparedness plan specific to residents receiving Secretion Management Tracheal Suctioning which shall specifically address total power failures (loss of power and generator), as well as other emergency circumstances.

(i) The facility shall have a written training program, including an annual demonstration of competencies, for all staff caring for residents receiving Secretion Management Tracheal Suctioning which shall include alarm response, positioning and transfers, care within licensure scope, and rescue breathing.

(7) When a NF establishes a “Tracheostomy Unit” by accepting Tracheal Suctioning Reimbursement, including Sub-Acute and Secretion Management, for more than three (3) residents on the same day, the licensed respiratory care practitioner described in Subparagraph (6)(a) shall be on site a minimum of daily for assessment, care management, and care planning of residents receiving Tracheal Suctioning.

(8) A NF must be operating in compliance with all of the conditions specified in Paragraph (6) in order to be eligible for Secretion Management Tracheal Suctioning Reimbursement.

(9) Eligibility for and access to ERC services by individuals from out-of-state is governed by 42 C.F.R. § 435.403. A NF shall not recruit individuals from other states to receive ERC in Tennessee. A NF shall not be eligible to receive TennCare reimbursement for ERC services for a resident placed by another state or any agency acting on behalf of another state in making the placement because such services are not available in the individual’s current state of residence, including residents admitted to the NF/SNF under the Medicare Skilled Nursing Facility care benefit when such benefit has been exhausted. The NF shall be responsible for arranging, prior to the resident’s admission to the facility, Medicaid reimbursement for ERC services from the Medicaid Agency of the state which placed the resident and which will commence when other payment sources (e.g., Medicare, private pay, but not TennCare) have been exhausted.

(10) If the resident has available resources to apply toward payment, including Patient Liability or TPL, which may include LTC insurance benefits, the payment made by TennCare is the per diem rate established by TennCare minus the resident’s available resources.

History

• Authority: T.C.A. §§ 4-5-202, 14-1905, 14-23-105, 14-23-109, 71-5-105, 71-5-109, and 71-5-1413.
• Administrative History: Original rule filed January 18, 1979; effective March 5, 1979. Amendment filed March 8, 1983; effective April 7, 1983. Amendment filed March 8, 1984; effective June 12, 1984. Amendment filed June 2, 1988; effective July 17, 1988. Repeal filed May 5, 2009; effective July 19, 2009. New rules filed May 1, 2018; effective July 30, 2018.

Tenn. Comp. R. & Regs. 1200-13-02-.05 COST REPORTS

(1) TennCare, in consultation with the Comptroller and THCA, shall develop the cost report format and submission process to be followed by participating Medicaid NFs. Medicaid participating NFs are required to file annual cost reports in accordance with the following:

(a) Medicaid participating NFs are required to report their allowable costs on the following cost reports:

1. Medicare Cost Report 2. Medicaid Supplemental Cost Report (b) The version of the Medicaid supplemental cost report required to be filed by the NF providers is the most recently available cost report version on TennCare’s or its designated contractor’s website as of the end date of the provider’s fiscal year, unless notified by TennCare to use an alternate version. Older versions of the cost report will not be accepted.

(c) All proposed updates and changes to the Medicaid supplemental cost report will be shared with NF industry stakeholders prior to their implementation to ensure the provider community has ample notice and understanding of the changes.

(d) Separate cost reports must be submitted by the home office, central office, or related party management companies when costs of the entity are reported in the NF provider’s Medicare cost report or Medicaid supplemental cost report. The Medicare home office cost statement (CMS Form 287-05, or its successor), or an equivalent document must be filed with the provider’s cost report submission package.

(e) Cost reports must be submitted annually. The due date for filing annual cost reports is the last day of the fifth (5th) month following the NF provider’s fiscal year-end. The year-end utilized for the Medicare cost report and the Medicaid supplemental cost report must be the same.

(f) Changes of Ownership. In the event of a change in ownership (CHOW) of the NF, the previous owner shall be required to submit a final cost report, both Medicare and Medicaid supplemental cost reporting forms, from the date of its last fiscal year-end to the date of sale or lease.

1. The previous owner must file a final cost report pursuant to Subparagraph (i).

2. If the new legal entity continues the operations of the NF as a provider of Medicaid services, the new legal entity shall be required to furnish TennCare with an initial cost report from the date of purchase or lease to the new fiscal year-end selected by the new legal entity.

(g) Initial Cost Report. The initial cost report submitted by all providers of NF services under the Medicaid program shall be based on the most recent fiscal year-end, and must be filed by the last day of the fifth (5th) month following the NF provider’s fiscal year-end. The year-end utilized for the Medicare cost report and the Medicaid supplemental cost report must be the same.

1. TennCare at its discretion may allow for exceptions to the initial filing period.

2. Subsequent cost reports shall be submitted annually by each NF provider by the last day of the fifth (5th) month following the NF provider’s fiscal year-end.

(h) New Nursing Facility Provider. A new NF provider may select an initial cost reporting period of at least one (1) month but not to exceed thirteen (13) months. The NF provider’s cost report must be filed by the last day of the fifth (5th) month following the NF provider’s fiscal year-end. Thereafter, the cost reports shall be submitted according to the guidelines for subsequent cost reports as defined in Subparagraph (e).

(i) Final (Terminating) Cost Reports. When a NF provider ceases to participate in the Medicaid program, it must file a cost report covering a period up to the effective date the NF provider ceases to participate in the program. Depending upon the circumstances involved in the preparation of the NF provider’s final cost report, the NF provider may file for a period not less than one (1) month and not more than thirteen (13) months. The previous entity has until the end of the fifth (5th) month following the effective date the NF provider ceases to participate in the Medicaid program or the effective date of the CHOW (whichever applies) to submit the final cost report.

(j) There shall be no automatic extension of the due date for the filing of cost reports. If a NF provider experiences unavoidable difficulties in preparing its cost report by the prescribed due date, a written request for an extension may be submitted to TennCare prior to the due date.

1. TennCare will have sole authority in approving both the extension and extension time frame.

2. Prior to approving a request for an extension, TennCare maintains the right to request additional information and supporting documentation from the NF in order to support the extension request.

(k) Amended Cost Reports. The Comptroller may accept amended cost reports in electronic format for a period of up to twelve (12) months following the end of the cost reporting period, with the caveat that cost reports may not be amended after an audit or desk review has been initiated. TennCare maintains the right, at its discretion, to supersede the amended cost report filing caveat. Amended cost reports should include a letter explaining the reason for the amendment, an amended certification statement with original signature, and the electronic format completed amended cost reports.

Each amended cost report submitted should be clearly marked with “Amended” in the file name.

(2) The Medicare and Medicaid supplemental cost reports must meet all of the following minimum criteria to be deemed acceptable cost reports:

(a) The NF Medicare and Medicaid supplemental provider and home/central office cost reports must be filed in the electronic format prescribed by TennCare.

(b) The Medicaid supplemental cost report version utilized by the NF provider must be the most current version as of the end of its cost reporting period unless notified by TennCare to use an alternate version.

(c) The cost reports must include all supporting documentation as required by the Medicaid supplemental cost report instructions and checklist.

(d) Cost reports must be prepared according to Medicaid supplemental cost reporting instructions, CMS Publication 15-2, cost reporting instructions, and definitions of allowable and non-allowable costs contained in CMS Publication 15-1. The CMS publications will dictate allowable and non-allowable costs, except where Medicaid reimbursement rules and Medicaid supplemental cost reporting instructions are more specific as to the allowability of certain costs.

(e) Medicaid specific accounting principles and allowable cost rules are as follows:

1. Only the straight-line method of computing depreciation is permitted.

2. Bad debt is not an allowable expense.

3. Costs may be included only for covered services as defined by federal regulations at 42 C.F.R. 483 Subpart B and TennCare.

4. Allowable cost must be adjusted for NF compensation limitations as detailed in Rules 1200-13-06-.11 and .12.

5. All cost report information shall be submitted consistent with generally accepted accounting principles unless state and federal rules and regulations require a separate treatment of an item. The accrual method of accounting is the only acceptable method for NF providers.

6. The Medicare cost report may allow more than one option for classifying costs according to CMS Publication 15, Provider Reimbursement Manual; however, Medicaid will only recognize costs in the cost component totals and direct care floor limit calculations based on the definitions of those cost components contained in this Chapter. If a NF provider classifies cost on the Medicare cost report in a manner other than in compliance with this Chapter, then the cost will be excluded from the applicable cost components and the direct care floor calculation, unless adjusted at audit or desk review.

7. The Medicaid NF assessment is an allowable cost to the Medicaid program; however, the NF assessment will be included in the excluded cost component for rate setting purposes.

(f) The Medicare and Medicaid supplemental cost reports must include consideration of all prior year adjustments and observations from Medicare and Medicaid audits, desk reviews, and settlements. Unresolved or protested prior year adjustments and observations should be noted in the cost reports or in a separate letter filed with the cost reports but cannot be disregarded.

(g) Patient Accounts and Patient Funds. Gross charges to the patients’ accounts must match the charges to the patient log. Adjustments to the patients’ accounts must then be made to bring the actual charges in line with the contractual and legal collection limits of the various medical programs. All charges in the patients’ accounts must be supported by charge slips and the proper notes in the patients’ files and must correspond to the charges reported on TennCare billing forms. Personal funds held by the provider for Medicaid patients used in purchasing clothing and personal incidentals must be properly accounted for with detailed records of amounts received and disbursed and shall not be commingled with NF funds. Patient funds in excess of $100 per patient must be kept in an insured interest bearing account. Interest earned must be credited to the patients. Bank fees or charges associated with resident trust fund accounts shall not be charged to or debited against individual resident trust fund accounts.

(h) Patient Logs and Census. Each facility must maintain daily census records and an adequate patient log. The format of the log is to be determined by each individual provider and may be combined with the revenue journal or other records at the convenience of the provider. This log must be sufficient to provide the following information on an individual basis and to accumulate monthly and yearly totals for Medicaid patients and for all other patients:

1. Days of service;

2. Charges for items and services covered by the Medicaid NF Program;

3. Charges for items and services not covered by the Medicaid NF Program;

4. Patient income applicable to the cost of covered items and services received by Medicaid NF patients;

5. Amounts collected and receivable from the Medicaid Program; and 6. Amounts collected and receivable from all other sources.

(i) Patient Log.

1. Suggested Patient Log. The headings below should be listed across the top of the page above the respective columns.

Column No. Heading (i) Patient Name (ii) Patient Days (iii) Room and Board Charge (iv) Total Other NF Covered Charges (Non-Room and Board)

(v) Total NF Covered Charges (Col. 3 + Col. 4)

(vi) Total NF Non-covered Charges (vii) Total Actual Charges (Col. 5 + Col. 6)

(viii) Date Medicaid NF Claim Paid (ix) Amounts Collected and Receivable from NF Program (x) Patient Income Applicable to NF Covered Services (xi) Amounts Collected and Receivable from Patients from NF Non-covered Services (xii) Amounts Collected and Receivable from Other Sources (xiii) Total Amounts Collected and Receivable (xiv) Comments 2. Directions for Completion of the Patient Log. The log should be maintained on a monthly basis with separate pages used for each month. Medicaid NF patients should be listed in a separate section of the log so that Medicaid NF program statistics can be generated. The columns should be completed and totaled as soon after the end of the month as the figures are available. Adjustments should be made to the monthly totals to reflect adjustments in the log due to changes in patient status, additional information, or other reasons. Complete explanations should accompany each adjustment. For non-TennCare patients, columns 8 through 14 can be omitted or adapted for other uses.

(3) Auditing of Cost Reports. The cost reports filed in compliance with this Chapter and all applicable provider records shall be subject to audit or desk review by the Comptroller. The cost reports filed in compliance with this Chapter must provide adequate cost and statistical data. This data must be based on and traceable to the provider’s financial and statistical records and must be adequate, accurate and in sufficient detail to support payment made for services rendered to beneficiaries. This data must also be available for and capable of verification by the Comptroller. The provider must permit the Comptroller to examine any records and documents necessary to ascertain information pertinent to the determination of the proper amount of program payments due. Data reflected on the cost report which cannot be substantiated may be disallowed.

(4) Records Retention. Each Medicaid participating provider of NF services is required to maintain adequate financial and statistical records which are accurate and in sufficient detail to substantiate the cost data reported. These records must be retained for a period of not less than ten (10) years from the date of the submission of the cost report, and the provider is required to make such records available upon demand to representatives of the Department of Finance and Administration, the Comptroller of the Treasury, or the United States Department of Health and Human Services.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 71-5-105, 71-5-109, 71-5-134, and 71-5-1413.
• Administrative History: Original rule filed January 18, 1979; effective March 5, 1979. Rule renumbered as 1200-13-02- .06. New rule filed June 2, 1988; effective July 17, 1988. Repeal filed May 5, 2009; effective July 19, 2009. New rules filed May 1, 2018; effective July 30, 2018. Amendments filed March 31, 2026; effective June 29, 2026.

Tenn. Comp. R. & Regs. 1200-13-02-.06 REIMBURSEMENT METHODOLOGY FOR NURSING FACILITIES

(1) Effective July 1, 2018, Medicaid participating NFs will be reimbursed using a case mix reimbursement system with quality informed rate components, and a stand-alone qualitybased component. The initial base-year cost report data used to establish the case mix rates will be the most recently audited or desk reviewed NF cost reports covering a period greater than six (6) months, with an end date on or before December 31, 2015.

(2) The base-year annualized Medicaid resident day-weighted median costs and prices shall be rebased at an interval no longer than three (3) years after a new base year period has been established. The new base year median costs and prices will be established using the most recently audited or desk reviewed cost reports that have a cost reporting period greater than six (6) months, with a cost report end date eighteen (18) months or more before the start of the rebase period.

(a) Cost reports issued a disclaimer of opinion during the audit process or cost reports containing substantial issues (including incomplete filing) during the desk review process, as solely determined by the Comptroller, will be excluded from the median and price calculations.

(b) Only audited or reviewed cost reports available prior to the July 1 rate setting will be considered in the median and price calculations.

(3) For rate periods between rebasing, an index factor shall be applied to the following:

(a) Direct care base year annualized Medicaid resident-day-weighted medians;

(b) Administrative and Operating base year annualized Medicaid resident-day-weighted medians; and (c) The provider’s cost-based component.

(4) Each NF provider’s reimbursement rate will be determined through the sum of the following cost components:

(a) The sum of the NF provider’s direct care case mix adjusted cost component, direct care non-case mix adjusted cost component, and the direct care spending floor adjustment;

(b) The statewide Administrative and Operating Cost Component;

(c) The NF provider’s capital cost component (FRV);

(d) The NF provider’s cost-based component; and (e) Adjustments to the rate.

(5) Determination of Rate Components.

(a) The NF provider’s direct care portion of the reimbursement rate is calculated as the sum of the direct care case mix adjusted cost component, the direct care non-case mix adjusted cost component, and the direct care spending floor adjustment.

1. The direct care case mix adjusted cost component reimbursement rate shall be determined as follows:

(i) The per diem direct care case mix adjusted cost for each NF is determined by dividing the facility’s direct care case mix adjusted cost from the base year cost reporting period by the NF’s actual total resident days during the cost reporting period. These costs shall be trended forward from the midpoint of the NF provider’s base year cost reporting period to the midpoint of the rate year using the index factor.

(ii) The per diem neutralized direct care case mix adjusted cost is calculated by dividing each NF provider’s inflated direct care case mix adjusted cost per diem by the NF provider’s NF cost report period case mix index.

(iii) The per diem neutralized inflated direct care case mix adjusted cost, for each Medicaid participating NF that meets the criteria to be included in the cost component median, is arrayed from low to high and the annualized Medicaid resident-day-weighted median cost is determined.

(iv) The statewide direct care case mix adjusted price is established at one hundred six percent (106.00%) of the direct care case mix adjusted annualized Medicaid resident-day-weighted median cost.

(v) The statewide direct care case mix adjusted price is then multiplied by each NF’s own Medicaid NF-wide semi-annual average case mix index for the rate period to establish the direct care case mix adjusted cost component.

2. The direct care non-case mix adjusted cost component reimbursement rate shall be determined as follows:

(i) The per diem inflated direct care non-case mix adjusted cost for each NF provider is determined by dividing the facility’s direct care non-case mix adjusted cost during the base year cost reporting period by the NF provider’s actual total resident days during the cost reporting period. These costs shall be trended forward from the midpoint of the NF’s base year cost reporting period to the midpoint of the rate year using the index factor.

(ii) The per diem inflated direct care non-case mix adjusted cost, for each NF that meets the criteria to be included in the cost component median, is arrayed from low to high and the annualized Medicaid resident-dayweighted median cost is determined.

(iii) The statewide direct care non-case mix adjusted price is established at one hundred six percent (106.00%) of the direct care non-case mix adjusted annualized Medicaid resident-day-weighted median cost.

(iv) The statewide direct care non-case mix adjusted price is then multiplied by each NF provider’s direct care non-case mix adjusted quality incentive multiplier to establish the NF provider’s direct care non-case mix adjusted cost component.

(v) The direct care non-case mix adjusted quality incentive multiplier is determined by the NF provider’s Quality Tier. The quality incentive multiplier is determined as follows:

(I) Quality Tier 1 – One hundred five percent (105.00%) multiplier (II) Quality Tier 2 – One hundred two and one-half percent (102.50%) multiplier (III) Quality Tier 3 – One hundred percent (100.00%) multiplier 3. The direct care spending floor adjustment is calculated as follows:

(i) The sum of the NF provider’s direct care case mix adjusted and direct care non-case mix adjusted cost components calculated above are multiplied by the NF provider specific spending floor percentage to determine the direct care spending floor threshold.

(ii) The direct care spending floor percentage for each NF provider is determined by the NF provider’s Quality Tier. The spending floor percentage is determined as follows:

Effective Date of Quality Tier Floor Percentage Quality Tier 1 Quality Tier 2 Quality Tier 3 July 1, 2018 82.50% 85.00% 87.50% July 1, 2019 85.00% 87.50% 90.00% July 1, 2020 87.50% 90.00% 92.50% July 1, 2021 and beyond 90.00% 92.00% 94.00% (iii) The direct care spending floor adjustment is calculated as the lesser of the Medicaid direct care cost per diem minus the direct care spending floor threshold, or zero.

(iv) The Medicaid direct care cost per diem used in the direct care spending floor calculation is established as follows :

(I) Utilize the most recently audited or desk reviewed cost reports covering a period of six (6) months or more, with an end date eighteen (18) months or more prior to each July 1 rate setting period.

(II) The per diem inflated direct care non-case mix adjusted cost for each NF provider is determined by dividing the facility’s direct care non-case mix adjusted cost during the applicable cost reporting period by the NF provider’s actual total resident days during the cost reporting period. These costs shall be trended forward from the midpoint of the applicable cost reporting period to the midpoint of the rate year using the index factor.

(III) The per diem direct care case mix adjusted cost for each NF is determined by dividing the facility’s direct care case mix adjusted cost from the applicable cost reporting period by the NF provider’s actual total resident days during the cost reporting period. These costs shall be trended forward from the midpoint of the cost reporting period to the midpoint of the rate year using the index factor.

(IV) The per diem neutralized inflated direct care case mix adjusted cost is calculated by dividing each NF provider’s inflated direct care case mix adjusted cost per diem by the NF provider’s NF cost report period case mix index.

(V) The per diem neutralized inflated direct care case mix adjusted cost is then multiplied by each NF provider’s own Medicaid NF-wide semi-annual average case mix index for the rate period to create the Medicaid direct care case mix adjusted cost per diem.

(VI) The Medicaid direct care case mix adjusted cost per diem is then added to the inflated direct care non-case mix adjusted cost per diem to create the Medicaid direct care cost per diem.

(b) The statewide Administrative and Operating Cost Component will be determined as follows:

1. The per diem administrative and operating cost for each NF provider is determined by dividing the provider’s administrative and operating cost during the base year cost reporting period by the NF provider’s actual total resident days during the cost reporting period. These costs shall be trended forward from the midpoint of the NF provider’s base year cost reporting period to the midpoint of the rate year using the index factor.

2. The per diem administrative and operating cost, for each NF that meets the criteria to be included in the cost component median, is arrayed from low to high and the annualized Medicaid resident-day-weighted median cost is determined.

3. The statewide Administrative and Operating Cost Component is established at one hundred one percent (101.00%) of the administrative and operating annualized Medicaid resident-day-weighted median cost.

4. Every NF provider will receive the statewide Administrative and Operating Cost Component as reimbursement in full for its administrative and operating expenditures.

5. For MDS Case-Mix Reviews that begin on or after July 1, 2026, if TennCare determines due to an MDS Case-Mix Review that a nursing facility has Unsupported MDS Resident Assessments, then the following procedures shall be followed in applying any penalties:

(i) The reviewer shall:

(I) Review a sample of MDS resident assessments; and (II) Determine the percent of assessments in the sample that are unsupported.

(ii) If the percent of assessments in the initial sample that are unsupported is greater than the minimum unsupported threshold, the reviewer shall expand to a larger sample of resident assessments. If the percent of assessments in the initial sample that are unsupported is equal to or less than the minimum unsupported threshold:

(I) The reviewer shall conclude the field portion of the MDS Case-Mix Review; and (II) No penalty shall be applied.

(iii) For nursing facilities with MDS Case-Mix Reviews performed on the initial and expanded sample of resident assessments, the reviewer will determine the percent of all assessments that are unsupported.

(iv) If the percentage of unsupported assessments for the initial and expanded sample of all assessments reviewed is greater than the minimum unsupported threshold in the MDS Case-Mix Review, a penalty shall apply and shall be calculated as follows:

(I) The Administrative and Operating Cost Component of the Medicaid rate shall be reduced by the percentage as shown in the following table. The impacted semi-annual rate period will be the rate effective date immediately following the completion of the MDS Case-Mix Review, unless the MDS Case-Mix Review is completed within the two calendar months prior to the rate effective date and then the subsequent rate effective date will be impacted. For example, MDS Case-Mix Reviews completed in November and December will impact the next July 1 rate setting period.

Administrative and Operating Cost Component:

Penalty Amounts for MDS Case-Mix Reviews MDS Review for Which Penalty Is Applied Less than 20.01 Percent Unsupported 20.01 (Minimum Unsupported Threshold) – 30.00 Percent Unsupported 30.01 – 40.00 Percent Unsupported Greater Than 40.00 Percent Unsupported First unsupported MDS field review N/A 0.50% 1.00% 1.50% Second consecutive unsupported MDS field review N/A 2.50% 3.00% 3.50% Third consecutive unsupported MDS field review N/A 5.00% 5.50% 6.00% Fourth consecutive unsupported MDS field review N/A 7.50% 8.00% 8.50% (II) Reimbursement lost as a result of any corrective remedies shall not be recoverable by the provider.

(v) If the percent of assessments for the initial and expanded sample of all assessments reviewed that are unsupported is equal to or less than the minimum unsupported threshold:

(I) The reviewer shall conclude the MDS Case-Mix Review; and (II) No penalty shall apply.

(c) The capital cost component of the reimbursement rate shall be based on a fair rental value (FRV) appraisal based reimbursement system, in lieu of reimbursement for capital specific costs such as depreciation, amortization, interest, rent/lease expense, etc. The capital cost component will be determined as follows:

1. Each NF provider will receive an appraisal from TennCare’s certified appraisal contractor. TennCare’s certified appraisal contractor must be selected through a formal procurement process for a single statewide contract.

2. If six (6) or more years have elapsed since statewide mandatory reappraisals were last completed, NF appraisal values will be subject to a statewide mandatory reappraisal process in conjunction with the next rebase. TennCare may, at its discretion, conduct a reappraisal in conjunction with an earlier rebase.

3. A NF provider may apply for a voluntary reappraisal. The voluntary NF reappraisal will be effective for rate setting purposes beginning with the semiannual rate period directly following the completion of the reappraisal process.

The reappraisal process will not be determined complete until the reappraisal is final. To obtain a voluntary reappraisal, the NF must meet all of the following criteria:

(i) The NF satisfies one of the following conditions:

(I) NF provider has moved its certificate of need/operations to a new permanent location. The new location is not required to be new construction. However, if the new location is one that has a current active appraisal or reappraisal valuation, the provider will be given the active appraisal value for rate setting purposes.

(II) NF provider has moved more than ten percent (10%) of its total licensed bed capacity to a new location on the current NF campus, and the new location was not previously included in any appraisal or reappraisal process.

(III) NF provider has performed and placed into service within the last twenty-four (24) months a renovation/improvement greater than or equal to fifteen percent (15%) of its current net depreciated facility appraisal value (excluding land, but including site improvements).

The total cost of the renovation shall only consider the cost of fixed assets as defined in this Chapter.

(IV) Any renovation/improvement included in a previous appraisal/reappraisal process must not be considered when determining if the reappraisal participation criteria has been met.

(ii) The NF has provided sufficient documentation to TennCare to support it has satisfied one of the conditions in subpart (i) above.

(iii) The NF agrees to utilize the certified appraisal firm and appraisal methodology designated by TennCare.

(iv) The NF agrees to be responsible for the cost of the appraisal.

(v) The NF agrees that all semi-annual capital improvement updates submitted prior to the reappraisal request will be considered as part of the new reappraisal, and removed from being separately considered in the rate setting process.

4. TennCare’s appraisal contractor will utilize the Marshall and Swift (Boeckh)

Building Valuation System for Nursing Facilities, or its successor, to calculate the fee simple replacement cost (undepreciated and depreciated) of the building(s), site improvements and the market value of land for each NF provider.

(i) The fee simple replacement cost of buildings and site improvements is calculated using the cost approach appraisal method.

(ii) Only physical deterioration is considered. The appraisals are performed under the assumption that the NF is financially and functionally viable and economic obsolescence is not considered.

(iii) Land values are determined using the sales comparison approach.

5. Determination of the Building(s) fee simple replacement cost.

(i) The comparative unit method (calculator method) from Marshall and Swift

section 15, or its successor, is utilized for this calculation.

(I) All costs, multipliers, and economic lives are directly pulled from the Marshall and Swift Commercial Estimator 7, or its successor.

(II) Only physical depreciation is considered, and assumptions are made that no obsolescence is present.

(III) Physical depreciation is determined based on the certified appraiser’s opinion of effective age based on the actual age of the facility and renovations and updates over time.

(IV) Only fixed assets are determined through the appraisal process.

Moveable equipment values are determined separately.

(ii) First, an actual weighted age of the facility is determined based on the age of building improvements, and the square footage of each section.

Separate buildings or additions to original buildings may be separately valued by the appraiser, if determined necessary. The weighted age will then be grouped into the following ranges:

Actual Age Implied Age for Depreciation 0 – 10 years Actual Age 11 – 15 years 13 years 16 – 20 years 18 years 21 – 25 years 23 years 26 – 30 years 28 years 31 – 35 years 33 years 35 years + 10 years remaining life (iii) After the determination of implied age, recent NF provider capital improvements will be considered to determine whether the implied age needs to be adjusted for depreciation purposes. Capital improvements submitted by the NF provider during the appraisal process are considered for effective age purposes. The allowed range of placed in service dates of capital improvements allowed for submission will be determined by TennCare.

(iv) The final calculated effective age (implied age less improvement considerations) will be divided into an economic life based on Marshall and Swift guidelines as detailed in the table below. At no time will remaining economic life (economic life less effective age) be less than 10 years.

Class Low Cost and Average Good and Excellent A 45 50 B 45 50 C 40 45 D 35 40 (v) The following is a listing of the description of the class of construction:

Class Description A Fireproofed structural steel B Reinforced concrete columns/beams C Masonry bearing walls D Wood or steel studs (vi) The following is a listing of the rank, or estimate of construction quality based on the Marshall and Swift definition of quality:

Rank Description 1 Low Cost 2 Average 3 Good 4+ Excellent 6. Determination of Site Improvement fee simple replacement cost. Site improvement cost estimates are based on Marshall and Swift section 66, or its successor. The site improvements will be depreciated based on a 15 year economic life.

7. Determination of Land Market Value. Land values are determined through the sales comparison approach.

(i) Sales and listings of vacant land comparable to the subject property are collected and analyzed.

(ii) The appraiser adjusts the prices to some common unit of comparison, and then adjusts the prices for market conditions, location, physical characteristics, available utilities, zoning, highest and best use, and other relevant variations.

(iii) From this information the appraiser derives a unit value applicable to the NF. This unit value is then utilized to establish the market value of land as if it was vacant.

(iv) The maximum value of land used in determining FRV per diem rates will be $7,500.00 per licensed bed. Licensed beds used in this calculation will be total current NF licensed beds as of the April 1 prior to each July 1 rate setting.

(v) The lesser of the maximum land value or the appraised land value will be the allowable land value utilized for FRV calculation purposes.

8. Fair Rental Value Per Diem Calculation.

(i) The undepreciated and depreciated values of the NF provider’s building(s), site improvements, and land (which is not depreciated) are determined through the appraisal process.

(ii) The depreciated values are subtracted from the undepreciated values to determine the total value of depreciation.

(iii) The calculated depreciation is then modified in the following manner to determine the total modified depreciation to be applied to the fair rental value system:

(I) NF providers with a weighted construction year age less than thirty (30) years will have calculated depreciation multiplied by fifty percent (50%) to determine their total modified depreciation to be applied to the fair rental value system.

(II) NF providers with a weighted construction year age of thirty (30) years or more will have their calculated depreciation multiplied by seventy percent (70%) to determine their total modified depreciation to be applied to the fair rental value system.

(iv) Total modified depreciation is subtracted from the undepreciated facility values (buildings, site improvements, and allowable land) and the value of NF provider fixed asset additions is added to the totals to determine total base facility value.

(v) The total base facility value is then compared to a maximum allowable base value threshold.

(vi) The maximum allowable base facility value threshold is established by multiplying the NF provider total licensed beds by $75,000. NF providers may increase the per licensed bed threshold of $75,000 based on their specific Medicaid private room resident day percentage. The Medicaid private room resident day percentage is calculated from base year cost report Medicaid private room resident days divided by total base year bed days available. Each NF provider is then compared to the thresholds established in the table below to determine any additions to the total per licensed bed value.

Total Addition to Per Bed Value Medicaid Private Room Resident Day Percentage Threshold $3,000 10% $1,500 5% $0 Less than 5% (vii) A moveable equipment value will be determined for each provider by multiplying total licensed beds by $7,500.

(viii) The lesser of the maximum allowable base facility value threshold or the actual total base facility value calculated above will be added to the total moveable equipment value to determine the total facility value.

(ix) The total facility value will be multiplied by a rental factor to establish an annual fair rental value. The rental factor will vary depending on the NF provider’s quality tier. The rental factor will be established as follows:

(I) Quality Tier 1 – Eight and seven-tenths percent (8.70%)

(II) Quality Tier 2 – Eight and thirty-five hundredths percent (8.35%)

(III) Quality Tier 3 – Eight percent (8.00%)

(x) The annual fair rental value will be divided by the greater of total annualized actual resident days, or the minimum occupancy percentage threshold of eighty-five percent (85%) of annualized licensed beds capacity of the provider to establish the provider’s fair rental value per diem.

(xi) The licensed beds utilized for fair rental value purposes will be recognized once annually. Total NF licensed beds will be determined using the current facility licensed beds as of the April 1 prior to each July 1 rate setting.

(xii) No depreciation or inflation factors will be applied to the appraisal totals in non-appraisal years.

9. Modification of Total Facility Value between Appraisal Periods.

(i) In order to continue to incentivize providers to perform capital improvement in non-appraisal years, TennCare will allow each NF provider to modify its total facility value on a semi-annual basis for capitalized fixed assets by meeting the requirements set out below in items (I) through (V). A facility may request a waiver of one or more of the requirements by submitting a written request to TennCare detailing the requirement(s) requested to be waived and the reasons supporting the request.

(I) The request for modification of total facility value is submitted at a minimum three (3) months prior to the July 1 or January 1 rate setting periods, and the modification is reported on the applicable form designated by TennCare.

(II) The total capitalized fixed assets are greater than $1,000 per licensed bed. Licensed bed totals will be determined as of the April 1 following the submission for modification.

(III) The cost must be capitalized according to CMS Publication 15-1, The Provider Reimbursement Manual – Part 1, and have been placed into service within the previous twenty-four (24) months prior to the submission date of the modification request.

(IV) Capitalized assets must contain only fixed assets as defined by CMS Publication 15-1, The Provider Reimbursement Manual – Part 1, sections 104.2 and 104.3. Major movable equipment that has been capitalized must not be included for modification purposes.

(V) The capitalized assets must be reported to TennCare net of any grant monies or insurance proceeds associated with the purchasing of the asset.

(ii) Qualifying capitalized fixed asset expenditures will be added to the total facility base value portion of the FRV per diem calculation.

(iii) No inflation or depreciation will be applied to the qualifying items.

(iv) A NF statewide mandatory appraisal or voluntary reappraisal will eliminate all previously submitted and accepted fixed asset addition amounts from the FRV per diem calculation.

(v) Request for modification will not be accepted during a statewide mandatory appraisal year, as it is assumed the provider will have received credit for these items within the appraisal process, regardless of whether or not the provider actually submitted the information to TennCare’s certified appraisal firm.

(d) Cost-Based Component. The NF provider’s cost-based component is the sum of the provider’s NF related real estate tax per diem calculation and the provider assessment cost-based reimbursement rate determined by TennCare. The cost-based component is determined as follows:

1. The NF provider’s NF real estate tax cost reported on the Medicaid supplemental cost report is divided by the greater of actual base year cost report resident days or eighty-five percent (85%) of base year cost report licensed beds capacity of the provider. These costs shall be trended forward from the midpoint of the NF provider’s base year cost reporting period to the midpoint of the rate year using the index factor.

2. The provider assessment cost-based reimbursement rate is determined by TennCare for only the Medicaid share of the provider assessment cost incurred by NF providers. NF providers will receive their cost-based reimbursement rate based on their specific provider class. The provider class will be determined for each NF provider from the cost report year information utilized in the calculation of the provider assessment. The provider class criteria and associated provider assessment cost-based reimbursement rate are determined as described in T.C.A. §71-5-1003, or its successor.

(e) Adjustments to the Reimbursement Rate.

1. Adjustments to the Medicaid daily rate may be made when changes occur that will eventually be recognized in updated cost report data, for example an increase in the federal minimum wage rate. These adjustments would be effective until the next rebasing of cost report data or until such time as the cost reports fully reflect the change. Adjustments to the rate will be made solely at the discretion of TennCare.

2. Budget Adjustment Factor (BAF). For the beginning of each state rate year effective July 1st TennCare will establish a NF program budget target and compare that to the annual expected Medicaid expenditures on nursing facility days for the upcoming rate year using established rate setting mechanics.

TennCare will establish the BAF to adjust the annual expected Medicaid expenditures to meet the program’s NF budget target. The BAF may be positive or negative and will be applied as an across the board percentage adjustment to all providers reimbursement rate components calculated according to this rule.

The following is the detailed calculation of the BAF:

(i) Rate System Expected Cost (I) Projected July 1 Provider Reimbursement Rates Calculated Using All Applicable Reimbursement Provisions Specified within this Chapter (prior to application of the BAF)

(II) X New Cost Report Medicaid Days (From Most Recent Comptroller Reviewed Cost Report data, or paid claims data if TennCare determines this data source to be more appropriate)

(III) = Expected Cost of NF Reimbursement System.

(ii) NF Budget Target (I) Projected July 1 Provider Reimbursement Rates Calculated Using All Applicable Reimbursement Provisions Specified within this Chapter (prior to application of the BAF)

(II) X New Cost Report Medicaid Days (From Most Recent Comptroller Reviewed Cost Report data, or paid claims data if TennCare determines this data source to be more appropriate)

(III) = Target Cost of NF reimbursement System Prior to Adjustments (IV) +/- State Budgetary Adjustments (V) = Final Budget Target of NF Reimbursement System.

(iii) BAF Calculation (I) NF Budget Target / Rate System Expected Cost = BAF % to apply to all provider rates.

(II) For each non-July 1 rate setting period, TennCare will recalculate the BAF to accommodate changes to the reimbursement system from new CMI, new facilities, legislative mandates, and other factors. The BAF is applied to all provider reimbursement rate components, and will be adjusted to ensure the state will continue to meet the NF budget target. The BAF adjustment may be positive or negative depending on circumstance.

3. For rate setting periods from July 1, 2018, to June 30, 2020, a phase-in of provider reimbursement rates will occur in an effort to ease the transition for providers to the case mix reimbursement system. The phase-in process will be calculated as follows:

(i) A NF provider’s base reimbursement rate will be established as the Medicaid day weighted average of the Level 1 and Level 2 NF reimbursement rate in effect for each NF provider on July 1, 2017, as determined on January 1, 2018. The Medicaid day weighted average will also consider the NF provider’s quarterly bridge payments for acuity and quality. The base reimbursement rate will be the starting point for all phase-in calculations.

(ii) For each July 1 rate setting, the current base reimbursement rates shall be trended forward from the midpoint of the previous rate year to the midpoint of the new rate year using the index factor.

(iii) The providers case mix system reimbursement rate will be determined according to the rate calculation procedures identified in this rule.

(iv) The reimbursement rate differential will be determined by subtracting the NF provider’s base reimbursement rate from the applicable case mix system reimbursement rate.

(v) If the calculated reimbursement rate differential exceeds a positive or negative TennCare determined corridor amount, then a rate adjustment will be applied to the NF provider’s case mix system reimbursement rate in an amount equal to the difference between the rate differential total and the corridor amount, in order to ensure the NF provider’s reimbursement rate is not increased or decreased more than the corridor amount from the calculated base reimbursement rate.

(vi) Effective for rate periods beginning July 1, 2018, the corridor amount will be a floor of minus six dollars (-$6) from the base reimbursement rate, with the ceiling being determined at an amount above the base reimbursement rate necessary to achieve statewide budget neutrality.

(vii) Effective for rate periods beginning July 1, 2019, the corridor amount will be a floor of minus twelve dollars (-$12) from the base reimbursement rate, with the ceiling being determined at an amount above the base reimbursement rate necessary to achieve statewide budget neutrality.

(viii) Effective for rate periods beginning July 1, 2020, the case mix system reimbursement rate will no longer be subjected to a phase-in.

History

• Authority: T. C.A. §§ 4-5-202, 4-5-203, 14-1905, 71-5-105, 71-5-109, 71-5-134, and 71-5-1413.
• Administrative History: (Formerly numbered as 1200-13-02-.05.) Original rule filed January 18, 1979; effective March 5, 1979. Amendment filed June 2, 1988; effective July 17, 1988. Repeal filed May 5, 2009; effective July 19, 2009. New rules filed May 1, 2018; effective July 30, 2018. Amendments filed January 28, 2021; effective April 28, 2021. Amendments filed July 6, 2022; effective October 4, 2022. Amendments filed March 31, 2026; effective June 29, 2026.

Tenn. Comp. R. & Regs. 1200-13-02-.07 CASE MIX INDEX CALCULATION

(1) The Resource Utilization Groups-IV (RUG-IV) Version 1.03, 48-Grouper, or its successor, index maximizer model shall be used as the resident classification system to determine all case mix indices, using data from the minimum data set (MDS) submitted by each NF provider until September 30, 2023. Standard Version 1.03, or its successor, case mix indices developed by CMS, using nursing-only RUG weights, shall be the basis for calculating average case mix indices to be used to adjust the direct care case mix adjusted cost component.

(2)

Through rate periods ending June 30, 2024, each resident in the facility with a completed and submitted assessment shall be assigned a RUG-IV 48-Grouper, or its successor. The RUG- IV 48 Grouper, or its successor, will be calculated using each resident MDS assessment transmitted and accepted by CMS. These assessments are then translated to the appropriate case mix index using the time-weighted acuity measurement system. Using the individual resident case mix indices, two NF provider case mix indices are calculated, the NF-wide semi-annual average case mix index and the Medicaid NF-wide semi-annual average case mix index. The two case mix indices for each Medicaid participating NF shall be determined two times per year.

(3) Effective for rate periods beginning July 1, 2024, the Patient Driven Payment Model (PDPM) resident classification system, or its successor, shall be used as the resident classification system to determine all case mix indices, using data from the minimum data set (MDS) submitted by each NF provider. The PDPM nursing component case mix groups (CMGs) and case mix index table effective October 1, 2023 as listed in the SNF PPS payment rule for FY 2024 are used to determine case mix indices for calculating average case mix indices to be used to adjust the direct care case mix adjusted cost component.

(4) Effective for rate periods beginning July 1, 2024, each resident in the facility with a completed and submitted assessment shall be assigned a PDPM-Grouper, or its successor. The PDPM- Grouper, or its successor, will be calculated using each resident MDS assessment transmitted and accepted by CMS. These assessments are then translated to the appropriate case mix index using the time-weighted acuity measurement system. Using the individual resident case mix indices, two NF provider case mix indices are calculated, the NF-wide semi-annual average case mix index and the Medicaid NF-wide semi-annual average case mix index. The two case mix indices for each Medicaid participating NF shall be determined two times per year.

(5) Any MDS assessments or MDS assessment periods which coincide with a federally or state declared public health emergency period may be excluded from or have BC1-Delinquent records removed from the calculation of the semi-annual case mix index averages. In the event that less than three (3) months of MDS assessment information is available for the semi-annual case mix index average calculations after exclusion, the most recently preceding semi-annual case mix index average calculations which contain three (3) or more months of MDS assessment information will be utilized for rate setting.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 14-23-105, 14-23-109, 14-23-130, 14-23-201, 71-5-105, 71-5- 109, 71-5-134, and 71-5-1413.
• Administrative History: (Formerly numbered as 1200-13-02-.06). Original rule filed June 25, 1985; effective July 25, 1985. Amendment filed June 2, 1988; effective July 17, 1988. Amendment filed January 30, 1989; effective March 16, 1989. Repeal filed May 5, 2009; effective July 19, 2009. New rules filed May 1, 2018; effective July 30, 2018. Amendments filed January 28, 2021; effective April 28, 2021. Amendments filed March 31, 2026; effective June 29, 2026.

Tenn. Comp. R. & Regs. 1200-13-02-.08 CASE MIX INDEX REPORTS PROCESS

(1) TennCare or its contractor shall provide each NF provider with the Preliminary Case Mix Index Report (PCIR) by approximately the fifteenth (15th) day of the second (2nd) month following the end of the MDS assessment collection period for each semi-annual rate period.

The PCIR will serve as notice of the MDS assessments transmitted and provide an opportunity for the NF provider to correct and transmit any missing MDS assessments or tracking records or apply the CMS correction policy where applicable.

(2) As part of the PCIR process, providers are required by TennCare to verify the end of therapy dates associated with their submitted MDS assessments. TennCare will designate the format and process providers must follow in order to satisfy the end of therapy dates reconciliation process. Should a provider choose not to perform the reconciliation of therapy dates, records with no discernable end of therapy date will be given a default date of two days after the start of therapy date associated with the record.

(3) TennCare or its contractor shall provide each NF provider with a Final Case Mix Index Report (FCIR) utilizing MDS assessments after allowing the NF provider two (2) weeks, or ten (10) business days, to process its corrections. TennCare may extend this time period if a request is received from the provider.

(a) A cut-off date will be published for each case mix index report period. New or revised MDS assessment records or end of therapy date updates submitted by the NF provider after the cut-off date will not be included in the case mix index FCIR. TennCare, at its sole discretion, may override the cut-off date only in cases of extraordinary circumstances that are beyond the control of the provider and through no fault of their own.

(b) If TennCare determines that a NF provider has delinquent MDS resident assessments, for purposes of determining both average case mix indices, such assessments shall be assigned the case mix index associated with the PDPM group “BC1-Delinquent” or its successor. A delinquent MDS shall be assigned a case mix index value equal to the lowest case mix index in the PDPM classification system or its successor.

(4) The case mix index values from the FCIR will be utilized in establishing NF provider reimbursement as described in Rule .06.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 71-5-105, 71-5-109, 71-5-134, and 71-5-1413 and Public Chapter 358 of the Acts of 1993.
• Administrative History: Original rule filed June 2, 1988; effective July 17, 1988. Repeal filed June 22, 1989; effective August 4, 1989. Amendment filed March 18, 1994; effective June 1, 1994. Repeal filed May 5, 2009; effective July 19, 2009. New rules filed May 1, 2018; effective July 30, 2018. Amendments filed March 31, 2026; effective June 29, 2026.

Tenn. Comp. R. & Regs. 1200-13-02-.09 NEW NURSING FACILITY PROVIDERS

(1) The reimbursement rate for new NF providers will be determined following the methodology detailed in Rules .06–.08 with the following exceptions:

(a) The provider’s Medicaid NF semi-annual case mix index will be calculated as the statewide annualized Medicaid resident day-weighted average Medicaid NF semiannual case mix index until the provider has completed one full semi-annual rate period of operation following the acceptance of Medicaid recipients.

(b) The provider will be exempt from the direct care spending floor until the July 1 rate setting following the date the initial cost report filing is submitted to TennCare, and the Comptroller has completed its review of the cost report filing.

(c) The provider will be included in quality tier three (3) for the rate determination process, as defined in Rule .06, until the July 1 rate setting following the date the provider has submitted at least six (6) consecutive months of quality performance data in order to determine the provider’s Quality Tier.

(d) The provider will be included in the new provider class for provider assessment costbased reimbursement rate purposes. The provider will remain in the new provider class until such time that the provider has its information included in a provider assessment calculation base period. The provider will then receive its provider assessment costbased reimbursement rate according to its specific provider class attributes as defined in Rule .06.

(e) The provider, if required to pay real estate tax, will receive the statewide annualized Medicaid resident day-weighted average inflated real estate tax cost value. The established real estate cost value will then be divided by the minimum occupancy percentage threshold of eighty-five percent (85%) of annualized bed days available to create the per diem real estate tax portion of the cost-based component of the rate.

The per diem real estate tax cost-based rate will remain in effect until at least one of the two timelines and criteria below are met:

1. The July 1 rate setting after the provider has submitted an acceptable initial cost reporting package to the Comptroller and the Comptroller has completed the review of the real estate tax portion of the report. The approved NF provider’s real estate tax amount from the Medicaid supplemental cost report is divided by the greater of actual base year cost report resident days, or eighty-five percent (85%) of base year cost report licensed beds capacity of the provider. These costs shall be trended forward from the midpoint of the NF provider’s base year cost reporting period to the midpoint of the rate year using the index factor.

2. The semi-annual rate period immediately following compliance with the criteria listed in subparts (i) and (ii). The approved NF provider’s real estate tax amount will be divided by the minimum occupancy percentage threshold of eighty-five percent (85%) of the NF provider’s annualized licensed bed days available of the provider. No trending factor will be applied as the tax amounts accepted will be assumed to be from the current period.

(i) The provider submits to the Comptroller documentation to support its real estate tax expense for the current cost reporting period. TennCare will be solely responsible for determining the format in which the information must be submitted, and what supporting documentation will be considered acceptable.

(ii) The Comptroller has reviewed the provider submission and has determined it to be acceptable.

(f) The capital component of the reimbursement rate will be determined as follows:

1. The provider must contact TennCare to arrange for an appraisal to be conducted by TennCare’s certified appraisal contractor. The appraisal will be utilized in capital component reimbursement consistent with Rule .06.

2. The facility will have a maximum of ninety (90) days from the Medicaid certification date to complete the appraisal process.

3. A new facility without an appraisal will receive the maximum total facility value possible under the FRV system until the semi-annual rate period in immediate succession to the completion of the appraisal process. When the appraisal process is complete, the appraisal will be utilized in capital component reimbursement consistent with Rule .06. The annual FRV will be divided by the minimum occupancy percentage threshold to establish the FRV per diem for the NF provider. The minimum occupancy percentage threshold applied to the FRV calculation will be modified for a new facility as follows:

(i) If the NF provider has not previously provided the NF level of care for any payer type, then the minimum occupancy percentage threshold will be calculated as follows:

(I) The minimum occupancy percentage threshold will be calculated at sixty-five percent (65%) of annualized NF provider bed days available until the July 1 rate setting immediately following the NF providers Medicaid certification date.

(II) If the initial July 1 rate setting period occurs prior to the NF provider receiving the sixty-five percent (65%) minimum occupancy percentage threshold for a full semi-annual rate period, then the NF provider will receive a minimum occupancy percentage threshold of seventy-five percent (75%) of annualized NF provider bed days available until the next July 1 rate setting occurs.

(III) All subsequent rate periods will have the minimum occupancy percentage threshold calculated according to capital component reimbursement Rule .06.

(ii) A NF provider that is new to Medicaid certification, but has previously provided NF level of care services, will not be subject to the modified minimum occupancy percentage threshold provisions.

4. If the new facility does not meet the ninety (90) day appraisal completion timeline, the facility will receive the lowest total FRV facility value in the state beginning with the semi-annual rate period in immediate succession to the ninety (90) day timeline expiring. The lowest total FRV facility value will be utilized to set the capital component per diem reimbursement rate according to reimbursement

Rule .06. The lowest total FRV facility value mandate will remain in effect for a minimum of one (1) semi-annual rate period, and will remain in effect until the semi-annual period in immediate succession to the facility’s completion of the appraisal process. Once the appraisal process is complete and the lowest total FRV facility value mandate period has elapsed, the appraisal will be utilized in capital component reimbursement in line with Rule .06.

5. No modification of the minimum occupancy percentage threshold will be applied for providers who have failed to complete the appraisal process within the required ninety (90) day timeline.

6. An appraisal process will not be determined complete until the appraisal is final.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 71-5-105, 71-5-109, 71-5-134, and 71-5-1413.
• Administrative History: Original rules filed May 1, 2018; effective July 30, 2018. Amendments filed March 31, 2026; effective June 29, 2026.

Tenn. Comp. R. & Regs. 1200-13-02-.10 CHANGES OF OWNERSHIP OF EXISTING NURSING FACILITIES

(1) A CHOW exists if the beds of the new owner have previously been certified to participate, or otherwise participated, in the Medicaid program under the previous owner’s provider agreement. Rates paid to NF providers that have undergone a CHOW will be calculated in the following manner:

(a) The initial NF provider reimbursement rate will be based upon the acuity, costs, days, appraisal data and quality information of the prior owner.

(b) If the CHOW is as a result of a non-related party transaction, the new NF provider may request from TennCare a provisional waiver of the application of any direct care spending floor rate reduction that would otherwise occur. If a direct care spending floor provisional waiver is granted by TennCare, the new NF provider reimbursement rate will be determined without a direct care spending floor reduction. However, for the entire period when a provisional waiver of the direct care spending floor is in effect, the new NF provider will be subject to a retroactive direct care spending floor settlement process, as follows:

1. If the new NF provider’s cost reporting period(s) Medicaid direct care cost per diem(s) are less than the spending floor(s) calculated at each rate period, the new NF provider will be responsible for a retroactive recoupment of the difference between its cost per diem and the spending floor for each Medicaid paid day. At no time will the retroactive recoupment per diem exceed the per diem amount granted under the provisional waiver.

2. In the event there is more than one direct care spending floor active during the new provider’s cost reporting period(s), the direct care spending floor settlement process will be independently applied to each spending floor. If the new NF provider’s cost reporting period(s) Medicaid direct care cost per diem(s) are less than any of the active spending floor(s), the calculated differences will be multiplied by the number of provider paid Medicaid days associated with the time period each direct care spending floor was active during the applicable cost reporting period. At no time will the retroactive recoupment per diem exceed the per diem amount granted under the provisional waiver.

3. Provisional waivers of the direct care spending floor will not be granted following the first rebase period in which the new NF provider has a six (6) month or more cost reporting period that could have been used in a rebase period.

(c) If the CHOW is as a result of a non-related party transaction, the new NF provider’s real estate tax cost-based reimbursement rate will be recalculated, according to Rule .06, on the first July 1st after the new NF provider has submitted a cost report of six (6) months or longer, and that cost report has been reviewed by the Comptroller.

(2) The previous owner and current owner must comply with the cost report filing requirements in

Rule .05.

(3)

TennCare maintains the right to withhold up to ten percent (10%) of the previous owner’s final Medicaid program payments until an acceptable final (terminating) cost report is received by the Comptroller. After receipt of the acceptable cost report, be it timely or non-timely, the withholding amount will be released to the facility (less any incurred penalties for non-timely filing).

(4) When there is a proposed CHOW of any Nursing Facility, the new provider shall provide to TennCare documents sufficient to obtain a Medicaid ID as specified in TennCare policy.

TennCare shall issue a new Medicaid ID based on appropriate documentation submitted by the new provider. Any Managed Care Contractor (MCC) previously contracted with the former owner or operator shall, subject to T.C.A. § 71-5-1412, enter into a provider agreement with the new owner/operator. A new provider with a Medicaid ID shall be reimbursed at one hundred percent (100%) from the effective date of the CHOW.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 71-5-105, 71-5-109, 71-5-134, and 71-5-1413.
• Administrative History: Original rules filed May 1, 2018; effective July 30, 2018. Amendments filed March 31, 2026; effective June 29, 2026.

Tenn. Comp. R. & Regs. 1200-13-02-.11 QUALITY-BASED COMPONENT OF THE REIMBURSEMENT METHODOLOGY FOR

NURSING FACILITIES.

(1) In addition to Quality Informed aspects of the NF reimbursement methodology, a specified amount of the funding for NF services shall be set aside during each fiscal year for purposes of calculating a quality-based component of each NF provider’s per diem payment (i.e., a quality incentive component). At implementation of this Chapter, the amount of funding set aside for the quality-based component of the reimbursement methodology for NFs shall be no less than forty million dollars ($40 million) or four percent (4.00%) of the total projected fiscal year expenditures for NF services, whichever is greater. In each subsequent year, the amount of funding set aside for the quality-based component of the reimbursement methodology for NFs shall increase at two (2) times the rate of inflation of the index factor.

Index factor inflation shall be calculated from the midpoint of the prior state fiscal year to the midpoint of the new state fiscal year. This annual quality-based component index factor adjustment shall continue until such time that the quality-based component of the reimbursement methodology for NFs constitutes ten percent (10%) of the total projected fiscal year expenditures for NF services. Once the quality-based component of the reimbursement methodology constitutes ten percent (10%) of the total projected fiscal year expenditures for NF services, it shall then increase or decrease at a rate necessary to ensure that the quality-based component of the reimbursement methodology remains at ten percent (10%). All noted minimum quality-based component thresholds and index factor inflationary adjustments are made prior to consideration of the BAF.

(2) The quality-based component of each NF provider’s per diem payment shall be calculated based on the facility’s volume of Medicaid resident days and the percentage of total quality points earned for the measurement period.

(3)

Quality outcome measures, performance benchmarks for each measure, and point values shall be reviewed and revised, as appropriate, in consultation with THCA and, as necessary, other NF stakeholders. Any modifications to such criteria shall be established through rulemaking and shall remain in effect for a minimum of three (3) years.

(4) Information about deadlines and training details shall be released annually to stakeholders and Medicaid licensed nursing facilities in advance of the submission and scoring process via the QuILTSS Memo, which shall include the QuILTSS Manual as an attachment. The QuILTSS Manual details the performance benchmark methodology, threshold measures, scoring methodologies, and special provisions established by this rule in consultation with THCA and NF stakeholders. The QuILTSS Memo and QuILTSS Manual shall be issued annually and posted on TennCare’s website at tn.gov/tenncare.

(5) Quality outcome measures shall be determined in consultation with THCA based on input from individuals receiving services, their family members and representatives, and other NF stakeholders, as appropriate, and shall reflect those aspects of NF service delivery that most impact the day-to-day experience of care for NF residents, as follows:

(a) Satisfaction shall be valued at thirty-five (35) of the one hundred (100) possible quality performance points.

1. Satisfaction shall include three (3) separate measures:

(i) Resident satisfaction shall be valued at fifteen (15) of the one hundred (100) possible quality performance points.

(ii) Family satisfaction shall be valued at ten (10) of the one hundred (100) possible quality performance points.

(iii) Staff satisfaction shall be valued at ten (10) of the one hundred (100) possible quality performance points.

2. In order to measure Satisfaction on the basis of outcomes and to establish performance benchmarks for each of the three (3) Satisfaction measures, NFs shall be required to use a standardized survey instrument and methodology that provides for anonymous submission to a neutral third party, which shall be responsible for submission of required data to TennCare.

3. The survey instrument(s) and methodology for conducting each survey shall be selected or designed with input from NF stakeholders, and subject to mutual agreement between TennCare and THCA. Providers shall be notified of the acceptable survey instrument(s) and methodology no later than two (2) months prior to their implementation.

4. The methodology used for calculating a facility’s Satisfaction score shall be based in part on whether the facility achieves the performance benchmark for each of the three (3) Satisfaction measures described in Part 1. of this subparagraph, and for facilities who do not achieve the performance benchmarks, a lesser score based on the percentage of improvement as determined by TennCare. Providers shall be notified of the performance benchmark methodology for each of the three (3) Satisfaction measures and the specific methodology for calculating a facility’s Satisfaction score at least thirty (30) days prior to the data collection period.

5. TennCare shall provide (or arrange for the provision of) training regarding each survey instrument, the survey methodology, and the methodology that will be used to calculate a facility’s score for each of the three (3) Satisfaction measures.

6. Results of each NF’s surveys (excluding any information that could be used to identify respondents) shall be made available to the NF for purposes of quality improvement activities.

(b) Culture Change and Quality of Life shall be valued at thirty (30) of the one hundred (100) possible quality performance points.

1. Culture Change and Quality of Life shall encompass four (4) different aspects of the degree to which a NF’s environment, programs, policies, and practices are individualized and person-directed; reflect the core values of self-determination, choice, dignity, and respect; and support meaningful roles and relationships for residents and staff. Culture Change and Quality of Life shall include four (4) separate measures:

(i) Respectful Treatment shall be valued at ten (10) out of the one hundred (100) possible quality performance points.

(ii) Resident Choice shall be valued at ten (10) out of the one hundred (100) possible quality performance points.

(iii) Resident and Family Input shall be valued at five (5) out of the one hundred (100) possible quality performance points.

(iv) Meaningful Activities shall be valued at five (5) out of the one hundred (100) possible quality performance points.

2. In order to measure Culture Change and Quality of Life on the basis of outcomes and to establish performance benchmarks for each of the four (4) Culture Change and Quality of Life measures, NFs shall be required to use a standardized survey instrument and methodology that provides for anonymous submission to a neutral third party, which shall be responsible for submission of required data to TennCare. The survey questions for measuring Culture Change and Quality of Life may be incorporated into the Resident satisfaction survey described in Subparagraph (a) above.

3. The survey questions and/or instrument and methodology for conducting the survey shall be selected or designed with input from NF stakeholders, and subject to mutual agreement between TennCare and THCA. Providers shall be notified of the acceptable survey instrument(s) and methodology no later than two (2) months prior to their implementation.

4. For purposes of the NF reimbursement rates effective on July 1, 2027, the methodology used for calculating a facility’s Culture Change and Quality of Life score shall be based in part on whether the facility achieves the performance benchmark for each of the four (4) Culture Change and Quality of Life measures described in Part 1. of this subparagraph, and for facilities who do not achieve the performance benchmarks, a lesser score based on the percentage of improvement as determined by TennCare. Providers shall be notified of the performance benchmark methodology for each of the four (4) Culture Change and Quality of Life measures and the specific methodology for calculating a facility’s Satisfaction score at least thirty (30) days prior to the data collection period.

5. TennCare shall provide (or arrange for the provision of) training regarding the methodology that will be used to calculate a facility’s score encompassing each of the four (4) aspects of Culture Change and Quality of Life.

6. Results of each NF’s performance on each of the four (4) aspects of Culture Change and Quality of Life (excluding any information that could be used to identify respondents) shall be made available to the NF for purposes of quality improvement activities.

(c) For purposes of the NF reimbursement rates effective July 1, 2027, Staffing and Staff Competency shall be valued at twenty (20) of the one hundred (100) possible quality performance points.

1. Staffing and Staff Competency shall include four (4) separate measures, with each measure valued at five (5) of the one hundred (100) possible quality performance points, as follows:

(i) Registered Nurse (RN) and Licensed Practical/Vocational Nurse (LPN/LVN) case mix adjusted hours per resident day.

(ii) Nurse Aide (NA) case mix adjusted hours per resident day.

(iii) Consistent Staff Assignment.

(iv) RN, LPN/LVN, and CNA Staff Retention.

2. RN, LPN/LVN, and NA case mix adjusted hours per resident day shall be defined and calculated consistent with the methodology described in the CMS Five Star Nursing Home Quality Rating System. RN case mix adjusted hours per resident day and LPN/LVN case mix adjusted hours per resident day shall be added together as a single measure as described in Part 1.

3. Consistent Staff Assignment shall be measured by the percent of Long-Stay Residents who have no more than twelve (12) caregivers within one (1) calendar month.

(i) To be eligible for Consistent Staff Assignment points, a NF must track its performance using the tools and methodologies created and/or specified by TennCare.

(ii) A caregiver shall be defined as any staff assigned to provide and delivering direct NA-type care to the resident during the measurement period.

(I) Caregivers shall include both NF employees (full-time and part-time) and individuals under an organization (agency) or individual contract that provide care to the resident during the measurement period.

(II) Staff assigned to assist one or more residents only with mealtime and/or bathing shall be counted as a caregiver for all residents for whom such assistance is provided, even if the staff functions as a float or as part of a care team dedicated to such functions on behalf of multiple residents.

4. Staff Retention shall be defined as the percentage of specified staff that have been continuously employed (or contracted) by the NF for at least one (1) calendar year.

(i) Specified staff shall include only RNs, LPNs/LVNs, and NAs.

(I) RNs shall include registered nurses, RN directors of nursing, and nurses with administrative duties.

(II) LPNs/LVNs shall include licensed practical/licensed vocational nurses.

(III) NAs shall include certified nurse aides, aides in training, and medication aides/technicians.

(ii) Specified staff shall include both NF employees (full-time and part-time) and individuals under an organization (agency) or individual contract.

Retention of contracted staff shall be reported and measured based on the length of service of each staff person, and not the length of the contract.

For example, if a staffing agency is used, a person shall be considered “continuously” contracted only if that staff person has been assigned to and working at the facility throughout the course of the twelve (12) month measurement period, even if the contract with that organization (agency) has been in place for a longer period.

(iii) Specified staff shall not include staff reimbursed by a resident or his/her family, hospice staff, or feeding assistants.

(iv) Specified staff information at the beginning and end of the measurement period shall be provided to TennCare in the required form and format.

(v) A NF’s performance on the Staff Retention measure shall be calculated by dividing the number of specified staff continuously employed (or contracted) by the facility for the twelve (12) month measurement period divided by the total number of specified facility staff employed at the outset of the twelve (12) month measurement period.

(d) For purposes of the NF reimbursement rates effective July 1, 2027, Clinical Performance shall be valued at fifteen (15) of the one hundred (100) possible quality performance points. Clinical Performance shall be defined and calculated consistent with methodology outlined in the CMS MDS 3.0 Quality Measures Manual v17.0, or any subsequent version and shall include three (3) separate measures, with each measure valued at five (5) of the one hundred (100) possible quality performance points, as follows:

1. Percentage of Long-Stay Residents who have/had a catheter inserted and left in their bladder.

2. Percentage of Long-Stay Residents with pressure ulcers.

3. Percentage of Long-Stay Residents who lose too much weight.

(e) In addition to the one hundred (100) possible quality performance points that a NF may score in the areas described in Subparagraphs (a) through (d) above, a NF may also earn ten (10) bonus points for qualifying awards and/or accreditations that evidence the facility’s commitment to quality improvement processes. Qualifying awards and accreditations will be reviewed and validated by TennCare and must be current in the review period. Qualifying awards and accreditations are restricted to the following:

1. Membership in Eden Alternative Growth or Certified member level, which must be active during the period in which bonus points are sought.

2. Achievement of the Malcolm Baldrige Quality Award. This includes AHCA Award (Bronze, Silver, or Gold). Any such award must have been achieved within the three (3) years prior to the end of the period in which bonus points are sought.

3. Accreditation by the Commission on Accreditation of Rehabilitation Facilities (CARF).

4. Accreditation by the Joint Commission.

(6) A NF shall be eligible to receive the quality-based component of the per diem payment for NF services only if it has fully satisfied the following:

(a) The facility has fulfilled the reimbursement conditions specified in Rule .03 of this

Chapter.

(b) The facility must be current on its payment of the NF Assessment Fee. Anytime a facility is more than thirty (30) days delinquent on its NF Assessment Fee, the qualitybased component of the per-diem payment for NF services shall be suspended, and the facility shall forfeit any quality-based component of its per diem reimbursement rate until such time that the NF is current on its Assessment Fee payments. This shall be operationalized as an MCO rate withhold, pursuant to T.C.A. § 71-5-1006.

(c) The facility has submitted complete, accurate and timely quality measurement data as required by TennCare in order to determine the NF’s quality performance.

1. Except as otherwise specified by TennCare, quality measurement data shall be submitted by the NF on an annual basis. Where possible and appropriate, TennCare will utilize existing data sources to minimize administrative burden.

2. The data measurement period shall be January 1 through December 31 of each year, which shall be used to inform the quality-based component of the per diem payment for the fiscal year beginning July 1 immediately after.

3. A NF shall not be entitled to a quality-based component of the per diem payment for any NF services provided if the facility has not complied with quality performance reporting requirements, or if the facility knowingly submits, or causes or allows to be submitted any such data used for purposes of setting quality-based rate components that is determined (including upon post-payment audit or review) to be inaccurate or incomplete.

4. Any facility knowingly submitting false (including inaccurate or incomplete) quality performance data for purposes of calculating its Medicaid payment shall be subject to all applicable federal and state laws, including but not limited to the federal False Claims Act (31 U.S.C. §§ 3729, et seq.) and the Tennessee Medicaid False Claims Act (T.C.A. §§ 71-5-182, et seq.), pertaining to the submission of false claims.

5. For purposes of this subparagraph, the term “knowingly” shall mean that a NF, or any person acting on its behalf: (a) has or should have, upon exercise of due diligence, actual knowledge of the information; (b) acts in deliberate ignorance of the truth or falsity of the information; or (c) acts in reckless disregard of the truth or falsity of the information. No proof of specific intent is required.

(7) Based on quality incentive program scoring, a NF will be placed into one of three quality tiers.

The quality tier cut points may only be updated during July 1 rate setting and must be effective for a minimum of three years. For the rate effective date of July 1, 2018, and until the effective date of any future quality tier cut point updates, the quality tier cut points will be as follows:

Quality Tier Cut Point Range Quality Tier 1 75+ Quality Tier 2 50 – 74.99 Quality Tier 3 0 – 49.99 (8) A NF’s quality tier and quality incentive program score will be established for each July 1 rate setting. The quality tier and quality incentive program score will be based on the quality incentive program measurement period for the calendar year period immediately preceding the applicable July 1 rate setting.

(9) A NFs quality incentive program score is based on the point structure previously described in this rule. As quality data is collected throughout the quality incentive program measurement period, the following score weighting will be applied to the varying metric collection intervals:

(a) Quality incentive program scoring metrics that are annual in nature will not be weighted.

(b) Quality incentive program scoring metrics that are quarterly in nature will be weighted as follows:

1. 50% weight for the fourth quarter of the calendar year.

2. 25% weight for the third quarter of the calendar year.

3. 15% weight for the second quarter of the calendar year.

4. 10% weight for the first quarter of the calendar year.

(c) For any metric collection period, regardless of collection interval, in which the final period is not the highest scoring period, the NF provider’s quality incentive program scoring metrics will use the metric weighting method below that results in the greatest overall quality incentive program score:

1. The quality incentive program scoring metric weighting methods previously described in this paragraph.

2. A quality incentive program scoring metric weighting method that equally weights all metric collection periods, regardless of collection interval.

(10) Confidentiality of Submitted Quality Information. Any submissions by any facility relating to documentation of and participation in the quality-based component of the Reimbursement Methodology for Nursing Facilities pursuant to Rule .11 shall be confidential and privileged and shall be protected from direct or indirect means of discovery, subpoena or admission into evidence in any judicial or administrative proceeding. However, nothing in this rule shall not be construed to make immune from discovery or use in any judicial or administrative proceeding information, record, or documents that are otherwise available from original sources kept in the facility, and would otherwise be available to a litigant through discovered requested from the facility. The confidentiality provisions of this paragraph shall also not apply to any judicial or administrative proceeding contesting the determination of TennCare regarding the facility’s quality component reimbursement.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 71-5-105, 71-5-109, 71-5-134, 71-5-1004, and 71-5-1413.
• Administrative History: Original rules filed May 1, 2018; effective July 30, 2018. Amendments filed January 28, 2021; effective April 28, 2021. Amendments filed March 31, 2026; effective June 29, 2026.

Tenn. Comp. R. & Regs. 1200-13-02-.12 ENHANCED RESPIRATORY CARE SERVICES ADD-ON PAYMENT

(1) ERC Reimbursement in a dual certified and licensed SNF/NF shall be made only by TennCare MCOs in compliance with this Chapter and rates established by TennCare.

(2) Each level of ERC Reimbursement shall be an add-on payment to the NF’s established per diem rate. The amount of the NF’s add-on payment for each of the specified levels of reimbursement shall be based on the facility’s performance on quality outcome and technology measures pursuant to a methodology established by TennCare and set forth in an ERC Operations Manual which shall be provided to NFs and posted on the TennCare website. Quality outcome and technology measures, performance benchmarks, and the methodology to apply such measures and performance benchmarks to each of the specified levels of ERC Reimbursement shall be adjusted no more frequently than annually in order to continuously improve the quality of care and quality of life outcomes experienced by individuals receiving ERC in a NF.

(3) ERC Reimbursement shall be provided only for services authorized and delivered in a facility operating in compliance with conditions of reimbursement for ERC specified in this Chapter, and in a bed specifically licensed for such purpose, as applicable. A NF shall not be eligible for ERC Reimbursement if it does not meet the conditions for reimbursement, or for any ERC services provided in excess of the facility’s licensed capacity to provide such services, regardless of payer source. Because Sub-Acute Tracheal Suctioning Reimbursement provides for intensive respiratory intervention during the period immediately following a person’s liberation from the ventilator, Sub-Acute Tracheal Suctioning Reimbursement shall be provided only in a bed specifically licensed for ventilator care.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-1413.
• Administrative History: Original rules filed May 1, 2018; effective July 30, 2018.

Tenn. Comp. R. & Regs. 1200-13-02-.13 APPEALS PROCESS

Appeals of recoupment or withhold actions shall be filed and conducted according to Chapter 1200-13-18.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-1413.
• Administrative History: Original rules filed May 1, 2018; effective July 30, 2018.

Tenn. Comp. R. & Regs. 1200-13-02-.14 AUDIT AND REVIEW AUTHORITY

TennCare maintains the right to audit or review all aspects of the case mix reimbursement system. Findings or adjustments generated from the audit or review may be used to adjust current or future NF provider reimbursement rates. The following are common aspects of the case mix reimbursement system that are subject to an audit or review process:

(1) NF provider MDS assessments, end-of-therapy date reconciliation submissions, and associated supporting documentation.

(2) NF provider quality incentive program add-on payment and supporting documentation.

(3) ERC services add-on payment and supporting documentation.

(4) NF provider submitted Medicare and Medicaid cost reports and supporting documentation.

(5) New NF provider submitted documentation.

(6) CHOW NF provider submitted documentation.

(7) NF provider submitted FRV updates, licensed bed totals, and requests for reappraisal.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-1413.
• Administrative History: Original rules filed May 1, 2018; effective July 30, 2018.

Tenn. Comp. R. & Regs. 1200-13-02-.15 PENALTIES, ADJUSTMENTS, AND WITHHOLDING

(1) NF providers may be subject to penalties, cost report adjustments, and payment withholdings for:

(a) Disclaimed Cost Reports.

(b) Cost Report Delinquent Filing.

(c) Cost Report Non-Filer.

(d) Final (Terminating) Cost Report.

(2) Disclaimed Cost Reports. A provider who has a disclaimed cost report will have its Medicare and Medicaid supplemental cost reports adjusted for use in the provider’s specific reimbursement rate. These cost report adjustments may include, but are not limited to the following:

(a) Adjusting costs without sufficient documentation to zero.

(b) Adjusting total resident days to one hundred percent (100%) occupancy, and reconciling Medicaid’s portion of those days to paid claims records.

(c) The direct care spending floor adjustment, as defined in Rule .06, will be calculated utilizing the adjusted cost report.

(3) Cost Report Delinquent Filing.

(a) A cost report will be considered delinquent if an acceptable cost reporting package has not been filed within the timelines specified in Rule .05. The NF provider will be subject to a penalty of ten dollars ($10) per day for each day the NF is not in compliance.

(b) Should the NF provider file a cost report that is received timely and initially accepted by the Comptroller, but upon further review by the Comptroller is determined to not be an acceptable cost report, the following will occur:

1. The Comptroller will provide written notice to the NF provider that an acceptable cost report has not been filed.

2. The NF provider will have thirty (30) days from receipt of the written notice to correct any issues noted and file an acceptable cost report.

3. If the NF provider does not file a corrected acceptable cost report within thirty (30) days of notice, it will be subjected to the penalty outlined in this paragraph from the date of the received written notice.

(4) Cost Report Non-Filer.

(a) A NF provider will be considered a cost report non-filer if its cost report is delinquent as of February 1 prior to the July 1 rate rebase in which it would have been used regardless if rebase actually occurs. A NF provider that is considered a cost report nonfiler will have its reimbursement rates adjusted to be set equal to the lowest rate of any other active NF provider. The rate adjustments will commence with the July 1 rate setting following the NF provider obtaining a cost report non-filer status, and remain in effect for a minimum of one (1) year. The non-filer reimbursement rate will be determined using NF provider reimbursement rates prior to phase-in considerations.

Reimbursement rate phase-in provisions established in Rule .06 are not applicable to the non-filer reimbursement rates.

(b) TennCare maintains the right to grant a waiver from the application of a portion or all of the rate and direct care spending floor adjustments should certain extenuating circumstances exist with the NF provider. TennCare must be contacted by the NF provider prior to the initial cost report filing deadline, for a waiver to be considered by TennCare.

(5) Final (Terminating) Cost Report. A NF provider is required to submit a final cost report as defined in Rule .05, and will be subject to a withholding of up to ten percent (10%) of the previous owner’s final Medicaid recipient payments until an acceptable terminating cost report is received by the Comptroller. After receipt of the acceptable cost report, whether timely or non-timely, the withholding amount will be released to the facility (less any incurred penalties for non-timely filing).

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, 71-5-130, and 71-5-1413.
• Administrative History: Original rules filed May 1, 2018; effective July 30, 2018.

Tenn. Comp. R. & Regs. 1200-13-02-.16 BED HOLDS

Effective July 1, 2018, Medicaid bed hold days will no longer be reimbursed.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-1413.
• Administrative History: Original rules filed May 1, 2018; effective July 30, 2018.

Tenn. Comp. R. & Regs. 1200-13-02-.17 OTHER REIMBURSEMENT ISSUES

(1) No change of ownership or controlling interest of an existing Medicaid provider, including NFs, can occur until monies as may be owed to TennCare or its contractors are provided for.

The purchaser shall notify TennCare of the purchase at the time of ownership change and is financially liable for the outstanding liabilities to TennCare or its contractors for one (1) year from the date of purchase or for one (1) year following TennCare’s receipt of the provider’s Medicare final notice of program reimbursement, whichever is later. The purchaser shall be entitled to use any means available to it by law to secure and recoup these funds from the selling entity. In addition, purchasers of NFs are responsible for obtaining an accurate accounting and transfer of funds held in trust for Medicaid residents at the time of the change of ownership or controlling interest.

(2) If TennCare or an MCO has not reimbursed a business for TennCare services provided under the TennCare Program at the time the business is sold, when such an amount is determined, TennCare or the MCO shall be required to reimburse the person owning the business provided such sale included the sale of such assets.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-1413.
• Administrative History: Original rules filed May 1, 2018; effective July 30, 2018.

Tenn. Comp. R. & Regs. 1200-13-02-.18 MDS CASE-MIX REVIEWS

(1) TennCare shall periodically review the documentation maintained by nursing facilities for all residents, regardless of payer type, for purposes of the MDS Case-Mix Review. The MDS Case-Mix Reviews shall be conducted as frequently as deemed necessary by TennCare, and each nursing facility shall be reviewed no less frequently than every thirty-six (36) months.

Advance notification of up to forty-eight (48) hours shall be provided by the reviewer for all MDS Case-Mix Reviews, except for follow-up reviews that are intended to ensure compliance with validation improvement plans. Advance notification for follow-up reviews shall not be required.

(2) When conducting the MDS Case-Mix Reviews, TennCare shall consider all documentation that is provided by the nursing facility and is available to the reviewers prior to the exit conference. Documentation that is provided by the nursing facility after the exit conference begins shall not be considered by TennCare.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 71-5-105, 71-5-109, 71-5-134, and 71-5-1413.
• Administrative History: New rule filed March 31, 2026; effective June 29, 2026.

Chapter 1200-13-03 Repealed

Tenn. Comp. R. & Regs. 1200-13-03-.01 REPEALED

History

• Authority: T.C.A. 4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original Rule filed August 15, 1979; effective September 29, 1979. Repealed and New Rule filed December 17, 1980; effective February 2, 1981. Repeal filed February 8, 2008; effective April 23, 2008.

Tenn. Comp. R. & Regs. 1200-13-03-.02 REPEALED

History

• Authority: T.C.A. 4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original Rule filed September 29, 1979. Repealed and New Rule filed December 17, 1980: effective February 2, 1981. Repeal filed February 8, 2008; effective April 23, 2008.

Tenn. Comp. R. & Regs. 1200-13-03-.03 REPEALED

History

• Authority: T.C.A. 4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original Rule filed August 15, 1979; effective September 29, 1979. Repealed and New Rule filed December 17, 1980; effective February 2, 1981. Repeal filed February 8, 2008; effective April 23, 2008.

Chapter 1200-13-04 Repealed

Tenn. Comp. R. & Regs. 1200-13-04-.01 REPEALED

Authority. T.C.A. §14-1905, 4-5-202, 7-5-105, and 7-5-109. Administrative History: Original rule filed December 10, 1979; effective January 24, 1980. Repeal filed May 5, 2009; effective July 19, 2009.

1200-13-04- .02 REPEALED.

History

• Authority: T.C.A. §14-1905, 4-5-202, 7-5-105, and 7-5-109.
• Administrative History: Original rule filed December 10, 1979; effective January 24, 1980. Repeal filed May 5, 2009; effective July 19, 2009.

Tenn. Comp. R. & Regs. 1200-13-04-.03 REPEALED

History

• Authority: T.C.A. §14-1905, 4-5-202, 7-5-105, and 7-5-109.
• Administrative History: Original rule filed December 10, 1979; effective January 24, 1980. Repeal filed May 5, 2009; effective July 19, 2009. 1200-13-04- .04 REPEALED. Authority: T.C.A. §14-1905, 4-5-202, 7-5-105, and 7-5-109.

Tenn. Comp. R. & Regs. 1200-13-04-.05 REPEALED

History

• Authority: T.C.A. §14-1905, 4-5-202, 7-5-105, and 7-5-109.
• Administrative History: Original rule filed December 10, 1979; effective January 24, 1980. Repeal filed May 5, 2009; effective July 19, 2009.

Tenn. Comp. R. & Regs. 1200-13-04-.06 REPEALED

History

• Authority: T.C.A. §14-1905, 4-5-202, 7-5-105, and 7-5-109.
• Administrative History: Original rule filed December 10, 1979; effective January 24,1980. Repeal filed May 5, 2009; effective July 19, 2009.

Tenn. Comp. R. & Regs. 1200-13-04-.07 REPEALED

History

• Authority: T.C.A. §14-1905, 4-5-202, 7-5-105, and 7-5-109.
• Administrative History: Original rule filed December 10, 1979; effective January 24,1980. Repeal filed May 5, 2009; effective July 19, 2009.

Tenn. Comp. R. & Regs. 1200-13-04-.08 REPEALED

History

• Authority: T.C.A. §14-1905, 4-5-202, 7-5-105, and 7-5-109.
• Administrative History: Original rule filed December 10, 1979; effective January 24, 1980. Repeal filed May 5, 2009; effective July 19, 2009.

Tenn. Comp. R. & Regs. 1200-13-04-.09 REPEALED

History

• Authority: T.C.A. §14-1905, 4-5-202, 7-5-105, and 7-5-109.
• Administrative History: Original rule filed December 10, 1979, effective January 24, 1980. Repeal filed May 5, 2009; effective July 19, 2009.

Tenn. Comp. R. & Regs. 1200-13-04-.10 REPEALED

History

• Authority: T.C.4. §14-1905, 4-5-202, 7-5-105, and 7-5-109.
• Administrative History: Original rule filed December 10, 1979; effective January 24. 1980. Repeal filed May 5, 2009; effective July 19, 2009.

Tenn. Comp. R. & Regs. 1200-13-04-.11 REPEALED

History

• Authority: T.C.A. §14-1905, 4-5-202, 7-5-105, and 7-5-109.
• Administrative History: Original rule filed December 10, 1979; effective January 24, 1980. Repeal filed May 5, 2009; effective July 19, 2009.

Tenn. Comp. R. & Regs. 1200-13-04-.12 REPEALED

History

• Authority: T.C.A. §14-1905, 4-5-202, 7-5-105, and 7-5-109.
• Administrative History: Original rule filed December 10, 1979; effective January 24, 1980. Repeal filed May 5, 2009; effective July 19, 2009.

Tenn. Comp. R. & Regs. 1200-13-04-.13 REPEALED

History

• Authority: T.C.A. §§71-5-105, 71-5-109 and 4-5-202.
• Administrative History: Original rule filed February 21,1991; effective April 7, 1991. Repeal filed May 5, 2009; effective July 19, 2009.

Tenn. Comp. R. & Regs. 1200-13-04-.14 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109 and Public Chapter 358 Acts of 1993.
• Administrative History: Original rule filed March 18, 1994; effective June 1, 1994. Repeal filed May 5, 2009; effective July 19, 2009.

Chapter 1200-13-05 Hospital Rate Variation Corridors

Tenn. Comp. R. & Regs. 1200-13-05-.01 DEFINITIONS

(1) Bureau of TennCare (Bureau). The administrative unit of TennCare which is responsible for the administration of TennCare as defined elsewhere in these rules.

(2) Existing Contracts. The contracts that were in place between a Tennessee hospital and a TennCare MCO as of July 1, 2013.

(3) Hospital. A general or specialty acute care facility licensed as a hospital by the Tennessee Department of Health pursuant to T.C.A. § 68-11-206, excluding hospitals that are categorized as Rehabilitation, Research, Long Term Acute or Psychiatric on the 2013 Joint Annual Report of Hospitals.

(4) Inpatient Services. Routine, nonspecialized services that are provided at many or most hospitals in the state to patients admitted to the hospital as inpatients.

(5) MCO (Managed Care Organization). An appropriately licensed Health Maintenance Organization (HMO) contracted with the Bureau of TennCare to manage the delivery, provide for access, contain the cost, and ensure the quality of specified covered medical and behavioral benefits to TennCare enrollee-members through a network of qualified providers. .

(6) Medicare. A hospital’s fee-for-service reimbursement under Title XVIII including that hospital’s adjustment for DSH, wage index, etc., and excluding only Indirect Medical Education (IME), pass through payments, and any Medicare payment adjustments for Sequestration, Value Based Purchasing, Readmissions and Hospital Acquired Conditions.

(7) Medicare Severity Diagnosis Related Groups (MS-DRG). The Medicare statistical system of classifying any inpatient stay into groups for the purpose of payment.

(8) New Contract. Any initial contract between an MCO and a hospital that did not exist on July 1, 2013. Contracts in place on July 1, 2013, that have been materially altered since July 1, 2013, are not new contracts.

(9) Outpatient Services. Services that are provided by a hospital to patients in the outpatient department of the hospital and patients receiving outpatient observation services.

(10) Rate Corridors. Upper and lower limits established by the state’s actuary and approved by the Bureau, in consultation with the Tennessee Hospital Association (THA), for payments by MCOs to hospitals for services provided to TennCare enrollees. The Rate Corridors are based on a hospital’s Medicare reimbursement that existed in FFY 2011 and used to determine the parameters of TennCare rates for contracts between Tennessee hospitals and TennCare MCOs after July 1, 2013. The determination of whether a hospital’s TennCare rates are within the prescribed Rate Corridors shall be made on the basis of reimbursement from all TennCare MCOs with which the hospital has a contract. The Rate Corridors, which were calculated by the State’s actuary as the budget neutral corridors, are as follows:

(a) For inpatient services, the minimum level is 53.8% and the maximum level is 80% of the hospital’s Medicare for 2011.

(b) For outpatient services, the minimum level is 93.2% and the maximum level is 104% of the hospital’s Medicare for 2011.

(c) For cardiac surgery, the minimum level is 32% and the maximum level is 83% of the hospital’s Medicare for 2011.

(d) For specialized neonatal services the minimum level is 4% and the maximum level is 174% of the hospital’s Medicare for 2011.

(e) For other specialized services the minimum level is 49% and the maximum level is 164% of the hospital’s Medicare for 2011.

(11) Specialized Services. Services that are typically provided in a small subset of hospitals, such as transplants, neonatal intensive care and level 1 trauma.

(12) TennCare. The TennCare waiver demonstration program(s) and/or Tennessee’s traditional Medicaid program.

(13) TennCare Actuary. The actuarial firm selected by the Bureau to assist the Bureau in establishing the capitation rates for TennCare MCOs each year.

(14) Total TennCare Rates. Payment rates for each hospital in the aggregate from all MCOs with which the hospital has network contracts.

(15) Year 1 Corridors. The initial upper and lower limits established by the Bureau in consultation with THA based on a hospital’s Medicare reimbursement that existed in FFY 2011 and that were used to implement rate variation limitations in contracts between Tennessee hospitals and TennCare MCOs from July 1, 2012 until July 1, 2013. The Year 1 Corridors are as follows:

(a) For inpatient services, the minimum level was 40% and the maximum level was 90% of the hospital’s Medicare for 2011.

(b) For outpatient services, the minimum level was 90% and the maximum level was 125% of the hospital’s Medicare for 2011.

(c) For cardiac surgery, the minimum level was 30% and the maximum level was 80% of the hospital’s Medicare for 2011.

(d) For specialized neonatal services the minimum level was 4% and the maximum level was 180% of the hospital’s Medicare for 2011.

(e) For other specialized services the minimum level was 30% and the maximum level was 160% of the hospital’s Medicare for 2011.

History

• Authority: T.C.A. §§ 4-5-208, 12-4-301, 71-5-105, 71-5-109, and 71-5-2801.
• Administrative History: Original rule filed June 26, 1985; effective July 26, 1985. Amendment filed January 13, 1987; effective February 27, 1987. Amendment filed September 25, 1992; effective November 9, 1992. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective December 20, 2015.

Tenn. Comp. R. & Regs. 1200-13-05-.02 IMPLEMENTATION OF CONTRACT AMENDMENTS FOR EXISTING CONTRACTS

BETWEEN HOSPITALS AND MCOS.

These contracts set rates for a period of two years effective July 1, 2013, and provided for rate amendments to be negotiated and implemented on July 1, 2015.

(1) For hospitals that had existing contracts with MCOs in place on July 1, 2013, and the MCO and hospital had negotiated contract amendments to bring rates for total TennCare into the Rate Corridors and the rates in the contracts have not been adjusted since July 1, 2013, the MCOs will reissue those amendments with a new effective date of July 1, 2015.

(2) In the case of a hospital that had contracts with MCOs in place on July 1, 2013, which contracts included amendments implementing rates within the Rate Corridors, and where the rates in the contracts have been adjusted since July 1, 2013, the Bureau shall evaluate the rates in the current contracts to determine if the total TennCare rates for the hospital are within the Rate Corridors. If the rate adjustments cause the total TennCare reimbursement for the hospital to be outside of the Rate Corridors, the affected MCOs shall implement contract amendments approved by the Bureau in consultation with the TennCare Actuary to bring the hospital rates into the Rate Corridors effective July 1, 2015.

(3) In the case of a hospital with contracts in existence on July 1, 2013, which contracts include rates outside of the Rate Corridors, the affected MCOs shall implement contract amendments to bring total TennCare rates into the Rate Corridors with an effective date of July 1, 2015.

The Bureau shall verify that the new contract rates in conjunction with contracts between the hospital and all other MCOs bring the hospital’s total TennCare rates within the Rate Corridors.

History

• Authority: T.C.A. §§ 4-5-208, 71-5-105, 71-5-109, and 71-5-2801.
• Administrative History: Original rule filed June 26, 1985; effective July 26, 1985. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective December 20, 2015.

Tenn. Comp. R. & Regs. 1200-13-05-.03 IMPLEMENTATION OF NEW CONTRACTS BETWEEN HOSPITALS AND MCOS

ENTERED INTO AFTER JULY 1, 2013.

These contracts have not yet been in effect for a period of time sufficient to negotiate rate amendments for a July 1, 2015, implementation date. In the case of a hospital that entered into a contract with an MCO after July 1, 2013, including a hospital that entered into a contract with an MCO with rates within Year 1 Corridors effective January 1, 2015, the affected MCOs shall implement contract amendments that bring the hospital rates within the Rate Corridors no later than September 30, 2015.

History

• Authority: T.C.A. §§ 4-5-208, 71-5-105, 71-5-109, and 71-5-2801.
• Administrative History: Original rule filed June 26, 1985; effective July 26, 1985. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective December 20, 2015.

Tenn. Comp. R. & Regs. 1200-13-05-.04 EXCLUSION OF ANY HOSPITAL FROM TENNCARE NETWORKS

A hospital that does not accept a contract amendment required by this Rule shall be excluded effective October 1, 2015, from participation in the TennCare MCO network to which the contract amendment applies.

History

• Authority: T.C.A. §§ 4-5-208, 71-5-105, 71-5-109, and 71-5-2801.
• Administrative History: Original rule filed June 26, 1985; effective July 26, 1985. Amendment filed January 30, 1989; effective March 16, 1989. Amendment filed April 14, 1989; effective May 8, 1989. Amendment filed October 14, 1998; effective December 28, 1998. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective December 20, 2015.

Tenn. Comp. R. & Regs. 1200-13-05-.05 OUT-OF-NETWORK REIMBURSEMENT

Out-of-Network payments to all hospitals shall be governed by TennCare Medicaid Rule 1200-13-13- .08(2)(a)-(c) and TennCare Standard Rule 1200-13-14-.08(2)(a)-(c).

History

• Authority: T.C.A. §§ 4-5-208, 71-5-105, 71-5-109, and 71-5-2801
• Administrative History: Original rule filed June 26, 1985; effective July 26, 1985. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective December 20, 2015.

Tenn. Comp. R. & Regs. 1200-13-05-.06 AGREEMENTS BETWEEN HOSPITALS AND MCOS FOR LIMITED SERVICES

Rates for a single case agreement negotiated between the MCOs and hospitals that are not in network with the MCOs to ensure access to services for TennCare enrollees may not exceed the ceiling or be below the floor of the Rate Corridors appropriate for those services.

History

• Authority: T.C.A. §§ 4-5-208, 71-5-105, 71-5-109, and 71-5-2801.
• Administrative History: Original rule filed June 26, 1985; effective July 26, 1985. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective December 20, 2015. 1200-13-05.-07 CHANGES TO HOSPITAL RATES NEGOTIATED BETWEEN MCOS AND HOSPITALS AFTER SEPTEMBER 30, 2015. To ensure that each hospital’s total TennCare reimbursement remains within the Rate Corridors, proposed rate changes after September 30, 2015, shall be evaluated by the Bureau to determine if the proposed rate change will move the hospital’s total TennCare rates outside of the Rate Corridors. If the evaluation indicates the change will put the hospital outside of the Rate Corridors, the Bureau shall provide the adjustments necessary to ensure that the contract is compliant with the limits of the Rate Corridors. TennCare rates between a hospital and an MCO may not be modified after September 30, 2015, without approval from the Bureau. Authority: T.C.A. §§ 4-5-208, 71-5-105, 71-5-109, 71-5-2801.

Tenn. Comp. R. & Regs. 1200-13-05-.08 CATEGORIZATION OF NEW SERVICES ADDED AFTER JULY 1, 2015

MS-DRG classifications serve as the basis for identifying services as inpatient or specialized. MS-DRG classifications may change and new MS-DRG classifications may be added from time to time. New or modified MS-DRG classifications shall be evaluated for assignment to appropriate inpatient or specialized categories by the Bureau in consultation with THA and the TennCare Actuary.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 71-5-105, 71-5-109, 71-5-2801, and 71-5-2803; Public Chapter 913 of the Acts of 1992. Administrative History. Original rule filed June 26, 1985; effective July 26, 1985. Amendment filed February 21, 1986; effective March 23, 1986. Amendment filed September 12, 1986, effective October 27, 1986. Amendment filed May 29, 1987, effective July 13, 1987. Amendment filed June 2, 1988, effective July 17, 1988. Amendment filed August 8, 1990, effective September 22, 1990. Amendment filed October 21, 1991; effective December 5,, 1991. Amendment filed September 25, 1992; effective November 9, 1992. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective December 20, 2015.

Tenn. Comp. R. & Regs. 1200-13-05-.09 REPEALED

History

• Authority: T.C.A. §§ 4-5-208, 71-5-105, 71-5-109 and 71-5-2801.
• Administrative History: Original rule filed June 26, 1985; effective July 26,1 985. Amendment filed August 8, 1990; effective September 22, 1990. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective December 20, 2015.

Tenn. Comp. R. & Regs. 1200-13-05-.10 REPEALED

Authority. T.C.A. §§ 4-5-208, 71-5-105, 71-5-109 and 71-5-2801.Administrative History. Original

rule filed June 26, 1985, effective July 26, 1985. Amendment filed April 29, 1986; effective May 29, 1986. Amendment filed December 30, 1986, effective February 13, 1987. Amendment filed December 8,1989; effective January 22, 1990. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective December 20, 2015.

Tenn. Comp. R. & Regs. 1200-13-05-.11 REPEALED

History

• Authority: T.C.A. §§ 4-5-208, 71-5-105, 71-5-109 and 71-5-2801.
• Administrative History: Original rule filed June 26, 1985; effective July 26, 1985. Amendment filed December 31, 1986; effective February 14, 1987. Amendment filed October 30, 1990; effective December 14, 1990. Amendment filed June 12, 1991; effective July 27, 1991. Amendment filed September 18, 1991; effective November 2, 1991. Amendment filed January 20, 1993; effective March 6, 1993. Amendment filed October 22, 1993; effective January 5, 1994. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective December 20, 2015.

Tenn. Comp. R. & Regs. 1200-13-05-.12 REPEALED

History

• Authority: T.C.A. §§ 4-5-208, 71-5-105, 71-5-109 and 71-5-2801.
• Administrative History: Original rule filed June 26, 1985; effective July 26, 1985. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective December 20, 2015.

Tenn. Comp. R. & Regs. 1200-13-05-.13 REPEALED

History

• Authority: T.C.A. §§ 4-5-208, 71-5-105, 71-5-109 and 71-5-2801.. Administrative History. Original rule filed June 26, 1985; effective July 26, 1985. Amendment filed April 30, 1987, effective June 14, 1987. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective December 20, 2015.

Tenn. Comp. R. & Regs. 1200-13-05-.14 REPEALED

History

• Authority: T.C.A. §§ 4-5-208, 71-5-105, 71-5-109 and 71-5-2801.
• Administrative History: Original rule filed June 26, 1985; effective July 26, 1985. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective December 20, 2015.

Tenn. Comp. R. & Regs. 1200-13-05-.15 REPEALED

History

• Authority: T.C.A. §§14-23-105, 14-23-109, 4-5-208, 71-5-105, 71-5-109, 71-1-2801, and 4-5-202. Administrative History. Original rule filed June 26, 1995, effective July 26, 1985. Amendment filed March 25, 1987, effective May 9, 1987. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective December 20, 2015.

Tenn. Comp. R. & Regs. 1200-13-05-.16 REPEALED

History

• Authority: T.C.A. §§ 4-5-208, 71-5-105, 71-5-109 and 71-5-2801..
• Administrative History: Original rule filed June 26, 1985; effective July 26, 1985. Amendment filed May 8, 1991; effective June 22, 1991. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective December 20, 2015.

Tenn. Comp. R. & Regs. 1200-13-05-.17 REPEALED

History

• Authority: T.C.A. §§ 4-5-208, 71-5-105, 71-5-109 and 71-5-2801..
• Administrative History: Original rule filed June 26, 1985; effective July 26,1985. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective December 20, 2015.

Tenn. Comp. R. & Regs. 1200-13-05-.18 REPEALED

History

• Authority: T.C.A. §§ 4-5-208, 71-5-105, 71-5-109 and 71-5-2801..
• Administrative History: Original rule filed March 18, 1994; effective June 1, 1994. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective December 20, 2015.

Chapter 1200-13-06 Nursing Facility Level I Program

Tenn. Comp. R. & Regs. 1200-13-06-.02 APPROVAL OF THE DEPARTMENT REQUIRED FOR PARTICIPATION

Only those institutions designated by and contracting with the Department as rendering Level I nursing facility services may participate and be reimbursed as a provider under these provisions. The Department shall notify the Comptroller of the Treasury when a provider enters the program and when its participation terminates.

History

• Authority: T.C.A. §§12-4-301, 71-5-105, 71-5-109, and 4-5-202.
• Administrative History: Original rule filed January 12, 1988; effective February 26, 1988. Amendment filed August 17, 1995; effective October 31, 1995.

Tenn. Comp. R. & Regs. 1200-13-06-.03 EXTENT OF REIMBURSEMENT TO BE DETERMINED BY THE DEPARTMENT

The reimbursable costs of institutions rendering Level I nursing facility services shall be reimbursable by each recipient and the State to the extent determined by the Department with the remainder not allowable as outside support from any other source available to the provider. The provider shall be limited to reimbursable per diem rate as determined by the Comptroller as the maximum it may collect from both sources for program services.

History

• Authority: T.C.A. §§12-4-301, 71-5-105, 71-5-109, and 4-5-202.
• Administrative History: Original rule filed January 12, 1988; effective February 26, 1988. Amendment filed August 17, 1995; effective October 31, 1995.

Tenn. Comp. R. & Regs. 1200-13-06-.04 BILLING PROCEDURE TO BE DETERMINED BY THE DEPARTMENT

Institutions providing Level I nursing facility services for Medicaid recipients shall bill the Department on the forms and in the manner designated by the Department.

History

• Authority: T.C.A. §§12-4-301, 71-5-105, 71-5-109, and 4-5-202.
• Administrative History: Original rule filed January 12, 1988; effective February 26, 1988. Amendment filed August 17, 1995; effective October 31, 1995.

Tenn. Comp. R. & Regs. 1200-13-06-.05 CHARGES TO NURSING FACILITY LEVEL I RECIPIENTS

The charge schedule of a provider must be applied uniformly to each recipient as services are furnished to the recipient. Appropriate writeoffs or adjustments shall be made to each account to reduce the gross charges to the contractual or legal collection limits of the various medical programs. The Comptroller of the Treasury must be notified of any changes in the schedule of charges.

History

• Authority: T.C.A. §§12-4-301, 71-5-105, 71-5-109, and 4-5-202.
• Administrative History: Original rule filed January 12, 1988; effective February 26, 1988. Amendment filed August 17, 1995; effective October 31, 1995.

Tenn. Comp. R. & Regs. 1200-13-06-.06 COVERED SERVICES

The specific items and services covered under the Level I nursing facility program shall be those defined and approved by the Department. Other non-covered services may be charged directly to the recipient (refer to the applicable Provider Manual).

History

• Authority: T.C.A. §§12-4-301, 71-5-105, 71-5-109, and 4-5-202.
• Administrative History: Original rule filed January 12, 1988; effective February 26, 1988. Amendment filed June 2, 1988; effective July 17, 1988. Amendment filed August 17, 1995; effective October 31, 1995.

Tenn. Comp. R. & Regs. 1200-13-06-.07 SUBMISSION OF COST REPORTS BY PROVIDERS

Medicaid program providers of Level I nursing facility services will be required to submit to the Comptroller of the Treasury a pro-forma (budgeted) cost report upon beginning participation as a new provider. New providers shall file a first actual cost report within six (6) or nine (9) months of commencing operations, depending on proximity of starting date to fiscal year end. Leases and changes of ownership are not considered new providers for this purpose and thus no budgeted cost reports are filed for leases or changes in ownership. Thereafter, cost reports shall be filed at their fiscal year end and submitted on forms described in rule 1200-13-6-.08. The report shall be due within three (3) months after the end of the designated fiscal period. An extension may be requested for due cause. Such cost reports must be completed in accordance with Medicare reimbursement principles except where these rules may specify otherwise. In the event that the provider does not file the required cost report by the due date, the provider shall be subject to a penalty of ten dollars ($10.00) per day in accordance with state law. In the event that a provider discovers a significant omission of costs, it may file an amended cost report at any time prior to the due date of its next annual cost report.

After that time, the cost report cannot be amended for cost omissions. Amended cost reports shall be subject to the same requirements as other cost reports, and will be the only accepted means to claim omitted costs. Rate increases resulting from submission of omitted costs will not be retroactive.

History

• Authority: T.C.A. §§4-5-202, 12-4-301, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed January 12, 1988; effective February 26, 1988. Amendment filed December 1, 1988; effective January 15, 1989. Amendment filed July 5, 1990; effective August 19, 1990. Amendment filed August 17, 1995; effective October 31, 1995. Amendment filed July 25, 2002; effective October 8, 2002.

Tenn. Comp. R. & Regs. 1200-13-06-.08 COST REPORT FOR THE NURSING FACILITY LEVEL I PROGRAM

STATE OF TENNESSEE

COMPTROLLER OF THE TREASURY

DEPARTMENT OF AUDIT

DIVISION OF STATE AUDIT

SUITE 1500 JAMES K. POLK STATE OFFICE BUILDING

NASHVILLE, TENNESSEE 37243-0264

IMPORTANT: Read Footnotes and Instructions and Accounting Principles before completing this form. Any form not properly completed may be rejected. DO NOT CHANGE THE EXISTING NOMENCLATURE. If the provider has accounts or descriptions that do not fit the existing categories, report the amounts in “Other” and attach a schedule with the desired nomenclature.

This will keep information comparable among cost reports.

Provider Numbers:

Level I Date Submitted , 19 Level II _________________________ Name of Facility _____________________________________________________________________________________________ Mailing Address ______________________________________________________________________________ Street, P.O. Box, RFD City State Zip Code Physical Address _____________________________________________________________________________ Street, P.O. Box, RFD City State Zip Code Name of Present Administrator ( ) Telephone Number Name of Home Office/Management Company Mailing Address__________________________________________________________ Street, P.O. Box, RFD City State Zip Code Contact Person _____________________________________ ( )_______________ Telephone Number Accounting Period Covered by this Report: From ____________, 19 thru _______, 19 Fiscal Year End ______________________________________________ ACCRUAL ACCOUNTING MUST BE USED FOR THIS REPORT 3,4 ENTER ALL AMOUNTS IN WHOLE DOLLARS ___________________________________________________________________________________________ A. Type of Facility (Check only one)

1. For Profit: __________ Sole Proprietor __________ Partnership __________ Corporation 2. Nonprofit: __________ Church __________ Corporation __________ Other 3. Government: __________ State __________ County __________ Other ____________________________________________________________________________________________ B. Statistical and Other Data (a) (b) (c) (d) (e)

Skilled (a + b) (c + d)

Certified Other NF TOTAL NF Non-NF TOTAL Beds Beds BEDS Beds BEDS 1. Licensed beds - beginning of the accounting period _______ _______ _______ _______ _______ a. Bed change - date_______ _______ _______ _______ _______ _______ b. Bed change - date_______ _______ _______ _______ _______ _______ 2. Licensed beds - end of the accounting period _______ _______ _______ _______ _______ 3. Possible bed days for the period _______ _______ _______ _______ _______ 4. Inpatient days for the period a. Medicare - Skilled ____________________ g. Private ICF/MR ___________________ b. Medicaid - NF2 ____________________ h. Other NF1 ___________________ c. Medicaid - NF1 ____________________ i. Other NF2 ___________________ d. Private - NF1 ____________________ j.

TOTAL NURSING FACILITY DAYS

e. Private - NF2 ____________________ (Add items a - i ) ___________________ f. Medicaid ICF/MR ____________________ k. Non-nursing facility days ___________________ l. TOTAL DAYS - Add items j and k ___________________ 5. Percent Occupancy (4.j. divided by 3.c.)

6. Meals served during the period a. Patients _______ b. Employees _______ (1) Considered part of compensation (Provided free of charge) _______ (2) Paid for by employees _______ c. Guests _______ (1) Provided free of charge _______ (2) Paid for by guests _______ d. Owners _______ (1) Provided free of charge _______ (2) Paid for by owners _______ e. Total Meals _______ B. Statistical and Other Data (continued)

7. List names of all persons living in the home that are not patients and their position or relationship to the home, such as owners, employees, etc. (If none, so state).

Name / Title, Position, or Relationship / Amount of Salary / Where in Section F is salary shown? __________________ _____________________ ___________ _________________________ __________________ _____________________ ___________ _________________________ 8. List changes in ownership during this reporting period and those changes anticipated during the next reporting period.

Type of Type of From Control To Control Date of Change __________________ ___________________ _____________________________ __________________ ___________________ _____________________________ __________________ ___________________ _____________________________ C. Balance Sheet (Date _________________, 19)

1. Assets a. Current Assets:

(1) Cash on hand and in bank $______ (2) Accounts receivable $______ Less allowance ______ ______ (3) Other accounts receivable ______ Less allowance ______ ______ (4) Notes receivable ______ (5) Due from officers/owners ______ (6) Inventory of supplies on hand ______ (7) Prepaid expenses ______ (8) Investments ______ (9) Intercompany receivables ______ (10) Other current assets (Specify) ___________________________ _______ ___________________________ _______ C. Balance Sheet (continued)

(11) Total Current Asset - Add items (1) through (10) $_______ b. Fixed Assets: Accumulated Cost Depreciation Book Value (1) Land $_____ _____ $_____ (2) Land Improvements $_____ _____ $_____ (3) Buildings _____ _____ _____ (4) Leasehold or building improvements _____ _____ _____ (5) Fixed Equipment _____ _____ _____ (6) Movable Equipment _____ _____ _____ (7) Motor vehicles _____ _____ _____ (8) Construction in progress _____ _____ _____ (9) Other depreciable assets (Specify) ____________________________ _____ _____ _____ ____________________________ _____ _____ _____ ____________________________ _____ _____ _____ (10) Total Fixed Assets Add items (1) through (9) $_____ $_____ $_____ c. Other Assets (if any):

(1) Deposits on loan $______ (2) Long term investments ______ (3) Special funds ______ (4) Patient trust funds ______ (5) Unamortized pre-opening expenses ______ (6) Unamortized organization expenses ______ (7) Other (Specify) _________________________ ______ _________________________ ______ _________________________ ______ C. Balance Sheet (continued)

(8) Total Other Assets - Add items (1) through (7) $______ d. Total Assets - Add items a(11), b(9), and c(8) $______ 2. Liabilities a. Current Liabilities:

(1) Accounts payable $______ (2) Mortgages payable within one year ______ (3) Notes and loans payable within one year ______ (4) Salaries and wages payable ______ (5) Payroll taxes payable ______ (6) Accrued taxes ______ (7) Deferred income ______ (8) Patient trust funds due to patients ______ (9) Intercompany payables ______ (10) Other current liabilities (specify) _______________________ ______ _______________________ ______ _______________________ ______ (11) Total Current Liabilities - Add items (1) through (10) $______ b. Long Term Liabilities (1) Mortgages payable beyond one year $______ (2) Notes payable beyond one year ______ (3) Unsecured loans ______ (4) Loans from owners ______ (5) Other long term liabilities (Specify) _______________________ ______ _______________________ ______ C. Balance Sheet (continued)

(6) Total Long Term Liabilities Add items (1) through (5) $______ c. Total Liabilities - Add items a(11) and b(6) $______ 3. Capital (Owner’s Equity or Fund Balance)

a. Net Worth:

(1) Individual $_______ (2) Partnership _______ (3) Corporation (a) Capital stock (at par or stated value) ________ (b) Paid in capital ________ (c) Treasury stock ________ (d) Retained earnings ________ (4) Fund Balance (Nonprofit) ________ b. Total Capital - Add items a(1) through a(4) $________ 4. Total Liabilities and Capital (Section C, item 2c plus item 3b) $________ D. Summary Statement of Income, Expense, and Retained Earnings 1. Income a. Gross Routine Service Charges (1) (2) (3)

Other Covered (1) + (2)

Room & Board Services Total (1) Medicare Skilled $________ $________ $________ (2) Medicaid - NF2 $________ ________ ________ (3) Medicaid - NF1 $________ ________ ________ (4) Private - NF1 $________ ________ ________ (5) Private - NF2 $________ ________ ________ (6) Medicaid - ICF/MR $________ ________ ________ (7) Private - ICF/MR $________ ________ ________ D. Summary Statement of Income, Expense, and Retained Earnings (continued)

(8) Other NF1 ________ ________ _________ (9) Other NF2 ________ ________ _________ (10) TOTAL ROUTINE NF CHARGES Add items (1) through (9) $________ $________ $_________ (11) Non-NF routine charges $_________ (12) TOTAL ROUTINE CHARGES - Add items (10) and (11) $_________ b. Other Income (1) Pharmacy $_________ (2) Laboratory _________ (3) X-ray _________ (4) All therapies _________ (5) Other ancillaries (Specify) ______________________________ _________ ______________________________ _________ (6) Cable TV income _________ (7) Rental income from non-routine nursing _________ home operations (8) Rental income from non-nursing home facilities _________ (9) Non-routine barber/beauty shop income _________ (10) Employee, owner, and guest meals _________ (11) Vending machine income _________ (12) Non-routine laundry income _________ (13) Interest and investment income on other than funded depreciation accounts (Attach Itemized Schedule) _________ (14) Interest on funded depreciation deposits _________ (15) Contributions, donations, and grants _________ D. Summary Statement of Income, Expense, and Retained Earnings (continued)

(16) Miscellaneous income Attach Itemized Schedule) _________ (17) Total Other Income Add items (1) through (16) $_________ c. Total Income Add items a(12) and b(17) $_________ 2. Deductions from Revenue:

a. Bad Debt Expenses (1) Applicable to Medicaid NF1 patients $_________ (2) Applicable to other patients _________ (3) Other bad debts (Specify) ____________________ _________ b. Contractual Allowance and Other Adjustments (1) Applicable to Medicaid NF1 patients $_________ (2) Applicable to other patients _________ (3) Other (Specify) ____________________ _________ c. Deductions from Revenue Add items 2a through 2b _________ 3. Net Revenue Item 1c minus 2c _________ 4. Operating Expense (Item F.21.) _________ 5. Profit or (Loss) Item 3 minus 4 $_________ 6. Additions and Deductions:

a. Additions other than revenue (Specify)

(1) _______________________ $_________ (2) _______________________ _________ (3) Total Additions $_________ b. Deductions (1) Dividends _________ (2) Withdrawal of earnings _________ (3) Other (Specify) _______________ _________ (4) Total Deductions _________ D. Summary Statement of Income, Expense, and Retained Earnings (continued)

c. Net Additions Over Deductions Item a(3) minus b(4) $_________ 7. Increase or (Decrease) in Balance of Retained Earnings for the Period - Add items 5 and 6c $_________ 8. Beginning Balance (If different from prior year ending balance, explain) $_________ 9. Retained Earnings (or Fund Balance) at the end of the reporting period - Add items 7 and 8 $__________ E. Information concerning Ownership of the Facility; Compensation of Owners, Administrators, and Relatives of Owners and Administrators; Related Party Transactions, including Home Office Costs; Charge Rates; and Patient Transportation. 9,10,11 1. Statement of Compensation to Owners Proprietors & Partners Corporate Shareholders Percent Share of Operating Percent of Providers Name Title Profit or (Loss) Stock Owned (1)_ (2)__ (3)_______ (4)___ a. _____________ ____________ ___________________________ ____________________________ b. _____________ ____________ ___________________________ ____________________________ c. _____________ ____________ ___________________________ ____________________________ d. _____________ ____________ ___________________________ ____________________________ Lines a through d continued below.

Percentage of Customary Inclusive Dates of Amount of Compensation Where in Section F Work Week Devoted to this Employment at this Included in Operating is the Compensation Facility Facility Costs for the Period included? (5)___ (6)___ (7)_ _(8) a. _______________________ _________________ _____________________ ___________________ b. _______________________ _________________ _____________________ ___________________ c. _______________________ _________________ _____________________ ___________________ d. _______________________ _________________ _____________________ ___________________ *Attach a statement describing actual duties performed by each individual listed.

E. Information concerning Ownership of the Facility; Compensation of Owners, Administrators, and Relatives of Owners and Administrators; Related Party Transactions, including Home Office Costs; Charge Rates; and Patient Transportation. 9,10,11 (continued) 2.

Statement of Compensation Paid to Administrators (Other than Owners) and Relatives of Owners and Administrators 13,14 Relationship to Owners, Percentage of Customary Administrators, or Assistant Work Week Devoted to this Name Title Administrators Facility (1)___ (2)____ (3)___ (4)_ a.___________ ______________ _______________________ ____________________________ b.___________ ______________ _______________________ ____________________________ c.___________ ______________ _______________________ ____________________________ d.___________ ______________ _______________________ ____________________________ Lines a through d continued below.

Where in Section F Inclusive Dates of Employment Amount of Compensation Included in is the Compensation at this Facility Operating Costs for the Period included? (5)___ (6)______ (7)___ a._______________________ _______________________________ ____________________________ b._______________________ _______________________________ ____________________________ c._______________________ _______________________________ ____________________________ d._______________________ _______________________________ ____________________________ *Attach a statement describing actual duties performed by each individual listed.

3. Intercompany Transfers and Transactions with Related Organizations, Including Home Office and Parent Companies 15,16,17 Note: A Home Office cost report and attached apportionment schedules must be filed before these costs can be considered allowable.

E. Information concerning Ownership of the Facility; Compensation of Owners, Administrators, and Relatives of Owners and Administrators; Related Party Transactions, including Home Office Costs; Charge Rates; and Patient Transportation. 9,10,11 (continued)

a. List all expenses included in Section F which were paid or accrued to a Related Organization:

Department or Account in Name of Organization _______ Amount Section F_________ _____________________________ ________________ ____________________________ _____________________________ ________________ ____________________________ _____________________________ ________________ ____________________________ _____________________________ ________________ ____________________________ b. Attach a schedule listing (1) All intercompany transfers and transactions between the facility and any Related Organization.

(2) The names of all business entities (a) that are related organizations, and (b) with whom the provider, during the reporting period, had more than $25,000 in business transactions or transacted 5 percent or more of the total operating expenses of the provider, whichever is less. (See footnote 12)

(3) Names, titles, positions, duties, and total compensation received by all members of Boards of Directors, Corporation Officers, Administrators, Owners, and any other key employees and their relatives, who constructively own 5 percent or more, of any of the organizations in (2) above, and the percentage of constructive ownership by each person listed. If none, so indicate.

4. List the name(s) and address(es) of the owner(s) of the land and buildings. 9,10,11 _______________________________________________________________________________________ _______________________________________________________________________________________ 5. If the land and buildings are rented, state the relationships (family and business) of the operator(s) of the nursing home to the owner(s) of the land and building, if any. If not related, so state. 9,10,11 _____________________________ __________________________________________________ _____________________________ __________________________________________________ E. Information concerning Ownership of the Facility; Compensation of Owners, Administrators, and Relatives of Owners and Administrators; Related Party Transactions, including Home Office Costs; Charge Rates; and Patient Transportation. 9,10,11 (continued)

5. Daily Room & Board Charge Rates NF1 NF2 ICF/MR Private Room Rate: effective date _______________ _______________ _____________ _______________ effective date _______________ _______________ _____________ _______________ effective date _______________ _______________ _____________ _______________ Semi-Private Room Rate: effective date _______________ _______________ _____________ _______________ effective date _______________ _______________ _____________ _______________ effective date _______________ _______________ _____________ _______________ Other Room Rates (Specify): effective date _______________ _______________ _____________ _______________ effective date _______________ _______________ _____________ _______________ effective date _______________ _______________ _____________ _______________ ______________________________ effective date _______________ _______________ _____________ _______________ effective date _______________ _______________ _____________ _______________ effective date _______________ _______________ _____________ _______________ Note: Any rate or charge change made during the year should be listed. Please do not include a charge range.

If charges have changed since the close of the accounting period, explain: ________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 7. Patient NonEmergency Transportation a. Does your facility provide or arrange to provide for non-emergency patient transportation? _______________________________________________________________________________ _______________________________________________________________________________ E. Information concerning Ownership of the Facility; Compensation of Owners, Administrators, and Relatives of Owners and Administrators; Related Party Transactions, including Home Office Costs; Charge Rates; and Patient Transportation. 9,10,11 (continued)

b. If you arrange for the transportation, provide the name of the organization and the amount of expense included in Section F that was paid for the service. ________________________________________________________________________________ ________________________________________________________________________________ c. If your facility provides the transportation, do you bill Medicaid separately for the service? ________________________________________________________________________________ If yes, what is the amount of income and where is it included in Section D? ________________________________________________________________________________ ________________________________________________________________________________ F. Operating Expenses: (Expenses per General Ledger) 4,18,19 *Enter all amounts in whole dollars.

Amount of Department or Account Expense Totals FTEs (1) (2)_ (3)_ (4) 1. Administration and General a. Salary of administrator $_________ ________ b. Other compensation to administrator _________ c. Other administrative salaries _________ ________ d. Office supplies and printing _________ e. Communications _________ f. Travel (Motor Vehicle) _________ g. Travel (Other) _________ h. Advertising _________ i. Licenses, dues, and subscriptions _________ j. Professional training and education _________ F. Operating Expenses: (Expenses per General Ledger) 4,18,19 (continued) *Enter all amounts in whole dollars.

Amount of Department or Account Expense Totals FTEs (1) (2)_ (3)_ (4) k. Conference registration and fees _________ l. Accounting and auditing _________ m. Legal services _________ n. Pharmacy consultant services _________ o. Other professional services _________ p. Management fees _________ q. Franchise tax and filing fees _________ r. Public relations _________ s. Excise taxes _________ t. Insurance (excluding amounts properly included in item 18d) _________ u. Utilization review fees _________ v. Other ______________________ _________ w. Total Add items a through v $_________ 2. Employee Benefits a. Social Security and Unemployment Insurance _________ b. Other employee benefits (Attach Itemized Schedule) _________ c. Total - Add items a and b __________ 3. Dietary a. Dietary salaries __________ _________ b. Raw food __________ F. Operating Expenses: (Expenses per General Ledger) 4,18,19 (continued) *Enter all amounts in whole dollars.

Amount of Department or Account Expense Totals FTEs (1) (2)_ (3)_ (4) c. Supplies _________ d. Purchased services (Attach Itemized Schedule) _________ e. Other _________________________ _________ f. Total Add items a through e ________ 4. Housekeeping a. Housekeeping salaries $_________ _________ b. Supplies _________ c. Purchased services (Attach Itemized Schedule) _________ d. Other ________________________ _________ e. Total - Add items a through d _________ 5. Laundry and Linen a. Laundry and linen salaries _________ _________ b. Linen and bedding _________ c. Supplies _________ d. Purchased services (Attach Itemized Schedule) _________ e. Other ________________________ _________ f. Total - Add items a through e _________ 6. Plant Operation and Maintenance a. Operation and maintenance salaries ________ ________ b. Fuel (Heating) _________ F. Operating Expenses: (Expenses per General Ledger) 4,18,19 (continued) *Enter all amounts in whole dollars.

Amount of Department or Account Expense Totals FTEs (1) (2)_ (3)_ (4) c. Gas _________ d. Electricity _________ e. Water and sewage _________ f. Supplies _________ g. Purchased services (Attach Itemized Schedule) _________ h. Repairs _________ i. Other _______________________ _________ j. Total Add items a through i ________ 7. Medical and Nursing a. Salaries Medical Director _________ ________ b. Salaries Registered Professional Nurses (RNs) _________ ________ c. Salaries Licensed Practical Nurses (LPNs) _________ ________ d. Salaries Attendants, orderlies, and aides _________ ________ e. Salaries Other nursing personnel _________ ________ f. Supplies _________ g. Purchased services (Attach Itemized Schedule) _________ h. Routine medical supplies _________ i. Other ________________________ _________ j. Total Add items a through i _________ 8. Physicians Care (Excluding Medical Director)

a. Physicians salaries or fees $_________ ________ F. Operating Expenses: (Expenses per General Ledger) 4,18,19 (continued) *Enter all amounts in whole dollars.

Amount of Department or Account Expense Totals FTEs (1) (2)_ (3)_ (4) b. Other salaries or fees _________ _______ c. Other ______________________ _________ d. Total Add items a through c $_______ 9. Pharmacy (Excluding consultant fees)

a. Pharmacy salaries or fees _________ _______ b. Drugs and pharmaceuticals _________ c. Supplies _________ d. Purchased services (Attach Itemized Schedule) _________ e. Other ________________________ _________ f. Total Add items a through e ________ 10. Laboratory a. Laboratory salaries or fees __________ _______ b. Supplies _________ c. Purchased services (Attach Itemized Schedule) _________ d. Other ________________________ _________ e. Total Add items a through d _________ 11. X-ray a. X-ray salaries or fees _________ ________ b. Supplies _________ c. Purchased services (Attach Itemized Schedule) _________ F. Operating Expenses: (Expenses per General Ledger) 4,18,19 (continued) *Enter all amounts in whole dollars.

Amount of Department or Account Expense Totals FTEs (1) (2)_ (3)_ (4) d. Other ________________________ _________ e. Total Add items a through d ________ 12. Recreational Activities a. Recreational salaries _________ ________ b. Supplies _________ c. Purchased services (Attach Itemized Schedule) _________ d. Other _______________________ _________ e. Total Add items a through d ________ 13. Social Service a. Social service salaries _________ ________ b. Other ________________________ _________ c. Total Add items a and b ________ 14. Physical Therapy a. Salaries $_________ ________ b. Supplies _________ c. Purchased services (Attach Itemized Schedule) _________ d. Other ________________________ _________ e. Total Add items a through d $________ 15. Psychiatric Services a. Salaries _________ _______ b. Purchased services (Attach Itemized Schedule) _________ F. Operating Expenses: (Expenses per General Ledger) 4,18,19 (continued) *Enter all amounts in whole dollars.

Amount of Department or Account Expense Totals FTEs (1) (2)_ (3)_ (4) c. Other _______________________ _________ d. Total Add items a through c _______ 16. Psychological Services a. Salaries _________ ________ b. Purchased services (Attach Itemized Schedule) _________ c. Other _______________________ _________ d. Total Add items a through c _______ 17. Medical Records a. Salaries _________ ________ b. Supplies _________ c. Other _______________________ _________ d. Total Add items a through c _______ 18. Property Expense a. Real estate taxes on property used only for nursing home purposes _________ b. Rent or lease fee on buildings or equipment used only for nursing home purposes _________ c. Interest expense on buildings or equipment used only for nursing home purposes _________ d. Insurance on property used only for nursing home purposes _________ e. Total Add items a through d _______ F. Operating Expenses: (Expenses per General Ledger) 4,18,19 (continued) *Enter all amounts in whole dollars.

Amount of Department or Account Expense Totals FTEs (1) (2)_ (3)_ (4) 19. Depreciation and Amortization (Complete Schedule L)

a. Land improvements _________ b. Buildings _________ c. Leasehold/building improvements _________ d. Fixed equipment _________ e. Movable equipment _________ f. Automotive equipment $_________ g. Other depreciation (Specify on Schedule L) _________ h. Amortization of pre-opening costs _________ i. Amortization of organization cost _________ j. Other Amortization (Specify on Schedule L) _________ k. Total Add items a through j $_________ 20. Other Expenses (Specify) (Attach schedule if additional space is needed)

a. Salaries ________________________ ___________ ________ b. Vending machines ___________ c. Purchased barber and beauty services ___________ d. Cable TV (not beneficial to all patients) ___________ e. Other interest not included on line 18 (Include on Schedule M) ___________ f. Annual nursing home privilege tax ___________ g. Other ___________________ ___________ F. Operating Expenses: (Expenses per General Ledger) 4,18,19 (continued) *Enter all amounts in whole dollars.

Amount of Department or Account Expense Totals FTEs (1) (2)_ (3)_ (4) h. Total Add items a through g _________ 21. Total Operating Expense Add totals in column 3, items 1 through 20 $______ _______ ____________________________________________________________________________________________ G. Adjustments for Calculating Allowable Routine Operating Expense 1. Total Amount of Expenses Per Books (Total should equal amount under Section F, Item 21) $_________ 2. Adjustments to be made (Deduct only items included in item 1 above)

Description of Expense or Income Base Amount a. Research and medical education ____________ $__________ b. Vending machines, concessions, etc. ____________ __________ c. Non-routine barber and beauty shop income ____________ __________ d. Non-routine medical and surgical supply income ____________ __________ e. Non-routine laundry income ____________ __________ f. Applicable miscellaneous income ____________ __________ g. Interest and investment income (limited to interest expense) ____________ __________ h. Telephone charges paid for by patients, guests, employees, and others ____________ __________ i. Guest, owner, and employee meals not considered as a part of compensation; and the cost of free meals to guests ____________ __________ j. Drugs, supplies, or other services purchased by non-patients ____________ $__________ k. Income from rental of facility furniture and equipment to patients and non-patients ____________ __________ G. Adjustments for Calculating Allowable Routine Operating Expense (continued)

Description of Expense or Income Base Amount l. Rental, maintenance, insurance, depreciation, taxes, and other expenses of non-nursing home facilities (attach supporting schedules) __________ __________ m. Bad debts or provisions therefor, charity and courtesy allowances included in operating expenses __________ __________ n. Expenses applicable to outpatients __________ __________ o. Amounts collected for and paid to pharmacists, physicians, and other professional individuals __________ __________ p. Non-allowable purchased services __________ __________ q. Salaries or fees paid to physicians for treatment of individual patients and related expenses __________ __________ r. Pharmacy (Amount shown in Section F, Item 9f as well as any other applicable amount) __________ __________ s. Laboratory (Amount shown in Section F, Item 10e) __________ __________ t. X-ray (Amount shown in Section F, Item 11e as well as any other applicable amount) __________ __________ u. Cable TV (Other than those in lounge or lobby for general benefit of all patients).

(Amount shown in Section F, Item 20d as well as any other applicable amount) __________ __________ v. Facilities or accommodations furnished owners, administrators, and other non-patients not considered compensation.

(Attach computation sheets) __________ __________ w. Indirect expenses apportioned to Ancillary Departments (Amount in Section H, Item 20) __________ __________ G. Adjustments for Calculating Allowable Routine Operating Expense (continued)

x. Related organization:

(1) Expense paid to a related organization $_________ (2) Cost of services by the related organization $_________ ___________ (Difference between (1) and (2) is the amount to be adjusted) (Attach supporting cost data and schedules)

Description of Expense or Income Base Amount y. Excess owner’s compensation ___________ ___________ z. Excise taxes (Amount shown in Section F, Item 1s) ___________ ___________ aa. Cost of items billed and collected from Medicare Part B on behalf of Medicaid NF1 recipients ___________ ___________ bb. All other items or services which are not covered by NF1 Medicaid services ___________ ___________ cc. Other adjustments (Specify on an attached itemized schedule) ___________ ___________ dd. Total Add items a through cc $__________ 3. Total Allowable Routine Operating Costs Item G1 minus G2dd $___________ H. Allocation of Cost to Routine, Ancillary, and Extra Charge Areas 26,27 Other Total Routine Pharmacy Laboratory Radiology Ancillary Cost Item (1) (2) (3) (4) (5) (6) 1. Administration & General (F1)

Allocation Statistics _______ _______ _______ _______ _______ _______ Cost $______ $______ $______ $______ $______ $______ 2. Employee Benefits (F2) Allocation Statistics Cost ______ ______ ______ ______ ______ ______ $_____ $ $ $ $ $ H. Allocation of Cost to Routine, Ancillary, and Extra Charge Areas 26,27 Other Total Routine Pharmacy Laboratory Radiology Ancillary Cost Item (1) (2) (3) __(4) (5) (6)

3. Dietary (F3)

Allocation Statistics ______ _______ _______ _______ _______ _______ Cost $_____ $______ $______ $______ $______ $______ 4. Housekeeping (F4)

Allocation Statistics _______ _______ _______ _______ _______ _______ Cost $______ $______ $______ $______ $______ $______ 5. Laundry and Linen (F5)

Allocation Statistics _______ _______ _______ _______ _______ _______ Cost $______ $______ $______ $______ $______ $______ 6. Plant Operation and Maintenance (F6)

Allocation Statistics _______ _______ _______ _______ _______ _______ Cost $______ $______ $______ $______ $______ $______ 7. Medical and Nursing (F7) Allocation Statistics Cost _______ _______ _______ _______ _______ _______ $______ $______ $______ $______ $______ $______ 8. Recreational Activities (F12)

Allocation Statistics Cost _______ _______ _______ _______ _______ _______ $______ $______ $______ $______ $______ $______ 9. Social Services (F13)

Allocation Statistics ______ ______ ______ ______ ______ ______ Cost $_____ $_____ $_____ $_____ $_____ $_____ 10. Physical Therapy (F14)

Allocation Statistics ______ ______ ______ ______ ______ ______ Cost $_____ $_____ $_____ $_____ $_____ $_____ 11. Psychiatric Services (F15)

Allocation Statistics ______ ______ _____ ______ ______ ______ $_____ $_____ $_____ $_____ $_____ $_____ 12. Psychological Services (F16)

Allocation Statistics ______ ______ ______ ______ ______ ______ Cost $_____ $_____ $_____ $_____ $_____ $_____ 13. Medical Records (F17)

Allocation Statistics ______ ______ ______ ______ ______ ______ Cost $_____ $_____ $_____ $_____ $_____ $_____ 14. Property Expense (F18)

Allocation Statistics ______ ______ ______ ______ ______ ______ Cost $_____ $_____ $_____ $_____ $_____ $_____ 15. Building Depreciation (F19a-c)

Allocation Statistics ______ ______ ______ ______ ______ ______ Cost $_____ $_____ $_____ $_____ $_____ $_____ Total Routine Pharmacy Laboratory Radiology Ancillary Cost Item (1) (2) (3) __(4) (5) (6)

16. Equipment and Other Depreciation (F19d-g)

Allocation Statistics ______ ______ ______ ______ ______ ______ Cost $_____ $_____ $_____ $_____ $_____ $_____ 17. Amortization (F19h-j)

Allocation Statistics ______ ______ ______ ______ ______ ______ Cost $_____ $_____ $_____ $_____ $_____ $_____ 18. Any Other Shared Cost Allocation Statistics ______ ______ ______ ______ ______ ______ Cost $_____ $_____ $_____ $_____ $_____ $_____ 19. Totals $______ $______ $_____ $______ $______ $______ 20. Allocated Ancillary Costs (Columns 3, 4, 5, and 6) $________________ I. Total Ancillary and Extra Charge Area Costs Other Pharmacy Laboratory Radiology Ancillary 1. Direct Costs (F8, F9, F10, etc.) $_______ $_______ $_______ $_______ 2. Indirect Costs (H19) _______ _______ _______ _______ 3. Total $_______ $_______ $________ $________ ________________________________________________________________________________________________ J. Summary of Ancillary Charges (a) (b) (c) (d)

Medicare Skilled Medicaid NF2 Private Total 1. Pharmacy $___________ $__________ $__________ $__________ 2. Laboratory ___________ ___________ ___________ ___________ 3. X-ray ___________ ___________ ___________ ___________ 4. All therapies ___________ ___________ ___________ ___________ 5. Other ancillaries (Specify) ___________ ____________ ___________ __________ _______________ ___________ ____________ ___________ __________ _______________ ___________ ____________ ___________ __________ _______________ ___________ ____________ ___________ __________ 6. Totals - Add items 1 through 5 $____________ $____________ $___________ $___________ ________________________________________________________________________________________________ K. Calculation of Expenses Applicable to NF1 Program (Reimbursable Cost)

a. Facilities rendering one level of care (NF1 only)

(1) (2) (3) (4) (5)

Total Allowable Expenses Total Nursing Medicaid NF1 % Medicaid NF1 Routine Operating Applicable Facility Days Inpatient Days Days to Total Days Costs to NF1 Program (B.4.j.) (B.4.c.) (Col. 2 / Col. 1) (G.3.) (Col. 3 x Col. 4) ============ =========== ============ ============ ============= b. Facilities rendering more than one level of care.

(1) (2) (3) (4) (5)

Routine Charges % Medicaid NF1 Total Allowable Expenses Total Routine to Medicaid NF1 Charges to Routine Operating Applicable NF Charges Patients Total Charges Costs to NF1 Program (D.1.a.10.) (D.1.a.3.) (Col. 2 / Col. 1) (G.3.) (Col. 3 x Col. 4) ___________ ____________ % $ $__________ L. Depreciation and Amortization Schedule Date Estimated Salvage Current Period Asset Cost Acquired Useful Life Value Method Depreciation Land Improvements $______ ________ _________ $_______ S/L $__________ Building ______ ________ _________ ________ S/L __ ___________ Leasehold/Building _______ ________ _________ ________ S/L __ ___________ Improvements Movable Equipment _______ ________ _________ ________ S/L __ ___________ Other Depreciable _______ ________ _________ ________ S/L __ ___________ Assets _______________ _______ ________ _________ ________ S/L __ ___________ _______ ________ _________ ________ S/L __ ___________ _______ ________ _________ ________ S/L __ ___________ Totals $ $ Amortization Method of Current Period Amortization Original Amount Starting Date Period Amortization Amortization Pre-opening Cost $ __________ 5 years __ S/L $_______ Organization Cost $__________ __________ 5 years __ S/L $_________ Other (Specify) $__________ __________ ________ S/L ____ $_____ _______________ $__________ __________ ________ S/L ____ $_____ Totals $_____________ ___________ ____________________________________________________________________________________________ M. Loans, Mortgages, and Notes 1. List individually all loans, mortgages, and notes made in the name of the facility, operators, and/or owners of the facility, for which the related interest expense has been included as an allowable cost. If the amount of previously outstanding loans, mortgages, or notes was increased during the period, list amount and date of increase. State the name of the lender (optional, if not identified by name, enter some code which will be traceable to the provider’s records), date of loan, amount of principal, and the amount of interest for the accounting period. List new obligations incurred during this period in item 2. below.

Beginning Ending Current Period Name of Lender Date of Loan Balance Balance Interest Expense _______________ ____________ $__________ $__________ $__________ _______________ ____________ ___________ ___________ ___________ _______________ ____________ ___________ ___________ ___________ _______________ ____________ ___________ ___________ ___________ _______________ ____________ ___________ ___________ ___________ _______________ ____________ ___________ ___________ ___________ _______________ ____________ ___________ ___________ ___________ _______________ ____________ ___________ ___________ ___________ _______________ ____________ ___________ ___________ ___________ Total Interest Expense for Item 1 ___________ 2. For each new obligation incurred during this reporting period state the name of lender (optional, if not identified by name, enter some code which will be traceable to the provider’s records), amount of the new obligation, interest expense included in Section F, the disposition of the proceeds of the loan, and the date the obligation was incurred. Do not duplicate items in 1 above.

Date of Original Ending Current Period Name of Lender

Purpose for Loan Loan Amount Amount Interest Expense _______________ ______________ ______ $______ $______ $____________ _______________ ______________ ______ _______ _______ _____________ _______________ ______________ ______ _______ _______ _____________ _______________ ______________ ______ _______ _______ _____________ _______________ ______________ ______ _______ _______ _____________ Total Interest Expense for Item 2 $____________ Total Interest Expense - Add items in 1 and 2 $____________ N. Statement of Equity Capital Date Amount 1. Change in Equity Capital (Dates are required for c, d, and e)

a. Equity Capital Beginning of Period $__________ b. Net Income (Loss) for the Period (Item D.5.) ___________ c. Capital Investments (Withdrawals) during the period (Attach schedule if more than one entry) __________________________________________ __________ ___________ d. Gain (Loss) on Fixed Assets (Attach schedule if more than one entry) __________________________________________ __________ ___________ e. Other Increases (Decreases)

(Specify Attach schedule if more than one entry) __________________________________________ __________ ___________ f. Equity Capital - End of Period $__________ 2. Reconciliation of Equity Capital with Total Capital a. Total Capital (Item C.3.b.) $__________ b. Additions (Deductions) (Identify each entry) ____________________________________ $____________ ____________________________________ _____________ ____________________________________ _____________ ____________________________________ _____________ __________ c. Equity Capital - End of Period $__________ ___________________________________________________________________________________________ O. Certification by Owner, Officer, or Administrator of Facility I, ___________________________________________, ____________________________________ of the (Name) (Title) ____________________________________________, _________________________, ________________ (Name of Facility) (City) (State) do certify that I have examined the attached report for the fiscal period beginning ________________, 19, and ending ______________, 19, the accompanying Footnotes and Instructions and Accounting Principles, and that to the best of my knowledge and belief, this report is a true and correct statement of the information required, and that charges and expenses for services provided to Medicaid Program recipients were in accordance with applicable state and federal regulations. I understand that any false claims, statements, or documents, or the concealment of a material fact may lead to prosecution under applicable Federal or State Laws.

Date _____________________, 19 ____________________________________________ Signature of Authorized Representative of Facility ____________________________________________ Typed Name of Authorized Representative ____________________________________________ Title

History

• Authority: T.C.A. §§4-5-202, 12-4-301, 71-5-105, and 71-5-109.
• Administrative History: Original chapter filed January 12, 1988; effective February 26, 1988. Amendment filed December 1, 1988; effective January 15, 1989. Amendment filed August 17, 1995; effective October 30, 1995. Amendment filed January 21, 2000; effective April 5, 2000.

Tenn. Comp. R. & Regs. 1200-13-06-.09 FOOTNOTES AND INSTRUCTIONS FOR THE NURSING FACILITY LEVEL I COST

REPORT.

(1) General 1. Enter the NF-1 Provider number as issued by the Tennessee Department of Health and the NF-2 Provider number as issued by Medicare. Providers with numbers other than NF-1 and NF-2 may include them on the Level II line.

2. Enter name of facility exactly as shown on the license (permit) to operate issued by the Tennessee Department of Health.

3. Cash basis accounting is not acceptable for purposes of this report. All amounts must be reported in whole dollars.

4. Adequate financial records, statistical data, and source documents must be maintained for proper determination of costs under the program.

B. Statistical Data 5. All statistics to be reported in this section will be for the same period as the accounting period covered by this report.

6. Possible bed days should be the sum of the count of the number of licensed beds for each day of the accounting period.

7. An inpatient day is that period of service rendered a patient between the census taking hours on two successive days, the day of discharge being counted only when the patient was admitted that same day. All days charged for must be included in the patient day statistics including leave days, reserved bed days, etc. A census will be recorded each day during the accounting period. All such records must be available for verification by the Comptroller’s Office. All inpatient days must be identified by the categories indicated.

8. Report all meals provided to patients, employees, guests, and owners. The cost of meals provided to owners must be included in compensation stated in Section E. Adequate meal records must be maintained.

E. Ownership of Facility; Compensation of Owners, Administrators, and Relatives of Owners and Administrators; Related Party Transactions, Including Home Office Costs; Charge Rates; and Patient Transportation 9. Controlling interest is defined as a person or entity that:

(a) has an ownership interest totaling five percent (5%) or more in a disclosing entity, (b) has an indirect ownership interest equal to five percent (5%) or more in a disclosing entity, (c) has a combination of direct and indirect ownership interest obligation secured by the disclosing entity if that interest equals at least five percent (5%) of the value of the property or assets of the disclosing entity, (d) is an officer or director of a disclosing entity that is organized as a corporation, or (e) is a partner in a disclosing entity that is organized as a partnership.

Indirect ownership interest is defined as any ownership interest in an entity that has an ownership interest in the disclosing entity. This includes an ownership interest in any entity that has an indirect ownership interest in the disclosing entity.

The amount of indirect ownership interest is determined by multiplying the percentages of ownership in each entity. EXAMPLE: A owns ten percent (10%) of the stock of Corporation B which owns eighty percent (80%) of the stock of the disclosing entity. A’s interest is an eight percent (8%) indirect ownership interest in the disclosing entity and must be disclosed.

The amount of ownership, mortgage, deed of trust, note, or other obligation is determined by multiplying the percentage owned in the obligation by the percentage of the disclosing entity’s assets used to secure the obligation. EXAMPLE: A owns ten percent (10%) of a note secured by sixty percent (60%) of the provider’s assets. A’s interest in the provider’s assets is six percent (6%) and must be disclosed.

10. Disclosing entities are defined as hospitals, skilled nursing facilities, clinical laboratories, renal disease facilities, health maintenance organizations, and rural health clinics (as established by P.

L. 95210) under Title XVIII (Medicare), entities (other than practitioners or groups of practitioners) that furnish or arrange for the furnishing of services under the Title XIX or Title V (Children’s Special Service) programs; fiscal intermediaries, fiscal agents, and carriers participating in Medicare or Medicaid; and providers of health related services under the Title XX program.

11. Information relating to ownership shall be maintained at the facility and available for audit and upon request at any time.

12. The amounts of business transacted with entities that are not related entities need not be disclosed in the cost report. However, in the event of a request, the disclosure of the amounts and the ownership of the business entity with whom the provider transacted business of more than $25,000 or five percent or more of the total operating expenses of the provider, whichever is less, may be required within 30 days of the request.

13. For reimbursement purposes, a reasonable allowance or compensation for services of an owner or persons related to an owner is an allowable cost, provided the services are performed in a necessary function. The requirement that the function be necessary means that had the owner not rendered the services, the institution would have had to employ another person to perform them. The services must be related to patient care and pertinent to the operation and sound management of the institution.

Total compensation to such persons must be listed in Section E, Items 1 and 2. Where such amounts include items other than salaries, a schedule must be attached that identifies the amounts and the method of assigning values to these benefits. All such costs included in

Section F must be reported in Section E.

The Comptroller’s Office will review these amounts and compare them with allowable compensation ranges and make necessary adjustments. The Comptroller will consider the duties, responsibilities, and managerial authority of the person as well as the services performed for other institutions and his engagements in other occupations. Only one fulltime position, or its equivalent will be allowed for each person. The duties performed, time spent, and compensation received by such a person must be substantiated by appropriate records.

Allowable ranges can be found in Chapter 1200-13-6-.11.

14. Complete Section E, Item 2 only for individuals who are not owners of the facility. If the individual is related to any owner by blood or marriage, this relationship must be indicated in Column 3. See PRM, Part 1, Section 902.5.

15. All loan transactions with related parties as defined in footnotes 9 and 10 shall be fully disclosed in Section E and the corresponding interest expense shall be disallowed in Section G.

16. The hospital parent or a hospital-based nursing home shall not be considered as a home office if the hospital is a regular provider in the Medicaid hospital program and files the appropriate Medicare-Medicaid hospital cost report in a timely manner. Costs allocated to the nursing home on the hospital’s Medicare-Medicaid cost report are includable in Section F of this cost report. These amounts do not have to be audited by the Certified Public Accountant or licensed Public Accountant if significant portions of the corresponding expenses before allocation are apportioned to the hospital and prior approval is received from the Comptroller’s Office. The report by the Certified Public Accountant must disclose the amounts allocated to the hospital and nursing facility, the bases used, and the corresponding figures which were not included in the audit.

17. Home Office costs directly related to those services performed for individual providers which relate to patient care, plus an appropriate share of indirect costs (overhead, rent, administrative salaries, etc.) may be allowable to the extent they are reasonable. Home Office costs or related organization costs that are not otherwise allowable costs when incurred directly by the provider cannot be allowable costs when allocated to providers. Nursing facility cost reports will not be processed until the home office costs are submitted.

F. Operating Expenses 18. Itemized schedules must be attached to support advertising, public relations, “other,” and “purchased services” accounts. Amounts not supported will be disallowed.

Enter in the appropriate classification the number of personnel employed full-time as of the end of the fiscal period covered by this statement. Report the fulltime equivalent (FTE) of all personnel working in the particular classification. For example, if five people are employed full-time as LPNs, one person is employed as an LPN one day per week (eight hours per day), and another person works as an LPN two days per week (eight hours per day), the total LPNs to be reported should be 5.6 full-time equivalent employees. The number of personnel in each particular classification under Section F, Column (4), “FTEs”, must coincide with the salaries reported in each particular classification of Section F, Column (2), “Amount of Expense”.

Payroll records are to be available for verification by the Comptroller’s Office.

19. All facilities should properly identify and include in Section F. “Operating Expense,” the cost of providing to all patients the medical supplies, equipment, and services specified by the Department of Health as covered services. These are items and services (per the Department of Health contract with all facilities) for which the facility may not receive extra payments from Medicaid patients, their relatives or others.

20. Include the cost of covered supplies only. Do not include drugs or pharmacy items that are not covered by the NF-1 program. Drugs and pharmacy should be included in item F.9.

21. Psychiatric and Psychological Services can be provided only to ICF/MR patients in an ICF/MR licensed facility.

22. The purpose of Section G, “Adjustments for Calculating Allowable Routine Operating Expense” is to determine the cost of room and board, nursing care, medical and nursing supplies, and other services as specified and defined by the Department of Health as NF-1 covered services. Consequently, the cost of any items or services not a part of the cost of providing NF-1 covered services included in Section F, “Operating Expense” are to be deducted from operating expenses in Section G. Accounting and other records of participating facilities are subject to audit and verification by the Comptroller’s Office for proper determination of cost of covered services. In addition to the items specifically identified in Section G, the following are also expenses not considered a part of the cost of providing routine service, and should be deducted. This list is not to be considered all inclusive. Generally, where an item is not specifically addressed, Medicare reimbursement principles apply.

a. Interest paid:

(1) On borrowed funds used for a non-allowable expenditure.

(2) On borrowed funds which create excess working capital.

(3) On borrowed funds used for investing in other than provider’s health care operations.

(4) To partners (owners), stockholders, or related organizations or relatives.

(5) On borrowed funds used to fund depreciation.

b. Any imputed value of produce, supplies or space donated to the provider.

c. Purchase discounts, cash discounts, trade discounts, quantity discounts or allowances.

d. Purchase refunds or rebates.

e. Costs which are not necessary or related to patient care.

f. Costs of non-competing covenant agreements.

g. Insurance premiums paid on the lives of owners, officers, and key personnel, if the provider is the direct or indirect beneficiary. If another party is beneficiary, the premiums are to be considered as compensation to the respective owner, officer, or key employee and should be disclosed separately.

h. Cost of personal comfort items and other non-covered items, as may be specified and defined by the Department of Health.

i. Cost of luxury items such as TV, telephone, and radio in patient rooms. (This does not include those items placed in lounges or recreation rooms to be used by all patients).

j. Any fines, penalties, or interest paid on any tax payments or interest charges on overdue payables.

k. Federal, State, or local income taxes, or excess profit taxes.

l. Any taxes for which exemptions are available but not taken.

m. Sales taxes collected by the provider and remitted to the state.

n. Real estate taxes and other expenses on property purchased and held for investment or expansion, and not used in rendering patient service.

o. Self employment taxes applicable to owners, partners, members of joint ventures, etc.

p. Casualty and other losses such as liability, theft, larceny, embezzlement, that are insurable but uninsured. (When insured, the insurance premiums and cost of deductibles for these losses are allowable). Medicare principles must apply.

q. Advertising costs incurred:

(1) To raise funds for the provider.

(2) Which are designed to encourage physicians to utilize the provider’s facilities in their capacity as an independent practitioner.

(3) In connection with the issuance of the provider’s own stock or sale of stock held by the provider in another corporation.

(4) Which seek to increase patient population or utilization of the provider’s facilities by the general public.

r. Membership dues, initiation fees, subscription costs or special assessments paid to Social, Fraternal, or other organizations whose activities are unrelated to the profession or business of their members.

s. Cost of private duty nurses and attendants.

t. Travel expenses which are personal in nature, not proper or related to patient care, and auto expenses applicable to non-business uses of the vehicles. Detailed justification for out of state travel must be retained for audit verification.

u. Any other costs which are identified and specified as non-allowable by the Medicaid Program manuals, or federal or state rules or regulations.

23. The cost of excludable expenses should be deducted. In the relatively few instances where such costs cannot be adequately determined, deduct the revenue received therefrom. If the amount shown is revenue enter “R” as the base.

24. Cost of facilities furnished to owners, administrators, and other non-patients must be determined on a reasonable basis. Where the nursing home has no plan for determining reasonable charges for these facilities, the patient charge schedule may be used by the Comptroller of the Treasury in arriving at the amount of exclusion.

25. In Section G. Item 2bb any costs or expenses included in Section F, “Operating Expense,” for the items or services for which Medicaid NF-1 patients may be charged extra by the facility in addition to the established reimbursable cost rate of the facility are to be deducted from operating expense.

26. Facilities with no ancillary or extra charge areas should omit Sections H and I.

H. Allocation of Cost to Routine, Ancillary and Extra Charge Areas (Facilities with no ancillary or extra charge areas can omit this section).

27. The statistical bases below shall be used to apportion indirect costs to ancillary and extra charge areas unless prior approval is obtained in writing from the Comptroller of the Treasury.

Cost Item

Basis 1. Administration and General Direct Costs (Section F)

2. Employee Benefits Salaries 3. Dietary Meals Served 4. Housekeeping Square Feet or Actual Time Spent 5. Laundry Pounds 6. Plant Operation and Maintenance Square Feet 7. Medical and Nursing Actual Cost 8. Recreational Activities Time Spent 9. Social Services Time Spent 10. Property Expenses Square Feet 11. Building Depreciation Square Feet 12. Equipment and Other Depreciation Dollar Value 13. Any other cost which should be Any reasonable basis allocated to Ancillary or approved by the State Extra-Charge areas Comptroller’s Office The first line under each cost item to be allocated should show the allocation statistics used to apportion the total cost. The second line should show the costs after allocation. The allocation formula is:

Area Statistic X Total Cost = Area Cost Total Statistic J. Patient Log Summary of Charges 28. Routine charges must be based on the facility’s established daily charge rate before contractual allowances. Ancillary charges (Section J) do not apply to Medicaid NF1 recipients.

29. If a facility is rendering only one level of care, the percentages of costs of the NF-1 program will be determined as a percentage of Medicaid NF-1 patient days to total patient days (Section K, Item a). If a facility is rendering more than one level of care, the percentage of costs to the NF-1 program will be determined as a percentage of Medicaid NF-1 covered charges to total covered charges (Section K, Item b).

L. Depreciation and Amortization Schedule 30. The Depreciation and Amortization Schedule (Section L) must be completed. Fixed Asset cost must agree with the Fixed Asset cost by classification shown in Section C. Do not include land, as land is not considered a depreciable asset. The sum of the current period total amortization expense reported in Section L and the current year unamortized expense reported in Section C.1.c. (Items (5) and (6)) should equal the unamortized expense reported in Section C.1.c.

(Items (5) and (6)) of the prior period cost report.

N. Statement of Equity Capital 31. Equity Capital means the net worth of a provider, excluding those assets not related to patient care. Specifically, Equity Capital, includes:

(a) a provider’s investment in plant, property, and equipment (net of depreciation and associated long-term debt) related to patient care plus funds deposited by a provider who leases plant, property, and equipment related to patient care and is required by terms of the lease to deposit such funds (net of noncurrent debt related to such investment or deposited funds) and (b) net working capital maintained for necessary and proper operation of patient care activities.

Providers of chain organizations may assign an appropriate share of the equity capital of the home office to each facility. This assignment must be shown in the home office cost report.

Debt representing loans from partners, stockholders, or related organizations and for which the interest is not an allowable cost shall be considered as equity capital and shall not be subtracted in the determination of (a) or (b) above.

Investments, excess fixed assets, excess inventory, goodwill, loans to officers, owners, related organizations, or employees, uncollectible accounts and notes receivable, cash in excess of reasonable needs, and other assets, current or noncurrent, that are not reasonably related to patient care must be excluded from equity capital. Further, any capital expenditure that has not been approved by the Tennessee Health Facilities Commission or its successor agency in accordance with state law must be excluded from equity capital.

If the current year’s beginning equity capital does not agree with the prior year’s ending equity capital shown on the prior year’s cost report, Section N, Statement of Equity Capital, a reconciliation must be attached.

All entries on line 1c, 1d, or 1e must be dated. Any changes in equity capital reported on lines 1c, 1d, and 1e must be supported by a schedule showing the date and amount of each change that has occurred during the period. EXAMPLE - If the beginning balance of a loan to an owner is $10,000 and the ending balance is $12,000 and the net change of $2,000 occurred at different dates in different amounts (e.g., on February 15, the owner repaid $1,000; on April 20, the owner repaid $1,000; on June 10, the owner borrowed $3,000; on September 5, the owner repaid $2,000; and on October 20, the owner borrowed $3,000) each increase and/or decrease during the period must be dated with the appropriate amounts reported separately. A return on equity amount cannot be calculated unless the changes are dated and the amounts are reported accurately.

32. Reserved

History

• Authority: T.C.A. §§4-5-202, 12-4-301, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed January 12, 1987; effective February 26, 1988. Amendment filed December 1, 1988; effective January 15, 1989. Amendment filed September 14, 1992; effective October 29, 1992. Amendment filed August 17, 1995; effective October 31, 1995. Amendment filed January 21, 2000; effective April 5, 2000.

Tenn. Comp. R. & Regs. 1200-13-06-.01 DETERMINATION OF REIMBURSABLE COSTS ON LEVEL I NURSING FACILITY

CARE PROVIDED BY THE BUREAU OF TENNCARE. The Department, in consultation with the Comptroller of the Treasury and the Tennessee Health Care Association, shall establish the rules and regulations for the determination of the reimbursable per diem cost for services provided to Medicaid recipients as part of the nursing facility Level I program. The method of cost determination shall include depreciation on buildings, equipment, and fixtures, and interest expense as allowable items of cost. The reimbursable per diem cost may take into consideration the kinds, levels, and quantities of services provided to the recipients by the institution, the cost of providing such services, and the levels and types of patient care required for recipients.

History

• Authority: T.C.A. §§12-4-301, 71-5-105, 71-5-109, and 4-5-202.
• Administrative History: Original rule filed January 12, 1988; effective February 26, 1988. Amendment filed August 17, 1995; effective October 31, 1995.

Tenn. Comp. R. & Regs. 1200-13-06-.10 MEDICAID NURSING FACILITY LEVEL I ACCOUNTING PRINCIPLES

(1) Reimbursable Cost This cost report must be completed in accordance with Medicare laws and principles of cost reimbursement as updated, except as specified in the cost report, the Footnotes and Instructions, and below:

(a) Only the straight line method of computing depreciation is permitted.

(b) Expenses related to disallowed capital expenditures such as depreciation, interest on borrowed funds, the return on equity capital in the case of proprietary providers, and repairs, are not allowable costs. Disallowed capital expenditures are those that have not been approved by the Tennessee Health Facilities Commissioner or its successor agency in accordance with state law.

(c) Bad debt is not an allowable expense.

(d) Costs may be included only for covered services as defined by the Department of Health.

(e) The reimbursement of excessive capitol costs arising from low occupancy is not permitted by the Medicaid NF-1 Program. Accordingly, Medicaid capital-related costs before application of any ceilings shall be recalculated according to the following scale:

Facility Percent of Actual % Occupancy Allowable Costs 80% and above 100% 75% to 79.999% 95% 70% to 74.999% 90% 65% to 69.999% 85% 60% to 64.999% 80% 55% to 59.999% 75% 50% to 54.999% 70% Below 50% 60% In addition, no incentive provisions will apply to providers with occupancies below 80%.

(f) Assets not relating to patient care, uncollectible accounts and notes receivable, and advances or loans to owners are to be excluded from equity capital.

(g) On a new lease effective after June 30, 1976, and renewal of such lease between either related or unrelated persons or entities, the lesser of rent on real property or equipment or the amount of the lessor’s depreciation, interest, other allowable costs, and return on equity capital, in accordance with principle 2 of this section, will be considered on an item by item basis.

Renewal of a lease negotiated before July 1, 1976, at the same rental amount or at an amount fixed or determinable according to conditions provided for in the original lease will not be considered a new lease according to this provision. This provision does not apply to the rental of equipment for periods of less than one year.

In cases where a provider leases a facility from a municipality or other governmental unit or agency at a nominal rental fee (e.g., $1.00 per year) and the lease meets the Medicare criteria for the allowance of depreciation in lieu of rent, other costs to the governmental agency, which are otherwise allowable, may also be included in the reimbursable cost to the provider. When depreciation and other costs to the governmental agency are included by the provider, these costs must be specified as such and supporting documents must be available for audit in the same manner as the provider’s own records.

(h) In regard to the revaluation of assets, recovery of depreciation, and limitation of capital related costs on assets sold or transferred at a gain, the Tennessee Medicaid Program will allow the lesser of 1. the asset’s purchase price at the time of sale, 2. the fair market value at the time of sale, or 3. for bona fide arms length sales on and after July 1, 1988, the seller’s allowable historical

basis trended forward by the asset revaluation multipliers. These multipliers are computed by the Comptroller’s Office based on the lesser of 50% of the Consumer Price Index or 50% of the Dodge Construction Index (measured from the seller’s date of acquisition) and then reduced by the seller’s accumulated deprecation to the time of sale.

Furthermore, for sales on and after July 1, 1988, the new provider’s combination of down payment and loan principal cannot exceed the revalued basis. The down payment is applied to the revalued basis first, and the remaining amount is the allowable debt basis.

The new provider’s allowable useful lives on assets purchased cannot be less than the seller’s remaining useful lives at the time of purchase. The provider of record (buyer) is responsible for providing the necessary initial information to the Comptroller’s Office in order to make the necessary revaluation. In subsequent years’ cost reports, the provider is responsible for maintaining records on assets subject to the revaluation limitation and must enter in Section G.2.cc. the excess of book depreciation and interest over the Medicaid allowable amount.

Assets and debt acquired subsequent to and not related to the change of ownership are not subject to revaluation limitations. In no case can interest expense on assets subject to revaluation limits exceed actual interest incurred by the new owner.

ILLUSTRATIVE EXAMPLE

Seller’s original building cost was $1,250,000 on July 1, 1980, with a useful life of 40 years.

On July 1, 1992, the facility is purchased by Buyer for $3,500,000 who decides to invest some of his own money in the purchase and finance the remainder at 9%. Accumulated depreciation for the building as of July 1, 1992 is $375,000, and the net book value is therefore $875,000.

The portion of the selling price allocated to the building is $1,531,250. Buyer’s remaining useful life for the building is 28 years. Buyer reported depreciation for the building for FYE 6/30/93 of $54,688. The building revaluation and depreciation limit is computed below. The index for assets acquired in 1980 and sold in 1992 is 1.17.

Seller’s original building cost in 1980 $1,250,000 Cost multiplier 1.17 Revalued original cost $1,462,500 Accumulated depreciation ($375,000)

Allowable basis to buyer $1,087,500 Allowable depreciation ($1,087,500/28) $38,839 Reported depreciation $54,688 Non-allowable depreciation $15,849 Assuming the provider’s allowable basis for all assets (including the building and equipment) is $2,292,322, allowable return on equity and interest would be computed as follows:

(i) If the buyer, (a for-profit entity), pays $1,000,000 down and finances the remaining $2,500,000 of the purchase, then he is allowed return on equity on $1,000,000 and interest expense of $1,292,322 at 9% for the loan term. Allowable interest expense decreases each year as principal is repaid.

(ii) If the buyer (a for-profit entity) pays $2,500,000 down and finances the remaining $1,000,000 of the purchase, then he is allowed return on equity of $2,292,322 and NO interest expense.

(iii) If the buyer (a not-for-profit entity) pays $1,000,000 down and finances the remaining $2,500,000 of the purchase, then he is allowed NO return on equity, and is allowed interest expense of $1,292,322 at 9% for the loan term. Allowable interest expense decreases each year as principal is repaid.

(i) A return on equity of no more than the amount allowed under Medicare principles in effect for services prior to October 1, 1993, shall be included as an allowable cost for proprietary providers, limited to $1.50 per patient day, and by the maximum payment rate.

(j) The effect of minimum wage and other direct pass-through cost items will be eliminated in the application of the inflation allowance.

(k) An incentive payment will be included in the reimbursable rate for providers who sufficiently contain costs as provided herein and maintain an average occupancy rate of 80% or greater.

Certain expenses are fixed and not controllable on a day today basis. These expenses include allowable rent, property taxes and insurance, depreciation, and interest. Total costs are determined for each provider and converted to a per patient day basis. Fixed costs are also determined for each provider and converted to a per patient day basis. Variable costs are determined by subtracting the fixed costs from the total costs. All intermediate care providers whose variable costs are less than the maximum reimbursement rate shall be eligible to receive a fifty percent (50%) cost containment incentive for every dollar they are below the maximum reimbursement rate, limited to three dollars ($3) per patient day and by the maximum reimbursement rate.

(l) No carryover of allowable costs shall be allowed.

(m) Providers of ICF/MR Services 1. For providers of ICF/MR services, the total of management fees charged by a non-related management company plus the total of home office costs claimed by a related parent company, is limited to the lesser of:

(i) Allowable costs of the non-related management company and the related parent company.

(ii) Charges, or (iii) 45% of total allowable administrative costs of the provider.

(iv) In addition, management fees of a non-related management company is further limited by:

I. The amount specified in the management contract between the management company and the ICF/MR facility; and II. The maximum component fees as defined in (h) below.

2. A non-related management company is an independent entity not related to the provider by ownership or control and which obtains its contract with the provider by means of an arms-length transaction. If a management company does not obtain its contract by means of an arms-length transaction, it will be deemed a related parent company. The management fees of a non-related management company are not allowable unless the company manages at least two ICF/MR facilities. A related parent company is one which owns, in part or in whole, its subsidiary ICF/MR facilities, or exercises significant control over its subsidiary ICF/MR facilities. A related parent company, as well as a non-related management company, maintains offices and administrative staff separate from and in addition to the individual facilities’ administrative offices and administrative staff.

3. For purposes of this rule, the term ownership is as defined to rule 1200-13-6-.09E.9.

Control exists where an individual or an organization has the power, directly or indirectly, significantly to influence or direct the actions or policies of an organization or institution. The term “control” includes any kind of control, whether or not it is legally enforceable and however it is exercisable or exercised. It is the reality of the control which is decisive, not its form or the mode of its exercise.

4. The allowable costs of a non-related management company may include a profit factor equal to the return on equity percentage currently allowed under the program. Unless otherwise indicated by state rules, allowable costs are determined in accordance with Medicare principles of retrospective reimbursement. Interest paid on overdue management fees is considered part of the management fees in the year paid.

5. For purposes of this provision, charges is the amount claimed for reimbursement by a non-related management company or related parent company on provider cost reports submitted to the state.

6. For purposes of this rule, administrative and general costs of the provider include the following:

(i) Salary of administrator;

(ii) Other administrative salaries;

(iii) Office supplies and printing;

(iv) Communications (telephone, fax);

(v) Travel expenses;

(vi) Advertising and public relations;

(vii) Licenses, dues and subscriptions;

(vii) Professional training and education;

(ix) Conference registration and fees;

(x) Accounting, bookkeeping, and auditing expenses;

(xi) Legal services;

(xii) Pharmacy, nursing, dietary, and all other consulting services;

(xiii) Franchise and filing fees;

(xiv) Excise taxes;

(xv) Insurance (other than property insurance);

(xvi) Utilization review expenses;

(xvii) Management fees; and (xviii) Home office costs.

7. The provider services tax is not included in administrative and general costs of the provider.

8. For purposes of this rule, maximum component fees are upper limits for services documented as provided by non-related management companies to client ICF/MR facilities. Component fees are allowable only if the service is not provided by the ICF/MR with its own staff or by independent contractors separate from the management company. Management companies and/or ICF/MR must maintain documentation that the service(s) are actually provided on-site at the ICF/MR facilities. Accounting and bookkeeping services do not necessarily have to be performed onsite at the provider.

The annual maximum component limits are as follows for facilities greater than 50 beds:

Nurse Consultant Services $10,500 Human Resource Services $10,500 Crisis Intervention Services $10,500 Pharmacy Consultant Services $7,000 Dietary Consultant Services $7,000 Social Service Consultant Services $3,000 Activity Service Consulting $1,500 Medical Records Consulting $1,500 Accounting Services $50,000 Bookkeeping Services $20,000 Staff Training Services $10,000 Retainer for Legal Counsel $3,000 General Oversight and Supervision $50,000 Total $184,500 9. The maximum annual allowable management fee for component services under this subsection, before consideration of allowances for management company profit and overhead, is $184,500. An additional 20% of the total allowed components will be added for overhead. In addition, a profit margin based on the total allowed components will be added. The profit percentage will be the current return on equity percentage used under the program. For facilities 50 beds or less, applicable amounts will be one-half the above amounts.

Illustrative Example Assume the following: A non-related management company is limited to (a)4.(ii), maximum component fees.

The management company manages five nursing facilities for the entire year. Four of the facilities have 100 beds and the fifth has 45 beds. Assume the applicable return on equity percentage is 7%. The management company documents that it has provided the following services to each of the five providers:

(i) Nurse Consulting (ii) Human Resource Services (ii) Crisis Intervention Services (iv) Accounting (v) Staff Training (vi) General Oversight and Supervision The maximum allowable management fee for each of the 100 bed facilities is $179,705 computed as follows:

Nurse Consulting $10,500 Human Resource Services $10,500 Crisis Intervention Services $10,500 Accounting $50,000 Staff Training $10,000 General Oversight/Supervision $50,000 Subtotal $141,500 Add overhead (20%) 28,300 Add profit (7%) 9,905 Total Allowable $179,705 The maximum allowable management fee for the 45 bed facility is $89,853.

10. It is the responsibility of ICF/MR providers to submit cost information of non-related management companies. Initially, the cost information is to be submitted on the effective date of this rule. Subsequently, the cost of non-related management companies shall include, but not be limited to, audited financial statements, a detailed trial balance, and allocation of costs to all managed facilities and owned facilities, if any, as well to other business activities of the management company. The cost information is subject to audit by the state Comptroller’s Office. In the event that audited financial statements are not available, unaudited statements shall be submitted. In the event that the fiscal year end of the management company differs from the fiscal year end of the ICF/MR provider(s), information from the most recently completed fiscal year shall be submitted.

Cost reports submitted without the required management company cost information shall be considered incomplete and will not be processed. Providers will be subject to a penalty of $10 per day in accordance with state law until the required cost information is filed.

11. The provisions of this section do not apply to ICF/MR services covered under a capitated payment system nor to management contracts with annual fees less than $75,000.

(2) Workers Compensation Expenses For Medicaid cost reporting purposes, when additional costs for workers compensation premiums are incurred from an insurance audit subsequent to a nursing facility’s fiscal year end and the cost report has been filed with the Comptroller’s Office without including the costs, the costs will be considered an expense in the year the amount becomes known. Should a workers compensation audit result in a premium credit, the credit will be applied to the next premium payment. In either case, amended cost reports cannot be filed.

(3) Disclosure of Information The Tennessee Medical Assistance program will follow federal requirements pertaining to the disclosure of certain information about ownership interest, business transactions, convictions of program related criminal offenses, etc. as required by 42 CFR Chapter IV, Part 420, Subpart C, and

Part 455, Subpart B, Principle C effective October 1, 1983.

(4) Patient Accounts and Patient Funds Gross charges to the patients’ accounts must match the charges to the patient log. Adjustments to the patients’ accounts must then be made to bring the actual charges in line with the contractual and legal collection limits of the various medical programs. All charges in the patients’ accounts must be supported by charge slips and the proper notes in the patients’ files and must correspond to the charges reported on the Department billing forms. Personal funds held by the provider for Medicaid patients used in purchasing clothing and personal incidentals must be properly accounted for with detailed records of amounts received and disbursed and shall not be commingled with nursing facility funds.

Patient funds in excess of $50 per patient must be kept in an insured interest bearing account. Interest earned must be credited to the patients.

(5) Patient Logs and Census Each facility must maintain daily census records and an adequate patient log. The format of the log is to be determined by each individual provider and may be combined with the revenue journal or other records at the convenience of the provider. This log, however, must be sufficient to provide the following information on an individual basis and to accumulate monthly and yearly totals for Medicaid NF-1 patients and for all other patients.

(a) Days of service, (b) Charges for items and services covered by the Medicaid NF-1 Program, (c) Charges for items and services not covered by Medicaid NF-1 Program, (d) Patient income applicable to the cost of covered items and services received by Medicaid NF-1 patients, (e) Amounts collected and receivable from the Medicaid NF-1 Program, and (f) Amounts collected and receivable from all other sources.

(6) Patient Log Directions (a) Suggested Patient Log The headings below should be listed across the top of the page above the respective columns.

Column No. Heading 1 Patient Name 2 Patient Days 3 Room and Board Charge 4 Total Other NF-1 Covered Charges 5 Total NF-1 Covered Charges (Col. 3 + Col. 4) 6 Total NF-1 Noncovered Charges 7 Total Actual Charges (Col. 5 + Col. 6) 8 Date Medicaid NF-1 Claim Paid 9 Amounts Collected and Receivable from NF-1 Program 10 Patient Income Applicable to NF-1 Covered Services 11 Amounts Collected and Receivable from Patients from NF-1 Noncovered Services 12 Amounts Collected and Receivable from Other Sources 13 Total Amounts Collected and Receivable 14 Comments (b) Directions for Completion of the Sample Patient Log The log should be maintained on a monthly basis with separate pages used for each month.

Medicaid NF-1 patients should be listed in a separate section of the log so that Medicaid NF-1 program statistics can be generated. The columns should be completed and totaled as soon after the end of the month as the figures are available. Adjustments should be made to the monthly totals to reflect adjustments in the log due to changes in patient status, additional information, or other reasons. Complete explanations should accompany each adjustment. For non-program patients, columns 8 through 14 can be omitted or adapted for other uses.

Column 1. Patient Name--Enter the individual patient’s name.

Column 2. Patient Days--Enter the patient days that the patient was charged for as this category of patient.

Column 3. Room and Board Charge--Enter the actual room and board charge, according to the facility’s charge schedule, for the month.

Column 4. Total Other NF-1-Covered Charges--Enter the total of the charges other than room and board, according to the facility’s charge schedule, for services covered by the NF-1 program.

Column 5. Total NF-1 Covered Charges--Enter the sum of column 3 and 4.

Column 6. Total NF-1Noncovered Charges--Enter the total of the charges, according to the facility’s charge schedule, for services not covered by the NF-1 program.

Column 7. Total Actual Charges--Enter the sum of column 5 and column 6.

Column 8. Date Medicaid NF-1 Claim Paid--For each Medicaid NF-1 patient, enter the date that each claim was paid by the Department of Health. For other types of patients, leave blank or adapt for other use.

Column 9. Amounts Collected and Receivable From NF-1 Program--For each Medicaid NF- 1 patient, enter the amount paid by and receivable from the Department of Health.

For other types of patients, leave blank or adapt for other use.

Column 10. Patient Income Applicable to NF-1 Covered Services--For each Medicaid NF-1 patient, enter the amount of each patient’s income applicable to NF-1 services.

For other types of patients, leave blank, or adapt for other use.

Column 11. Amounts Collected and Receivable from Patients for NF-1 Noncovered Services-- For each Medicaid NF-1 patient, enter the amounts collected and receivable for services not covered by the NF-1 program. For other types of patients, leave blank, or adapt for other use.

Column 12. Amounts Collected and Receivable from Other Sources For each Medicaid NF-1 patient, enter the amounts collected from other sources. State the source under Column 14. For other types of patients, leave blank, or adapt for other use.

Column 13. Total Amounts Collected and Due--For each Medicaid NF-1 patient, enter the sum of columns 9, 10, 11, and 12. For other types of patients, leave blank, or adapt for other use.

Column 14. Comments--This column is for special notes relating to the entries in the log.

(7) Sample Entries to Patient Accounts, NF1 Turnaround Document, and the Patient Log.

Basic Data Example Example Example Month-September 30 days 30 30 30 Comptroller’s Office Rate Per Day 66.09 66.09 66.09 Charge Schedule:

Room and Board Rate Per Day 60.00 70.00 66.09 NF-1 Covered Items Per Month 45.00 ------- 30.00 NF-1 Noncovered Items Per Month 20.00 40.00 10.00 Patient Income Per Month (Form 2362) 482.70 482.70 482.70 Allowance Per Month 30.00 30.00 30.00 Example 1 - Basic charge is for Room and Board only for private paying patients, all other supplies and services are charged as used.

(a) Patient Account Entries Nature of Charge Date Debit Credit Other Account or Credit 9/1 1,800.00 Revenue-Medicaid NF-1 Room & Board Charge Covered Services ($60.00 x 30 days) 9/1 482.70 Cash Collection of Patient Income Based on 2362 Information 9/30 45.00 Revenue-Medicaid NF-1 NF-1 Covered Items Covered Services for September 9/30 20.00 Revenue-Medicaid NF-1 NF-1 Noncovered Items Non-covered Services for September 9/30 20.00 Cash Collection for NF-1 Non-covered Items from Patient Personal Needs Funds 9/30 45.00 Contractual Adjustment To adjust charge for covered services to contractual limits 10/31 1,500.00 Cash Medicaid NF-1 Payment ___________________ $1,865.00 $2,047.70 *Patient account balance applicable to $66.09 x 30 = $1,982.70 September is $182.70 overcollected (b) NF-1 TURNAROUND DOCUMENT Number of Days of Service 30 Rate Assigned by the Comptroller of the Treasury $66.09 $66.09 x 30 days = $1,982.70 Less 2362 Amount 482.70 _________ $1,500.00 (c) Patient Log (See Example 1) *An adjustment must be filed with the State of Tennessee.

Example 2 Basic charge is an all inclusive rate for all patients. No extra charges to any patients for routine covered service items are made. Non-covered services are charged to all patients.

(d) Patient Account Entries Nature of Charge Date Debit Credit Other Account or Credit 9/1 2,100.00 Revenue-Medicaid NF-1 Room & Board Charge Covered Services (70.00 x 30 days) 9/1 482.70 Cash Collection of Patient Income Based on 2362 Information 9/30 40.00 Revenue-Medicaid NF-1 NF-1 Non-Covered Items Noncovered Services for September 9/30 30.00 Cash Collection for NF-1 Noncovered Items from Patient Personal Needs Funds 9/30 117.30 Contractual Adjustment To adjust charge for Covered Services to Contractual Limits 10/31 1,500.00 Cash Medicaid NF-1 Payment __________________ $2,140.00 $2,130.00 Patient account balance applicable to September is $10.00. This balance is solely due to charges for noncovered services. This amount can be collected from personal funds if such funds are or become available.

(e) NF-1 TURNAROUND DOCUMENT Number of Days of Service 30 Rate Assigned by the Comptroller of the Treasury $66.09 $66.09 x 30 days = $1,982.70 Less 2362 Amount 482.70 _________ $1,500.00 (f) Patient Log (See Example 2) *An adjustment must be filed with the State of Tennessee.

Example 3 -Basic charge is for Room and Board only for private paying patients, all other supplies and services are charged as used.

(g) Patient Account Entries Nature of Charges Date Debit Credit Other Account or Credit 9/1 1,982.70 Revenue-Medicaid NF-1 Room & Board Charge Covered Services (66.09 x 30 days) 9/1 482.70 Cash Collection of Patient Income Based on 2362 Information 9/30 30.00 Revenue-Medicaid NF-1 NF-1 Covered Items Covered Services for September 9/30 10.00 Revenue-Medicaid NF-1 NF-1 Noncovered Items Noncovered Services for September 9/30 10.00 Cash Collection for NF-1 Noncovered Items from Patient Personal Needs Funds 9/30 30.00 Contractual Adjustment To Adjust Charge for Covered Services to Contractual Limits 10/31 1,500.00 Cash Medicaid NF-1 Payment ___________________ $2,022.70 $2,022.70 Patient account balance applicable to September is zero.

(h) NF-1 TURNAROUND DOCUMENT Number of Days of Service 30 Rate Assigned by the Comptroller of the Treasury $66.09 $66.09 x 30 days = $1,982.70 Less 2362 Amount 482.70 _________ $1,500.00 (i) Patient Log (See Example 3)

TOTAL DATE

ROOM AND OTHER NF1 TOTAL NF1 TOTAL NF1 TOTAL MEDICAID

PATIENT PATIENT BOARD COVERED COVERED NONCOVERED ACTUAL NF1 CLAIM

NAME DAYS CHARGE CHARGES CHARGES CHARGES CHARGE PAID

(1) (2) (3) (4) (5) (6) (7) (8)

EXAMPLE 1 30 $1,800.00 $45.00 $1,845.00 $20.00 $1,865.00 10/31

EXAMPLE 2 30 $2,100.00 $0.00 $2,100.00 $40.00 $2,140.00 10/31

EXAMPLE 3 30 $1,982.70 $30.00 $2,012.70 $10.00 $2,022.70 10/31

AMOUNTS

PATIENT COLLECTED

INCOME FROM

AMOUNTS APPLICABLE PATIENTS AMOUNTS

COLLECTED TO NF1 FOR NF1 COLLECTED TOTAL

FROM NF1 COVERED NONCOVERED FROM OTHER AMOUNTS

PROGRAM SERVICES SERVICES SOURCES COLLECTED COMMENTS

(9) (10) (11) (12) (13) (14)

EXAMPLE 1 $1,500.00 $482.70 $20.00 $0.00 $2,002.70 $182.70

(continued) OVERPAYMENT TO BE REFUNDED TO NF1 PROGRAM.

$45.00 CONTRACTUAL

ADJUSTMENT.

EXAMPLE 2 $1,500.00 $482.70 $30.00 $0.00 $2,012.70 $117.30

(continued) CONTRACTUAL ADJUSTMENT.

EXAMPLE 3 $1,500.00 $482.70 $10.00 $0.00 $1,992.70 $30.00

CONTRACTUAL

ADJUSTMENT.

History

• Authority: T.C.A. §§4-5-202, 12-4-301, 71-5-105, 71-5-109, and Executive Order 23.
• Administrative History: Original rule filed January 12, 1988; effective February 26, 1988. Amendment filed June 15, 1989; effective July 30, 1989. Amendment filed August 17, 1990; effective October 1, 1990. Amendment filed September 14, 1992; effective October 29, 1992. Amendment filed August 17, 1995; effective October 31, 1995. Amendment filed July 15, 1996; effective September 28, 1996. Amendment filed May 18, 2000; effective August 2, 2000.

Tenn. Comp. R. & Regs. 1200-13-06-.11 NURSING FACILITY ALLOWABLE COMPENSATION RANGES

(1) ALLOWABLE COMPENSATION RANGES FOR OWNERS AND/OR THEIR RELATIVES

EMPLOYED IN AN INDIVIDUAL NURSING FACILITY.

(a) Administrator:

Base Amount Per In To A Bed Size Allowance Each Bed Excess of Maximum of 25 or under $20,230 $-- $10,230 26 - 50 20,621 390.34 26 beds 29,989 51 - 75 30,352 362.25 51 beds 39,046 76 - 100 39,213 169.75 76 beds 43,287 101 - 150 43,368 79.22 101 beds 47,250 151 & above 47,329 79.22 151 beds 59,274 (b) Other Positions: 1-50 51-100 101-150 151 & Above Beds Beds Beds Beds Assistant or Co-Administrator $-- $26,171 $27,020 $28,153 Bookkeeper 1 7,401 20,230 22,351 24,474 Licensed Dietitian 23,767 24,616 25,323 26,738 Dietary Supervisor 15,702 17,684 19,522 21,502 Dietary Worker 14,429 14,429 14,429 14,429 Housekeeping Supervisor 14,855 16,552 17,964 19,664 Housekeeper 14,429 14,429 14,429 14,429 Laundry Supervisor -- -- 17,401 17,964 Laundry & Linen Worker 14,429 14,429 14,429 14,429 Maintenance Man 19,664 19,664 19,664 19,664 Medical Director 33,387 33,387 33,387 33,387 Director of Nursing 27,160 28,292 29,989 33,387 Registered Nurse 25,039 25,888 26,738 28,009 Licensed Practical Nurse 19,380 20,230 20,795 21,502 Speech, Occupational, Physical, Recreational Therapist 26,738 26,738 26,738 26,738 Attendants, Orderlies, Aides 15,702 15,702 15,702 15,702 Recreational Director 15,702 15,702 15,702 15,702 Activity Coordinator Social Activities Director 16,409 16,409 16,409 16,409 Medical Records Clerk 17,684 18,391 19,098 19,664 Secretary 20,514 20,514 20,514 20,514 (c) The above are maximum limits of allowable compensation to owners and/or relatives who are actually performing these duties 100% of a normal work week. Part-time performance will be computed on percentage of time spent. For purposes of this rule, a normal work week is defined as 40 hours.

(d) If the facility has under 51 beds, only (1) Administrator and/or Business Manager is allowed, and the rate is set according to bed size/Administrator table.

(e) Allowances for any position not specifically listed herein will be based on other comparable positions and other available information.

(f) Allowances for any position shall not exceed the administrator’s compensation.

(g) Other items of consideration to be used in adjustments to these maximum allowances are:

1. necessity of services provided and duties performed by the individual, 2. the time period during which these duties were performed, 3. accounting period bed changes based on dates of change, 4. other relevant circumstances and data verified by the Comptroller of the Treasury.

(h) Allowable compensation amounts shown above will be increased annually effective with cost reports ending June 30 and later based on the preliminary Skilled Nursing Facility Market Basket Index as computed by Health Care Financing Administration, Office of the Actuary, Division of National Cost Estimate, current as of June 30, but in no case will the annual compensation adjustment exceed 10%.

History

• Authority: T.C.A. §§4-5-202, 12-4-301, 71-5-105, 71-5-109, Executive Order No. 1 of 1995, and Public Chapter 358 of the Acts of 1993.
• Administrative History: Original rule filed January 12, 1988; effective February 26, 1988. Amendment filed June 15, 1989; effective July 30, 1989. Amendment filed August 17, 1995; effective October 31, 1995. Amendment filed July 15, 1996; effective September 28, 1996.

Tenn. Comp. R. & Regs. 1200-13-06-.12 ALLOWABLE COMPENSATION RANGES FOR OWNERS AND/OR THEIR RELATIVES

EMPLOYED BY PARENT COMPANIES WHOSE SUBSIDIARY OR DIVISION PARTICIPATES IN

THE BUREAU OF TENNCARE NURSING FACILITY LEVEL I PROGRAM.

(1) Chief Operating Executive:

Base Amount Per In To A Bed Size Allowance Each Bed Excess of Maximum of 200 and under $27,7 29 $-- -- $27,729 201 - 500 27,746 19.81 201 beds 33,668 501 - 1,000 33,686 18.68 501 beds 43,005 1001 - 2,000 43,023 18.25 1,001 beds 61,254 2,001 and over 61,271 17.24 2,001 beds 160,421 Allowance as % of Chief Operating Executive Compensation Maximum (2) Other Positions:

Medical Director (M.D.) 90% N/A Assistant Chief Operating Executive, Controller, Corporate Secretary, Treasurer, Attorney 75% N/A Accountant, Business Manager, Purchasing Agent, Regional Administrator, Regional VicePresident, Regional Executive 70% $36,356 Consultants, (Social Activities, Dietary, (R.D.), Physical Therapist (RPT), Medical Records (RRA), Nursing (B.S.R.N.)) 65% 29,143 Secretaries/Clerks 25,514 Bookkeepers 24,474 (3) The above are maximum limits of allowable cost for owners and/or relatives who are actually performing these duties 100% of a normal work week. Part-time performance will be computed according to time spent. For purposes of this rule, a normal work week is defined as 40 hours.

(4) No assistant operating executive will be authorized for a chain with 200 beds or less.

(5) If chief operating executive is a licensed administrator and is actually performing the duties of administrator in one of the facilities, those owner/administrator guidelines will apply.

(6) Other items of consideration to be used in adjustments to these maximum allowances:

(a) services provided to the facilities by home office, (b) positions filled and duties performed by other personnel in the home office compared to related positions and duties performed by other personnel in the individual facilities, (c) comparable salaries that would have to be paid to non-owners for the same services, (d) accounting period bed changes based on dates of change, and (e) other relevant circumstances and data verified by the Comptroller of the Treasury.

(7) Allowable compensation amounts will be increased annually using the same percentage that is developed under 1200-13-6-.11(8).

History

• Authority: T.C.A. §§4-5-202, 12-4-301, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed January 12, 1988; effective February 26, 1988. Amendment filed June 15, 1989; effective July 30, 1989.

Tenn. Comp. R. & Regs. 1200-13-06-.13 ESTABLISHMENT OF PER DIEM REIMBURSEMENT RATES

(1) The Comptroller of the Treasury will establish per diem reimbursement rates for nursing facility Level I services provided to Tennessee Medicaid recipients.

(2) The Comptroller of the Treasury will use:

(a) the cost report required by rule 0380-1-10-.07, (b) budgeted information supplied by the provider, (c) the charge system of the provider, and (d) any other data the Comptroller considers relevant in rate determination.

History

• Authority: T.C.A. §§4-5-202, 12-4-301, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed January 12, 1988; effective February 26, 1988. Amendment filed August 17, 1995; effective October 31, 1995.

Tenn. Comp. R. & Regs. 1200-13-06-.14 MAXIMUM AMOUNT OF REIMBURSABLE COST PAYABLE TO A PROVIDER

(1) The maximum amount of reimbursable cost payable to a provider as provided for in these rules and regulations shall be the lesser of:

(a) The usual and customary charges for comparable services of a particular provider; or (b) A maximum program-wide rate for Nursing facility Level I services as may be established by the Department in consultation with the Department of Finance and Administration; or (c) An allowable amount as determined by the Comptroller of the Treasury in accordance with the Department’s rules. In the event that an item is not addressed in the Department’s rules, Medicare principles of retrospective cost reimbursement shall apply.

History

• Authority: T.C.A. §§4-5-202, 12-4-301, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed January 12, 1988; effective February 26, 1988. Amendment filed august 17, 1995; effective October 31, 1995.

Tenn. Comp. R. & Regs. 1200-13-06-.15 AUDITING OF COST REPORTS

The cost reports filed in accordance with the rules above and all provider records pertaining thereto shall be subject to audit by the Comptroller of the Treasury or his agents.

The cost reports filed in accordance with the rules above must provide adequate cost and statistical data. This data must be based on and traceable to the provider’s financial and statistical records and must be adequate, accurate and in sufficient detail to support payment made for services rendered to beneficiaries. This data must also be available for and capable of verification by the Comptroller of the Treasury or his agents. The provider must permit the Comptroller or his agents to examine any records and documents necessary to ascertain information pertinent to the determination of the proper amount of program payments due. Data reflected on the cost report which cannot be substantiated may be disallowed with reimbursement being required of the provider.

History

• Authority: T.C.A. §§14-23-105, 14-23-109, 14-23-130, and 4-5-202.
• Administrative History: Original rule filed January 12, 1988; effective February 26, 1988.

Tenn. Comp. R. & Regs. 1200-13-06-.16 RECORDS RETENTION

Each provider of Level I nursing facility services is required to maintain adequate financial and statistical records which are accurate and in sufficient detail to substantiate the cost data reported. These records must be retained for a period of not less than five years from the date of the submission of the cost report, and the provider is required to make such records available upon demand to representatives of the State Department of Health, the State Comptroller of the Treasury, or the United States Department of Health and Human Services.

History

• Authority: T.C.A. §§4-5-202, 12-4-301, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed January 12, 1988; effective February 26, 1988. Amendment filed August 17, 1995; effective October 31, 1995.

Chapter 1200-13-07 Reserved

Tenn. Comp. R. & Regs. 1200-13-07 Reserved

RULES

OF THE DEPARTMENT OF HEALTH AND ENVIRONMENT

CHAPTER 1200 - 13 - 7

RESERVED

Chapter 1200-13-08 Skilled Nursing Home Program

Tenn. Comp. R. & Regs. 1200-13-08-.01 DETERMINATION OF REIMBURSABLE COST FOR SKILLED NURSING CARE

The Department, in consultation with the Comptroller of the Treasury and the Tennessee Health Care Association, shall establish the rules and regulations for the determination of the reimbursable per diem cost for those institutions or distinct parts thereof providing skilled nursing care. The Department may establish the maximum amount to be paid to such institutions.

History

• Authority: T.C.A. §§4-5-202, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed March 7, 1989; effective April 21, 1989.

Tenn. Comp. R. & Regs. 1200-13-08-.04 BILLING PROCEDURE

Institutions or distinct parts thereof rendering skilled nursing care shall bill the Department on the forms and in the manner designated by the Department.

History

• Authority: T.C.A. §§4-5-202, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed March 7, 1989; effective April 21, 1989.

Tenn. Comp. R. & Regs. 1200-13-08-.05 CHARGES TO SKILLED NURSING FACILITY RECIPIENTS

The charge schedule of a provider must be applied uniformly to all patients as services are furnished. Appropriate writeoffs or adjustments shall be made to each Medicaid recipient’s account to reduce the gross charges to the contractual or legal collection limits of the Medicaid Program.

History

• Authority: T.C.A. §§4-5-202, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed March 7, 1989; effective April 21, 1989.

Tenn. Comp. R. & Regs. 1200-13-08-.06 EXTENT OF REIMBURSEMENT

The per diem reimbursable costs of institutions or distinct parts thereof rendering skilled nursing care shall be reimbursable by the State as provided in Rule 1200-13-8-.14 with the remainder not allowable as outside support from other sources. The provider shall be limited to reimbursable per diem as the maximum it may collect from all sources for program services.

History

• Authority: T.C.A. §§4-5-202, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed March 7, 1989; effective April 21, 1989.

Tenn. Comp. R. & Regs. 1200-13-08-.07 ESTABLISHMENT OF PROSPECTIVE PER DIEM COST RATES

The Comptroller of the Treasury will establish prospective per diem reimbursement rates for the institutions or distinct parts thereof rendering Level II nursing care (formerly referred to as skilled nursing care). The Comptroller of the Treasury shall consider the charge system of the provider, prior cost date, results of audits, budgeted information supplied by the provider in instances of new facilities, and any other relevant data submitted by the provider in establishing these rates.

History

• Authority: T.C.A. §§4-5-202, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed March 7, 1989; effective April 21, 1989. Amendment filed July 15, 1996; effective September 28, 1996.

Tenn. Comp. R. & Regs. 1200-13-08-.08 SUBMISSION OF COST REPORTS BY PROVIDERS

(1)In-state and out-of-state Providers of Medicaid Level II nursing care will be required to contract with the Department and submit to the Comptroller of the Treasury a pro-forma (budgeted) cost report upon beginning participation as a new provider. Leases and changes of ownership are not considered new providers for this purpose and thus no budgeted cost reports are filed for leases or changes in ownership. Thereafter, cost reports shall be filed at their fiscal year end on forms designated by the Department. The report shall be due within three (3) months after the end of the designated fiscal period or the alternative due date designated by Medicare if applicable. An extension may be requested for due cause. Such cost reports must be completed in accordance with Medicare reimbursement principles except where these rules may specify otherwise. All covered charges are to be in accordance with the Medicaid Program definition of covered services. Also, all charges to Medicaid recipients must be made consistently and in accordance with the providers schedule of charges in effect for the period covered for all patients. In the event that a provider does not file the required cost report by the due date, the provider shall be subject to a penalty of ten dollars ($10.00) per day in accordance with T.C.A. 12-4-304. In the event that a provider discovers a significant omission of costs, it may file an amended cost report at any time prior to the due date of its next annual cost report. After that time, the cost report cannot be amended for cost omissions. Amended cost reports shall be subject to the same requirements as other cost reports, and will be the only accepted means to claim omitted costs. Rate increases resulting from submission of omitted costs will not be retroactive.

(2)Providers of skilled nursing care that do not file cost reports required in this section or do not file the cost reports in a timely manner as provided in Medicare Principles of Reimbursement, in effect October 1, 1984, may be subject to sanctions as provided by the Medicare Principles of Reimbursement. Providers of skilled nursing care who fail to file cost reports for a specific period shall be subject to penalties in accordance with state law.

(3)After a period of five years following the implementation of Medicaid prospective payment for Level II nursing facility services on October 1, 1996, amended or corrected Level II nursing facility cost reports with claims for reimbursement for services prior to October 1, 1996 shall not be accepted.

History

• Authority: T.C.A. §§4-5-202, 12-4-301, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed March 7, 1989; effective April 21, 1989. Amendment filed October 14, 1998; effective December 28, 1998. Amendment filed July 25, 2002; effective October 8, 2002.

Tenn. Comp. R. & Regs. 1200-13-08-.02 APPROVAL OF THE DEPARTMENT REQUIRED FOR PARTICIPATION

Only those institutions or distinct parts thereof designated and certified by, and contracting with, the Department as rendering skilled nursing care may participate and be reimbursed as a provider under these provisions. The Department shall notify the Comptroller of the Treasury when a provider enters the program and when its participation terminates.

History

• Authority: T.C.A. §§4-5-202, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed March 7, 1989; effective April 21, 1989.

Tenn. Comp. R. & Regs. 1200-13-08-.03 COVERED SERVICES

The specific items and services covered under skilled nursing care shall be those defined and approved by the Department. Noncovered services may be charged directly to the recipient.

History

• Authority: T.C.A. §§4-5-202, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed March 7, 1989; effective April 21, 1989.

Tenn. Comp. R. & Regs. 1200-13-08-.09 MAXIMUM COMPENSATION RANGES FOR OWNERS AND/OR THEIR RELATIVES

Effective for fiscal years ending June 30, 1984 and later, the following maximum compensation for owners and/or their relatives employed by an individual skilled care facility or by a parent company whose subsidiary or division participates in the Medicaid Skilled Care Program shall apply.

(1)MAXIMUM COMPENSATION FOR OWNERS AND/OR THEIR RELATIVES EMPLOYED IN

AN INDIVIDUAL SKILLED NURSING FACILITY.

(a)Administrator:

BaseAmount PerInTo A Bed Size AllowanceEach BedExcess ofMaximum of 25 or under$15,824$--$15,824 26 - 5016,129305.3326 beds23,457 51 - 7523,741283.2951 beds30,540 76 - 10030,672132.7576 beds33,858 101 - 15033,92261.96101 beds36,958 151 & above37,01961.96151 beds46,363 (b)Other Positions: 1 - 5051- 100101- 150151 & Above BedsBedsBedsBeds Assistant or Co-Administrator$----$20,471$21,135$22,020 Bookkeeper13,61115,82417,48319,143 Licensed Dietician18,59019,25419,80720,913 Dietary Supervisor12,28213,83215,27016,818 Dietary Worker11,28611,28611,28611,286 Housekeeping11,61812,94614,05215,381 Supervisor Housekeeper11,28611,28611,28611,286 Laundry Supervisor------13,61114,052 Laundry & Linen11,28611,28611,28611,286 Worker Maintenance Man15,38115,38115,38115,381 Medical Director26,11426,11426,11426,114 Director of Nursing21,24422,13023,45726,114 Registered Nurse19,58520,24920,91321,909 Licensed Practical Nurse15,15915,82416,26516,818 Speech, Occupational, Physical, Recreational Therapist20,91320,91320,91320,913 Attendants, Orderlies, Aides12,28212,28212,28212,282 Recreational Director Activity Coordinator Social Activities Director12,83512,83512,83512,835 Medical Records Clerk13,83214,38514,93815,381 Secretary16,04516,04516,04516,045 (c)The above are maximum limits of allowable compensation to owners and/or relatives who are actually performing these duties 100% of a normal work week. Part-time performance will be computed on percentage of time spent.

(d)If the facility has under 51 beds, only one (1) Administrator and/or Business Manager is allowed, and the rate is set according to bed size/Administrator table.

(e)Allowances for any position not specifically listed herein will be based on other comparable positions and other available information.

(f)Allowances for any position shall not exceed the administrator’s compensation.

(g)Other items of consideration to be used in adjustments to these maximum allowances are: 1.necessity of services provided and duties performed by the individual, 2.the time period during which these duties were performed, 3.accounting period bed changes based on dates of change, 4.other relevant circumstances and data verified by the Comptroller of the Treasury.

(h)Allowable compensation amounts shown above will be adjusted annually effective with cost reports ending June 30 and later based on the preliminary Skilled Nursing Facility Market Basket Index as computed by Health Care Financing Administration, Office of the Actuary, Division of National Cost Estimate, current as of June 30, but in no case will the annual compensation adjustment exceed 10%.

(2)MAXIMUM COMPENSATION FOR OWNERS AND/OR THEIR RELATIVES EMPLOYED BY

PARENT COMPANIES WHOSE SUBSIDIARY OR DIVISION PARTICIPATES IN THE

MEDICAID SKILLED NURSING PROGRAM

(a)Chief Operating Executive:

BaseAmount PerInTo A Bed Size AllowanceEach BedExcess ofMaximum of 200 & Under$21,688$------$21,688 201 50021,70315.49201 beds26,335 501 1,00026,34914.61501 beds33,638 1,001 2,00033,65214.271,001 beds47,912 2,001 & over47,92513.492,001 beds125,479 (b)Other Positions Allowance as % of Chief Operating Executive Compensation Maximum Medical Director (M.D.)90% Assistant Chief Operating Executive, Controller, Corporate Secretary, Treasurer, Attorney75% Allowance as % of Chief Operating Executive Compensation Maximum Accountant, Business Manager, Purchasing Agent, Regional Administrator, Regional ice President, Regional Executive70%$28,437 Consultants, (Social Activities, Dietary (R.D.), Physical Therapist (RPT), Medical Records (RRA), Nursing (B.S.R.N.)65%22,794 Secretaries/Clerks16,045 Bookkeepers19,143 The above are maximum limits of allowable cost for owners and/or relatives who are actually performing these duties 100% of a normal work week. Part-time performance will be computed according to time spent.

(c)No assistant operating executive will be authorized for a chain with 200 beds or less.

(d)If chief operating executive is a licensed administrator and is actually performing the duties of administrator in one of the facilities, those owner/administrator guidelines will apply.

(e)Other items of consideration to be used in adjustments to these maximum allowances: 1.services provided to the facilities by home office, 2.positions filled and duties performed by other personnel in the home office compared to related positions and duties performed by other personnel in the individual facilities, 3.comparable salaries that would have to be paid to nonowners for the same services, 4.accounting period bed changes based on dates of change, and 5.Other relevant circumstances and data verified by the Comptroller of the Treasury.

(f)Allowable compensation amounts will be adjusted annually using the same percentage that is developed under rule 1200-13-8-.09(1)(h).

History

• Authority: T.C.A. §§4-5-202, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed March 7, 1989; effective April 21, 1989.

Tenn. Comp. R. & Regs. 1200-13-08-.10 EXPENSES RELATED TO DISALLOWED CAPITAL EXPENDITURES

Expenses related to disallowed capital expenditures, such as depreciation, interest on borrowed funds, the return on equity capital in the case of proprietary providers, and repairs are not allowable costs. Disallowed capital expenditures are those occurring on or after June 24, 1973, and on or before August 31, 1979, and that exceeds $100,000, or on or after September 1, 1979, and on or before July 17, 1984, that exceeds $150,000, and on or after July 18, 1984, and on or before April 17, 1985, that exceeds $500,000, and on or after April 18, 1985, and on or before June 30, 1987 that exceeds $1,000,000, and on or after July 1, 1987, that exceeds $1,500,000, or change the facility bed capacity, or substantially change the facility’s services, and that have not been approved by the Tennessee Health Facilities Commission and or its successor agency.

History

• Authority: T.C.A. §§4-5-202, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed March 7, 1989; effective April 21, 1989.

Tenn. Comp. R. & Regs. 1200-13-08-.11 LEASE AND RENT EXPENSE

On a new lease negotiated after December 31, 1977, and renewal of such lease, the lesser of rent on real property or equipment or the amount of the lessor’s depreciation, interest, other allowable costs, and return on equity capital, (for approved capital expenditures excluding expenses not considered allowable) in accordance with Rule 1200-138-.10, will be considered an allowable cost. Renewal of a lease negotiated before January 1, 1978, at the same rental amount or at an amount fixed or determinable according to conditions provided for in the original lease will not be considered a new lease according to this provision. This provision does not apply to the rental of equipment for periods of less than one year.

History

• Authority: T.C.A. §§4-5-202, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed March 7, 1989; effective April 21, 1989.

Tenn. Comp. R. & Regs. 1200-13-08-.12 CHANGE OF OWNERSHIP

Additional capital costs due to revalued assets will be recognized only when an existing provider is purchased by another provider in a bona fide sale (arms length transaction). The new value for reimbursement purposes shall be the lesser of (1) the purchase price of the asset at the time of the sale, (2) the fair market value of the asset at the time of the sale (as determined by an MAI appraisal), (3) current reproduction cost of the asset depreciated on a straight line basis over its useful life to the time of the sale, or (4) for facilities under going a change of ownership on or after July 18, 1984, the acquisition cost to the first owner of record on or after July 18, 1984. The cost basis of depreciable assets in a sale not considered bona fide is additionally limited to (5) the seller’s cost basis less accumulated depreciation. The purchaser has the burden of proving that the transaction is a bona fide sale should the issue arise. Gains realized from the disposal of depreciable assets while a provider is participating in the program are to be a deduction from allowable capital costs. All sales as of July 18, 1984, will be in compliance with the provisions of Section 2314 of DEFRA.

History

• Authority: T.C.A. §§4-5-202, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed March 7, 1989; effective April 21, 1989.

Tenn. Comp. R. & Regs. 1200-13-08-.13 RESERVED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed March 7, 1989; effective April 21, 1989. Repeal filed July 15, 1996; effective September 28, 1996.

Tenn. Comp. R. & Regs. 1200-13-08-.14 INCENTIVE PAYMENT

An incentive payment will be included in the reimbursable costs of Level II providers that sufficiently contain costs and maintain an average occupancy rate of 80% or greater. Skilled providers with operating costs less than the maximum reimbursable rate shall be eligible to receive a fifty percent (50%) cost-containment incentive for every dollar they are below the maximum reimbursement rate, limited to three dollars per patient day and by the maximum reimbursement rate. Operating costs are defined as total costs less capital-related costs.

History

• Authority: T.C.A. §§4-5-202, 12-4-301, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed March 7, 1989; effective April 21, 1989. Amendment filed August 17, 1990; effective October 1, 1990. Amendment filed July 15, 1996; effective September 28, 1996.

Tenn. Comp. R. & Regs. 1200-13-08-.15 AUDITING OF COST REPORTS

The cost reports filed in accordance with the rules above and all provider records pertaining thereto shall be subject to audit by the Department, the Comptroller of the Treasury, or their agents. The cost reports filed in accordance with the rules above must provide adequate cost and statistical data. This data must be based on and traceable to the provider’s financial and statistical records and must be adequate, accurate, and in sufficient detail, to support payment made for services rendered to beneficiaries. This data must also be available for and capable of verification by the Department, the Comptroller of the Treasury, or their agents. The provider must permit the Department, the Comptroller or their agents to examine any records and documents necessary to ascertain information pertinent to the determination of the proper amount of program payments due. Data as reflected on the cost report which cannot be substantiated shall be disallowed with reimbursement being required of the provider. The Department will provide for all costs of auditing performed under this provision. However, the costs of audits or other costs incurred in the preparation of cost reports are not covered by this provision.

History

• Authority: T.C.A. §§4-5-202, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed March 7, 1989; effective April 21, 1989.

Tenn. Comp. R. & Regs. 1200-13-08-.16 RECORDS RETENTION

Each provider of skilled nursing services is required to maintain adequate financial and statistical records which are accurate, and in sufficient detail to substantiate the cost data reported. These records must be retained for a period of not less than five years from the date of the submission of the cost report, and the provider is required to immediately make such records available upon demand to representatives of the Department, the State Comptroller of the Treasury, or the United States Department of Health and Human Services, or their agents.

History

• Authority: T.C.A. §§4-5-202, 71-5-105, and 71-5-109.
• Administrative History: Original rule filed March 7, 1989; effective April 21, 1989.

Chapter 1200-13-09 Psychiatric Hospital Reimbursement Program

Tenn. Comp. R. & Regs. 1200-13-09-.01 DEFINITIONS

The following definitions shall apply to Rules 1200-13-9-.02 through 1200-13-9- .14 inclusive, unless otherwise indicated.

(1)Capital Costs means those costs which are required or allowed by Title XVIII principles to be included in all depreciation columns on worksheet B of HCFA form 2552-85 (12/85). Capital costs shall not include costs associated with non-reimbursable cost centers.

(2)Direct Medical Education Costs means those costs associated with a nursing school or internresident services in an approved residency program which are required or allowed by Title XVIII principles to be included on worksheet B of HCFA form 2552-85 (12/85). Medical education costs shall not include costs associated with non-reimbursable cost centers, nor shall they include costs for routine, in-service training.

(3)Utilization Ratio means the ratio of Medicaid covered inpatient days attributable to patients determined eligible for Medicaid by the State of Tennessee to total inpatient days. Education costs are considered as a part of the operating component when educational services are an integral part of a recipient's acute inpatient psychiatric care involving active treatment pursuant to an individual plan of care developed by an interdisciplinary treatment team, and ordered by the recipient's attending physician.

(4)Medicaid Day means any part of a day, including the day of admission in which a person determined eligible for Medicaid by the State of Tennessee is admitted as an inpatient with the intention of remaining overnight. The day of discharge is not counted as a day. If admission and discharge occur on the same day, the day is considered one inpatient day.

(5)Operating Component means those costs, applicable to inpatient services only, which are required or allowed by Title XVIII principles to be included on worksheet E of HCFA form 2552-85 (12/85), including costs relating to hospital-based physicians if applicable, and COSTS for educational services when they are an integral part of a recipient's acute inpatient psychiatric care involving active treatment, pursuant to an individual plan of care developed by an interdisciplinary treatment team, and ordered by the recipient's attending physician, less the portion of capitalrelated and direct medical education costs attributable to patients determined eligible for Medicaid by the State of Tennessee.

(6)Pass Through Component means the share which is attributable to patients determined eligible for Medicaid by the State of Tennessee of actual capital costs and actual direct medical education costs. Upon the effective date of these rules, the Services Tax will be an allowable cost included in the pass-through component.

(7)Title XVIII principles means, except where indicated otherwise, those Medicare principles which are applicable to hospitals, which were in effect on October 1, 1982, and which are described at 42 CFR Part 405.

(8)Base Year Cost Report for inpatient psychiatric services is the 12 month cost report (for each provider) ending in calendar year 1986. If a provider does not have a 12 month cost report ending within that time period, then the base year shall be the next preceding 12 month cost report. If there is no such cost report, then the base year shall be the most recently filed 12 month cost report. Inpatient psychiatric providers not meeting any of the above conditions shall be handled in accordance with Rule 1200-13-9-.11 NEW PROVIDERS.

(9)Hospital means both those health care facilities defined by T.C.A. §68-11-201(10), which are licensed by this Department and the Tennessee Board for Licensing Health Care Facilities pursuant to regulatory Chapter 1200-8-1, and those inpatient facilities licensed by the Tennessee Department of Mental Health and Mental Retardation, pursuant to T.C.A. §33-2-501 et. seq. as defined by regulatory chapter 0940-5-1-.06(l) and (3). "Hospital" also means the whole, or the distinct part, of a health care facility that has been certified by this Department and the Federal Health Care Financing Administration to participate as a provider of Medicaid inpatient hospital services (as defined by the October 1, 1986, edition of 42 CFR 440. 10 and 440.140) or inpatient psychiatric services for individuals under twenty-one (21) (as defined by the October 1, 1986, edition of 42 CFR 440.160).

History

• Authority: T.C.A. §§4-5-202,12-4-301, 71-5-105 and 71-5-109, Public Chapter 913 of the Acts of 1992.
• Administrative History: Original rule filed June 2, 1988; effective July 17, 1988. Amendment filed September 25, 1992; effective November 9, 1992.

Tenn. Comp. R. & Regs. 1200-13-09-.02 DETERMINATION OF REIMBURSABLE COST

The Comptroller of the Treasury in accordance with this chapter of the Department's rules and regulations shall make the determination of reimbursable per them cost for hospitals.

History

• Authority: T.C.A. §§71-5-105, 71-5-109 and 4-5-202. Administrative History. Original rule filed June 2, 1992; effective July 17, 1988.

Tenn. Comp. R. & Regs. 1200-13-09-.03 APPROVAL OF THE DEPARTMENT REQUIRED FOR PARTICIPATION

Only those in situations or distinct parts thereof accredited by the Joint Commission on Accreditation of Hospitals as psychiatric facilities and contracting with Medicaid may participate and be reimbursed as providers under these provisions. The Department shall notify the Comptroller of the Treasury when a provider enters the program and when its participation terminates.

Authority. T. C.A. §§71-5-105, 71-5-109 and 4-5-202. Administrative History: Original rule filed June 2, 1992; effective July 17, 1988.

Tenn. Comp. R. & Regs. 1200-13-09-.04 COST REPORTS REQUIRED

(1)In order to be eligible for payment by the Medicaid program for hospital services provided to Tennessee Medicaid beneficiaries, providers, including those paid by a prospective method, are required at each provider's fiscal year end, upon termination of provider status, change in ownership, or enrollment as a new provider, as per Rule 1200-13-9-.11, to submit to the Comptroller of the Treasury an annual cost report on forms designated by the Department. This report shall be submitted not later than three months from the end of each provider's fiscal year.

Such cost reports must be completed in accordance with the Medicare principles of cost reimbursement set out in the Medicare Provider Reimbursement Manual, in effect on October 1, 1982, except where the Department may specify otherwise by these rules.

(2)Providers which fail to submit cost reports which comply with Title XVIII principles in effect on October 1, 1982 and described at 42 CFR Part 405 shall be subject to penalties imposed by such regulations. Except as stated in Rule 1200-13-9-.07(3), hospitals not filing cost reports for a specified period shall be required to refund all payments made under this program for that period.

(3)To be eligible to receive payment, contracting hospitals shall use uniform hospital statistics and classification of accounts as published by the American Hospital Association for all accounting records, or any other acceptable accounting methods approved by the Department of Health and Environment in consultation with the Comptroller and the Tennessee Hospital Association.

However, accounts, statistics and records pertaining to "medical indigents", "bad debts" and "charity" shall be classified as defined by T.C.A. §68-1-109, as amended by Chapter 319 of the Public Acts of 1987.

(4) After a period of five years following the implementation of the TennCare Program on January 1, 1994, amended or corrected hospital cost reports with claims for reimbursement for services prior to January 1, 1994 shall not be accepted.

History

• Authority: T.C.A. §§71-5-105,71-5-109 and 4-5-202. Administrative History. Original rule filed June 2,1988; effective July 17, 1988. Amendment filed October 14, 1998; effective December 28, 1998.

Tenn. Comp. R. & Regs. 1200-13-09-.05 BILLING PROCEDURE

Institutions or distinct parts thereof rendering hospital care shall bill the Department or other agency or organization designated by the Department on the forms and in the manner designated. No provider shall charge for Medicaid patients more than is charged for private paying patients for equivalent accommodations and services.

History

• Authority: T.C.A. §§71-5-105, 71-5-109 and 4-5-202.
• Administrative History: Original rule filed June 2,1988, effective July 17, 1988.

Tenn. Comp. R. & Regs. 1200-13-09-.06 APPLICATION OF PROSPECTIVE PAYMENT METHOD

Except for those providers exempted by the provisions of Rule 1200-13-9-.07, all Medicaid providers of inpatient psychiatric services shall be paid by the prospective methods set forth in this chapter. For hospitals, or distinct parts thereof, certified to participate in Medicaid as providers of inpatient psychiatric services to persons under the age of twenty-one (21) these provisions apply to dates of service beginning on, or after, July 1, 1988. For institutions for mental diseases or distinct parts thereof, that are certified to participate in Medicaid as providers of inpatient hospital services for individuals age sixty-five (65) or older, these provisions apply to dates of service beginning on, or after, July 1, 1988. These effective dates apply without regard to the provider's fiscal year end.

History

• Authority: T.C.A. §§71-5-105,71-5-109 and 4-5-202. Administrative History. Original rule filed June 2,1988; effective July 17, 1988.

Tenn. Comp. R. & Regs. 1200-13-09-.07 PROVIDERS EXEMPTED FROM PROSPECTIVE PAYMENT SYSTEM

The prospective payment system shall not apply to the following hospitals and services:

(1)Any health care facility that is not a "hospital", as defined by Rule 1200-13-9-.01(9), skilled nursing facilities and intermediate care facilities located within hospitals when certified or licensed as "nursing" homes and swing beds, while being used to provide nursing services at less than the acute level of hospital care.

(2)Inpatient services provided before July 1, 1988, by providers of either inpatient psychiatric services to persons under the age of twenty-one (21), or inpatient hospital services in institutions for mental disease to individuals age sixty-five (65) or older.

(3)Psychiatric hospitals which elect not to submit a cost report and which have less than $10,000 annually, based on the provider's fiscal year, in total charges to patients determined eligible for Medicaid by the State of Tennessee. Such providers shall be reimbursed an amount not to exceed 80% of reasonable charges for covered items billed by the provider. Reasonable charges are those which are charged by comparable providers for similar services. In the event that providers exceed $10,000 in total Tennessee Medicaid charges annually, they will be treated as new providers as specified in Rule 1200-13-9-.11.

(4) Outpatient hospital services, as defined by the October 1, 1986, edition of 42 CFR 440.20.

History

• Authority: T.C.A. §§71-5-105, 71-.5-109 and 4-.5-202.
• Administrative History: Original rule filed June 2,1988; effective July 17, 1988.

Tenn. Comp. R. & Regs. 1200-13-09-.08 PROSPECTIVE PAYMENT METHODOLOGY

(1) Except as provided by other provisions of this chapter, each hospital's reimbursable inpatient costs will be determined in accordance with Medicare Title XVIII principles from a base year cost reporting period, as defined by Rule 1200-13-9-.01(8). Costs will be separated into an operating component (defined by Rule 1200-13-9-.01(5)) and a pass-through component (defined by Rule 1200-13-9-.01(6). A trending factor (defined by Rule 1200-13-9-.08(3)) will be applied to the operating component only. The prospective rate will consist of the trended operating component.

Tennessee Medicaid costs will be determined by a computed utilization ratio (defined by Rule 1200-13-9-.01(3)) from HCFA Form 2552 which must be submitted by the provider. The prospective payment (operating costs) will be made as a rate per inpatient day. On and after July 1, 1988, in psychiatric hospitals and institutions for mental disease, which dates apply without regard to the date upon which the provider's fiscal year may end, the pass-through component will not be a part of the per diem rate, but will, instead, be paid in lump sum amounts on a monthly

basis.

(2)Pass Through Component (a)For inpatient services in psychiatric facilities on or after July 1, 1988, irrespective of provider fiscal year end, the reimbursable per diem rate will consist of only the operating component.

The remaining components: capital, direct medical education, and return on equity will be paid in a lump sum amount. Capital, direct medical education, and return on equity costs will be estimated from each provider's most recent cost report on file as of 4:30 p.m. C.D.T., Monday, June 30, 1988. The estimates will be used to compute a lump sum amount for capital, direct medical education, and return on equity. Payments will be made monthly starting July 1, 1988. Each provider's subsequent cost report will be used to adjust the capital, direct medical education, and return on equity for the subsequent fiscal year. This adjustment shall be effective on the first day of the next month, one month subsequent to the date of receipt of the provider's cost report. Capital, direct medical education, and return on equity costs will be subject to year end cost settlement for inpatient psychiatric services on and after July 1, 1988. Upon the effective date of these rules, the Services Tax will be an allowable cost included in the pass-through component.

(b)Additional costs due to revalued assets will be recognized only when an existing provider is purchased by another provider in a bona fide sale (arms length transaction). The new value for reimbursement purposes shall be the lesser of (1) the purchase price of the asset at the time of the sale, (2) the fair market value of the asset at the time of the sale (as determined by an MAI appraisal), (3) current reproduction cost of the asset depreciated on a straight line basis over its useful life to the time of the sale, or (4) for facilities undergoing a change of ownership on or after July 18, 1984, the acquisition cost to the first owner of record on or after July 18, 1984. The purchaser has the burden of proving that the transaction is a bona fide sale should the issue arise. Gains realized from the disposal of depreciable assets while a provider is participating in the program are to be a deduction from allowable capital costs.

(c)The payment of return on equity (for Proprietary providers only) will be determined by Medicare principles of cost reimbursement, 42 CFR Part 405, in effect on August 1, 1983 providing that, effective April 20, 1983, return on equity shall be adjusted to reflect 100% of the average rate of interest on obligations issued for purchase by the Federal Hospital Insurance Trust Fund. 1.The return on equity for acute care and psychiatric proprietary provider will be reduced as follows: for cost reporting periods beginning after September 1986, payment will be 75% of the current amount; 50 % of the current amount for reporting periods beginning after September 1987; 25 % of the current amount for reporting periods beginning after September 1988; and zero thereafter.

(d)Beginning with fiscal years beginning July 1, 1987 and later, capital costs will be reduced by 3.5% for dates of service July 1, 1987 through September 30, 1987, by 7 % for dates of service October 1, 1987 through December 31, 1987, by 12% for dates of service January 1, 1988 through September 30, 1988 and by 15% for dates of service October 1, 1988 through September 30, 1989, by 0% for dates of service October 1, 1989 through December 31, 1989, and by 15 % for dates of service January 1, 1990 and later. Reduction will be figured into year end final settlements. Hospitals designated as Sole Community Hospitals are exempt from percentage reductions in capital costs. Upon the effective date of these rules, hospitals will be reimbursed 100% of their capital costs.

(3)Operating Component - Each facility's initial prospective rate shall also include an operating component which is computed from the base year cost report. In base years all providers including providers that are within the first three years of operation will be subject to the routine per diem cost limitations for prospective rate purposes. The routine per diem limitations for these purposes will be set in the same manner as those used for acute care hospitals. All new providers may have their prospective rate adjusted at the end of the first five year period. The operating component will be trended forward each year. The trending period shall be from the midpoint of each hospital's base year to the midpoint of the hospital's first cost reporting period subject to prospective payment. Trending to the new rebased year (1988 cost reports or if not available the prior cost report) will be computed by utilizing the indexing rate recommended by the Prospective Payment Assessment Commission, applied from the end of the hospital's fiscal year to October 1, 1989.

Thereafter, the treading index shall be that rate of increase on prospective payments as recommended by the Prospective Payment Assessment Commission and as published in the Tennessee Administrative Register. The trending indexes above shall be applied from October 1, 1989, to the midpoint of the state's fiscal year, no earlier than December 31, 1990, and shall be effective the first of the state's fiscal year, no earlier than July 1, 1990. When necessary, indexes will be prorated to correspond to the provider's year end. Each provider will be notified of their new operating rate due to indexing within 30 days of the beginning of the state’s fiscal year.

Medical malpractice insurance reimbursement will be limited to 7.5% of allowable malpractice insurance premiums for prospective rate purposes.

Education costs are considered as a part of the operating component, when educational services are an integral part of a recipients acute inpatient psychiatric care involving active treatment, pursuant to an individual plan of care developed by an inter-disciplinary treatment, and ordered by the recipient's attending physician.

History

• Authority: T.C.A. §§4-5-202, 12-4-301, 71-5-105 and 71-5-109; Public Chapter 913 of the Acts of 1992.
• Administrative History: Original rule filed June 2, 1988; effective July 17, 1988. Amendment filed August 8. 1990, effective September 22, 1990. Amendment filed September 25, 1992, effective November 9, 1992. Amendment filed November 17, 1983; effective January 31, 1994.

Tenn. Comp. R. & Regs. 1200-13-09-.16 TERMINATION OF MEDICAID PSYCHIATRIC HOSPITAL REIMBURSEMENT

PROGRAM. For psychiatric hospital services provided prior to January 1, 1994, the rules as set out at rule chapter 1200-13-9 shall apply. Effective January 1, 1994, the rules of TennCare as set out at rule chapter 1200-13-12 shall apply except that Tennessee Medicaid will continue to pay Medicare premiums, deductibles and copayments in accordance with the Medicaid rules in effect prior to January 1, 1994, and as may be amended.

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Public Chapter 358 of the Acts of 1993.
• Administrative History: Original rule filed March 18, 1994; effective June 1, 1994.

Tenn. Comp. R. & Regs. 1200-13-09-.09 MINIMUM OCCUPANCY ADJUSTMENT

Capital costs shall be adjusted each year, using the formula set out below, if a facility's occupancy rate, based on staffed beds during the year, is below a minimum level.

If a hospital exceeds its minimum occupancy rate, the formula is not applied. The minimum level is as follows:

Hospitals over 100 beds - 70%Hospitals with 100 beds or fewer - 60% The adjustment will be computed as follows and will be made at the same time as the pass through adjustment as set out in rule 1200-13-9-.08.

ACC = TCC x T'BD ABD (Y)

ACC = allowable capital costs TCC = total capital costs TBD = total beds used during the period ABD = total bed days available during the period Y = .6 for hospitals with 100 beds or fewer = .7 for hospitals over 100 beds All references to beds mean staffed beds. Staffed beds mean those beds which are equipped and available for patient use. Any beds or hospital wing which is unavailable for patient use, such as being closed for reasons including but not limited to, painting, maintenance, or insufficient nursing staff will not be considered staffed beds. It shall be the responsibility of the provider to determine, at least monthly, its number of staffed beds. A schedule showing the number of staffed and unstaffed beds, along with the reasons for being unstaffed, must be submitted with the cost report. This schedule is subject to audit in accordance with rule 1200-13-9-.14. If no schedule of staffed beds is received, staffed beds will be the number of beds at the end of the cost report period. For psychiatric providers, the minimum occupancy, adjustment will apply to services on and after July 1, 1988. The minimum occupancy adjustment will be applied before the adjustment specified in rule 1200-13-9.08(2)(d). Effective October 1, 1989, Tennessee Medicaid will not impose a minimum occupancy penalty.

History

• Authority: T.C.A. §§4-5-202, 12-4-301, 71-5-105 and 71--5-109.
• Administrative History: Original rule filed June 2, 1988; effective July 17, 1988. Amendment filed August 8, 1990; effective September 22, 1990.

Tenn. Comp. R. & Regs. 1200-13-09-.10 MEDICAID DISPROPORTIONATE SHARE ADJUSTMENT (MDSA)

(1)Effective July 1, 1988, inpatient psychiatric hospitals having a utilization ratio at least one standard deviation above the mean Medicaid inpatient utilization rate for all hospitals receiving Medicaid payments or a low income utilization rate exceeding 25 percent will receive a 1% adjustment to the prospective rate for each percentage above the 14% up to a cap of 3%; or a 2% adjustment to the prospective rate for each percentage above the 25% low income utilization rate up to a cap of 3%.

(a)Low income utilization rate will be calculated as follows and will use information obtained from the latest Hospital Joint Annual Report as submitted to the State Center of Health Statistics. The sum of. 1.Total Medicaid inpatient revenues paid to the hospital, plus the amount of the cash subsidies received directly from State and local governments in a cost reporting period, divided by the total amount of revenues of the hospital for inpatient services (including the amount of such cash subsidies) in the same cost report period; and, 2.The total amount of the hospitals charges for inpatient hospital services attributable to charity care (care provided to individuals who have no source of payment, third party or personal resources) in a cost reporting period, divided by the total amount of the hospital's charges for inpatient services in the hospital in the same period. The total inpatient charges attributed to charity care shall not include contractual allowances and discounts (other than for indigent patients not eligible for medical assistance under an approved Medicaid State plan) that is, reductions in charges given to other third party payers, such as HMOs, Medicare or Blue Cross.

(b)No total payment of the disproportionate share adjustment will exceed 80% inpatient charity care plus 80% of inpatient bad debt. All inpatient charity care and inpatient bad debt will be determined by the latest Hospital Joint Annual Report as submitted to the State Center of Health Statistics.

(c)Each year a redetermination of the MDSA will be made at the same time the new pass through component is determined. This determination will be made on the basis of the best information available. Once the determination is made, it will not be changed until the next scheduled redetermination. The effective date will coincide with the new pass through adjustment.

(d)Beginning July 1, 1988, the disproportionate share adjustment will be paid on a monthly

basis and established in June of each year. The monthly payment will be prospective based on the disproportionate share adjustment multiplied by the anticipated number of Medicaid days for the upcoming fiscal year July-June. This will be estimated based on projections from historical experience and the addition of any expected improvements.

(2)Effective July 1, 1989, psychiatric hospitals having over 3,000 patient days attributable to patients determined eligible for Medicaid by the state of Tennessee or a utilization ratio of 14% or one standard deviation above the mean utilization ratio for all hospitals, whichever is lower, will be provided a payment incentive. The MDSA shall not be subject to trending. The MDSA will be the higher of (a) or (b) but shall not exceed 34%.

(a)The prospective rate will be adjusted upward by 6% for each 1% increment in the utilization rate above 14% or one standard deviation above the mean, whichever is lower.

(b)The prospective rate will be adjusted upward by 6% for each increment of 1,000 reimbursed inpatient reported Medicaid days over 3,000 and the prospective rate will be increased upward by 3% if total days exceed 3,650 but are less than 4,000.

(c)No total payment of the disproportionate share adjustment will exceed 80% of inpatient charity care plus 80% of inpatient bad debt. All inpatient charity care and inpatient bad debt will be determined by the latest Hospital Joint Annual Report as submitted to the State Center of Health Statistics.

(d)Psychiatric hospitals that do not qualify under the criteria in (2) but have a low-income inpatient utilization rate exceeding 25% will receive the following payment incentive: 1.The prospective rate will be adjusted upward by 2% for each percentage above 25% up to a cap of 10%. 2.No total payment of the disproportionate share adjustment will exceed 80% of inpatient charity care plus 80% of inpatient bad debt. All inpatient charity care and inpatient bad debt will be determined by the latest Hospital Joint Annual Report as submitted to the State Center of Health Statistics. 3.Low income utilization rate will be calculated as follows from information obtained from the latest Hospital Joint Annual Report as submitted to the State Center of Health Statistics. The sum of:

(I)Total Medicaid inpatient revenues paid to the hospital, plus the amount of the cash subsidies received directly from state and local governments in a cost reporting period, divided by the total amount of revenues of the hospital for inpatient services (including the amount of such cash subsidies) in the same cost reporting period; and, (ii)The total amount of the hospital's charges for inpatient hospital services attributable to charity care (care provided to individuals who have no source of payment, third party or personal resources) in a cost reporting period, divided by the total amount of the hospital's charges for inpatient services in the hospital in the same period. The total inpatient charges attributed to charity care shall not include contractual allowances and discounts (other than for indigent patients not eligible for medical assistance under an approved Medicaid State plan) that is, reductions in charges given to other third party payers, such as HMOs, Medicare or Blue Cross.

(e)Each year a redetermination of the MDSA will be made at the same time the new pass through component is determined. This determination will be made on the basis of the best information available. Once the determination is made, it will not be changed until the next scheduled redetermination. The effective date will coincide with the new pass through adjustment.

(f)The disproportionate share adjustment will be paid on a monthly basis and established in June of each year. The monthly payment will be prospective based on the disproportionate share adjustment multiplied by the anticipated number of Medicaid days for the upcoming fiscal year July - June. This will be estimated based on projections from historical experience and the addition of any expected improvements.

(3)Effective October 1, 1992, psychiatric hospitals having over 1,000 cost report patient days attributable to patients determined eligible for Medicaid by the State of Tennessee or a 9.31 % Medicaid utilization ratio or having a low income utilization rate equal to or greater than 25 % will be provided a payment incentive (MDSA). The MDSA will be the higher of (a), (b), or (c) but cannot exceed 10% of inpatient and outpatient charity charges plus Medicare and Medicaid contractual adjustments adjusted to cost. For the purposes of this rule, Medicaid days will not include days reimbursed by the Primary Care Network. For the purposes of this rule charity, unless otherwise specified, will be defined as inpatient and outpatient charity charges (including medically indigent, low income, and medically indigent other), bad debt, and Medicare and Medicaid contractual adjustments adjusted to cost. Charity will include charges for both in-state and out-of-state services.

(a)The prospective rate will be adjusted upward by a factor of 5.8 times the difference between the actual utilization rate and a 9.31% utilization rate.

(b)The prospective rate will be adjusted upward by 5.8% times the number of days above 1,000 days divided by 1,000 days.

(c)The prospective rate will be adjusted upward by 2% times the difference between the low income utilization rate and a 25% low income utilization rate. This adjustment will be capped at 10%.

(d)Low-income utilization rate will be calculated as follows from information obtained from the latest industry complete Hospital Joint Annual Report as submitted to the State Center of Health Statistics. The sum of: 1.Total Medicaid inpatient revenues paid to the hospital, plus the amount of the cash subsidies received directly from state and local governments in a cost reporting period, divided by the total amount of revenues of the hospital for inpatient services (including the amount of such cash subsidies) in the same cost reporting period; and 2.The total amount of the hospital's charges for inpatient hospital services attributable to charity care (care provided to individuals who have no source of payment, third-party or personal resources) in a cost reporting period, divided by the total amount of the hospital's charges for inpatient services in the hospital in the same period. The total inpatient charges attributed to charity care shall not include contractual allowances and discounts (other than for indigent patients not eligible for medical assistance under an approved Medicaid State Plan) that is reductions in charges given to other third-party payers, such as HMOs, Medicare or Blue Cross.

(e)Each year a predetermination of the MDSA will be made at the same time the new pass through component is determined. This determination will be made on the basis of the best information available. Once the determination is made, it will not be changed until the next scheduled redetermination. The effective date will coincide with the new pass through adjustment.

(f)In accordance with the Medicaid State Plan, the disproportionate share adjustment will be paid on a monthly basis. The monthly payment will be prospective based on the disproportionate share adjustment multiplied by the anticipated number of Medicaid days.

This will be estimated based on projections from historical experience and the addition of any expected improvements.

(g)The total amount of MDSA payments for both acute care and psychiatric hospitals will be limited by a federal cap. When allocating the amount of payments that will be made, the amount of payments based on subparagraph (g) of paragraph (9) of the amendment to rule

Tenn. Comp. R. & Regs. 1200-13-05-.11 , will be excluded. After calculations have been made, hospitals will receive their proportionate share of the total available MDSA allotment.

(4)Effective July 1, 1993, psychiatric hospitals having over 1,000 cost report patient days attributable to patients determined eligible for Medicaid by the State of Tennessee or a 10.45% Medicaid utilization ratio or having a low income utilization rate equal to or greater than 25% will be provided a payment incentive (MDSA). The MDSA will be the higher of (a), (b), or (c) but cannot exceed 10% of inpatient and outpatient "charity" charges plus Medicare and Medicaid contractual adjustments adjusted to cost. For the purpose of this rule Medicaid days will not include days reimbursed by the Primary Care Network. For the purpose of this rule "charity”, unless otherwise specified, will be defined as inpatient and outpatient "charity" charges (including medical), indigent, low income, and medically indigent other), bad debt, and Medicare and Medicaid contractual adjustments adjusted to cost. "Charity" will include charges for both instate and out-of-state services.

(a)The prospective rate will be adjusted upward by a factor of 5.8 times the difference between the actual utilization rate and a 10.45% utilization rate.

(b)The prospective rate will be adjusted upward by 5.8% times thc number of days above 1,000 days divided by 1,000 days.

(c)The prospective rate will be adjusted upwards by 2% times the difference between the low income utilization rate and a 25% low income utilization rate. This adjustment will be capped at 10%.

(d)Low-income utilization rate will be calculated as follows from information obtained from the 1991 Hospital Joint Annual Report as submitted to the State Center of Health Statistics. The sum of: 1.Total Medicaid inpatient revenues paid to the hospital, plus the amount of the cash subsidies received directly from the state and local governments in a cost reporting period, divided by the total amount of revenues of the hospital for inpatient services (including the amount of such cash subsidies) in the same cost reporting period; and 2.The total amount of the hospital’s charges for inpatient hospital services attributable to “charity care” (care provided to individuals who have no source of payment, thirty-party or personal resources( in a cost reporting period, divided by the total amount of the hospital’s charges for inpatient services in the hospital in the same period. The total inpatient charges attributed to “charity care” shall not include contractual allowances and discounts (other than for indigent patients not eligible for Medical assistance under an approved Medicaid State Plan) that are reductions in charges given to other third-party payers, such as HMOs, Medicare or Blue Cross.

(e)Each year a redetermination of the MDSA will be made at the same time the new passthrough component is determined. This determination will be made on the basis of the best information available. Once the determination is made, it will not be changed until the next scheduled redetermination. The effective date will coincide with the new pass through adjustment.

(f)In accordance with the Medicaid State Plan, the disproportionate share adjustment will be paid on a monthly basis. The monthly payment will be prospective based on the disproportionate share adjustment multiplied by the number of Medicaid days reported on the 1992 cost report. In cases where the 1992 report is unavailable, the latest report on file will be used.

(g)The total amount of MDSA for both acute care and psychiatric hospitals will be limited by a federal cap. When allocating the amount of payments that will be made, the amount of payments based on subparagraph (g) of paragraph (10) of the amendment to rule 1200- 13-5-.11, will be excluded. After calculations have been made, hospitals will receive their proportionate share of the total available MDSA allotment.

History

• Authority: T.C.A. §§12-4-301, 71-5-105, 71-5-109 and 4-5-202.
• Administrative History: Original rule filed August 2, 1989; effective September 16, 1989. Amendment filed January 29, 1990; effective March 15, 1990. Amendment filed January 20, 1993; effective March 6, 1993.

Tenn. Comp. R. & Regs. 1200-13-09-.11 RATE OR PAYMENT ADJUSTMENTS

(1)Prospective per diem rate or lump sum payment amounts are subject to adjustment in the event of a mistake.

(2)Operating per diem rates may be adjusted if there is a significant change in case mix resulting in a $25,000 effect on Tennessee Medicaid reimbursement. Case mix, for this purpose, is a diagnostic or therapeutic related factor requiring either an increase or decrease in the professional staff per patient ratio. Requests for adjustments must be accompanied by detailed supporting information.

Such rate adjustments if approved become effective on the first day of the month following the approval.

(3)Providers may request an increase in monthly interim payments for return on equity, capital, and direct medical education if a provider’s actual amounts are expected to exceed the estimated amount by at least 25%. Supporting financial data must be submitted with the request. No more than one request per year for an increase will be accepted per provider. The Commissioner reserves the right, after notifying the provider, to decrease estimated payments when information is made available indicating the estimated payments are materially higher than what is actually being incurred.

History

• Authority: TC.A. §§71-5-105, 71-5-109 and 4--5-202.
• Administrative History: Original rule filed June 2, 1992; effective July 17,1988. Amendment renumbering 1200-13-.I0 through 1200-13-.14 to read 1200-13-.11 through

Tenn. Comp. R. & Regs. 1200-13-09-.12 NEW PROVIDERS

New providers who have not submitted a cost report and who are entering the program for the first time will be required to submit a budgeted cost report from which an interim prospective operating rate will be set. Each new provider must submit, in accordance with rule 1200-13-9-.04 an actual cost report covering the first full year of actual operations, at which point a final prospective operating rate, with a retroactive adjustment, will be used. A change of ownership does not constitute a new provider. The budgeted cost report will also be used to estimate interim payments for capital, direct medical education, and return on equity.

History

• Authority: T.C.A. §§71-5-105, 71-5-109 and 4-5-202. Administrative History :Original rule filed June 2,1988; effective July 17,1988. Amendment renumbering 1200-13-.10 through 1200-13-.14 to read 1200-13-.11 through

Tenn. Comp. R. & Regs. 1200-13-09-.13 LOWER OF COST OR CHARGES LIMIT

In the base year, the lower of cost or charges limitation will be waived for prospective rate determination purposes only. The limitation will, however, be applied for settlement purposes for all periods prior to a facility’s first Fiscal year under prospective payment. Carry forwards of unreimbursed costs will not be recognized once a provider's initial Fiscal year under the prospective payment method has begun.

History

• Authority: T.C.A. §§ 71-5-105, 71-5-109 and 4-5-202. Administrative History. Original rule filed June 2, 1988; effective July 17, 1988. Amendment renumbering 1200-13-.10 through 1200-13-.14 to read 1200-13-.11 through

Tenn. Comp. R. & Regs. 1200-13-09-.14 METHOD FOR PAYING PROVIDERS WHICH ARE EXEMPT FROM PROSPECTIVE

SYSTEM.

(1)The Comptroller of the Treasury, will determine, in accordance with Medicare principles of cost reimbursement in effect on October 1, 1982, and described at 42 CFR Part 405, per diem reimbursable costs for those Medicaid providers of psychiatric hospital services exempted from the prospective system set out in Rules 1200-13-9-.06 through 1200-13-9-.12 inclusive, except those hospitals described in item (3) of Rule 1200-13-9-.07 which shall be reimbursable as described in that item. The maximum limit of such reimbursable costs shall be the lessor of: (a) the reasonable cost of covered services, or (b) the customary charges to the general public for such services. Provided, however, that such providers which are public hospitals rendering services free or at a nominal charge shall not be subject to the lower of cost or charges limitation but shall be paid fair compensation for services in accordance with provisions of 42 CFR Part 405 in effect on October 1, 1982. Covered services means covered services as defined by the Department. Each provider's per diem reimbursable cost will be based on the provider's cost report which is to be filled out and submitted in accordance with Rule 1200-13-9-.04.

(2)Interim Rate. The Comptroller of the Treasury will establish interim per diem reimbursable rates for providers "exempted from the prospective payment system. The interim rate remains in effect until the provider's actual reimbursable cost, based on the provider's cost report, is established.

Interim rates shall be based on prior cost report data and shall be subject to revision upon further review, audit, and/or subsequent finding of the Comptroller of the Treasury. For new facilities, budgeted information supplied by the provider may be used to establish an interim rate.

(3)Approval of Initial Settlement.

When a provider's cost report is received, it is reviewed and compared with:

(a)The amount of charges for covered services provided to Medicaid beneficiaries by the provider during the provider's fiscal period.

(b)The amount of interim payments paid by the Department to the provider for the provider's fiscal period.

(c)The number of inpatient days approved for the provider by the Department during the provider's fiscal period.

On the basis of the comparison and review, the Comptroller of the Treasury will make an initial determination of the cost settlement due to the provider or the state for the designated period.

Approval of the initial settlement will be subject to further review, audit, and/or subsequent finding of the comptroller of the Treasury. On the basis of the initial settlement, the Department or the fiscal agent will (as may be required) either make arrangements for an additional payment to the provider for services provided during the fiscal year or submit a claim to the provider requesting payment to the Department for the amount of overpayment to the provider during the fiscal year.

(4)Approval of Final Cost Settlement. After the necessary final review and/or auditing has been performed by the Comptroller of the Treasury, the Comptroller will advise the Department of the final cost settlement approved. On the basis of the approved final settlement, the Department or the fiscal agent will (as may be required) either make arrangements for an additional payment to the provider for services provided during the fiscal year or submit a claim to the provider requesting payment to the Department for the amount of overpayment made to the provider during the fiscal year.

(5)Inpatient Routine Operating Per Diem Cost Limitation. In the event that data is not available to compute the inpatient routine operating per diem cost limitation for all or any part of a provider's fiscal year, the Comptroller of the Treasury will use each provider's per diem cost limitation in effect prior to the provider's first fiscal year subject to prospective payment which will be appropriately trended, by that rate of increase on prospective payments allowed by Medicare as published annually in the Federal Register and in the Tennessee Administrative Register.

History

• Authority: T.C.A. §§71-5-105, 71-5-109 and 4-5-202.
• Administrative History: Original rule filed June 2, 1988; effective July 17, 1988. Amendment renumbering 1200-13-.10 through 1200-13-.14 to read 1200-13-.11 through

Tenn. Comp. R. & Regs. 1200-13-09-.15 AUDIT

(1)All hospital cost reports are subject to audit at anytime by the Comptroller of the Treasury and the Department or their designated representative. Cost report data must be based on and traceable to the provider's financial statistical records and must be adequate, accurate, and in sufficient detail to support payment made for services rendered to beneficiaries. Retroactive adjustments to the prospective rate may be made for audit exceptions.

(2)Hospitals will be subject to medical audits at any time. Medical audits include, but are not limited to, "medical necessity" or "length of stay". Medical audit exceptions may result in a direct recoupment rather than a rate change.

(3)The Department will provide for all costs of auditing which may be required.

History

• Authority: T.C.A. §§71-5-105, 71-5-109 and 4-5-202.
• Administrative History: Original rule filed June 2, 1988; effective July 17, 1988. Amendment renumbering 1200-13-.10 through 1200-13-.14 to read 1200-13-.11 through

Chapter 1200-13-10 Repealed

Tenn. Comp. R. & Regs. 1200-13-10-.01 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109 and Executive Order Number 23.
• Administrative History: Original rule filed June 12, 1991; effective July 27, 1991. Repeal filed November 30, 2007; effective February 13, 2008.

Tenn. Comp. R. & Regs. 1200-13-10-.02 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109 and Executive Order Number 23.
• Administrative History: Original rule certified June 7, 1974; effective May 17, 1974. Amendment filed January 10, 1977, effective February 9, 1977. Amended filed March 13, 1978; effective April I2, 1978. Amendment filed May 7, 1979; effective June 21, 1979. Amendment filed October 28, 1981, effective December 14, 1981. Amendment filed June 12, 1991, effective July 27, 1991. Repeal filed November 30, 2007; effective February 13, 2008.

Tenn. Comp. R. & Regs. 1200-13-10-.03 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109 and Executive Order Number 23.
• Administrative History: Original rule certified June 7, 1974; effective May 17, 1974. Repeal filed February 5, 1979; effective March 21, 1979. Amendment filed June 12, 1991, effective July 27, 1991. Repeal filed November 30, 2007; effective February 13, 2008.

Tenn. Comp. R. & Regs. 1200-13-10-.04 REPEAL

History

• Authority:. T.C.A. §§4-5-202, 71-5-105, 71-5-109 and Executive Order Number 23.
• Administrative History: Original rule filed June 12, 1991; effective July 27, 1991. Repeal filed November 30, 2007; effective February 13, 2008.

Tenn. Comp. R. & Regs. 1200-13-10-.05 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109 and Executive Order Number 23.
• Administrative History: Original rule filed June 12, 1991; effective July 27, 1991. Repeal filed November 30, 2007; effective February 13, 2008.

Tenn. Comp. R. & Regs. 1200-13-10-.06 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order Number 23.
• Administrative History: Original rule filed March 18, 1994; effective June 1, 1994. Repeal filed November 30, 2007; effective February 13, 2008.

Chapter 1200-13-11 Public Records Access

Tenn. Comp. R. & Regs. 1200-13-11-.01 SCOPE AND AUTHORITY

The Tennessee Public Records Act (TPRA), T.C.A. §§ 10- 7-501, et seq., requires each state agency to provide public access to agency records, unless exempted by the TPRA. This chapter establishes the process and procedure through which the Division of TennCare shall provide access to public records, pursuant to T.C.A. § 10-7-503.

(1) TennCare shall provide economical and efficient access to public records.

(2) TennCare public records shall, at all times during business hours, 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 law.

(3) Personnel of TennCare shall timely and efficiently provide access and assistance to persons requesting to view or receive copies of public records.

(4) The integrity and organization of public records, as well as the efficient and safe operation of TennCare, its programs and the individuals they support, shall be protected as provided by law.

(5) TennCare is not required to sort through files to compile information or to create or recreate a record that does not exist in order to satisfy a records request.

History

• Authority: T.C.A. §§ 4-5-202, 10-7-503, 71-5-105, 71-5-109, and Public Chapter 358 of the Acts of 1993.
• Administrative History: Original rule filed March 16, 1992; effective April 30, 1992. Amendment filed March 18, 1994; effective June 1, 1994. Amendment filed June 9, 1994; effective August 23, 1994. Repeal and new rule filed January 3, 2019; effective April 3, 2019.

Tenn. Comp. R. & Regs. 1200-13-11-.02 DEFINITIONS

(1) Division of TennCare (TennCare). A state governmental agency administratively located within the Tennessee Department of Finance and Administration; includes references to all employees and subdivisions of the agency.

(2) Media. This term includes reporters, editors and journalists working with radio, television, online or any other news organizations, and serving the general public.

(3) Media Inquiries. Inquiries not related to the use or disclosure of public records, made by or on behalf of members of the media.

(4) Protected Health Information (PHI). Health information that identifies or may be used to identify an individual and that meets the following criteria:

(a) Information that is:

1. Transmitted by electronic media; or, 2. Maintained in electronic media; or, 3. Transmitted or maintained in any other form or medium, including demographic information that identifies or may be used to identify an individual; and, (b) Is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and, (c) Relates to the physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual. See 45 C.F.R. § 160.103.

(5) Public Records. 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.

(6) Public Records Request Coordinator (PRRC). The individual, or individuals, designated in

Rule .03, who has, or have, the responsibility to ensure public records requests are routed to the appropriate records custodian and are fulfilled according to the TPRA. The PRRC may also be a records custodian.

(7) Records Custodian. 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.

(8) Requestor. A person seeking access to a public record, whether it is for inspection or duplication.

(9) TennCare Public Records Request Form (Request Form). The form utilized by TennCare for processing a public records request, available on the TennCare website at https://www.tn.gov/tenncare/ or in Rule .09.

History

• Authority: T.C.A. §§ 4-5-202, 10-7-503, and 71-5-105.
• Administrative History: Original rules filed January 3, 2019; effective April 3, 2019.

Tenn. Comp. R. & Regs. 1200-13-11-.03 REQUESTING ACCESS TO PUBLIC RECORDS

(1) Public records requests shall be made to the PRRC or designee in order to ensure that public records requests are routed to the appropriate records custodian and fulfilled in a timely manner. The TennCare designated PRRC is the Privacy and Public Records Officer, in the Office of General Counsel, whose contact information is available in the Request Form and as follows:

TennCare Public Records Request Coordinator Department of Finance and Administration Division of TennCare 310 Great Circle Road Nashville, TN 37243 1-866-797-9469 fax: (615) 734-5289 email: Privacy.Records.TennCare@tn.gov (2) Requests for inspection may be made orally or in writing using the Request Form, at the PRRC’s mailing address, email address, fax or phone number. The PRRC shall request contact information from the requestor for providing any written communication required under the TPRA.

(3) Requests for copies, or requests for inspection and copies, shall be made to the PRRC in writing using the Request Form at the mail or email address or fax number provided.

(4) Proof of Tennessee citizenship by presentation of a valid Tennessee driver’s license (or at TennCare discretion an alternative acceptable form of ID) is required as a condition to inspect or receive copies of public records.

(5) Requests by journalists, media organizations, outlets, agencies and their representatives may be treated as Media Inquiries and responded to based on the procedures of the TennCare Communications Office. It is the policy of TennCare to respond only to public record requests by journalists who are Tennessee citizens. Interstate journalist and media organization requests shall be treated as Media Inquiries rather than as records requests and such requests will be responded to at the discretion of the TennCare Deputy Director of Communications and Employee Relations. Contact information for the Communications Office is available on the TennCare website.

History

• Authority: T.C.A. §§ 4-5-202, 10-7-503, and 71-5-105.
• Administrative History: Original rules filed January 3, 2019; effective April 3, 2019.

Tenn. Comp. R. & Regs. 1200-13-11-.04 RESPONDING TO PUBLIC RECORDS REQUESTS

(1) Public Records Request Coordinator.

(a) The PRRC shall review public records requests and make an initial determination of the following:

1. If the requestor provided evidence of Tennessee citizenship;

2. If the records requested are described with sufficient specificity to identify them; and 3. If TennCare is the custodian of the records.

(b) The PRRC shall acknowledge receipt of the request and take any of the following appropriate actions:

1. Advise the requestor of this rule chapter and the decisions made regarding:

(i) Proof of Tennessee citizenship;

(ii) Any forms required for copies;

(iii) Fees; or, (iv) Aggregation of multiple or frequent requests.

2. If appropriate, deny the request in writing, using the TennCare Public Records Request Response Form (Response Form) providing the appropriate ground for denial such as:

(i) The requestor is not, or has not presented evidence of being, a Tennessee citizen;

(ii) The request lacks specificity;

(iii) An exemption makes the record not subject to disclosure under the TPRA;

(iv) TennCare is not the custodian of the requested records; or, (v) The records requested do not exist.

3. If appropriate, contact the requestor to see if the request can be narrowed or otherwise clarified.

4. Forward the records request to the appropriate records custodian within TennCare.

5. If requested records are in the custody of a different governmental entity, and the PRRC knows the correct governmental entity, advise the requestor of the correct governmental entity.

(2) Records Custodian.

(a) Upon receiving a public records request, a TennCare records custodian in collaboration with the PRRC shall promptly make requested public records available using the Response Form. If the records custodian is uncertain that an applicable TPRA exemption applies, the custodian may consult with the PRRC or the Office of General Counsel.

(b) If not practicable to promptly provide requested records, a records custodian in collaboration with the PRRC shall, within seven (7) business days from the records custodian’s receipt of the request, send the requestor a completed Response Form indicating the reason for the delay and an estimate of the time necessary to produce the records or determine the proper response to the request because additional time is necessary:

1. To determine whether the requested records exist;

2. To search for, retrieve, or otherwise gain access to records;

3. To determine whether the records are open;

4. To redact records; or 5. For other similar reasons.

(c) If a records custodian in collaboration with the PRRC denies a public records request, he or she shall deny the request in writing as provided above using the Response Form.

(d) If a records custodian in collaboration with 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 Response Form should be used 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 records custodian or PRRC should contact the requestor to see if the request can be narrowed.

(e) If a records custodian discovers records responsive to a records request were omitted, the records custodian in collaboration with the PRRC should contact the requestor concerning the omission and produce the records as quickly as practicable.

(3) Confidential Records and Redaction.

(a) If the PRRC determines that the requested records are considered confidential or privileged records under federal or state law and are not available for public inspection, the PRRC shall communicate the determination to the requester in writing. However, nothing in this rule chapter shall be construed to require TennCare to generate a detailed description of each confidential record withheld from inspection, such as may be required with respect to the production of documents in discovery under the Tennessee Rules of Civil Procedure.

(b) Individually identifying information and Protected Health Information (PHI) is generally not subject to public records requests. PHI and other sensitive information are confidential except as use or disclosure is permitted by The Privacy Act, HIPAA and other federal and state privacy rules.

(c) If a TennCare record contains confidential information or information that is not open for public inspection, the records custodian shall prepare a redacted copy prior to providing access or copies. If questions arise concerning redaction, the records custodian should coordinate with the PRRC or counsel or other appropriate parties regarding review and redaction of records. The records custodian, the PRRC, and the Office of General Counsel may also consult with the Comptroller of the Treasury’s Office of Open Records Counsel (OORC) or with the Office of the Attorney General and Reporter regarding this topic or others regarding open records requests.

(d) Whenever a redacted record is provided, a records custodian shall provide the requestor with the basis for redaction. The basis given for redaction shall be general in nature and not disclose confidential information.

History

• Authority: T.C.A. §§ 4-5-202, 10-7-503, and 71-5-105.
• Administrative History: Original rules filed January 3, 2019; effective April 3, 2019.

Tenn. Comp. R. & Regs. 1200-13-11-.05 INSPECTION OF RECORDS

(1) There shall be no charge for inspection of open public records. Charges may be assessed for reasonable costs incurred in producing requested materials in accordance with T.C.A. §§ 10- 7-503(a)(5) and 10-7-503(a)(7)(C)(i).

(2) The location for inspection of records shall be reasonably determined by the PRRC or the records custodian.

(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. §§ 4-5-202, 10-7-503, and 71-5-105.
• Administrative History: Original rules filed January 3, 2019; effective April 3, 2019.

Tenn. Comp. R. & Regs. 1200-13-11-.06 COPIES OF RECORDS

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

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

(3) Upon payment for postage and fees for copies and labor, copies will be delivered to the requestor’s home address via the United States Postal Service. Additional permitted means of delivery may be agreed upon with the requestor, including email, electronic transfer or via disk, upon payment of fees for copies and labor and in the case of use of devices such as flash drives, the agency’s cost for procuring such a device.

(4) Except for the use of a cell phone or handheld camera, a requestor will not be allowed to make copies of records with their personal equipment during the inspection of such records.

History

• Authority: T.C.A. §§ 4-5-202, 10-7-503, and 71-5-105.
• Administrative History: Original rules filed January 3, 2019; effective April 3, 2019.

Tenn. Comp. R. & Regs. 1200-13-11-.07 FEES AND CHARGES AND PROCEDURES FOR BILLING AND PAYMENT

(1) Excessive fees and charges for copies of public records shall not be used to hinder access to public records.

(2) Records custodians in collaboration with the PRRC shall provide requestors with an itemized estimate of the charges prior to producing copies of records and shall require pre-payment of such charges before producing requested records.

(3) When fees for copies and labor do not exceed $50.00, the fees will be waived. Requests for waivers for fees above $50.00 must be presented to the PRRC, who is authorized to determine if such waiver is in the best interest of TennCare and for the public good. Fees associated with aggregated records requests will not be waived.

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

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

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

(c) Shipping or mailing costs in excess of $15.00.

(d) Labor when time exceeds 1 hour for time reasonably necessary to produce requested records, including the time spent locating, retrieving, reviewing, reproducing, redacting or scanning records. The cost will vary depending on the hourly rates of the employee(s) doing the work and may include the time of an attorney reasonably necessary to review records and redactions to ensure compliance with confidentiality requirements of state and federal law.

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

(f) If transfer is performed via disk, such as a flash drive, the agency’s cost for procuring such a device.

(5) No duplication costs will be charged for requests for less than 10 pages.

(6) Payment is to be made by check or money order payable to TennCare and presented to the PRRC via mail or hand delivery, at the address provided in the Request and Response Forms.

History

• Authority: T.C.A. §§ 4-5-202, 10-7-503, and 71-5-105.
• Administrative History: Original rules filed January 3, 2019; effective April 3, 2019.

Tenn. Comp. R. & Regs. 1200-13-11-.08 AGGREGATION OF FREQUENT AND MULTIPLE REQUESTS

(1) TennCare will aggregate record requests according to 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 working in concert.

(2) The PRRC is responsible for making the determination that a group of individuals are working in concert. The PRRC must inform the individuals that they have been deemed to be working in concert and that they have the right to appeal the decision to the OORC.

(3) Requests for any TennCare records, regardless of the type of records requested or whether the request pertains to any office or sub-division of the agency, may be aggregated.

(4) Once the aggregation threshold is reached, the exemption for labor charges up to one hour specified above does not apply for any ongoing and subsequent requests.

History

• Authority: T.C.A. §§ 4-5-202, 10-7-503, and 71-5-105.
• Administrative History: Original rules filed January 3, 2019; effective April 3, 2019.

Tenn. Comp. R. & Regs. 1200-13-11-.09 TENNCARE PUBLIC RECORDS REQUEST FORM

The following form is utilized by TennCare for processing a public records request. A requestor may use a copy of the form produced below or the electronic version of the form available on the TennCare website at https://www.tn.gov/tenncare/ (This space intentionally left blank)

TENNCARE PUBLIC RECORDS REQUEST FORM

The Tennessee Public Records Act (TPRA) grants Tennessee citizens the right to access open public records that exist at the time of the request. The TPRA does not require records custodians to compile information or create or recreate records that do not exist.

To: TennCare Public Records Request Coordinator Department of Finance and Administration, Division of TennCare 310 Great Circle Road Nashville, TN 37243 1-866-797-9469, fax (615) 734-5289 email the completed form to Privacy.Records.TennCare@tn.gov From: Requestor Name:____________________________________________________________ Residence address:__________________________________________________________ Mailing or delivery information:__________________________________________________ __________________________________________________________________________ Phone:_______________________ Email:_______________________________________ Is the requestor a Tennessee citizen?_____Yes_____No (A copy of a valid driver’s license or other evidence showing requestor’s address is required prior to access to public records.)

Request: _____Inspection (The TPRA does not permit copying fees or require a written request for inspection only. Fees may be assessed for redaction as appropriate.) _____Copies/Duplicates (There is no fee for requests for records of less than 10 pages and labor charges of one hour or less. If fees are to be assessed, the requestor has a right to receive a good faith estimate prior to receiving the documents requested. More details as to fees and charges may be found in the TennCare Public Records Policy.)

Do you wish to waive your right to an estimate and agree to pay copying and duplication costs in an amount not to exceed $____________________? If so, initial here:_____________.

Delivery preference: On-Site Pick-Up USPS First-Class Mail Electronic Other:_________ Records Requested:

Provide a detailed description of the records requested, including:

(1) type of records;

(2) timeframe or dates for the records sought; and (3) subject matter or key words related to the records.

Under the TPRA, records requests must be sufficiently detailed to enable a governmental entity to identify the specific records sought. As such, your records request must provide enough detail to enable the records custodian responding to the request to identify the specific records requested.

Description:______________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ ________________________________________ Signature of Requestor and Date Submitted TENNCARE OFFICE USE ONLY Received by:_______________________________ Date and time received:______________________ Notes: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

History

• Authority: T.C.A. §§ 4-5-202, 10-7-503, and 71-5-105.
• Administrative History: Original rules filed January 3, 2019; effective April 3, 2019.

Chapter 1200-13-12 Repealed

Tenn. Comp. R. & Regs. 1200-13-12 Repealed

RULES

OF TENNESSEE DEPARTMENT OF FINANCE AND ADMINISTRATION

TABLE OF CONTENTS

REPEALED

Chapter 1200-13-13 TennCare Medicaid

Tenn. Comp. R. & Regs. 1200-13-13-.01 , when prescribed by an attending physician for treatment and services rendered by a Registered Nurse (R.N.) or a licensed practical nurse (L.P.N.).

Prior authorization required, as described in Paragraph (6) of this

rule.

Covered as medically necessary in accordance with the definition of Private Duty Nursing at Rule 1200-13-13-.01, when prescribed by an attending physician for treatment and services rendered by a Registered Nurse (R.N.) or a licensed practical nurse (L.P.N.). Private duty nursing services are limited to services that support the use of ventilator equipment or other life-sustaining technology when constant nursing supervision, visual assessment, and monitoring of both equipment and patient are required. Prior authorization required, as described in Paragraph (6) of this rule.

31. Prosthetic Devices [defined at 42 C.F.R. § 440.120(c)].

Covered as medically necessary. Covered as medically necessary.

32. Psychiatric Inpatient Facility Services [defined at 42 C.F.R. § 441, Subparts C and D and including services for persons of all ages].

Covered as medically necessary.

Preadmission and concurrent reviews by the MCC are allowed.

Covered as medically necessary.

Preadmission and concurrent reviews by the MCC are allowed.

33. Psychiatric Pharmacy.

See “Pharmacy Services.” See “Pharmacy Services.”

34. Psychiatric Rehabilitation Services [defined as psychiatric services delivered in accordance with 42 Covered as medically necessary. Covered as medically necessary.

SERVICE BENEFIT FOR PERSONS

UNDER AGE 21

BENEFIT FOR PERSONS AGED 21

AND OLDER

C.F.R. § 440.130(d)].

35. Psychiatric Physician Inpatient Services [defined at 42 C.F.R. § 440.50].

Covered as medically necessary. Covered as medically necessary.

36. Psychiatric Physician Outpatient Services.

See “Outpatient Mental Health Services.”

See “Outpatient Mental Health Services.”

37. Psychiatric Residential Treatment Services [defined at 42 C.F.R. § 483.352] and including services for persons of all ages].

Covered as medically necessary. Covered as medically necessary.

38. Reconstructive Breast Surgery [defined in accordance with Tenn. Code Ann. § 56-7-2507].

Covered in accordance with Tenn. Code Ann. § 56-7-2507 which requires coverage of all stages of reconstructive breast surgery on a diseased breast as a result of a mastectomy as well as any surgical procedure on the non-diseased breast deemed necessary to establish symmetry between the two breasts in the manner chosen by the physician.

The surgical procedure performed on a non-diseased breast to establish symmetry with the diseased breast will only be covered if the surgical procedure performed on a non-diseased breast occurs within five (5) years of the date the reconstructive breast surgery was performed on a diseased breast.

Covered in accordance with Tenn. Code Ann. § 56-7-2507 which requires coverage of all stages of reconstructive breast surgery on a diseased breast as a result of a mastectomy as well as any surgical procedure on the non-diseased breast deemed necessary to establish symmetry between the two breasts in the manner chosen by the physician. The surgical procedure performed on a nondiseased breast to establish symmetry with the diseased breast will only be covered if the surgical procedure performed on a non-diseased breast occurs within five (5) years of the date the reconstructive breast surgery was performed on a diseased breast.

39. Rehabilitation Services.

See “Occupational Therapy,” and “Physical Therapy,” and “Speech Therapy,” and “Inpatient Rehabilitation Facility Services.”

See “Occupational Therapy,” “Physical Therapy,” and “Speech Therapy.”

40. Renal Dialysis Clinic Services [defined at 42 C.F.R. § 440.90].

Covered as medically necessary.

Generally limited to the beginning ninety (90) day period prior to the enrollee’s becoming eligible for coverage by the Medicare program.

Covered as medically necessary.

Generally limited to the beginning ninety (90) day period prior to the enrollee’s becoming eligible for coverage by the Medicare program.

41. Speech Therapy [defined at 42 C.F.R. § 440.110(c)].

Covered as medically necessary, by a Licensed Speech Therapist to restore, improve, stabilize or ameliorate impaired functions.

Covered as medically necessary, as long as there is continued medical progress, by a Licensed Speech Therapist to restore speech after a loss or impairment.

42. Transportation. See “Emergency Air and Ground Transportation,” “Non-Emergency Ambulance Transportation,” and “Non-Emergency Transportation.”

See “Emergency Air and Ground Transportation,” “Non-Emergency Ambulance Transportation,” and “Non- Emergency Transportation.”

43. Vision Services Preventive, diagnostic, and Medical eye care, meaning evaluation SERVICE BENEFIT FOR PERSONS UNDER AGE 21 BENEFIT FOR PERSONS AGED 21 AND OLDER [defined as services to treat conditions of the eyes]. treatment services (including eyeglasses) covered as medically necessary. and management of abnormal conditions, diseases, and disorders of the eye (not including evaluation and treatment of the refractive state) is covered. Routine, periodic assessment, evaluation or screening of normal eyes, and examinations for the purpose of prescribing, fitting, or changing eyeglasses and/or contact lenses are not covered.

One pair of cataract glasses or lenses is covered for adults following cataract surgery.

(c) Pharmacy TennCare is permitted under the terms and conditions of the demonstration project approved by the federal government to restrict coverage of prescription and nonprescription drugs to a TennCare-approved list of drugs known as a drug formulary.

TennCare must make this list of covered drugs available to the public. Through the use of a formulary, the following drugs or classes of drugs, or their medical uses, shall be excluded from coverage or otherwise restricted by TennCare as described in Section 1927 of the Social Security Act [42 U.S.C. § 1396r-8]:

1. Agents for weight loss or weight gain, except for weight loss drugs when prescribed for treatment of obesity.

2. Agents to promote fertility or for the treatment of impotence or infertility or for the reversal of sterilization.

3. Agents for cosmetic purposes or hair growth.

4. Agents for symptomatic relief of coughs and colds.

5. Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations.

6. Nonprescription drugs.

7. Covered outpatient drugs, which the manufacturer seeks to require as a condition of sale that associated tests or monitoring services be purchased exclusively from the manufacturer or his designee.

8. TennCare shall not cover drugs considered by the FDA to be Less Than Effective (LTE) and DESI drugs, or drugs considered to be Identical, Related and Similar (IRS) to DESI and LTE drugs or any other pharmacy services for which federal financial participation (FFP) is not available. The exclusion of drugs for which no FFP is available extends to all TennCare enrollees regardless of the enrollee’s age. TennCare shall not cover experimental or investigational drugs which have not received final approval from the FDA.

9. Buprenorphine products for opiate addiction treatment for persons aged 21 and older are restricted as follows:

(i) Dosage shall not exceed sixteen milligrams (16 mg) per day for a period of up to six (6) months from the initiation of therapy.

(ii) For enrollees who are pregnant while receiving the sixteen milligrams (16 mg) per day dosage, the six-month period does not begin until the enrollee is no longer pregnant.

(iii) At the end of the six-month period described in subparts (i) and (ii), the covered dosage amount shall not exceed eight milligrams (8 mg) per day.

10. Sedative hypnotic medications for persons aged 21 and older shall not exceed fourteen (14) pills per month for sedative hypnotic formulations in pill form such as Ambien and Lunesta, one hundred forty milliliters (140 ml) per month of chloral hydrate, or one (1) bottle every sixty (60) days of Zolpimist.

11. Allergy medications.

12. Opioid products for persons aged twenty-one (21) and older are restricted as follows:

(i) “Chronic opioid user” means:

(I) A TennCare enrollee whose TennCare paid claims data demonstrates that he has received at least a ninety (90) day quantity of prescribed opioids in the one hundred eighty (180) day period immediately preceding the opioid’s prescription date.

(II) For a TennCare enrollee who has not been enrolled in TennCare long enough to demonstrate that he is a chronic opioid user as defined in Item (I), the enrollee may demonstrate that he has received at least a ninety (90) day quantity of prescribed opioids in the one hundred eighty (180) day period immediately preceding the opioid’s prescription date by supplying paid claims data and medical records from his previous healthcare provider(s) or health insurer(s).

(ii) “Non-chronic opioid user” means a TennCare enrollee whose TennCare paid claims data demonstrates he has received less than a ninety (90) day quantity of prescribed opioids in the one hundred eighty (180) day period immediately preceding the opioid’s prescription date.

(iii) Non-chronic opioid users shall be eligible to receive covered prescription opioid products as follows:

(I) A maximum of fifteen (15) dosage days in any six (6) month period; and (II) Daily dosage shall not exceed sixty (60) morphine milligram equivalents (MME) per day.

(iv) The restrictions in Subpart (iii) do not apply for enrollees:

(I) With severe cancer pain undergoing active or palliative cancer treatment;

(II) With sickle cell disease or these related disorders: sickle cell anemia, sickle hemoglobin-C disease, sickle beta-plus thalassemia, sickle beta zero thalassemia, hemoglobin SD (HbSD), hemoglobin SE (HbSE), or hemoglobin SO (HbSo);

(III) Who are severe burn victims; or (IV) Who are receiving hospice or palliative care.

(v) Notwithstanding the restrictions in Subpart (iii), enrollees residing in a Medicaid-certified Nursing Facility may receive up to forty-five (45) days of sixty (60) MME per day in any ninety (90) day period.

(vi) Opioid prescriptions are subject to prior authorization following the first fill of a new opioid prescription.

(vii) For women of child-bearing age (between the ages of fifteen (15) and fortyfour (44)) and ability, when prior authorization is required for an opioid prescription, the prescribing provider must submit information to the enrollee’s PBM regarding the enrollee’s pregnancy status and use of contraception or family planning methods, and the provision of counseling regarding the risks of becoming pregnant while receiving opioid medication. The information regarding pregnancy status and contraceptive use may, when appropriate, be based on self-reporting by the patient.

(d) The MCC shall be allowed to provide cost effective alternative services as defined in paragraph 1200-13-13-.01(30). Cost effective alternative services are not reimbursable in any circumstances other than those described in that paragraph.

(e) Remote ultrasound procedures and remote fetal nonstress tests are covered as medically necessary and as follows:

1. A remote fetal ultrasound procedure or remote fetal nonstress test is reimbursable when the provider uses digital technology:

(i) To collect medical and other forms of health data from a patient and electronically transmit that information securely to a healthcare provider who is in a separate location for the purpose of interpretation and making recommendations;

(ii) That is compliant with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA)(42 U.S.C. § 1320d et seq.); and (iii ) That is approved by the federal food and drug administration.

2. A fetal nonstress test is only reimbursable with a place of service modifier for athome monitoring with remote monitoring solutions that are cleared by the federal food and drug administration for on-label use for monitoring fetal heart rate, maternal heart rate, and uterine activity.

(2) Use of Cost Effective Alternative Services.

(a) MCCs shall be allowed, but are not required, to use cost effective alternative services if and only if:

1. These services are listed in the MCC contract and/or in Policy BEN 08-001; or 2. These services are provided under the CHOICES program for individuals enrolled in the CHOICES program in accordance with Rule 1200-13-01-.05 or the ECF CHOICES program for individuals enrolled in the ECF CHOICES program in accordance with Rule 1200-13-01-.31; and 3. They are medically appropriate and cost effective.

(b) Use of approved cost effective alternative services is made at the sole discretion of the MCC.

(3) Emergency Medical Services.

Emergency Medical Services shall be available twenty-four (24) hours per day, seven (7) days per week. Coverage of emergency medical services shall not be subject to prior authorization by the managed care organization but may include a requirement that notice be given to the MCC of use of out-of-plan emergency services. However, such notice requirements shall provide at least a 24-hour time frame after the emergency for notice to be given to the MCC.

(4) Hospital Discharges.

Hospital discharges of mothers and newborn babies following delivery shall take into consideration the following guidelines:

(a) The decision to discharge postpartum mothers and newborns less than 24-48 hours after delivery should be made based upon discharge criteria collaboratively developed and adopted by obstetricians, pediatricians, family practitioners, delivery hospitals, and health plans. The criteria must be contingent upon appropriate preparation, meeting in hospital criteria for both mother and baby, and the planning and implementation of appropriate follow-up. An individualized plan of care must include identification of a primary care provider for both mother and baby and arrangements for follow-up evaluation of the newborn.

Length of hospital stay is only one factor to consider when attempting to optimize patient outcomes for postpartum women and newborns. Excellent outcomes are possible even when length of stay is very brief (less than 24 hours) if perinatal health care is well planned, allows for continuity of care, and patients are well chosen. Some postpartum patients and/or newborns may require extended hospitalization (greater than 48-72 hours) despite meticulous care due to medical, obstetric, or neonatal complications. The decision for time of discharge must be individualized and made by the physicians caring for the mother-baby pair. The following guidelines have been developed to aid in the identification of postpartum mothers and newborns who may be candidates for discharge prior to 24-48 hours. The guidelines also provide examples where discharge is inappropriate.

Principles of patient care should be based upon data obtained by clinical research.

Regarding the question of postpartum and newborn length of hospitalization, there are inadequate studies available to provide clear direction for clinical decision-making.

Clinical guidelines represent an attempt to conceptualize what is, in reality, a dynamic process of health care refinement. Review of these guidelines is desirable and expected.

No provider shall be denied participation, reimbursement or reduction in reimbursement within a network solely related to his/her compliance with the “Guidelines for Discharge of Postpartum Mothers and Newborns.”

(b) Guidelines for Discharge of Postpartum Mothers and Newborns.

1. Discharge Planning.

(i) Discharge planning should occur in a planned and systematic fashion for all postpartum women and newborns in order to enhance care, prevent complications and minimize the need for rehospitalization. Prior to discharge a discussion should be held between the physician or another health care provider and the mother (and father if possible) about any expected perinatal problems and ways to cope with them. Plans for future and immediate care as well as instructions to follow in the event of an emergency or complication should be discussed.

(ii) Follow-up care must be planned for both mother and baby at the time of discharge. For patients leaving the hospital prior to 24-48 hours, contact within 48-72 hours of discharge is recommended and may include appropriate follow-up within 48-72 hours as deemed necessary by the attending provider, depending upon individual patient need. This follow-up visit will be acknowledged as a provider encounter.

(I) Maternal Considerations:

I. Prior to discharge, the patient should be informed of normal postpartum events including but not limited to:

A. Lochial patterns;

B. Range of activity and exercise;

C. Breast care;

D. Bladder care;

E. Dietary needs;

F. Perineal care;

G. Emotional responses;

H. What to report to physician or other health care provider including:

(A) Elevation of temperature, (B) Chills, (C) Leg pains, and (D) Increased vaginal bleeding.

I. Method of contraception;

J. Coitus resumption; and K. Specific instructions for follow-up (routine and emergent).

(II) Neonatal Considerations:

I. Prior to discharge, the following points should be reviewed with the mother or, preferably, with both parents:

A. Condition of the neonate;

B. Immediate needs of the neonate, (e.g., feeding methods and environmental supports);

C. Instructions to follow in the event of a newborn complication or emergency;

D. Feeding techniques;

E. Skin care, including cord care and genital care;

F. Temperature assessment and measurement with the thermometer; and G. Assessment of neonatal well-being;

H. Recognition of illness including jaundice;

I. Proper infant safety including use of car seat and sleeping position;

J. Reasonable expectations for the future; and K. Importance of maintaining immunization begun with initial dose of hepatitis B vaccine.

2. Criteria for Maternal Discharge Less Than 24-48 Hours Following Delivery.

(i) Prior to discharge of the mother, the following should occur:

(I) The mother should have been observed after delivery for a sufficient time to ensure that her condition is stable, that she has sufficiently recovered and may be safely transferred to outpatient care.

(II) Laboratory evaluations should be obtained and include ABO blood group and Rh typing with appropriate use of Rh immune globulin; and hematocrit or hemoglobin.

(III) The mother should have received adequate preparation for and be able to assume self and immediate neonatal care.

(ii) Factors which may exclude maternal discharge prior to 24-48 hours include:

(I) Abnormal bleeding.

(II) Fever equal to or greater than 100.4 degrees.

(III) Inadequate or no prenatal care.

(IV) Cesarean section.

(V) Untreated or unstable maternal medical condition.

(VI) Uncontrolled hypertension.

(VII) Inability to void.

(VIII) Inability to tolerate solid foods.

(IX) Adolescent mother without adequate support and where appropriate follow-up has not been established. A nurse home visit within 24-48 hours of discharge would act as appropriate follow-up.

(X) All efforts should be made to keep mother and infant together to ensure simultaneous discharge.

(XI) Psychosocial problems (maternal or family) which have been identified prenatally or in hospital. Where appropriate follow-up has not been established, a nurse home visit within 24-48 hours of discharge would act as appropriate follow-up.

3. Criteria for Neonatal Discharge Less than 24-48 Hours Following Delivery.

The nursery stay is planned to allow the identification of early problems and to reinforce instruction in preparation for care of the infant at home. Complications often are not predictable by prenatal and intrapartum events. Because many neonatal problems do not become apparent until several days after birth there is an element of medical risk in early neonatal discharge. Most problems are manifest during the first 12 hours, and discharge at or prior to 24 hours is appropriate for many newborns.

(i) Prior to discharge of the newborn at 24-48 hours, the following should have occurred:

(I) The course of antepartum, intrapartum, and postpartum care for both mother and fetus should be without problems, which may lead to newborn complications.

(II) The baby is a single birth at 37 to 42 weeks’ gestation and the birth weight is appropriate for gestational age according to appropriate intrauterine growth curves.

(III) The baby’s vital signs are documented as being normal and stable for the 12 hours preceding discharge, including a respiratory rate below 60/minute, a heart rate of 100 to 160 beats per minute, and an axillary temperature of 36.1 degrees C in an open crib with appropriate clothing.

(IV) The baby has urinated and passed at least one stool.

(V) No evidence of excessive bleeding after circumcision greater than 2 hours.

(VI) The baby has completed at least two successful feedings, with documentation that the baby is able to coordinate sucking, swallowing, and breathing while feeding.

(VII) No evidence of significant jaundice in the first 24 hours of life.

(VIII) The parent’s or caretaker’s knowledge, ability, and confidence to provide adequate care for her baby are documented.

(IX) Laboratory data are available and reviewed including:

I. Maternal syphilis and hepatitis B surface antigen status.

II. Cord or infant blood type and direct Coomb’s test result as clinically indicated.

(X) Screening tests are performed in accordance with state regulations.

If the test is performed before 24 hours of milk feeding, a system for repeating the test must be assured during the follow-up visit.

(XI) Initial hepatitis B vaccine is administered or a scheduled appointment for its administration has been made.

(XII) A physician-directed source of continuing medical care for both the mother and the baby is identified. For newborns discharged less than 24-48 hours after delivery, a definitive plan for contact within 48-72 hours after discharge has been made. A nurse home visit within 24-48 hours would be considered appropriate follow-up.

(ii) Maternal factors which may exclude discharge of the newborn prior to 24- 48 hours include:

(I) Inadequate or no prenatal care, (II) Medical conditions that pose a significant risk to the infant, (III) Group B streptococcus colonization, (IV) Untreated syphilis, (V) Suspected active genital herpes, (VI) HIV, (VII) Adolescent without adequate support and where appropriate followup has not been established (a nurse home visit within 24-48 hours of discharge will act as appropriate follow-up), (VIII) Mental retardation or psychiatric illness, and (IX) Requirements for continued maternal hospitalization.

(iii) Newborn factors which may exclude discharge of the newborn prior to 24- 48 hours include:

(I) Preterm gestation (less than 37 weeks);

(II) Small for gestational age;

(III) Large for gestational age;

(IV) Abnormal physical exam, vital signs, colors, activity, feeding or stooling;

(V) Significant congenital malformations; and (VI) Abnormal laboratory finding:

I. Hypoglycemia, II. Hyperbilirubinemia, III. Polycythemia, IV. Anemia, and V. Rapid plasma reagin positive.

(5) Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services for TennCare Medicaid Enrollees under the Age of Twenty-One (21).

The Bureau of TennCare, through its contracts with Managed Care Organizations (MCOs) and other contractors (also referred to collectively as Contractors), operates an EPSDT program to provide health care services as required by 42 C.F.R. Part 441, Subpart B and the “Omnibus Budget Reconciliation Act of 1989” to TennCare Medicaid-eligible enrollees under the age of twenty-one (21).

(a) Responsibilities of the Bureau of TennCare.

1. The Bureau will:

(i) Keep Contractors informed as to changes to the requirements for the operation of the EPSDT program;

(ii) Make changes to TennCare policy when necessary to keep the EPSDT program in compliance with federal and state requirements;

(iii) Provide policy clarification when needed; and (iv) Oversee the activities of the Contractors to assure compliance with all aspects of the EPSDT program.

2. The Bureau, through local health departments, shall provide information on covered services to adolescent prenatal patients who enter TennCare Medicaid through presumptive eligibility. Assistance will be offered to presumptive eligibles on the day eligibility is determined in making a timely first prenatal appointment.

For a woman past her first trimester, this appointment should occur within fifteen (15) days.

3. The Bureau, through the Department of Children’s Services, shall inform foster parents and institutions or other residential treatment settings with a number of eligible children, annually or more often when the need arises, including when a change of administrators, social workers, or foster parents occur, of the availability of EPSDT services.

(b) Responsibilities of Contractors.

1. Contractors shall aggressively and effectively inform TennCare Medicaid enrollees of the existence of the EPSDT program, including the availability of specific EPSDT screening and treatment services. Such informing shall occur in a timely manner, generally within sixty (60) days of the MCC’s receipt of notification of the child’s enrollment in its plan and if no one eligible in the family has utilized EPSDT services, at least annually thereafter.

Contractors shall document to the Bureau the contractor’s outreach activities and what efforts were made to inform TennCare Medicaid enrollees and/or the enrollee’s responsible party about the availability of EPSDT services and how to access such services. All children, particularly those who have not received complete screenings timely, shall be the target of outreach efforts by the MCOs which are reasonably calculated to insure the child’s participation in EPSDT.

Failure to timely submit the requested data may result in liquidated damages as described in the contracts between the Bureau of TennCare and the Contractors.

2. Contractors shall use clear and non-technical terms to provide a combination of written and oral information so that the program is clearly and easily understandable.

3. Contractors shall use effective methods (developed through collaboration with agencies which have established procedures for working with such individuals) to inform TennCare Medicaid individuals who are illiterate, blind, deaf, or cannot understand English, about the availability of EPSDT services.

4. Contractors shall design and conduct outreach to inform all TennCare Medicaideligible individuals about what services are available under EPSDT, the benefits of preventive health care, where services are available, and how to obtain them; and that necessary transportation and scheduling assistance is available.

5. Contractors shall create a system so that TennCare Medicaid families can readily access an accurate list of names and phone numbers of contract providers who are currently accepting TennCare.

6. Contractors shall make known and offer to a TennCare Medicaid-covered child and the child’s responsible party of the availability for both transportation and scheduling assistance prior to the due date of the TennCare Medicaid child’s periodic examination.

7. Contractors shall provide TennCare Medicaid enrollees assistance in scheduling appointments, and obtaining transportation prior to the date of each periodic examination as requested and necessary.

8. Contractors shall document services declined by a parent or guardian of a TennCare Medicaid-eligible child or a mature competent child, specifying the particular service declined so that outreach and education for other EPSDT services continues.

9. Contractors shall maintain records of the efforts taken to outreach TennCare Medicaid children who have missed screening appointments when scheduled or who have failed to schedule regular check-ups. These records shall be made available to the Bureau and other parties as directed.

10. Contractors shall treat a TennCare Medicaid-eligible woman’s request for EPSDT services during pregnancy as a request for EPSDT services for the child at birth.

If the pregnant woman is under age twenty-one (21), she may request EPSDT services for herself.

(c) Compliance.

Contractors must document and maintain records of all outreach efforts made to inform TennCare Medicaid enrollees about the availability of EPSDT services.

(6) Prior Authorization for Home Health Nurse, Home Health Aide, and Private Duty Nursing Services. Prior authorization by the MCC must be obtained in order to establish the medical necessity of all requested home health nurse, home health aide, and private duty nursing services.

(a) The following information must be provided when seeking prior authorization for home health nurse, home health aide, and private duty nursing services:

1. Name of physician prescribing the service(s);

2. Specific information regarding the patient’s medical condition and any associated disability that creates the need for the requested service(s); and 3. Specific information regarding the service(s) the nurse or aide is expected to perform, including the frequency with which each service must be performed (e.g., tube feeding patient 7:00 a.m., 12:00 p.m., and 5:00 p.m. daily; bathe patient once per day; administer medications three (3) times per day; catheterize patient as needed from 8:00 a.m. to 5:00 p.m. Monday through Friday; change dressing on wound three (3) times per week). Such information should also include the total period of time that the services are anticipated to be medically necessary by the treating physician (e.g., total number of weeks or months).

(b) Home health nurses and aides and private duty nurses will never be authorized to personally transport a TennCare enrollee. Home health nurses and aides delivering prior approved home health care services may accompany an enrollee outside the home in accordance with T.C.A. § 71-5-107(a)(12).

(c) Private duty nursing services are limited to services provided in the recipient’s own home, with the following two exceptions:

1. A recipient age twenty-one (21) or older who requires eight (8) or more hours of skilled nursing care in a 24-hour period and is authorized to receive private duty nursing services in the home setting may make use of the approved hours outside of that setting in order for the nurse to accompany the recipient to:

(i) Outpatient health care services (including services delivered through a TennCare home and community based services waiver program);

(ii) Public or private secondary school or credit classes at an accredited vocational or technical school or institute of higher education; or, (iii) Work at his place of employment.

2. A recipient under the age of twenty-one (21) who requires eight (8) or more hours of continuous skilled nursing care in a 24-hour period and is authorized to receive those services in the home setting may make use of the approved hours outside of that setting when normal life activities temporarily take him outside of that setting. Normal life activity for a child under the age of twenty-one (21) means routine work (including work in supported or sheltered work settings); licensed child care; school and school-related activities; religious services and related activities; and outpatient health care services (including services delivered through a TennCare home and community based services waiver program). Normal life activities do not include non-routine or extended home absences.

(d) A private duty nurse may accompany a recipient in the circumstances outlined in subparagraph (c) immediately above, but may not drive.

(e) Private duty nursing services will only be authorized when there are competent family members or caregivers as indicated below:

1. Private duty nursing services include services to teach and train the recipient and the recipient’s family or other caregivers how to manage the treatment regimen.

Having a caregiver willing to learn the tasks necessary to provide a safe environment and quality in home care is essential to assuring the recipient is properly attended to when a nurse or other paid caregiver is not present, including those times when the recipient chooses to attend community activities to which these rules do not specifically permit the private duty nurse or other paid caregiver to accompany the patient.

2. To ensure the health, safety, and welfare of the individual, in order to receive private duty nursing services, the recipient must have family or caregivers who:

(i) Have a demonstrated understanding, ability, and commitment in the care of the individual related to ventilator management, support of other lifesustaining technology, medication administration and feeding, or in the case of children, other medically necessary skilled nursing functions, as applicable; and (ii) Are trained and willing to meet the recipient’s nursing needs during the hours when paid nursing care is not provided, and to provide backup in the event of an emergency; and (iii) Are willing and available as needed to meet the recipient’s non-nursing support needs.

(iv) In the case of children under the age of 18, the parent or guardian will be expected to fill this role. In the case of an adult age 18 and older, if the health, safety, and welfare of the individual cannot be assured because the recipient does not have such family or caregiver, private duty nursing services may be denied, subject to items (I) and (II) below. However, it shall be the responsibility of the MCO to:

(I) Arrange for the appropriate level of care, which may include nursing facility care, if applicable; and (II) In the case of a person currently receiving private duty nursing services, facilitate transition to such appropriate level of care prior to termination of the private duty nursing service.

(f) Nursing services (provided as part of home health services or by a private duty nurse) will be approved only if the requested service(s) is of the type that must be provided by a nurse as opposed to an aide, except that the MCO may elect to have a nurse perform home health aide services in addition to nursing services if the MCO determines that this is a less costly alternative than providing the services of both a nurse and an aide.

Examples of appropriate nursing services include, but are not limited to, management of ventilator equipment or other life-sustaining medical technology, medication management, and tube feedings.

(g) Home health aide services will only be approved if the requested service(s) meet all medical necessity requirements including the requirements of 1200-13-16-.05(4)(d).

Thus, home health aide services will not be approved to provide child care services, prepare meals, perform housework, or generally supervise patients. Examples of appropriate home health aide services include, but are not limited to, patient transfers and bathing.

History

• Authority: T.C.A. §§ 4-3-1013, 4-5-202, 4-5-203, 4-5-208, 4-5-209, 71-5-102, 71-5-105, 71-5-107, 71-5- 109, 71-5-134, 71-5-146, 71-5-168, 71-5-197, 71-5-198, and 71-5-1404; Executive Order No. 23; Public Chapter 473, Acts of 2011; and 2025 Public Chapter No. 530.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-13-.04; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Public necessity rule filed July 1, 2005; effective through December 13, 2005. Public necessity rule filed September 7, 2005; effective through February 19, 2006. Amendments filed September 29, 2005; effective December 13, 2005. Public necessity rule filed December 29, 2005; expired June 12, 2006. On June 13, 2006, affected rules reverted to status on December 28, 2005. Public necessity rule filed March 13, 2006; effective through August 25, 2006. Public necessity rules filed May 3, 2006; effective through October 15, 2006. Amendments filed March 31, 2006; effective June 14, 2006. Amendment filed June 12, 2006; effective August 26, 2006. Amendment filed July 28, 2006; effective October 11, 2006. Public necessity rule filed December 1, 2006; expires May 5, 2007. Public necessity rule filed January 26, 2007; expires July 10, 2007. Public necessity rule filed February 2, 2007; effective through July 16, 2007. Amendment filed February 2, 2007; effective April 18, 2007. Amendment filed April 25, 2007; effective July 9, 2007. Amendments filed May 2, 2007; effective July 16, 2007. Public necessity rule filed October 11, 2007; effective through March 24, 2008. Amendment filed January 8, 2008; effective March 23, 2008. Public necessity rule filed September 8, 2008; effective through February 20, 2009. Amendment filed August 19, 2008; effective November 2, 2008. Amendment filed December 5, 2008; effective February 18, 2009. Public necessity rule filed July 1, 2009; effective through December 13, 2009. Amendment filed June 11, 2009; effective August 25, 2009. Amendment filed September 11, 2009; effective December 10, 2009. Amendments filed September 25, 2009; effective December 24, 2009. Amendments filed September 30, 2009; effective December 29, 2009. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendments filed May 27, 2010; effective August 25, 2010. Amendment filed October 26, 2010; effective January 24, 2011. Emergency rules filed July 1, 2011; effective through December 28, 2011. Emergency rule filed August 2, 2011; effective through January 29, 2012. Amendments filed September 23, 2011; effective December 22, 2011. Amendment filed October 28, 2011; effective January 26, 2012. Amendment filed August 10, 2011; effective January 29, 2012. Amendment filed April 25, 2012; effective September 28, 2012. Emergency rule filed September 27, 2013; effective through March 26, 2014. Amendments filed July 1, 2013; effective September 29, 2013. Amendment filed August 7, 2013; effective November 5, 2013. Amendment filed September 27, 2013; effective December 26, 2013. Amendment filed December 17, 2013; effective March 17, 2014. Emergency rule filed September 30, 2015; effective through March 28, 2016. Amendments filed December 29, 2015; effective March 28, 2016. Emergency rules filed June 24, 2016; effective through December 21, 2016. Emergency rules filed July 1, 2016; effective through December 28, 2016. Amendments filed September 13, 2016; effective December 12, 2016. Amendments filed September 30, 2016; effective December 29, 2016. Emergency rules filed January 16, 2018; effective through July 15, 2018. Amendments filed April 9, 2018; effective July 8, 2018. Amendments filed January 3, 2019; effective April 3, 2019. Amendments filed July 8, 2021; effective October 6, 2021. Amendments filed October 26, 2021; effective January 24, 2022. Amendments filed February 16, 2022; effective May 17, 2022. Emergency rules filed December 27, 2022 to become effective January 1, 2023; effective through June 30, 2023. Amendments filed January 19, 2023; effective April 19, 2023. Emergency rules filed August 7, 2024; effective through February 3, 2025. Amendments filed September 11, 2024; effective December 10, 2024. Emergency rules filed December 30, 2024; effective through June 28, 2025. Amendments filed November 4, 2024; effective February 2, 2025. Amendments filed March 28, 2025; effective June 26, 2025. Emergency rules filed August 1, 2025; effective through January 28, 2026. Amendments filed July 7, 2025; effective October 5, 2025. Amendments filed October 28, 2025; effective January 26, 2026.

Tenn. Comp. R. & Regs. 1200-13-13-.02 ELIGIBILITY

(1) Delineation of agency roles and responsibilities.

(a) The Tennessee Department of Finance and Administration (F&A) is the lead State agency for the TennCare Program.

(b) The Bureau of TennCare (Bureau) is the administrative unit within F&A with the responsibility for day-to-day operations of the TennCare Program. The Bureau is responsible for establishing policy and procedural requirements and criteria for TennCare.

1. With respect to the eligibility of children applying for TennCare as medically eligible persons, the Bureau is responsible for determining the presence of a qualifying medical condition under TennCare Standard.

2. With respect to the eligibility of individuals applying for the TennCare CHOICES program, the Bureau is responsible for determining that the individual meets level of care eligibility criteria for the long-term care services or reimbursement requested. For enrollment into CHOICES Group 2, the Bureau is also responsible for determining the state’s ability to provide appropriate Home and Community Based Services (HCBS) as determined by the availability of slots under the established enrollment target in accordance with Rule 1200-13-01-.05 and for confirming a determination by an Area Agency on Aging and Disability or TennCare Managed Care Organization that:

(i) The individual is an adult aged sixty-five (65) or older, or an adult aged twenty-one (21) or older with physical disabilities; and (ii) Such individual can be safely and appropriately served in the community and at a cost that does not exceed the individual’s cost neutrality cap pursuant to Rule 1200-13-01-.05.

3. With respect to the eligibility of individuals applying for the ECF CHOICES program, the Bureau is responsible for determining that the individual meets all applicable eligibility and enrollment criteria, including target population, medical or level of care eligibility, categorical and financial eligibility, the state’s ability to provide appropriate ECF HCBS (as defined in Rule 1200-13-01-.02) as determined by the availability of slots under the established enrollment target for each ECF CHOICES Group in accordance with Rule 1200-13-01-.31 and pursuant to intake and enrollment policies and processes described in 1200-13- 01-.31 and in TennCare policies and protocols, and for confirming a determination by a TennCare Managed Care Organization that the individual can be safely and appropriately served in the community and at a cost that does not exceed the individual’s expenditure cap pursuant to Rule 1200-13-01-.31.

(c) The Tennessee Department of Human Services (DHS) is under contract with the Bureau to determine initial eligibility for TennCare Medicaid and TennCare Standard, as well as to redetermine, at regular intervals, whether eligibility should be continued.

DHS is not responsible for making decisions about the presence of a qualifying medical condition for those applying as medically eligible persons under TennCare Standard.

(d) The Social Security Administration determines eligibility for the Supplemental Security Income (SSI) Program. Tennessee residents determined eligible for SSI benefits are automatically eligible for and enrolled in TennCare Medicaid benefits.

(e) The Tennessee Department of Health (DOH) determines presumptive eligibility under TennCare Medicaid for pregnant women and for women diagnosed with breast or cervical cancer through administration of the Breast and Cervical Cancer Screening Program.

(2) Delineation of TennCare enrollee’s responsibilities.

(a) It is the responsibility of each TennCare enrollee to report to the DHS any material change affecting any information given by the applicant/enrollee to DHS at the time of application or redetermination of his eligibility. This information includes, but is not limited to, changes in address, income, family size, employment, or access to insurance. The applicant/enrollee shall mail, or present in person, documentation of any such change to the DHS county office where the enrollee resides. This documentation must be presented within the time frame specified in Chapter 1240-01- 16 of the rules of DHS.

(b) It is the responsibility of each TennCare enrollee to report to his provider that he is a TennCare enrollee.

(3) Technical and financial eligibility requirements for TennCare Medicaid. To be eligible for TennCare Medicaid, each individual must:

(a) Meet all technical requirements applicable to the appropriate category of medical assistance as described in the DHS - Division of Medical Services Rule 1240-03-03- .02, and all financial eligibility requirements applicable to the appropriate category of medical assistance as described in the DHS - Division of Medical Services Rule 1240- 03-03-.03; or (b) Meet the financial eligibility requirements of the SSI Program of the Social Security Administration and be approved for SSI benefits by the Social Security Administration; or (c) Be a woman who:

1. Is under age sixty-five (65);

2. Is uninsured or has health insurance that does not provide coverage for treatment of breast or cervical cancer;

3. Is not eligible for Medicaid;

4. Is a U.S. citizen or qualified alien; and 5. Has been diagnosed with breast or cervical cancer, including a Precancerous condition, by a screening at a Centers for Disease Control and Prevention (CDC) site, and who needs treatment.

(4) General application requirements.

(a) By applying for TennCare Medicaid, an applicant agrees to provide information to the Bureau, or its designee, about any third party coverage. MCCs shall release insurance information from their files to the Bureau of TennCare on a regular basis, as required by contract between the MCCs and the Department of Finance and Administration.

(b) By applying for TennCare Medicaid, an applicant grants permission and authorizes release of information to the Bureau, or its designee, to investigate any and all information provided, or any information not provided if it could affect eligibility, in order to determine TennCare eligibility; and, if approved, the amount of, if any, cost sharing which may be required of the applicant as found in these rules. Information may be verified through, but not limited to, the following sources:

1. The United States Internal Revenue Service (IRS);

2. State income tax records for Tennessee or any other state where income is earned;

3. The Tennessee Department of Labor and Workforce Development, and other employment security offices within any state where the applicant may have received wages or been employed;

4. Credit bureaus;

5. Insurance companies; or 6. Any other governmental agency or public or private source of information where such information may impact an applicant’s eligibility or cost sharing requirements for the TennCare Program.

(c) By applying for TennCare, an applicant understands it is a felony offense, pursuant to Tennessee Code Annotated § 71-5-2601, to obtain TennCare coverage under false means or to help anyone get on TennCare under false means.

(5) Current eligibility groups under TennCare Medicaid.

(a) Eligibility for TennCare Medicaid is currently limited to individuals who are Tennessee residents as defined at 42 C.F.R. § 435.403, Tennessee Code Annotated § 71-5-120, and who are listed in DHS rule Chapter 1240-03-02, Coverage Groups under Medicaid.

1. Individuals enrolled as Categorically Needy, as defined at Rule 1200-13-13-.01.

2. Individuals enrolled as Medically Needy, as defined at Rule 1200-13-13-.01.

Enrollment in this category is limited to pregnant women and children under the age of twenty-one (21). Eligibility for this category shall be for a period of one (1)

year. At the end of that year, eligibility must be reestablished in order for these individuals to continue in the program. For non-pregnant individuals who are under age 21, eligibility in this category shall end when the individual reaches his twenty-first birthday or the individual reaches the end of his one (1) year eligibility, whichever comes first.

3. Individuals who are determined eligible for the SSI Program by the Social Security Administration.

4. Women who have been enrolled as a result of needing treatment for breast or cervical cancer and who meet the technical requirements found at 1200-13-13- .02(3)(c).

(b) Effective date of eligibility.

1. For SSI eligibles, the date determined by the Social Security Administration in approving the individual for SSI coverage.

2. For all other Medicaid eligibles, the date of the application or the date of the qualifying event (such as the date that a spend-down obligation is met), whichever is later.

3. For persons applying for Medicaid eligibility during a period when the DHS offices are not open, the date the faxed application is received at DHS.

(6) Redetermination of TennCare Medicaid eligibility.

(a) Enrollees eligible for TennCare Medicaid as a result of being eligible for SSI benefits shall follow the Redetermination requirements of the Social Security Administration.

(b) An enrollee who qualifies for TennCare Medicaid through DHS shall have his TennCare Medicaid eligibility redetermined as required by the appropriate category of medical assistance as described in Chapter 1240-03-03 of the rules of DHS - Division of Medical Services. Prior to termination of Medicaid eligibility for enrollees of the Core Medicaid Population, eligibility will be reviewed in accordance with the following process:

1. At least thirty (30) days prior to the expiration of their current eligibility period, the Bureau of TennCare will send a Request for Information to all Core Medicaid enrollees. The Request for Information will include a form to be completed with information needed to determine eligibility for open Medicaid categories.

2. Enrollees will be given thirty (30) days inclusive of mail time from the date of the Request for Information to return the completed form to DHS and to provide DHS with the necessary verifications to determine eligibility for open Medicaid categories.

3. Enrollees with a health problem, mental health problem, learning problem or a disability will be given the opportunity to request assistance in responding to the Request for Information. Enrollees with Limited English Proficiency will have the opportunity to request translation assistance for responding to the Request for Information.

4. If an enrollee provides some but not all of the necessary information to DHS to determine his eligibility for open Medicaid categories during the thirty (30) day period following the Request for Information, DHS will send the enrollee a Verification Request. The Verification Request will provide the enrollee with ten (10) days inclusive of mail time to submit any missing information as identified in the Verification Request.

5. Enrollees who respond to the Request for Information within the thirty (30) day period shall retain their eligibility for TennCare Medicaid (subject to any changes in covered services generally applicable to enrollees in their Medicaid category) while DHS reviews their eligibility for open Medicaid categories.

6. Enrollees who respond to the Request for Information or the Verification Request after the requisite time period specified in those notices but before the date of termination shall retain their eligibility for TennCare Medicaid while DHS reviews their eligibility for open Medicaid categories. If DHS determines that the enrollee remains eligible for his current Medicaid category, the enrollee will remain enrolled in such Medicaid category. If DHS makes a determination that the enrollee is eligible for a different open Medicaid category, DHS will so notify the enrollee and the enrollee will be enrolled in the new appropriate TennCare Medicaid category. When the enrollee is enrolled in the appropriate TennCare Medicaid category, his eligibility in the previous category shall be terminated without additional notice. If a child is reviewed for Medicaid eligibility and is found not to be eligible for any open Medicaid category, the child will be reviewed for eligibility for TennCare Standard under Rule 1200-13-14-.02. If DHS makes a determination that the enrollee is not eligible for any open Medicaid categories, the TennCare Bureau will send the enrollee a twenty (20) day advance Termination Notice.

7. Individuals may provide the information and verifications specified in the Request for Information after termination of eligibility. DHS shall review all such information pursuant to the rules, policies and procedures of DHS and the Bureau of TennCare applicable to new applicants for TennCare Medicaid coverage. The individual shall not be entitled to be reinstated into TennCare Medicaid pending this review. If the individual is subsequently determined to be eligible for an open Medicaid category, he shall be granted retroactive coverage to the date of application, or in the case of spend down eligibility for Medically Needy pregnant women and children, to the latter of (a) the date of the application, or (b) the date spend down eligibility is met.

(c) A woman who has been determined eligible for TennCare Medicaid under 1200-13-13- .02(3)(c) of these rules shall annually recertify her eligibility in terms of continuation of active treatment, her address, and access to health insurance. If she is found to no longer be eligible through this review, the enrollee will be reviewed using the Redetermination process set forth in 1200-13-13-.02(6)(b) of these rules.

(7) Termination of eligibility.

(a) Eligibility for TennCare Medicaid shall cease when:

1. The individual no longer qualifies for TennCare Medicaid pursuant to Chapter 1240-03-03 of the rules of DHS; or 2. A woman determined eligible under 1200-13-13-.02(3)(c) of these rules:

(i) Reaches age sixty-five (65); or (ii) Gains access to group health insurance that provides coverage for treatment of breast or cervical cancer as defined elsewhere in these rules; or (iii) It has been determined that she no longer needs treatment for breast or cervical cancer, including pre-cancerous conditions.

(b) The TennCare Bureau will send Termination Notices to all Core Medicaid Population enrollees being terminated pursuant to state and federal law who are not determined to be eligible for open Medicaid categories pursuant to the Request for Information processes described herein.

(c) Termination Notices will be sent twenty (20) days in advance of the date upon which the coverage will be terminated.

(d) Termination Notices will provide enrollees with forty (40) days from the date of the notice to appeal the termination and will inform enrollees how they may request a hearing. Appeals will be processed by DHS in accordance with Rule 1200-13-13-.12.

(e) Enrollees with a health problem, mental health problem, learning problem or a disability will be given the opportunity to request additional assistance for their appeal. Enrollees with Limited English Proficiency will have the opportunity to request translation assistance for their appeal.

(8) Disenrollment related to discontinued Medicaid categories.

Prior to the disenrollment of any enrollee in a discontinued Medicaid category based on coverage terminations resulting from TennCare Medicaid Eligibility Reforms, Medicaid eligibility shall be reviewed in accordance with the following:

(a) Ex Parte Review.

DHS will conduct an ex parte review for open Medicaid categories for all enrollees in eligibility groups due to be terminated as part of the TennCare Medicaid eligibility reforms. Such ex parte review shall be conducted in accordance with federal requirements as set forth by CMS in the Special Terms and Conditions of the TennCare demonstration project.

(b) Request for Information.

1. At least thirty (30) days prior to the expiration of their current eligibility period, the Bureau of TennCare will send a Request for Information to enrollees in eligibility groups being terminated pursuant to TennCare Medicaid eligibility reforms. The Request for Information will include a form to be completed with information needed to determine eligibility for open Medicaid categories, as well as a list of the types of proof needed to verify certain information.

2. Enrollees will be given thirty (30) days inclusive of mail time from the date of the Request for Information to return the completed form to DHS and to provide DHS with the necessary verifications to determine eligibility for open Medicaid categories.

3. Enrollees with a health problem, mental health problem, learning problem or a disability will be given the opportunity to request assistance in responding to this Request for Information. Enrollees with Limited English Proficiency will have the opportunity to request translation assistance for responding to the Request for Information.

4. Enrollees will be given an opportunity until the date of termination to request one extension for good cause of the thirty (30) day time frame for responding to the Request for Information. The good cause extension is intended to allow a limited avenue for possible relief for certain enrollees who face significant unforeseen circumstances, or who, as a result of a health problem, mental health problem, learning problem, disability, or limited English proficiency, are unable to respond timely. The good cause exception does not confer an entitlement upon enrollees and the application of this exception will be within the discretion of DHS. Only one (1) thirty (30) day good cause extension can be granted to each enrollee.

Good cause is determined by DHS eligibility staff. Good cause is not requested nor determined by filing an appeal. Requests for an extension of the thirty (30) day time frame to respond to the Request for Information must be initiated by the enrollee. However, the enrollee may receive assistance in initiating such request.

DHS will not accept a request for extension of the thirty (30) day time frame submitted by a family member, advocate, provider, or CMHC, acting on the enrollee’s behalf without the involvement and knowledge of the enrollee, for example, to allow time for such entity to locate the enrollee if his whereabouts are unknown. All requests for a good cause extension must be made prior to termination of Medicaid eligibility. A good cause extension will be granted if DHS determines that a health problem, mental health problem, learning problem, disability or limited English proficiency prevented an enrollee from understanding or responding timely to the Request for Information. Except in the aforementioned circumstances, a good cause extension will only be granted if such request is submitted in writing to DHS prior to termination of Medicaid eligibility and DHS determines that serious personal circumstances such as illness or death prevent an enrollee from responding to the Request for Information for an extended period of time. Proof of the serious personal circumstances is required with the submission of the written request in order for a good cause extension to be granted. Good cause extensions will be granted at the sole discretion of DHS, and, if granted, shall provide the enrollee with an additional thirty (30) days inclusive of mail time from the date of DHS’s decision to grant the good cause extension. DHS will send the enrollee a letter granting or denying the request for good cause extension. DHS’s decisions with respect to good cause extensions shall not be appealable.

5. If an enrollee provides some but not all of the necessary information to DHS to determine his eligibility for open Medicaid categories during the thirty (30) day period following the Request for Information, DHS will send the enrollee a Verification Request. The Verification Request will provide the enrollee with ten (10) days inclusive of mail time to submit any missing information as identified in the Verification Request. Enrollees will not have the opportunity to request an extension for good cause of the ten (10) day time frame for responding to the Verification Request.

6. Enrollees who respond to the Request for Information within the thirty (30) day period or within any extension of such period granted by DHS shall retain their eligibility for TennCare Medicaid (subject to any changes in covered services generally applicable to enrollees in their Medicaid category) while DHS reviews their eligibility for open Medicaid categories.

7. DHS shall review all information and verifications provided within the requisite time period by an enrollee pursuant to the Request for Information and/or Verification Request to determine whether the enrollee is eligible for any open Medicaid categories. If DHS makes a determination that the enrollee is eligible for an open Medicaid category, DHS will so notify the enrollee and the enrollee will be enrolled in the appropriate Medicaid category. When the enrollee is enrolled in the appropriate TennCare Medicaid category, his eligibility in the discontinued Medicaid category shall be terminated without additional notice. If DHS makes a determination that the enrollee is not eligible for any open Medicaid categories or if an enrollee does not respond to the Request for Information within the requisite thirty (30) day time period or any extension of such period granted by DHS, the TennCare Bureau will send the enrollee a twenty (20) day advance Termination Notice.

8. Enrollees who respond to the Request for Information or the Verification Request after the requisite time period specified in those notices or after any extension of such time period granted by DHS but before the date of termination shall retain their eligibility for TennCare Medicaid (subject to any changes in covered services generally applicable to enrollees in their Medicaid category) while DHS reviews their eligibility for open Medicaid categories. If DHS makes a determination that the enrollee is eligible for an open Medicaid category, DHS will so notify the enrollee, and the enrollee will be enrolled in the appropriate TennCare Medicaid category, and his eligibility in the discontinued Medicaid category shall be terminated without additional notice. If DHS makes a determination that the enrollee is not eligible for any open Medicaid categories, the TennCare Bureau will send the enrollee a twenty-(20) day advance Termination Notice.

9. Individuals may provide information and verifications specified in the Request for Information after termination of eligibility. DHS shall review all such information pursuant to the rules, policies and procedures of DHS and the Bureau of TennCare applicable to new applicants for TennCare coverage. The individual shall not be entitled to be reinstated into TennCare pending this review. If the individual is subsequently determined to be eligible for an open Medicaid category, he shall be granted retroactive coverage to the date of application, or in the case of spend down eligibility for Medically Needy pregnant women and children, to the latter of (a) the date of application, or (b) the date spend down eligibility is met.

(c) Termination Notice.

1. The TennCare Bureau will send Termination Notices to all enrollees being terminated pursuant to TennCare Medicaid eligibility reforms who are not determined to be eligible for open Medicaid categories pursuant to the Ex Parte Review or Request for Information processes described in this subparagraph.

2. Termination Notices will be sent twenty (20) days in advance of the date upon which the coverage will be terminated.

3. Termination Notices will provide enrollees with forty (40) days from the date of the notice to appeal valid factual disputes related to the disenrollment and will inform enrollees how they may request a hearing.

4. Enrollees with a health problem, mental health problem, learning problem, or a disability will be given the opportunity to request additional assistance for their appeal. Enrollees with Limited English Proficiency will have the opportunity to request translation assistance for their appeal.

5. Enrollees will not have the opportunity to request an extension for good cause of the forty (40) day time frame in which to request a hearing.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 4-5-209, 71-5-105, and 71-5-109 and Executive Order No. 23.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-13- .02; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Amendment filed April 9, 2003; effective June 23, 2003. Public necessity rule filed April 29, 2005, effective through October 11, 2005. Public necessity rule filed June 3, 2005; effective through November 15, 2005. Amendment filed July 28, 2005; effective October 11, 2005. Amendments filed September 1, 2005; effective November 15, 2005. Public necessity rule filed December 9, 2005; effective through May 23, 2006. Public necessity rule filed March 3, 2006; effective through August 15, 2006. Amendment filed March 3, 2006; effective May 17, 2006. Amendment filed June 1, 2006; effective August 15, 2006. Public necessity rule filed February 8, 2008; effective through July 22, 2008. Repeal and new rule filed May 7, 2008; effective July 21, 2008. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendment filed May 27, 2010; effective August 25, 2010. Amendment filed October 26, 2010; effective January 24, 2011. Amendment filed September 26, 2013; effective December 25, 2013. Emergency rules filed July 1, 2016; effective through December 28, 2016. Amendments filed September 30, 2016; effective December 29, 2016.

Tenn. Comp. R. & Regs. 1200-13-13-.03 ENROLLMENT, REASSIGNMENT, AND DISENROLLMENT WITH MANAGED CARE

CONTRACTORS (MCCS).

(1) Enrollment.

There are three (3) different types of managed care entities that provide services to TennCare enrollees. Enrollment procedures differ according to the type of managed care entity, the geographic area, and the number of managed care entities operating in each geographic area. Enrollment procedures also differ for ECF CHOICES, as described in subparagraph (c) below.

(a) TennCare Managed Care Organizations (MCOs) other than TennCare Select.

1. Except as provided in subparagraph (c), individuals or families determined eligible for TennCare shall select a health plan (Managed Care Organization/MCO) at the time of application. The health plan must be available in the Grand Division of the State in which the enrollee lives. All family members living in the same household and enrolled in TennCare must be assigned to the same MCO except children determined by the Bureau to be eligible to enroll in TennCare Select. An enrollee is given his choice of MCOs when possible. If the requested MCO cannot accept new enrollees, the Bureau will assign each enrollee to an MCO that is accepting new enrollees. If no MCO is available to enroll new members in the enrollee’s Grand Division, the enrollee will be assigned to TennCare Select until such time as another MCO becomes available. The Bureau may also assign TennCare children with special health care needs to TennCare Select.

Individuals enrolled as a result of being eligible for SSI benefits will be assigned to an MCO as they do not have the opportunity to select a health plan prior to the effective date of coverage, since they are enrolled through the Social Security Administration.

2. Except as provided in subparagraph (c), a TennCare enrollee may change MCOs one (1) time within the initial ninety (90) calendar days (inclusive of mail time) from the date of the letter informing him of his MCO assignment, if there is another MCO in the enrollee’s Grand Division that is currently permitted by the Bureau to accept new enrollees. No additional changes will be allowed except as otherwise specified in these rules. An enrollee shall remain a member of the designated plan until he is given an opportunity to change once each year during an annual change period. The annual change period will occur each year in March for enrollees in West Tennessee, in May for enrollees in Middle Tennessee, and in July for enrollees in East Tennessee. Thereafter, an MCO change is permitted only during an annual change period, unless the Bureau authorizes a change as the result of the resolution of an appeal requesting a “hardship” reassignment as specified in paragraph (2)(b) below. When an enrollee changes MCOs, the enrollee’s medical care will be the responsibility of the current MCO until he is enrolled in the requested MCO.

3. Each MCO shall offer its enrollees, to the extent possible, freedom of choice among participating providers. If after notification of enrollment the enrollee has not chosen a primary care provider, one will be selected for him by the MCO.

The period during which an enrollee may choose his primary care provider shall not be less than fifteen (15) calendar days.

4. In the event a pregnant woman entering an MCO’s plan is receiving medically necessary prenatal care the day before enrollment, the MCO shall be responsible for the costs of continuation of such medically necessary services, without any form of prior approval and without regard to whether such services are being provided within or outside the MCO’s provider network until such time as the MCO can reasonably transfer the enrollee to a service and/or network provider without impeding service delivery that might be harmful to the enrollee’s health.

In the event a pregnant woman entering the MCO’s plan is in her second or third trimester of pregnancy and is receiving medically necessary prenatal care services the day before enrollment, the MCO shall be responsible for providing continued access to the provider (regardless of network affiliation) through the postpartum period. Reimbursement to an out-of-network provider shall be as set out in Rule 1200-13-13-.08.

(b) TennCare Select.

TennCare Select is a prepaid inpatient health plan (PIHP), as defined in 42 C.F.R. § 438.2, which operates in all areas of the State and covers the same services as the MCOs. The State’s TennCare Select contractor is reimbursed on a non-risk, noncapitated basis for services rendered to covered populations, and in addition receives fees from the State to offset administrative costs.

1. The TennCare populations included in the TennCare Select delivery system are as follows:

(i) Children under the age of twenty-one (21) years who are eligible for Supplemental Security Income.

(ii) Children in state custody and children leaving state custody for six (6) months post-custody as long as the child remains eligible.

(iii) Children under the age of twenty-one (21) years in an institutional eligibility category who are receiving care in a Nursing Facility or an Intermediate Care Facility for persons with Mental Retardation (or pursuant to federal law, Intermediate Care Facility for the Mentally Retarded) (ICF/MR), and children and adults in a Home and Community Based Services 1915(c) waiver for individuals with mental retardation.

(iv) Enrollees living in areas where there is insufficient MCO capacity to serve them.

After being assigned to TennCare Select, persons in categories (i) and (iii) above may choose to disenroll from TennCare Select and enroll in another MCO if one is available. Persons in categories (ii) and (iv) must remain in TennCare Select.

TennCare Select is not open to voluntary selection by TennCare enrollees.

2. TennCare Select also provides the following functions:

(i) It is the back-up plan should one of the MCOs leave the TennCare program unexpectedly. For TennCare enrollees previously enrolled with the MCO, TennCare Select provides medical case management and all MCO covered services.

(ii) It is the only entity responsible for payment of the services described in 42 C.F.R. § 431.52, services provided to residents temporarily absent from the State, and provides all MCO covered services (primarily emergency services).

(iii) It is the only entity responsible for payment of the services described in 42 C.F.R. § 440.255, limited services for certain aliens.

(c) TennCare Managed Care Organizations (MCOs) for ECF CHOICES. Individuals enrolled in ECF CHOICES may select from only the MCOs participating in ECF CHOICES.

1. If an individual enrolled in an MCO other than an ECF CHOICES participating MCO wants to enroll in the ECF CHOICES program, the individual must choose to enroll in an ECF CHOICES participating MCO in order to enroll in ECF CHOICES.

2. If an individual enrolled in the ECF CHOICES program elects to transition to an MCO that is not participating in ECF CHOICES, the individual is choosing to voluntarily disenroll from ECF CHOICES. Because this is a voluntary decision, advance notice and the right to a fair hearing shall not be provided. However, the individual may elect to transition back to an ECF CHOICES participating MCO in order to resume enrollment in ECF CHOICES.

(d) TennCare Dental Benefits Manager (DBM).

TennCare Enrollees shall be assigned to the Dental Benefits Manager (DBM) under contract with the Bureau to provide dental benefits as set out in Rule .04, Dental Services. TennCare adults age 21 and older enrolled in ECF CHOICES or a 1915(c)

Waiver program shall also receive Adult Dental Services, as outlined in Chapter 1200- 13-01.

(e) TennCare Pharmacy Benefits Manager (PBM).

TennCare enrollees who are eligible to receive pharmacy services shall be assigned to the Pharmacy Benefits Manager (PBM) under contract with the Bureau to provide pharmacy benefits for both medical and behavioral health services through the TennCare Program.

(2) Reassignment.

(a) Reassignment to an MCO other than the current MCO in which the TennCare enrollee is enrolled is subject to another MCO’s capacity to accept new enrollees and must be approved by the Bureau of TennCare in accordance with one of the following:

1. During the initial ninety (90) day period following notification of MCO assignment as described at Rule 1200-13-13-.03, a TennCare enrollee may request a change of MCOs.

2. A TennCare enrollee must change MCOs if he moves outside the MCO’s Grand Division, and that MCO is not authorized to operate in the enrollee’s new place of residence. Until the TennCare enrollee selects or is assigned to a new MCO and his enrollment is deemed complete, his medical care will remain the responsibility of the original MCO.

3. If an enrollee’s MCO withdraws from participation in the TennCare Program, TennCare will assign him to an MCO operating in his Grand Division, if one is available. The enrollee will be provided notice of the change and will have ninety (90) days to select another MCO in his Grand Division. If no MCO is available to accept enrollees from an exiting plan, the enrollees will be assigned to TennCare Select until such time as another MCO becomes available.

4. An enrollee shall be given an opportunity to change MCOs once each year during an annual change period. Only one (1) MCO change is permitted every twelve (12) months, unless the Bureau authorizes a change as the result of the resolution of an appeal requesting a “hardship” reassignment. When an enrollee changes MCOs, the enrollee’s medical care will be the responsibility of the current MCO until enrolled in the requested MCO. If an enrollee changes MCOs during an annual change period, all family members living in the same household and enrolled in TennCare shall also be changed except children enrolled in TennCare Select.

(b) A TennCare enrollee may change MCOs if the TennCare Bureau has granted a request for a change in MCOs or an appeal of a denial of a request for a change in MCOs has been resolved in his favor based on hardship criteria.

1. The following situations will not be determined to be “hardships”:

(i) The enrollee is unhappy with the current MCO or primary care provider (PCP), but there is no hardship medical situation (as stated in Part 2. below);

(ii) The enrollee claims lack of access to services but the plan meets the state’s access standard;

(iii) The enrollee is unhappy with a current PCP or other providers, and has refused alternative PCP or provider choices offered by the MCO;

(iv) The enrollee is concerned that a current provider might drop out of the plan in the future;

(v) The enrollee is a Medicare beneficiary who (with the exception of pharmacy) may utilize choice of providers, regardless of network affiliation; or (vi) The enrollee’s PCP is no longer in the MCO’s network, the enrollee wants to continue to see the current PCP and has refused alternative PCP or provider choices offered by the MCO.

2. Requests for hardship MCO reassignments must meet all of the following six (6) hardship criteria for reassignment. Determinations will be made on an individual

basis.

(i) A member has a medical condition that requires complex, extensive, and ongoing care; and (ii) The member’s specialist has stopped participating in the member’s current MCO network and has refused continuation of care to the member in his current MCO assignment; and (iii) The ongoing medical condition of the member is such that another physician or provider with appropriate expertise would be unable to take over his care without significant and negative impact on his care; and (iv) The current MCO has been unable to negotiate continued care for this member with the current specialist; and (v) The current provider of services is in the network of one or more alternative MCOs; and (vi) An alternative MCO is available to enrolled members (i.e., has not given notice of withdrawal from the TennCare Program, is not in receivership, and is not at member capacity for the member’s region).

Requests to change MCOs submitted by TennCare enrollees shall be evaluated in accordance with the hardship criteria referenced above. If an enrollee’s request to change MCOs is granted due to hardship, all family members living in the same household and enrolled in TennCare will be assigned to the new MCO except children determined by the Bureau to be eligible to enroll in TennCare Select. Upon denial of a request to change MCOs, enrollees shall be provided notice and appeal rights as described in applicable provisions of Rule 1200-13-13-.11.

(c) Members receiving long-term services and supports.

1. In the event that a CHOICES member is determined, based on an assessment of needs, to require a long-term care service that is not currently available under the MCO in which he is currently enrolled, but that is available through another MCO, the Bureau shall work with the current MCO to arrange for provision of the required service, which may involve providing such service out-of-network. It shall be considered to be a hardship reason to change MCO assignment only if the current MCO, after working with the Bureau, is unable to provide the required service. In such cases, the MCO that is unable to provide the required service after working with the Bureau may be subject to sanctions.

2. A CHOICES or ECF CHOICES member may request and shall have cause to change MCO assignment if all of the following are met:

(i) The member receives institutional, residential, or employment support services in the MLTSS program in which he is enrolled;

(ii) The member’s institutional, residential, or employment support services provider has stopped participating in the member’s MCO network and has refused continuation of care to the member in his current MCO assignment;

(iii) The member’s current MCO has been unable to negotiate continued services for the member with the current provider;

(iv) The member would have to change his residential, institutional, or employment supports provider based on that provider’s change in status from an in-network to an out-of-network provider with the MCO;

(v) As a result, the member would experience a disruption in his residence or employment;

(vi) The current institutional, residential, or employment support services provider is in the network of one or more alternative MCOs; and (vii) The alternative MCO the member has selected is available to enroll members (i.e., has not given notice of withdrawal from the TennCare Program, is not in receivership, and is not at member capacity for the member’s region).

(d) Enrollees who are out-of-state on a temporary basis, but maintain their status as Tennessee residents under federal and state laws, shall be reassigned to TennCare Select for the period they are out-of-state.

(e) TennCare shall only accept a request to change MCO assignment from the affected enrollee, his parent, guardian, spouse, child over age eighteen (18), or responsible party as defined in Rule 1200-13-13-.01.

(3) Disenrollment.

(a) When it has been determined that an individual no longer meets the criteria for TennCare eligibility, that individual shall be disenrolled from the TennCare Program, including the CHOICES and ECF CHOICES program, as applicable. Services provided by the TennCare MCO in which the individual has been enrolled, as well as the PBM and DBM, if applicable, shall be terminated upon disenrollment. Such disenrollment action will be accompanied by appropriate due process procedures as described elsewhere in this Chapter. Disenrollment from the CHOICES program shall proceed as described in Rule 1200-13-01-.05. Disenrollment from the ECF CHOICES program shall proceed as described in Rule 1200-13-01-.31.

(b) Coverage shall cease at 12:00 midnight, local time, on the date that an individual is disenrolled from TennCare.

(c) TennCare may reassign individuals from a designated MCO and place them in another MCO as described elsewhere in these rules. A TennCare MCO may not reassign an enrollee without the permission of TennCare. A TennCare MCO shall not request the reassignment of a TennCare enrollee for any of the following reasons:

1. Adverse changes in the enrollee’s health;

2. Pre-existing medical conditions; or 3. High cost medical bills.

Coverage by a particular MCO shall cease at 12:00 midnight local time on the date that an individual has been reassigned by TennCare from one MCO and placed in another plan. Coverage by the new MCO will begin when coverage by the old MCO ends.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-208, 4-5-209, 71-5-105, 71-5-107, and 71-5-109 and Executive Order No. 23.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-13-.03; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Public necessity rule filed April 29, 2005; effective through October 11, 2005. Amendments filed July 28, 2005; effective October 11, 2005. Public necessity rule filed December 29, 2005; expired June 12, 2006. On June 13, 2006, affected rules reverted to status on December 28, 2005. Amendment filed March 31, 2006; effective June 14, 2006. Amendment filed August 14, 2006; effective October 28, 2006. Public necessity rule filed February 8, 2008; effective through July 22, 2008. Repeal and new rule filed May 7, 2008; effective July 21, 2008. Amendments filed September 25, 2009; effective December 24, 2009. Amendment filed November 30, 2009; effective February 28, 2010. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendments filed May 27, 2010; effective August 25, 2010. Amendments filed October 26, 2010; effective January 24, 2011. Emergency rules filed July 1, 2016; effective through December 28, 2016. Amendments filed September 30, 2016; effective December 29, 2016. Amendments filed September 25, 2017; effective December 24, 2017. Amendments filed July 8, 2021; effective October 6, 2021. Amendments filed February 16, 2022; effective May 17, 2022. Emergency rules filed December 27, 2022 to become effective January 1, 2023; effective through June 30, 2023. Amendments filed January 19, 2023; effective April 19, 2023.

Tenn. Comp. R. & Regs. 1200-13-13-.04 COVERED SERVICES

(1) Benefits Covered Under the Managed Care Program.

(a) TennCare MCCs shall cover the following services and benefits subject to any applicable limitations described in this Chapter. TennCare MCCs shall cover TennCare CHOICES services and benefits for individuals enrolled in the TennCare CHOICES program in accordance with Rule 1200-13-01-.05 and ECF CHOICES services and benefits for individuals enrolled in the ECF CHOICES program in accordance with Rule

Tenn. Comp. R. & Regs. 1200-13-13-.05 ENROLLEE COST SHARING

(1) TennCare Medicaid enrollees do not have cost sharing responsibilities for TennCare coverage and covered services, except TennCare Medicaid adults (age 21 and older) who receive pharmacy services have nominal copays for the pharmacy services. The copays are $3.00 (three dollars) for each covered branded drug and $1.50 (one dollar and fifty cents) for each covered generic drug. Branded drugs which exceed the limit of two (2) prescriptions or refills per enrollee per month are not covered. Family planning drugs and emergency services are exempt from copay. Enrollees may not be denied a service for inability to pay a copay.

(2) The following adult groups are exempt from copay:

(a) Individuals receiving hospice services who provide verbal notification of such to the pharmacy provider at the point of service;

(b) Individuals who are pregnant who provide verbal notification of such to the pharmacy provider at the point of service; and (c) Individuals who are receiving services in a Nursing Facility, an Intermediate Care Facility for Individuals with Intellectual Disabilities, CHOICES Group 2, or a Home and Community Based Services waiver for individuals with intellectual disabilities.

(d) Adults age 21 and older enrolled in ECF CHOICES who meet nursing facility level of care or transitioned from a Section 1915(c) waiver into ECF CHOICES and granted an exception by TennCare based on ICF/IID level of care.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-208, 4-5-209, 71-5-102, 71-5-105, 71-5-107, 71-5-109, and 71-5-134; Acts of 2003, Public Chapter 412, §1(c); Executive Order No. 23; and 2025 Public Chapter No. 530.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13- 13-.05; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Amendment by Acts of 2003, Public Chapter 412, §1(c) filed and effective June 25, 2003. Public necessity rule filed July 1, 2005; effective through December 13, 2005. Amendment filed September 26, 2005; effective December 10, 2005. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendment filed May 27, 2010; effective August 25, 2010. Emergency rule filed September 26, 2013; effective through March 25, 2014. Amendment filed December 17, 2013; effective March 17, 2014. Emergency rules filed July 1, 2016; effective through December 28, 2016. Amendments filed September 30, 2016; effective December 29, 2016. Emergency rules filed August 1, 2025; effective through January 28, 2026. Amendments filed October 28, 2025; effective January 26, 2026.

Tenn. Comp. R. & Regs. 1200-13-13-.06 MANAGED CARE ORGANIZATIONS

Managed Care Organizations participating in TennCare will be limited to Health Maintenance Organizations that are appropriately licensed to operate within the state of Tennessee to provide medical, behavioral, and long-term care services in the TennCare program. Managed Care Organizations shall have a fully executed contract with the Tennessee Department of Finance and Administration. MCOs, DBMs and PBMs shall agree to comply with all applicable rules, policies, and contract requirements as specified by the Tennessee Department of Finance and Administration as applicable. Managed Care Organizations must continually demonstrate a sufficient provider network based on the standards set by the Bureau of TennCare to remain in the program and must reasonably meet all quality of care requirements established by the Bureau of TennCare.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 71-5-105, and 71-5-109 and Executive Order No. 23.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-13- .06; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Amendment filed September 25, 2009; effective December 24, 2009. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendment filed May 27, 2010; effective August 25, 2010.

Tenn. Comp. R. & Regs. 1200-13-13-.07 MANAGED CARE ORGANIZATION PAYMENT

Managed care organizations will be paid pursuant to the contract the MCO has fully executed with the Tennessee Department of Finance and Administration.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, and 71-5-109 and Executive Order No. 23.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-13-.07; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003.

Tenn. Comp. R. & Regs. 1200-13-13-.08 PROVIDERS

(1) Payment in full.

(a) All Participating Providers, as defined in this Chapter, must accept as payment in full for provision of covered services to TennCare enrollees, the amounts paid by the MCC plus any copayment required by the TennCare Program to be paid by the individual.

(b) Any Non-Participating Providers who provide TennCare Program covered services by authorization from an MCC must accept as payment in full for provision of covered services to TennCare enrollees, the amounts paid by the MCC plus any copayment required by the TennCare Program to be paid by the individual.

(c) Any Non-Participating Provider, as defined in this Chapter, who provides TennCare Program covered non-emergency services to TennCare enrollees without authorization from the enrollee’s MCC does so at his own risk. He may not bill the patient for such services except as provided for in Rule 1200-13-13-.08(5).

(d) Any Out-of-State Emergency Provider, as defined in this Chapter, who provides covered emergency services to TennCare enrollees in accordance with this Chapter must accept as payment in full the amounts paid by the MCC plus any copayment required by the TennCare Program.

(2) In situations where a MCC authorizes a service to be rendered by a provider who is not a participating network provider with the MCC, payment to the provider shall be no less than eighty percent (80%) of the lowest rate paid by the MCC to equivalent participating network providers for the same service. For emergency services provided to an enrollee by a provider who is not a participating network provider, the MCC shall reimburse the provider at the rate of 100% of the lowest rate paid to the MCC’s network providers. Emergency care to enrollees shall not require preauthorization.

(a) Reserved.

(b) Reserved.

(c) Reserved.

(d) Non-Participating Providers who furnish covered CHOICES services are reimbursed in accordance with Rule 1200-13-01-.05.

(e) Non-Participating Providers who furnish covered ECF CHOICES services are reimbursed in accordance with Rule 1200-13-01-.31.

(3) Participation in the TennCare program will be limited to providers who:

(a) Accept, as payment in full, the amounts paid by the managed care contractor, including copays from the enrollee, or the amounts paid in lieu of the managed care contractor by a third party (Medicare, insurance, etc.);

(b) Maintain Tennessee, or the State in which they practice, medical licenses and/or certifications as required by their practice, or licensure by the TDMHDD, if appropriate;

(c) Are not under a federal Drug Enforcement Agency (DEA) restriction of their prescribing and/or dispensing certification for scheduled drugs (relative to physicians, osteopaths, dentists and pharmacists);

(d) Agree to maintain and provide access to TennCare and/or its agent all TennCare enrollee medical records for five (5) years from the date of service or upon written authorization from TennCare following an audit, whichever is shorter;

(e) Provide medical assistance at or above recognized standards of practice; and (f) Comply with all contractual terms between the provider and the managed care contractor and TennCare policies as outlined in federal and state rules and regulations and TennCare provider manuals and bulletins.

(g) Failure to comply with any of the above provisions (a) through (f) may subject a provider to the following actions:

1. Sanctions set out in T.C.A. § 71-5-118. In addition, the provider may be subject to stringent review/audit procedures, which may include clinical evaluation of services and a prepayment requirement for documentation and justification for each claim.

2. The Bureau of TennCare may withhold or recover payments to managed care contractors in cases of provider fraud, willful misrepresentation, or flagrant noncompliance with contractual requirements and/or TennCare policies.

3. The Bureau of TennCare may refuse to approve or may suspend provider participation with a provider if any person who has an ownership or controlling interest in the provider, or who is an agent or managing employee of the provider, has been convicted of a criminal offense related to that person’s involvement in any program established under Medicare, Medicaid or the U.S.

Title XX Services Program.

4. The Bureau of TennCare may refuse to approve or may suspend provider participation if it determines that the provider did not fully and accurately make any disclosure of any person who has ownership or controlling interest in the provider, or is an agent or managing employee of the provider and has been convicted of a criminal offense related to that person’s involvement in any program under Medicare, Medicaid or the U.S. Title XX Services Program since the inception of these programs.

5. The Bureau of TennCare shall refuse to approve or shall suspend provider participation if the appropriate State Board of Licensing or Certification fails to license or certify the provider at any time for any reason or suspends or revokes a license or certification.

6. The Bureau of TennCare shall refuse to approve or shall suspend provider participation upon notification by the U.S. Office of Inspector General Department of Health and Human Services that the provider is not eligible under Medicare or Medicaid for federal financial participation.

7. The Bureau of TennCare may recover from a managed care contractor any payments made by an enrollee and/or his family for a covered service, in total or in part, except as permitted. If a provider knowingly bills an enrollee and/or his family for a covered service, in total or in part, except as permitted, the Bureau of TennCare may terminate the provider’s participation in TennCare.

(4) Solicitations and Referrals.

(a) Managed care contractors and providers shall not solicit TennCare enrollees by any method offering as enticements other goods and services (free or otherwise) for the opportunity of providing the enrollee with TennCare covered services that are not medically necessary and/or that overutilize the TennCare program.

(b) A managed care contractor may request a waiver from this restriction in writing to TennCare. TennCare shall determine the value of a waiver request based upon the medical necessity and need for the solicitation. The managed care contractor may implement the solicitation only upon receipt of a written waiver approval from TennCare. This waiver is not transferable and may be canceled by TennCare upon written notice.

(c) TennCare payments for services related to a non-waivered solicitation enticement shall be considered by TennCare as a non-covered service and recouped. Neither the managed care contractor nor the provider may bill the enrollee for non-covered services recouped under this authority.

(d) A provider shall not offer or receive remuneration in any form related to the volume or value of referrals made or received from or to another provider.

(5) Providers may seek payment from a TennCare enrollee only under the following circumstances. These circumstances apply to all TennCare providers, as defined in this

Chapter, including those who are Out-of-Network Providers in a particular enrollee’s MCC.

These circumstances include situations where the enrollee may choose to seek an out-ofnetwork provider for a specific covered service.

(a) If the services are not covered by the TennCare program and, prior to providing the services, the provider informed the enrollee that the services were not covered; or (b) If the services are not covered because they are in excess of an enrollee’s benefit limit and one of the following circumstances applies:

1. The provider determines effective on the date of service that the enrollee has reached his/her benefit limit for the particular service being requested and, prior to providing the service, informs the enrollee that the service is not covered and the service will not be paid for by TennCare. The source of the provider’s information must be a database listed on the TennCare website as approved by TennCare on the date of the provider’s inquiry.

2. The provider has information in his/her own records to support the fact that the enrollee has reached his/her benefit limit for the particular service being requested and, prior to providing the service, informs the enrollee that the service is not covered and will not be paid for by TennCare. This information may include:

(i) A previous written denial of a claim on the basis that the service was in excess of the enrollee’s benefit limit for a service within the same benefit category as the service being requested, if the time period applicable to the benefit limit is still in effect; or (ii) That the provider had previously examined the database referenced in

part 1. above and determined that the enrollee had reached his/her benefit limit for the particular service being requested, if the time period applicable to that benefit limit is still in effect; or (iii) That the provider had personally provided services to the enrollee in excess of his/her benefit limit within the same benefit category as the service being requested, if the time period applicable to that benefit period is still in effect; or (iv) The enrollee’s MCO has provided confirmation to the provider that the enrollee has reached his/her benefit limit for the applicable service.

3. The provider submits a claim for service to the appropriate managed care contractor (MCC) and receives a written denial of that claim on the basis that the service exceeds the enrollee’s benefit limit. Thereafter, following informing the enrollee and within the remainder of the period applicable to that benefit limit, the provider may bill the enrollee for services within that same exhausted benefit category without having to submit, for repeated MCC denial, claims for those subsequent services. If the provider informed the enrollee prior to providing the service for which the claim was denied that the service would exceed the enrollee’s benefit limit and would not be paid for by TennCare, the provider may bill the enrollee for that service.

4. The provider had previously taken the steps in parts 1., 2. or 3. above and determined that the enrollee had reached his/her benefit limit for the particular service being requested, if the time period applicable to the benefit limit is still in effect, and informs the enrollee, prior to providing the service, that the service is not covered and will not be paid for by TennCare.

(c) If the services are covered only with prior authorization and prior authorization has been requested but denied, or is requested and a specified lesser level of care is approved, and the provider has given prior notice to the enrollee that the services are not covered, the enrollee may elect to receive those services for which prior authorization has been denied or which exceed the authorized level of care and be billed by the provider for such services.

(6) Providers may not seek payment from a TennCare enrollee under the following conditions:

(a) The provider knew or should have known about the patient’s TennCare eligibility or pending eligibility prior to providing services.

(b) The claim(s) submitted to TennCare or the enrollee’s managed care contractor for payment was/were denied due to provider billing error or a TennCare claim processing error.

(c) The provider accepted TennCare assignment on a claim and it is determined that another payer paid an amount equal to or greater than the TennCare allowable amount.

(d) The provider failed to comply with TennCare policies and procedures or provided a service which lacks medical necessity or justification.

(e) The provider failed to submit or resubmit claims for payment within the time periods required by the managed care contractor or TennCare.

(f) The provider failed to ascertain the existence of TennCare eligibility or pending eligibility prior to providing non-emergency services. Even if the enrollee presents another form of insurance, the provider must determine whether the patient is covered under TennCare.

(g) The provider failed to inform the enrollee prior to providing a service not covered by TennCare that the service was not covered and the enrollee may be responsible for the cost of the service. Services which are non-covered by virtue of exceeding limitations are exempt from this requirement. Notwithstanding this exemption, providers shall remain obligated to provide notice to enrollees who have exceeded benefit limits in accordance with Rule 1200-13-13-.11.

(h) The enrollee failed to keep a scheduled appointment(s).

(i) The provider is a TennCare Provider, as defined in this Chapter, but is not participating with a particular enrollee’s MCC and is seeking to bill the enrollee as though the provider were a Non-TennCare Provider, as defined in this Chapter.

(7) Providers may seek payment from a person whose TennCare eligibility is pending at the time services are provided if the provider informs the person that TennCare assignment will not be accepted whether or not eligibility is established retroactively.

(8) Providers may seek payment from a person whose TennCare eligibility is pending at the time services are provided. Providers may bill such persons at the provider’s usual and customary rate for the services rendered. However, all monies collected for TennCare-covered services rendered during a period of TennCare eligibility must be refunded when a claim is submitted to TennCare if the provider agreed to accept TennCare assignment once retroactive TennCare eligibility was established.

(9) Providers of inpatient hospital services, outpatient hospital services, skilled nursing facility services, independent laboratory and x-ray services, hospice services, and home health agencies must be approved for Title XVIII-Medicare in order to be certified as providers under the TennCare Program; in the case of hospitals, the hospital must meet state licensure requirements and be approved by TennCare as an acute care hospital as of the date of enrollment in TennCare. Children’s hospitals and State mental hospitals may participate in TennCare without having been Medicare approved; however, the hospital must be approved by the Joint Commission for Accreditation of Health Care Organizations as a condition of participation.

(10) Pharmacy providers may not waive pharmacy copayments for TennCare Standard enrollees as a means of attracting business to their establishments. This does not prohibit a pharmacy from exercising professional judgment in cases where an enrollee may have a temporary or acute need for a prescribed drug, but is unable, at that moment, to pay the required copayment.

(11) Providers shall not deny services for a Medicaid enrollee’s failure to make copayments.

(12) All claims must be filed in accordance with the following:

(a) Claims filed with an MCC must be submitted in accordance with the requirements and timeframes set forth in the MCC’s contract.

(b) All other fee-for-service claims for services delivered outside of the TennCare managed care program must be filed with the Bureau of TennCare as follows:

1. All claims must be filed within one (1) year of the date of service except in the following circumstances:

(i) Recipient eligibility was determined retroactively to the extent that filing within one (1) year was not possible. In such situations, claims must be filed within one (1) year after final determination of eligibility.

(ii) If a claim filed with Medicare on a timely basis does not automatically cross over from the Medicare carrier to the Bureau, a TennCare claim may be filed within six (6) months of notification of payment or denial from Medicare.

2. Should an original claim be denied, any resubmission or follow-up of the initial claim must be received within six (6) months from the date the original claim was filed. The Bureau will not process submissions received after the six (6) month time limit. The one exception is those claims returned due to available third party coverage. These claims must be submitted within sixty (60) days of notice from the third party resource.

3. Should a correction document involving a suspended claim be sent to the provider, the claim will be denied if the correction document is not completed by the provider and returned to the Bureau within ninety (90) days from the date on the document.

4. If claim is not filed within the above timeframes, no reimbursement may be made.

5. Claims will be paid on a first claim approved - first claim paid basis.

6. The Bureau will not reimburse providers for services for which there is no Federal Financial Participation.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 4-5-209, 71-5-105, 71-5-109, and 71-5-134; Acts of 2003, Public Chapter 412, §1(c); and Executive Order No. 23.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-13-.08; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Amendment by Acts of 2003, Public Chapter 412, §1(c) filed and effective June 25, 2003. Amendment filed October 12, 2004; effective December 26, 2004. Public necessity rule filed July 29, 2005; effective through January 10, 2006. Public necessity rule filed December 29, 2005; expired June 12, 2006. On June 13, 2006, affected rules reverted to status on December 28, 2005. Amendment filed October 27, 2005; effective January 10, 2006. Amendment filed March 31, 2006; effective June 14, 2006. Public necessity rule filed September 8, 2008; eff ective through February 20, 2009. Amendment filed December 5, 2008; effective February 18, 2009. Amendment filed February 25, 2009; declared 1200-13-13-.08(2)(b) void and of no effect pursuant to court opinions issued in Case No. 18-926-II, Chancery Court for the 20th Judicial District, and Case No. 21-1150-II, Chancery Court for the 20th Judicial District, and the Tennessee Court of Appeals opinion issued in No. M2023-01350-COA-R3-CV, see also Attorney General Opinion 11-78. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendment filed May 27, 2010; effective August 25, 2010. Emergency rule filed September 3, 2010; effective through March 2, 2011. Amendment filed December 2, 2010 to have become effective March 2, 2011 was stayed by the Government Operations Committee on March 2, 2011; declared 1200-13-13-.08(2)(c) void and of no effect pursuant to court opinions issued in Case No. 18-926-II, Chancery Court for the 20th Judicial District, and Case No. 21- 1150-II, Chancery Court for the 20th Judicial District, and the Tennessee Court of Appeals opinion issued in No. M2023-01350-COA-R3-CV, see also Attorney General Opinion 11-78. Emergency rules filed July 1, 2016; effective December 28, 2016. Amendments filed September 30, 2016; effective December 29, 2016.

Tenn. Comp. R. & Regs. 1200-13-13-.15 BESMART

This rule supersedes any other rules related to the use of buprenorphine products for treatment of opioid use disorder (OUD) in office based opioid treatment (OBOT) or an opioid treatment program (OTP) by a treating provider participating in an MCO’s network of BESMART providers.

(1) BESMART treatment is a component of covered outpatient substance abuse benefits and consists of a set of coordinated medically necessary covered services which includes:

(a) Psychosocial assessment and development of a treatment plan;

(b) Individual or group counseling;

(c) Peer recovery services;

(d) Care coordination;

(e) Opioid-agonist therapy consisting of buprenorphine products that have been FDA approved for OUD treatment and may be prescribed in excess of the limits described in rules .04 and .10, when determined to be medically necessary by a treating provider in an MCO’s network of BESMART providers and under the participant’s plan of care.

1. Except as otherwise provided for in this rule, participants may receive up to sixteen (16) mg of buprenorphine containing products daily; however, providers shall initiate and lead a discussion regarding a participant’s readiness to taper down or off treatment at any time upon a participant’s request, but no later than one (1) year after initiating treatment and every six (6) months thereafter.

2. Under the best practices for treatment of OUD, the BESMART provider shall utilize the lowest effective dose of Medication-Assisted Treatment (MAT).

3. The following adult populations shall be eligible to receive a maximum daily dosage of twenty-four (24) mg of buprenorphine, not to exceed one (1) year in duration:

(i) Pregnant participants confirmed by provider attestation.

(ii) Postpartum participants for a period of twelve (12) months from delivery date as shown by medical records or insurance claim.

(iii) Recent intravenous (IV) drug users confirmed by prescriber attestation and a positive urine drug screen.

(iv) Current users receiving greater than fifty (50) mg of methadone for OUD treatment transitioning to buprenorphine agonist therapy demonstrated by paid claims data from the participant’s health insurer, provider attestation, or medical records.

(v) Current users of sixteen (16) mg to twenty-four (24) mg per day of buprenorphine demonstrated by paid claims data from the participant’s previous health insurer.

(vi) For one (1) year from the effective date of this rule, a member who does not qualify under the criteria of this part but receives greater than sixteen (16) mg per day of buprenorphine as demonstrated by the controlled substance monitoring database shall be eligible to receive a maximum daily dose of twenty-four (24) mg.

(2) BESMART treatment requires medical office visits at least weekly for participants in the induction and stabilization phase of treatment; at least every two (2) to four (4) weeks for participants in the maintenance phase of treatment; and at least every two (2) months for participants who have been in the maintenance phase of treatment for one (1) year or longer.

(3) To be reimbursed for a BESMART covered service, treating providers must demonstrate an ability to provide all BESMART services in a coordinated, person-centric way, including the ability to facilitate access to all related treatment modalities and provider types, and must participate in at least one (1) MCO’s network of BESMART providers.

(4) Prescriptions of buprenorphine containing products to TennCare enrollees by nurse practitioners and physician assistants for the treatment of OUD will not be reimbursed unless the nurse practitioner or physician assistant participates in at least one (1) MCO’s network of BESMART providers.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 71-5-105, 71-5-107, and 71-5-109.
• Administrative History: Emergency rules filed April 15, 2021; effective through October 12, 2021. New rule filed June 29, 2021; effective September 27, 2021.

Tenn. Comp. R. & Regs. 1200-13-01-.05 ; or (b) In the instance of enrollees who are eligible for and enrolled in federal Medicaid waivers under Section 1915(c) of the Social Security Act, the services and benefits that are covered under the terms and conditions of such waivers.

(33) CPT4 CODES are descriptive terms contained in the Physician’s Current Procedural Terminology, used to identify medical services and procedures performed by physicians or other licensed health professionals.

(34) DBM (DENTAL BENEFITS MANAGER) shall mean a contractor approved by the Tennessee Department of Finance and Administration to provide dental benefits to enrollees in the TennCare Program to the extent such services are covered by TennCare.

(35) DELAY shall mean failure to provide timely receipt of TennCare services, and no specific waiting period may be required before the enrollee can appeal.

(36) DEMAND LETTER shall mean a letter sent by TennCare to a TennCare Standard enrollee with premium obligations notifying the enrollee that he is at least sixty (60) days delinquent in his premium payments.

(37) DISCONTINUED DEMONSTRATION GROUP shall mean the group of non-Medicaid eligible individuals who were enrolled in TennCare Standard on April 29, 2005, when the categories in which they were enrolled were terminated, and who have not yet been enrolled in TennCare Medicaid or disenrolled from the TennCare program.

(38) DISENROLLMENT shall mean the discontinuance of an individual’s enrollment in TennCare.

(39) DURABLE MEDICAL EQUIPMENT (DME) shall mean equipment that can withstand repeated use, can be removable, is primarily and customarily used to serve a medical

purpose, generally is not useful to a person in the absence of an illness or injury, is suitable for use in any non-institutional setting in which everyday life activities take place, and is related to the patient’s physical disorder. Non-institutional settings do not include a hospital or nursing facility (NF). Routine DME items, including but not limited to wheelchairs (except as defined below), walkers, hospital beds, canes, commodes, traction equipment, suction machines, patient lifts, weight scales, and other items provided to a member receiving services in a NF that are within the scope of per diem reimbursement for NF services shall not be covered or reimbursable under the Medicaid program separate and apart from payment for the NF service. Customized wheelchairs, wheelchair seating systems, and other items that are beyond the scope of Medicaid reimbursement for NF services shall be covered by the member’s managed care organization, so long as such items:

(a) Are medically necessary for the continuous care of a member; and (b) Must be custom-made or modified or may be commercially available, but must be individually measured and selected to address the member’s unique and permanent medical need for positioning, support or mobility; and (c) Are solely for the use of that member and not for other NF residents.

(40) EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT (EPSDT)

SERVICES, a covered benefit for TennCare Medicaid-enrolled children only, shall mean:

(a) Screening in accordance with professional standards, and interperiodic, diagnostic services to determine the existence of physical or mental illnesses or conditions of TennCare Medicaid enrollees under age twenty-one (21); and (b) Health care, treatment, and other measures, described in 42 U.S.C. § 1396a(a) to correct or ameliorate any defects and physical and mental illnesses and conditions discovered.

(41) ELIGIBLE shall mean a person who has been determined to meet the eligibility criteria of TennCare Medicaid or TennCare Standard.

(42) EMPLOYMENT AND COMMUNITY FIRST (ECF) CHOICES shall mean the program defined in Rule 1200-13-01-.02 and described in Rule 1200-13-01-.31.

(43) ENROLLEE shall mean an individual eligible for and enrolled in the TennCare program or in any Tennessee federal Medicaid waiver program approved by the Secretary of the U.S.

Department of Health and Human Services pursuant to Sections 1115 or 1915 of the Social Security Act. As concerns MCC compliance with these rules, the term only applies to those individuals for whom the MCC has received at least one day’s prior written or electronic notice from the TennCare Bureau of the individual’s assignment to the MCC.

(44) ENROLLMENT shall mean the process by which a TennCare-eligible person becomes enrolled in TennCare.

(45) ESCORT shall mean an individual who accompanies an enrollee to receive a medically necessary service. For the purpose of determining whether an individual may qualify as an escort who may be transported without cost to the enrollee as a covered TennCare benefit, the following criteria apply:

(a) Any person over the age of twelve (12) selected by the enrollee;

(b) Any person under the age of twelve (12) is presumed to be too young to serve as an escort. At the time of request for transportation, this presumption can be overcome by specific facts provided by the enrollee, which would demonstrate to a reasonable person that the proposed escort could in fact be of assistance to the enrollee; and (c) Any person under the age of six (6) is excluded in all cases from the role of escort.

(46) FAMILY shall mean that as defined in the rules of the Tennessee Department of Human Services found at 1240-01-03 and 1240-01-04, Family Assistance Division, and 1240-03-03, Division of Medical Services.

(47) FEDERAL FINANCIAL PARTICIPATION (FFP) shall mean the Federal Government’s share of a state’s expenditure under the Title XIX Medicaid Program.

(48) FINAL AGENCY ACTION shall mean the resolution of an appeal by the TennCare Bureau or an initial decision on the merits of an appeal by an administrative judge or hearing officer when such initial decision is not modified or overturned by the TennCare Bureau. Final agency action shall be treated as binding for purposes of these rules.

(49) FRAUD shall mean an intentional deception or misrepresentation made by a person who knows or should have known that the deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud under applicable federal or state law.

(50) GRAND DIVISIONS shall mean the three (3) distinct geographic areas of the State of Tennessee, known as Eastern, Middle, and Western, as designated in Tennessee Code Annotated § 4-1-201.

(51) GROUP HEALTH INSURANCE shall mean an employee welfare benefit plan to the extent that the plan provides medical care to employees or their dependents (as defined under the terms of the plan) directly through insurance reimbursement mechanism. This definition includes those types of health insurance found in the Health Insurance Portability And Accountability Act of 1996, as amended, definition of creditable coverage (with the exception that the 50 or more participants criteria does not apply), which includes Medicare and TRICARE. Health insurance benefits obtained through COBRA are included in this definition.

It also covers group health insurance available to an individual through membership in a professional organization or a school.

(52) HANDICAPPING MALOCCLUSION shall mean a malocclusion which causes one of the following medical conditions:

(a) A nutritional deficiency that has proven non-responsive to medical treatment without orthodontic treatment. The nutritional deficiency must have been diagnosed by a qualified treating physician and must have been documented in the qualified treating physician’s progress notes. The progress notes that document the nutritional deficiency must predate the treating orthodontist’s prior authorization request for orthodontics.

(b) A speech pathology that has proven non-responsive to speech therapy without orthodontic treatment. The speech pathology must have been diagnosed by a qualified speech therapist and must have been documented in the qualified speech therapist’s progress notes. The progress notes that document the speech pathology must predate the treating orthodontist’s prior authorization request for orthodontics.

(c) Laceration of soft tissue caused by a deep impinging overbite. Occasional cheek biting does not constitute laceration of soft tissue. Laceration of the soft tissue must be documented in the treating orthodontist’s progress notes and must predate the treating orthodontist’s prior authorization request for orthodontics.

Anecdotal information is insufficient to document the presence of a handicapping malocclusion. The presence of a handicapping malocclusion must be supported by the treating professional’s progress notes and patient record.

(53) HEALTH INSURANCE, for the purposes of determining eligibility under these regulations:

(a) Shall mean:

1. Any hospital and medical expense-incurred policy;

2. Medicare;

3. TRICARE;

4. COBRA;

5. Medicaid;

6. State health risk pool;

7. Nonprofit health care service plan contract;

8. Health maintenance organization subscriber contracts;

9. An employee welfare benefit plan to the extent that the plan provides medical care to an employee or his/her dependents (as defined under the terms of the plan) directly through insurance, any form of self insurance, or a reimbursement mechanism;

10. Coverage available to an individual through membership in a professional organization or a school;

11. Coverage under a policy covering one person or all the members of a family under a single policy where the contract exists solely between the individual and the insurance company;

12. Any of the above types of policies where:

(i) The policy contains a type of benefit (such as mental health benefits) which has been completely exhausted;

(ii) The policy contains a type of benefit (such as pharmacy) for which an annual limitation has been reached;

(iii) The policy has a specific exclusion or rider of non-coverage based on a specific prior existing condition or an existing condition or treatment of such a condition; or 13. Any of the types of policies listed above will be considered health insurance even if one or more of the following circumstances exists:

(i) The policy contains fewer benefits than TennCare;

(ii) The policy costs more than TennCare; or (iii) The policy is one the individual could have bought during a specified period of time (such as COBRA) but chose not to do so.

(b) Shall not mean:

1. Short-term coverage;

2. Accident coverage;

3. Fixed indemnity insurance;

4. Long-term care insurance;

5. Disability income contracts;

6. Limited benefits policies as defined elsewhere in these rules;

7. Credit insurance;

8. School-sponsored sports-related injury coverage;

9. Coverage issued as a supplemental to liability insurance;

10. Automobile medical payment insurance;

11. Insurance under which benefits are payable with or without regard to fault and which are statutorily required to be contained in any liability insurance policy or equivalent self-insurance;

12. A medical care program of the Indian Health Services (IHS) or a tribal organization;

13. Benefits received through the Veteran’s Administration; or 14. Health care provided through a government clinic or program such as, but not limited to, vaccinations, flu shots, mammograms, and care or services received through a disease- or condition-specific program such as, but not limited to, the Ryan White Care Act.

(54) HEALTH MAINTENANCE ORGANIZATION (HMO) shall mean an entity licensed by the Tennessee Department of Commerce and Insurance under applicable provisions of Tennessee Code Annotated (T.C.A.) Title 56, Chapter 32 to provide health care services.

(55) HEALTH PLAN shall mean a Managed Care Organization authorized by the Tennessee Department of Finance and Administration to provide medical and behavioral services to enrollees in the TennCare Program.

(56) HEARING OFFICER shall mean an administrative judge or hearing officer who is not an employee, agent or representative of the MCC or who did not participate in, nor was consulted about, any TennCare Bureau review prior to the State Fair Hearing (SFH).

(57) HIPAA shall mean the Health Insurance Portability and Accountability Act of 1996, as amended.

(58) HOME HEALTH SERVICES shall mean:

(a) Any of the services identified in 42 C.F.R. § 440.70 and delivered in accordance with the provisions of 42 C.F.R. § 440.70. “Part-time or intermittent nursing services” and “home health aide services” are covered only as defined specifically in these rules.

1. Part-time or intermittent nursing services.

(i) To be considered “part-time or intermittent,” nursing services must be provided as no more than one visit per day, with each visit lasting less than eight (8) hours, and no more than 27 total hours of nursing care may be provided per week. In addition, nursing services and home health aide services combined must total less than or equal to eight (8) hours per day and 35 or fewer hours per week. On a case-by-case basis, the weekly total for nursing services may be increased to 30 hours and the weekly total for nursing services and home health aide services combined may be increased to 40 hours for patients qualifying for Level 2 skilled nursing care.

(ii) Part-time or intermittent nursing services are not covered if the only skilled nursing function needed is administration of medications on a p.r.n. (as needed) basis. Nursing services may include medication administration; however, a nursing visit will not be extended in order to administer medication or perform other skilled nursing functions at more than one point during the day, unless skilled nursing services are medically necessary throughout the intervening period. If there is more than one person in a household who is determined to require TennCare-reimbursed home health nursing services, it is not necessary to have multiple nurses providing the services. A single nurse may provide services to multiple enrollees in the same home and during the same hours, as long as he can provide these services safely and appropriately to each enrollee.

(iii) The above limits may be exceeded when medically necessary for children under the age of 21.

2. Home health aide services.

(i) Home health aide services must be provided as no more than two visits per day with care provided less than or equal to eight (8) hours per day.

Nursing services and home health aide services combined must total less than or equal to eight (8) hours per day and 35 or fewer hours per week.

On a case-by-case basis, the weekly total may be increased to 40 hours for patients qualifying for Level 2 skilled nursing care. If there is more than one person in a household who is determined to require TennCarereimbursed home health aide services, it is not necessary to have multiple home health aides providing the services. A single home health aide may provide services to multiple enrollees in the same home and during the same hours, as long as he can provide these services safely and appropriately to each enrollee.

(ii) The above limits may be exceeded when medically necessary for children under the age of 21.

(b) Home health providers shall only provide services to the recipient that have been ordered by the treating physician and are pursuant to a plan of care and shall not provide other services such as general child care services, cleaning services, preparation of meals, or services to other household members. Because children typically have non-medical care needs which must be met, to the extent that home health services are provided to a person under 18 years of age, a responsible adult (other than the home health care provider) must be present at all times in the home during the provision of home health services unless all of the following criteria are met:

1. The child is non-ambulatory; and 2. The child has no or extremely limited ability to interact with caregivers; and 3. The child shall not reasonably be expected to have needs that fall outside the scope of medically necessary TennCare covered benefits (e.g. the child has no need for general supervision or meal preparation) during the time the home health provider is present in the home without the presence of another responsible adult; and 4. No other children requiring adult care or supervision shall be present in the home during the time the home health provider is present in the home without the presence of another responsible adult, unless these children meet all the criteria stated above and are also receiving TennCare-reimbursed home health services.

(59) INCOME shall mean that definition of income in Rule 1240-01-04 of the Tennessee Department of Human Services - Family Assistance Division.

(60) INDIVIDUAL HEALTH INSURANCE shall mean health insurance coverage under a policy covering one person or all the members of a family under a single policy where the contract exists solely between that person and the insurance company.

(61) INFANT DIAPER shall mean a disposable product with absorbent material that is designed by the manufacturer to be fastened around a child’s waist and between the child’s legs to absorb and retain urine or feces. Infant Diapers do not include cloth or non-disposable diapers or diapering supplies (such as wipes or diaper cream). Coverage for Infant Diapers is outlined in Rule .04.

(62) INITIATING PROVIDER shall mean the provider who renders the first covered service to a TennCare member whose current medical condition requires the services of more than one (1) provider.

(63) INMATE shall mean an individual confined in a local, state, or federal prison, jail, youth development center, or other penal or correctional facility, including a furlough from such facility.

(64) IN-NETWORK PROVIDER shall have the same meaning as Participating Provider.

(65) INPATIENT REHABILITATION FACILITIES shall mean rehabilitation hospitals and distinct parts of hospitals that are designated as ‘IRFs’ by Medicare.

(66) INSTITUTION FOR MENTAL DISEASES (IMD) shall mean a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services.

(67) LICENSED MENTAL HEALTH PROFESSIONAL shall mean 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 with a current valid license by the Tennessee Licensing Board for the Healing Arts.

(68) LIMITED BENEFITS POLICY shall mean a policy of health coverage for a specific disease (e.g., cancer), or an accident occurring while engaged in a specified activity (e.g., schoolbased sports), or which provides for a cash benefit payable directly to the insured in the event of an accident or hospitalization (e.g., hospital indemnity).

(69) LOCK-IN PROVIDER. A provider, pharmacy or physician, chosen by an enrollee on pharmacy lock-in status to whom the enrollee is assigned by TennCare for the purpose of receiving covered pharmacy services.

(70) LOCK-IN STATUS. The restriction of an enrollee to a specified physician, or to a specified pharmacy provider at a specified single location.

(71) LONG-TERM CARE shall mean programs and services described under Rule 1200-13-01- .01.

(72) MCC (MANAGED CARE CONTRACTOR) shall mean:

(a) A Managed Care Organization, Pharmacy Benefits Manager and/or a Dental Benefits Manager which has signed a TennCare Contractor Risk Agreement with the State and operates a provider network and provides covered health services to TennCare enrollees; or (b) A Pharmacy Benefits Manager, Behavioral Health Organization or Dental Benefits Manager which subcontracts with a Managed Care Organization to provide services; or (c) A State government agency that contracts with TennCare for the provision of services.

(73) MCO (Managed Care Organization) shall mean an appropriately licensed Health Maintenance Organization (HMO) approved by the Bureau of TennCare as capable of providing medical, behavioral, and long-term care services in the TennCare Program.

(74) MEDICAID shall mean the federal- and state-financed, state-run program of medical assistance pursuant to Title XIX of the Social Security Act. Medicaid eligibility in Tennessee is determined by the Tennessee Department of Human Services, under contract to the Tennessee Department of Finance and Administration. Tennessee residents determined eligible for SSI benefits by the Social Security Administration are also enrolled in Tennessee’s TennCare Medicaid program.

(75) MEDICAID “ROLLOVER” ENROLLEE shall mean a TennCare Medicaid enrollee who no longer meets technical eligibility requirements for Medicaid and will be afforded an opportunity to enroll in TennCare Standard in accordance with the provisions of these rules.

(76) MEDICAL ASSISTANCE shall mean health care, services and supplies furnished to an enrollee and funded in whole or in part under Title XIX of the Social Security Act, 42 U.S.C. §§ 1396, et seq. and Tennessee Code Annotated §§ 71-5-101, et seq. Medical assistance includes the payment of the cost of care, services, drugs and supplies. Such care, services, drugs, and supplies shall include services of qualified providers who have contracted with an MCC or are otherwise authorized to provide services to TennCare enrollees (i.e., emergency services provided out-of-network or medically necessary services obtained out-of-network because of an MCC’s failure to provide adequate access to services in-network).

(77) MEDICAL RECORD shall mean all medical histories; records, reports and summaries; diagnoses; prognoses; records of treatment and medication ordered and given; x-ray and radiology interpretations; physical therapy charts and notes; lab reports; other individualized medical documentation in written or electronic format; and analyses of such information.

(78) MEDICAL SUPPLIES shall mean covered medical supplies that are deemed medically necessary and appropriate and are prescribed for use in the diagnosis and treatment of medical conditions. Medically necessary medical supplies not included as part of institutional services shall be covered only when provided by or through a licensed home health agency, by or through a licensed medical vendor supplier or by or through a licensed pharmacist.

(79) MEDICALLY ELIGIBLE shall mean a person who has met the medical eligibility criteria for the TennCare Standard program through a mechanism permitted under the provisions of these rules.

(80) MEDICALLY NECESSARY is defined by Tennessee Code Annotated, Section 71-5-144, and shall describe a medical item or service that meets the criteria set forth in that statute. The term “medically necessary,” as defined by Tennessee Code Annotated, Section 71-5-144, applies to TennCare enrollees. Implementation of the term “medically necessary” is provided for in these rules, consistent with the statutory provisions, which control in case of ambiguity.

No enrollee shall be entitled to receive and TennCare shall not be required to pay for any items or services that fail fully to satisfy all criteria of “medically necessary” items or services, as defined either in the statute or in the Medical Necessity rule chapter at 1200-13-16.

(81) MEDICALLY NEEDY shall mean that category of TennCare Medicaid-eligibles as defined in

Rule 1240-03-02-.03 of the Tennessee Department of Human Services - Division of Medical Services.

(82) MEDICARE shall mean the program administered through the Social Security Administration pursuant to Title XVIII, available to most individuals upon attaining age sixty-five (65), to some disabled individuals under age sixty-five (65), and to individuals having End Stage Renal Disease (ESRD).

(83) MEMBER shall mean a TennCare Medicaid- or TennCare Standard-eligible individual who is enrolled in a managed care organization.

(84) NON-CONTRACT PROVIDER shall have the same meaning as Non-Participating Provider.

(85) NON-PARTICIPATING PROVIDER shall mean a TennCare provider, as defined in this Rule, who is not contracted with a particular enrollee’s MCO. This term may include TennCare providers who furnish services outside the managed care program on a fee-for-service basis, as well as TennCare providers who receive Medicare crossover payments from TennCare.

(86) NON-TENNCARE PROVIDER shall mean a provider who is not enrolled in TennCare and who accepts no TennCare reimbursement for any service, including Medicare crossover payments.

(87) OPEN ENROLLMENT shall mean a designated period of time, determined by the Bureau of TennCare, during which persons who are not currently TennCare eligible may apply for the Standard Spend Down program.

(88) OPEN MEDICAID CATEGORIES shall mean those Medicaid eligibility categories for which enrollment has not been closed pursuant to authority granted by CMS as part of the TennCare demonstration project.

(89) OUT-OF-NETWORK PROVIDER shall have the same meaning as Non-Participating Provider.

(90) OUT-OF-STATE EMERGENCY PROVIDER shall mean a provider outside the State of Tennessee who does not participate in TennCare in any way except to bill for emergency services, as defined in this Chapter, provided out-of-state to a particular MCC’s enrollee. An Out-of-State Emergency Provider must abide by all TennCare rules and regulations, including those concerning provider billing of enrollees as found in Rule 1200-13-13-.08. In order to receive payment from TennCare, Out-of-State Emergency Providers must be appropriately licensed in the state in which the emergency services were delivered, they must enroll with TennCare and they must not be excluded from participation in Medicare or Medicaid.

(91) OVERUTILIZATION shall mean any of the following:

(a) The enrollee initiated use of TennCare services or supplies at a frequency or amount that is not medically necessary or medically justified.

(b) Overutilization, or attempted overutilization, of the TennCare Pharmacy Program which justifies placement on lock-in status for all enrollees involved.

(c) Activities or practices which may evidence overutilization of the TennCare Pharmacy Program including, but not limited to, the following:

1. Treatment by several physicians for the same diagnosis;

2. Obtaining the same or similar controlled substances from several physicians;

3. Obtaining controlled substances in excess of the maximum recommended dose;

4. Receiving combinations of drugs which act synergistically or belong to the same class;

5. Frequent treatment for diagnoses which are highly susceptible to abuse;

6. Receiving services and/or drugs from numerous providers;

7. Obtaining the same or similar drugs on the same day or at frequent intervals; or 8. Frequent use of the emergency room in non-emergency situations in order to obtain prescription drugs.

(92) PARTICIPATING PROVIDER shall mean a TennCare provider, as defined in this Rule, who has entered into a contract with an enrollee’s Managed Care Contractor.

(93) PBM (PHARMACY BENEFITS MANAGER) shall mean an organization approved by the Tennessee Department of Finance and Administration to administer pharmacy benefits to enrollees to the extent such services are covered by the TennCare Program. A PBM may have a signed TennCare Contractor Risk Agreement with the State, or may be a subcontractor to an MCO.

(94) PERSONAL CARE SERVICES shall refer to an optional Medicaid benefit defined at 42 C.F.R. § 440.167 that, per the Tennessee Medicaid State Plan, Tennessee has not elected to include in the TennCare benefit package. To the extent that such services are available to children under the age of 21 when medically necessary under the provisions of EPSDT, the Bureau of TennCare designates home health aides as the providers qualified to deliver such services. When medically necessary, personal care services may be authorized outside of the home setting when normal life activities temporarily take the recipient outside of that setting. Normal life activity for a child under the age of 21 means routine work (including work in supported or sheltered work settings); licensed child care; school and school-related activities; religious services and related activities; and outpatient health care services (including services delivered through a TennCare home and community based services waiver program). The home health aide providing personal care services may accompany the recipient but may not drive. Normal life activities do not include non-routine or extended home absences.

(95) PHARMACY LOCK-IN PROGRAM shall mean the program designed to reduce enrollee pharmacy benefit Abuse or Overutilization, as set forth in 1200-13-13-.13.

(96) PHYSICIAN shall mean a person licensed pursuant to chapter 6 or 9 of title 63 of the Tennessee Code Annotated.

(97) POVERTY LEVEL shall mean the poverty level established by the Federal Government.

(98) POWER SEATING ACCESSORIES. Accessories available to modify a power wheelchair base are covered by TennCare when all listed criteria are met as follows:

(a) Power Seat Elevation System.

1. It is ordered by the Enrollee’s treating physician.

2. An assessment conducted by a licensed physical therapist or licensed occupational therapist establishes that:

(i) The Enrollee has the cognitive ability and enough upper extremity function to carry out mobility-related activities of daily living such as feeding, grooming, dressing, and transferring; and (ii) The activities for which the accessory will be used are conducted primarily in the enrollee’s home.

(b) Power Standing System.

1. It is ordered by the Enrollee’s treating physician.

2. An assessment conducted by a licensed physical therapist or licensed occupational therapist establishes that the Enrollee:

(i) Has a chronic condition that causes him to have limited or no ability to stand; and (ii) Has a physical condition that allows him to stand, when supported, for meaningful periods of time, i.e ., he will not suffer loss of blood pressure or have problems with bowel or urine retention; and (iii) Has the cognitive ability and enough upper extremity function to carry out mobility-related activities of daily living such as feeding, grooming, dressing, and transferring; and (iv) Meets at least one other complex rehabilitation criterion for a power seat accessory such as a tilt seat and also qualifies for a Group 3 base Power Wheelchair.

(99) POWER WHEELCHAIR ACCESSORIES. All powered wheelchair accessories not defined in this rule as Power Seating Accessories are excluded from TennCare coverage but may be provided by an MCO as a cost effective alternative service as defined in this rule.

(100) PRESCRIBER. An individual authorized by law to prescribe drugs.

(101) PRIMARY CARE PHYSICIAN shall mean a physician responsible for supervising, coordinating, and providing initial and primary care to patients; for initiating referrals for specialist care; and for maintaining the continuity of patient care. A primary care physician is a physician who has limited his practice of medicine to general practice or who is a Board Certified or Eligible Internist, Pediatrician, Obstetrician/Gynecologist, or Family Practitioner.

(102) PRIMARY CARE PROVIDER shall mean health care professional capable of providing a wide variety of basic health services. Primary care providers include practitioners of family, general, or internal medicine; pediatricians and obstetricians; nurse practitioners; midwives; and physician’s assistant in general or family practice.

(103) PRIOR APPROVAL STATUS shall mean the restriction of an enrollee to a procedure wherein services, except in emergency situations, must be approved by the TennCare Bureau or the MCC prior to the delivery of services.

(104) PRIOR AUTHORIZATION shall mean the process under which services, except in emergency situations, must be approved by the TennCare Bureau or the MCC prior to the delivery in order for such services to be covered by the TennCare program.

(105) PRIOR AUTHORIZATION STATUS (PA STATUS) shall mean the status wherein an enrollee has triggered an event described in Rule .13 of this Chapter and as a result must acquire a prior authorization for every prescription fill of any controlled substance, with the exclusion of medications intended for the treatment of opioid use disorder (i.e., buprenorphine or buprenorphine/naloxone).

(106) PRIVATE DUTY NURSING SERVICES shall mean nursing services for recipients who require eight (8) or more hours of continuous skilled nursing care during a 24-hour period.

(a) A person who needs intermittent skilled nursing functions at specified intervals, but who does not require continuous skilled nursing care throughout the period between each interval, shall not be determined to need continuous skilled nursing care. Skilled nursing care is provided by a registered nurse or licensed practical nurse under the direction of the recipient’s physician to the recipient and not to other household members. If there is more than one person in a household who is determined to require TennCare-reimbursed private duty nursing services, it is not necessary to have multiple nurses providing the services. A single nurse may provide services to multiple enrollees in the same home and during the same hours, as long as he can provide these services safely and appropriately to each enrollee.

(b) If it is determined by the MCO to be cost-effective, non-skilled services may be provided by a nurse rather than a home health aide. However, it is the total number of hours of skilled nursing services, not the number of hours that the nurse is in the home, that determines whether the nursing services are continuous or intermittent.

(c) Private duty nursing services are covered for adults aged 21 and older only when medically necessary to support the use of ventilator equipment or other life-sustaining medical technology when constant nursing supervision, visual assessment, and monitoring of both equipment and patient are required. For purposes of this rule, an adult is considered to be using ventilator equipment or other life-sustaining medical technology if he:

1. Is ventilator dependent for at least 12 hours each day with an invasive patient end of the circuit (i.e., tracheostomy cannula); or 2. Is ventilator dependent with a progressive neuromuscular disorder or spinal cord injury, and is ventilated using noninvasive positive pressure ventilation (NIPPV) by mask or mouthpiece for at least 12 hours each day in order to avoid or delay tracheostomy (requires medical review); or 3. Has a functioning tracheostomy:

(i) Requiring suctioning; and (ii) Oxygen supplementation; and (iii) Receiving nebulizer treatments or requiring the use of Cough Assist/inexsufflator devices; and (iv) In addition, at least one subitem from each of the following items (I and II) must be met:

(I) Medication:

I. Receiving medication via a gastrostomy tube (G-tube); or II. Receiving medication via a Peripherally Inserted Central Catheter (PICC) line or central port; and (II) Nutrition:

I. Receiving bolus or continuous feedings via a permanent access such as a G-tube, Mickey Button, or Gastrojejunostomy tube (G-J tube); or II. Receiving total parenteral nutrition.

(d) Private duty nursing services are covered as medically necessary for children under the age of 21 in accordance with EPSDT requirements. As a general rule, only a child who is dependent upon technology-based medical equipment requiring constant nursing supervision, visual assessment, and monitoring of both equipment and child will be determined to need private duty nursing services. However, determinations of medical necessity will continue to be made on an individualized basis.

(e) A child who needs less than eight (8) hours of continuous skilled nursing care during a 24-hour period or an adult who needs nursing care but does not qualify for private duty nursing care per the requirements of these rules may receive medically necessary nursing care as an intermittent service under home health.

(f) General childcare services and other non-hands-on assistance such as cleaning and meal preparation shall not be provided by a private duty nurse. Because children typically have non-medical care needs which must be met, to the extent that private duty nursing services are provided to a person or persons under 18 years of age, a responsible adult (other than the private duty nurse) must be present at all times in the home during the provision of private duty nursing services unless all of the following criteria are met:

1. The child is non-ambulatory; and 2. The child has no or extremely limited ability to interact with caregivers; and 3. The child shall not reasonably be expected to have needs that fall outside the scope of medically necessary TennCare covered benefits (e.g., the child has no need for general supervision or meal preparation) during the time the private duty nurse is present in the home without the presence of another responsible adult; and 4. No other children shall be present in the home during the time the private duty nurse is present in the home without the presence of another responsible adult, unless these children meet all of the criteria stated above and are also receiving TennCare-reimbursed private duty nursing services.

(107) PROVIDER shall mean an appropriately licensed institution, facility, agency, person, corporation, partnership, or association that delivers health care services. Providers are categorized as either TennCare Providers or Non-TennCare Providers. TennCare Providers may be further categorized as being one of the following:

(a) Participating Providers or In-Network Providers (b) Non-Participating Providers or Out-of-Network Providers (c) Out-of-State Emergency Providers Definitions of each of these terms are contained in this Rule.

(108) PROVIDER-INITIATED REDUCTION, TERMINATION OR SUSPENSION OF SERVICES shall mean a decision to reduce, terminate, or suspend an enrollee’s TennCare services which is initiated by the enrollee’s provider, rather than by the MCC.

(109) PROVIDER WITH PRESCRIBING AUTHORITY shall mean, in the context of TennCare pharmacy services, a health care professional authorized by law or regulation to order prescription medications for his/her patients, and who:

(a) Participates in the provider network of the MCC in which the enrollee is enrolled; or (b) Has received a referral of the enrollee, approved by the MCC, authorizing her to treat the enrollee; or (c) In the case of a TennCare enrollee who is also enrolled in Medicare, is authorized to treat Medicare patients.

(110) PRUDENT LAY PERSON shall mean a reasonable person who possesses an average knowledge of health and medicine.

(111) QUALIFIED LONG TERM CARE INSURANCE POLICY shall mean a long-term care insurance policy issued on or after October 1, 2008, that has been pre-certified by the Tennessee Department of Commerce and Insurance pursuant to Rule 0780-01-61 as:

(a) A policy that meets all applicable Tennessee Long Term Care Partnership requirements; or (b) A policy that has been issued in another Partnership state and which is covered under a reciprocal agreement between such other state and the State of Tennessee.

(112) QUALIFIED UNINSURED PERSON shall mean an uninsured person who meets the technical, financial, and insurance requirements for the TennCare Standard Program.

(113) QUALIFYING MEDICAL CONDITION shall mean a medical condition which is included among a list of conditions established by the Bureau and which will render a qualified uninsured applicant medically eligible.

(114) READABLE shall mean easily understood language and format. See 42 C.F.R. § 438.10.

(115) REASSIGNMENT shall mean the process by which the Bureau of TennCare transfers an enrollee from one MCO to another as described in these rules.

(116) RECEIPT OF MAILED NOTICES shall mean that receipt of mailed notices is presumed to occur within five (5) days of mailing.

(117) RECERTIFICATION shall have the same meaning as Redetermination.

(118) RECONSIDERATION shall mean the mandatory process, triggered by an enrollee’s request for a SFH, by which an MCC reviews and renders a decision affirming or reversing the MCC’s adverse benefit determination. An MCC satisfies the plan-level requirements of 42 C.F.R. Part 438 Subpart F when the review includes all available, relevant, clinical documentation (including documentation which may not have been considered in the original review); is performed by a physician other than the original reviewing physician; and produces a timely written finding. See June 5, 2017, CMS letter from Jackie Glaze to Wendy Long, M.D., M.P.H.

(119) REQUEST FOR REIMBURSEMENT shall mean a request from an enrollee for reimbursement of amounts paid out of pocket to providers for medical, dental or pharmacy services received. Enrollees seeking reimbursement are required to submit receipts or bills that include the following information: the amount paid by enrollee, a description of the prescriptions, care or services received, the date the prescriptions, care or services were received, and the name of the provider or pharmacy. All required information must be received from enrollees within the sixty (60) day timeframe to request reimbursement as prescribed by Rule 1200-13-13-.11(2)(d).

(120) RESPONSIBLE PARTY(IES) shall mean the following individuals, who are representatives and/or relatives of recipients of medical assistance who are not financially eligible to receive benefits: parents, spouses, children, and guardians; as defined at Tennessee Code Annotated § 71-5-103(10).

(121) SSI (SUPPLEMENTAL SECURITY INCOME) BENEFITS shall mean the benefits provided through a program administered by the Social Security Administration for those meeting program eligibility requirements. Tennessee residents determined eligible for SSI benefits are automatically enrolled in TennCare Medicaid.

(122) STANDARD SPEND DOWN (SSD) shall mean the demonstration eligibility category composed of adults age twenty-one (21) and older who have been found to meet the criteria in Rule 1200-13-14-.02.

(123) STATE FAIR HEARING (SFH) shall mean an evidentiary hearing requested by or on behalf of an enrollee to allow the enrollee to appeal an adverse benefit determination, which is conducted in accordance with 42 C.F.R. Part 431 Subpart E and the Tennessee Uniform Administrative Procedures Act, T.C.A. §§ 4-5-301, et seq. An initial order under T.C.A. § 4-5- 314 shall be entered when an evidentiary hearing is held before a hearing officer. If any party appeals the initial order under T.C.A. § 4-5-315, the Commissioner may render a final order.

(124) TARGETED PHARMACY. A pharmacy meeting one of the following criteria:

(a) It is located outside the State of Tennessee.

(b) It has had previous controlled substance violations with the Tennessee State Board of Pharmacy.

(c) The Bureau has knowledge that the pharmacy is under investigation.

(125) TECHNICAL ELIGIBILITY REQUIREMENTS shall mean the eligibility requirements applicable to the appropriate category of medical assistance as discussed in Chapter 1240- 03-03-.03 of the rules of the TDHS - Division of Medical Services, and the additional eligibility requirements set forth in these rules.

(126) TENNCARE shall mean the program administered by the Single State agency as designated by the State and CMS pursuant to Title XIX of the Social Security Act and the Section 1115 Research and Demonstration waiver granted to the State of Tennessee.

(127) TENNCARE APPEAL FORM shall mean the TennCare form(s) which are completed by an enrollee or by a person authorized by the enrollee to do so, when an enrollee appeals an adverse benefit determination.

(128) TENNCARE CHOICES in Long-Term Care shall mean the program described in Rule 1200- 13-01-.05.

(129) TENNCARE MEDICAID shall mean that part of the TennCare program, which covers persons eligible for Medicaid under Tennessee’s Title XIX State Plan for Medical Assistance.

The following persons are eligible for TennCare Medicaid:

(a) Tennessee residents determined to be eligible for Medicaid in accordance with 1240- 03-03 of the rules of the Tennessee Department of Human Services - Division of Medical Services.

(b) Individuals who qualify as dually eligible for Medicare and Medicaid are enrolled in TennCare Medicaid.

(c) A Tennessee resident who is an uninsured woman, under age sixty-five (65), a U.S. citizen or qualified alien, is not eligible for any other category of Medicaid, has been diagnosed as the result of a screening at a Centers for Disease Control and Prevention (CDC) site with breast or cervical cancer, including pre-cancerous conditions.

(d) Tennessee residents determined eligible for SSI benefits by the Social Security Administration are automatically enrolled in TennCare Medicaid.

(130) TENNCARE MEDICAID ELIGIBILITY REFORMS shall mean the amendments to the TennCare demonstration project approved by CMS on March 24, 2005, to close enrollment into TennCare Medicaid for non-pregnant adults age twenty-one (21) or older who qualify as Medically Needy under Tennessee’s Title XIX State Plan for Medical Assistance and to disenroll non-pregnant adults age twenty-one (21) or older who qualify as Medically Needy under Tennessee’s Title XIX State Plan for Medical Assistance after completion of their twelve (12) months of eligibility.

(131) TENNCARE PHARMACY PROGRAMS shall mean any TennCare pharmacy carve-outs, including, but not limited to, enrollees with dual eligibility and all pharmacy services provided by the TennCare Managed Care Organizations (MCOs).

(132) TENNCARE PROVIDER shall mean a provider who accepts as payment in full for furnishing benefits to a TennCare enrollee, the amounts paid pursuant to an approved agreement with an MCC or TennCare. Such payment may include copayments from the enrollee or the enrollee’s responsible party. TennCare providers must be enrolled with TennCare. TennCare providers must abide by all TennCare rules and regulations, including requirements regarding provider billing of patients as found in Rule 1200-13-13-.08. TennCare providers must be appropriately licensed for the services they deliver and must not be providers who have been excluded from participation in Medicare or Medicaid.

(133) TENNCARE SELECT shall mean a state self-insured HMO established by the Bureau of TennCare and administered by a contractor to provide medical services to certain eligible enrollees.

(134) TENNCARE SERVICES OR TENNCARE BENEFITS, for purposes of this rule, shall mean any medical assistance that is administered by the Bureau of TennCare or its contractors and which is funded wholly or in part with federal funds under the Medicaid Act or any waiver thereof, but excluding:

(a) Medical assistance that can be appealed through an appeal of a pre-admission evaluation (PAE) determination; and (b) Medicare cost sharing services that do not involve utilization review by the Bureau of TennCare or its contractors.

(135) TENNCARE STANDARD shall mean that part of the TennCare Program which provides health coverage for Tennessee residents who are not eligible for Medicaid and who meet the eligibility criteria found in Rule 1200-13-14-.02.

(136) TENNCARE STANDARD ELIGIBILITY REFORMS shall mean the amendments to the TennCare demonstration project approved by CMS on March 24, 2005, to terminate coverage for adults aged nineteen (19) and older in TennCare Standard eligibility groups.

(137) TENNderCARE shall mean the name given to the preventive health care program for TennCare children.

(138) TERMINATION shall mean the discontinuance of an enrollee’s coverage under the TennCare Medicaid or TennCare standard program.

(139) THIRD PARTY shall mean any entity or funding source other than the enrollee or his/her responsible party, which is or may be liable to pay for all or a part of the costs of medical care of the enrollee.

(140) TRANSITION GROUP shall mean existing Medicaid Medically Needy adults age twenty-one (21) or older enrolled as of October 5, 2007, who have not yet been assessed for transition to the Standard Spend Down Demonstration population for non-pregnant adults age twenty-one (21) or older.

(141) TREATING PHYSICIAN (OR CLINICIAN) shall mean a health care provider who has provided diagnostic or treatment services for an enrollee (whether or not those services were covered by TennCare), for purposes of treating, or supporting the treatment of, a known or suspected medical condition. The term excludes providers who have evaluated an enrollee’s medical condition primarily or exclusively for the purposes of supporting or participating in a decision regarding TennCare coverage.

(142) UNINSURED shall mean any person who does not have health insurance directly or indirectly through another family member, or who does not have access to group health insurance. For purposes of the Medicaid eligibility category of women under 65 requiring treatment for breast or cervical cancer, “Uninsured” shall mean any person who does not have health insurance or access to health insurance which covers treatment for breast or cervical cancer.

(143) VALID FACTUAL DISPUTE shall mean a dispute which, if resolved in favor of the enrollee, would result in the proposed action not being taken.

History

• Authority: T.C.A. §§ 4-3-1013, 4-5-202, 4-5-203, 4-5-208, 4-5-209, 71-5-102, 71-5-105, 71-5-107, 71-5- 109, 71-5-113, 71-5-134, 71-5-146, 71-5-197, and 71-5-198; 42 C.F.R. Part 431 Subpart E; 42 C.F.R. Part 438 Subpart F; 42 C.F.R. Part 455 Subpart E; and Executive Order No. 23.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-13-.01; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Amendment filed April 9, 2003; effective June 23, 2003. Public necessity rule filed May 5, 2005; effective through October 17, 2005. Public necessity rule filed June 3, 2005; effective through November 15, 2005. Amendment filed July 14, 2005; effective September 27, 2005. Amendment filed July 20, 2005; effective October 3, 2005. Amendment filed July 28, 2005; effective October 11, 2005. Amendment filed September 1, 2005; effective November 15, 2005. Public necessity rule filed December 9, 2005; effective through May 23, 2006. Public necessity rule filed December 29, 2005; effective through June 12, 2006. Public necessity rules filed March 3, 2006; effective through August 15, 2006. Amendment filed March 3, 2006; effective May 17, 2006. Public necessity rule filed December 29, 2005; expired June 12, 2006. On June 13, 2006, affected rules reverted to status on December 28, 2005. Amendments filed March 31, 2006; effective June 14, 2006. Amendment filed June 1, 2006; effective August 15, 2006. Public necessity rule filed December 1, 2006; expired May 5, 2007. Public necessity rule filed February 2, 2007; effective through July 16, 2007. Amendment filed January 26, 2007; effective April 11, 2007. Amendment filed May 2, 2007; effective July 16, 2007. Amendment filed June 11, 2007; effective August 25, 2007. Public necessity rule filed October 11, 2007; effective through March 24, 2008. Public necessity rule filed February 8, 2008; effective through July 22, 2008. Amendments filed May 7, 2008; effective July 21, 2008. Public necessity rule filed September 8, 2008; effective through February 20, 2009. Amendment filed December 5, 2008; effective February 18, 2009. Amendment filed February 18, 2009; effective May 4, 2009. Amendments filed September 25, 2009; effective December 24, 2009. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendments filed May 27, 2010; effective August 25, 2010. Amendment filed July 1, 2013; effective September 29, 2013. Amendments filed October 3, 2013; effective January 1, 2014. Amendment filed December 23, 2014; effective March 23, 2015. Emergency rules filed July 1, 2016; effective through December 28, 2016. Amendment filed June 30, 2016; effective September 28, 2016. Amendments filed September 30, 2016; effective December 29, 2016. Amendments filed July 3, 2017; effective October 1, 2017. Amendments filed September 25, 2017; effective, December 24, 2017. Emergency rules filed April 15, 2021; effective through October 12, 2021. Amendments filed June 29, 2021; effective September 27, 2021. Amendments filed July 8, 2021; effective October 6, 2021. Amendments filed October 26, 2021; effective January 24, 2022. Emergency rules filed August 7, 2024; effective through February 3, 2025. Amendments filed September 11, 2024; effective December 10, 2024. Amendments filed November 4, 2024; effective February 2, 2025.

Tenn. Comp. R. & Regs. 1200-13-01-.31 .

1. Any and all medically necessary services may require prior authorization or approval by the MCC, except where prohibited by law.

2. An MCC shall not refuse to pay for a service solely because of a lack of prior authorization as follows:

(i) EPSDT services. MCCs shall provide all medically necessary, covered services regardless of whether the need for such services was identified by a provider whose services had received prior authorization from the MCC or by an in-network provider.

(ii) Emergency services. MCCs shall not require prior authorization or approval for covered services rendered in the event of an emergency, as defined in these rules. Such emergency services may be reviewed on the

basis of medical necessity or other MCC administrator requirements, but cannot be denied solely because the provider did not obtain prior authorization or approval from the enrollee’s MCC.

3. MCCs shall not impose any service limitations that are more restrictive than those described herein; however, this shall not limit the MCC’s ability to establish procedures for the determination of medical necessity.

4. Services for which there is no federal financial participation (FFP) are not covered.

5. Non-covered services are non-covered regardless of medical necessity.

(b) The following physical health and mental health benefits are covered under the TennCare managed care program. Benefits offered under the TennCare CHOICES program are also covered under the TennCare managed care program, as described in

Rule 1200-13-01-.05. Benefits offered under the ECF CHOICES program are also covered under the TennCare managed care program, as described in Rule 1200-13- 01-.31. There are some exclusions to the benefits listed below. The exclusions are listed in this rule and in Rule 1200-13-13-.10.

SERVICE BENEFIT FOR PERSONS

UNDER AGE 21

BENEFIT FOR PERSONS AGED 21

AND OLDER

1. Ambulance Services. See “Emergency Air and Ground Transportation” and “Non- Emergency Ambulance Transportation.”

See “Emergency Air and Ground Transportation” and “Non-Emergency Ambulance Transportation.”

2. Bariatric Surgery, defined as surgery to induce weight loss.

Covered as medically necessary. Covered as medically necessary.

3. Chiropractic Services [defined at 42 C.F.R. § 440.60(b)].

Covered as medically necessary. Covered as medically necessary.

4. Community Health Services, [defined at 42 C.F.R. § 440.20(b) and (c) and 42 C.F.R. § 440.90].

Covered as medically necessary. Covered as medically necessary.

5. Dental Services [defined at 42 C.F.R. § 440.100].

Preventive, diagnostic, and treatment services covered as medically necessary.

Dental services under EPSDT are provided in accordance with the state’s periodicity schedule as determined after consultation with recognized dental organizations and at other intervals as medically necessary.

Orthodontic services must be prior authorized by the Dental Benefits Manager (DBM).

Services from within each of the following categories are covered as medically necessary:

(A) Diagnostic x-rays and exams;

(B) Preventative cleanings;

(C) Topical fluoride treatments and caries arresting medicament;

(D) Restorative (fillings);

(E) Endodontics;

SERVICE BENEFIT FOR PERSONS

UNDER AGE 21

BENEFIT FOR PERSONS AGED 21

AND OLDER

Orthodontic services are only covered for individuals under age 21. Effective October 1, 2013, TennCare reimbursement for orthodontic treatment approved and begun before age 21 will end on the individual’s 21st birthday.

For individuals receiving treatment prior to October 1, 2013, such treatment may continue until completion as long as the enrollee remains eligible for TennCare.

Orthodontic treatment is not covered unless it is medically necessary to treat a handicapping malocclusion. Cleft palate, hemifacial microsomia, or mandibulofacial dysostosis shall be considered handicapping malocclusions.

A TennCare-approved Malocclusion Severity Assessment (MSA) will be conducted to measure the severity of the malocclusion. An MSA score of 28 or higher, as determined by the DBM’s dentist reviewer(s), will be used for making orthodontic treatment determinations of medical necessity. However, an MSA score alone cannot be used to deny orthodontic treatment.

Orthodontic treatment will not be authorized for cosmetic purposes.

Orthodontic treatment will be paid for by TennCare only as long as the individual remains eligible for TennCare.

The MCO is responsible for the provision of transportation to and from covered dental services, as well as the medical and anesthesia services related to the covered dental services.

(F) Scaling and root planing;

(G) Full mouth debridement;

(H) Crowns;

(I) Partial Dentures;

(J) Complete dentures;

(K) Immediate complete dentures and complete denture relines;

(L) Tooth extraction;

(M) Alveoloplasty;

(N) Removal of lateral exostosis;

(O) Removal of torus palatinus;

(P) Removal of torus mandibularis;

(Q) Palliative treatment; and (R) Nitrous oxide inhalation sedation.

A current list of the specific procedure codes covered within this rule and TennCare’s “Dental Office Reference Manual” shall be made available on the TennCare website at tn.gov/tenncare.

6. Durable Medical Equipment [defined at 42 C.F.R. § 440.70(b)(3)].

Covered as medically necessary. Covered as medically necessary.

SERVICE BENEFIT FOR PERSONS

UNDER AGE 21

BENEFIT FOR PERSONS AGED 21

AND OLDER

7. Emergency Air and Ground Transportation [defined at 42 C.F.R. § 440.170(a)(1) and (3)].

Covered as medically necessary. Covered as medically necessary.

8. EPSDT Services, [defined at 42 C.F.R. § 441, Subpart B].

Screening and interperiodic screening covered in accordance with federal regulations.

(Interperiodic screens are screens in between regular checkups which are covered if a parent or caregiver suspects there may be a problem.)

Diagnostic and follow-up treatment services covered as medically necessary and in accordance with federal regulations.

The periodicity schedule for child health screens is that set forth in the latest “American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care.”

All components of the screens must be consistent with the latest “American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care.”

Not applicable. (EPSDT is for persons under age 21.)

9. Health Home Services for Persons with Serious and Persistent Mental Illness [described at 42 U.S.C. § 1396w- 4(h)(4)].

Covered as medically necessary. Covered as medically necessary.

10. Home Health Care [defined at 42 C.F.R. § 440.70(a), (b), (c), and (e) and at Rule 1200- 13-13-.01].

Covered as medically necessary in accordance with the definition of Home Health Care at Rule

Tenn. Comp. R. & Regs. 1200-13-13-.09 THIRD PARTY RESOURCES

(1) Individuals applying for TennCare Medicaid or TennCare Standard coverage shall disclose the availability of any third party health care coverage to the agency responsible for determining the individual’s eligibility for TennCare.

(2) An individual enrolled in TennCare Medicaid or TennCare Standard shall disclose access to third party resources to his/her specified Managed Care Contractors as soon as s/he becomes aware of the existence of any third party resources.

(3) Managed Care Contractors under contract with the Tennessee Departments of Finance and Administration or Mental Health and Developmental Disabilities shall provide all third party resource information obtained from the plan’s enrollees to the Bureau of TennCare on a regular basis as required by their contracts.

(4) Managed Care Contractors shall enforce TennCare subrogation rights pursuant to T.C.A. § 71-5-117.

(5) Managed Care Contractors may pay health insurance premiums for their enrollees if such payments are determined by the Bureau to be cost effective.

(6) TennCare shall be the payor of last resort, except where contrary to federal or state law.

(7) Asset Disregards for Qualifying Long Term Care Insurance Policies:

(a) Individuals who purchase a qualified long term care insurance policy may have certain assets disregarded in the determination of eligibility for TennCare Medicaid. The Department of Human Services (DHS) shall disregard an individual’s assets up to the amount of payments made by the individual’s qualifying long-term care insurance policy for services covered under the policy at the time of TennCare application.

(b) The amount of the individual’s assets properly disregarded under these provisions shall continue to be disregarded through the lifetime of the individual.

(c) Assets which were disregarded for purposes of Medicaid eligibility determination during the person’s lifetime are also protected from estate recovery. When the amount of assets disregarded during the person’s lifetime was less than total benefits paid by the qualified long term care insurance policy, additional assets may be protected in the estate recovery process up to the amount of payments made by the individual’s qualifying long term care policy for services covered under the policy. If no assets were disregarded during the person’s lifetime, the personal representative may designate assets to protect from estate recovery up to the lesser of the two options specified above, even if a qualified long term care policy’s benefits were not completely exhausted.

(8) Upon enrollment in TennCare Medicaid or TennCare Standard an individual assigns to the Bureau any rights to third party insurance benefits to which the individual may be entitled.

(9) Upon accepting medical assistance, an enrollee in TennCare Medicaid or TennCare Standard shall be deemed to have made an assignment to the Bureau of the right to third party insurance benefits to which the enrollee may be entitled.

(10) The Bureau shall utilize direct billing when it is determined that a previously paid service may have been covered by a third party.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-117 and Executive Order No. 23.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-13- .09; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Amendment filed February 18, 2009; effective May 4, 2009. Amendment filed January 15, 2013; effective April 15, 2013.

Tenn. Comp. R. & Regs. 1200-13-13-.10 EXCLUSIONS

(1) General exclusions. The following items and services shall not be considered covered services by TennCare:

(a) Provision of medical assistance which is outside the scope of benefits as defined in these rules.

(b) Provision of services to persons who are not enrolled in TennCare, either on the date the services are delivered or retroactively to the date the services are delivered.

(c) Services for which there is no Federal Financial Participation (FFP).

(d) Services provided outside the United States or its territories.

(e) Services provided outside the geographic borders of Tennessee, including transportation to return to Tennessee to receive medical care except in the following circumstances:

1. Emergency medical services are needed because of an emergency medical condition;

2. Non-emergency urgent care services are requested because the recipient’s health would be endangered if he were required to travel, but only upon the explicit prior authorization of the MCC;

3. The covered medical service would not be readily available within Tennessee if the enrollee was physically located in Tennessee at the time of need and the covered service is explicitly prior authorized by the enrollee’s TennCare MCC; or 4. The out-of-state provider is participating in the enrollee’s MCC network.

(f) Investigative or experimental services or procedures including, but not limited to:

1. Drug or device that lacks FDA approval except when medically necessary as defined by TennCare;

2. Drug or device that lacks approval of facility’s Institutional Review Board;

3. Requested treatment that is the subject of Phase I or Phase II clinical trials or the investigational arm of Phase III clinical trials; or 4. A requested service about which prevailing opinion among experts is that further study is required to determine safety, efficacy, or long-term clinical outcomes of requested service.

(g) Services which are delivered in connection with, or required by, an item or service not covered by TennCare, including the transportation to receive such non-covered services, except that treatment of conditions resulting from the provision of noncovered services may be covered if medically necessary, notwithstanding the exclusions set out herein.

(h) Items or services furnished to provide a safe surrounding, including the charges for providing a surrounding free from exposure that can worsen the disease or injury.

(i) Non-emergency services that are ordered or furnished by an out-of-network provider and that have not been approved by the enrollee’s MCC. An exception exists for dually eligible enrollees. In-network care ordered by out-of-network providers is covered for dually eligible enrollees unless the MCO has informed such enrollee in advance of a request for a service that the specific service requires prior authorization and an order from an in-network provider.

(j) Services that are free to the public, with the exception of services delivered in the schools pursuant to the Individuals with Disabilities in Education Act (IDEA).

(k) Items or services ordered, prescribed, administered, supplied, or provided by an individual or entity that has been excluded from participation in the Medicaid program under the authority of the United States Department of Health and Human Services or the Bureau of TennCare.

(l) Items or services ordered, prescribed, administered, supplied, or provided by an individual or entity that is not licensed by the appropriate licensing board.

(m) Items or services outside the scope and/or authority of a provider’s specialty and/or area of practice.

(n) Items or services to the extent that Medicare or a third party payer is legally responsible to pay or would have been legally responsible to pay except for the enrollee’s or the treating provider’s failure to comply with the requirements for coverage of such services.

(o) Medical services for inmates confined in a local, state, or federal prison, jail, or other penal or correctional facility, including a furlough from such facility.

(p) Services delivered by a specific provider, even a provider who is an in-network provider with the enrollee’s managed care plan, when the managed care plan has offered the enrollee the services of a qualified provider who is available to provide the needed services.

(q) Items or services that are not covered by Medicare or a third party payer for an individual enrollee because the item or service is essentially equivalent to a Medicare or third party payer service that is being covered (e.g., home health services for individuals receiving hospice care).

(2) Exception to General and Specific Exclusions: COST EFFECTIVE ALTERNATIVE. As approved by CMS and/or authorized by Policy BEN 08-001, each MCC has sole discretionary

authority to provide certain cost effective alternatives when providing appropriate medically necessary care. These services are otherwise excluded and are not covered services unless the MCC has followed the procedures set forth in Policy BEN 08-001 and opts at its sole discretion to provide such requested item or service.

(3) Specific exclusions. The following services, products, and supplies are specifically excluded from coverage under the TennCare Section 1115 waiver program unless excepted by paragraph (2) herein. Some of these services may be covered under the CHOICES or ECF CHOICES programs or outside the managed care program under a Section 1915(c) Home and Community Based Services waiver when provided as part of an approved plan of care, in accordance with the appropriate approved TennCare Home and Community Based Services waiver.

(a) Services, products, and supplies that are specifically excluded from coverage except as medically necessary for children under the age of 21:

1. Audiological therapy or training 2. Beds and bedding equipment as follows:

(i) Powered air flotation beds, air fluidized beds (including Clinitron beds), water pressure mattress, or gel mattress For persons age 21 and older: Not covered unless a member has both severely impaired mobility (i.e., unable to make independent changes in body position to alleviate pain or pressure) and any stage pressure ulcer on the trunk or pelvis combined with at least one of the following: impaired nutritional status, fecal or urinary incontinence, altered sensory perception, or compromised circulatory status.

(ii) Bead beds, or similar devices (iii) Bed boards (iv) Bedding and bed casings (v) Ortho-prone beds (vi) Oscillating beds (vii) Springbase beds (viii) Vail beds, or similar bed 3. Biofeedback 4. Cushions, pads, and mattresses as follows:

(i) Aquamatic K Pads (ii) Elbow protectors (iii) Heat and massage foam cushion pads (iv) Heating pads (v) Heel protectors (vi) Lamb’s wool pads (vii) Steam packs 5. Diagnostic tests conducted solely for the purpose of evaluating the need for a service which is excluded from coverage under these rules.

6. Ear plugs 7. Food supplements and substitutes including formulas For persons 21 years of age and older: Not covered, except that Parenteral Nutrition formulas, Enteral Nutrition formulas for tube feedings and phenylalanine-free formulas (not foods) used to treat PKU, as required by T.C.A. § 56-7-2505, are covered for adults. In addition, oral liquid nutrition may be covered when medically necessary for adults with swallowing or breathing disorders who are severely underweight (BMI<15 kg/m ) and physically incapable of otherwise consuming a sufficient intake of food to meet basic nutritional requirements.

7. Hearing services, including the prescribing, fitting, or changing of hearing aids and cochlear implants 9. Humidifiers (central or room) and dehumidifiers 10. Inpatient rehabilitation facility services 11. Medical supplies, over-the-counter, as follows:

(i) Alcohol, rubbing (ii) Band-aids (iii) Cotton balls (iv) Eyewash (v) Peroxide (vi) Q-tips or cotton swabs 12. Nutritional supplements and vitamins, over-the-counter, except that prenatal vitamins for pregnant women and folic acid for women of childbearing age are covered 13. Orthodontic services, except as defined in Rule 1200-13-13-.04(1)(b)5. or 1200- 13-14-.04(1)(b)5.

14. Certain pharmacy items as follows:

(i) Agents when used for anorexia or weight loss, except for weight loss drugs when prescribed for treatment of obesity (ii) Agents when used to promote fertility (iii) Agents when used for cosmetic purposes or hair growth (iv) Agents when used for the symptomatic relief of cough and colds (v) Covered outpatient drugs which the manufacturer seeks to require as a condition of sale that associated tests or monitoring services be purchased exclusively from the manufacturer or its designee (vi) Nonprescription drugs (vii) Buprenorphine-containing products used for treatment of opiate addiction in excess of the covered amounts listed below:

(I) Dosage of sixteen milligrams (16 mg) per day for a period of up to six (6) months (183 days) from the initiation of therapy or from the conclusion of pregnancy, if the enrollee is pregnant during this initial maximum dosage therapy; and (II) Dosage of eight milligrams (8 mg) per day after the sixth (6th) month (183rd day) of therapy.

(viii) Sedative hypnotic medications in dosage amounts that exceed the dosage amounts listed below:

(I) Fourteen (14) pills per month for sedative hypnotic formulations in pill form such as Ambien and Lunesta;

(II) One hundred forty milliliters (140 ml) per month of chloral hydrate; or (III) One (1) bottle every sixty (60) days of Zolpimist.

(ix ) Allergy medications (x) Opioid products are restricted as set out in Rule .04(1)(c)12.

15. Purchase, repair, or replacement of materials or equipment when the reason for the purchase, repair, or replacement is the result of enrollee abuse 16. Purchase, repair, or replacement of materials or equipment that has been stolen or destroyed except when the following documentation is provided:

(i) Explanation of continuing medical necessity for the item, and (ii) Explanation that the item was stolen or destroyed, and (iii) Copy of police, fire department, or insurance report if applicable 17. Radial keratotomy 18. Reimbursement to a provider or enrollee for the replacement of a rented durable medical equipment (DME) item that is stolen or destroyed 19. Repair of DME items not covered by TennCare 20. Repair of DME items covered under the provider’s or manufacturer’s warranty 21. Repair of a rented DME item 22. Speech, language, and hearing services to address speech problems caused by mental, psychoneurotic, or personality disorders 23. Standing tables 24. Vision services for persons 21 years of age and older that are not needed to treat a systemic disease process including, but not limited to:

(i) Eyeglasses, sunglasses, and/or contact lenses for persons aged 21 and older, including eye examinations for the purpose of prescribing, fitting, or changing eyeglasses, sunglasses, and/or contact lenses; procedures performed to determine the refractive state of the eye(s); one pair of cataract glasses or lenses is covered for adults following cataract surgery (ii) LASIK (iii) Orthoptics (iv) Vision perception training (v) Vision therapy (b) Services, products, and supplies that are specifically excluded from coverage under the TennCare program.

1. Air cleaners, purifiers, or HEPA filters 2. Alcoholic beverages 3. Animal therapy including, but not limited to:

(i) Dolphin therapy (ii) Equine therapy (iii) Hippo therapy (iv) Pet therapy 4. Art therapy 5. Autopsy 6. Bathtub equipment and supplies as follows:

(i) Paraffin baths (ii) Sauna baths 7. Beds and bedding equipment as follows:

(i) Adjust-a-Beds, lounge beds, or similar devices (ii) Pillows (iii ) Waterbeds 8. Bioenergetic therapy 9. Body adornment and enhancement services including, but not limited to:

(i) Body piercing (ii) Breast augmentation (iii) Breast capsulectomy (iv) Breast implant removal that is not medically indicated (v) Ear piercing (vi) Hair transplantation, and agents for hair growth (vii) Tattoos or removal of tattoos (viii) Tongue splitting or repair of tongue splitting (ix) Wigs or hairpieces 10. Breathing equipment as follows:

(i) Intrapulmonary Percussive Ventilators (IPVs)

(ii) Spirometers, except for peak flow meters for medical management of asthma and incentive spirometers (iii) Vaporizers 11. Carbon dioxide therapy 12. Care facilities or services, the primary purpose of which is non-medical, including, but not limited to:

(i) Day care (ii) Evening care centers (iii) Respite care, except as a component of Mental Health Crisis Services benefits or Hospice Care benefits as provided at Rule 1200-13-13- .04(1)(b).

(iv) Rest cures (v) Social or diversion services related to the judicial system 13. Carotid body tumor, excision of, as treatment for asthma 14. Chelation therapy, except for the treatment of heavy metal poisoning or secondary hemochromatosis in selected settings. Chelation therapy for treatment of arteriosclerosis or autism is not covered. Chelation therapy for asymptomatic individuals is not covered. In the case of lead poisoning, the lead levels must be extremely high. For children, a minimum level of 45 ug/dl is recommended.

Because chelation therapy and its after-effects must be continuously monitored for possible adverse reactions, chelation therapy is covered only in inpatient or outpatient hospital settings, renal dialysis facilities, and skilled nursing facilities. It is not covered in an office setting, an ambulatory surgical center, or a home setting.

15. Clothing, including adaptive clothing 16. Cold therapy devices 17. Comfort and convenience items including, but not limited to:

(i) Corn plasters (ii) Garter belts (iii) Incontinence products (including, but not limited to, diapers, liners, and underpads) are not covered unless needed for a medical condition and are not covered for children age 3 and younger, except Infant Diapers as described in Rule .04.

(iv) Support stockings, when light or medium weight or prescribed for relief of tired or aching legs or treatment of spider/varicose veins. Surgical weight stockings prescribed by a doctor or other qualified licensed health care practitioner for the treatment of chronic foot/ankle swelling, venous insufficiencies, or other medical conditions and thrombo-embolic deterrent support stockings for pre- and post-surgical procedures are covered as medically necessary.

18. Computers, personal, and peripherals including, but not limited to printers, modems, monitors, scanners, and software, including their use in conjunction with an Augmentative Communication Device 19. Convalescent care.

19. Cosmetic dentistry, cosmetic oral surgery, and cosmetic orthodontic services 21. Cosmetic prosthetic devices 22. Cosmetic surgery or surgical procedures primarily for the purpose of changing the appearance of any part of the body to improve appearance or self-esteem, including scar revision. The following services are not considered cosmetic services:

(i) Reconstructive surgery to correct the results of an injury or disease (ii) Surgery to treat congenital defects (such as cleft lip and cleft palate) to restore normal bodily function (iii) Surgery to reconstruct a breast after mastectomy that was done to treat a disease, or as a continuation of a staged reconstructive procedure (iv) In accordance with Tennessee law, surgery of the non-diseased breast following mastectomy and reconstruction to create symmetrical appearance (v) Surgery for the improvement of the functioning of a malformed body member (vi) Reduction mammoplasty, when the minimum amount of breast material to be removed is equal to or greater than the 22nd percentile of the Schnur Sliding Scale based on the individual’s body surface area.

23. Dance therapy 24. Services provided solely or primarily for educational purposes, including, but not limited to:

(i) Academic performance testing (ii) Educational tests and training programs (iii) Habilitation (iv) Job training (v) Lamaze classes (vi) Lovaas therapy (vii) Picture illustrations (viii) Remedial education (ix) Sign language instruction (x) Special education (xi) Tutors 25. Encounter groups or workshops 26. Environmental modifications including, but not limited to:

(i) Air conditioners, central or unit (ii) Micronaire environmentals, and similar devices (iii) Pollen extractors (iv) Portable room heaters (v) Vacuum systems for dust filtering (vi) Water purifiers (vii) Water softeners 27. Exercise equipment including, but not limited to:

(i) Exercise equipment (ii) Exercycles (including cardiac use)

(iii) Functional electrical stimulation (iv) Gravitronic traction devices (v) Gravity guidance inversion boots (vi) Parallel bars (vii) Pulse tachometers (viii) Tilt tables when used for inversion (ix) Training balls (x) Treadmill exercisers (xi) Weighted quad boots 28. Food and food products (distinct from food supplements or substitutes, as defined in Rule 1200-13-13-.10(3)(a)10.), including but not limited to specialty food items for use in diets such as:

(i) Low-phenylalanine or phenylalanine-free (ii) Gluten-free (iii) Casein-free (iv) Ketogenic 29. Generators and auxiliary power equipment that may be used to provide power for covered medical equipment or for any purpose 30. Grooming services including, but not limited to:

(i) Barber services (ii) Beauty services (iii) Electrolysis (iv) Hairpieces or wigs (v) Manicures (vi) Pedicures 31. Hair analysis 32. Home health aide services or services from any other individual or agency that are for the primary purpose of safety monitoring 33. Home modifications and items for use in the home (i) Decks (ii) Enlarged doorways (iii) Environmental accessibility modifications such as grab bars and ramps (iv) Fences (v) Furniture, indoor or outdoor (vi) Handrails (vii) Meals (viii) Overbed tables (ix) Patios, sidewalks, driveways, and concrete slabs (x) Plexiglass (xi) Plumbing repairs (xii) Porch gliders (xiii) Rollabout chairs (xiv) Room additions and room expansions (xv) Telephone alert systems (xvi) Telephone arms (xvii) Telephone service in home (xviii) Televisions (xix) Tilt tables when used for inversion (xx) Toilet trainers and potty chairs. Positioning commodes and toilet supports are covered as medically necessary.

(xxi) Utilities (gas, electric, water, etc.)

34. Homemaker services 35. Hospital inpatient items that are not directly related to the treatment of an injury or illness (such as radios, TVs, movies, telephones, massage, guest beds, haircuts, hair styling, guest trays, etc.)

35. Hotel charges, unless pre-approved in conjunction with a transplant or as part of a non-emergency transportation service 37. Hypnosis or hypnotherapy 38. Infant/child car seats, except that adaptive car seats may be covered for a person with disabilities such as severe cerebral palsy, spina bifida, muscular dystrophy, and similar disorders who meets all of the following conditions:

(i) Cannot sit upright unassisted, and (ii) Infant/child care seats are too small or do not provide adequate support, and (iii) Safe automobile transport is not otherwise possible.

39. Infertility or impotence services including, but not limited to:

(i) Artificial insemination services (ii) Purchase of donor sperm and any charges for the storage of sperm (iii) Purchase of donor eggs, and any charges associated with care of the donor required for donor egg retrievals or transfers of gestational carriers (iv) Cryopreservation and storage of cryopreserved embryos (v) Services associated with a gestational carrier program (surrogate parenting) for the recipient or the gestational carrier (vi) Fertility drugs (vii) Home ovulation prediction kits (viii) Services for couples in which one of the partners has had a previous sterilization procedure, with or without reversal (ix) Reversal of sterilization procedures (x) Any other service or procedure intended to create a pregnancy (xi) Testing and/or treatment, including therapy, supplies, and counseling, for frigidity or impotence 40. Injections for the treatment of pain such as:

(i) Facet/medial branch injections for therapeutic purposes (ii) Medial branch injections for diagnostic purposes in excess of four (4) injections in a calendar year (iii) Trigger point injections in excess of four (4) injections per muscle trigger point during any period of six (6) consecutive months (iv) Epidural steroid injections in excess of three (3) injections during any period of six (6) consecutive months, except epidural injections associated with childbirth 41. Lamps such as:

(i) Heating lamps (ii) Lava lamps (iii) Sunlamps (iv) Ultraviolet lamps 42. Lifts as follows:

(i) Automobile van lifts (ii) Electric powered recliner, elevating seats, and lift chairs (iii) Elevators (iv) Overhead or ceiling lifts, ceiling track system lifts, or wall mounted lifts when installation would require significant structural modification and/or renovation to the dwelling (e.g., moving walls, enlarging passageways, strengthening ceilings and supports). The request for prior authorization must include a specific breakdown of equipment and installation costs, specifying all required structural modifications (however minor) and the cost associated thereto.

(v) Stairway lifts, stair glides, and platform lifts, including but not limited to Wheel-O-Vators 43. Ligation of mammary arteries, unilateral or bilateral 44. Megavitamin therapy 45. Motor vehicle parts and services including, but not limited to:

(i) Automobile controls (ii) Automobile repairs or modifications 46. Music therapy 47. Nail analysis 48. Naturopathic services 49. Necropsy 50. Organ and tissue transplants that have been determined experimental or investigational 51. Organ and tissue donor services provided in connection with organ or tissue transplants covered pursuant to Rule 1200-13-13-.04(1)(b)22., including, but not limited to:

(i) Transplants from a donor who is a living TennCare enrollee and the transplant is to a non-TennCare enrollee (ii) Donor services other than the direct services related to organ procurement (such as, hospitalization, physician services, anesthesia)

(iii) Hotels, meals, or similar items provided outside the hospital setting for the donor (iv) Any costs incurred by the next of kin of the donor (v) Any services provided outside of any “bundled rates” after the donor is discharged from the hospital 52. Oxygen, except when provided under the order of a physician and administered under the direction of a physician 53. Oxygen, preset system (flow rate not adjustable)

54. Certain pharmacy items as follows: DESI, LTE, and IRS drugs 55. Play therapy 56. Primal therapy 57. Prophylactic use of stainless steel crowns 58. Psychodrama 59. Psychogenic sexual dysfunction or transformation services 60. Purging 61. Recertification of patients in Level 1 and Level II Nursing Facilities 62. Recreational therapy 63. Religious counseling 64. Retreats for mental disorders 65. Rolfing 66. Routine health services which may be required by an employer; or by a facility where an individual lives, goes to school, or works; or by the enrollee’s intent to travel (i) Drug screenings (ii) Employment and pre-employment physicals (iii) Fitness to duty examinations (iv) Immunizations related to travel or work (v) Insurance physicals (vi) Job related illness or injury covered by workers’ compensation 67. Sensitivity training or workshops 68. Sensory integration therapy and equipment used in sensory integration therapy including, but not limited to:

(i) Ankle weights (ii) Floor mats (iii) Mini-trampolines (iv) Poof chairs (v) Sensory balls (vi) Sky chairs (vii) Suspension swings (viii) Trampolines (ix) Therapy balls (x) Weighted blankets or weighted vests 69. Sensory stimulation services 70. Services provided by immediate relatives, i.e., a spouse, parent, grandparent, stepparent, child, grandchild, brother, sister, half brother, half sister, a spouse’s parents or stepparents, or members of the recipient’s household, except that Home Health Services and Private Duty Nursing Services may be delivered by an immediate family member, provided that the immediate family member is a qualified provider for Home Health Services or Private Duty Nursing and otherwise meets the requirements for Participating Providers under this Chapter.

71. Sex change or transformation surgery 72. Sexual dysfunction or inadequacy services and medicine, including drugs for erectile dysfunctions and penile implant devices 73. Sitter services 74. Speech devices as follows:

(i) Phone mirror handivoice (ii) Speech software (iii) Speech teaching machines 75. Sphygmomanometers (blood pressure cuffs)

76. Stethoscopes 77. Supports: Cervical pillows 78. TENS (transcutaneous electrical nerve stimulation) units for the treatment of chronic lower back pain 79. Thermograms 80. Thermography 81. Time involved in completing necessary forms, claims, or reports 82. Tinnitus maskers 83. Toy equipment such as: Flash switches (for toys)

77. Transportation costs as follows:

(i) Transportation to a provider who is outside the geographical access standards that the MCC is required to meet when a network provider is available within such geographical access standards or, in the case of Medicare beneficiaries, transportation to Medicare providers who are outside the geographical access standards of the TennCare program when there are Medicare providers available within those standards (ii) Mileage reimbursement, car rental fees, or other reimbursement for use of a private vehicle unless prior authorized by the MCC in lieu of contracted transportation services (iii) Transportation back to Tennessee from vacation or other travel out-of-state in order to access non-emergency covered services (unless authorized by the MCC)

(iv) Any non-emergency out-of-state transportation, including airfare, that has not been prior authorized by the MCC. This includes the costs of transportation to obtain out-of-state care that has been authorized by the MCC. Out-of-state transportation must be prior authorized independently of out-of-state care.

85. Transsexual surgery 86. Urine drug testing that, within a calendar year, is in excess of twenty-four (24) presumptive urine drug tests using optical observation, and twelve (12) presumptive urine drug tests using instrument chemistry analyzers, and twelve (12) definitive drug urine tests 87. Vagus nerve stimulators, except after conventional therapy has failed in treating partial onset of seizures 88. Weight loss or weight gain and physical fitness programs including, but not limited to:

(i) Dietary programs of weight loss programs, including, but not limited to, Optifast, Nutrisystem, and other similar programs or exercise programs.

Food supplements will not be authorized for use in weight loss programs or for weight gain.

(ii) Health clubs, membership fees (e.g., YMCA)

(iii) Marathons, activity and entry fees (iv) Swimming pools 89. Wheelchairs and wheelchair accessories as follows:

(i) Wheelchairs defined by CMS as power operated vehicles (POVs), namely, scooters and devices with three (3) or four (4) wheels that have tiller steering and limited seat modification capabilities (i.e. provide little or no back support).

(ii) Standing wheelchairs. However a power standing system is covered as set out in the definition of Power Seating Accessories in Rule 1200-13-13-.01.

(iii) Stair climbing wheelchairs.

(iv) Recreational wheelchairs.

90. Whirlpools and whirlpool equipment such as:

(i) Action bath hydro massage (ii) Aero massage (iii) Aqua whirl (iv) Aquasage pump, or similar devices (v) Hand-D-Jets, or similar devices (vi) Jacuzzis, or similar devices (vii) Turbojets (viii) Whirlpool bath equipment (ix) Whirlpool pumps

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-208, 71-5-102, 71-5-105, 71-5-107, 71-5-109, 71-5-113, 71-5- 134, and 71-5-1404; 42 C.F.R. Part 431 Subpart E; 42 C.F.R. Part 438 Subpart F; Executive Order No. 23; Public Chapter 473, Acts of 2011; and 2025 Public Chapter No. 530.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-13-.10; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Repeal and new rule filed October 27, 2005; effective January 10, 2006. Public necessity rules filed May 3, 2006; effective through October 15, 2006. Public necessity rule filed May 3, 2006; effective through October 15, 2006. Amendment filed July 28, 2006; effective October 11, 2006. Public necessity rule filed February 2, 2007; effective through July 16, 2007. Amendment filed January 30, 2007; effective April 15, 2007. Amendment filed May 2, 2007; effective July 16, 2007. Amendment filed June 27, 2007; effective Sept 10, 2007. Amendment filed February 8, 2008; effective April 23, 2008. Amendment filed February 11, 2008; effective April 26, 2008. Amendment filed April 2, 2008; effective June 16, 2008. Amendments filed August 19, 2008; effective November 2, 2008. Amendment filed July 28, 2009; effective October 26, 2009. Amendment filed November 9, 2009; effective February 7, 2010. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendment filed May 27, 2010; effective August 25, 2010. Amendment filed October 26, 2010; effective January 24, 2011. Amendment filed December 14, 2010; effective May 31, 2011. Emergency rule filed July 1, 2011; effective through December 28, 2011. Emergency rule filed August 2, 2011; effective through January 29, 2012. Amendment filed September 23, 2011; effective December 22, 2011. Amendment filed October 28, 2011; effective January 26, 2012. Emergency rule filed September 27, 2013; effective through March 26, 2014. Amendment filed July 1, 2013; effective September 29, 2013. Amendment filed September 27, 2013; effective December 26, 2013. Amendment filed December 17, 2013; effective March 17, 2014. Amendments filed December 23, 2014; effective March 23, 2015. Emergency rule filed September 30, 2015; effective through March 28, 2016. Amendments filed December 29, 2015; effective March 28, 2016. Amendments filed December 30, 2015; effective March 29, 2016. Emergency rules filed June 24, 2016; effective through December 21, 2016. Emergency rules filed July 1, 2016; effective through December 28, 2016. Amendments filed September 13, 2016; effective December 12, 2016. Amendments filed September 30, 2016; effective December 29, 2016. Amendments filed September 25, 2017; effective December 24, 2017. Emergency rules filed January 16, 2018; effective through July 15, 2018. Amendments filed April 9, 2018; effective July 8, 2018. Amendments filed July 8, 2021; effective October 6, 2021. Amendments filed February 16, 2022; effective May 17, 2022. Emergency rules filed December 27, 2022 to become effective January 1, 2023; effective through June 30, 2023. Amendments filed January 19, 2023; effective April 19, 2023. Emergency rules filed August 7, 2024; effective through February 3, 2025. Amendments filed November 4, 2024; effective February 2, 2025. Emergency rules filed August 1, 2025; effective through January 28, 2026. Amendments filed July 7, 2025; effective October 5, 2025. Amendments filed October 28, 2025; effective January 26, 2026.

Tenn. Comp. R. & Regs. 1200-13-13-.11 APPEAL OF ADVERSE BENEFIT DETERMINATIONS

(1) Notice Requirements.

(a) When Written Notice is Required.

1. A written notice shall be given to an enrollee by his/her MCC of any adverse benefit determination.

2. A written notice shall be given to an enrollee of any MCC-initiated reduction, termination or suspension of inpatient hospital care.

3. A written notice shall be given to an enrollee of any provider-initiated reduction, termination or suspension.

4. Appropriate notice shall be given to an enrollee by the State or MCC when a claim for service or reimbursement is denied because an enrollee has exceeded a benefit limit. Such notice shall not be subject to the requirements of Rule 1200- 13-13-.11(1)(c)1. During the applicable time period for each benefit limit, such notice shall only be provided the first time a claim is denied because an enrollee has exceeded a benefit limit. The State or MCC will not be required to provide any notice when an enrollee is approaching or reaches a benefit limit.

5. Appropriate notice shall be given to an enrollee by a provider when an enrollee exceeds a non-pharmacy benefit limit in the following circumstances:

(i) The provider denies the request for a non-pharmacy service because an enrollee has exceeded the applicable benefit limit; or (ii) The provider informs an enrollee that the non-pharmacy service will not be covered by TennCare because he/she has exceeded the applicable benefit limit and the enrollee chooses not to receive the service.

During the applicable time period for each non-pharmacy benefit limit, providers shall only be required to issue this notice the first time an enrollee does not receive a nonpharmacy service from the provider because he/she has exceeded the applicable benefit limit. Such notice shall not be subject to the requirements of Rule 1200-13-13- .11(1)(c)1. Providers will not be required to issue any notice when an enrollee is approaching or reaches a non-pharmacy benefit limit.

(b) Timing of Written Notice.

1. Written notice of MCC-initiated reduction, termination or suspension of medical assistance must be provided to an enrollee within the time frames required by 42 C.F.R. §§ 431.210 - 431.214 (usually ten (10) days in advance). However, in instances of MCC-initiated reduction, termination or suspension of inpatient hospital treatment, the notice may be provided to an enrollee the same day of the proposed action. Where applicable and not in conflict with this rule, the exceptions set out at 42 C.F.R. §§ 431.211 - 431.214 permit or require reduction of the time frames within which advance notice must be provided.

2. An MCC must notify an enrollee of its decision in response to a request by or on behalf of an enrollee for prior authorization for medical or related services as set out in 42 C.F.R. § 438.210(d).

3. Written notice of delay of covered medical assistance must be provided to an enrollee immediately upon an MCC’s receipt of information leading it to expect that such delay will occur.

4. Written notice of provider-initiated reduction, termination or suspension of services must be provided to an enrollee in compliance with 42 C.F.R. §§ 431.211, 431.213 and 431.214.

5. Written notice is deemed to be provided to an enrollee upon deposit with the U.S.

Postal Service or other commercial mail carrier, or upon hand-delivery to an enrollee or his/her representative.

(c) Notice Contents.

1. Whenever this rule requires that a TennCare enrollee receive written notice of an adverse benefit determination, the notice must be readable and must comply with the requirements of 42 C.F.R. §§ 431.210 and 438.404.

2. Remedying of Notice. If a notice of adverse benefit determination provided to an enrollee does not meet the notice content requirements of Rule 1200-13-13- .11(1)(c)1., TennCare or the MCC may cure any such deficiencies by providing one corrected notice to enrollees. If a corrected notice is provided to an enrollee, the reviewing authority shall consider only the factual reasons and legal authorities cited in the corrected notice, except that additional evidence beneficial to the enrollee may be considered on appeal.

(2) Appeal Rights of Enrollees. Enrollees have the following rights:

(a) To appeal adverse benefit determinations.

(b) An enrollee’s request for appeal, including oral or written expressions by the enrollee, or on his behalf, of dissatisfaction or disagreement with adverse benefit determinations that have been made or are proposed to be made, may not be denied.

(c) To have the appeal rights that are prescribed by 42 C.F.R. Part 431, Subpart E and Tennessee Code Annotated §§ 4-5-301, et seq.

(d) To be allowed sixty (60) days from the date on the written notice or, if no notice is provided, from the time the enrollee becomes aware of an adverse benefit determination, to appeal any adverse benefit determination. To file a Request for Reimbursement for expenses incurred between the effective eligibility date and the date that notice of eligibility is provided, the enrollee must request reimbursement and provide complete information to TennCare, as prescribed by Rule .01, within sixty (60) days from the date of the written notification of the effective eligibility date or, if no written notice is provided, within sixty (60) days from the date the enrollee becomes aware of the effective eligibility date. For all other Requests for Reimbursement, the enrollee must request reimbursement and provide complete information, as prescribed by Rule .01, within sixty (60) days from the date the enrollee paid out of pocket for covered services.

(e) To appeal in person, by telephone, or in writing. Reasonable accommodations shall be made for any person with disabilities who requires assistance with his/her appeal, such as an appeal by TDD services or other communication device for people with disabilities. Written requests for appeals made at county TDHS offices shall be stamped and immediately forwarded to the TennCare Bureau for processing and entry in the central registry.

(f) For ongoing services, have the right to continuation or reinstatement of services, pursuant to 42 C.F.R. §§ 431.230 and 431.231 as modified by this rule, pending resolution of the appeal when the enrollee submits a timely appeal and timely request for COB. When an enrollee is so entitled to continuation or reinstatement of services, this right may not be denied for any reason, including:

1. An MCC’s failure to inform an enrollee of the availability of such continued services;

2. An MCC’s failure to reimburse providers for delivering services pending appeal; or 3. An MCC’s failure to provide such services when timely requested.

(g) To an appeals process. But for initial reconsideration by an MCC as permitted by this

rule, no person who is an employee, agent or representative of an MCC may participate in deciding the outcome of a SFH. No state official who was directly involved in the initial determination of the action in question may participate in deciding the outcome of an enrollee’s appeal.

(3) Special Provisions Relating to Appeals.

(a) Individualized Decisions Required. Neither the TennCare program nor its MCCs may employ utilization control guidelines or other quantitative coverage limits, whether explicit or de facto, unless supported by an individualized determination of medical necessity based upon the needs of each TennCare enrollee and his or her medical

history.

(b) Medical Evidence.

1. Appeal decisions must be based on an evaluation of pertinent medical evidence.

TennCare and the MCCs shall elicit from enrollees and their treating providers all pertinent medical records that support an appeal; and 2. Medical opinions shall be evaluated pursuant to TennCare Medical Necessity

Rule 1200-13-16. Reliance upon insurance industry guidelines or utilization control criteria of general application, without consideration of the individual enrollee’s medical history, does not satisfy this requirement and cannot be relied upon to support an adverse benefit determination.

(c) Record on Review. When TennCare receives an appeal from an enrollee regarding an adverse benefit determination, TennCare is responsible for obtaining from the MCC any and all records or documents pertaining to the MCC’s decision to take the contested action. TennCare shall correct any violation of this rule that is evident from a review of those records.

(d) Valid Factual Disputes. When TennCare receives an appeal from an enrollee, TennCare will dismiss this appeal unless the enrollee has established a valid factual dispute relating to an adverse benefit determination.

1. Processing of Appeals. TennCare shall screen all appeals submitted by TennCare enrollees to determine if the enrollees have presented a valid factual dispute. If TennCare determines that an enrollee failed to present a valid factual dispute, TennCare will immediately provide the enrollee with a notice, informing him/her that the enrollee must provide additional information as identified in the notice. If the enrollee does not provide this information, the appeal shall be dismissed without the opportunity for a state fair hearing within ten (10) days of the date of the notice. If the enrollee adequately responds to this notice, TennCare shall inform the enrollee that the appeal will proceed to a hearing. If the enrollee responds but fails to provide adequate information, TennCare will provide a notice to the enrollee, informing him/her that the appeal is dismissed without the opportunity for a state fair hearing. If the enrollee does not respond, the appeal will be dismissed without the opportunity for a state fair hearing, without further notice to the enrollee.

2. Information Required to Establish Valid Factual Disputes. In order to establish a valid factual dispute, TennCare enrollees must provide the following information:

Enrollee’s name; member SSN or TennCare ID#; address and phone; identification of the service or item that is the subject of the adverse benefit determination; and the reason for the appeal, including any factual error the enrollee believes TennCare or the MCC has made. For reimbursement and billing appeals, enrollees must also provide the date the service was provided, the name of the provider, copies of receipts which prove that the enrollee paid for the services or copies of a bill for the services, whichever is applicable.

(e) Appeals When Enrollees Lack a Prescription. When a TennCare enrollee attempts to lodge an appeal for a benefit for which the enrollee lacks a prescription, TennCare may require the enrollee to exhaust the following administrative process before an appeal can proceed:

1. TennCare will provide appropriate notice to the enrollee informing him/her that he/she will be required to complete an administrative process. Such administrative process requires the enrollee to contact the MCC to make an appointment with a provider to evaluate the request for the service. The MCC shall be required to make such appointment for the enrollee within a 3-week period or forty-eight (48) hours for urgent care from the date the enrollee contacts the MCC. Appeal timeframes will be tolled during this administrative process.

2. In order for this appeal to continue, the enrollee shall be required to contact TennCare after attending the appointment with a physician and demonstrate that he/she remains without a prescription for the service. If the enrollee fails to contact TennCare within sixty (60) days from the date of the notice described in subparagraph (e)1., TennCare will dismiss the appeal without providing an opportunity for a hearing for the enrollee.

(f) Appeals When No Adverse Benefit Determination Has Been Made. Enrollees shall not possess the right to appeal when no adverse benefit determination has been made. If enrollees request a hearing in this circumstance, their request shall be denied by the TennCare bureau without the opportunity for a hearing. Such circumstances include but are not limited to when enrollees appeal and no request for services had previously been denied.

(4) Hearing Rights of Enrollees.

(a) TennCare shall inform enrollees of their state fair hearing rights;

(b) Enrollees shall be entitled to a hearing before a hearing officer that affords each enrollee the right to:

1. Representation at the hearing by anyone of his/her choice, including a lawyer;

2. Review information and facts relied on for the decisions by the MCC and the TennCare Bureau before the hearing;

3. Cross-examine adverse witnesses;

4. Present evidence, including the right to compel attendance of witnesses at hearings;

5. Review and present information from his/her medical records;

6. Present evidence at the hearing challenging the adverse decision by his/her MCC;

7. Ask for an independent medical opinion, at no expense to the enrollee;

8. Continue or reinstate ongoing services pending a hearing decision, as specified in this rule;

9. A written decision setting out the hearing officer’s rulings on findings of fact and conclusions of law; and 10. Resolution, including a hearing before a hearing officer if the case has not been previously resolved in favor of the enrollee, pursuant to 42 C.F.R. § 431.244.

(c) TennCare shall not impair the ability of an enrollee to appeal an adverse hearing decision by requiring that the enrollee bear the expense of purchasing a hearing transcript when such purchase would be a financial hardship for the enrollee.

(d) Parties to an Appeal. Under this rule, the parties to a state fair hearing are limited to the enrollee and TennCare, permitted by federal regulations as modified by CMS letter dated June 5, 2017. The purpose of the hearing is to focus on the enrollee’s medical needs.

(e) Consistent with the Code of Judicial Conduct, hearing officers shall assist pro se enrollees in developing the factual record and shall have authority to order second medical opinions at no expense to the enrollee.

(f) Review of Hearing Decisions.

1. Hearing officers shall promptly issue an Order of their decision. Any Order delivered orally from the bench in an expedited hearing by a hearing officer shall be effective immediately as to the provision or denial of benefits. In accordance with 42 C.F.R. Part 431 Subpart E and 42 C.F.R. Part 438 Subpart F, the hearing officer shall enter a written order as soon as practicable and shall provide the parties with copies of such Orders. The time for appealing any oral Order shall not begin to run until entry of the written Order.

2. The TennCare Bureau shall have the opportunity to review all decisions of hearing officers, in accordance with T.C.A. §§ 4-5-314 and 4-5-315, to determine whether such decisions are contrary to applicable law, regulations or policy interpretations, which shall include but not be limited to decisions regarding the defined package of covered benefits, determinations of medical necessity and decisions based on the application of this chapter and 42 C.F.R. Part 431

Subpart E and 42 C.F.R. Part 438 Subpart F.

(i) If TennCare modifies or overturns the decision of the hearing officer, TennCare shall issue a written decision that will be provided to the enrollee and the hearing officer. TennCare’s decision shall constitute final agency action.

(ii) If TennCare does not modify or overturn the decision of the hearing officer, the hearing officer’s decision shall constitute final agency action without additional notice to the enrollee.

(iii) Review of final agency action shall be available to enrollees pursuant to T.C.A. § 4-5-322.

(iv) A hearing officer’s decision in an enrollee’s appeal shall not be deemed precedent for future appeals.

(g) Continuation or Reinstatement of TennCare Services.

1. As permitted under 42 C.F.R. §§ 431.230, 431.231 and 438.420, if required or if the enrollee requests, TennCare services shall continue or be reinstated until the earlier of dismissal of the appeal through the valid factual dispute process, enrollee’s withdrawal of the appeal, or an initial hearing decision adverse to the enrollee.

2. In the case of a timely request for continuation or reinstatement of the TennCare services described in paragraph (4)(g)1. above, the services shall continue or be reinstated only if and to the extent prescribed by the enrollee’s treating clinician.

3. Notwithstanding the requirements of this part, TennCare enrollees are not entitled to continuation or reinstatement of services pending an appeal related to the following:

(i) When a service is denied because the enrollee has exceeded the benefit limit applicable to that service;

(ii) When a request for prior authorization is denied for a prescription drug, with the exception of:

(I) Pharmacists shall provide a single 72-hour interim supply in emergency situations for the non-authorized drug, unless such supply would exceed applicable pharmacy benefit limits; or (II) When the drug has been prescribed on an ongoing basis or with unlimited refills and becomes subject to prior authorization requirements.

(iii) When coverage of a prescription drug or service is denied because the requested drug or service is not a category or class of drugs or services covered by TennCare;

(iv) When coverage for a prescription drug is denied because the enrollee has been locked into one pharmacy and the enrollee seeks to fill a prescription at another pharmacy;

(v) When a request for reimbursement is denied and the enrollee appeals this denial;

(vi) When a physician has failed to prescribe or order the service or level of service for which continuation or reinstatement is requested; or (vii) If TennCare had not paid for the type and amount of service for which continuation or reinstatement is requested prior to the appeal.

(h) Reserved.

(5) Reserved.

(6) Release of Enrollees’ Medical Records.

(a) When a request is made, by or on behalf of a TennCare enrollee, for approval of a TennCare service or for an appeal of an adverse benefit determination, the enrollee is deemed to have consented to release of his/her relevant medical records to his/her MCC and the TennCare Bureau for the purposes of acting upon the enrollee’s request.

(b) Providers shall promptly provide copies of an enrollee’s medical records to the enrollee’s MCC(s) and to the TennCare Bureau upon being informed by the MCC(s) or TennCare Bureau that the records have been requested for the purpose of acting upon an enrollee’s request for approval of a TennCare service or an enrollee’s appeal of an adverse benefit determination.

(c) An enrollee’s consent to release of his/her medical records may be evidenced by his signature (or his provider’s or authorized representative’s signature) upon the enrollee’s initial application for TennCare, upon his TennCare appeal form or other written request for authorization or appeal, or, in the event of an appeal by telephone, by a TennCare Bureau employee’s signing of an appeal form on behalf of an enrollee with documentation of consent to do so.

(d) The medical records obtained by MCCs and the TennCare Bureau under this rule remain confidential. MCCs and the TennCare Bureau may use and disclose the records only as necessary in their consideration of the enrollee’s request for approval of a TennCare service or the enrollee’s appeal of an adverse benefit determination.

(7) Time Requirements.

(a) MCCs must act upon a request for prior authorization as provided in 42 C.F.R. § 438.210.

(b) MCCs must complete reconsideration of standard appeals within fourteen (14) calendar days of the request from TennCare. MCCs must complete reconsideration of expedited appeals within seventy-two (72) hours of the request for SFH.

(c) All standard and expedited appeals not previously resolved in favor of the enrollee during reconsideration, shall be set for hearing before a hearing officer, and shall be resolved pursuant to the timeframes set forth in 42 C.F.R. § 431.244. In accordance with 42 C.F.R. § 438.410(a) and 42 C.F.R. § 431.244(f)(2), SFH requests which are approved for expedited resolution and which are not resolved in the enrollee’s favor during MCC’s reconsideration, shall be resolved by TennCare within three (3) working days from the date of the MCC’s reconsideration determination. TennCare is not charged with any delays attributable to the enrollee.

(d) In no circumstance will a directive be issued by the TennCare Bureau or a hearing officer to provide a service to an enrollee if, when the appeal is resolved, the service is no longer covered by TennCare for the enrollee. A directive also will not be issued by the TennCare Bureau if the service cannot reasonably be provided to the enrollee before the date when the service is no longer covered by TennCare for the enrollee.

(8) Reserved.

(9) Special Provisions Relating to Children in State Custody. Children in the custody of the State have the rights and protections established by 42 C.F.R. Part 431, Subpart E regarding TennCare services and benefits.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 71-5-105, 71-5-109, and 71-5-113; 42 C.F.R. Part 431 Subpart E; 42 C.F.R. Part 438 Subpart F; and Executive Order No. 23.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-13-.11; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Public necessity rule filed May 5, 2005; effective through October 17, 2005. Public necessity rule filed July 29, 2005; effective through January 10, 2006. Amendments filed July 28, 2005; effective October 11, 2005. Public necessity rule filed December 29, 2005; expired June 12, 2006. On June 13, 2006, affected rules reverted to status on December 28, 2005. Amendments filed October 27, 2005; effective January 10, 2006. However, Notice of Withdrawal of permanent rule amendments (1)(d)3., (1)(d)4., (4)(g)6., (5)(a)5., (5)(e), (5)(f), and (7)(h) filed and effective January 6, 2006 (to have been effective January 10, 2006). Public necessity rule filed May 17, 2006; effective through October 29, 2006. Amendments filed March 31, 2006; effective June 14, 2006. Amendment filed August 14, 2006; effective October 28, 2006. Public necessity rule filed December 1, 2006; effective through May 15, 2007. Amendment filed March 1, 2007; effective May 15, 2007. Amendment filed August 19, 2008; effective November 2, 2008. Amendment filed September 30, 2009; effective December 29, 2009. Amendment filed October 26, 2010; effective January 24, 2011. Emergency rule filed July 1, 2011; effective through December 28, 2011. Amendment filed September 23, 2011; effective December 22, 2011. Amendments filed September 27, 2013; effective December 26, 2013. Amendments filed September 25, 2017; effective December 24, 2017. Amendments filed July 8, 2021; effective October 6, 2021.

Tenn. Comp. R. & Regs. 1200-13-13-.12 OTHER APPEALS BY TENNCARE APPLICANTS AND ENROLLEES

Notwithstanding Rule 1200-13-19-.01, or any rule to the contrary, appeals by applicants and enrollees of all non-medical eligibility matters are removed to Rule Chapter 1200-13-19, effective upon expiration of the TDHS contract to determine eligibility matters.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-209, 71-5-105, 71-5-109, and 71-5-113; 42 C.F.R. Part 431 Subpart E; 42 C.F.R. Part 438 Subpart F; and Executive Order No. 23.
• Administrative History: Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-13-.12; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Public necessity rule filed June 8, 2005; effective through November 20, 2005. Amendment to public necessity rule filed July 6, 2005; effective through November 20, 2005. Amendment filed September 6, 2005; effective November 20, 2005. Amendments filed September 25, 2017; effective December 24, 2017.

Tenn. Comp. R. & Regs. 1200-13-13-.13 MEMBER ABUSE OR OVERUTILIZATION OF THE TENNCARE PHARMACY

PROGRAM.

(1) The Bureau is authorized to implement and maintain a Pharmacy Lock-in Program designed to address member Abuse or Overutilization. Activities which may indicate Abuse or Overutilization justifying placement on Lock-in Status or Prior Authorization Status (PA Status) include, but are not limited to, the following:

(a) Forging or altering a prescription for drugs.

(b) Selling TennCare paid prescription drugs.

(c) Visiting multiple prescribers or pharmacies to obtain controlled substances.

(d) Trading, swapping or selling a TennCare card.

(e) Failing to promptly report the loss or theft of a TennCare card.

(f) Forging or altering a TennCare card.

(g) Knowingly providing false, incomplete, inaccurate or erroneous information to provider(s) in order to receive covered services for which the member is ineligible.

(h) Permitting the use of a TennCare card by anyone other than the member to whom the card is assigned in order to receive or attempt to receive services.

(2) The TennCare Pharmacy Lock-in Program shall be administered by the Bureau. Monitoring of enrollee activities listed in Paragraph (1) shall be conducted by the Bureau, the MCCs, including the PBM, and the Tennessee Office of Inspector General (OIG). When an enrollee has been identified as having participated in any Abuse or Overutilization activities, including, but not limited to, the activities listed in Paragraph (1), the enrollee’s name shall be referred to the Bureau as appropriate for the Pharmacy Lock-in Program as follows:

(a) Any enrollee who has been identified by the OIG as having been convicted of TennCare Fraud or a drug-related offense.

(b) Any enrollee who has been arrested for or charged with TennCare Fraud.

(c) Any enrollee who has been arrested for or charged with a drug-related offense.

(d) Any enrollee who has obtained multiple controlled substance prescriptions over a ninety (90) day period when the prescriptions were filled by three (3) or more different pharmacies and written by three (3) or more different prescribers.

(3) Pharmacy Lock-in Program procedures shall include:

(a) A determination to place an enrollee who has been referred as appropriate for the Pharmacy Lock-in Program on Lock-in Status shall be made by the TennCare Pharmacy Director or designee after the enrollee’s relevant pharmacy claims data has been reviewed by clinical staff.

(b) Any enrollee determined to be appropriate for the Pharmacy Lock-in Program shall be notified by the Bureau or the MCC prior to the imposition of Lock-in Status. The notice shall include a brief explanation of the Pharmacy Lock-in Program, the reason for the determination to place the enrollee on Lock-in Status, the date the Lock-in Status will become effective, and the information necessary for the enrollee to appeal the decision of the Bureau, pursuant to Rule 1200-13-13-.11. If the enrollee has an authorized representative on file on their profile, the notice shall be sent to the enrollee’s authorized representative.

(c) If an enrollee fails to appeal placement in the Pharmacy Lock-in Program or an appeal is not resolved in his favor, the enrollee will be provided TennCare pharmacy services only at the Lock-in Provider to which the enrollee is assigned.

(d) Any enrollee who has a diagnosis of malignant neoplasm or sickle cell disease (or sickle cell related disorders outlined in Subpart (iv) of Part 12. of Subparagraph (c) of Paragraph (1) of this rule) shall not be placed in the Pharmacy Lock-in Program. Any enrollee currently in the Pharmacy Lock-in Program shall be removed from the Pharmacy Lock-in Program if the enrollee’s medical records indicate one of these diagnoses. However, this exception shall not apply if the enrollee has been arrested for, charged with, or convicted of an activity outlined in Paragraph (1) of this rule (1200- 13-13-.13(1)), or been convicted of TennCare Fraud.

(4) Lock-in Provider selection. A pharmacy will qualify for and may be selected by the enrollee as a Lock-in Provider only if it meets all the following criteria:

(a) It is enrolled in the TennCare Pharmacy Network;

(b) It is within the State of Tennessee;

(c) It is a full-service pharmacy that carries all medications normally carried by pharmacies;

(d) It is not a mail order or specialty pharmacy;

(e) It is not a Targeted Pharmacy;

(f) It is a single pharmacy location at a specific address. A chain pharmacy may be selected but only the specific named location may be used, not multiple locations or outlets of the chain; and (g) It is in proximity to the enrollee’s residence, which must be the current address on file with the Bureau. If no pharmacy is available within fifteen (15) miles of the enrollee’s residence, reasonable efforts shall be made to use the nearest qualifying pharmacy.

(5) After twelve (12) months a member may request a change of Lock-in Provider once each year. Additional changes are limited to the following reasons:

(a) The member has moved and his new address is at least fifteen (15) miles from the lock-in pharmacy and he has updated his address with the Bureau.

(b) The member’s lock-in pharmacy has permanently closed.

(c) The member’s lock-in pharmacy has voluntarily dismissed the enrollee from its practice and has notified the Bureau and the PBM.

(d) The Bureau may, at its sole discretion, determine that there is a compelling need to change the member’s lock-in pharmacy.

(6) Review of Lock-in Status. The Bureau or the MCC shall periodically review the claims information of members on Lock-in Status to determine the need for continued lock-in or escalation to Prior Authorization Status. This review shall occur at least one time annually.

(a) Lock-in Status will be discontinued if the Bureau determines that a member has met all of the following criteria for at least six (6) consecutive months:

1. Has not received any opioid medications while on buprenorphine-containing products for addiction, unless it is established that opioid use was/is appropriate according to the enrollee’s provider of addiction therapy.

2. Has received TennCare reimbursed controlled substance prescriptions from only one (1) provider, except under the following:

(i) If the enrollee is under the care of two (2) providers, and claims data shows consistent, appropriate use of controlled substances within standards of care from both providers, an exception may be made if both providers acknowledge in writing that they are aware of the other provider’s care and prescribing and agree that the enrollee is being treated appropriately within standards of care.

(ii) Enrollees with claims from multiple providers all in the same practice or in different locations within the same practice will be considered to have used one (1) provider.

(iii) Enrollees with claims from multiple BESMART providers will be considered to have used one (1) provider.

3. Has received TennCare reimbursed prescriptions from only one (1) pharmacy.

However, if the enrollee has changed his or her pharmacy by requesting a Lockin Provider change that was approved by the Bureau during the review period, an exception may be made to consider the enrollee as having used one (1) pharmacy.

(b) If a member is removed from Lock-in Status, the Bureau or the MCC will monitor the member for changes in utilization patterns and return him to Lock-in Status if appropriate under Paragraphs (1)–(3).

(7) Prior Authorization Status (PA Status).

(a) A member against whom criminal process alleging TennCare Fraud has been issued or who has been convicted of TennCare Fraud shall automatically be placed on PA Status.

(b) Lock-in Status shall be escalated to PA Status if a member on Lock-in Status meets three (3) of the following criteria over a 90 day period:

1. Has filled prescriptions for controlled substances at three (3) or more pharmacies. However, if the enrollee has changed his or her pharmacy by requesting a Lock-in Provider change that was approved by the Bureau during the review period, an exception may be made to consider the enrollee as having used one (1) pharmacy.

2. Has received controlled substance prescriptions from three (3) or more prescribers, except under the following:

(i) If the enrollee is under the care of two (2) providers, and claims data shows consistent, appropriate use of controlled substances within standards of care from both providers, an exception may be made if both providers acknowledge in writing that they are aware of the other provider’s care and prescribing and agree that the enrollee is being treated appropriately within standards of care.

(ii) Enrollees with claims from multiple providers all in the same practice or in different locations within the same practice will be considered to have used one (1) provider.

(iii) Enrollees with claims from multiple BESMART providers will be considered to have used one (1) provider.

3. Has received an opioid prescription while receiving buprenorphine-containing products for addiction, unless it is established that opioid use was/is appropriate according to the enrollee’s provider of addiction therapy.

(c) A member who has been treated in a hospital emergency department for an overdose of an illicit controlled substance, as identified in the most recently available TennCare diagnosis data, shall automatically be placed on PA Status.

(8) Review of Prior Authorization Status (PA Status). The Bureau or the MCC shall periodically review the claims information of members on PA Status to determine the need for continued PA Status.

(a) PA Status for enrollees will be discontinued if TennCare determines that a member has met all of the following criteria for at least six (6) consecutive months:

1. Has not received any opioid medications while on buprenorphine-containing products for addiction, unless it is established that opioid use was/is appropriate according to the enrollee’s provider of addiction therapy.

2. Has received TennCare reimbursed controlled substance prescriptions from only one (1) provider, except under the following:

(i) If the enrollee is under the care of two (2) providers, and claims data shows consistent, appropriate use of controlled substances within standards of care from both providers, an exception may be made if both providers acknowledge in writing that they are aware of the other provider’s care and prescribing and agree that the enrollee is being treated appropriately within standards of care.

(ii) Enrollees with claims from multiple providers all in the same practice or in different locations within the same practice will be considered to have used one (1) provider.

(iii) Enrollees with claims from multiple BESMART providers will be considered to have used one (1) provider.

3. Has received TennCare reimbursed prescriptions from only one (1) pharmacy.

However, if the enrollee has changed his or her pharmacy by requesting a Lockin Provider change that was approved by the Bureau during the review period, an exception may be made to consider the enrollee as having used one (1) pharmacy.

(b) Enrollees removed from PA Status remain in the Pharmacy Lock-in Program and are required to qualify for removal from the Pharmacy Lock-in Program after a re-review of their prescription claims as described in Paragraph (6) of this rule. If an enrollee is removed from PA Status, TennCare or the MCC will monitor the enrollee for changes in utilization patterns and return the enrollee to PA Status if appropriate under Paragraph (7).

(c) Enrollees who are not eligible for review of PA Status:

1. When the Bureau has been notified by OIG that an enrollee has been identified as having participated in any Abuse or Overutilization activities, including but not limited to the activities listed in Paragraph (1) of this rule, then that enrollee is not eligible for review of PA Status.

2. An enrollee who has been convicted of TennCare Fraud is not eligible for review of PA Status.

3. If an enrollee was charged or arrested for TennCare Fraud, the enrollee is not eligible for PA Status review pending the final resolution of the charge or allegation. If the enrollee’s TennCare Fraud charges are dismissed or if the enrollee is otherwise not convicted of TennCare Fraud and that TennCare Fraud charge was the sole basis for the enrollee’s Lock-in Status, all Pharmacy Lock-in Program and PA Status edits will be terminated on the day that the TennCare Fraud charge was closed.

(9) Emergency pharmacy services may be obtained with a TennCare or MCC override of a member’s Lock-in Status. The PBM has clinical staff available at all times to respond to emergency situations. The PBM must verify that a genuine emergency exists, such as documented proof from the lock-in pharmacy that it is temporarily out of stock of a needed medication. A lock-in override will not be provided simply because a pharmacy is closed for the day unless a true medical emergency exists.

History

• Authority: T.C.A. §§ 4-3-1013, 4-5-202, 4-5-203, 71-5-105, 71-5-109, 71-5-146, 71-5-197, and 71-5-198 and Executive Order No. 23.
• Administrative History: Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-13-.13; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Public necessity rule filed December 29, 2005; expired June 12, 2006. On June 13, 2006, affected rules reverted to status on December 28, 2005. Repeal and new rule filed March 31, 2006; effective June 14, 2006. Amendment filed October 3, 2013; effective January 1, 2014. Amendments filed December 29, 2015; effective March 28, 2016. Amendments filed September 11, 2024; effective December 10, 2024.

Tenn. Comp. R. & Regs. 1200-13-13-.14 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, and 71-5-109 and Executive Order No. 23.
• Administrative History: Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule

Chapter 1200-13-14 TennCare Standard

Tenn. Comp. R. & Regs. 1200-13-14-.01 for a definition of who may be an escort.

22. Occupational Therapy [defined at 42 C.F.R. § 440.110(b)].

Covered as medically necessary, by a Licensed Occupational Therapist, to restore, improve, stabilize or ameliorate impaired functions.

Covered as medically necessary, by a Licensed Occupational Therapist, to restore, improve, or stabilize impaired functions.

23. Organ and Tissue Transplant Services and Donor Organ/Tissue Procurement Services [defined as Covered as medically necessary.

Experimental or investigational transplants are not covered.

Covered as medically necessary when coverable by Medicare.

Experimental or investigational transplants are not covered.

SERVICE BENEFIT FOR PERSONS UNDER

AGE 21

BENEFIT FOR PERSONS AGED 21 AND

OLDER the transfer of an organ or tissue from an individual to a TennCare enrollee].

24. Outpatient Hospital Services [defined at 42 C.F.R. § 440.20(a)].

Covered as medically necessary. Covered as medically necessary.

25. Outpatient Mental Health Services (including Physician Services), [defined at 42 C.F.R. § 440.20(a), 42 C.F.R. § 440.50, and 42 C.F.R. § 440.90].

Covered as medically necessary. Covered as medically necessary.

26. Pharmacy Services [defined at 42 C.F.R. § 440.120(a) and obtained directly from an ambulatory retail pharmacy setting, outpatient hospital pharmacy, mail order pharmacy, or those administered to a long-term care facility (nursing facility) resident].

Covered as medically necessary.

Certain drugs (known as DESI, LTE, IRS drugs) are excluded from coverage.

Pharmacy services are the responsibility of the PBM, except for pharmaceuticals supplied and administered in a doctor’s office, which are the responsibility of the MCO.

For TennCare Standard children under age 21 who are Medicare beneficiaries, TennCare pays for medically necessary outpatient prescription drugs when they are covered by TennCare but not by Medicare Part D. Pharmaceuticals supplied and administered in a doctor’s office to persons under age 21 are the responsibility of the MCO if not covered by Medicare.

(A) Covered as follows, subject to the limitations set out below. Certain drugs known as DESI, LTE or IRS drugs are excluded from coverage. Persons dually eligible for TennCare Standard and Medicare will receive their pharmacy services through Medicare Part D.

(B) Pharmacy services are the responsibility of the PBM, except for pharmaceuticals supplied and administered in a doctor’s office.

(C) For non-Medicare enrollees in the CHOICES 217-Like Group, the CHOICES 1 and 2 Carryover Group, adults age 21 and older enrolled in ECF CHOICES who meet nursing facility level of care or transitioned from a Section 1915(c) waiver into ECF CHOICES and granted an exception by TennCare based on ICF/IID level of care, and the PACE Carryover Group, covered with no quantity limits on the number of prescriptions per month.

(D) For hospice patients, drugs used for the relief of pain and symptom control related to their terminal illness are covered as part of the hospice benefit. If the patient is not a Medicare beneficiary, pharmacy services needed for conditions unrelated to the terminal illness are covered by TennCare.

There are no quantity limits on the number of prescriptions per month covered by TennCare if the hospice patient is receiving TennCare-reimbursed room and board in a Nursing Facility. If the patient is receiving SERVICE BENEFIT FOR PERSONS UNDER AGE 21 BENEFIT FOR PERSONS AGED 21 AND OLDER hospice services at home or in a residential hospice, coverage of pharmacy services is as described in sections (C) and (E).

(E) For all other non-Medicare enrollees, coverage is limited to no more than two (2) brand name prescriptions and/or refills per enrollee per month. Additional brand name drugs for these enrollees shall not be covered except as specified in (G) and (H) below. There is no quantity limit on the number of covered generic drugs.

(F) Prescriptions shall be counted beginning on the first day of each calendar month. Each prescription and/or refill counts as one (1).

(G) TennCare shall maintain an Automatic Exemption List of medications which shall not count against such limit. TennCare may modify the Automatic Exemption List at its discretion. The most current version of the Automatic Exemption List will be made available to enrollees via the internet on the TennCare website at www.tn.gov/tenncare and upon request by calling TennCare Connect at the toll-free number in the Member Handbook. The medications that are specified on the current version of the Automatic Exemption List on the date of service shall be considered exempt from applicable prescription limits.

(H) TennCare may also maintain a Prescriber Attestation List of medications available when the prescriber attests to an urgent need. TennCare may include certain drugs or categories of drugs on the list, and may maintain and make available to physicians, providers, pharmacists and the public, a list that shall indicate the drugs or types of drugs TennCare has determined to include. Drugs on the Prescriber Attestation List may be approved for enrollees who have already met an applicable benefit limit only if the prescribing professional seeks and obtains a special exemption. In order to obtain a special exemption, the prescribing provider must submit an attestation as directed by TennCare regarding the urgent need for the drug.

TennCare will approve the prescribing provider’s determination that the criteria for SERVICE BENEFIT FOR PERSONS UNDER AGE 21 BENEFIT FOR PERSONS AGED 21 AND OLDER the special exemption are met, without further review, within 24 hours of receipt.

Enrollees will not be entitled to a hearing regarding their eligibility for a special exemption if (i) the prescribing provider has not submitted the required attestation, or (ii) the requested drug is not on the Prescriber Attestation List. At its discretion, TennCare may combine the Prescriber Attestation List with the Automatic Exemption List and thereby suspend the requirement that prescribing providers seek a special exemption. In so doing, TennCare will treat the drugs on the Prescriber Attestation List as if they appeared on the Automatic Exemption List, and thus, those drugs will also be exempt from the applicable prescription limits. TennCare must specify on its website the decision to combine the Prescriber Attestation List with the Automatic Exemption List.

(I) Over-the-counter (OTC) drugs for TennCare adults are not covered even if the enrollee has a prescription for such service, unless the drug is listed on the “Covered OTC Drug List” that is available on the TennCare website located at www.tn.gov/tenncare on the date of service.

27. Physical Therapy [defined at 42 C.F.R. § 440.110(a)].

Covered as medically necessary, by a Licensed Physical Therapist, to restore, improve, stabilize or ameliorate impaired functions.

Covered as medically necessary, by a Licensed Physical Therapist, to restore, improve, or stabilize impaired functions.

28. Physician Inpatient Services [defined at 42 C.F.R. § 440.50].

Covered as medically necessary. Covered as medically necessary.

29. Physician Outpatient Services/Community Health Clinics/Other Clinic Services [defined at 42 C.F.R. § 440.20(b), 42 C.F.R. § 440.50, and 42 C.F.R. § 440.90].

Covered as medically necessary.

Services provided by a Primary Care Provider when the enrollee has a primary behavioral health diagnosis (ICD-9-CM 290.xx- 319.xx) are the responsibility of the MCO.

Medical evaluations provided by a neurologist, as approved by the MCO, and/or an emergency room provider to establish a primary behavioral health diagnosis are the responsibility of the MCO.

Covered as medically necessary.

Services provided by a Primary Care Provider when the enrollee has a primary behavioral health diagnosis (ICD-9-CM 290.xx-319.xx) are the responsibility of the MCO.

Medical evaluations provided by a neurologist, as approved by the MCO, and/or an emergency room provider to establish a primary behavioral health diagnosis are the responsibility of the MCO.

SERVICE BENEFIT FOR PERSONS UNDER

AGE 21

BENEFIT FOR PERSONS AGED 21 AND

OLDER

30. Private Duty Nursing [defined at 42 C.F.R. § 440.80 and at Rule 1200- 13-14-.01].

Covered as medically necessary in accordance with the definition of Private Duty Nursing at Rule 1200- 13-14-.01, when prescribed by an attending physician for treatment and services rendered by a Registered Nurse (R.N.) or a licensed practical nurse (L.P.N.).

Prior authorization required, as described in Paragraph (7) of this

rule.

Covered as medically necessary in accordance with the definition of Private Duty Nursing at Rule 1200-13-14-.01, when prescribed by an attending physician for treatment and services rendered by a Registered Nurse (R.N.) or a licensed practical nurse (L.P.N.). Private duty nursing services are limited to services that support the use of ventilator equipment or other life-sustaining technology when constant nursing supervision, visual assessment, and monitoring of both equipment and patient are required. Prior authorization required, as described in Paragraph (7) of this rule.

31. Prosthetic Devices [defined at 42 C.F.R. § 440.120(c)].

Covered as medically necessary. Covered as medically necessary.

32. Psychiatric Inpatient Facility Services [defined at 42 C.F.R. § 441, Subparts C and D and including services for persons of all ages].

Covered as medically necessary.

Preadmission and concurrent reviews by the MCC are allowed.

Covered as medically necessary.

Preadmission and concurrent reviews by the MCC are allowed.

33. Psychiatric Pharmacy.

See “Pharmacy Services.” See “Pharmacy Services.”

34. Psychiatric Rehabilitation Services [defined as psychiatric services delivered in accordance with 42 C.F.R. § 440.130(d)].

Covered as medically necessary. Covered as medically necessary.

35. Psychiatric Physician Inpatient Services [defined at 42 C.F.R. § 440.50].

Covered as medically necessary. Covered as medically necessary.

36. Psychiatric Physician Outpatient Services.

See “Outpatient Mental Health Services.”

See “Outpatient Mental Health Services.”

37. Psychiatric Residential Treatment Services [defined at 42 C.F.R. § 483.352] and including services for persons of all ages].

Covered as medically necessary. Covered as medically necessary.

SERVICE BENEFIT FOR PERSONS UNDER

AGE 21

BENEFIT FOR PERSONS AGED 21 AND

OLDER

38. Reconstructive Breast Surgery [defined in accordance with Tenn. Code Ann. § 56-7-2507].

Covered in accordance with Tenn.

Code Ann. § 56-7-2507 which requires coverage of all stages of reconstructive breast surgery on a diseased breast as a result of a mastectomy as well as any surgical procedure on the non-diseased breast deemed necessary to establish symmetry between the two breasts in the manner chosen by the physician. The surgical procedure performed on a nondiseased breast to establish symmetry with the diseased breast will only be covered if the surgical procedure performed on a nondiseased breast occurs within five (5) years of the date the reconstructive breast surgery was performed on a diseased breast.

Covered in accordance with Tenn. Code Ann. § 56-7-2507 which requires coverage of all stages of reconstructive breast surgery on a diseased breast as a result of a mastectomy as well as any surgical procedure on the non-diseased breast deemed necessary to establish symmetry between the two breasts in the manner chosen by the physician. The surgical procedure performed on a non-diseased breast to establish symmetry with the diseased breast will only be covered if the surgical procedure performed on a nondiseased breast occurs within five (5) years of the date the reconstructive breast surgery was performed on a diseased breast.

39. Rehabilitation services.

See “Occupational Therapy,”

“Physical Therapy,” and “Speech Therapy,” and “Inpatient Rehabilitation Facility Services”

See “Occupational Therapy,” “Physical Therapy,” and “Speech Therapy.”

40. Renal Dialysis Clinic Services [defined at 42 C.F.R. § 440.90].

Covered as medically necessary.

Generally limited to the beginning ninety (90) day period prior to the enrollee’s becoming eligible for coverage by the Medicare program.

Covered as medically necessary. Generally limited to the beginning ninety (90) day period prior to the enrollee’s becoming eligible for coverage by the Medicare program.

41. Speech Therapy [defined at 42 C.F.R. § 440.110(c)].

Covered as medically necessary, by a Licensed Speech Therapist to restore, improve, stabilize or ameliorate impaired functions.

Covered as medically necessary, as long as there is continued medical progress, by a Licensed Speech Therapist to restore speech after a loss or impairment.

42. Transportation. See “Emergency Air and Ground Transportation,” “Non-Emergency Ambulance Transportation,” and “Non-Emergency Transportation.”

See “Emergency Air and Ground Transportation,” “Non-Emergency Ambulance Transportation,” and “Non- Emergency Transportation.”

43. Vision Services [defined as services to treat conditions of the eyes].

Preventive, diagnostic, and treatment services (including eyeglasses) covered as medically necessary.

Medical eye care, meaning evaluation and management of abnormal conditions, diseases, and disorders of the eye (not including evaluation and treatment of the refractive state) is covered. Routine, periodic assessment, evaluation or screening of normal eyes, and examinations for the purpose of prescribing, fitting, or changing eyeglasses and/or contact lenses are not covered.

One pair of cataract glasses or lenses is covered for adults following cataract surgery.

(c) Pharmacy TennCare is permitted under the terms and conditions of the demonstration project approved by the federal government to restrict coverage of prescription and nonprescription drugs to a TennCare-approved list of drugs known as a drug formulary.

TennCare must make this list of covered drugs available to the public. Through the use of a formulary, the following drugs or classes of drugs, or their medical uses, shall be excluded from coverage or otherwise restricted by TennCare as described in Section 1927 of the Social Security Act [42 U.S.C. § 1396r-8]:

1. Agents for weight loss or weight gain, except for weight loss drugs when prescribed for treatment of obesity.

2. Agents to promote fertility or for the treatment of impotence or infertility or for the reversal of sterilization.

3. Agents for cosmetic purposes or hair growth.

4. Agents for symptomatic relief of coughs and colds.

5. Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations.

6. Nonprescription drugs.

7. Covered outpatient drugs, which the manufacturer seeks to require as a condition of sale that associated tests or monitoring services be purchased exclusively from the manufacturer or his designee.

8. TennCare shall not cover drugs considered by the FDA to be Less Than Effective (LTE) and DESI drugs, or drugs considered to be Identical, Related and Similar (IRS) to DESI and LTE drugs or any other pharmacy services for which federal financial participation (FFP) is not available. The exclusion of drugs for which no FFP is available extends to all TennCare enrollees regardless of the enrollee’s age. TennCare shall not cover experimental or investigational drugs which have not received final approval from the FDA.

9. Buprenorphine products for opiate addiction treatment for persons aged 21 and older are restricted as follows:

(i) Dosage shall not exceed sixteen milligrams (16 mg) per day for a period of up to six (6) months from the initiation of therapy.

(ii) For enrollees who are pregnant while receiving the sixteen milligrams (16 mg) per day dosage, the six-month period does not begin until the enrollee is no longer pregnant.

(iii) At the end of the six-month period described in subparts (i) and (ii), the covered dosage amount shall not exceed eight milligrams (8 mg) per day.

10. Sedative hypnotic medications for persons aged 21 and older shall not exceed fourteen (14) pills per month for sedative hypnotic formulations in pill form such as Ambien and Lunesta, one hundred forty milliliters (140 ml) per month of chloral hydrate, or one (1) bottle every sixty (60) days of Zolpimist.

11. Allergy medications.

12. Opioid products for persons aged twenty-one (21) and older are restricted as follows:

(i) “Chronic opioid user” means:

(I) A TennCare enrollee whose TennCare paid claims data demonstrates that he has received at least a ninety (90) day quantity of prescribed opioids in the one hundred eighty (180) day period immediately preceding the opioid’s prescription date.

(II) For a TennCare enrollee who has not been enrolled in TennCare long enough to demonstrate that he is a chronic opioid user as defined in Item (I), the enrollee may demonstrate that he has received at least a ninety (90) day quantity of prescribed opioids in the one hundred eighty (180) day period immediately preceding the opioid’s prescription date by supplying paid claims data and medical records from his previous healthcare provider(s) or health insurer(s).

(ii) “Non-chronic opioid user” means a TennCare enrollee whose TennCare paid claims data demonstrates he has received less than a ninety (90) day quantity of prescribed opioids in the one hundred eighty (180) day period immediately preceding the opioid’s prescription date.

(iii) Non-chronic opioid users shall be eligible to receive covered prescription opioid products as follows:

(I) A maximum of fifteen (15) dosage days in any six (6) month period; and (II) Daily dosage shall not exceed sixty (60) morphine milligram equivalents (MME) per day.

(iv) The restrictions in Subpart (iii) do not apply for enrollees:

(I) With severe cancer pain undergoing active or palliative cancer treatment;

(II) With sickle cell disease or these related disorders: sickle cell anemia, sickle hemoglobin-C disease, sickle beta-plus thalassemia, sickle beta zero thalassemia, hemoglobin SD (HbSD), hemoglobin SE (HbSE), or hemoglobin SO (HbSo);

(III) Who are severe burn victims; or (IV) Who are receiving hospice or palliative care.

(v) Notwithstanding the restrictions in Subpart (iii), enrollees residing in a Medicaid-certified Nursing Facility may receive up to forty-five (45) days of sixty (60) MME per day in any ninety (90) day period.

(vi) Opioid prescriptions are subject to prior authorization following the first fill of a new opioid prescription.

(vii) For women of child-bearing age (between the ages of fifteen (15) and fortyfour (44)) and ability, when prior authorization is required for an opioid prescription, the prescribing provider must submit information to the enrollee’s PBM regarding the enrollee’s pregnancy status and use of contraception or family planning methods, and the provision of counseling regarding the risks of becoming pregnant while receiving opioid medication. The information regarding pregnancy status and contraceptive use may, when appropriate, be based on self-reporting by the patient.

(d) The MCC shall be allowed to provide cost effective alternative services as defined in paragraph 1200-13-14-.01(34). Cost effective alternative services are not reimbursable in any circumstances other than those described in that paragraph.

(e) Remote ultrasound procedures and remote fetal nonstress tests are covered as medically necessary and as follows:

1. A remote fetal ultrasound procedure or remote fetal nonstress test is reimbursable when the provider uses digital technology:

(i) To collect medical and other forms of health data from a patient and electronically transmit that information securely to a healthcare provider who is in a separate location for the purpose of interpretation and making recommendations;

(ii) That is compliant with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA)(42 U.S.C. § 1320d et seq.); and (iii ) That is approved by the federal food and drug administration.

2. A fetal nonstress test is only reimbursable with a place of service modifier for athome monitoring with remote monitoring solutions that are cleared by the federal food and drug administration for on-label use for monitoring fetal heart rate, maternal heart rate, and uterine activity.

(2) Use of Cost Effective Alternative Services.

(a) MCCs shall be allowed, but are not required, to use cost effective alternative services if and only if:

1. These services are listed in the MCC contract and/or in Policy BEN 08-001; or 2. These services are provided under the CHOICES program for individuals enrolled in the CHOICES program in accordance with Rule 1200-13-01-.05 or the ECF CHOICES program for individuals enrolled in the ECF CHOICES program in accordance with Rule 1200-13-01-.31; and 3. They are medically appropriate and cost effective.

(b) Use of approved cost effective alternative services is made at the sole discretion of the MCC.

(3) Emergency Medical Services.

Emergency medical services shall be available twenty-four (24) hours per day, seven (7) days per week. Coverage of emergency medical services shall not be subject to prior authorization by the MCC but may include a requirement that notice be given to the MCC of use of out-of-plan emergency services. However, such requirements shall provide at least a twenty-four (24) hour time frame after the emergency for notice to be given to the MCC.

(4) Preventive, Diagnostic and Treatment Services for Individuals Under Twenty-One (21).

The Bureau of TennCare, through its contracts with Managed Care Organizations (MCOs) and other contractors (also referred to collectively as Contractors), operates an EPSDT program to provide health care services as required by 42 C.F.R. Part 441, Subpart B and the “Omnibus Budget Reconciliation Act of 1989” to eligible enrollees under the age of 21.

(a) Responsibilities of the Bureau of TennCare 1. The Bureau will:

(i) Keep Contractors informed as to changes to the requirements for the operation of the EPSDT program;

(ii) Make changes to the rules of TennCare when necessary to keep the EPSDT program in compliance with federal and state requirements;

(iii) Provide policy clarification when needed; and (iv) Oversee the activities of the Contractors to assure compliance with all aspects of the EPSDT program.

2. The Bureau, through local health departments, shall inform families of uninsured children who are enrolled in TennCare, of the benefits covered under TennCare and the importance of accessing preventive services.

3. The Bureau, through local health departments, shall provide information on covered services to adolescent prenatal patients who enter TennCare through presumptive eligibility. Assistance will be offered to presumptive eligibles on the day eligibility is determined in making a timely first prenatal appointment; for a woman past her first trimester, this appointment should occur within fifteen (15) days.

4. The Bureau, through the Department of Children’s Services, shall inform foster parents and institutions or other residential treatment settings with a number of eligible children, annually or more often when the need arises, including when a change of administrators, social workers, or foster parents occur, of the availability of EPSDT services.

(b) Responsibilities of Contractors 1. Contractors shall aggressively and effectively inform enrollees of the existence of the EPSDT program, including the availability of specific EPSDT screening and treatment services. Such informing shall occur in a timely manner, generally within sixty (60) days of the MCO’s receipt of notification of the child’s enrollment in its plan and if no one eligible in the family has utilized EPSDT services, at least annually thereafter.

Contractors shall document to the Bureau the contractor’s outreach activities and what efforts were made to inform enrollees and/or the enrollee’s responsible party about the availability of EPSDT services and how to access such services.

Failure to timely submit the requested data may result in liquidated damages as described in the contracts between the Bureau of TennCare and the Contractors.

2. Contractors shall use clear and non-technical terms to provide a combination of written and oral information so that the program is clearly and easily understandable.

3. Contractors shall use effective methods (developed through collaboration with agencies which have established procedures for working with such individuals) to inform individuals who are illiterate, blind, deaf, or cannot understand English, about the availability of EPSDT services.

4. Contractors shall design and conduct outreach to inform all eligible individuals about what services are available under EPSDT, the benefits of preventive health care, where services are available, and how to obtain them; and that necessary transportation and scheduling assistance is available.

5. Contractors shall create a system so that families can readily access an accurate list of names and phone numbers of contract providers who are currently accepting TennCare.

6. Contractors shall offer both transportation and scheduling assistance prior to the due date of the child’s periodic examination.

7. Contractors shall provide enrollees assistance in scheduling appointments and obtaining transportation prior to the date of each periodic examination as requested and necessary.

8. Contractors shall document services declined by a parent or guardian or a mature competent child, specifying the particular service declined so that outreach and education for other EPSDT services continues.

9. Contractors shall maintain records of the efforts taken to outreach children who have missed screening appointments when scheduled or who have failed to schedule regular check-ups. These records shall be made available to the Bureau and other parties as directed by TennCare.

10. Contractors shall inform families of the costs, if any, of EPSDT services.

11. Contractors shall treat a TennCare-eligible woman’s request for EPSDT services during pregnancy as a request for EPSDT services for the child at birth.

(c) Compliance Contractors must document and maintain records of all outreach efforts made to inform enrollees about the availability of EPSDT services.

(5) Preventive Medical Services. The following services (identified by applicable CPT procedure codes) shall be covered subject to any limitations described herein, within the scope of standard medical practice, without copay.

(a) Office Visits 1. New Patient 99381 - Initial evaluation 99382 - ages 1 through 4 years 99383 - ages 5 through 11 years 99384 - ages 12 through 17 years 99385 - ages 18 through 39 years 99386 - ages 40 through 64 years 99387 - ages 65 years and older 2. Established Patient 99391 - Periodic evaluation 99392 - ages 1 through 4 years 99393 - ages 5 through 11 years 99394 - ages 12 through 17 years 99395 - ages 18 through 39 years 99396 - ages 40 through 64 years 99397 - ages 65 years and older (b) Counseling and Risk Factor Reduction Intervention 1. Individual 99401 - approximately 15 minutes 99402 - approximately 30 minutes 99403 - approximately 45 minutes 99404 - approximately 60 minutes 2. Group 99411 - approximately 30 minutes 99412 - approximately 60 minutes (c) Family Planning Services, if not part of a preventive services office visit, should be billed by using the codes in (b)1. above.

(d) Mental health case management services including T1016 and H0004.

(e) Vaccines as recommended by the Advisory Committee on Immunization Practices (ACIP).

(f) Any other covered service assigned a rating of A or B by the US Preventative Services Task Force (USPSTF).

(6) Hospital Discharges.

Hospital discharges of mothers and newborn babies following delivery shall take into consideration the following guidelines:

(a) The decision to discharge postpartum mothers and newborns less than 24-48 hours after delivery should be made based upon discharge criteria collaboratively developed and adopted by obstetricians, pediatricians, family practitioners, delivery hospitals, and health plans. The criteria must be contingent upon appropriate preparation, meeting in hospital criteria for both mother and baby, and the planning and implementation of appropriate follow-up. An individualized plan of care must include identification of a primary care provider for both mother and baby and arrangements for follow-up evaluation of the newborn.

Length of hospital stay is only one factor to consider when attempting to optimize patient outcomes for postpartum women and newborns. Excellent outcomes are possible even when length of stay is very brief (less than 24 hours) if perinatal health care is well planned, allows for continuity of care, and patients are well chosen. Some postpartum patients and/or newborns may require extended hospitalization (greater than 48-72 hours) despite meticulous care due to medical, obstetric, or neonatal complications. The decision for time of discharge must be individualized and made by the physicians caring for the mother-baby pair. The following guidelines have been developed to aid in the identification of postpartum mothers and newborns who may be candidates for discharge prior to 24-48 hours. The guidelines also provide examples where discharge is inappropriate.

Principles of patient care should be based upon data obtained by clinical research.

Regarding the question of postpartum and newborn length of hospitalization, there are inadequate studies available to provide clear direction for clinical decision-making.

Clinical guidelines represent an attempt to conceptualize what is, in reality, a dynamic process of health care refinement. Review of these guidelines is desirable and expected.

No provider shall be denied participation, reimbursement or reduction in reimbursement within a network solely related to his/her compliance with the “Guidelines for Discharge of Postpartum Mothers and Newborns.”

(b) Guidelines for Discharge of Postpartum Mothers and Newborns 1. Discharge Planning.

(i) Discharge planning should occur in a planned and systematic fashion for all postpartum women and newborns in order to enhance care, prevent complications and minimize the need for rehospitalization. Prior to discharge a discussion should be held between the physician or another health care provider and the mother (and father if possible) about any expected perinatal problems and ways to cope with them. Plans for future and immediate care as well as instructions to follow in the event of an emergency or complication should be discussed.

Follow-up care must be planned for both mother and baby at the time of discharge. For patients leaving the hospital prior to 24-48 hours, contact within 48-72 hours of discharge is recommended and may include appropriate follow-up within 48-72 hours as deemed necessary by the attending provider, depending upon individual patient need. This follow-up visit will be acknowledged as a provider encounter.

(I) Maternal Considerations:

I. Prior to discharge, the patient should be informed of normal postpartum events including but not limited to:

A. Lochial patterns;

B. Range of activity and exercise;

C. Breast care;

D. Bladder care;

E. Dietary needs;

F. Perineal care;

G. Emotional responses;

H. What to report to physician or other health care provider including:

(A) Elevation of temperature, (B) Chills, (C) Leg pains, and (D) Increased vaginal bleeding.

I. Method of contraception;

J. Coitus resumption; and K. Specific instructions for follow-up (routine and emergent)

(II) Neonatal Considerations:

I. Prior to discharge, the following points should be reviewed with the mother or, preferably, with both parents:

A. Condition of the neonate;

B. Immediate needs of the neonate; (e.g., feeding methods and environmental supports);

C. Instructions to follow in the event of a newborn complication or emergency;

D. Feeding techniques: skin care, including cord care and genital care; temperature assessment and measurement with the thermometer; and assessment of neonatal wellbeing; recognition of illness including jaundice; proper infant safety including use of car seat and sleeping position;

E. Reasonable expectations for the future; and F. Importance of maintaining immunization begun with initial dose of hepatitis B vaccine.

2. Criteria for Maternal Discharge Less Than 24-48 Hours Following Delivery.

(i) Prior to discharge of the mother, the following should occur:

(I) The mother should have been observed after delivery for a sufficient time to ensure that her condition is stable, that she has sufficiently recovered and may be safely transferred to outpatient care.

(II) Laboratory evaluations should be obtained and include ABO blood group and Rh typing with appropriate use of Rh immune globulin; and hematocrit or hemoglobin.

(III) The mother should have received adequate preparation for and be able to assume self and immediate neonatal care.

(ii) Factors which may exclude maternal discharge prior to 24-48 hours include:

(I) Abnormal bleeding.

(II) Fever equal to or greater than 100.4 degrees.

(III) Inadequate or no prenatal care.

(IV) Cesarean section.

(V) Untreated or unstable maternal medical condition.

(VI) Uncontrolled hypertension.

(VII) Inability to void.

(VIII) Inability to tolerate solid foods.

(IX) Adolescent mother without adequate support and where appropriate follow-up has not been established. A nurse home visit within 24-48 hours of discharge would act as appropriate follow-up.

(X) All efforts should be made to keep mother and infant together to ensure simultaneous discharge.

(XI) Psychosocial problems (maternal or family) which have been identified prenatally or in hospital. Where appropriate follow-up has not been established, a nurse home visit within 24-48 hours of discharge would act as appropriate follow-up.

3. Criteria for Neonatal, Discharge Less than 24-48 Hours Following Delivery.

(i) The nursery stay is planned to allow the identification of early problems and to reinforce instruction in preparation for care of the infant at home.

Complications often are not predictable by prenatal and intrapartum events. Because many neonatal problems do not become apparent until several days after birth there is an element of medical risk in early neonatal discharge. Most problems are manifest during the first twelve (12) hours, and discharge at or prior to twenty-four (24) hours is appropriate for many newborns.

(I) Prior to discharge of the newborn at 24-48 hours, the following should have occurred:

I. The course of antepartum, intrapartum, and postpartum care for both mother and fetus should be without problems, which may lead to newborn complications.

II. The baby is a single birth at 37 to 42 weeks’ gestation and the birth weight is appropriate for gestational age according to appropriate intrauterine growth curves.

III. The baby’s vital signs are documented as being normal and stable for the twelve (12) hours preceding discharge, including a respiratory rate below 60/minute, a heart rate of 100 to 160 beats per minute, and an axillary temperature of 36.1 degrees C in an open crib with appropriate clothing.

IV. The baby has urinated and passed at least one stool.

V. No evidence of excessive bleeding after circumcision greater than two (2) hours.

VI. The baby has completed at least two successful feedings, with documentation that the baby is able to coordinate sucking, swallowing, and breathing while feeding.

VII. No evidence of significant jaundice in the first twenty-four (24) hours of life.

VIII. The parent’s or caretaker’s knowledge, ability, and confidence to provide adequate care for her baby are documented.

IX. Laboratory data are available and reviewed including:

A. Maternal syphilis and hepatitis B surface antigen status.

B. Cord or infant blood type and direct Coomb’s test result as clinically indicated.

X. Screening tests are performed in accordance with state regulations. If the test is performed before twenty-four (24) hours of milk feeding, a system for repeating the test must be assured during the follow-up visit.

XI. Initial hepatitis B vaccine is administered or a scheduled appointment for its administration has been made.

XII. A physician-directed source of continuing medical care for both the mother and the baby is identified. For newborns discharged less than 24-48 hours after delivery, a definitive plan for contact within 48-72 hours after discharge has been made. A nurse home visit within 24-48 hours would be considered appropriate follow-up.

(II) Maternal factors which may exclude discharge of the newborn prior to 24-48 hours include:

I. Inadequate or no prenatal care, II. Medical conditions that pose a significant risk to the infant, III. Group B streptococcus colonization, IV. Untreated syphilis, V. Suspected active genital herpes, VI. HIV, VII. Adolescent without adequate support and where appropriate follow-up has not been established (a nurse home visit within 24-48 hours of discharge will act as appropriate follow-up), VIII. Mental retardation or psychiatric illness, and IX. Requirements for continued maternal hospitalization.

(III) Newborn factors which may exclude discharge of the newborn prior to 24-48 hours include:

I. Preterm gestation (less than 37 weeks);

II. Small for gestational age;

III. Large for gestational age;

IV. Abnormal physical exam, vital signs, color, activity, feeding or stooling;

V. Significant congenital malformations; and VI. Abnormal laboratory finding:

A. Hypoglycemia, B. Hyperbilirubinemia, C. Polycythemia, D. Anemia, and E. Rapid plasma reagin positive.

(7) Prior Authorization for Home Health Nurse, Home Health Aide, and Private Duty Nursing Services. Prior authorization by the MCC must be obtained in order to establish the medical necessity of all requested home health nurse, home health aide, and private duty nursing services.

(a) The following information must be provided when seeking prior authorization for home health nurse, home health aide, and private duty nursing services:

1. Name of physician prescribing the service(s);

2. Specific information regarding the patient’s medical condition and any associated disability that creates the need for the requested service(s); and 3. Specific information regarding the service(s) the nurse or aide is expected to perform, including the frequency with which each service must be performed (e.g., tube feeding patient 7:00 a.m., 12:00 p.m., and 5:00 p.m. daily; bathe patient once per day; administer medications three (3) times per day; catheterize patient as needed from 8:00 a.m. to 5:00 p.m. Monday through Friday; change dressing on wound three (3) times per week). Such information should also include the total period of time that the services are anticipated to be medically necessary by the treating physician (e.g., total number of weeks or months).

(b) Home health nurses and aides and private duty nurses will never be authorized to personally transport a TennCare enrollee. Home health nurses and aides delivering prior approved home health care services may accompany an enrollee outside the home in accordance with T.C.A. § 71-5-107(a)(12).

(c) Private duty nursing services are limited to services provided in the recipient’s own home, with the following two exceptions:

1. A recipient age twenty-one (21) or older who requires eight (8) or more hours of skilled nursing care in a 24-hour period and is authorized to receive private duty nursing services in the home setting may make use of the approved hours outside of that setting in order for the nurse to accompany the recipient to:

(i) Outpatient health care services (including services delivered through a TennCare home and community based services waiver program);

(ii) Public or private secondary school or credit classes at an accredited vocational or technical school or institute of higher education; or, (iii) Work at his place of employment.

2. A recipient under the age of twenty-one (21) who requires eight (8) or more hours of continuous skilled nursing care in a 24-hour period and is authorized to receive those services in the home setting may make use of the approved hours outside of that setting when normal life activities temporarily take him outside of that setting. Normal life activity for a child under the age of twenty-one (21) means routine work (including work in supported or sheltered work settings); licensed child care; school and school-related activities; religious services and related activities; and outpatient health care services (including services delivered through a TennCare home and community based services waiver program). Normal life activities do not include non-routine or extended home absences.

(d) A private duty nurse may accompany a recipient in the circumstances outlined in subparagraph (c) immediately above, but may not drive.

(e) Private duty nursing services will only be authorized when there are competent family members or caregivers as indicated below:

1. Private duty nursing services include services to teach and train the recipient and the recipient’s family or other caregivers how to manage the treatment regimen.

Having a caregiver willing to learn the tasks necessary to provide a safe environment and quality in home care is essential to assuring the recipient is properly attended to when a nurse or other paid caregiver is not present, including those times when the recipient chooses to attend community activities to which these rules do not specifically permit the private duty nurse or other paid caregiver to accompany the patient.

2. To ensure the health, safety, and welfare of the individual, in order to receive private duty nursing services, the recipient must have family or caregivers who:

(i) Have a demonstrated understanding, ability, and commitment in the care of the individual related to ventilator management, support of other lifesustaining technology, medication administration and feeding, or in the case of children, other medically necessary skilled nursing functions, as applicable; and (ii) Are trained and willing to meet the recipient’s nursing needs during the hours when paid nursing care is not provided, and to provide backup in the event of an emergency; and (iii) Are willing and available as needed to meet the recipient’s non-nursing support needs.

(iv) In the case of children under the age of 18, the parent or guardian will be expected to fill this role. In the case of an adult age 18 and older, if the health, safety, and welfare of the individual cannot be assured because the recipient does not have such family or caregiver, private duty nursing services may be denied, subject to items (I) and (II) below. However, it shall be the responsibility of the MCO to:

(I) Arrange for the appropriate level of care, which may include nursing facility care, if applicable; and (II) In the case of a person currently receiving private duty nursing services, facilitate transition to such appropriate level of care prior to termination of the private duty nursing service.

(f) Nursing services (provided as part of home health services or by a private duty nurse) will be approved only if the requested service(s) is of the type that must be provided by a nurse as opposed to an aide, except that the MCO may elect to have a nurse perform home health aide services in addition to nursing services if the MCO determines that this is a less costly alternative than providing the services of both a nurse and an aide.

Examples of appropriate nursing services include, but are not limited to, management of ventilator equipment or other life-sustaining medical technology, medication management, and tube feedings.

(g) Home health aide services will only be approved if the requested service(s) meet all medical necessity requirements including the requirements of 1200-13-16-.05(4)(d).

Thus, home health aide services will not be approved to provide child care services, prepare meals, perform housework, or generally supervise patients. Examples of appropriate home health aide services include, but are not limited to, patient transfers and bathing.

History

• Authority: T.C.A. §§ 4-3-1013, 4-5-202, 4-5-203, 4-5-208, 4-5-209, 71-5-102, 71-5-105, 71-5-107, 71-5- 109, 71-5-134, 71-5-146, 71-5-168, 71-5-197, 71-5-198, and 71-5-1404; Executive Order No. 23; Public Chapter 473, Acts of 2011; and 2025 Public Chapter No. 530.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-14-.04; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Public necessity rule filed July 1, 2005; effective through December 13, 2005. Amendments filed September 29, 2005; effective December 13, 2005. Public necessity rule filed December 29, 2005; expired June 12, 2006. On June 13, 2006, affected rules reverted to status on December 28, 2005. Public necessity rule filed March 13, 2006; effective through August 25, 2006. Public necessity rule filed May 3, 2006; effective through October 15, 2006. Amendments filed March 31, 2006; effective June 14, 2006. Amendment filed June 12, 2006; effective August 26, 2006. Amendment filed July 28, 2006; effective October 11, 2006. Public necessity rule filed December 1, 2006; effective through May 15, 2007. Public necessity rule filed February 1, 2007; effective through July 16, 2007. Amendment filed February 2, 2007; effective April 18, 2007. Amendment filed May 2, 2007; effective July 16, 2007. Public necessity rule filed October 11, 2007; effective through March 24, 2008. Public necessity rule filed February 8, 2008; effective through July 22, 2008. Amendment filed May 7, 2008; effective July 21, 2008. Public necessity rule filed September 8, 2008; effective through February 20, 2009. Amendments filed August 19, 2008; effective November 2, 2008. Amendment filed December 5, 2008; effective February 18, 2009. Public necessity rule filed July 1, 2009; effective through December 13, 2009. Amendment filed June 11, 2009; effective August 25, 2009. Amendment filed September 11, 2009; effective December 10, 2009. Amendments filed September 25, 2009; effective December 24, 2009. Amendments filed September 30, 2009; effective December 29, 2009. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendments filed May 27, 2010; effective August 25, 2010. Amendment filed October 26, 2010; effective January 24, 2011. Emergency rules filed July 1, 2011; effective through December 28, 2011. Emergency rule filed August 2, 2011; effective through January 29, 2012. Amendments filed September 23, 2011; effective December 22, 2011. Amendment filed October 28, 2011; effective January 26, 2012. Amendment filed August 10, 2011; effective January 29, 2012. Amendment filed April 25, 2012; effective September 28, 2012. Emergency rule filed September 27, 2013; effective through March 26, 2014. Amendments filed July 1, 2013; effective September 29, 2013. Amendment filed August 7, 2013; effective November 5, 2013. Amendment filed September 27, 2013; effective December 26, 2013. Amendment filed December 17, 2013; effective March 17, 2014. Amendment filed June 17, 2014; effective September 15, 2014. Emergency rule filed September 30, 2015; effective through March 28, 2016. Amendments filed December 29, 2015; effective March 28, 2016. Emergency rules filed June 24, 2016; effective through December 21, 2016. Emergency rules filed July 1, 2016; effective through December 28, 2016. Amendments filed September 13, 2016; effective December 12, 2016. Amendments filed September 30, 2016; effective December 29, 2016. Emergency rules filed January 16, 2018; effective through July 15, 2018. Amendments filed April 9, 2018; effective July 8, 2018. Amendments filed January 3, 2019; effective April 3, 2019. Amendments filed July 8, 2021; effective October 6, 2021. Amendments filed October 26, 2021; effective January 24, 2022. Amendments filed February 16, 2022; effective May 17, 2022. Emergency rules filed December 27, 2022 to become effective January 1, 2023; effective through June 30, 2023. Amendments filed January 19, 2023; effective April 19, 2023. Emergency rules filed August 7, 2024; effective through February 3, 2025. Amendments filed September 11, 2024; effective December 10, 2024. Emergency rules filed December 30, 2024; effective through June 28, 2025. Amendments filed November 4, 2024; effective February 2, 2025. Amendments filed March 28, 2025; effective June 26, 2025. Emergency rules filed August 1, 2025; effective through January 28, 2026. Amendments filed July 7, 2025; effective October 5, 2025. Amendments filed October 28, 2025; effective January 26, 2026.

Tenn. Comp. R. & Regs. 1200-13-14-.02 ELIGIBILITY

(1) Delineation of agency roles and responsibilities.

(a) The Tennessee Department of Finance and Administration (F&A) is the lead State agency for the TennCare Program.

(b) The Bureau of TennCare (Bureau) is the administrative unit within F&A with the responsibility for day-to-day operations of the TennCare Program. The Bureau is responsible for establishing policy and procedural requirements and criteria for TennCare.

1. With respect to the eligibility of children applying for TennCare as medically eligible persons, the Bureau is responsible for determining the presence of a qualifying medical condition under TennCare Standard.

2. With respect to the eligibility of individuals applying for the TennCare CHOICES program, the Bureau is responsible for determining that the individual meets level of care eligibility criteria for the long-term care services or reimbursement requested. For enrollment into CHOICES Group 2, the Bureau is also responsible for determining the state’s ability to provide appropriate Home and Community Based Services (HCBS) as determined by the availability of slots under the established enrollment target in accordance with Rule 1200-13-01-.05 and for confirming a determination by an Area Agency on Aging and Disability or TennCare Managed Care Organization that:

(i) The individual is an adult aged sixty-five (65) or older, or an adult aged twenty-one (21) or older with physical disabilities; and (ii) Such individual can be safely and appropriately served in the community and at a cost that does not exceed the individual’s cost neutrality cap pursuant to Rule 1200-13-01-.05.

3. With respect to the eligibility of individuals applying for the ECF CHOICES program, the Bureau is responsible for determining that the individual meets all applicable eligibility and enrollment criteria, including target population, medical or level of care eligibility, categorical and financial eligibility, the state’s ability to provide appropriate ECF HCBS (as defined in Rule 1200-13-01-.02) as determined by the availability of slots under the established enrollment target for each ECF CHOICES Group in accordance with Rule 1200-13-01-.31 and pursuant to intake and enrollment policies and processes described in 1200-13- 01-.31 and in TennCare policies and protocols, and for confirming a determination by a TennCare Managed Care Organization that the individual can be safely and appropriately served in the community and at a cost that does not exceed the individual’s expenditure cap pursuant to Rule 1200-13-01-.31.

(c) The Tennessee Department of Human Services (DHS) is under contract with the Bureau to determine initial eligibility for TennCare Medicaid and TennCare Standard, as well as to redetermine, at regular intervals, whether eligibility should be continued.

DHS is not responsible for making decisions about the presence of a qualifying medical condition for those applying as medically eligible persons under TennCare Standard.

(d) The Social Security Administration determines eligibility for the Supplemental Security Income (SSI) Program. Tennessee residents determined eligible for SSI benefits are automatically eligible for and enrolled in TennCare Medicaid.

(e) The Tennessee Department of Health (DOH) determines presumptive eligibility under TennCare Medicaid for pregnant women and for women diagnosed with breast or cervical cancer through administration of the Breast and Cervical Cancer Screening Program.

(2) Delineation of TennCare enrollee’s responsibilities.

(a) It is the responsibility of each TennCare enrollee to report to the DHS any material change affecting any information given by the applicant/enrollee to DHS at the time of application or redetermination of his eligibility. This information includes, but is not limited to, changes in address, income, family size, employment, or access to insurance. The applicant/enrollee shall mail, or present in person, documentation of any such change to the DHS county office where the enrollee resides. This documentation must be presented within the time frame established by Tennessee Code Annotated § 71-5-110 for reporting changes.

(b) It is the responsibility of each TennCare enrollee to report to his provider that he is a TennCare enrollee.

(3) Technical and financial eligibility requirements for TennCare Standard.

To be eligible for TennCare Standard, each individual must:

(a) Not be eligible for Medicaid as determined by DHS.

(b) Provide a statement from his employer, if employed, concerning the availability of group health insurance. (Access to insurance is not considered in determining eligibility in the Standard Spend Down category or any CHOICES or ECF CHOICES demonstration category.)

(c) Be a U.S. citizen, lawfully admitted alien, or an alien permanently residing in the U.S. under color of law.

(d) Be a Tennessee resident as described under federal and state law.

(e) Present a Social Security number or proof of having applied for one, or assist the DHS caseworker in applying for a Social Security number, for each person applying for TennCare Standard.

(f) Not be an inmate as defined in these rules.

(g) Not be eligible for or have purchased other health insurance as defined at Rule 1200- 13-14-.01, except for persons in the category of uninsured children under the age of nineteen (19) whose family income is below two hundred percent (200%) of poverty and who have been continuously enrolled in TennCare Standard since at least December 31, 2001. (Access to insurance is not considered in determining eligibility in the Standard Spend Down category or any CHOICES or ECF CHOICES demonstration category.)

(h) Not be enrolled in, or eligible for participation in, Medicare. (Access to insurance is not considered in determining eligibility in the Standard Spend Down category or any CHOICES or ECF CHOICES demonstration category.)

(4) General application requirements.

(a) By applying for TennCare, an applicant grants permission and authorizes release of information to the Bureau, or its designee, to investigate any and all information provided, or any information not provided if it could affect eligibility, to determine TennCare eligibility; and if approved, what cost sharing, if any, may be required of the applicant as found in these rules. Information may be verified through, but not limited to, the following sources:

1. The United States Internal Revenue Service (IRS);

2. State income tax records for Tennessee or any other state where income is earned;

3. The Tennessee Department of Labor and Work Force Development, and other Employment Security offices within any state where the applicant may have received wages or been employed;

4. Credit bureaus;

5. Insurance companies; or, 6. Any other governmental agency or public or private source of information where such information may impact an applicant’s eligibility or cost sharing requirements for the TennCare Program.

(b) By applying for TennCare, an applicant understands it is a felony offense, pursuant to Tennessee Code Annotated § 71-5-2601, to obtain TennCare coverage under false means or to help anyone get on TennCare under false means.

(5) TennCare Standard: Uninsured and medically eligible children.

(a) Coverage groups:

1. Group 1: Uninsured children under age nineteen (19) who are losing eligibility for Medicaid, who have family incomes below two hundred percent (200%) of poverty, and who do not have access to insurance.

2. Group 2: Uninsured children under age nineteen (19) who are losing eligibility for Medicaid, who have family incomes that equal or exceed two hundred percent (200%) of poverty, who do not have access to insurance, and who have been determined medically eligible in accordance with these rules.

3. Group 3: Uninsured children under age nineteen (19) who have been continuously enrolled in TennCare Standard since December 31, 2001, who have family incomes below two hundred percent (200%) of poverty, and who have not purchased insurance even if they have access to it. This is a “grandfathered” eligibility category. At such time as a person loses eligibility in this category, he will not be able to re-enroll in it.

4. TennCare Standard is closed to new enrollment for children, except those children identified in (5)(a)1. and (5)(a)2. above.

(b) Eligibility criteria:

1. The individual must be under nineteen (19) years of age.

2. The individual must lack access to insurance, except those individuals in Group 3, defined in part (a)3. above. Individuals in Group 3 must not have purchased insurance that may be available to them.

3. For persons in Groups 1 and 3 defined in parts (a)1. and 3. above, have family incomes that do not exceed two hundred percent (200%) of poverty.

4. For persons in Group 2 defined in part (a)2. above, have been determined medically eligible in accordance with these rules.

(c) Application procedures:

1. Uninsured children.

An individual who is losing eligibility for TennCare Medicaid and who is under the age of nineteen (19) may be approved for TennCare Standard as a Medicaid “Rollover” Enrollee according to the following process:

(i) At least thirty (30) days prior to the expiration of their current eligibility period, the Bureau of TennCare will send the enrollee a Request for Information in accordance with Rule 1200-13-13-.02(6)(b). The Request for Information will include a form to be completed with information needed to determine eligibility.

(ii) Enrollees will be given thirty (30) days inclusive of mail time from the date of the Request for Information to return the completed form to DHS and to provide DHS with the necessary verifications to determine eligibility. When the individual returns a completed Request for Information form, he will first be screened for TennCare Medicaid eligibility. If the individual is no longer TennCare Medicaid eligible, he will be screened for eligibility as a Medicaid “Rollover” Enrollee in accordance with TennCare Standard eligibility criteria under Rule 1200-13-14-.02.

(iii) If DHS makes a determination that the enrollee is not eligible for any open Medicaid or Standard categories, the TennCare Bureau will send the enrollee a twenty (20) day advance Termination Notice.

2. Medically eligible children.

(i) Applicants have two (2) options for proving medical eligibility:

(I) Option 1: A completed medical eligibility application and medical records to support any medical condition listed on the application, with a signed release for medical records in the event additional medical records are needed.

(II) Option 2: Have a current CRG 1, 2, 3/TPG 2 assessment on file with the Bureau.

(ii) If a Medicaid enrollee under age nineteen (19) whose Medicaid eligibility is ending is determined to otherwise meet technical eligibility requirements for TennCare Standard, but is not eligible as uninsured because his income is above two hundred percent (200%) of poverty, he will be sent a letter denying TennCare Standard coverage as uninsured and notifying the enrollee that he may qualify as medically eligible. The enrollee will have forty (40) days (inclusive of mail time) to appeal the denial of TennCare Standard as uninsured.

(iii) When DHS makes the determination that the enrollee does not qualify for TennCare Standard as uninsured, TennCare will be notified and will send the enrollee a medical eligibility packet with an explanation regarding how to apply for TennCare Standard as a medically eligible person. The enrollee will have sixty (60) days from the date of the letter (inclusive of mail time) to submit his medical eligibility packet. If the individual is determined to qualify as medically eligible, coverage will be provided throughout the eligibility determination period and will continue with no break.

(iv) The required medical eligibility application information must be returned to the address specified within sixty (60) days from the date of the letter included in the packet. A medical eligibility form and documentation received after that time will not be processed as it exceeds the timely filing requirement. Packets which are not completed by the sixtieth (60th) day will be denied with a notice of appeal rights and the “good cause” reasons for not completing the process timely, which include:

(I) The applicant was sick.

(II) A member of the applicant’s immediate family was very sick.

(III) The applicant had a family emergency or tragedy.

(IV) The applicant could not get the medical records he needed from a provider. It was not his fault.

(V) The applicant asked for help because he had a disability. Neither the Bureau nor DHS gave the help the applicant needed.

(VI) The applicant asked for help because he does not speak English.

Neither the Bureau nor DHS gave the help the applicant needed.

(v) The Bureau of TennCare will review the completed medical eligibility packet. Evaluation of completed packets will be made within thirty (30) days of receipt from the applicant. Medical Reviewers will assess the records submitted against TennCare medical insurance underwriting guidelines. Applicants who are not determined to be medically eligible by the Bureau will not be eligible for TennCare Standard. They will receive a termination notice which contains appeal rights including the right to appeal within forty (40) days from the receipt of the termination notice. Appeals received by the Bureau after forty (40) days will be considered untimely and will not be forwarded to hearing.

(vi) Applicants deemed medically eligible by the Bureau of TennCare will be approved for TennCare Standard. The Bureau will send the applicant an approval notice of coverage. The eligibility period for medically eligible individuals is twelve (12) months. At the end of twelve (12) months, the enrollee must complete the redetermination/reapplication process.

(vii) The effective date of coverage will be the date of application.

(6) TennCare Standard: Standard Spend Down (SSD) Program.

(a) Coverage group.

Non pregnant adults, age 21 and older, who have been determined to meet criteria patterned after the Medically Needy requirements, as outlined in DHS Rule 1240-03- 02-.03 and who are age 65 or older, blind, disabled, or caretaker relatives of Medicaideligible children.

(b) Eligibility criteria:

1. Must be age twenty-one (21) or older.

2. Must not be pregnant.

3. Must meet one of the following criteria:

(i) Be sixty-five (65) years of age or older; or (ii) Be blind, as defined in DHS Rule 1240-03-03-.02; or (iii) Be disabled, as defined in DHS Rule 1240-03-03-.02; or (iv) Be a caretaker relative, as defined at T.C.A. § 71-3-153.

4. Must meet the financial eligibility criteria, including income and resource limitations that apply to Medically Needy pregnant women and children eligible under the State plan. These criteria are found at DHS rules 1240-03-03-.05 and

Tenn. Comp. R. & Regs. 1200-13-14-.03 ENROLLMENT, REASSIGNMENT, AND DISENROLLMENT WITH MANAGED CARE

CONTRACTORS (MCCS).

(1) Enrollment.

There are three (3) different types of managed care entities that provide services to TennCare enrollees. Enrollment procedures differ according to the type of managed care entity, the geographic area, and the number of managed care entities operating in each geographic area. Enrollment procedures also differ for ECF CHOICES, as described in subparagraph (c) below.

(a) TennCare Managed Care Organizations (MCOs) other than TennCare Select.

1. Except as provided in subparagraph (c), individuals or families determined eligible for TennCare shall select a health plan (Managed Care Organization/MCO) at the time of application. The health plan must be available in the Grand Division of the State in which the enrollee lives. All family members living in the same household and enrolled in TennCare must be assigned to the same MCO except children determined by the Bureau to be eligible to enroll in TennCare Select. An enrollee is given his choice of MCOs when possible. If the requested MCO cannot accept new enrollees, the Bureau will assign each enrollee to an MCO that is accepting new enrollees. If no MCO is available to enroll new members in the enrollee’s Grand Division, the enrollee will be assigned to TennCare Select until such time as another MCO becomes available. The Bureau may also assign TennCare children with special health care needs to TennCare Select.

2. Except as provided in subparagraph (c), a TennCare enrollee may change MCOs one (1) time within the initial ninety (90) calendar days (inclusive of mail time) from the date of the letter informing him of his MCO assignment, if there is another MCO in the enrollee’s Grand Division that is currently permitted by the Bureau to accept new enrollees. No additional changes will be allowed except as otherwise specified in these rules. An enrollee shall remain a member of the designated plan until he is given an opportunity to change once each year during an annual change period. The annual change period will occur each year in March for enrollees in West Tennessee, in May for enrollees in Middle Tennessee, and in July for enrollees in East Tennessee. Thereafter, an MCO change is permitted only during an annual change period, unless the Bureau authorizes a change as the result of the resolution of an appeal requesting a “hardship” reassignment as specified in paragraph (2)(b) below. When an enrollee changes MCOs, the enrollee’s medical care will be the responsibility of the current MCO until he is enrolled in the requested MCO.

3. Each MCO shall offer its enrollees, to the extent possible, freedom of choice among participating providers. If after notification of enrollment the enrollee has not chosen a primary care provider, one will be selected for him by the MCO.

The period during which an enrollee may choose his primary care provider shall not be less than fifteen (15) calendar days.

4. In the event a pregnant woman entering an MCO’s plan is receiving medically necessary prenatal care the day before enrollment, the MCO shall be responsible for the costs of continuation of such medically necessary services, without any form of prior approval and without regard to whether such services are being provided within or outside the MCO’s provider network until such time as the MCO can reasonably transfer the enrollee to a service and/or network provider without impeding service delivery that might be harmful to the enrollee’s health.

In the event a pregnant woman entering the MCO’s plan is in her second or third trimester of pregnancy and is receiving medically necessary prenatal care services the day before enrollment, the MCO shall be responsible for providing continued access to the provider (regardless of network affiliation) through the postpartum period. Reimbursement to an out-of-network provider shall be as set out in Rule 1200-13-14-.08.

(b) TennCare Select.

TennCare Select is a prepaid inpatient health plan (PIHP), as defined in 42 C.F.R. § 438.2, which operates in all areas of the State and covers the same services as the MCOs. The State’s TennCare Select contractor is reimbursed on a non-risk, noncapitated basis for services rendered to covered populations, and in addition receives fees from the State to offset administrative costs.

1. The TennCare populations included in the TennCare Select delivery system are as follows:

(i) Children under the age of twenty-one (21) years who are eligible for Supplemental Security Income.

(ii) Children in state custody and children leaving state custody for six (6) months post-custody as long as the child remains eligible.

(iii) Children under the age of twenty-one (21) years in an institutional eligibility category who are receiving care in a Nursing Facility or an Intermediate Care Facility for persons with Mental Retardation (or pursuant to federal law, Intermediate Care Facility for the Mentally Retarded) (ICF/MR), and children and adults in a Home and Community Based Services 1915(c) waiver for individuals with mental retardation.

(iv) Enrollees living in areas where there is insufficient MCO capacity to serve them.

After being assigned to TennCare Select, persons in categories (i) and (iii) above may choose to disenroll from TennCare Select and enroll in another MCO if one is available. Persons in categories (ii) and (iv) must remain in TennCare Select.

TennCare Select is not open to voluntary selection by TennCare enrollees.

2. TennCare Select also provides the following functions:

(i) It is the back-up plan should one of the MCOs leave the TennCare program unexpectedly. For TennCare enrollees previously enrolled with the MCO, TennCare Select provides medical case management and all MCO covered services.

(ii) It is the only entity responsible for payment of the services described in 42 C.F.R. § 431.52, services provided to residents temporarily absent from the State, and provides all MCO covered services (primarily emergency services).

(iii) It is also the only entity responsible for payment of the services described in 42 C.F.R. § 440.255, emergency services for certain aliens.

(c) TennCare Managed Care Organizations (MCOs) for ECF CHOICES. Individuals enrolled in ECF CHOICES may select from only the MCOs participating in ECF CHOICES.

1. If an individual enrolled in an MCO other than an ECF CHOICES participating MCO wants to enroll in the ECF CHOICES program, the individual must choose to enroll in an ECF CHOICES participating MCO in order to enroll in ECF CHOICES.

2. If an individual enrolled in the ECF CHOICES program elects to transition to an MCO that is not participating in ECF CHOICES, the individual is choosing to voluntarily disenroll from ECF CHOICES. Because this is a voluntary decision, advance notice and the right to a fair hearing shall not be provided. However, the individual may elect to transition back to an ECF CHOICES participating MCO in order to resume enrollment in ECF CHOICES.

(d) TennCare Dental Benefits Manager (DBM).

TennCare Enrollees shall be assigned to the Dental Benefits Manager (DBM) under contract with the Bureau to provide dental benefits as set out in Rule .04, Dental Services. TennCare adults age 21 and older enrolled in ECF CHOICES or a 1915(c)

Waiver program shall also receive Adult Dental Services, as outlined in Chapter 1200- 13-01.

(e) TennCare Pharmacy Benefits Manager (PBM).

TennCare enrollees who are eligible to receive pharmacy services shall be assigned to the Pharmacy Benefits Manager (PBM) under contract with the Bureau to provide pharmacy benefits for both medical and behavioral health services through the TennCare Program.

(2) Reassignment.

(a) Reassignment to an MCO other than the current MCO in which the TennCare enrollee is enrolled is subject to another MCO’s capacity to accept new enrollees and must be approved by the Bureau of TennCare in accordance with one of the following:

1. During the initial ninety (90) day period following notification of MCO assignment as described at Rule 1200-13-14-.03, a TennCare Standard enrollee may request a change of MCOs.

2. A TennCare enrollee must change MCOs if he moves outside the MCO’s Grand Division, and that MCO is not authorized to operate in the enrollee’s new place of residence. Until the TennCare enrollee selects or is assigned to a new MCO and his enrollment is deemed complete, his medical care will remain the responsibility of the original MCO.

3. If an enrollee’s MCO withdraws from participation in the TennCare Program, TennCare will assign him to a MCO operating in his Grand Division, if one is available. The enrollee will be provided notice of the change and will have ninety (90) days to select another MCO in his Grand Division. If no MCO is available to accept enrollees from an exiting plan, the enrollees will be assigned to TennCare Select until such time as another MCO becomes available.

4. An enrollee shall be given an opportunity to change MCOs once each year during an annual change period. Only one (1) MCO change is permitted every twelve (12) months, unless the Bureau authorizes a change as the result of the resolution of an appeal requesting a “hardship” reassignment. When an enrollee changes MCOs, the enrollee’s medical care will be the responsibility of the current MCO until enrolled in the requested MCO. If an enrollee changes MCOs during an annual change period, all family members living in the same household and enrolled in TennCare shall also be changed except children enrolled in TennCare Select.

(b) A TennCare enrollee may change MCOs if the TennCare Bureau has granted a request for a change in MCOs or an appeal of a denial of a request for a change in MCOs has been resolved in his favor based on hardship criteria.

1. The following situations will not be determined to be “hardships”:

(i) The enrollee is unhappy with the current MCO or primary care provider (PCP), but there is no hardship medical situation (as stated in Part 2. below);

(ii) The enrollee claims lack of access to services but the plan meets the state’s access standard;

(iii) The enrollee is unhappy with a current PCP or other providers, and has refused alternative PCP or provider choices offered by the MCO;

(iv) The enrollee is concerned that a current provider might drop out of the plan in the future;

(v) The enrollee is a Medicare beneficiary who (with the exception of pharmacy) may utilize choice of providers, regardless of network affiliation; or (vi) The enrollee’s PCP is no longer in the MCO’s network, the enrollee wants to continue to see the current PCP and has refused alternative PCP or provider choices offered by the MCO.

2. Requests for hardship MCO reassignments must meet all of the following six (6) hardship criteria for reassignment. Determinations will be made on an individual

basis.

(i) A member has a medical condition that requires complex, extensive, and ongoing care; and (ii) The member’s specialist has stopped participating in the member’s current MCO network and has refused continuation of care to the member in his current MCO assignment; and (iii) The ongoing medical condition of the member is such that another physician or provider with appropriate expertise would be unable to take over his care without significant and negative impact on his care; and (iv) The current MCO has been unable to negotiate continued care for this member with the current specialist; and (v) The current provider of services is in the network of one or more alternative MCOs; and (vi) An alternative MCO is available to enrolled members (i.e., has not given notice of withdrawal from the TennCare Program, is not in receivership, and is not at member capacity for the member’s region).

Requests to change MCOs submitted by TennCare enrollees shall be evaluated in accordance with the hardship criteria referenced above. If an enrollee’s request to change MCOs is granted due to hardship, all family members living in the same household and enrolled in TennCare will be assigned to the new MCO except children determined by the Bureau to be eligible to enroll in TennCare Select. Upon denial of a request to change MCOs, enrollees shall be provided notice and appeal rights as described in applicable provisions of Rule 1200-13-14-.11.

(c) Members receiving long-term services and supports.

1. In the event that a CHOICES member is determined, based on an assessment of needs, to require a long-term care service that is not currently available under the MCO in which he is currently enrolled, but that is available through another MCO, the Bureau shall work with the current MCO to arrange for provision of the required service, which may involve providing such service out-of-network. It shall be considered to be a hardship reason to change MCO assignment only if the current MCO, after working with the Bureau, is unable to provide the required service. In such cases, the MCO that is unable to provide the required service after working with the Bureau may be subject to sanctions.

2. A CHOICES or ECF CHOICES member may request and shall have cause to change MCO assignment if all of the following are met:

(i) The member receives institutional, residential, or employment support services in the MLTSS program in which he is enrolled;

(ii) The member’s institutional, residential, or employment support services provider has stopped participating in the member’s MCO network and has refused continuation of care to the member in his current MCO assignment;

(iii) The member’s current MCO has been unable to negotiate continued services for the member with the current provider;

(iv) The member would have to change his residential, institutional, or employment supports provider based on that provider’s change in status from an in-network to an out-of-network provider with the MCO;

(v) As a result, the member would experience a disruption in his residence or employment;

(vi) The current institutional, residential, or employment support services provider is in the network of one or more alternative MCOs; and (vii) The alternative MCO the member has selected is available to enroll members (i.e., has not given notice of withdrawal from the TennCare Program, is not in receivership, and is not at member capacity for the member’s region).

(d) Enrollees who are out-of-state on a temporary basis, but maintain their status as a Tennessee resident under federal and state laws, shall be reassigned to TennCare Select for the period they are out-of-state.

(e) TennCare shall only accept a request to change MCO assignment from the affected enrollee, his parent, guardian, spouse, child over age eighteen (18) or responsible party as defined in Rule 1200-13-14-.01.

(3) Disenrollment.

(a) When it has been determined that an individual no longer meets the criteria for TennCare eligibility, that individual shall be disenrolled from the TennCare Program, including the CHOICES and ECF CHOICES program, as applicable. Services provided by the TennCare MCO in which the individual has been enrolled, as well as the PBM and DBM, if applicable, shall be terminated upon disenrollment. Such disenrollment action will be accompanied by appropriate due process procedures as described elsewhere in this Chapter. Disenrollment from the CHOICES program shall proceed as described in Rule 1200-13-01-.05. Disenrollment from the ECF CHOICES program shall proceed as described in Rule 1200-13-01-.31.

(b) Coverage shall cease at 12:00 midnight, local time, on the date that an individual is disenrolled from TennCare.

(c) TennCare may reassign individuals from a designated MCO and place them in another MCO as described elsewhere in these rules. A TennCare MCO may not reassign an enrollee without the permission of TennCare. A TennCare MCO shall not request the reassignment of a TennCare enrollee for any of the following reasons:

1. Adverse changes in the enrollee’s health;

2. Pre-existing medical conditions; or 3. High cost medical bills.

Coverage by a particular MCO shall cease at 12:00 midnight local time on the date that an individual has been reassigned by TennCare from one MCO and placed in another plan. Coverage by the new MCO will begin when coverage by the old MCO ends.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 4-5-209, 71-5-105, 71-5-107, and 71-5-109 and Executive Order No. 23.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13- 14-.03; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Public necessity rule filed December 29, 2005; expired June 12, 2006. On June 13, 2006, affected rules reverted to status on December 28, 2005. Amendment filed March 31, 2006; effective June 14, 2006. Amendment filed August 14, 2006; effective October 28, 2006. Amendment filed January 26, 2007; effective April 11, 2007. Amendment filed September 13, 2007; effective November 27, 2007. Public necessity rule filed February 8, 2008; effective through July 22, 2008. Repeal and new rule filed May 7, 2008; effective July 21, 2008. Amendments filed September 25, 2009; effective December 24, 2009. Amendment filed November 30, 2009; effective February 28, 2010. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendment filed May 27, 2010; effective August 25, 2010. Amendments filed October 26, 2010; effective January 24, 2011. Amendments filed June 18, 2012; effective September 16, 2012. Emergency rules filed July 1, 2016; effective through December 28, 2016. Amendments filed September 30, 2016; effective December 29, 2016. Amendments filed September 25, 2017; effective December 24, 2017. Amendments filed July 8, 2021; effective October 6, 2021. Amendments filed February 16, 2022; effective May 17, 2022. Emergency rules filed December 27, 2022 to become effective January 1, 2023; effective through June 30, 2023. Amendments filed January 19, 2023; effective April 19, 2023.

Tenn. Comp. R. & Regs. 1200-13-14-.04 COVERED SERVICES

(1) Benefits Covered Under the Managed Care Program.

(a) TennCare MCCs shall cover the following services and benefits subject to any applicable limitations described in this Chapter. TennCare MCCs shall cover TennCare CHOICES services and benefits for individuals enrolled in the TennCare CHOICES program in accordance with Rule 1200-13-01-.05 and ECF CHOICES services and benefits for individuals enrolled in the ECF CHOICES program in accordance with Rule

Tenn. Comp. R. & Regs. 1200-13-14-.05 ENROLLEE COST SHARING

(1) Premiums and deductibles.

(a) Enrollees are not required to pay premiums for TennCare.

(b) There are no TennCare deductibles.

(2) Copays.

(a) The following TennCare Standard enrollees are exempt from TennCare copays:

1. Enrollees who are receiving hospice services and who provide verbal notification of such to the provider at the point of service.

2. Enrollees who are pregnant and who provide verbal notification of such to the provider at the point of service.

3. Enrollees who are enrolled in any of the following CHOICES or ECF CHOICES demonstration categories:

(i) The CHOICES 217-Like Group (ii) The CHOICES 1 and 2 Carryover Group (iii) The PACE Carryover Group (iv) The ECF CHOICES 217-Like Group 4. Children who are enrolled in TennCare Standard and who have family incomes below 100% of poverty.

(b) The following TennCare services are exempt from TennCare copays for all enrollees:

1. Emergency services, including the seventy-two (72) hour emergency supply of a medication in an emergency situation, as described in Rule 1200-13-14-.11.

2. Family planning services and supplies.

3. Preventive services as identified in Rule 1200-13-14-.04.

(c) Pharmacy copays. The following TennCare Standard enrollees have pharmacy copays of $3.00 per covered brand name prescription and $1.50 per covered generic prescription:

1. TennCare Standard children with family incomes that are 100% of poverty or greater.

2. Enrollees in the Standard Spend Down program.

3. Enrollees in the CHOICES At-Risk Demonstration Group.

4. Adults age 21 and older in the Interim ECF CHOICES At-Risk Demonstration Group.

(d) Copays for other TennCare services. The following copays are applicable to TennCare Standard children, except children enrolled in ECF CHOICES.

Benefit Copay if income is 0%-99% of poverty Copay if income is 100%-199% of poverty Copay if income is 200% of poverty or greater Hospital emergency room use for non-emergency services (waived if admitted) $0 $10 $50 Primary care provider services other than preventive care $0 $5 $15 Community Mental Health Agency services other than preventive care $0 $5 $15 Physician specialists and dentists $0 $5 $20 Prescription or refill $0 $3 for covered branded prescriptions and $1.50 for covered generic prescriptions $3 for covered branded prescriptions and $1.50 for covered generic prescriptions Inpatient hospital admission $0 $5 $100 (e) Copays for non-emergency services provided in an emergency department are not required unless the hospital has first provided the enrollee with assistance in gaining access to a non-emergency services provider (a physician’s office, health care clinic, community health center, hospital outpatient department, or similar provider). This requirement on the part of the hospital can be met if, before providing non-emergency care subject to copay, the emergency room staff recommends that the enrollee or the enrollee’s caretaker call the 24/7 nurse staffed call center for the enrollee’s MCO to obtain help in locating an available provider in the community, and offers to assist with placing a call to the call center.

(3) Aggregate cost-sharing cap.

(a) The aggregate cost-sharing cap is applicable only to TennCare copays incurred by TennCare Standard children with incomes at or above 100% of poverty and their TennCare family members.

(b) The aggregate cost-sharing cap is calculated by combining the TennCare cost sharing for all TennCare family members who have TennCare cost-sharing obligations, and may not exceed 5 percent of the family’s annual income, prorated to a quarterly equivalent. Family income will be calculated using the same methodology used to calculate income for the determination of eligibility, and the family will be assigned to the corresponding income band to determine the standardized aggregate cap, which is based on the lower end of the income band. The following income bands and the corresponding aggregate annual caps will be used:

Income Bands Poverty levels Standardized Annual Aggregate Cap 1 0% - 99% Not applicable 2 100% - 149% 5% of the amount that corresponds to 100% FPL 3 150% - 199% 5% of the amount that corresponds to 150% FPL 4 200% - 249% 5% of the amount that corresponds to 200% FPL 5 250% - 299% 5% of the amount that corresponds to 250% FPL 6 300% - 349% 5% of the amount that corresponds to 300% FPL 7 350% - 399% 5% of the amount that corresponds to 350% FPL 8 400% - 499% 5% of the amount that corresponds to 400% FPL 9 500% - 599% 5% of the amount that corresponds to 500% FPL 10 600% and over 5% of the amount that corresponds to 600% FPL (c) Families of applicable TennCare Standard children are responsible for tracking their own incurred cost sharing obligations, including keeping copies of receipts and similar documentation, and notifying the Bureau of TennCare when they believe they have reached their aggregate cost-sharing cap for a particular calendar quarter.

(d) After receiving the information described in subparagraph (c), TennCare will notify families of applicable TennCare Standard children of the date when it has been determined that the aggregate cost-sharing cap, as prorated for the quarter, has been reached. When that occurs, there are no further TennCare cost-sharing obligations required for the remainder of the calendar quarter. Any TennCare copays that are paid by the family during the quarter after the family’s aggregate cost-sharing cap, as prorated for that quarter, has been reached will be refunded to the family by TennCare.

(4) This paragraph applies to all TennCare Managed Care Contractors and providers.

(a) In accordance with 42 C.F.R. § 447.53(e), providers may not refuse to deliver a covered service to an enrollee because of the enrollee’s inability to make his copay.

(b) Managed care contractors participating in the TennCare program shall be specifically prohibited from waiving or discouraging TennCare enrollees from paying any applicable cost-sharing amounts.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 4-5-209, 71-5-105, and 71-5-109 and Executive Order No. 23.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-14- .05; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Public necessity rules filed June 3, 2005; effective through November 15, 2005. Public necessity rule filed July 1, 2005; effective through December 13, 2005. Amendments filed September 1, 2005; effective November 15, 2005. Amendments filed September 26, 2005; effective December 10, 2005. Public necessity rule filed December 29, 2005; expired June 12, 2006. On June 13, 2006, affected rules reverted to status on December 28, 2005. Amendment filed March 31, 2006; effective June 14, 2006. Public necessity rule filed March 21, 2007; effective through September 2, 2007. Amendment filed June 11, 2007; effective August 25, 2007. Public necessity rules filed November 30, 2007; effective through May 13, 2008. Amendment filed February 14, 2008; effective April 29, 2008. Emergency rule filed March 1, 2010; effective through August 28, 2010. Emergency rule filed July 26, 2010; effective through January 22, 2011. Amendment filed May 27, 2010; effective August 25, 2010. Amendment filed October 20, 2010; effective January 18, 2011. Repeal and new rule filed January 15, 2013; effective April 15, 2013. Emergency rules filed September 26, 2013; effective through March 25, 2014. Amendment filed December 17, 2013; effective March 17, 2014. Emergency rules filed July 1, 2016; effective through December 28, 2016. Amendments filed September 30, 2016; effective December 29, 2016.

Tenn. Comp. R. & Regs. 1200-13-14-.06 MANAGED CARE ORGANIZATIONS

Managed Care Organizations participating in TennCare will be limited to Health Maintenance Organizations that are appropriately licensed to operate within the state of Tennessee to provide medical, behavioral, and long-term care services in the TennCare program. Managed Care Organizations shall have a fully executed contract with the Tennessee Department of Finance and Administration. MCOs, DBMs and PBMs shall agree to comply with all applicable rules, policies, and contract requirements as specified by the Tennessee Department of Finance and Administration as applicable. Managed Care Organizations must continually demonstrate a sufficient provider network based on the standards set by the Bureau of TennCare to remain in the program and must reasonably meet all quality of care requirements established by the Bureau of TennCare.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 71-5-105, and 71-5-109 and Executive Order No. 23.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-14- .06; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Amendment filed September 25, 2009; effective December 24, 2009. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendment filed May 27, 2010; effective August 25, 2010.

Tenn. Comp. R. & Regs. 1200-13-14-.07 MANAGED CARE ORGANIZATION PAYMENT

Managed care organizations will be paid pursuant to the contract the MCO has fully executed with the Tennessee Department of Finance and Administration.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, and 71-5-109 and Executive Order No. 23.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-14-.07; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003.

Tenn. Comp. R. & Regs. 1200-13-14-.08 PROVIDERS

(1) Payment in full.

(a) All Participating Providers, as defined in this Chapter, must accept as payment in full for provision of covered services to TennCare enrollees, the amounts paid by the MCC plus any copayment required by the TennCare Program to be paid by the individual.

(b) Any Non-Participating Providers who provide TennCare Program covered services by authorization from an MCC must accept as payment in full for provision of covered services to TennCare enrollees, the amounts paid by the MCC plus any copayment required by the TennCare Program to be paid by the individual.

(c) Any Non-Participating Provider, as defined in this Chapter, who provides TennCare Program covered non-emergency services to TennCare enrollees without authorization from the enrollee’s MCC does so at his own risk. He may not bill the patient for such services except as provided for in Rule 1200-13-14-.08(5).

(d) Any Out-of-State Emergency Provider, as defined in this Chapter, who provides covered emergency services to TennCare enrollees in accordance with this Chapter must accept as payment in full the amounts paid by the MCC plus any copayment required by the TennCare Program.

(2) Non-Participating Providers.

(a) In situations where a MCC authorizes a service to be rendered by a provider who is not a Participating Provider with the MCC, as defined in this Chapter, payment to the provider shall be no less than eighty percent (80%) of the lowest rate paid by the MCC to equivalent participating network providers for the same service.

(b) Covered medically necessary outpatient emergency services, when provided to Medicaid managed care enrollees by non-contract hospitals in accordance with Section 1932(b)(2)(D) of the Social Security Act (42 U.S.C.A. § 1396u-2(b)(2)(D)), shall be reimbursed at seventy-four percent (74%) of the 2006 Medicare rates for these services. Emergency care to enrollees shall not require preauthorization.

(c) Covered medically necessary inpatient hospital admissions required as the result of emergency outpatient services, when provided to Medicaid managed care enrollees by non-contract hospitals in accordance with Section 1932(b)(2)(B) of the Social Security Act (42 U.S.C.A. § 1396u-2(b)(2)(B)), shall be reimbursed at 57 percent of the 2008 Medicare Diagnostic Related Groups (DRG) rates (excluding Medical Education and Disproportionate Share components) determined in accordance with 42 C.F.R. § 412 for those services. For DRG codes that are adopted after 2008, 57 percent of the rate from the year of adoption will apply. Such an inpatient stay will continue until no longer medically necessary or until the patient can be safely transported to a contract hospital or to another contract service, whichever comes first.

(d) Non-Participating Providers who furnish covered CHOICES services are reimbursed in accordance with Rule 1200-13-01-.05.

(e) Non-Participating Providers who furnish covered ECF CHOICES services are reimbursed in accordance with Rule 1200-13-01-.31.

(3) Participation in the TennCare program will be limited to providers who:

(a) Accept, as payment in full, the amounts paid by the managed care contractor, including copays from the enrollee, or the amounts paid in lieu of the managed care contractor by a third party (Medicare, insurance, etc.);

(b) Maintain Tennessee, or the State in which they practice, medical licenses and/or certifications as required by their practice, or licensure by the TDMHDD, if appropriate;

(c) Are not under a federal Drug Enforcement Agency (DEA) restriction of their prescribing and/or dispensing certification for scheduled drugs (relative to physicians, osteopaths, dentists and pharmacists);

(d) Agree to maintain and provide access to TennCare and/or its agent all TennCare enrollee medical records for five (5) years from the date of service or upon written authorization from TennCare following an audit, whichever is shorter;

(e) Provide medical assistance at or above recognized standards of practice; and (f) Comply with all contractual terms between the provider and the managed care contractor and TennCare policies as outlined in federal and state rules and regulations and TennCare provider manuals and bulletins.

(g) Failure to comply with any of the above provisions (a) through (f) may subject a provider to the following actions:

1. Sanctions set out in T.C.A. § 71-5-118. In addition, the provider may be subject to stringent review/audit procedures, which may include clinical evaluation of services and a prepayment requirement for documentation and justification for each claim.

2. The Bureau of TennCare may withhold or recover payments to managed care contractors in cases of provider fraud, willful misrepresentation, or flagrant noncompliance with contractual requirements and/or TennCare policies.

3. The Bureau of TennCare may refuse to approve or may suspend provider participation with a provider if any person who has an ownership or controlling interest in the provider, or who is an agent or managing employee of the provider, has been convicted of a criminal offense related to that person’s involvement in any program established under Medicare, Medicaid or the U.S.

Title XX Services Program.

4. The Bureau of TennCare may refuse to approve or may suspend provider participation if it determines that the provider did not fully and accurately make any disclosure of any person who has ownership or controlling interest in the provider, or is an agent or managing employee of the provider and has been convicted of a criminal offense related to that person’s involvement in any program under Medicare, Medicaid or the U.S. Title XX Services Program since the inception of these programs.

5. The Bureau of TennCare shall refuse to approve or shall suspend provider participation if the appropriate State Board of Licensing or Certification fails to license or certify the provider at any time for any reason or suspends or revokes a license or certification.

6. The Bureau of TennCare shall refuse to approve or shall suspend provider participation upon notification by the U.S. Office of Inspector General Department of Health and Human Services that the provider is not eligible under Medicare or Medicaid for federal financial participation.

7. The Bureau of TennCare may recover from a managed care contractor any payments made by an enrollee and/or his family for a covered service, in total or in part, except as permitted. If a provider knowingly bills an enrollee and/or his family for a covered service, in total or in part, except as permitted, the Bureau of TennCare may terminate the provider’s participation in TennCare.

(4) Solicitations and Referrals.

(a) Managed care contractors and providers shall not solicit TennCare enrollees by any method offering as enticements other goods and services (free or otherwise) for the opportunity of providing the enrollee with TennCare covered services that are not medically necessary and/or that overutilize the TennCare program.

(b) A managed care contractor may request a waiver from this restriction in writing to TennCare. TennCare shall determine the value of a waiver request based upon the medical necessity and need for the solicitation. The managed care contractor may implement the solicitation only upon receipt of a written waiver approval from TennCare. This waiver is not transferable and may be canceled by TennCare upon written notice.

(c) TennCare payments for services related to a non-waivered solicitation enticement shall be considered by TennCare as a non-covered service and recouped. Neither the managed care contractor nor the provider may bill the enrollee for non-covered services recouped under this authority.

(d) A provider shall not offer or receive remuneration in any form related to the volume or value of referrals made or received from or to another provider.

(5) Providers may seek payment from a TennCare enrollee only under the following circumstances. These circumstances apply to all TennCare providers, as defined in this

Chapter, including those who are Out-of-Network Providers in a particular enrollee’s MCC.

These circumstances include situations where the enrollee may choose to seek an out-ofnetwork provider for a specific covered service.

(a) If the services are not covered by the TennCare program and, prior to providing the services, the provider informed the enrollee that the services were not covered; or (b) If the services are not covered because they are in excess of an enrollee’s benefit limit and one of the following circumstances applies:

1. The provider determines effective on the date of service that the enrollee has reached his/her benefit limit for the particular service being requested and, prior to providing the service, informs the enrollee that the service is not covered and the service will not be paid for by TennCare. The source of the provider’s information must be a database listed on the TennCare website as approved by TennCare on the date of the provider’s inquiry.

2. The provider has information in his/her own records to support the fact that the enrollee has reached his/her benefit limit for the particular service being requested and, prior to providing the service, informs the enrollee that the service is not covered and will not be paid for by TennCare. This information may include:

(i) A previous written denial of a claim on the basis that the service was in excess of the enrollee’s benefit limit for a service within the same benefit category as the service being requested, if the time period applicable to the benefit limit is still in effect; or (ii) That the provider had previously examined the database referenced in part 1. above and determined that the enrollee had reached his/her benefit limit for the particular service being requested, if the time period applicable to that benefit limit is still in effect; or (iii) That the provider had personally provided services to the enrollee in excess of his/her benefit limit within the same benefit category as the service being requested, if the time period applicable to that benefit period is still in effect; or (iv) The enrollee’s MCO has provided confirmation to the provider that the enrollee has reached his/her benefit limit for the applicable service.

3. The provider submits a claim for service to the appropriate managed care contractor (MCC) and receives a written denial of that claim on the basis that the service exceeds the enrollee’s benefit limit. Thereafter, following informing the enrollee and within the remainder of the period applicable to that benefit limit, the provider may bill the enrollee for services within that same exhausted benefit category without having to submit, for repeated MCC denial, claims for those subsequent services. If the provider informed the enrollee prior to providing the service for which the claim was denied that the service would exceed the enrollee’s benefit limit and would not be paid for by TennCare, the provider may bill the enrollee for that service.

4. The provider had previously taken the steps in parts 1., 2. or 3. above and determined that the enrollee had reached his/her benefit limit for the particular service being requested, if the time period applicable to the benefit limit is still in effect, and informs the enrollee, prior to providing the service, that the service is not covered and will not be paid for by TennCare.

(c) If the services are covered only with prior authorization and prior authorization has been requested but denied, or is requested and a specified lesser level of care is approved, and the provider has given prior notice to the enrollee that the services are not covered, the enrollee may elect to receive those services for which prior authorization has been denied or which exceed the authorized level of care and be billed by the provider for such services.

(6) Providers may not seek payment from a TennCare enrollee under the following conditions:

(a) The provider knew or should have known about the patient’s TennCare eligibility or pending eligibility prior to providing services.

(b) The claim(s) submitted to TennCare or the enrollee’s managed care contractor for payment was denied due to provider billing error or a TennCare claim processing error.

(c) The provider accepted TennCare assignment on a claim and it is determined that another payer paid an amount equal to or greater than the TennCare allowable amount.

(d) The provider failed to comply with TennCare policies and procedures or provided a service which lacks medical necessity or justification.

(e) The provider failed to submit or resubmit claims for payment within the time periods required by the managed care contractor or TennCare.

(f) The provider failed to ascertain the existence of TennCare eligibility or pending eligibility prior to providing non-emergency services. Even if the enrollee presents another form of insurance, the provider must determine whether the patient is covered under TennCare.

(g) The provider failed to inform the enrollee prior to providing a service not covered by TennCare that the service was not covered and the enrollee may be responsible for the cost of the service. Services which are non-covered by virtue of exceeding limitations are exempt from this requirement. Notwithstanding this exemption, providers shall remain obligated to provide notice to enrollees who have exceeded benefit limits in accordance with Rule 1200-13-14-.11.

(h) The enrollee failed to keep a scheduled appointment(s).

(i) The provider is a TennCare provider, as defined in this Chapter, but is not participating with a particular enrollee’s MCC and is seeking to bill the enrollee as though the provider were a Non-TennCare Provider, as defined in this Chapter.

(7) Providers may seek payment from a person whose TennCare eligibility is pending at the time services are provided if the provider informs the person that TennCare assignment will not be accepted whether or not eligibility is established retroactively.

(8) Providers may seek payment from a person whose TennCare eligibility is pending at the time services are provided. Providers may bill such persons at the provider’s usual and customary rate for the services rendered. However, all monies collected for TennCare-covered services rendered during a period of TennCare eligibility must be refunded when a claim is submitted to TennCare if the provider agreed to accept TennCare assignment once retroactive TennCare eligibility was established.

(9) Providers of inpatient hospital services, outpatient hospital services, skilled nursing facility services, independent laboratory and x-ray services, hospice services, and home health agencies must be approved for Title XVIII-Medicare in order to be certified as providers under the TennCare Program; in the case of hospitals, the hospital must meet state licensure requirements and be approved by TennCare as an acute care hospital as of the date of enrollment in TennCare. Children’s hospitals and State mental hospitals may participate in TennCare without having been Medicare approved; however, the hospital must be approved by the Joint Commission for Accreditation of Health Care Organizations as a condition of participation.

(10) Pharmacy providers may not waive pharmacy copayments for TennCare Medicaid or TennCare Standard enrollees as a means of attracting business to their establishment. This does not prohibit a pharmacy from exercising professional judgment in cases where an enrollee may have a temporary or acute need for a prescribed drug, but is unable, at that moment, to pay the required copayment.

(11) Providers shall not deny services for Medicaid enrollee failure to make copayments.

(12) All claims must be filed in accordance with the following:

(a) Claims filed with an MCC must be submitted in accordance with the requirements and timeframes set forth in the MCC’s contract.

(b) All other fee-for-service claims for services delivered outside of the TennCare managed care program must be filed with the Bureau of TennCare as follows:

1. All claims must be filed within one (1) year of the date of service except in the following circumstances:

(i) Recipient eligibility was determined retroactively to the extent that filing within one (1) year was not possible. In such situations, claims must be filed within one (1) year after final determination of eligibility.

(ii) If a claim filed with Medicare on a timely basis does not automatically cross over from the Medicare carrier to the Bureau, a TennCare claim may be filed within six (6) months of notification of payment or denial from Medicare.

2. Should an original claim be denied, any resubmission or follow-up of the initial claim must be received within six (6) months from the date the original claim was filed. The Bureau will not process submissions received after the six (6) month time limit. The one exception is those claims returned due to available third party coverage. These claims must be submitted within sixty (60) days of notice from the third party resource.

3. Should a correction document involving a suspended claim be sent to the provider, the claim will be denied if the correction document is not completed by the provider and returned to the Bureau within ninety (90) days from the date on the document.

4. If claim is not filed within the above timeframes, no reimbursement may be made.

5. Claims will be paid on a first claim approved - first claim paid basis.

6. The Bureau will not reimburse providers for services for which there is no Federal Financial Participation.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 4-5-209, 71-5-105, 71-5-109, and 71-5-134 and Executive Order No. 23.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13- 14-.08; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Public necessity rule filed January 2, 2003; effective through June 16, 2003. Amendment filed October 12, 2004; effective December 26, 2004. Public necessity rule filed July 29, 2005; effective through January 10, 2006. Public necessity rule filed December 29, 2005; expired June 12, 2006. On June 13, 2006, affected rules reverted to status on December 28, 2005. Amendment filed October 27, 2005; effective January 10, 2006. Amendment filed March 31, 2006; effective June 14, 2006. Public necessity rule filed September 8, 2008; effective through February 20, 2009. Amendment filed December 5, 2008; effective February 18, 2009. Amendment filed February 25, 2009; effective May 11, 2009. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendments filed May 27, 2010; effective August 25, 2010. Emergency rule filed September 3, 2010; effective through March 2, 2011. Amendment filed December 2, 2010; to have been effective March 2, 2011, was stayed 28 days by the Government Operations Committee; new effective date March 29, 2011. Emergency rules filed July 1, 2016; effective through December 28, 2016. Amendments filed September 30, 2016; effective December 29, 2016.

Tenn. Comp. R. & Regs. 1200-13-14-.15 BESMART

This rule supersedes any other rules related to the use of buprenorphine products for treatment of opioid use disorder (OUD) in office based opioid treatment (OBOT) or an opioid treatment program (OTP) by a treating provider participating in an MCO’s network of BESMART providers.

(1) BESMART treatment is a component of covered outpatient substance abuse benefits and consists of a set of coordinated medically necessary covered services which includes:

(a) Psychosocial assessment and development of a treatment plan;

(b) Individual or group counseling;

(c) Peer recovery services;

(d) Care coordination;

(e) Opioid-agonist therapy consisting of buprenorphine products that have been FDA approved for OUD treatment and may be prescribed in excess of the limits described in rules .04 and .10, when determined to be medically necessary by a treating provider in an MCO’s network of BESMART providers and under the participant’s plan of care.

1. Except as otherwise provided for in this rule, participants may receive up to sixteen (16) mg of buprenorphine containing products daily; however, providers shall initiate and lead a discussion regarding a participant’s readiness to taper down or off treatment at any time upon a participant’s request, but no later than one (1) year after initiating treatment and every six (6) months thereafter.

2. Under the best practices for treatment of OUD, the BESMART provider shall utilize the lowest effective dose of Medication-Assisted Treatment (MAT).

3. The following adult populations shall be eligible to receive a maximum daily dosage of twenty-four (24) mg of buprenorphine, not to exceed one (1) year in duration:

(i) Pregnant participants confirmed by provider attestation.

(ii) Postpartum participants for a period of twelve (12) months from delivery date as shown by medical records or insurance claim.

(iii) Recent intravenous (IV) drug users confirmed by prescriber attestation and a positive urine drug screen.

(iv) Current users receiving greater than fifty (50) mg of methadone for OUD treatment transitioning to buprenorphine agonist therapy demonstrated by paid claims data from the participant’s health insurer, provider attestation, or medical records.

(v) Current users of sixteen (16) mg to twenty-four (24) mg per day of buprenorphine demonstrated by paid claims data from the participant’s previous health insurer.

(vi) For one (1) year from the effective date of this rule, a member who does not qualify under the criteria of this part but receives greater than sixteen (16) mg per day of buprenorphine as demonstrated by the controlled substance monitoring database shall be eligible to receive a maximum daily dose of twenty-four (24) mg.

(2) BESMART treatment requires medical office visits at least weekly for participants in the induction and stabilization phase of treatment; at least every two (2) to four (4) weeks for participants in the maintenance phase of treatment; and at least every two (2) months for participants who have been in the maintenance phase of treatment for one (1) year or longer.

(3) To be reimbursed for a BESMART covered service, treating providers must demonstrate an ability to provide all BESMART services in a coordinated, person-centric way, including the ability to facilitate access to all related treatment modalities and provider types, and must participate in at least one (1) MCO’s network of BESMART providers.

(4) Prescriptions of buprenorphine containing products to TennCare enrollees by nurse practitioners and physician assistants for the treatment of OUD will not be reimbursed unless the nurse practitioner or physician assistant participates in at least one (1) MCO’s network of BESMART providers.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 71-5-105, 71-5-107, and 71-5-109.
• Administrative History: Emergency rules filed April 15, 2021; effective through October 12, 2021. New rule filed June 29, 2021; effective September 27, 2021.

Tenn. Comp. R. & Regs. 1200-13-01-.05 ; or (b) In the instance of enrollees who are eligible for and enrolled in federal Medicaid waivers under Section 1915(c) of the Social Security Act, the services and benefits that are covered under the terms and conditions of such waivers.

(37) CPT4 CODES are descriptive terms contained in the Physician’s Current Procedural Terminology, used to identify medical services and procedures performed by physicians or other licensed health professionals.

(38) DBM (DENTAL BENEFITS MANAGER) shall mean a contractor approved by the Tennessee Department of Finance and Administration to provide dental benefits to enrollees in the TennCare Program to the extent such services are covered by TennCare.

(39) DEDUCTIBLE. A specified amount of money paid each year by an insured person for benefits before his health plan starts paying claims.

(40) DELAY shall mean any failure to provide timely receipt of TennCare services, and no specific waiting period may be required before the enrollee can appeal.

(41) DEMAND LETTER shall mean a letter sent by TennCare to a TennCare Standard enrollee with premium obligations notifying the enrollee that he is at least 60 days delinquent in his premium payments.

(42) DISCONTINUED DEMONSTRATION GROUP shall mean the group of non-Medicaid eligible individuals who were enrolled in TennCare Standard on April 29, 2005, when the categories in which they were enrolled were terminated, and who have not yet been enrolled in TennCare Medicaid or disenrolled from the TennCare program.

(43) DISENROLLMENT shall mean the discontinuance of an individual’s enrollment in TennCare.

(44) DURABLE MEDICAL EQUIPMENT (DME) shall mean equipment that can withstand repeated use, can be removable, is primarily and customarily used to serve a medical

purpose, generally is not useful to a person in the absence of an illness or injury, is suitable for use in any non-institutional setting in which everyday life activities take place, and is related to the patient’s physical disorder. Non-institutional settings do not include a hospital or nursing facility (NF). Routine DME items, including but not limited to wheelchairs (except as defined below), walkers, hospital beds, canes, commodes, traction equipment, suction machines, patient lifts, weight scales, and other items provided to a member receiving services in a NF that are within the scope of per diem reimbursement for NF services shall not be covered or reimbursable under the Medicaid program separate and apart from payment for the NF service. Customized wheelchairs, wheelchair seating systems, and other items that are beyond the scope of Medicaid reimbursement for NF services shall be covered by the member’s managed care organization, so long as such items:

(a) Are medically necessary for the continuous care of a member; and (b) Must be custom-made or modified or may be commercially available, but must be individually measured and selected to address the member’s unique and permanent medical need for positioning, support or mobility; and (c) Are solely for the use of that member and not for other NF residents.

(45) EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT (EPSDT) Services, a covered benefit for TennCare Medicaid-enrolled children only, shall mean:

(a) Screening in accordance with professional standards, and interperiodic, diagnostic services to determine the existence of physical or mental illnesses or conditions of TennCare Medicaid enrollees under age twenty-one (21); and (b) Health care, treatment, and other measures, described in 42 U.S.C. § 1396a(a) to correct or ameliorate any defects and physical and mental illnesses and conditions discovered.

(46) ELIGIBLE shall mean a person who has been determined to meet the eligibility criteria of TennCare Medicaid or TennCare Standard.

(47) EMPLOYMENT AND COMMUNITY FIRST (ECF) CHOICES shall mean the program defined in Rule 1200-13-01-.02 and described in Rule 1200-13-01-.31.

(48) ENROLLEE shall mean an individual eligible for and enrolled in the TennCare program or in any Tennessee federal Medicaid waiver program approved by the Secretary of the U.S.

Department of Health and Human Services pursuant to Sections 1115 or 1915 of the Social Security Act. As concerns MCC compliance with these rules, the term only applies to those individuals for whom the MCC has received at least one day’s prior written or electronic notice from the TennCare Bureau of the individual’s assignment to the MCC.

(49) ENROLLMENT shall mean the process by which a TennCare-eligible person becomes enrolled in TennCare.

(50) ESCORT shall mean an individual who accompanies an enrollee to receive a medically necessary service. For the purpose of determining whether an individual may qualify as an escort who may be transported without cost to the enrollee as a covered TennCare benefit, the following criteria apply:

(a) Any person over the age of twelve (12) selected by the enrollee;

(b) Any person under the age of twelve (12) is presumed to be too young to serve as an escort. At the time of request for transportation, this presumption can be overcome by specific facts provided by the enrollee, which would demonstrate to a reasonable person that the proposed escort could in fact be of assistance to the enrollee; and (c) Any person under the age of six (6) is excluded in all cases from the role of escort.

(51) FAMILY shall mean that as defined in the rules of the Tennessee Department of Human Services found at 1240-01-03 and 1240-01-04, Family Assistance Division, and 1240-03-03, Division of Medical Services.

(52) FEDERAL FINANCIAL PARTICIPATION (FFP) shall mean the Federal Government’s share of a state’s expenditure under the Title XIX Medicaid Program.

(53) FINAL AGENCY ACTION shall mean the resolution of an appeal by the TennCare Bureau or an initial decision on the merits of an appeal by an administrative judge or hearing officer when such initial decision is not modified or overturned by the TennCare Bureau. Final agency action shall be treated as binding for purposes of these rules.

(54) FRAUD shall mean an intentional deception or misrepresentation made by a person who knows or should have known that the deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud under applicable federal or state law.

(55) GRAND DIVISIONS shall mean the three (3) distinct geographic areas of the State of Tennessee, known as Eastern, Middle, and Western, as designated in Tennessee Code Annotated § 4-1-201.

(56) GROUP HEALTH INSURANCE shall mean an employee welfare benefit plan to the extent that the plan provides medical care to employees or their dependents (as defined under the terms of the plan) directly through insurance reimbursement mechanism. This definition includes those types of health insurance found in the Health Insurance Portability And Accountability Act of 1996, as amended, definition of creditable coverage (with the exception that the 50 or more participants criteria does not apply), which includes Medicare and TRICARE. Health insurance benefits obtained through COBRA are included in this definition.

It also covers group health insurance available to an individual through membership in a professional organization or a school.

(57) HANDICAPPING MALOCCLUSION shall mean a malocclusion which causes one of the following medical conditions:

(a) A nutritional deficiency that has proven non-responsive to medical treatment without orthodontic treatment. The nutritional deficiency must have been diagnosed by a qualified treating physician and must have been documented in the qualified treating physician’s progress notes. The progress notes that document the nutritional deficiency must predate the treating orthodontist’s prior authorization request for orthodontics.

(b) A speech pathology that has proven non-responsive to speech therapy without orthodontic treatment. The speech pathology must have been diagnosed by a qualified speech therapist and must have been documented in the qualified speech therapist’s progress notes. The progress notes that document the speech pathology must predate the treating orthodontist’s prior authorization request for orthodontics.

(c) Laceration of soft tissue caused by a deep impinging overbite. Occasional cheek biting does not constitute laceration of soft tissue. Laceration of the soft tissue must be documented in the treating orthodontist’s progress notes and must predate the treating orthodontist’s prior authorization request for orthodontics.

Anecdotal information is insufficient to document the presence of a handicapping malocclusion. The presence of a handicapping malocclusion must be supported by the treating professional’s progress notes and patient record.

(58) HEALTH INSURANCE, for the purposes of determining eligibility under these regulations:

(a) Shall mean:

1. Any hospital and medical expense-incurred policy;

2. Medicare;

3. TRICARE;

4. COBRA;

5. Medicaid;

6. State health risk pool;

7. Nonprofit health care service plan contract;

8. Health maintenance organization subscriber contracts;

9. An employee welfare benefit plan to the extent that the plan provides medical care to an employee or his/her dependents (as defined under the terms of the plan) directly through insurance, any form of self insurance, or a reimbursement mechanism;

10. Coverage available to an individual through membership in a professional organization or a school;

11. Coverage under a policy covering one person or all the members of a family under a single policy where the contract exists solely between the individual and the insurance company;

12. Any of the above types of policies where:

(i) The policy contains a type of benefit (such as mental health benefits) which has been completely exhausted;

(ii) The policy contains a type of benefit (such as pharmacy) for which an annual limitation has been reached;

(iii) The policy has a specific exclusion or rider of non-coverage based on a specific prior existing condition or an existing condition or treatment of such a condition; or 13. Any of the types of policies listed above will be considered health insurance even if one or more of the following circumstances exists:

(i) The policy contains fewer benefits than TennCare;

(ii) The policy costs more than TennCare; or (iii) The policy is one the individual could have bought during a specified period of time (such as COBRA) but chose not to do so.

(b) Shall not mean:

1. Short-term coverage;

2. Accident coverage;

3. Fixed indemnity insurance;

4. Long-term care insurance;

5. Disability income contracts;

6. Limited benefits policies as defined elsewhere in these rules;

7. Credit insurance;

8. School-sponsored sports-related injury coverage;

9. Coverage issued as a supplemental to liability insurance;

10. Automobile medical payment insurance;

11. Insurance under which benefits are payable with or without regard to fault and which are statutorily required to be contained in any liability insurance policy or equivalent self-insurance;

12. A medical care program of the Indian Health Services (IHS) or a tribal organization;

13. Benefits received through the Veteran’s Administration; or 14. Health care provided through a government clinic or program such as, but not limited to, vaccinations, flu shots, mammograms, and care or services received through a disease- or condition-specific program such as, but not limited to, the Ryan White Care Act.

(59) HEALTH MAINTENANCE ORGANIZATION (HMO) shall mean an entity licensed by the Tennessee Department of Commerce and Insurance under applicable provisions of Tennessee Code Annotated (T.C.A.) Title 56, Chapter 32 to provide health care services.

(60) HEALTH PLAN shall mean a Managed Care Organization authorized by the Tennessee Department of Finance and Administration to provide medical and behavioral services to enrollees in the TennCare Program.

(61) HEARING OFFICER shall mean an administrative judge or hearing officer who is not an employee, agent or representative of the MCC or who did not participate in, nor was consulted about, any TennCare Bureau review prior to the State Fair Hearing (SFH).

(62) HIPAA shall mean the Health Insurance Portability and Accountability Act of 1996, as amended.

(63) HOME HEALTH SERVICES shall mean:

(a) Any of the services identified in 42 C.F.R. § 440.70 and delivered in accordance with the provisions of 42 C.F.R. § 440.70. “Part-time or intermittent nursing services” and “home health aide services” are covered only as defined specifically in these rules.

1. Part-time or intermittent nursing services.

(i) To be considered “part-time or intermittent,” nursing services must be provided as no more than one visit per day, with each visit lasting less than eight (8) hours, and no more than 27 total hours of nursing care may be provided per week. In addition, nursing services and home health aide services combined must total less than or equal to eight (8) hours per day and 35 or fewer hours per week. On a case-by-case basis, the weekly total for nursing services may be increased to 30 hours and the weekly total for nursing services and home health aide services combined may be increased to 40 hours for patients qualifying for Level 2 skilled nursing care.

(ii) Part-time or intermittent nursing services are not covered if the only skilled nursing function needed is administration of medications on a p.r.n. (as needed) basis. Nursing services may include medication administration; however, a nursing visit will not be extended in order to administer medication or perform other skilled nursing functions at more than one point during the day, unless skilled nursing services are medically necessary throughout the intervening period. If there is more than one person in the household who is determined to require TennCarereimbursed home health nursing services, it is not necessary to have multiple nurses providing the services. A single nurse may provide services to multiple enrollees in the same home and during the same hours, as long as he can provide these services safely and appropriately to each enrollee.

(iii) The above limits may be exceeded when medically necessary for children under the age of 21.

2. Home health aide services.

(i) Home health aide services must be provided as no more than two visits per day with care provided less than or equal to eight (8) hours per day.

Nursing services and home health aide services combined must total less than or equal to eight (8) hours per day and 35 or fewer hours per week.

On a case-by-case basis, the weekly total may be increased to 40 hours for patients qualifying for Level 2 skilled nursing care. If there is more than one person in a household who is determined to require TennCarereimbursed home health aide services, it is not necessary to have multiple home health aides providing the services. A single home health aide may provide services to multiple enrollees in the same home and during the same hours, as long as he can provide these services safely and appropriately to each enrollee.

(ii) The above limits may be exceeded when medically necessary for children under the age of 21.

(b) Home health providers shall only provide services to the recipient that have been ordered by the treating physician and are pursuant to a plan of care and shall not provide other services such as general child care services, cleaning services, preparation of meals, or services to other household members. Because children typically have non-medical care needs which must be met, to the extent that home health services are provided to a person under 18 years of age, a responsible adult (other than the home health care provider) must be present at all times in the home during the provision of home health services unless all of the following criteria are met:

1. The child is non-ambulatory; and 2. The child has no or extremely limited ability to interact with caregivers; and 3. The child shall not reasonably be expected to have needs that fall outside the scope of medically necessary TennCare covered benefits (e.g. the child has no need for general supervision or meal preparation) during the time the home health provider is present in the home without the presence of another responsible adult; and 4. No other children requiring adult care or supervision shall be present in the home during the time the home health provider is present in the home without the presence of another responsible adult, unless these children meet all the criteria stated above and are also receiving TennCare-reimbursed home health services.

(64) INCOME shall mean that definition of income in Rule 1240-01-04 of the Tennessee Department of Human Services - Family Assistance Division.

(65) INDIVIDUAL HEALTH INSURANCE shall mean health insurance coverage under a policy covering one person or all the members of a family under a single policy where the contract exists solely between that person and the insurance company.

(66) INFANT DIAPER shall mean a disposable product with absorbent material that is designed by the manufacturer to be fastened around a child’s waist and between the child’s legs to absorb and retain urine or feces. Infant Diapers do not include cloth or non-disposable diapers or diapering supplies (such as wipes or diaper cream). Coverage for Infant Diapers is outlined in Rule .04.

(67) INITIATING PROVIDER shall mean the provider who renders the first covered service to a TennCare member whose current medical condition requires the services of more than one (1) provider.

(68) INMATE shall mean an individual confined in a local, state, or federal prison, jail, youth development center, or other penal or correctional facility, including a furlough from such facility.

(69) IN-NETWORK PROVIDER shall have the same meaning as Participating Provider.

(70) INPATIENT REHABILITATION FACILITIES shall mean rehabilitation hospitals and distinct parts of hospitals that are designated as ‘IRFs’ by Medicare.

(71) INSTITUTION FOR MENTAL DISEASES (IMD) shall mean a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services.

(72) LICENSED MENTAL HEALTH PROFESSIONAL shall mean 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 with a current valid license by the Tennessee Licensing Board for the Healing Arts.

(73) LIMITED BENEFITS POLICY shall mean a policy of health coverage for a specific disease (e.g., cancer), or an accident occurring while engaged in a specified activity (e.g., schoolbased sports), or which provides for a cash benefit payable directly to the insured in the event of an accident or hospitalization (e.g., hospital indemnity).

(74) LOCK-IN PROVIDER. A provider, pharmacy or physician, chosen by an enrollee on pharmacy lock-in status to whom the enrollee is assigned by TennCare for the purpose of receiving covered pharmacy services.

(75) LOCK-IN STATUS. The restriction of an enrollee to a specified physician, or to a specified pharmacy provider at a specified single location.

(76) LONG-TERM CARE shall mean programs and services described under Rule 1200-13-01- .01.

(77) MCC (MANAGED CARE CONTRACTOR) shall mean:

(a) A Managed Care Organization, Pharmacy Benefits Manager and/or a Dental Benefits Manager which has signed a TennCare Contractor Risk Agreement with the State and operates a provider network and provides covered health services to TennCare enrollees; or (b) A Pharmacy Benefits Manager, Behavioral Health Organization or Dental Benefits Manager which subcontracts with a Managed Care Organization to provide services; or (c) A State government agency that contracts with TennCare for the provision of services.

(78) MCO (Managed Care Organization) shall mean an appropriately licensed Health Maintenance Organization (HMO) approved by the Bureau of TennCare as capable of providing medical, behavioral, and long-term care services in the TennCare Program.

(79) MEDICAID shall mean the federal- and state-financed, state-run program of medical assistance pursuant to Title XIX of the Social Security Act. Medicaid eligibility in Tennessee is determined by the Tennessee Department of Human Services, under contract to the Tennessee Department of Finance and Administration. Tennessee residents determined eligible for SSI benefits by the Social Security Administration are also enrolled in Tennessee’s TennCare Medicaid program.

(80) MEDICAID “ROLLOVER” ENROLLEE shall mean a TennCare Medicaid enrollee who no longer meets technical eligibility requirements for Medicaid and will be afforded an opportunity to enroll in TennCare Standard in accordance with the provisions of these rules.

(81) MEDICAL ASSISTANCE shall mean health care, services and supplies furnished to an enrollee and funded in whole or in part under Title XIX of the Social Security Act, 42 U.S.C. §§ 1396, et seq. and Tennessee Code Annotated §§ 71-5-101, et seq. Medical assistance includes the payment of the cost of care, services, drugs and supplies. Such care, services, drugs, and supplies shall include services of qualified providers who have contracted with an MCC or are otherwise authorized to provide services to TennCare enrollees (i.e., emergency services provided out-of-network or medically necessary services obtained out-of-network because of an MCC’s failure to provide adequate access to services in-network).

(82) MEDICAL RECORD shall mean all medical histories; records, reports and summaries; diagnoses; prognoses; records of treatment and medication ordered and given; x-ray and radiology interpretations; physical therapy charts and notes; lab reports; other individualized medical documentation in written or electronic format; and analyses of such information.

(83) MEDICAL SUPPLIES shall mean covered medical supplies that are deemed medically necessary and appropriate and are prescribed for use in the diagnosis and treatment of medical conditions. Medically necessary medical supplies not included as part of institutional services shall be covered only when provided by or through a licensed home health agency, by or through a licensed medical vendor supplier or by or through a licensed pharmacist.

(84) MEDICALLY ELIGIBLE shall mean a person who has met the medical eligibility criteria for the TennCare Standard program through a mechanism permitted under the provisions of these rules.

(85) MEDICALLY NECESSARY is defined by Tennessee Code Annotated, Section 71-5-144, and shall describe a medical item or service that meets the criteria set forth in that statute. The term “medically necessary,” as defined by Tennessee Code Annotated, Section 71-5-144, applies to TennCare enrollees. Implementation of the term “medically necessary” is provided for in these rules, consistent with the statutory provisions, which control in case of ambiguity.

No enrollee shall be entitled to receive and TennCare shall not be required to pay for any items or services that fail fully to satisfy all criteria of “medically necessary” items or services, as defined either in the statute or in the Medical Necessity rule chapter at 1200-13-16.

(86) MEDICALLY NEEDY shall mean that category of TennCare Medicaid-eligibles as defined in

Rule 1240-03-02-.03 of the Tennessee Department of Human Services - Division of Medical Services.

(87) MEDICARE shall mean the program administered through the Social Security Administration pursuant to Title XVIII, available to most individuals upon attaining age sixty-five (65), to some disabled individuals under age sixty-five (65), and to individuals having End Stage Renal Disease (ESRD).

(88) MEMBER shall mean a TennCare Medicaid- or TennCare Standard-eligible individual who is enrolled in a managed care organization.

(89) NON-CONTRACT PROVIDER shall have the same meaning as Non-Participating Provider.

(90) NON-PARTICIPATING PROVIDER shall mean a TennCare provider, as defined in this Rule, who is not contracted with a particular enrollee’s MCO. This term may include TennCare providers who furnish services outside the managed care program on a fee-for-service basis, as well as TennCare providers who receive Medicare crossover payments from TennCare.

(91) NON-TENNCARE PROVIDER shall mean a provider who is not enrolled in TennCare and who accepts no TennCare reimbursement for any service, including Medicare crossover payments.

(92) OPEN ENROLLMENT shall mean a designated period of time, determined by the Bureau of TennCare, during which persons who are not currently TennCare eligible may apply for the Standard Spend Down program.

(93) OPEN MEDICAID CATEGORIES shall mean those Medicaid eligibility categories for which enrollment has not been closed pursuant to authority granted by CMS as part of the TennCare demonstration project.

(94) OUT-OF-NETWORK PROVIDER shall have the same meaning as Non-Participating Provider.

(95) OUT-OF-STATE EMERGENCY PROVIDER shall mean a provider outside the State of Tennessee who does not participate in TennCare in any way except to bill for emergency services, as defined in this Chapter, provided out-of-state to a particular MCC’s enrollee. An Out-of-State Emergency Provider must abide by all TennCare rules and regulations, including those concerning provider billing of enrollees as found in Rule 1200-13-14-.08. In order to receive payment from TennCare, Out-of-State Emergency Providers must be appropriately licensed in the state in which the emergency services were delivered, they must enroll with TennCare and they must not be excluded from participation in Medicare or Medicaid.

(96) OVERUTILIZATION shall mean any of the following:

(a) The enrollee initiated use of TennCare services or supplies at a frequency or amount that is not medically necessary or medically justified.

(b) Overutilization, or attempted overutilization, of the TennCare Pharmacy Program which justifies placement on lock-in status for all enrollees involved.

(c) Activities or practices which may evidence overutilization of the TennCare Pharmacy Program including, but not limited to, the following:

1. Treatment by several physicians for the same diagnosis;

2. Obtaining the same or similar controlled substances from several physicians;

3. Obtaining controlled substances in excess of the maximum recommended dose;

4. Receiving combinations of drugs which act synergistically or belong to the same class;

5. Frequent treatment for diagnoses which are highly susceptible to abuse;

6. Receiving services and/or drugs from numerous providers;

7. Obtaining the same or similar drugs on the same day or at frequent intervals; or 8. Frequent use of the emergency room in non-emergency situations in order to obtain prescription drugs.

(97) PACE Carryover Group. See definition in Rule 1200-13-01-.02.

(98) PARTICIPATING PROVIDER shall mean a TennCare provider, as defined in this Rule, who has entered into a contract with an enrollee’s Managed Care Contractor.

(99) PBM (PHARMACY BENEFITS MANAGER) shall mean an organization approved by the Tennessee Department of Finance and Administration to administer pharmacy benefits to enrollees to the extent such services are covered by the TennCare Program. A PBM may have a signed TennCare Contractor Risk Agreement with the State, or may be a subcontractor to an MCO.

(100) PERSONAL CARE SERVICES shall refer to an optional Medicaid benefit defined at 42 C.F.R. § 440.167 that, per the Tennessee Medicaid State Plan, Tennessee has not elected to include in the TennCare benefit package. To the extent that such services are available to children under the age of 21 when medically necessary under the provisions of EPSDT, the Bureau of TennCare designates home health aides as the providers qualified to deliver such services. When medically necessary, personal care services may be authorized outside of the home setting when normal life activities temporarily take the recipient outside of that setting. Normal life activity for a child under the age of 21 means routine work (including work in supported or sheltered work settings); licensed child care; school and school-related activities; religious services and related activities; and outpatient health care services (including services delivered through a TennCare home and community based services waiver program). The home health aide providing personal care services may accompany the recipient but may not drive. Normal life activities do not include non-routine or extended home absences.

(101) PHARMACY LOCK-IN PROGRAM shall mean the program designed to reduce enrollee pharmacy benefit Abuse or Overutilization, as set forth in 1200-13-14-.13.

(102) PHYSICIAN shall mean a person licensed pursuant to chapter 6 or 9 of title 63 of the Tennessee Code Annotated.

(103) POVERTY LEVEL shall mean the poverty level established by the Federal Government.

(104) POWER SEATING ACCESSORIES. Accessories available to modify a power wheelchair base are covered by TennCare when all listed criteria are met as follows:

(a) Power Seat Elevation System.

1. It is ordered by the Enrollee’s treating physician.

2. An assessment conducted by a licensed physical therapist or licensed occupational therapist establishes that:

(i) The Enrollee has the cognitive ability and enough upper extremity function to carry out mobility-related activities of daily living such as feeding, grooming, dressing, and transferring; and (ii) The activities for which the accessory will be used are conducted primarily in the enrollee’s home.

(b) Power Standing System.

1. It is ordered by the Enrollee’s treating physician.

2. An assessment conducted by a licensed physical therapist or licensed occupational therapist establishes that the Enrollee:

(i) Has a chronic condition that causes him to have limited or no ability to stand; and (ii) Has a physical condition that allows him to stand, when supported, for meaningful periods of time, i.e ., he will not suffer loss of blood pressure or have problems with bowel or urine retention; and (iii) Has the cognitive ability and enough upper extremity function to carry out mobility-related activities of daily living such as feeding, grooming, dressing, and transferring; and (iv) Meets at least one other complex rehabilitation criterion for a power seat accessory such as a tilt seat and also qualifies for a Group 3 base Power Wheelchair.

(105) POWER WHEELCHAIR ACCESSORIES. All powered wheelchair accessories not defined in this rule as Power Seating Accessories are excluded from TennCare coverage but may be provided by an MCO as a cost effective alternative service as defined in this rule.

(106) PREMIUM. A specified amount of money that an insured person is required to pay on a regular basis in order to participate in a health plan.

(107) PRESCRIBER. An individual authorized by law to prescribe drugs.

(108) PRIMARY CARE PHYSICIAN shall mean a physician responsible for supervising, coordinating, and providing initial and primary care to patients; for initiating referrals for specialist care; and for maintaining the continuity of patient care. A primary care physician is a physician who has limited his practice of medicine to general practice or who is a Board Certified or Eligible Internist, Pediatrician, Obstetrician/Gynecologist, or Family Practitioner.

(109) PRIMARY CARE PROVIDER shall mean health care professional capable of providing a wide variety of basic health services. Primary care providers include practitioners of family, general, or internal medicine; pediatricians and obstetricians; nurse practitioners; midwives; and physician’s assistant in general or family practice.

(110) PRIOR APPROVAL STATUS shall mean the restriction of an enrollee to a procedure wherein services, except in emergency situations, must be approved by the TennCare Bureau or the MCC prior to the delivery of services.

(111) PRIOR AUTHORIZATION shall mean the process under which services, except in emergency situations, must be approved by the TennCare Bureau or the MCC prior to the delivery in order for such services to be covered by the TennCare program.

(112) PRIOR AUTHORIZATION STATUS (PA STATUS) shall mean the status wherein an enrollee has triggered an event described in Rule .13 of this Chapter and as a result must acquire a prior authorization for every prescription fill of any controlled substance, with the exclusion of medications intended for the treatment of opioid use disorder (i.e., buprenorphine or buprenorphine/naloxone).

(113) PRIVATE DUTY NURSING SERVICES shall mean nursing services for recipients who require eight (8) or more hours of continuous skilled nursing care during a 24-hour period.

(a) A person who needs intermittent skilled nursing functions at specified intervals, but who does not require continuous skilled nursing care throughout the period between each interval, shall not be determined to need continuous skilled nursing care. Skilled nursing care is provided by a registered nurse or licensed practical nurse under the direction of the recipient’s physician to the recipient and not to other household members. If there is more than one person in a household who is determined to require TennCare-reimbursed private duty nursing services, it is not necessary to have multiple nurses providing the services. A single nurse may provide services to multiple enrollees in the same home and during the same hours, as long as he can provide these services safely and appropriately to each enrollee.

(b) If it is determined by the MCO to be cost-effective, non-skilled services may be provided by a nurse rather than a home health aide. However, it is the total number of hours of skilled nursing services, not the number of hours that the nurse is in the home, that determines whether the nursing services are continuous or intermittent.

(c) Private duty nursing services are covered for adults aged 21 and older only when medically necessary to support the use of ventilator equipment or other life-sustaining medical technology when constant nursing supervision, visual assessment, and monitoring of both equipment and patient are required. For purposes of this rule, an adult is considered to be using ventilator equipment or other life-sustaining medical technology if he:

1. Is ventilator dependent for at least 12 hours each day with an invasive patient end of the circuit (i.e., tracheostomy cannula); or 2. Is ventilator dependent with a progressive neuromuscular disorder or spinal cord injury, and is ventilated using noninvasive positive pressure ventilation (NIPPV) by mask or mouthpiece for at least 12 hours each day in order to avoid or delay tracheostomy (requires medical review); or 3. Has a functioning tracheostomy:

(i) Requiring suctioning; and (ii) Oxygen supplementation; and (iii) Receiving nebulizer treatments or requiring the use of Cough Assist/inexsufflator devices; and (iv) In addition, at least one subitem from each of the following items [(I) and (II)] must be met:

(I) Medication:

I. Receiving medication via a gastrostomy tube (G-tube); or II. Receiving medication via a Peripherally Inserted Central Catheter (PICC) line or central port; and (II) Nutrition:

I. Receiving bolus or continuous feedings via a permanent access such as a G-tube, Mickey Button, or Gastrojejunostomy tube (G-J tube); or II. Receiving total parenteral nutrition.

(d) Private duty nursing services are covered as medically necessary for children under the age of 21 in accordance with EPSDT requirements. As a general rule, only a child who is dependent upon technology-based medical equipment requiring constant nursing supervision, visual assessment, and monitoring of both equipment and child will be determined to need private duty nursing services. However, determinations of medical necessity will continue to be made on an individualized basis.

(e) A child who needs less than eight (8) hours of continuous skilled nursing care during a 24-hour period or an adult who needs nursing care but does not qualify for private duty nursing care per the requirements of these rules may receive medically necessary nursing care as an intermittent service under home health.

(f) General childcare services and other non-hands-on assistance such as cleaning and meal preparation shall not be provided by a private duty nurse. Because children typically have non-medical care needs which must be met, to the extent that private duty nursing services are provided to a person or persons under 18 years of age, a responsible adult (other than the private duty nurse) must be present at all times in the home during the provision of private duty nursing services unless all of the following criteria are met:

1. The child is non-ambulatory; and 2. The child has no or extremely limited ability to interact with caregivers; and 3. The child shall not reasonably be expected to have needs that fall outside the scope of medically necessary TennCare covered benefits (e.g., the child has no need for general supervision or meal preparation) during the time the private duty nurse is present in the home without the presence of another responsible adult; and 4. No other children shall be present in the home during the time the private duty nurse is present in the home without the presence of another responsible adult, unless these children meet all of the criteria stated above and are also receiving TennCare-reimbursed private duty nursing services.

(114) PROVIDER shall mean an appropriately licensed institution, facility, agency, person, corporation, partnership, or association that delivers health care services. Providers are categorized as either TennCare Providers or Non-TennCare Providers. TennCare Providers may be further categorized as being one of the following:

(a) Participating Providers or In-Network Providers (b) Non-Participating Providers or Out-of-Network Providers (c) Out-of-State Emergency Providers Definitions of each of these terms are contained in this Rule.

(115) PROVIDER-INITIATED REDUCTION, TERMINATION OR SUSPENSION OF SERVICES shall mean a decision to reduce, terminate, or suspend an enrollee’s TennCare services which is initiated by the enrollee’s provider, rather than by the MCC.

(116) PROVIDER WITH PRESCRIBING AUTHORITY shall mean, in the context of TennCare pharmacy services, a health care professional authorized by law or regulation to order prescription medications for his/her patients, and who:

(a) Participates in the provider network of the MCC in which the enrollee is enrolled; or (b) Has received a referral of the enrollee, approved by the MCC, authorizing her to treat the enrollee; or (c) In the case of a TennCare enrollee who is also enrolled in Medicare, is authorized to treat Medicare patients.

(117) PRUDENT LAY PERSON shall mean a reasonable person who possesses an average knowledge of health and medicine.

(118) QUALIFIED UNINSURED PERSON shall mean an uninsured person who meets the technical, financial, and insurance requirements for the TennCare Standard Program.

(119) QUALIFYING MEDICAL CONDITION shall mean a medical condition which is included among a list of conditions established by the Bureau and which will render a qualified uninsured applicant medically eligible.

(120) READABLE shall mean easily understood language and format. See 42 C.F.R. § 438.10.

(121) REASSIGNMENT shall mean the process by which the Bureau of TennCare transfers an enrollee from one MCO to another as described in these rules.

(122) RECEIPT OF MAILED NOTICES shall mean that receipt of mailed notices is presumed to occur within five (5) days of mailing.

(123) RECERTIFICATION shall have the same meaning as Redetermination.

(124) RECONSIDERATION shall mean the mandatory process, triggered by an enrollee’s request for a SFH, by which an MCC reviews and renders a decision affirming or reversing the MCC’s adverse benefit determination. An MCC satisfies the plan-level requirements of 42 C.F.R. Part 438 Subpart F when the review includes all available, relevant, clinical documentation (including documentation which may not have been considered in the original review); is performed by a physician other than the original reviewing physician; and produces a timely written finding. See June 5, 2017, CMS letter from Jackie Glaze to Wendy Long, M.D., M.P.H.

(125) REDETERMINATION shall mean the process by which DHS evaluates the ongoing eligibility status of TennCare Medicaid and TennCare Standard enrollees. This is a periodic process that is conducted at specified intervals or when an enrollee’s circumstances change. The process is conducted in accordance with TennCare’s, or its designee’s, policies and procedures.

(126) REQUEST FOR REIMBURSEMENT shall mean a request from an enrollee for reimbursement of amounts paid out of pocket to providers for medical, dental or pharmacy services received. Enrollees seeking reimbursement are required to submit receipts or bills that include the following information: the amount paid by enrollee, a description of the prescriptions, care or services received, the date the prescriptions, care or services were received, and the name of the provider or pharmacy. All required information must be received from enrollees within the sixty (60) day timeframe to request reimbursement as prescribed by Rule 1200-13-14-.11(2)(d).

(127) RESPONSIBLE PARTY(IES) shall mean the following individuals, who are representatives and/or relatives of recipients of medical assistance who are not financially eligible to receive benefits: parents, spouses, children, and guardians; as defined at Tennessee Code Annotated § 71-5-103(10).

(128) SSI (SUPPLEMENTAL SECURITY INCOME) BENEFITS shall mean the benefits provided through a program administered by the Social Security Administration for those meeting program eligibility requirements. Tennessee residents determined eligible for SSI benefits are automatically enrolled in TennCare Medicaid.

(129) STANDARD SPEND DOWN (SSD) shall mean the demonstration eligibility category composed of adults age twenty-one (21) and older who have been found to meet the criteria in Rule 1200-13-14-.02.

(130) STATE FAIR HEARING (SFH) shall mean an evidentiary hearing requested by or on behalf of an enrollee to allow the enrollee to appeal an adverse benefit determination, which is conducted in accordance with 42 C.F.R. Part 431 Subpart E and the Tennessee Uniform Administrative Procedures Act, T.C.A. §§ 4-5-301, et seq. An initial order under T.C.A. § 4-5- 314 shall be entered when an evidentiary hearing is held before a hearing officer. If any party appeals the initial order under T.C.A. § 4-5-315, the Commissioner may render a final order.

(131) TARGETED PHARMACY. A pharmacy meeting one of the following criteria:

(a) It is located outside the State of Tennessee.

(b) It has had previous controlled substance violations with the Tennessee State Board of Pharmacy.

(c) The Bureau has knowledge that the pharmacy is under investigation.

(132) TECHNICAL ELIGIBILITY REQUIREMENTS shall mean the eligibility requirements applicable to the appropriate category of medical assistance as discussed in Chapter 1240- 03-03-.03 of the rules of the TDHS - Division of Medical Services, and the additional eligibility requirements set forth in these rules.

(133) TENNCARE shall mean the program administered by the Single State agency as designated by the State and CMS pursuant to Title XIX of the Social Security Act and the Section 1115 Research and Demonstration waiver granted to the State of Tennessee.

(134) TENNCARE APPEAL FORM shall mean the TennCare form(s) which are completed by an enrollee or by a person authorized by the enrollee to do so, when an enrollee appeals an adverse benefit determination.

(135) TENNCARE CHOICES in Long-Term Care shall mean the program described in Rule 1200- 13-01-.05.

(136) TENNCARE MEDICAID shall mean that part of the TennCare program, which covers persons eligible for Medicaid under Tennessee’s Title XIX State Plan for Medical Assistance.

The following persons are eligible for TennCare Medicaid:

(a) Tennessee residents determined to be eligible for Medicaid in accordance with 1240- 03-03 of the rules of the Tennessee Department of Human Services - Division of Medical Services.

(b) Individuals who qualify as dually eligible for Medicare and Medicaid are enrolled in TennCare Medicaid.

(c) A Tennessee resident who is an uninsured woman, under age sixty-five (65), a US citizen or qualified alien, is not eligible for any other category of Medicaid, has been diagnosed as the result of a screening at a Centers for Disease Control and Prevention (CDC) site with breast or cervical cancer, including pre-cancerous conditions.

(d) Tennessee residents determined eligible for SSI benefits by the Social Security Administration are automatically enrolled in TennCare Medicaid.

(137) TENNCARE MEDICAID ELIGIBILITY REFORMS shall mean the amendments to the TennCare demonstration project approved by CMS on March 24, 2005, to close enrollment into TennCare Medicaid for non-pregnant adults age twenty-one (21) or older who qualify as Medically Needy under Tennessee’s Title XIX State Plan for Medical Assistance and to disenroll non-pregnant adults age twenty-one (21) or older who qualify as Medically Needy under Tennessee’s Title XIX State Plan for Medical Assistance after completion of their twelve (12) months of eligibility.

(138) TENNCARE PHARMACY PROGRAMS shall mean any TennCare pharmacy carve-outs, including, but not limited to, enrollees with dual eligibility and all pharmacy services provided by the TennCare Managed Care Organizations (MCOs).

(139) TENNCARE PROVIDER shall mean a provider who accepts as payment in full for furnishing benefits to a TennCare enrollee, the amounts paid pursuant to an approved agreement with an MCC or TennCare. Such payment may include copayments from the enrollee or the enrollee’s responsible party. TennCare providers must be enrolled with TennCare. TennCare providers must abide by all TennCare rules and regulations, including requirements regarding provider billing of patients as found in Rule 1200-13-14-.08. TennCare providers must be appropriately licensed for the services they deliver and must not be providers who have been excluded from participation in Medicare or Medicaid.

(140) TENNCARE SELECT shall mean a state self-insured HMO established by the Bureau of TennCare and administered by a contractor to provide medical services to certain eligible enrollees.

(141) TENNCARE SERVICES OR BENEFITS for purposes of this rule shall mean any medical assistance that is administered by the Bureau of TennCare or its contactors and which is funded wholly or in part with federal funds under the Medicaid Act or any waiver thereof, but excluding:

(a) Medical assistance that can be appealed through an appeal of a pre-admission evaluation (PAE) determination;and (b) Medicare cost sharing services that do not involve utilization review by the Bureau of TennCare or its contractors.

(142) TENNCARE STANDARD shall mean that part of the TennCare Program which provides health coverage for Tennessee residents who are not eligible for Medicaid and who meet the eligibility criteria found in Rule 1200-13-14-.02.

(143) TENNCARE STANDARD ELIGIBILITY REFORMS shall mean the amendments to the TennCare demonstration project approved by CMS on March 24, 2005, to terminate coverage for adults aged 19 and older in TennCare Standard eligibility groups.

(144) TENNderCARE shall mean the name given to the preventive health care program for TennCare children.

(145) TERMINATION shall mean the discontinuance of an enrollee’s coverage under the TennCare Medicaid or TennCare standard program.

(146) THIRD PARTY shall mean any entity or funding source other than the enrollee or his/her responsible party, which is or may be liable to pay for all or a part of the costs of medical care of the enrollee.

(147) TRANSITION GROUP shall mean existing Medically Needy adults age twenty-one (21) or older enrolled as of October 5, 2007, who have not yet been assessed for transition to the Standard Spend Down Demonstration population for non-pregnant adults age twenty-one (21) or older.

(148) TREATING PHYSICIAN (OR CLINICIAN) shall mean a health care provider who has provided diagnostic or treatment services for an enrollee (whether or not those services were covered by TennCare), for purposes of treating, or supporting the treatment of, a known or suspected medical condition. The term excludes providers who have evaluated an enrollee’s medical condition primarily or exclusively for the purposes of supporting or participating in a decision regarding TennCare coverage.

(149) UNINSURED shall mean any person who does not have health insurance directly or indirectly through another family member, or who does not have access to group health insurance. For purposes of the Medicaid eligibility category of women under 65 requiring treatment for breast or cervical cancer, “Uninsured” shall mean any person who does not have health insurance or access to health insurance which covers treatment for breast or cervical cancer.

(150) VALID FACTUAL DISPUTE shall mean a dispute which, if resolved in favor of the enrollee, would result in the proposed action not being taken.

History

• Authority: T.C.A. §§ 4-3-1013, 4-5-202, 4-5-203, 4-5-208, 4-5-209, 71-5-102, 71-5-105, 71-5-107, 71-5- 109, 71-5-113, 71-5-134, 71-5-146, 71-5-197, and 71-5-198; 42 C.F.R. Part 431 Subpart E; 42 C.F.R. Part 438 Subpart F; 42 C.F.R. Part 455 Subpart E; and Executive Order No. 23.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-14-.01; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Amendment filed April 9, 2003; effective June 23, 2003. Public necessity rule filed May 5, 2005; effective through October 17, 2005. Public necessity rule filed June 3, 2005; effective through November 15, 2005. Amendment filed July 14, 2005; effective September 27, 2005. Amendment filed July 20, 2005; effective October 3, 2005. Amendment filed July 28, 2005; effective October 11, 2005. Amendment filed September 1, 2005; effective November 15, 2005. Public necessity rule filed December 29, 2005; expired June 12, 2006. On June 13, 2006, affected rules reverted to status on December 28, 2005. Amendments filed March 31, 2006; effective June 14, 2006. Public Necessity rule filed December 1, 2006; effective through May 15, 2007. Public necessity rule filed February 1, 2007; effective through July 16, 2007. Public necessity rule filed March 21, 2007; effective through September 2, 2007. Amendment filed January 26, 2007; effective April 11, 2007. Amendments filed May 2, 2007; effective July 16, 2007. Amendments filed June 11, 2007; effective August 25, 2007. Public necessity rule filed October 11, 2007; effective through March 24, 2008. Public necessity rule filed February 8, 2008; effective through July 22, 2008. Amendments filed May 7, 2008; effective July 21, 2008. Public necessity rule filed September 8, 2008; effective through February 20, 2009. Amendment filed December 5, 2008; effective February 18, 2009. Amendments filed September 25, 2009; effective December 24, 2009. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendments filed May 27, 2010; effective August 25, 2010. Amendments filed January 15, 2013; effective April 15, 2013. Amendment filed July 1, 2013; effective September 29, 2013. Amendments filed October 3, 2013; effective January 1, 2014. Amendment filed December 23, 2014; effective March 23, 2015. Emergency rules filed July 1, 2016; effective through December 28, 2016. Amendment filed June 30, 2016; effective September 28, 2016. Amendments filed September 30, 2016; effective December 29, 2016. Amendments filed July 3, 2017; effective October 1, 2017. Amendments filed September 25, 2017; effective December 24, 2017. Emergency rules filed April 15, 2021; effective through October 12, 2021. Amendments filed June 29, 2021; effective September 27, 2021. Amendments filed July 8, 2021; effective October 6, 2021. Amendments filed October 26, 2021; effective January 24, 2022. Emergency rules filed August 7, 2024; effective through February 3, 2025. Amendments filed September 11, 2024; effective December 10, 2024. Amendments filed November 4, 2024; effective February 2, 2025.

Tenn. Comp. R. & Regs. 1240-03-03-.06 .

5. Must be enrolled in accordance with an enrollment target of 100,000 Tennessee residents who have been determined to be eligible for the Standard Spend Down (SSD) Program; with a maximum of 105,000 persons to be enrolled at any given time.

(c) Application procedures:

1. SSD categories.

(i) Category 1. Individuals who are not eligible for Medicaid at the time the SSD program is implemented and who meet the criteria for the new SSD program.

Category 1 applicants will be processed for eligibility only through a single toll-free telephone point of entry (the Call-in Line) initiated in periods of open enrollment. In each such period, the State will determine a specified number of calls that it will accept through the Call-in Line based on the number of Category 1 applications that the State estimates it can process within Federal timeliness standards. The number of calls to be accepted in these periods will be based on the number of remaining slots available under the enrollment target of 100,000 persons. The State will not accept or track calls received outside of these periods.

(ii) Category 2. Individuals in the Transition Group who, at the time the SSD program is implemented, are eligible for Medicaid in a non-pregnant adult Medically Needy category, who have completed their twelve (12) months of Medicaid eligibility, have been found to be ineligible for any other Medicaid category, and have been determined to meet the criteria of the SSD program.

For Category 2 individuals, the State will determine their SSD eligibility on a rolling basis in conjunction with their termination from Medicaid, and shall reserve sufficient slots within the enrollment target to ensure that all such persons who are eligible may be accepted in the SSD category.

Termination procedures for Category 2 individuals who are not eligible for Medicaid or for SSD will be conducted in accordance with those outlined in Paragraph (7)(b) of this rule.

Upon implementation of the SSD program, the State will review all Category 2 individuals for either eligibility in a new Medicaid category or approval as a Standard Spend Down eligible. After the review of all Category 2 individuals is complete and it is determined how many additional enrollees can be added to the SSD program without exceeding the enrollment cap, the State will begin enrolling persons in Category 1.

2. Initial application period for Category 1.

The State will establish an initial target enrollment figure based on its determination of the minimum number of applications the State estimates it can process in a timely manner in accordance with Federal standards. The State’s decision to open or close enrollment is a policy decision that is within the State’s discretion and the State is not required to provide fair hearings for challenges to these decisions. A toll-free Call-in Line to receive requests for applications will be established and requests will be processed as follows:

(i) Callers to the Call-in Line will be asked for basic demographic information and will be assigned a unique identifier.

(ii) A match will be conducted to verify that callers are not already eligible in a TennCare Medicaid category. Those callers who are already eligible in a TennCare Medicaid category will be sent letters advising them that they currently have benefits and need not apply for Standard Spend Down.

(iii) For those callers who are not Medicaid eligible, the State will send a written application form, accompanied by a letter advising the individual of the requirement to complete, sign, and return the application within thirty (30) days.

(iv) Completed, signed applications received by the State by the thirty (30)-day deadline will be evaluated for Medicaid eligibility and SSD eligibility.

Applications received after the deadline will not be reviewed for SSD eligibility but will be processed for Medicaid eligibility. There will be no “good cause” exception to the written application deadline set by the State.

If the State does not receive an application by the deadline, the State will send the individual a letter advising him that since no application was received, the State will not make an eligibility determination for him, but the individual is free to apply for SSD during any subsequent open application period and to apply for Medicaid at any time. No hearings will be granted to individuals concerning this process who have not timely submitted signed applications unless the individual alleges a valid factual dispute that he did submit a signed, written application within the deadline.

(v) Since all SSD applications received during an open application period will be processed and either approved or denied, there is no requirement for the State to maintain a “waiting list” of potential SSD applicants. No applications submitted in one open application period will be carried forward to future open application periods. The State will determine SSD eligibility within the timeframes specified by Federal regulations at 42 C.F.R. § 435.911; such time frames will begin on the date a signed written application is received by the State.

3. New application periods after the SSD enrollment target has been reached.

Once the State has reached its targeted enrollment of 100,000 persons, new application periods will be scheduled when the number of approved eligibles in the SSD program drops to ninety percent (90%) of target enrollment, or 90,000 persons. Any subsequent application periods will remain open until a predetermined number of calls to the Call-in Line have been received. The number of calls to be received will be based on the State’s determination of the minimum number of applications necessary to fill open slots in the program and the number of applications the state estimates it can process in a timely manner in accordance with Federal standards. The State’s decision to open or close enrollment is a policy decision that is within the State’s discretion and the State is not required to provide fair hearings for challenges to these decisions.

4. Period of eligibility.

All enrollees in the SSD demonstration category will have an eligibility period of twelve (12) months from the effective date of eligibility. At the end of the twelve (12)-month period each enrollee must have his eligibility redetermined in order to establish SSD or Medicaid eligibility. The duration of the eligibility period for SSD eligibility is the same as that used for Medically Needy pregnant women and children in TennCare Medicaid.

5. Effective date of eligibility for SSD enrollees.

The effective date of SSD eligibility for an individual whose application for SSD eligibility is initiated through the Call-in Line and who submits a timely signed application will be the later of:

(i) The date his call was received by the Call-in Line; or (ii) The date spend-down is met (which must be no later than the end of the one (1)-month budget period—in this case, the end of the month of the original call to the Call-in Line).

(iii) The effective date of SSD eligibility for an individual whose eligibility is being redetermined is the application date.

(iv) For Category 2 individuals the effective date will be determined in accordance with DHS Rule 1240-03-02-.04.

(7) TennCare Standard: CHOICES 217-Like Group.

(a) Coverage group. Individuals age sixty-five (65) and older and adults age twenty-one (21) and older with physical disabilities who meet the Nursing Facility (NF) level of care criteria, who could have been eligible for HCBS under 42 C.F.R. § 435.217 had the state continued its 1915(c) HCBS Waiver for persons who are elderly and/or physically disabled, and who need and are receiving HCBS as an alternative to Nursing Facility (NF) care. This group exists only in the Grand Divisions of the state where the CHOICES program has been implemented, and participation is subject to the enrollment target for CHOICES Group 2.

(b) Eligibility criteria:

1. Must be aged sixty-five (65) and older or aged twenty-one (21) and older with physical disabilities as defined in Rule 1200-13-01-.02;

2. Must meet the Nursing Facility level of care requirements;

3. Must have a current determination by an Area Agency on Aging and Disability or the TennCare MCO to which the individual is assigned, that he is able to be safely and appropriately served in the community and within his individual cost neutrality cap as defined in Rule 1200-13-01-.05;

4. May be enrolled in accordance with requirements pertaining to the enrollment target for CHOICES Group 2, as described in Rule 1200-13-01-.05;

5. Will be enrolled and begin receiving Home and Community Based Services (HCBS) upon determination of financial eligibility by DHS and continue to receive HCBS as a CHOICES Group 2 participant. Qualifying for enrollment into CHOICES Group 2 (HCBS) is not sufficient to establish eligibility in the CHOICES 217-Like Group if the person will not actually be enrolled and receiving HCBS; and 6. Would be eligible in the same manner as specified under 42 C.F.R. §§ 435.217, 435.236, and 435.726 and section 1924 of the Social Security Act (42 U.S.C.A. § 1396r-d), if the Home and Community Based Services (HCBS) were provided under a section 1915(c) waiver.

(c) Application procedures:

1. To be eligible for the CHOICES 217-Like Group, each individual must meet all technical and financial requirements applicable to this category as described in DHS Rule Chapter 1240-03-03.

2. The effective date of eligibility in the CHOICES 217-Like Group shall be the date the application is approved by DHS. In no instance shall the effective date of eligibility precede the date the application was filed with DHS.

(8) TennCare Standard: ECF CHOICES 217-Like Group.

(a) Coverage group. Individuals with I/DD of all ages who meet the NF LOC criteria who need and are receiving HCBS, and who would be eligible in the same manner as specified under Section 1902(a) of the Social Security Act and 42 C.F.R. § 435.217, if the HCBS were provided under a Section 1915(c) waiver. Enrollment in this group shall be subject to the enrollment targets established for each applicable ECF CHOICES benefit group. An Applicant may qualify in the ECF CHOICES 217-Like Group only when there is an available slot for enrollment into an ECF CHOICES benefit group for which the Applicant meets all eligibility and enrollment criteria, including prioritization criteria for enrollment into ECF CHOICES as established in these Rules, and when the Applicant upon approval of financial eligibility, will be enrolled by TennCare into such ECF CHOICES group.

(b) Eligibility criteria:

1. Must have an intellectual or developmental disability as defined in Rule 1200-13- 01-.02;

2. Must meet the Nursing Facility level of care requirements;

3. Must have a current determination by the TennCare MCO to which the individual is assigned, that he is able to be safely and appropriately served in the community and within his expenditure cap as defined in Rule 1200-13-01-.31, except in instances where the Applicant is not eligible for TennCare at the time of ECF CHOICES application, in which case, such determination shall be made by the MCO upon enrollment into ECF CHOICES;

4. May be enrolled in accordance with requirements pertaining to the enrollment target for each ECF CHOICES Group, including prioritization criteria for enrollment into ECF CHOICES, as described in Rule 1200-13-01-.31;

5. Will be enrolled and begin receiving Home and Community Based Services (HCBS) upon determination of financial eligibility by TennCare and continue to receive HCBS as an ECF CHOICES participant. Qualifying for enrollment into ECF CHOICES is not sufficient to establish eligibility in the ECF CHOICES 217- Like Group if the person will not actually be enrolled and receiving HCBS; and 6. Would be eligible in the same manner as specified under Section 1902(a) of the Social Security Act and 42 C.F.R. § 435.217, if the Home and Community Based Services (HCBS) were provided under a section 1915(c) waiver.

(c) Application procedures:

1. To be eligible for the ECF CHOICES 217-Like Group, each individual must meet all technical and financial requirements applicable to this category as described in Rule Chapter 1200-13-20.

2. The effective date of eligibility in the ECF CHOICES 217-Like Group shall be the date the application is approved by TennCare. In no instance shall the effective date of eligibility precede the date the application was filed with TennCare.

(9) TennCare Standard: Interim ECF CHOICES At-Risk Group.

(a) Coverage group. Individuals who have an intellectual or developmental disability as defined in Rule 1200-13-01.-02 who meet the financial eligibility standards for the ECF CHOICES 217-Like Group; do not meet the Nursing Facility (NF) level of care criteria, but in the absence of ECF CHOICES HCBS, are At Risk for Institutionalization as defined in Rule 1200-13-01-.02; and who need and are receiving ECF CHOICES HCBS. The Interim ECF CHOICES At-Risk Demonstration Group will open to new enrollment only until such time that the Employment and Community First CHOICES At-Risk Demonstration Group (with income up to one hundred and fifty percent (150%) of the FPL) and the Employment and Community First CHOICES Working Disabled Demonstration Groups can be established. Persons enrolled in the Interim ECF CHOICES At-Risk Demonstration Group as of the date new enrollment into the group closes may continue to qualify in the group as long as they continue to meet nursing facility financial eligibility standards and are At-Risk for Institutionalization as defined in

Rule 1200-13-01-.02, and remain continuously eligible and enrolled in the Interim ECF CHOICES At-Risk Demonstration Group. Enrollment in this group shall be subject to the enrollment targets established for each applicable ECF CHOICES benefit group.

An Applicant may qualify in the Interim ECF CHOICES At-Risk Group only when there is an available slot for enrollment into an ECF CHOICES benefit group for which the Applicant meets all eligibility and enrollment criteria, including prioritization criteria for enrollment into ECF CHOICES as established in Rule 1200-13-01-.31, and when the Applicant, upon approval of financial eligibility, will be enrolled by TennCare into such ECF CHOICES group.

(b) Eligibility criteria:

1. Must have an intellectual or developmental disability as defined in Rule 1200-13- 01-.02;

2. Must meet the financial eligibility standards for the ECF CHOICES 217-Like Group;

3. Do not meet the Nursing Facility level of care, but in the absence of ECF CHOICES HCBS, are At Risk for Institutionalization as defined in Rule 1200-13- 01-.02;

4. Must have a current determination by the TennCare MCO to which the individual is assigned, that he is able to be safely and appropriately served in the community and within his expenditure cap as defined in Rule 1200-13-01-.31, except in instances where the Applicant is not eligible for TennCare at the time of ECF CHOICES application, in which case, such determination shall be made by the MCO upon enrollment into ECF CHOICES; and 5. May be enrolled in accordance with requirements pertaining to the enrollment target for each ECF CHOICES Group, including prioritization criteria for enrollment into ECF CHOICES as described in Rule 1200-13-01-.31; and 6. Will be enrolled and begin receiving Home and Community Based Services (HCBS) upon determination of financial eligibility by TennCare and continue to receive HCBS as an ECF CHOICES participant. Qualifying for enrollment into ECF CHOICES is not sufficient to establish eligibility in the Interim ECF CHOICES At-Risk Group if the person will not actually be enrolled and receiving ECF CHOICES HCBS.

(c) Application procedures:

1. To be eligible for the Interim ECF CHOICES At-Risk Group, each individual must meet all technical and financial requirements applicable to this category as described in Rule Chapter 1200-13-20.

2. The effective date of eligibility in the Interim ECF CHOICES At-Risk Group shall be the date the application is approved by TennCare. In no instance shall the effective date of eligibility precede the date the application was filed with TennCare.

(10) Redetermination of eligibility in TennCare Standard (other than CHOICES 217-Like Group, ECF CHOICES 217-Like Group, and Interim ECF CHOICES At-Risk Group).

(a) All enrollees must reapply and have their TennCare coverage redetermined based on the approved policies and procedures in effect at the time of their next scheduled redetermination/reapplication process. TennCare Standard enrollees shall have their eligibility redetermined in accordance with the following process:

1. Ex Parte Review.

DHS will conduct an ex parte review of eligibility for open Medicaid and Standard categories for all TennCare Standard enrollees due for redetermination. Such ex parte reviews shall be conducted in accordance with federal requirements set forth by CMS in the Special Terms and Conditions of the TennCare demonstration project.

2. Request for Information.

(i) At least thirty (30) days prior to the expiration of their current eligibility period, the Bureau of TennCare will send a Request for Information to all TennCare Standard enrollees. The Request for Information will include a form to be completed with the information needed to determine eligibility for open Medicaid and Standard categories, as well as a list of the types of proof needed to verify certain information.

(ii) Enrollees will be given thirty (30) days inclusive of mail time from the date of the Request for Information to return the completed from to DHS and provide DHS with the necessary verifications to determine eligibility for open Medicaid and Standard categories.

(iii) Enrollees with a health problem, mental health problem, learning problem, or a disability will be given the opportunity to request assistance in responding to the Request for Information. Enrollees with Limited English Proficiency will have the opportunity to request translation assistance for responding to the Request for Information.

(iv) Enrollees will be given an opportunity until the date of termination to request one (1) extension for good cause of the thirty (30) day time frame for responding to the Request for Information. The good cause extension is intended to allow a limited avenue for possible relief for certain enrollees who face significant unforeseen circumstances, or who, as a result of a health problem, mental health problem, learning problem, disability, or limited English proficiency, are unable to respond timely. The good cause exception does not confer entitlement upon enrollees and the application of this exception will be within the discretion of DHS. Only one (1) thirty (30) day good cause extension can be granted to each enrollee. Good cause is determined by DHS eligibility staff. Good cause is not requested nor determined through filing an appeal. Requests for an extension of the thirty (30) day time frame to respond to the Request for Information must be initiated by the enrollee. However, the enrollee may receive assistance in initiating such request. DHS will not accept a request for extension of the thirty (30) day time frame submitted by a family member, advocate, provider, or CMHC, acting on the enrollee’s behalf without the involvement and knowledge of the enrollee, for example, to allow time for such entity to locate the enrollee if his whereabouts are unknown. All such requests for good cause extension must be made prior to termination of TennCare eligibility. A good cause extension will be granted if DHS determines that a health problem, mental health problem, learning problem, disability, or limited English proficiency prevented an enrollee from understanding or responding timely to the Request for Information. Except in the aforementioned circumstances, a good cause extension will only be granted if such request is submitted in writing to DHS prior to termination of TennCare eligibility and DHS determines that serious personal circumstances such as illness or death prevent an enrollee from responding to the Request for Information for an extended period of time.

Proof of the serious personal circumstances is required with the submission of the written request in order for a good cause extension to be granted. Good cause extensions will be granted at the sole discretion of DHS and if granted shall provide the enrollee with an additional thirty (30) days inclusive of mail time from the date of DHS’s decision to grant the good cause extension. DHS will send the enrollee a letter granting or denying the request for good cause extension. DHS’s decisions with respect to good cause extensions shall not be appealable.

(v) If an enrollee provides some but not all of the necessary information to DHS to determine his eligibility for open Medicaid categories or continuation in TennCare Standard during the thirty (30) day period following the Request for Information, DHS will send the enrollee a Verification Request. The Verification Request will provide the enrollee ten (10) days inclusive of mail time to submit any missing information as identified in the Verification Request. Enrollees will not have the opportunity to request an extension for good cause of the ten (10) day time frame for responding to the Verification Request.

(vi) Enrollees who respond to the Request for Information within the thirty (30) day period or within any extension of such period granted by DHS shall retain their eligibility for TennCare Standard (subject to any changes in covered services generally applicable to enrollees in their TennCare Standard category) while DHS reviews their eligibility.

(vii) DHS shall review all information and verifications provided within the requisite time period by an enrollee pursuant to the Request for Information and/or Verification Request to determine whether the enrollee is eligible for any open Medicaid categories or whether the enrollee is eligible to remain in TennCare Standard. If DHS makes a determination that the enrollee is eligible for an open Medicaid category or to remain in TennCare Standard, DHS will so notify the enrollee and the enrollee will be enrolled in the appropriate TennCare category. When the enrollee is enrolled in TennCare Medicaid, his TennCare Standard eligibility shall be terminated without additional notice. If DHS makes a determination that the enrollee is not eligible for any TennCare category or if the enrollee does not respond to the Request for Information within the requisite thirty (30) day time frame or any extension of such period granted by DHS, the TennCare Bureau will send the enrollee a twenty- (20) day advance Termination Notice.

(viii) DHS shall, pursuant to the rules, policies, and procedures of DHS and the Bureau of TennCare applicable to new applicants for TennCare coverage, review all information and verifications provided by an enrollee after the thirty (30) day period following the Request for Information or after any extension of such period granted by DHS, but the enrollee shall not be entitled to retain eligibility for TennCare Standard pending this review. If the individual is subsequently determined to be eligible for an open Medicaid category, he shall be granted retroactive coverage to the date of application, or in the case of spend down eligibility for Medically Needy pregnant women and children, to the latter of (a) the date of his application, or (b) the date spend down eligibility is met as defined in Department of Human Services Rule 1240-03-02-.04.

3. Notice of termination.

(i) The TennCare Bureau will send Termination Notices to all TennCare Standard enrollees being terminated who are not determined to be eligible for open Medicaid or Standard categories pursuant to the Ex Parte Review or Request for Information processes described in this subparagraph.

(ii) Termination Notices will be sent twenty (20) days in advance of the date upon which the coverage will be terminated.

(iii) Termination Notices will provide enrollees with forty (40) days from the date of the notice to appeal valid factual disputes related to the disenrollment and will inform enrollees how they may request a hearing.

(iv) Enrollees with a health problem, mental health problem, learning problem, or a disability will be given the opportunity to request additional assistance for their appeal. Enrollees with Limited English Proficiency will have the opportunity to request translation assistance for their appeal.

(v) Enrollees will not have the opportunity to request an extension for good cause of the forty (40) day time frame in which to request a hearing.

(b) A TennCare Standard enrollee shall be required to have his eligibility redetermined for TennCare Standard prior to the expiration date of the current period of coverage as instructed by the DHS. The enrollee’s continued eligibility for TennCare Standard is determined as of the date of the redetermination appointment or a later date if the enrollee does not submit all required documentation at the initial appointment. (The later date must be before the date of expiration of coverage.)

(c) Information to be recertified includes changes in address, income, employment, family size, and access to health insurance (access to insurance is not considered in determining eligibility in the Standard Spend Down category). Redetermination appointments must be scheduled and kept regardless of whether any changes have occurred. It is the responsibility of the enrollee to furnish all information requested. The notice reminding the enrollee that he must have his eligibility redetermined will inform the enrollee of the documentation to be brought to the appointment.

(d) The enrollee must complete the entire redetermination process prior to the expiration date of his coverage. Failure to do so will result in coverage lapsing as of the expiration date. The enrollee will not be permitted to appeal the expiration of his coverage in this situation. However, he may appeal on the grounds that:

1. He did, in fact, complete the redetermination process but an administrative error on the part of the State resulted in his coverage expiring; or 2. He was prevented from completing the redetermination process by specific acts or omissions of state employees. However, this ground for appeal does not include challenges to relevant TennCare rules, policies or timeframes.

The individual will receive a notice of the expiration of his coverage and his right to appeal, as set out above, within ten (10) days. There will be no continuation or reinstatement of coverage pending appeal.

(e) Enrollees approved for TennCare Standard as medically eligible persons may also be required to submit proof of continued medical eligibility. Documentation shall be that as required elsewhere in these rules. If as a result of the redetermination appointment it is determined that any enrollee no longer meets the technical eligibility requirements set out at Rule 1200-13-14-.02, the enrollee will be disenrolled from TennCare Standard.

The enrollee will be sent a notice of termination, and the enrollee has the right to appeal the decision within forty (40) calendar days of the receipt of the letter informing the enrollee of the loss of eligibility. The enrollee’s right to appeal is set out at Rule

Tenn. Comp. R. & Regs. 1200-13-14-.12 OTHER APPEALS BY TENNCARE APPLICANTS AND ENROLLEES

Notwithstanding Rule 1200-13-19-.01, or any rule to the contrary, appeals by applicants and enrollees of all non-medical eligibility matters are removed to Rule Chapter 1200-13-19, effective upon expiration of the TDHS contract to determine eligibility matters.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-209, 71-5-105, 71-5-109, and 71-5-113; 42 C.F.R. Part 431 Subpart E; 42 C.F.R. Part 438 Subpart F; and Executive Order No. 23.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-14-.12; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Public necessity rule filed June 8, 2005; effective through November 20, 2005. Amendment to public necessity rule filed July 6, 2005; effective through November 20, 2005. Amendment filed September 6, 2005; effective November 20, 2005. Amendments filed September 25, 2017; effective December 24, 2017.

Tenn. Comp. R. & Regs. 1200-13-01-.31 .

1. Any and all medically necessary services may require prior authorization or approval by the MCC, except where prohibited by law.

2. An MCC shall not refuse to pay for a service solely because of a lack of prior authorization as follows:

(i) Preventive, diagnostic, and treatment services for persons under age 21.

MCCs shall provide all medically necessary, covered services regardless of whether the need for such services was identified by a provider whose services had received prior authorization from the MCC or by an in-network provider.

(ii) Emergency services. MCCs shall not require prior authorization or approval for covered services rendered in the event of an emergency, as defined in these rules. Such emergency services may be reviewed on the

basis of medical necessity or other MCC administrator requirements, but cannot be denied solely because the provider did not obtain prior authorization or approval from the enrollee’s MCC.

3. MCCs shall not impose any service limitations that are more restrictive than those described herein; however, this shall not limit the MCC’s ability to establish procedures for the determination of medical necessity.

4. Services for which there is no federal financial participation (FFP) are not covered.

5. Non-covered services are non-covered regardless of medical necessity.

(b) The following physical health and mental health benefits are covered under the TennCare managed care program. Benefits offered under the TennCare CHOICES program are also covered under the TennCare managed care program, as described in

Rule 1200-13-01-.05. Benefits offered under the ECF CHOICES program are also covered under the TennCare managed care program, as described in Rule 1200-13- 01-.31. There are some exclusions to the benefits listed below. The exclusions are listed in this rule and in Rule 1200-13-14-.10.

SERVICE BENEFIT FOR PERSONS UNDER

AGE 21

BENEFIT FOR PERSONS AGED 21 AND

OLDER

1. Ambulance Sevices.

See “Emergency Air and Ground Transportation” and “Non- Emergency Ambulance Transportation.”

See “Emergency Air and Ground Transportation” and “Non-Emergency Ambulance Transportation.”

2. Bariatric Surgery, defined as surgery to induce weight loss.

Covered as medically necessary. Covered as medically necessary.

3. Chiropractic Services [defined at 42 C.F.R. § 440.60(b)].

Covered as medically necessary. Covered as medically necessary.

4. Community Health Services, [defined at 42 C.F.R. § 440.20(b) and (c) and 42 C.F.R. § 440.90].

Covered as medically necessary. Covered as medically necessary.

5. Dental Services [defined at 42 C.F.R. § 440.100].

Preventive, diagnostic, and treatment services covered as medically necessary.

Dental services under EPSDT are provided in accordance with the state’s periodicity schedule as determined after consultation with recognized dental organizations and at other intervals as medically necessary.

Orthodontic services must be prior authorized by the Dental Benefits Manager (DBM). Orthodontic services are only covered for individuals under age 21. Effective October 1, 2013, TennCare reimbursement for orthodontic treatment approved and begun before age 21 will end on the individual’s 21st birthday. For individuals receiving treatment prior to October 1, 2013, such treatment may continue until completion as long as the enrollee remains eligible for TennCare.

Services from within each of the following categories are covered as medically necessary:

(A) Diagnostic x-rays and exams;

(B) Preventative cleanings;

(C) Topical fluoride treatments and caries arresting medicament;

(D) Restorative (fillings);

(E) Endodontics;

(F) Scaling and root planing;

(G) Full mouth debridement;

(H) Crowns;

(I) Partial Dentures;

(J) Complete dentures;

(K) Immediate complete dentures and complete denture relines;

SERVICE BENEFIT FOR PERSONS UNDER

AGE 21

BENEFIT FOR PERSONS AGED 21 AND

OLDER

Orthodontic treatment is not covered unless it is medically necessary to treat a handicapping malocclusion. Cleft palate, hemifacial microsomia, or mandibulofacial dysostosis shall be considered handicapping malocclusions.

A TennCare-approved Malocclusion Severity Assessment (MSA) will be conducted to measure the severity of the malocclusion. An MSA score of 28 or higher, as determined by the DBM’s dentist reviewer(s), will be used for making orthodontic treatment determinations of medical necessity. However, an MSA score alone cannot be used to deny orthodontic treatment.

Orthodontic treatment will not be authorized for cosmetic purposes.

Orthodontic treatment will be paid for by TennCare only as long as the individual remains eligible for TennCare.

The MCO is responsible for the provision of transportation to and from covered dental services, as well as the medical and anesthesia services related to the covered dental services.

(L) Tooth extraction;

(M) Alveoloplasty;

(N) Removal of lateral exostosis;

(O) Removal of torus palatinus;

(P) Removal of torus mandibularis;

(Q) Palliative treatment; and (R) Nitrous oxide inhalation sedation.

A current list of the specific procedure codes covered within this rule and TennCare’s “Dental Office Reference Manual” shall be made available on the TennCare website at tn.gov/tenncare.

6. Durable Medical Equipment [defined at 42 C.F.R. § 440.70(b)(3)].

Covered as medically necessary. Covered as medically necessary.

7. Emergency Air and Ground Transportation [defined at 42 C.F.R. § 440.170(a)(1) and (3)].

Covered as medically necessary. Covered as medically necessary.

8. Preventive, Diagnostic, and Treatment Services for Persons Under Age 21.

Screening and interperiodic screening covered in accordance with federal regulations.

(Interperiodic screens are screens in between regular checkups which are covered if a parent or caregiver suspects there may be a problem.)

Not applicable.

SERVICE BENEFIT FOR PERSONS UNDER

AGE 21

BENEFIT FOR PERSONS AGED 21 AND

OLDER

Diagnostic and follow-up treatment services covered as medically necessary and in accordance with federal regulations.

The periodicity schedule for child health screens is that set forth in the latest “American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care.”

All components of the screens must be consistent with the latest “American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care.”

9. Health Home Services for Persons with Serious and Persistent Mental Illness [described at 42 U.S.C. § 1396w- 4(h)(4)].

Covered as medically necessary. Covered as medically necessary.

10. Home Health Care [defined at 42 C.F.R. § 440.70(a), (b), (c), and (e) and at Rule 1200-13-14- .01].

Covered as medically necessary in accordance with the definition of Home Health Care at Rule 1200- 13-14-.01. Prior authorization required for home health nurse and home health aide services, as described in Paragraph (7) of this

rule.

All home health care must be delivered by a licensed Home Health Agency, as defined by 42 C.F.R. § 440.70.

Covered as medically necessary in accordance with the definition of Home Health Care at Rule 1200-13-14-.01. Prior authorization required for home health nurse and home health aide services, as described in Paragraph (7) of this rule.

All home health care must be delivered by a licensed Home Health Agency, as defined by 42 C.F.R. § 440.70.

11. Hospice Care [defined at 42 C.F.R., Part 418].

Covered as medically necessary.

Must be provided by an organization certified pursuant to Medicare Hospice requirements.

Covered as medically necessary.

Must be provided by an organization certified pursuant to Medicare Hospice requirements.

12. Infant Diapers.

Infant Diapers, as defined by Rule .01, are presumed to be medically necessary and covered for enrollees under age 2, not to exceed 100 per enrollee per calendar month.

Infant Diapers are not covered for enrollees age 2 or older.

Infant Diapers are only provided through participating pharmacies contracted with TennCare’s PBM. A current list of the specific brands Not Covered.

SERVICE BENEFIT FOR PERSONS UNDER

AGE 21

BENEFIT FOR PERSONS AGED 21 AND

OLDER and quantity limitations covered within this rule shall be made available on the TennCare website at tn.gov/tenncare.

Enrollees who qualify to receive Infant Diapers under this benefit cannot submit a Request for Reimbursement (as defined in Rule .01) for amounts paid out of pocket.

Diapering and incontinence supplies, which includes but is not limited to disposable wet wipes, diaper creams, baby talcum powder, diaper disposal systems, incontinence liners, underpads, sterile gloves, and non-sterile gloves, are not covered.

13. Inpatient and Outpatient Substance Abuse Benefits [defined as services for the treatment of substance abuse that are provided (a) in an inpatient hospital (as defined at 42 C.F.R. § 440.10) or (b) as outpatient hospital services (see 42 C.F.R. § 440.20(a); includes services in IMDs as provided for in 42 U.S.C. § 1396n(l)].

Covered as medically necessary.

Covered as medically necessary.

Substance abuse benefits delivered in IMDs are covered up to 30 days per year.

14. Inpatient Hospital Services [defined at 42 C.F.R. § 440.10].

Covered as medically necessary.

Preadmission and concurrent reviews allowed.

Covered as medically necessary.

Preadmission and concurrent reviews allowed.

15. Inpatient Rehabilitation Facility Services.

See “Inpatient Hospital Services.” Not Covered.

16. Lab and X-ray Services [defined at 42 C.F.R. § 440.30].

Covered as medically necessary.

Covered as medically necessary.

17. Medical Supplies [defined at 42 C.F.R. § 440.70(b)(3)].

Covered as medically necessary. Covered as medically necessary.

18. Mental Health Crisis Services [defined as services rendered to alleviate Covered as medically necessary. Covered as medically necessary.

SERVICE BENEFIT FOR PERSONS UNDER

AGE 21

BENEFIT FOR PERSONS AGED 21 AND

OLDER a psychiatric emergency].

19. Methadone Clinic Services [defined as services provided by a methadone clinic].

Covered as medically necessary. Covered as medically necessary.

20. Non-Emergency Ambulance Transportation, [defined at 42 C.F.R. § 440.170(a)(1) and (3)].

Covered as medically necessary. Covered as medically necessary.

21. Non-Emergency Transportation [defined at 42 C.F.R. § 440.170(a)(1) and (3)].

Covered as necessary for enrollees lacking accessible transportation for covered services. Emphasis shall be placed on the utilization of fixed route and/or public transportation where appropriate and available.

The travel to access primary care and dental services must meet the requirements of the TennCare demonstration project terms and conditions. The availability of specialty services as related to travel distance should meet the usual and customary standards for the community. However, in the event the MCC is unable to negotiate such an arrangement for an enrollee, transportation must be provided regardless of whether the enrollee has access to transportation.

If the enrollee is a minor child, transportation must be provided for the child and an accompanying adult. However, transportation for a minor child shall not be denied pursuant to any policy which poses a blanket restriction due to enrollee’s age or lack of parental accompaniment. Any decision to deny transportation of a minor child due to an enrollee’s age or lack of parental accompaniment must be made on a case-by-case basis and must be based on the individual facts surrounding the request. As with any denial, all notices and actions must be in accordance with Covered as necessary for enrollees lacking accessible transportation for covered services. Emphasis shall be placed on the utilization of fixed route and/or public transportation where appropriate and available.

The travel to access primary care and dental services must meet the requirements of the TennCare demonstration project terms and conditions. The availability of specialty services as related to travel distance should meet the usual and customary standards for the community. However, in the event the MCC is unable to negotiate such an arrangement for an enrollee, transportation must be provided regardless of whether the enrollee has access to transportation.

For persons dually eligible for Medicare and Medicaid, non-emergency transportation to access medical services covered by Medicare is provided, as long as these services would be covered by TennCare for the enrollee if he did not have Medicare. The Medicare provider of the medical service does not have to participate in TennCare. Transportation to these medical services is covered within the same access standards as those applicable for TennCare enrollees who are not also Medicare beneficiaries.

One escort is allowed per enrollee if the enrollee requires assistance. Assistance is defined for purposes of this rule as help provided to the enrollee that enables the enrollee to receive a medically necessary service. Examples of assistance are:

SERVICE BENEFIT FOR PERSONS UNDER

AGE 21

BENEFIT FOR PERSONS AGED 21 AND

OLDER the appeals process.

Tennessee recognizes the “mature minor exception” to permission for medical treatment.

The provision of transportation to and from covered dental services is the responsibility of the MCO.

For persons dually eligible for Medicare and Medicaid, nonemergency transportation to access medical services covered by Medicare is provided, as long as these services would be covered by TennCare for the enrollee if he did not have Medicare. The Medicare provider of the medical services does not have to participate in TennCare. Transportation to these medical services is covered within the same access standards as those applicable for TennCare enrollees who are not also Medicare beneficiaries.

One escort is allowed per enrollee if the enrollee requires assistance.

Assistance is defined for purposes of this rule as help provided to the enrollee that enables the enrollee to receive a medically necessary service. Examples of assistance are: physical assistance such as holding doors or pushing wheelchairs; language assistance such as interpreter services or reading for someone who is illiterate; or decision making assistance. See Rule 1200-13-14- .01 for a definition of who may be an escort. physical assistance such as holding doors or pushing wheelchairs; language assistance such as interpreter services or reading for someone who is illiterate; or decision making assistance. See Rule

Tenn. Comp. R. & Regs. 1200-13-14-.09 THIRD PARTY RESOURCES

(1) Individuals applying for TennCare Medicaid or TennCare Standard coverage shall disclose the availability of any third party health care coverage to the agency responsible for determining the individual’s eligibility for TennCare.

(2) An individual enrolled in TennCare Medicaid or TennCare Standard shall disclose access to third party resources to his/her specified Managed Care Contractors as soon as s/he becomes aware of the existence of any third party resources.

(3) Managed Care Contractors under contract with the Tennessee Departments of Finance and Administration or Mental Health and Developmental Disabilities shall provide all third party resource information obtained from the plan’s enrollees to the Bureau of TennCare on a regular basis as required by their contracts.

(4) Managed Care Contractors shall enforce TennCare subrogation rights pursuant to T.C.A. § 71-5-117.

(5) Managed Care Contractors may pay health insurance premiums for their enrollees if such payments are determined by the Bureau to be cost effective.

(6) TennCare shall be the payor of last resort, except where contrary to federal or state law.

(7) Upon enrollment in TennCare Medicaid or TennCare Standard an individual assigns to the Bureau any rights to third party insurance benefits to which the individual may be entitled.

(8) Upon accepting medical assistance, an enrollee in TennCare Medicaid or TennCare Standard shall be deemed to have made an assignment to the Bureau of the right to third party insurance benefits to which the enrollee may be entitled.

(9) The Bureau shall utilize direct billing when it is determined that a previously paid service may have been covered by a third party.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-117 and Executive Order No. 23.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-14- .09; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Amendment filed January 15, 2013; effective April 15, 2013.

Tenn. Comp. R. & Regs. 1200-13-14-.10 EXCLUSIONS

(1) General exclusions. The following items and services shall not be considered covered services by TennCare:

(a) Provision of medical assistance which is outside the scope of benefits as defined in these rules.

(b) Provision of services to persons who are not enrolled in TennCare, either on the date the services are delivered or retroactively to the date the services are delivered.

(c) Services for which there is no Federal Financial Participation (FFP).

(d) Services provided outside the United States or its territories.

(e) Services provided outside the geographic borders of Tennessee, including transportation to return to Tennessee to receive medical care except in the following circumstances:

1. Emergency medical services are needed because of an emergency medical condition;

2. Non-emergency urgent care services are requested because the recipient’s health would be endangered if he were required to travel, but only upon the explicit prior authorization of the MCC;

3. The covered medical service would not be readily available within Tennessee if the enrollee was physically located in Tennessee at the time of need and the covered service is explicitly prior authorized by the enrollee’s TennCare MCC; or 4. The out-of-state provider is participating in the enrollee’s MCC network.

(f) Investigative or experimental services or procedures including, but not limited to:

1. Drug or device that lacks FDA approval except when medically necessary as defined by TennCare;

2. Drug or device that lacks approval of facility’s Institutional Review Board;

3. Requested treatment that is the subject of Phase I or Phase II clinical trials or the investigational arm of Phase III clinical trials; or 4. A requested service about which prevailing opinion among experts is that further study is required to determine safety, efficacy, or long-term clinical outcomes of requested service.

(g) Services which are delivered in connection with, or required by, an item or service not covered by TennCare, including the transportation to receive such non-covered services, except that treatment of conditions resulting from the provision of noncovered services may be covered if medically necessary, notwithstanding the exclusions set out herein.

(h) Items or services furnished to provide a safe surrounding, including the charges for providing a surrounding free from exposure that can worsen the disease or injury.

(i) Non-emergency services that are ordered or furnished by an out-of-network provider and that have not been approved by the enrollee’s MCC. An exception exists for dually eligible enrollees. In-network care ordered by out-of-network providers is covered for dually eligible enrollees unless the MCO has informed such enrollee in advance of a request for a service that the specific service requires prior authorization and an order from an in-network provider.

(j) Services that are free to the public, with the exception of services delivered in the schools pursuant to the Individuals with Disabilities in Education Act (IDEA).

(k) Items or services ordered, prescribed, administered, supplied, or provided by an individual or entity that has been excluded from participation in the Medicaid program under the authority of the United States Department of Health and Human Services or the Bureau of TennCare.

(l) Items or services ordered, prescribed, administered, supplied, or provided by an individual or entity that is not licensed by the appropriate licensing board.

(m) Items or services outside the scope and/or authority of a provider’s specialty and/or area of practice.

(n) Items or services to the extent that Medicare or a third party payer is legally responsible to pay or would have been legally responsible to pay except for the enrollee’s or the treating provider’s failure to comply with the requirements for coverage of such services.

(o) Medical services for inmates confined in a local, state, or federal prison, jail, or other penal or correctional facility, including a furlough from such facility.

(p) Services delivered by a specific provider, even a provider who is an in-network provider with the enrollee’s managed care plan, when the managed care plan has offered the enrollee the services of a qualified provider who is available to provide the needed services.

(q) Items or services that are not covered by Medicare or a third party payer for an individual enrollee because the item or service is essentially equivalent to a Medicare or third party payer service that is being covered (e.g., home health services for individuals receiving hospice care).

(2) Exception to General and Specific Exclusions: COST EFFECTIVE ALTERNATIVE. As approved by CMS and/or authorized by Policy BEN 08-001, each MCC has sole discretionary

authority to provide certain cost effective alternatives when providing appropriate medically necessary care. These services are otherwise excluded and are not covered services unless the MCC has followed the procedures set forth in Policy BEN 08-001 and opts at its sole discretion to provide such requested item or service.

(3) Specific exclusions. The following services, products, and supplies are specifically excluded from coverage under the TennCare Section 1115 waiver program unless excepted by paragraph (2) herein. Some of these services may be covered under the CHOICES or ECF CHOICES programs or outside the managed care program under a Section 1915(c) Home and Community Based Services waiver when provided as part of an approved plan of care, in accordance with the appropriate approved TennCare Home and Community Based Services waiver.

(a) Services, products, and supplies that are specifically excluded from coverage except as medically necessary for children under the age of 21.

1. Audiological therapy or training 2. Beds and bedding equipment as follows:

(i) Powered air flotation beds, air fluidized beds (including Clinitron beds), water pressure mattress, or gel mattress For persons age 21 and older: Not covered unless a member has both severely impaired mobility (i.e., unable to make independent changes in body position to alleviate pain or pressure) and any stage pressure ulcer on the trunk or pelvis combined with at least one of the following: impaired nutritional status, fecal or urinary incontinence, altered sensory perception, or compromised circulatory status.

(ii) Bead beds, or similar devices (iii) Bed boards (iv) Bedding and bed casings (v) Ortho-prone beds (vi) Oscillating beds (vii) Springbase beds (viii) Vail beds, or similar bed 3. Biofeedback 4. Cushions, pads, and mattresses as follows:

(i) Aquamatic K Pads (ii) Elbow protectors (iii) Heat and massage foam cushion pads (iv) Heating pads (v) Heel protectors (vi) Lamb’s wool pads (vii) Steam packs 5. Diagnostic tests conducted solely for the purpose of evaluating the need for a service which is excluded from coverage under these rules.

6. Ear plugs 7. Food supplements and substitutes including formulas For persons 21 years of age and older: Not covered, except that Parenteral Nutrition formulas, Enteral Nutrition formulas for tube feedings and phenylalanine-free formulas (not foods) used to treat PKU, as required by T.C.A. § 56-7-2505, are covered for adults. In addition, oral liquid nutrition may be covered when medically necessary for adults with swallowing or breathing disorders who are severely underweight (BMI<15 kg/m2) and physically incapable of otherwise consuming a sufficient intake of food to meet basic nutritional requirements.

7. Hearing services, including the prescribing, fitting, or changing of hearing aids and cochlear implants 9. Humidifiers (central or room) and dehumidifiers 10. Inpatient rehabilitation facility services 11. Medical supplies, over-the-counter, as follows:

(i) Alcohol, rubbing (ii) Band-aids (iii) Cotton balls (iv) Eyewash (v) Peroxide (vi) Q-tips or cotton swabs 12. Nutritional supplements and vitamins, over-the-counter, except that prenatal vitamins for pregnant women and folic acid for women of childbearing age are covered 13. Orthodontic services, except as defined in Rule 1200-13-13-.04(1)(b)5. or 1200- 13-14-.04(1)(b)5.

14. Certain pharmacy items as follows:

(i) Agents when used for anorexia or weight loss, except for weight loss drugs when prescribed for treatment of obesity (ii) Agents when used to promote fertility (iii) Agents when used for cosmetic purposes or hair growth (iv) Agents when used for the symptomatic relief of cough and colds (v) Covered outpatient drugs which the manufacturer seeks to require as a condition of sale that associated tests or monitoring services be purchased exclusively from the manufacturer or its designee (vi) Nonprescription drugs (vii) Buprenorphine-containing products used for treatment of opiate addiction in excess of the covered amounts listed below:

(I) Dosage of sixteen milligrams (16 mg) per day for a period of up to six (6) months (183 days) from the initiation of therapy or from the conclusion of pregnancy, if the enrollee is pregnant during this initial maximum dosage therapy; and (II) Dosage of eight milligrams (8 mg) per day after the sixth (6th) month (183rd day) of therapy.

(viii) Sedative hypnotic medications in dosage amounts that exceed the dosage amounts listed below:

(I) Fourteen (14) pills per month for sedative hypnotic formulations in pill form such as Ambien and Lunesta;

(II) One hundred forty milliliters (140 ml) per month of chloral hydrate; or (III) One (1) bottle every sixty (60) days of Zolpimist.

(ix ) Allergy medications (x) Opioid products are restricted as set out in Rule .04(1)(c)12.

15. Purchase, repair, or replacement of materials or equipment when the reason for the purchase, repair, or replacement is the result of enrollee abuse 16. Purchase, repair, or replacement of materials or equipment that has been stolen or destroyed except when the following documentation is provided:

(i) Explanation of continuing medical necessity for the item, and (ii) Explanation that the item was stolen or destroyed, and (iii) Copy of police, fire department, or insurance report if applicable 17. Radial keratotomy 18. Reimbursement to a provider or enrollee for the replacement of a rented durable medical equipment (DME) item that is stolen or destroyed 19. Repair of DME items not covered by TennCare 20. Repair of DME items covered under the provider’s or manufacturer’s warranty 21. Repair of a rented DME item 22. Speech, language, and hearing services to address speech problems caused by mental, psychoneurotic, or personality disorders 23. Standing tables 24. Vision services for persons 21 years of age and older that are not needed to treat a systemic disease process including, but not limited to:

(i) Eyeglasses, sunglasses, and/or contact lenses for persons aged 21 and older, including eye examinations for the purpose of prescribing, fitting, or changing eyeglasses, sunglasses, and/or contact lenses; procedures performed to determine the refractive state of the eye(s); one pair of cataract glasses or lenses is covered for adults following cataract surgery (ii) LASIK (iii) Orthoptics (iv) Vision perception training (v) Vision therapy (b) Services, products, and supplies that are specifically excluded from coverage under the TennCare program.

1. Air cleaners, purifiers, or HEPA filters 2. Alcoholic beverages 3. Animal therapy including, but not limited to:

(i) Dolphin therapy (ii) Equine therapy (iii) Hippo therapy (iv) Pet therapy 4. Art therapy 5. Autopsy 6. Bathtub equipment and supplies as follows:

(i) Paraffin baths (ii) Sauna baths 7. Beds and bedding equipment as follows:

(i) Adjust-a-Beds, lounge beds, or similar devices (ii) Pillows (iii) Waterbeds 8. Bioenergetic therapy 9. Body adornment and enhancement services including, but not limited to:

(i) Body piercing (ii) Breast augmentation (iii) Breast capsulectomy (iv) Breast implant removal that is not medically indicated (v) Ear piercing (vi) Hair transplantation, and agents for hair growth (vii) Tattoos or removal of tattoos (viii) Tongue splitting or repair of tongue splitting (ix) Wigs or hairpieces 10. Breathing equipment as follows:

(i) Intrapulmonary Percussive Ventilators (IPVs)

(ii) Spirometers, except for peak flow meters for medical management of asthma and incentive spirometers (iii) Vaporizers 11. Carbon dioxide therapy 12. Care facilities or services, the primary purpose of which is non-medical, including, but not limited to:

(i) Day care (ii) Evening care centers (iii) Respite care, except as a component of Mental Health Crisis Services benefits or Hospice Care benefits as provided at Rule 1200-13-14- .04(1)(b).

(iv) Rest cures (v) Social or diversion services related to the judicial system 13. Carotid body tumor, excision of, as treatment for asthma 14. Chelation therapy, except for the treatment of heavy metal poisoning or secondary hemochromatosis in selected settings. Chelation therapy for treatment of arteriosclerosis or autism is not covered. Chelation therapy for asymptomatic individuals is not covered. In the case of lead poisoning, the lead levels must be extremely high. For children, a minimum level of 45 ug/dl is recommended.

Because chelation therapy and its after-effects must be continuously monitored for possible adverse reactions, chelation therapy is covered only in inpatient or outpatient hospital settings, renal dialysis facilities, and skilled nursing facilities. It is not covered in an office setting, an ambulatory surgical center, or a home setting.

15. Clothing, including adaptive clothing 16. Cold therapy devices 17. Comfort and convenience items including, but not limited to:

(i) Corn plasters (ii) Garter belts (iii) Incontinence products (including, but not limited to, diapers, liners, and underpads) are not covered unless needed for a medical condition and are not covered for children age 3 and younger, except Infant Diapers as described in Rule .04.

(iv) Support stockings, when light or medium weight or prescribed for relief of tired or aching legs or treatment of spider/varicose veins. Surgical weight stockings prescribed by a doctor or other qualified licensed health care practitioner for the treatment of chronic foot/ankle swelling, venous insufficiencies, or other medical conditions and thrombo-embolic deterrent support stockings for pre- and post-surgical procedures are covered as medically necessary.

18. Computers, personal, and peripherals including, but not limited to printers, modems, monitors, scanners, and software, including their use in conjunction with an Augmentative Communication Device 19. Convalescent care 20. Cosmetic dentistry, cosmetic oral surgery, and cosmetic orthodontic services 21. Cosmetic prosthetic devices 22. Cosmetic surgery or surgical procedures primarily for the purpose of changing the appearance of any part of the body to improve appearance or self-esteem, including scar revision. The following services are not considered cosmetic services:

(i) Reconstructive surgery to correct the results of an injury or disease (ii) Surgery to treat congenital defects (such as cleft lip and cleft palate) to restore normal bodily function (iii) Surgery to reconstruct a breast after mastectomy that was done to treat a disease, or as a continuation of a staged reconstructive procedure (iv) In accordance with Tennessee law, surgery of the non-diseased breast following mastectomy and reconstruction to create symmetrical appearance (v) Surgery for the improvement of the functioning of a malformed body member (vi) Reduction mammoplasty, when the minimum amount of breast material to be removed is equal to or greater than the 22nd percentile of the Schnur Sliding Scale based on the individual’s body surface area.

23. Dance therapy 24. Services provided solely or primarily for educational purposes, including, but not limited to:

(i) Academic performance testing (ii) Educational tests and training programs (iii) Habilitation (iv) Job training (v) Lamaze classes (vi) Lovaas therapy (vii) Picture illustrations (viii) Remedial education (ix) Sign language instruction (x) Special education (xi) Tutors 25. Encounter groups or workshops 26. Environmental modifications including, but not limited to:

(i) Air conditioners, central or unit (ii) Micronaire environmentals, and similar devices (iii) Pollen extractors (iv) Portable room heaters (v) Vacuum systems for dust filtering (vi) Water purifiers (vii) Water softeners 27. Exercise equipment including, but not limited to:

(i) Exercise equipment (ii) Exercycles (including cardiac use)

(iii) Functional electrical stimulation (iv) Gravitronic traction devices (v) Gravity guidance inversion boots (vi) Parallel bars (vii) Pulse tachometers (viii) Tilt tables when used for inversion (ix) Training balls (x) Treadmill exercisers (xi) Weighted quad boots 28. Food and food products (distinct from food supplements or substitutes, as defined in Rule 1200-13-14-.10(3)(a)10.), including but not limited to specialty food items for use in diets such as:

(i) Low-phenylalanine or phenylalanine-free (ii) Gluten-free (iii) Casein-free (iv) Ketogenic 29. Generators and auxiliary power equipment that may be used to provide power for covered medical equipment or for any purpose 30. Grooming services including, but not limited to:

(i) Barber services (ii) Beauty services (iii) Electrolysis (iv) Hairpieces or wigs (v) Manicures (vi) Pedicures 31. Hair analysis 32. Home health aide services or services from any other individual or agency that are for the primary purpose of safety monitoring 33. Home modifications and items for use in the home (i) Decks (ii) Enlarged doorways (iii) Environmental accessibility modifications such as grab bars and ramps (iv) Fences (v) Furniture, indoor or outdoor (vi) Handrails (vii) Meals (viii) Overbed tables (ix) Patios, sidewalks, driveways, and concrete slabs (x) Plexiglass (xi) Plumbing repairs (xii) Porch gliders (xiii) Rollabout chairs (xiv) Room additions and room expansions (xv) Telephone alert systems (xvi) Telephone arms (xvii) Telephone service in home (xviii) Televisions (xix) Tilt tables when used for inversion (xx) Toilet trainers and potty chairs. Positioning commodes and toilet supports are covered as medically necessary.

(xxi) Utilities (gas, electric, water, etc.)

34. Homemaker services 35. Hospital inpatient items that are not directly related to the treatment of an injury or illness (such as radios, TVs, movies, telephones, massage, guest beds, haircuts, hair styling, guest trays, etc.)

35. Hotel charges, unless pre-approved in conjunction with a transplant or as part of a non-emergency transportation service 37. Hypnosis or hypnotherapy 38. Infant/child car seats, except that adaptive car seats may be covered for a person with disabilities such as severe cerebral palsy, spina bifida, muscular dystrophy, and similar disorders who meets all of the following conditions:

(i) Cannot sit upright unassisted, and (ii) Infant/child care seats are too small or do not provide adequate support, and (iii) Safe automobile transport is not otherwise possible.

39. Infertility or impotence services including, but not limited to:

(i) Artificial insemination services (ii) Purchase of donor sperm and any charges for the storage of sperm (iii) Purchase of donor eggs, and any charges associated with care of the donor required for donor egg retrievals or transfers of gestational carriers (iv) Cryopreservation and storage of cryopreserved embryos (v) Services associated with a gestational carrier program (surrogate parenting) for the recipient or the gestational carrier (vi) Fertility drugs (vii) Home ovulation prediction kits (viii) Services for couples in which one of the partners has had a previous sterilization procedure, with or without reversal (ix) Reversal of sterilization procedures (x) Any other service or procedure intended to create a pregnancy (xi) Testing and/or treatment, including therapy, supplies, and counseling, for frigidity or impotence 40. Injections for the treatment of pain such as:

(i) Facet/medial branch injections for therapeutic purposes (ii) Medial branch injections for diagnostic purposes in excess of four (4) injections in a calendar year (iii) Trigger point injections in excess of four (4) injections per muscle trigger point during any period of six (6) consecutive months (iv) Epidural steroid injections in excess of three (3) injections during any period of six (6) consecutive months, except epidural injections associated with childbirth 41. Lamps such as:

(i) Heating lamps (ii) Lava lamps (iii) Sunlamps (iv) Ultraviolet lamps 42. Lifts as follows:

(i) Automobile van lifts (ii) Electric powered recliner, elevating seats, and lift chairs (iii) Elevators (iv) Overhead or ceiling lifts, ceiling track system lifts, or wall mounted lifts when installation would require significant structural modification and/or renovation to the dwelling (e.g., moving walls, enlarging passageways, strengthening ceilings and supports). The request for prior authorization must include a specific breakdown of equipment and installation costs, specifying all required structural modifications (however minor) and the cost associated thereto.

(v) Stairway lifts, stair glides, and platform lifts, including but not limited to Wheel-O-Vators 43. Ligation of mammary arteries, unilateral or bilateral 44. Megavitamin therapy 45. Motor vehicle parts and services including, but not limited to:

(i) Automobile controls (ii) Automobile repairs or modifications 46. Music therapy 47. Nail analysis 48. Naturopathic services 49. Necropsy 50. Organ and tissue transplants that have been determined experimental or investigational 51. Organ and tissue donor services provided in connection with organ or tissue transplants covered pursuant to Rule 1200-13-14-.04(1)(b)22., including, but not limited to:

(i) Transplants from a donor who is a living TennCare enrollee and the transplant is to a non-TennCare enrollee (ii) Donor services other than the direct services related to organ procurement (such as, hospitalization, physician services, anesthesia)

(iii) Hotels, meals, or similar items provided outside the hospital setting for the donor (iv) Any costs incurred by the next of kin of the donor (v) Any services provided outside of any “bundled rates” after the donor is discharged from the hospital 52. Oxygen, except when provided under the order of a physician and administered under the direction of a physician 53. Oxygen, preset system (flow rate not adjustable)

54. Certain pharmacy items as follows: DESI, LTE, and IRS drugs 55. Play therapy 56. Primal therapy 57. Prophylactic use of stainless steel crowns 58. Psychodrama 59. Psychogenic sexual dysfunction or transformation services 60. Purging 61. Recertification of patients in Level 1 and Level II Nursing Facilities 62. Recreational therapy 63. Religious counseling 64. Retreats for mental disorders 65. Rolfing 66. Routine health services which may be required by an employer; or by a facility where an individual lives, goes to school, or works; or by the enrollee’s intent to travel (i) Drug screenings (ii) Employment and pre-employment physicals (iii) Fitness to duty examinations (iv) Immunizations related to travel or work (v) Insurance physicals (vi) Job related illness or injury covered by workers’ compensation 67. Sensitivity training or workshops 68. Sensory integration therapy and equipment used in sensory integration therapy including, but not limited to:

(i) Ankle weights (ii) Floor mats (iii) Mini-trampolines (iv) Poof chairs (v) Sensory balls (vi) Sky chairs (vii) Suspension swings (viii) Trampolines (ix) Therapy balls (x) Weighted blankets or weighted vests 69. Sensory stimulation services 70. Services provided by immediate relatives, i.e., a spouse, parent, grandparent, stepparent, child, grandchild, brother, sister, half brother, half sister, a spouse’s parents or stepparents, or members of the recipient’s household, except that Home Health Services and Private Duty Nursing Services may be delivered by an immediate family member, provided that the immediate family member is a qualified provider for Home Health Services or Private Duty Nursing and otherwise meets the requirements for Participating Providers under this Chapter.

71. Sex change or transformation surgery 72. Sexual dysfunction or inadequacy services and medicine, including drugs for erectile dysfunctions and penile implant devices 73. Sitter services 74. Speech devices as follows:

(i) Phone mirror handivoice (ii) Speech software (iii) Speech teaching machines 75. Sphygmomanometers (blood pressure cuffs)

76. Stethoscopes 77. Supports: Cervical pillows 78. TENS (transcutaneous electrical nerve stimulation) units for the treatment of chronic lower back pain 79. Thermograms 80. Thermography 81. Time involved in completing necessary forms, claims, or reports 82. Tinnitus maskers 83. Toy equipment such as: Flash switches (for toys)

77. Transportation costs as follows:

(i) Transportation to a provider who is outside the geographical access standards that the MCC is required to meet when a network provider is available within such geographical access standards or, in the case of Medicare beneficiaries, transportation to Medicare providers who are outside the geographical access standards of the TennCare program when there are Medicare providers available within those standards (ii) Mileage reimbursement, car rental fees, or other reimbursement for use of a private vehicle unless prior authorized by the MCC in lieu of contracted transportation services (iii) Transportation back to Tennessee from vacation or other travel out-of-state in order to access non-emergency covered services (unless authorized by the MCC)

(iv) Any non-emergency out-of-state transportation, including airfare, that has not been prior authorized by the MCC. This includes the costs of transportation to obtain out-of-state care that has been authorized by the MCC. Out-of-state transportation must be prior authorized independently of out-of-state care.

85. Transsexual surgery 86. Urine Drug testing that, within a calendar year, is in excess of twenty-four (24) presumptive urine drug tests using optical observation, and twelve (12) presumptive urine drug tests using instrument chemistry analyzers, and twelve (12) definitive drug urine tests.

86. Vagus nerve stimulators, except after conventional therapy has failed in treating partial onset of seizures.

87. Weight loss or weight gain and physical fitness programs including, but not limited to:

(i) Dietary programs of weight loss programs, including, but not limited to, Optifast, Nutrisystem, and other similar programs or exercise programs.

Food supplements will not be authorized for use in weight loss programs or for weight gain.

(ii) Health clubs, membership fees (e.g., YMCA)

(iii) Marathons, activity and entry fees (iv) Swimming pools 89. Wheelchairs and wheelchair accessories as follows:

(i) Wheelchairs defined by CMS as power operated vehicles (POVs), namely, scooters and devices with three (3) or four (4) wheels that have tiller steering and limited seat modification capabilities (i.e. provide little or no back support).

(ii) Standing wheelchairs. However a power standing system is covered as set out in the definition of Power Seating Accessories in Rule 1200-13-14-.01.

(iii) Stair climbing wheelchairs (iv) Recreational wheelchairs 90. Whirlpools and whirlpool equipment such as:

(i) Action bath hydro massage (ii) Aero massage (iii) Aqua whirl (iv) Aquasage pump, or similar devices (v) Hand-D-Jets, or similar devices (vi) Jacuzzis, or similar devices (vii) Turbojets (viii) Whirlpool bath equipment (ix) Whirlpool pumps

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-208, 4-5-209, 71-5-102, 71-5-105, 71-5-107, 71-5-109, 71-5- 113, 71-5-134, and 71-5-1404; 42 C.F.R. Part 431 Subpart E; 42 C.F.R. Part 438 Subpart F; Executive Order No. 23; Public Chapter 473, Acts of 2011; and 2025 Public Chapter No. 530.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-14-.10; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Repeal and new rule filed October 27, 2005; effective January 10, 2006. Public necessity rule filed May 3, 2006; effective through October 15, 2006. Amendment filed July 28, 2006; effective October 11, 2006. Public necessity rule filed February 1, 2007; effective through July 16, 2007. Amendment filed January 30, 2007; effective April 15, 2007. Amendment filed May 2, 2007; effective July 16, 2007. Amendment filed June 27, 2007; effective September 10, 2007. Amendment filed February 8, 2008; effective April 23, 2008. Amendment filed February 11, 2008; effective April 26, 2008. Amendment filed April 2, 2008; effective June 16, 2008. Amendments filed August 19, 2008; effective November 2, 2008. Amendment filed July 28, 2009; effective October 26, 2009. Amendment filed November 9, 2009; effective February 7, 2010. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendment filed May 27, 2010; effective August 25, 2010. Amendment filed October 26, 2010; effective January 24, 2011. Amendment filed December 14, 2010; effective May 31, 2011. Emergency rule filed July 1, 2011; effective through December 28, 2011. Emergency rule filed August 2, 2011; effective through January 29, 2012. Amendment filed September 23, 2011; effective December 22, 2011. Amendment filed October 28, 2011; effective January 26, 2012. Emergency rule filed September 27, 2013; effective through March 26, 2014. Amendment filed July 1, 2013; effective September 29, 2013. Amendment filed September 27, 2013; effective December 26, 2013. Amendment filed December 17, 2013; effective March 17, 2014. Amendments filed December 23, 2014; effective March 23, 2015. Emergency rule filed September 30, 2015; effective through March 28, 2016. Amendments filed December 29, 2015; effective March 28, 2016. Amendments filed December 30, 2015; effective March 29, 2016. Emergency rules filed June 24, 2016; effective through December 21, 2016. Emergency rules filed July 1, 2016; effective through December 28, 2016. Amendments filed September 13, 2016; effective December 12, 2016. Amendments filed September 30, 2016; effective December 29, 2016. Amendments filed September 25, 2017; effective December 24, 2017. Emergency rules filed January 16, 2018; effective through July 15, 2018. Amendments filed April 9, 2018; effective July 8, 2018. Amendments filed July 8, 2021; effective October 6, 2021. Amendments filed February 16, 2022; effective May 17, 2022. Emergency rules filed December 27, 2022 to become effective January 1, 2023; effective through June 30, 2023. Amendments filed January 19, 2023; effective April 19, 2023. Emergency rules filed August 7, 2024; effective through February 3, 2025. Amendments filed November 4, 2024; effective February 2, 2025. Emergency rules filed August 1, 2025; effective through January 28, 2026. Amendments filed July 7, 2025; effective October 5, 2025.

Tenn. Comp. R. & Regs. 1200-13-14-.11 APPEAL OF ADVERSE BENEFIT DETERMINATIONS

(1) Notice Requirements.

(a) When Written Notice is Required.

1. A written notice shall be given to an enrollee by his/her MCC of any adverse benefit determination.

2. A written notice shall be given to an enrollee of any MCC-initiated reduction, termination or suspension of inpatient hospital care.

3. A written notice shall be given to an enrollee of any provider-initiated reduction, termination or suspension.

4. Appropriate notice shall be given to an enrollee by the State or MCC when a claim for service or reimbursement is denied because an enrollee has exceeded a benefit limit. Such notice shall not be subject to the requirements of Rule 1200- 13-14-.11(1)(c)1. During the applicable time period for each benefit limit, such notice shall only be provided the first time a claim is denied because an enrollee has exceeded a benefit limit. The State or MCC will not be required to provide any notice when an enrollee is approaching or reaches a benefit limit.

5. Appropriate notice shall be given to an enrollee by a provider when an enrollee exceeds a non-pharmacy benefit limit in the following circumstances:

(i) The provider denies the request for a non-pharmacy service because an enrollee has exceeded the applicable benefit limit; or (ii) The provider informs an enrollee that the non-pharmacy service will not be covered by TennCare because he/she has exceeded the applicable benefit limit and the enrollee chooses not to receive the service.

During the applicable time period for each non-pharmacy benefit limit, providers shall only be required to issue this notice the first time an enrollee does not receive a non-pharmacy service from the provider because he/she has exceeded the applicable benefit limit. Such notice shall not be subject to the requirements of Rule 1200-13-14-.11(1)(c)1. Providers will not be required to issue any notice when an enrollee is approaching or reaches a non-pharmacy benefit limit.

(b) Timing of Written Notice.

1. Written notice of MCC-initiated reduction, termination or suspension of medical assistance must be provided to an enrollee within the time frames required by 42 C.F.R. §§ 431.210 - 431.214 (usually ten (10) days in advance). However, in instances of MCC-initiated reduction, termination or suspension of inpatient hospital treatment, the notice may be provided to an enrollee the same day of the proposed action. Where applicable and not in conflict with this rule, the exceptions set out at 42 C.F.R. §§ 431.211 - 431.214 permit or require reduction of the time frames within which advance notice must be provided.

2. An MCC must notify an enrollee of its decision in response to a request by or on behalf of an enrollee for prior authorization for medical or related services as set out in 42 C.F.R. § 438.210(d).

3. Written notice of delay of covered medical assistance must be provided to an enrollee immediately upon an MCC’s receipt of information leading it to expect that such delay will occur.

4. Written notice of provider-initiated reduction, termination or suspension of services must be provided to an enrollee in compliance with 42 C.F.R. §§ 431.211, 431.213 and 431.214.

5. Written notice is deemed to be provided to an enrollee upon deposit with the US Postal Service or other commercial mail carrier, or upon hand-delivery to an enrollee or his/her representative.

(c) Notice Contents.

1. Whenever this rule requires that a TennCare enrollee receive written notice of an adverse benefit determination, the notice must be readable and must comply with the requirements of 42 C.F.R. §§ 431.210 and 438.404.

2. Remedying of Notice. If a notice of adverse benefit determination provided to an enrollee does not meet the notice content requirements of Rule 1200-13-14- .11(1)(c)1., TennCare or the MCC may cure any such deficiencies by providing one corrected notice to enrollees. If a corrected notice is provided to an enrollee, the reviewing authority shall consider only the factual reasons and legal authorities cited in the corrected notice, except that additional evidence beneficial to the enrollee may be considered on appeal.

(2) Appeal Rights of Enrollees. Enrollees have the following rights:

(a) To appeal adverse actions benefit determinations.

(b) An enrollee’s request for appeal, including oral or written expressions by the enrollee, or on his behalf, of dissatisfaction or disagreement with adverse benefit determinations that have been made or are proposed to be made, may not be denied.

(c) To have the appeal rights that are prescribed by 42 C.F.R. Part 431, Subpart E and Tennessee Code Annotated §§ 4-5-301, et seq.

(d) To be allowed sixty (60) days from the date on the written notice or, if no notice is provided, from the time the enrollee becomes aware of an adverse benefit determination, to appeal any adverse benefit determination. To file a Request for Reimbursement for expenses incurred between the effective eligibility date and the date that notice of eligibility is provided, the enrollee must request reimbursement and provide complete information to TennCare, as prescribed by Rule .01, within sixty (60) days from the date of the written notification of the effective eligibility date or, if no written notice is provided, within sixty (60) days from the date the enrollee becomes aware of the effective eligibility date. For all other Requests for Reimbursement, the enrollee must request reimbursement and provide complete information, as prescribed by Rule .01, within sixty (60) days from the date the enrollee paid out of pocket for covered services.

(e) To appeal in person, by telephone, or in writing. Reasonable accommodations shall be made for any person with disabilities who requires assistance with his/her appeal, such as an appeal by TDD services or other communication device for people with disabilities. Written requests for appeals made at county TDHS offices shall be stamped and immediately forwarded to the TennCare Bureau for processing and entry in the central registry.

(f) For ongoing services, have the right to continuation or reinstatement of services, pursuant to 42 C.F.R. §§ 431.230 and 431.231 as modified by this rule, pending resolution of the appeal when the enrollee submits a timely appeal and timely request for COB. When an enrollee is so entitled to continuation or reinstatement of services, this right may not be denied for any reason, including:

1. An MCC’s failure to inform an enrollee of the availability of such continued services;

2. An MCC’s failure to reimburse providers for delivering services pending appeal; or 3. An MCC’s failure to provide such services when timely requested.

(g) To an appeals process. But for initial reconsideration by an MCC as permitted by this

rule, no person who is an employee, agent or representative of an MCC may participate in deciding the outcome of a SFH. No state official who was directly involved in the initial determination of the action in question may participate in deciding the outcome of an enrollee’s appeal.

(3) Special Provisions Relating to Appeals.

(a) Individualized Decisions Required. Neither the TennCare program nor its MCCs may employ utilization control guidelines or other quantitative coverage limits, whether explicit or de facto, unless supported by an individualized determination of medical necessity based upon the needs of each TennCare enrollee and his or her medical

history.

(b) Medical Evidence.

1. Appeal decisions must be based on an evaluation of pertinent medical evidence.

TennCare and the MCCs shall elicit from enrollees and their treating providers all pertinent medical records that support an appeal; and 2. Medical opinions shall be evaluated pursuant to TennCare Medical Necessity

Rule 1200-13-16. Reliance upon insurance industry guidelines or utilization control criteria of general application, without consideration of the individual enrollee’s medical history, does not satisfy this requirement and cannot be relied upon to support an adverse benefit determination.

(c) Record on Review. When TennCare receives an appeal from an enrollee regarding an adverse benefit determination, TennCare is responsible for obtaining from the MCC any and all records or documents pertaining to the MCC’s decision to take the contested action. TennCare shall correct any violation of this rule that is evident from a review of those records.

(d) Valid Factual Disputes. When TennCare receives an appeal from an enrollee, TennCare will dismiss this appeal unless the enrollee has established a valid factual dispute relating to an adverse benefit determination.

1. Processing of Appeals. TennCare shall screen all appeals submitted by TennCare enrollees to determine if the enrollees have presented a valid factual dispute. If TennCare determines that an enrollee failed to present a valid factual dispute, TennCare will immediately provide the enrollee with a notice, informing him/her that the enrollee must provide additional information as identified in the notice. If the enrollee does not provide this information, the appeal shall be dismissed without the opportunity for a state fair hearing within ten (10) days of the date of the notice. If the enrollee adequately responds to this notice, TennCare shall inform the enrollee that the appeal will proceed to a hearing. If the enrollee responds but fails to provide adequate information, TennCare will provide a notice to the enrollee, informing him/her that the appeal is dismissed without the opportunity for a state fair hearing. If the enrollee does not respond, the appeal will be dismissed without the opportunity for a state fair hearing, without further notice to the enrollee.

2. Information Required to Establish Valid Factual Disputes. In order to establish a valid factual dispute, TennCare enrollees must provide the following information:

Enrollee’s name; member SSN or TennCare ID#; address and phone; identification of the service or item that is the subject of the adverse benefit determination; and the reason for the appeal, including any factual error the enrollee believes TennCare or the MCC has made. For reimbursement and billing appeals, enrollees must also provide the date the service was provided, the name of the provider, copies of receipts which prove that the enrollee paid for the services or copies of a bill for the services, whichever is applicable.

(e) Appeals When Enrollees Lack a Prescription. When a TennCare enrollee attempts to lodge an appeal for a benefit for which the enrollee lacks a prescription, TennCare may require the enrollee to exhaust the following administrative process before an appeal can proceed:

1. TennCare will provide appropriate notice to the enrollee informing him/her that he/she will be required to complete an administrative process. Such administrative process requires the enrollee to contact the MCC to make an appointment with a provider to evaluate the request for the service. The MCC shall be required to make such appointment for the enrollee within a 3-week period or forty-eight (48) hours for urgent care from the date the enrollee contacts the MCC. Appeal timeframes will be tolled during this administrative process.

2. In order for this appeal to continue, the enrollee shall be required to contact TennCare after attending the appointment with a physician and demonstrate that he/she remains without a prescription for the service. If the enrollee fails to contact TennCare within sixty (60) days from the date of the notice described in subparagraph (e)1., TennCare will dismiss the appeal without providing an opportunity for a hearing for the enrollee.

(f) Appeals When No Adverse Benefit Determination Has Been Made. Enrollees shall not possess the right to appeal when no adverse benefit determination has been made. If enrollees request a hearing in this circumstance, their request shall be denied by the TennCare bureau without the opportunity for a hearing. Such circumstances include but are not limited to when enrollees appeal and no request for services had previously been denied.

(4) Hearing Rights of Enrollees.

(a) TennCare shall inform enrollees of their state fair hearing rights;

(b) Enrollees shall be entitled to a hearing before a hearing officer that affords each enrollee the right to:

1. Representation at the hearing by anyone of his/her choice, including a lawyer;

2. Review information and facts relied on for the decisions by the MCC and the TennCare Bureau before the hearing;

3. Cross-examine adverse witnesses;

4. Present evidence, including the right to compel attendance of witnesses at hearings;

5. Review and present information from his/her medical records;

6. Present evidence at the hearing challenging the adverse decision by his/her MCC;

7. Ask for an independent medical opinion, at no expense to the enrollee;

8. Continue or reinstate ongoing services pending a hearing decision, as specified in this rule;

9. A written decision setting out the hearing officer’s rulings on findings of fact and conclusions of law; and 10. Resolution, including a hearing before a hearing officer if the case has not been previously resolved in favor of the enrollee, pursuant to 42 C.F.R. § 431.244.

(c) TennCare shall not impair the ability of an enrollee to appeal an adverse hearing decision by requiring that the enrollee bear the expense of purchasing a hearing transcript when such purchase would be a financial hardship for the enrollee.

(d) Parties to an Appeal. Under this rule, the parties to a state fair hearing are limited to the enrollee and TennCare, permitted by federal regulations as modified by CMS letter dated June 5, 2017. The purpose of the hearing is to focus on the enrollee’s medical needs.

(e) Consistent with the Code of Judicial Conduct, hearing officers shall assist pro se enrollees in developing the factual record and shall have authority to order second medical opinions at no expense to the enrollee.

(f) Review of Hearing Decisions.

1. Hearing officers shall promptly issue an Order of their decision. Any Order delivered orally from the bench in an expedited hearing by a hearing officer shall be effective immediately as to the provision or denial of benefits. In accordance with 42 C.F.R. Part 431 Subpart E and 42 C.F.R. Part 438 Subpart F, the hearing officer shall enter a written order as soon as practicable and shall provide the parties with copies of such Orders. The time for appealing any oral Order shall not begin to run until entry of the written Order.

2. The TennCare Bureau shall have the opportunity to review all decisions of hearing officers, in accordance with T.C.A. §§ 4-5-314 and 4-5-315, to determine whether such decisions are contrary to applicable law, regulations or policy interpretations, which shall include but not be limited to decisions regarding the defined package of covered benefits, determinations of medical necessity and decisions based on the application of this chapter and 42 C.F.R. Part 431

Subpart E and 42 C.F.R. Part 438 Subpart F.

(i) If TennCare modifies or overturns the decision of the hearing officer, TennCare shall issue a written decision that will be provided to the enrollee and the hearing officer. TennCare’s decision shall constitute final agency action.

(ii) If TennCare does not modify or overturn the decision of the hearing officer, the hearing officer’s decision shall constitute final agency action without additional notice to the enrollee.

(iii) Review of final agency action shall be available to enrollees pursuant to T.C.A. § 4-5-322.

(iv) A hearing officer’s decision in an enrollee’s appeal shall not be deemed precedent for future appeals.

(g) Continuation or Reinstatement of TennCare Services.

1. As permitted under 42 C.F.R. §§ 431.230, 431.231 and 438.420, if required or if the enrollee requests, TennCare services shall continue or be reinstated until the earlier of dismissal of the appeal through the valid factual dispute process, enrollee’s withdrawal of the appeal, or an initial hearing decision adverse to the enrollee.

2. In the case of a timely request for continuation or reinstatement of the TennCare services described in paragraph (4)(g)1. above, the services shall continue or be reinstated only if and to the extent prescribed by the enrollee’s treating clinician.

3. Notwithstanding the requirements of this part, TennCare enrollees are not entitled to continuation or reinstatement of services pending an appeal related to the following:

(i) When a service is denied because the enrollee has exceeded the benefit limit applicable to that service;

(ii) When a request for prior authorization is denied for a prescription drug, with the exception of:

(I) Pharmacists shall provide a single 72-hour interim supply in emergency situations for the non-authorized drug unless such supply would exceed applicable pharmacy benefit limits; or (II) When the drug has been prescribed on an ongoing basis or with unlimited refills and becomes subject to prior authorization requirements.

(iii) When coverage of a prescription drug or service is denied because the requested drug or service is not a category or class of drugs or services covered by TennCare;

(iv) When coverage for a prescription drug is denied because the enrollee has been locked into one pharmacy and the enrollee seeks to fill a prescription at another pharmacy;

(v) When a request for reimbursement is denied and the enrollee appeals this denial;

(vi) When a physician has failed to prescribe or order the service or level of service for which continuation or reinstatement is requested; or (vii) If TennCare had not paid for the type and amount of service for which continuation or reinstatement is requested prior to the appeal.

(h) Reserved.

(5) Reserved.

(6) Release of Enrollee’s Medical Records.

(a) When a request is made, by or on behalf of a TennCare enrollee, for approval of a TennCare service or for an appeal of an adverse benefit determination, the enrollee is deemed to have consented to release of his/her relevant medical records to his/her MCC and the TennCare Bureau for the purposes of acting upon the enrollee’s request.

(b) Providers shall promptly provide copies of an enrollee’s medical records to the enrollee’s MCC(s) and to the TennCare Bureau upon being informed by the MCC(s) or TennCare Bureau that the records have been requested for the purpose of acting upon an enrollee’s request for approval of a TennCare service or an enrollee’s appeal of an adverse benefit determination.

(c) An enrollee’s consent to release of his/her medical records may be evidenced by his signature (or his provider’s or authorized representative’s signature) upon the enrollee’s initial application for TennCare, upon his TennCare appeal form or other written request for authorization or appeal, or, in the event of an appeal by telephone, by a TennCare Bureau employee’s signing of an appeal form on behalf of an enrollee with documentation of consent to do so.

(d) The medical records obtained by MCCs and the TennCare Bureau under this rule remain confidential. MCCs and the TennCare Bureau may use and disclose the records only as necessary in their consideration of the enrollee’s request for approval of a TennCare service or the enrollee’s appeal of an adverse benefit determination.

(7) Time Requirements.

(a) MCCs must act upon a request for prior authorization as provided in 42 C.F.R. § 438.210.

(b) MCCs must complete reconsideration of standard appeals within fourteen (14) calendar days of the request from TennCare. MCCs must complete reconsideration of expedited appeals within seventy-two (72) hours of the request for SFH.

(c) All standard and expedited appeals not previously resolved in favor of the enrollee during reconsideration, shall be set for hearing before a hearing officer, and shall be resolved pursuant to the timeframes set forth in 42 C.F.R. § 431.244. In accordance with 42 C.F.R. § 438.410(a) and 42 C.F.R. § 431.244(f)(2), SFH requests which are approved for expedited resolution and which are not resolved in the enrollee’s favor during MCC’s reconsideration, shall be resolved by TennCare within three (3) working days from the date of the MCC’s reconsideration determination. TennCare is not charged with any delays attributable to the enrollee.

(d) In no circumstance will a directive be issued by the TennCare Bureau or a hearing officer to provide a service to an enrollee if, when the appeal is resolved, the service is no longer covered by TennCare for the enrollee. A directive also will not be issued by the TennCare Bureau if the service cannot reasonably be provided to the enrollee before the date when the service is no longer covered by TennCare for the enrollee.

(8) Reserved.

(9) Special Provisions Relating to Children in State Custody. Children in the custody of the State have the rights and protections established by 42 C.F.R. Part 431, Subpart E regarding TennCare services and benefits.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 71-5-105, 71-5-109, and 71-5-113; 42 C.F.R. Part 431 Subpart E; 42 C.F.R. Part 438 Subpart F; and Executive Order No. 23.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-14-.11; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Public necessity rule filed May 5, 2005; effective through October 17, 2005. Public necessity rule filed July 29, 2005; effective through January 10, 2006. Amendments filed July 28, 2005; effective October 11, 2005. Public necessity rule filed December 29, 2005; expired June 12, 2006. On June 13, 2006, affected rules reverted to status on December 28, 2005. Amendments filed October 27, 2005; effective January 10, 2006. However, Notice of Withdrawal of permanent rule amendments (1)(d)3., (1)(d)4., (4)(g)6., (5)(a)5., (5)(e), (5)(f), and (7)(h) filed and effective January 6, 2006 (to have been effective January 10, 2006). Public necessity rule filed May 17, 2006; effective through October 29, 2006. Amendments filed March 31, 2006; effective June 14, 2006. Amendment filed August 14, 2006; effective October 28, 2006. Public Necessity rule filed December 1, 2006; effective through May 15, 2007. Amendment filed January 30, 2007; effective April 15, 2007. Amendment filed March 1, 2007; effective May 15, 2007. Amendment filed September 13, 2007; effective November 27, 2007. Amendment filed August 19, 2008; effective November 2, 2008. Amendment filed September 30, 2009; effective December 29, 2009. Amendment filed October 26, 2010; effective January 24, 2011. Amendment filed September 23, 2011; effective December 22, 2011. Amendments filed September 27, 2013; effective December 26, 2013. Amendments filed September 25, 2017; effective December 24, 2017. Amendments filed July 8, 2021; effective October 6, 2021.

Tenn. Comp. R. & Regs. 1200-13-14-.13 MEMBER ABUSE OR OVERUTILIZATION OF THE TENNCARE PHARMACY

PROGRAM.

(1) The Bureau is authorized to implement and maintain a Pharmacy Lock-in Program designed to address member Abuse or Overutilization. Activities which may indicate Abuse or Overutilization justifying placement on Lock-in Status or Prior Authorization Status (PA Status) include, but are not limited to, the following:

(a) Forging or altering a prescription for drugs.

(b) Selling TennCare paid prescription drugs.

(c) Visiting multiple prescribers or pharmacies to obtain controlled substances.

(d) Trading, swapping or selling a TennCare card.

(e) Failing to promptly report the loss or theft of a TennCare card.

(f) Forging or altering a TennCare card.

(g) Knowingly providing false, incomplete, inaccurate or erroneous information to provider(s) in order to receive covered services for which the member is eligible.

(h) Permitting the use of a TennCare card by anyone other than the member to whom the card is assigned in order to receive or attempt to receive services.

(2) The TennCare Pharmacy Lock-in Program shall be administered by the Bureau. Monitoring of enrollee activities listed in Paragraph (1) shall be conducted by the Bureau, the MCCs, including the PBM, and the Tennessee Office of Inspector General (OIG). When an enrollee has been identified as having participated in any Abuse or Overutilization activities, including, but not limited to, the activities listed in Paragraph (1), the enrollee’s name shall be referred to the Bureau as appropriate for the Pharmacy Lock-in Program as follows:

(a) Any enrollee who has been identified by the OIG as having been convicted of TennCare Fraud or a drug-related offense.

(b) Any enrollee who has been arrested for or charged with TennCare Fraud.

(c) Any enrollee who has been arrested for or charged with a drug-related offense.

(d) Any enrollee who has obtained multiple controlled substance prescriptions over a ninety (90) day period when the prescriptions were filled by three (3) or more different pharmacies and written by three (3) or more different prescribers.

(3) Pharmacy Lock-in Program procedures shall include:

(a) A determination to place an enrollee who has been referred as appropriate for the Pharmacy Lock-in Program on Lock-in Status shall be made by the TennCare Pharmacy Director or designee after the enrollee’s relevant pharmacy claims data has been reviewed by clinical staff.

(b) Any enrollee determined to be appropriate for the Pharmacy Lock-in Program shall be notified by the Bureau or the MCC prior to the imposition of Lock-in Status. The notice shall include a brief explanation of the Pharmacy Lock-in Program, the reason for the determination to place the enrollee on Lock-in Status, the date the Lock-in Status will become effective, and the information necessary for the enrollee to appeal the decision of the Bureau, pursuant to Rule 1200-13-14-.11. If the enrollee has an authorized representative on file on their profile, the notice shall be sent to the enrollee’s authorized representative.

(c) If an enrollee fails to appeal placement in the Pharmacy Lock-in Program or an appeal is not resolved in his favor, the enrollee will be provided TennCare pharmacy services only at the Lock-in Provider to which the enrollee is assigned.

(d) Any enrollee who has a diagnosis of malignant neoplasm or sickle cell disease (or sickle cell related disorders outlined in Subpart (iv) of Part 12. of Subparagraph (c) of Paragraph (1) of this rule) shall not be placed in the Pharmacy Lock-in Program. Any enrollee currently in the Pharmacy Lock-in Program shall be removed from the Pharmacy Lock-in Program if the enrollee’s medical records indicate one of these diagnoses. However, this exception shall not apply if the enrollee has been arrested for, charged with, or convicted of an activity outlined in Paragraph (1) of this rule (1200- 13-14-.13(1)), or been convicted of TennCare Fraud.

(4) Lock-in Provider selection. A pharmacy will qualify for and may be selected by the enrollee as a Lock-in Provider only if it meets all the following criteria:

(a) It is enrolled in the TennCare Pharmacy Network;

(b) It is within the State of Tennessee;

(c) It is a full-service pharmacy that carries all medications normally carried by pharmacies;

(d) It is not a mail order or specialty pharmacy;

(e) It is not a Targeted Pharmacy;

(f) It is a single pharmacy location at a specific address. A chain pharmacy may be selected but only the specific named location may be used, not multiple locations or outlets of the chain; and (g) It is in proximity to the enrollee’s residence, which must be the current address on file with the Bureau. If no pharmacy is available within fifteen (15) miles of the enrollee’s residence, reasonable efforts shall be made to use the nearest qualifying pharmacy.

(5) After twelve (12) months a member may request a change of Lock-in Provider once each year. Additional changes are limited to the following reasons:

(a) The member has moved and his new address is at least fifteen (15) miles from the lock-in pharmacy and he has updated his address with the Bureau.

(b) The member’s lock-in pharmacy has permanently closed.

(c) The member’s lock-in pharmacy has voluntarily dismissed the enrollee from its practice and has notified the Bureau and the PBM.

(d) The Bureau may, at its sole discretion, determine that there is a compelling need to change the member’s lock-in pharmacy.

(6) Review of Lock-in Status. The Bureau or the MCC shall periodically review the claims information of members on Lock-in Status to determine the need for continued lock-in or escalation to Prior Authorization Status. This review shall occur at least one time annually.

(a) Lock-in Status will be discontinued if the Bureau determines that a member has met all of the following criteria for at least six (6) consecutive months:

1. Has not received any opioid medications while on buprenorphine-containing products for addiction, unless it is established that opioid use was/is appropriate according to the enrollee’s provider of addiction therapy.

2. Has received TennCare reimbursed controlled substance prescriptions from only one (1) provider, except under the following:

(i) If the enrollee is under the care of two (2) providers, and claims data shows consistent, appropriate use of controlled substances within standards of care from both providers, an exception may be made if both providers acknowledge in writing that they are aware of the other provider’s care and prescribing and agree that the enrollee is being treated appropriately within standards of care.

(ii) Enrollees with claims from multiple providers all in the same practice or in different locations within the same practice will be considered to have used one (1) provider.

(iii) Enrollees with claims from multiple BESMART providers will be considered to have used one (1) provider.

3. Has received TennCare reimbursed prescriptions from only one (1) pharmacy.

However, if the enrollee has changed his or her pharmacy by requesting a Lockin Provider change that was approved by the Bureau during the review period, an exception may be made to consider the enrollee as having used one (1) pharmacy.

(b) If a member is removed from Lock-in Status, the Bureau or the MCC will monitor the member for changes in utilization patterns and return him to Lock-in Status if appropriate under Paragraphs (1)–(3).

(7) Prior Authorization Status (PA Status).

(a) A member against whom criminal process alleging TennCare Fraud has been issued or who has been convicted of TennCare Fraud shall automatically be placed on PA Status.

(b) Lock-in Status shall be escalated to PA Status if a member on Lock-in Status meets three (3) of the following criteria over a 90 day period:

1. Has filled prescriptions for controlled substances at three (3) or more pharmacies. However, if the enrollee has changed his or her pharmacy by requesting a Lock-in Provider change that was approved by the Bureau during the review period, an exception may be made to consider the enrollee as having used one (1) pharmacy.

2. Has received controlled substance prescriptions from three (3) or more prescribers, except under the following:

(i) If the enrollee is under the care of two (2) providers, and claims data shows consistent, appropriate use of controlled substances within standards of care from both providers, an exception may be made if both providers acknowledge in writing that they are aware of the other provider’s care and prescribing and agree that the enrollee is being treated appropriately within standards of care.

(ii) Enrollees with claims from multiple providers all in the same practice or in different locations within the same practice will be considered to have used one (1) provider.

(iii) Enrollees with claims from multiple BESMART providers will be considered to have used one (1) provider.

3. Has received an opioid prescription while receiving buprenorphine-containing products for addiction, unless it is established that opioid use was/is appropriate according to the enrollee’s provider of addiction therapy.

(c) A member who has been treated in a hospital emergency department for an overdose of an illicit controlled substance, as identified in the most recently available TennCare diagnosis data, shall automatically be placed on PA Status.

(8) Review of Prior Authorization Status (PA Status). The Bureau or the MCC shall periodically review the claims information of members on PA Status to determine the need for continued PA Status.

(a) PA Status for enrollees will be discontinued if TennCare determines that a member has met all of the following criteria for at least six (6) consecutive months:

1. Has not received any opioid medications while on buprenorphine-containing products for addiction, unless it is established that opioid use is/was appropriate according to the enrollee’s provider of addiction therapy.

2. Has received TennCare reimbursed controlled substance prescriptions from only one (1) provider, except under the following.

(i) If the enrollee is under the care of two (2) providers, and claims data shows consistent, appropriate use of controlled substances within standards of care from both providers, an exception may be made if both providers acknowledge in writing that they are aware of the other provider’s care and prescribing and agree that the enrollee is being treated appropriately within standards of care.

(ii) Enrollees with claims from multiple providers all in the same practice or in different locations within the same practice will be considered to have used one (1) provider.

(iii) Enrollees with claims from multiple BESMART providers will be considered to have used one (1) provider.

3. Has received TennCare reimbursed prescriptions from only one (1) pharmacy.

However, if the enrollee has changed his or her pharmacy by requesting a Lockin Provider change that was approved by the Bureau during the review period, an exception may be made to consider the enrollee as having used one (1) pharmacy.

(b) Enrollees removed from PA Status remain in the Pharmacy Lock-in Program and are required to qualify for removal from the Pharmacy Lock-in Program after a re-review of their prescription claims as described in Paragraph (6) of this rule. If an enrollee is removed from PA Status, TennCare or the MCC will monitor the enrollee for changes in utilization patterns and return the enrollee to PA Status if appropriate under Paragraph (7).

(c) Enrollees who are not eligible for review of PA Status:

1. When the Bureau has been notified by OIG that an enrollee has been identified as having participated in any Abuse or Overutilization activities, including but not limited to the activities listed in Paragraph (1) of this rule, then that enrollee is not eligible for review of PA Status.

2. An enrollee who has been convicted of TennCare Fraud is not eligible for review of PA Status.

3. If an enrollee was charged or arrested for TennCare Fraud, the enrollee is not eligible for PA Status review pending the final resolution of the charge or allegation. If the enrollee’s TennCare Fraud charges are dismissed or if the enrollee is otherwise not convicted of TennCare Fraud and that TennCare Fraud charge was the sole basis for the enrollee’s Lock-in Status, all Pharmacy Lock-in Program and PA Status edits will be terminated on the day that the TennCare Fraud charge was closed.

(9) Emergency pharmacy services may be obtained with a TennCare or MCC override of a member’s Lock-in Status. The PBM has clinical staff available at all times to respond to emergency situations. The PBM must verify that a genuine emergency exists, such as documented proof from the lock-in pharmacy that it is temporarily out of stock of a needed medication. A lock-in override will not be provided simply because a pharmacy is closed for the day unless a true medical emergency exists.

History

• Authority: T.C.A. §§ 4-3-1013, 4-5-202, 4-5-203, 71-5-105, 71-5-109, 71-5-146, 71-5-197, and 71-5-198 and Executive Order No. 23.
• Administrative History: Public necessity rule filed July 1, 2002; effective through December 13, 2002. Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule 1200-13-14-.13; new effective date February 12, 2003. Emergency rule filed December 13, 2002; effective through May 27, 2003. Public necessity rule filed December 29, 2005; expired June 12, 2006. On June 13, 2006, affected rules reverted to status on December 28, 2005. Repeal and new rule filed March 31, 2006; effective June 14, 2006. Amendment filed October 3, 2013; effective January 1, 2014. Amendments filed December 29, 2015; effective March 28, 2016. Amendments filed September 11, 2024; effective December 10, 2024.

Tenn. Comp. R. & Regs. 1200-13-14-.14 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, and 71-5-109 and Executive Order No. 23.
• Administrative History: Original rule filed September 30, 2002; to be effective December 14, 2002; however, on December 9, 2002, the House Government Operations Committee of the General Assembly stayed Rule

Chapter 1200-13-15 Repealed

Tenn. Comp. R. & Regs. 1200-13-15-.01 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.02 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.03 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.04 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.05 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.06 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.07 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.08 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.09 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.10 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.11 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.12 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.13 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.14 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.15 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.16 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29. 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.17 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.18 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.19 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.20 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.21 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.22 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.23 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.24 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.25 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.26 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 1200-13-15-.27 REPEALED

History

• Authority: T.C.A. §§4-5-202, 71-5-105, 71-5-109, and Executive Order No. 23.
• Administrative History: Original rule filed October 29, 2003; effective January 12, 2004. Repeal filed March 4, 2010; effective August 29, 2010.

Chapter 1200-13-16 Medical Necessity

Tenn. Comp. R. & Regs. 1200-13-16-.01 DEFINITIONS

(1) ADEQUATE when applied to a medical item or service shall mean that the item or service, considered as part of a course of diagnosis or treatment, is sufficient, but not in excess of what is needed, for diagnosis or treatment of the particular medical condition. In order for a medical item or service to be determined adequate, such item or service must also satisfy the requirements at Rule 1200-13-16-.05(5) regarding “safe and effective” and the requirements at Rule 1200-13-16-.05(6) regarding “not experimental or investigational.”

(2) BENEFITS shall mean the defined package of health care services, including long term care services, for which an enrollee is eligible under the TennCare Program including applicable limits on such services.

(3) BUREAU OF TENNCARE shall mean the single State Medicaid agency which is responsible for the administration of the TennCare program.

(4) CASE-CONTROL STUDY shall mean a study in which the study and control groups are selected on the basis of whether they have the disease (cases) rather than whether they have been exposed to a risk factor or clinical intervention. The design is therefore observational (as opposed to experimental) and retrospective (as opposed to prospective), with the clinical outcome already known at the outset. Principal disadvantages of this study design are that important confounding variables may be difficult to identify and adjust for, clinical outcome is already known and may influence the measurement and interpretation of data (observer bias), and participants may have difficulty in accurately recalling past medical

history and previous exposures (recall bias).

(5) CASE REPORT shall mean an uncontrolled observational study (prospective or retrospective) involving an intervention and an outcome in a single patient.

(6) CASE SERIES shall mean an uncontrolled study (prospective or retrospective) of a succession of consecutive patients who receive a particular intervention and are followed to observe their outcomes.

(7) CLINICAL TRIAL shall mean a study that involves the administration of a test regimen to humans to evaluate its efficacy and safety.

(8) CONTROL GROUP shall mean a group of patients that serves as the basis of comparison when assessing the effects of the intervention of interest that is given to the patients in the treatment group. Depending upon the circumstances of the trial, a control group may receive no treatment, a “usual” or “standard” treatment, or a placebo. To make the comparison valid, the composition of the control group should resemble that of the treatment group as closely as possible.

(9) CONTROLLED CLINICAL TRIAL shall mean a clinical trial in which a control group (which receives a standard intervention, which may be no treatment) is compared to a study group (which receives the intervention under study) in order to test a research hypothesis. A controlled clinical trial may or may not be randomized.

(10) CONTROLLED COHORT STUDY shall mean an observational study in which outcomes in a group of patients that received an intervention are compared with outcomes in a similar group i.e., the cohort, either contemporary or historical, of patients that did not receive the intervention. Cohort studies are more subject to systematic bias than randomized trials because treatments, risk factors, and other covariables may be chosen by patients or physicians on the basis of important (and often unrecognized) factors that are related to outcome. Therefore, investigators in controlled cohort studies may identify and correct for confounding variables, which are related factors that may be more directly responsible for clinical outcome than the intervention/exposure in question. For example, in an adjusted- (or matched-) cohort study, investigators identify (or make statistical adjustments to provide) a cohort group that has characteristics (e.g., age, gender, disease severity) that are as similar as possible to the group that experienced the intervention.

(11) CONVENIENCE shall mean the degree to which an item or service is designed or recommended for the personal comfort or ease of an enrollee, caregiver, or provider.

Alleviation of pain is not considered a matter of convenience.

(12) COST EFFECTIVE when applied to a medical item or service shall mean that the benefits associated with the item or service, considered as part of diagnosis or treatment, outweigh the costs associated with the item or service. When appropriate, such analysis may include assessment of aggregate, population-level data related to the costs or benefits of a medical item or service.

(13) COST-EFFECTIVE ALTERNATIVE SERVICE shall mean a service that is not a covered service but that is approved by TennCare and CMS and provided at an MCC’s discretion.

TennCare enrollees are not entitled to receive these services. Cost-effective alternative services may be provided because they are either (1) alternatives to covered Medicaid services that, in the MCC’s judgment, are cost-effective or (2) preventative in nature and offered to avoid the development of conditions that, in the MCC’s judgment, would require more costly treatment in the future. Cost-effective alternative services need not be determined medically necessary except to the extent that they are provided as an alternative to covered Medicaid services. Even if medically necessary, a cost effective alternative service is not a covered service and is provided only at an MCC’s discretion.

(14) COVERED SERVICES shall mean medical items and services that are within an enrollee’s scope of defined benefits, and not in excess of any applicable limits on such items or services. Covered services include long term care services for those enrollees eligible for long term care. With the exception of cost-effective alternative services and even in cases of emergency, only a covered service can be determined to be medically necessary for reimbursement purposes under the program.

(15) DIAGNOSIS shall mean the act or process of identifying or determining the nature and cause of a medical problem or condition through evaluation of patient history, examination, and review of laboratory data and other pertinent information. Diagnosis may include cost effective screening services provided in accordance with nationally accepted standards or guidelines developed or endorsed by respected medical organizations, such as the Centers for Disease Control and Prevention.

(16) EFFECTIVE describes the use of a medical item or service that produces the intended result and where the benefit of the medical item or service outweighs the adverse medical risks or consequences.

(17) ELIGIBLE describes a person who has been determined to meet the eligibility criteria for the TennCare program.

(18) ENROLLEE shall mean an individual who is eligible for and enrolled in the TennCare program.

(19) EVIDENCE-BASED shall mean the ordered and explicit use of the best medical evidence available when making health care decisions.

(20) EXPERIMENTAL STUDY shall mean a randomized controlled clinical trial.

(21) HIERARCHY OF EVIDENCE shall mean a ranking of the weight given to medical evidence depending on objective indicators of its validity and reliability including the nature and source of the medical evidence, the empirical characteristics of the studies or trials upon which the medical evidence is based, and the consistency of the outcome with comparable studies. The hierarchy in descending order, with Type I given the greatest weight is:

(a) Type I: Meta-analysis done with multiple, well-designed controlled clinical trials;

(b) Type II: One or more well-designed experimental studies;

(c) Type III: Well-designed, quasi-experimental studies;

(d) Type IV: Well-designed, non-experimental studies; and (e) Type V: Other medical evidence defined as evidence-based 1. Clinical guidelines, standards or recommendations from respected medical organizations or governmental health agencies;

2. Analyses from independent health technology assessment organizations; or 3. Policies of other health plans.

(22) HOME HEALTH SERVICES shall mean those services as defined at 1200-13-13-.01 and

Tenn. Comp. R. & Regs. 1200-13-16-.02 INTRODUCTION

The medical necessity standard set forth at Tennessee Code Annotated Section 71-5-144 and in these rules shall govern the delivery of all medical items and services to all enrollees or classes of beneficiaries in the TennCare program. The definition of medical necessity will be implemented consistent with federal law, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements, and within the state’s authority to define what constitutes a medically necessary Medicaid service. The State recognizes that current EPSDT requirements include coverage of “necessary health care, diagnostic services, treatment and other measures to correct or ameliorate defects and physical and mental illness and conditions discovered by screening services, whether or not such services are covered under the state plan.”

History

• Authority: T.C.A. §§ 4-5-209, 71-5-105, 71-5-109, Executive Order No. 23.
• Administrative History: Public necessity rule filed December 1, 2006; expires May 15, 2007. Original rule filed March 1, 2007; effective May 15, 2007.

Tenn. Comp. R. & Regs. 1200-13-16-.03 THE SCOPE OF TENNCARE’S PAYMENT OBLIGATION

(1) Tennessee has an obligation to provide payment on behalf of TennCare enrollees for and only for (a) covered services (b) that are medically necessary.

(2) No TennCare enrollee is entitled to receive (a) non-covered services including cost effective alternative services or (b) covered services that are not medically necessary.

(3) In the context of prior authorization or concurrent review:

(a) When a covered service has been designated by the Bureau of TennCare or a managed care contractor as requiring prior approval, no TennCare enrollee is entitled to receive the covered service until the favorable conclusion of the prior approval process.

(b) When a covered service has been designated by the Bureau of TennCare or a managed care contractor as requiring concurrent review, the enrollee may receive covered services until the expiration of any existing authorization for treatment or until a determination that such service is no longer medically necessary. No TennCare enrollee is entitled to receive covered services subject to concurrent review beyond the expiration of any existing authorization for treatment unless such authorization has been extended through the concurrent review process. For TennCare enrollees under age 21, upon receipt of a timely filed request to continue authorization of a service originally prescribed on an ongoing basis, such authorization is automatically extended pending completion of concurrent review. A request to continue authorization shall be timely if received by the MCC prior to the expiration of the current authorization.

History

• Authority: T.C.A. §§ 4-5-209, 71-5-105, 71-5-109, Executive Order No. 23.
• Administrative History: Public necessity rule filed December 1, 2006; expires May 15, 2007. Original rule filed March 1, 2007; effective May 15, 2007.

Tenn. Comp. R. & Regs. 1200-13-16-.04 PRIOR AUTHORIZATION AND CONCURRENT UTILIZATION REVIEW

(1) The Bureau of TennCare may identify certain items or services that, for purposes of determining medical necessity, shall require prior authorization and/or concurrent review.

(a) Managed care contractors and/or a state agency performing the function of a managed care contractor shall implement prior authorization and/or concurrent review procedures for all items or services specified by the Bureau of TennCare and, at their individual discretion, may require prior authorization and/or concurrent review for additional non-emergency medical items or services not specified by the Bureau of TennCare.

(b) Managed care contractors and/or a state agency performing the function of a managed care contractor will inform their enrollees and their participating providers which medical items or services require prior authorization and/or concurrent review. Such notice need not be individualized in nature. Thus, failure to provide individualized prior authorization notices does not invalidate the requirement for prior authorization and/or concurrent review. Notice to providers shall be in writing and such notice requirement may be satisfied by publishing notice on the internet.

History

• Authority: T.C.A. §§ 4-5-209, 71-5-105, 71-5-109, Executive Order No. 23.
• Administrative History: Public necessity rule filed December 1, 2006; expires May 15, 2007. Original rule filed March 1, 2007; effective May 15, 2007.

Tenn. Comp. R. & Regs. 1200-13-16-.05 MEDICAL NECESSITY CRITERIA

(1) To be medically necessary, a medical item or service must satisfy each of the following criteria:

(a) It must be recommended by a licensed physician who is treating the enrollee or other licensed healthcare provider practicing within the scope of his or her license who is treating the enrollee;

(b) It must be required in order to diagnose or treat an enrollee’s medical condition;

(c) It must be safe and effective;

(d) It must not be experimental or investigational; and (e) It must be the least costly alternative course of diagnosis or treatment that is adequate for the enrollee’s medical condition.

(2) The convenience of an enrollee, the enrollee’s family, the enrollee’s caregiver, or a provider, shall not be a factor or justification in determining that a medical item or service is medically necessary.

(3) Services required to diagnose an enrollee’s medical condition.

(a) Provided that all the other medical necessity criteria are satisfied, services required to diagnose an enrollee’s medical condition may include screening services, as appropriate.

(b) Screening services are “appropriate” if they meet one of the following three categories:

1. Services required to achieve compliance with federal statutory or regulatory mandates under the EPSDT program;

2. Newborn testing for metabolic/genetic defects as set forth in Tennessee Code Annotated, Section 68-5-401; or 3. Pap smears, mammograms, prostate cancer screenings, colorectal cancer screenings, and screening for tuberculosis and sexually transmitted diseases, including HIV, in accordance with nationally accepted clinical guidelines adopted by the Bureau of TennCare.

(c) Unless specifically provided for herein, other screening services are “appropriate” only if they satisfy each of the following criteria:

1. The Bureau of TennCare, a managed care contractor, or a state agency performing the functions of a managed care contractor determines that the screening services are cost effective;

2. The screening must have a significant probability of detecting the disease;

3. The disease for which the screening is conducted must have a significant detrimental effect on the health status of the affected person;

4. Tests must be available at a reasonable cost;

5. Evidence-based methods of treatment must be available for treating the disease at the disease stage which the screening is designed to detect; and 6. Treatment in the asymptomatic phase must yield a therapeutic result.

(d) Services required to diagnose an enrollee’s medical condition include diagnostic services mandated by EPSDT requirements.

(4) Services required to treat an enrollee’s medical condition. Provided that all other elements of medical necessity are satisfied, treatment of an enrollee’s medical condition may only include:

(a) Medical care that is essential in order to treat a diagnosed medical condition, the symptoms of a diagnosed medical condition, or the effects of a diagnosed medical condition and which, if not provided, would have a significant and demonstrable adverse impact on quality or length of life.

(b) Medical care that is essential in order to treat the significant side effects of another medically necessary treatment (e.g., nausea medications for side effects of chemotherapy).

(c) Medical care that is essential, based on an individualized determination of a particular patient’s medical condition, to avoid the onset of significant health problems or significant complications that, with reasonable medical probability, will arise from that medical condition in the absence of such care.

(d) Home health services.

1. Home health aide services are necessary to treat an enrollee’s medical condition only if such services;

(i) Are of a type that the enrollee cannot perform for himself or herself;

(ii) Are of a type for which there is no caregiver able to provide the services; and (iii) Consist of hands-on care of the enrollee.

2. All other home health services are necessary to treat an enrollee’s medical condition only if they are ordered by the treating physician, are pursuant to a plan of care, and meet the requirements described at subparagraph (a), (b), or (c) immediately above or (f) immediately below. Services that do not meet these requirements, such as general child care services, cleaning services or preparation of meals, are not required to treat an enrollee’s medical condition and will not be provided. Because children typically have non-medical care needs which must be met, to the extent that home health services or Private Duty Nursing Services are provided to a person under 18 years of age, a responsible adult (other than the health care provider) must be present at all times in the home during provision of home health or Private Duty Nursing Services unless all of the following criteria are met:

(i) The child is non-ambulatory; and (ii) The child has no or extremely limited ability to interact with caregivers; and (iii) The child shall not reasonably be expected to have needs that fall outside the scope of medically necessary TennCare covered benefits (e.g. the child has no need for general supervision or meal preparation) during the time the home health provider or private duty nurse is in the home without the presence of another responsible adult; and (iv) No other children shall be present in the home during the time the home health provider or private duty nurse is present in the home without the presence of another responsible adult.

3. Private Duty Nursing Services are separate services from home health services.

When private duty nurses are authorized by the MCC to provide home health aide services pursuant to Rule 1200-13-13-.04(6)(f) or 1200-13-14-.04(7)(f), these services must meet the requirements described at Part 1. immediately above.

4. Home health services may not be denied on any of the following grounds:

(i) Because such services are medically necessary on a long term basis or are required for the treatment of a chronic condition;

(ii) Because such services are deemed to be custodial care;

(iii) Because the enrollee is not homebound;

(iv) Because private insurance utilization guidelines, including but not limited to those published by Milliman & Robertson or developed in-house by TennCare managed care contractors, do not authorize such health care as referenced above;

(v) Because the enrollee does not meet coverage criteria for Medicare or some other health insurance program, other than TennCare;

(vi) Because the home health care that is needed does not require or involve a skilled nursing service;

(vii) Because the care that is required involves assistance with activities of daily living;

(viii) Because the home health service that is needed involves home health aide services; or (ix) Because the enrollee meets the criteria for receiving Medicaid nursing facility services.

(e) Personal Care Services.

1. Personal care services are necessary to treat an enrollee’s medical condition only if such services are ordered by the treating physician pursuant to a plan of care to address a medical condition identified as a result of an EPSDT screening.

Personal care services must be supervised by a registered nurse and delivered by a home health aide. In addition the services must:

(i) Be of a type that the enrollee cannot perform for himself or herself;

(ii) Be of a type for which there is no caregiver able to provide the services; and (iii) Consist of hands-on care of the enrollee.

2. Services that do not meet these requirements, such as general child care services, cleaning services or preparation of meals, are not required to treat an enrollee’s medical condition and will not be provided. For this reason, to the extent that personal care services are provided to a person under 18 years of age, a responsible adult (other than the home health aide) must be present at all times during provision of personal care services.

(f) The following preventive services:

1. Prenatal and maternity care delivered in accordance with standards endorsed by the American College of Obstetrics and Gynecology;

2. Family planning services;

3. Age-appropriate childhood immunizations delivered according to guidelines developed by the Advisory Committee on Immunization Practices;

4. Health education services for TennCare-eligible children under age 21 in accordance with 42 U.S.C. Section 1396d;

5. Other preventive services that are required to achieve compliance with federal statutory or regulatory mandates under the EPSDT program; or 6. Other preventive services that have been endorsed by the Bureau of TennCare or a particular managed care contractor as representing a cost effective approach to meeting the medically necessary health care needs of an individual enrollee or group of enrollees.

(5) Safe and effective.

(a) To qualify as being safe and effective, the type, scope, frequency, intensity, and duration of a medical item or service must be consistent with the symptoms or confirmed diagnosis and treatment of the particular medical condition. The type, scope, frequency, intensity, and duration of a medical item or service must not be in excess of the enrollee’s needs.

(b) The reasonably anticipated medical benefits of the item or service must outweigh the reasonably anticipated medical risks based on:

1. The enrollee’s condition; and 2. The weight of medical evidence as ranked in the hierarchy of evidence in Rule 1200-13-16-.01(21) and as applied in Rule 1200-13-16-.06(6) and (7).

(6) Not experimental or investigational.

(a) A medical item or service is not experimental or investigational if the weight of medical evidence supports the safety and efficacy of the medical item or service in question as ranked in the hierarchy of evidence in Rule 1200-13-16-.01(21) and as applied in Rule 1200-13-16-.06(6) and (7). This standard is not satisfied by a provider’s subjective clinical judgment on the safety and effectiveness of a medical item or service or by a reasonable medical or clinical hypothesis based on an extrapolation from use in diagnosing or treating another condition. However, extrapolation from one population group to another (e.g. from adults to children) may be appropriate. For example, extrapolation may be appropriate when the item or service has been proven effective, but not yet tested in the population group in question.

(b) Subject to the provisions set forth in subparagraph (c) immediately below, use of a drug or biological product that has not been approved for marketing under a new drug application or abbreviated new drug application by the United States Food and Drug Administration (FDA) is deemed experimental.

(c) Use of a drug or biological product that has been approved for marketing by the FDA but is proposed to be used for other than the FDA-approved purpose (i.e., off-label use) is experimental and not medically necessary unless the off-label use is shown to be widespread and all other medical necessity criteria as set forth in Rule 1200-13-16- .05(1)(a), (b), (c) and (e) are satisfied.

(d) Items or services provided or performed for research purposes are experimental and not medically necessary. Evidence of such research purposes may include written protocols in which evaluation of the safety and efficacy of the service is a stated objective or when the ability to perform the service is contingent upon approval from an Institutional Review Board, or a similar body.

(e) Unless a proposed diagnosis or treatment independently satisfies the criteria for “not experimental or investigational”, and satisfies all other medical necessity criteria, the fact that an experimental/investigational treatment is the only available treatment for a particular medical condition or that the patient has tried other more conventional therapies without success does not qualify the service for coverage.

(7) The least costly alternative course of diagnosis or treatment that is adequate for the medical condition of the enrollee.

(a) Where there are less costly alternative courses of diagnosis or treatment that are adequate for the medical condition of the enrollee, more costly alternative courses of diagnosis or treatment are not medically necessary, even if the less costly alternative is a non-covered service under TennCare.

(b) Where there are less costly alternative settings in which a course of diagnosis or treatment can be provided that is adequate for the medical condition of the enrollee, the provision of services in a setting more costly to TennCare is not medically necessary.

(c) If a medical item or service can be safely provided to a person in an outpatient setting for the same or lesser cost than providing the same item or service in an inpatient setting, the provision of such medical item or service in an inpatient setting is not medically necessary and TennCare shall not provide payment for that inpatient service.

(d) An alternative course of diagnosis or treatment may include observation, lifestyle, or behavioral changes or, where appropriate, no treatment at all when such alternative is adequate for the medical condition of the enrollee.

(e) The following is a non-exhaustive illustrative set of circumstances that could fit within the provisions of Rule 1200-13-16-.05(7)(d). These examples may or may not be appropriate, depending on an individualized medical assessment of a patient’s unique circumstances:

1. Rest, fluids and over-the-counter medication for symptomatic relief might be recommended for a viral respiratory infection, as opposed to a prescription for an antibiotic;

2. Rest, ice packs and/or heat for acute, uncomplicated, mechanical low back pain along with over-the-counter pain medicine, as opposed to x-rays and a prescription for analgesics;

3. Clear liquids and advance diet as tolerated for uncomplicated, acute gastroenteritis, as opposed to prescription antidiarrheals.

(f) Least Costly Setting Calculations for PDN Services. Private Duty Nursing Services for Enrollees age 21 and older, as described in Rule 1200-13-13-.04 and Rule 1200-13- 14-.04, are only Medically Necessary when provided in the least costly setting that is Adequate for the Medical Condition of the Enrollee. Private Duty Nursing Services for Enrollees age 21 and older shall be subject to the following cost provisions.

1. If a facility-based setting is determined to be Adequate, then an available bed in an Adequate setting will be offered or the Enrollee may choose to accept an amount of Private Duty Nursing Services that does not exceed the cost of the least costly Adequate setting.

(i) The determination that a facility-based setting is Adequate does not require the Enrollee to receive care in this setting.

(ii) The availability of a bed in a specific facility is not required for a facility setting to be determined Adequate for purposes of least costly setting calculations.

2. The cost of facility care utilized for least costly setting calculations shall be published in a policy made available on the TennCare website at tn.gov/tenncare. The averages utilized for least costly setting calculations established using 2025 rates must be recalculated using current rates no more frequently than every three years.

(i) Dual-certified enhanced respiratory care facility (ERCF) settings. A dualcertified ERCF is a nursing facility/skilled nursing facility which is both Medicaid-certified and Medicare-certified by the state and federal governments and which is equipped to provide Enhanced Respiratory Care (ERC) as ERC is outlined in Rules 1200-13-02-.04 and 1200-13-02-.12.

(I) For Enrollees qualifying for Private Duty Nursing Services based on receipt of ventilator care as described in Rule 1200-13-13-.01 and

Rule 1200-13-14-.01, the cost of facility care is based on the chronic ventilator ERC expenditure cap available in the Employment and Community First CHOICES program.

(II) For Enrollees qualifying for Private Duty Nursing Services based on having a tracheostomy as described in Rule 1200-13-13-.01 and

Rule 1200-13-14-.01, the cost of facility care is based on the tracheal suctioning ERC expenditure cap available in the Employment and Community First CHOICES program.

(III) ERCF settings are responsible for providing specialized services identified by the PreAdmission Screening/Resident Review (PASRR) within the facility’s applicable reimbursement amount.

(ii) Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) settings.

(I) For Enrollees with a diagnosis of an Intellectual Disability (ID) documented and confirmed by TennCare consistent with Chapter 1200-13-01, and who qualify to receive care in an ICF/IID, the cost of facility care is based on the ICF/IID expenditure cap available in the Employment and Community First CHOICES program.

(II) ICF/IID facilities are responsible for compliance with 42 CFR 483.440(a), which includes active treatment services in the plan of care within the facility’s applicable reimbursement amount.

(iii) If an enrollee meets the requirements for both ERCF and ICF/IID settings, the facility with the higher cost will be utilized.

3. The average cost of Private Duty Nursing Services shall be utilized for least costly setting calculations and shall be published in a policy made available on the TennCare website at tn.gov/tenncare. The average cost of Private Duty Nursing Services, established using 2023 encounter data, must be recalculated no more frequently than every three years, using the prior calendar year encounter data.

4. To determine the least costly setting, the cost of facility care, as established in these rules, will be compared to the cost of the requested Private Duty Nursing Services.

(i) If the cost of the requested Private Duty Nursing Services exceeds the cost of facility care, then the enrollee has the option of receiving care in a facility or receiving an amount of Private Duty Nursing Services that does not exceed the cost of facility care.

(ii) To determine the hours of Private Duty Nursing Services that do not exceed the cost of facility care, the cost of facility care will be converted to a daily number of hours of Private Duty Nursing Services and rounded to the nearest whole number.

(8) The Bureau of TennCare may make limited special exceptions to the medical necessity requirements described at Rule 1200-13-16-.05(1) for particular items or services, such as long term care, or such as may be required for compliance with federal law.

(9) Transportation services that meet the requirements described at Rule 1200-13-13-.04 and

Tenn. Comp. R. & Regs. 1200-13-16-.06 DETERMINATION OF MEDICAL NECESSITY

(1) The Bureau of TennCare is ultimately responsible for determining whether specific medical items and/or services under TennCare (a) are covered services and (b) are medically necessary. In the vast majority of cases, medical necessity determinations will be made as

part of a prior authorization or concurrent review process. However, less frequently such determinations may be made retrospectively in the course of the investigation of unusual billing or practice patterns. The Bureau of TennCare may delegate covered services and/or medical necessity decisions to managed care contractors. All medical necessity decisions must be made by licensed medical staff with appropriate clinical expertise. The Bureau may review such decisions as a part of routine monitoring or as a result of an enrollee appeal or provider complaint and may overturn such decisions if not made in accordance with these rules.

(2) Non-covered services, including medical items and services in excess of benefit limits, are never to be paid for by TennCare, even if they otherwise would qualify as “medically necessary,” regardless of the medical circumstances involved, unless an MCC, in its discretion, provides a cost effective alternative service.

(3) If, after an enrollee is provided the opportunity by the State or managed care contractor to consult with a physician, a medical item or service has not been recommended, ordered or prescribed by a treating physician or other treating health care provider practicing within the scope of his or her license, it is not medically necessary and is not covered under TennCare.

(4) In making a medical necessity determination, TennCare or its designee will consider a recommendation, order, or prescription for a covered medical item or service from a treating physician or other treating health care provider.

(a) A recommendation, order or prescription from a treating physician or other treating health care professional shall be based on a thorough, up-to-date assessment of the enrollee’s medical condition, with careful consideration of all required medical necessity criteria as defined by statute and by these rules.

(b) The managed care contractor will evaluate the information provided by the treating provider in support of a recommendation, order or prescription for a covered service. If the information or opinion of the treating provider deviates significantly from that of the MCC, the MCC will request further explanation from the treating provider. Upon request from the enrollee’s MCC or the Bureau of TennCare for purposes of making an individualized medical necessity determination, the treating physician or other treating health care provider shall provide information and/or documentation supporting the need for the recommended medical item or service in order to diagnose or treat the enrollee’s medical condition.

(c) In addition, when requested, the treating physician or other treating health care provider will provide a written explanation as to why a less costly alternative proposed by the MCC is not believed to be adequate to address the enrollee’s medical condition.

(d) Information/documentation requested by the managed care contractor or the Bureau of TennCare for purposes of making a medical necessity determination will be provided free of charge.

(e) Providers who fail to provide information/documentation requested by the managed care contractor or the Bureau of TennCare for purposes of making a medical necessity determination shall not be entitled to payment for provision of the applicable medical item or service. In such instances, providers may not seek payment from patients or third parties for items or services denied payment.

(5) The treating physician’s conclusory statements, without more, are not binding on the State.

(6) In evaluating the request/recommendation of the treating physician or other treating health care provider, a managed care contractor and/or the Bureau of TennCare shall use the hierarchy of evidence to determine if the requested item or service is safe and effective, as referenced at Rule 1200-13-16-.05(5) and (6)(a), for the enrollee by classifying the item or service as having an A, B, C or D level of supporting evidence, as indicated below. In classifying the item or service as having A, B, C or D level of supporting evidence, extrapolation from one population group to another (e.g. from adults to children) may be appropriate. For example, extrapolation may be appropriate when the item or service has been proven effective, but not yet tested in the population group in question.

(a) “A” level evidence: Shows the requested medical item or service is a proven benefit to the enrollee’s condition as demonstrated by strong scientific literature and welldesigned clinical trials such as Type I evidence or multiple Type II evidence or combinations of Type II, III, or IV evidence with consistent results. An “A” rating cannot be based on Type III, Type IV, or Type V evidence alone.

(b) “B” level evidence: Shows the requested medical item or service has some proven benefit to the enrollee’s condition as demonstrated by:

1. Multiple Type II or III evidence or combinations of Type II, III, or IV evidence with generally consistent findings of effectiveness and safety. A “B” rating cannot be based on Type IV or V evidence alone; or 2. Singular Type II, III, IV, or V evidence when consistent with Bureau of TennCare endorsed or established evidence-based clinical guidelines.

(c) “C” level evidence: Shows only weak and inconclusive evidence regarding safety and/or efficacy for the enrollee’s condition such as:

1. Type II, III, or IV evidence with inconsistent findings; or 2. Only Type V evidence is available.

(d) “D” level evidence: Is not supported by any evidence regarding safety and efficacy for the enrollee’s condition.

(7) Application of the Hierarchy of Evidence. After classifying the available evidence, the Bureau of TennCare or a managed care contractor will approve items or services in the following manner:

(a) Medical items or services with supporting “A” and “B” rated evidence will be considered safe and effective if the item or service does not place the enrollee at a greater risk of morbidity and mortality than an equally effective alternative treatment.

(b) Medical items or services with “C” rated evidence or a physician’s clinical judgment that is not supported by objective evidence, will be considered safe and effective only if the provider shows that the requested service is the optimal intervention for meeting the enrollee’s specific condition or treatment needs, and:

1. Does not place the enrollee at greater risk of morbidity or mortality than an equally effective alternative treatment; and 2. Is the next reasonable step for the enrollee in light of the enrollee’s past medical treatment.

(c) Medical items or services with “D” rated evidence will not be considered safe and effective and, therefore, will not be determined medically necessary.

(8) The Bureau of TennCare or the managed care contractor’s classification of available medical evidence as defined at Rule 1200-13-16-.01(21) and any resulting approval of items or services as described at Rule 1200-13-16-.06(6) and (7) shall be binding on TennCare enrollees and providers.

(9) The managed care contractor or the Bureau of TennCare will rely upon all relevant information in making a medical necessity determination. Such determinations must be individualized and made in the context of medical/behavioral history information included in the enrollee’s medical record.

(10) The fact that a particular medical item or service has been covered in one instance does not make such item or service medically necessary in any other case, even if such case is similar in certain respects to the situation in which the item or service was determined to be medically necessary.

(11) Items or services that are not determined medically necessary, as defined by the statute or by these rules, shall not be paid for by TennCare.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-209, 71-5-105, 71-5-109, 71-5-144 and Executive Order No. 23.
• Administrative History: Public necessity rule filed December 1, 2006; expires May 15, 2007. Original rule filed March 1, 2007; effective May 15, 2007. Amendment filed June 17, 2011; effective November 28, 2011.

Tenn. Comp. R. & Regs. 1200-13-16-.07 DEVELOPMENT OF EVIDENCE-BASED MEDICAL NECESSITY GUIDELINES

(1) In recognition of the ever-evolving nature of the study and practice of medicine, the growing body of evidence-based medical practice guidelines, the opportunity to achieve costcontainment objectives consistent with quality care, and the existence of practice variability among health care practitioners, the Bureau of TennCare may, on occasion, endorse or establish medical necessity guidelines that shall guide determinations of medical necessity for specific items or services across all managed care contractors and State agencies performing the function of managed care contractors.

(2) Such guidelines shall be established with input from managed care contractors, practicing physicians and other health care providers, shall be evidence-based and shall take into consideration all criteria of the statutory definition of medical necessity.

(3) The Bureau of TennCare will disseminate approved evidence-based medical necessity guidelines to its contractors and the provider community.

(4) The Bureau of TennCare will implement a continuous medical review process to ensure that approved evidence-based medical necessity guidelines are responsive to advances in medical knowledge and technology.

History

• Authority: T.C.A. §§ 4-5-209, 71-5-105, 71-5-109, Executive Order No. 23.
• Administrative History: Public necessity rule filed December 1, 2006; expires May 15, 2007. Original rule filed March 1, 2007; effective May 15, 2007.

Tenn. Comp. R. & Regs. 1200-13-16-.08 RIGHT TO APPEAL A MEDICAL NECESSITY DETERMINATION

An enrollee may appeal a determination that a medical item or service that is within the enrollee’s scope of covered benefits is not medically necessary. In all such appeals, the burden of proof will rest with the enrollee at all stages.

History

• Authority: T.C.A. §§ 4-5-209, 71-5-105, 71-5-109, Executive Order No. 23.
• Administrative History: Public necessity rule filed December 1, 2006; expires May 15, 2007. Original rule filed March 1, 2007; effective May 15, 2007.

Tenn. Comp. R. & Regs. 1200-13-14-.01 .

(23) INSTITUTIONAL REVIEW BOARD shall mean a specifically constituted review body established or designated by an entity to protect the welfare of human subjects recruited to participate in biomedical or behavioral research.

(24) INTELLECTUAL DISABILITY (ID). See definition in Rule 1200-13-01-.02.

(25) INTERMEDIATE CARE FACILITY FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES

(ICF/IID). See definition in Rule 1200-13-01-.02.

(26) LONG TERM CARE shall mean institutional services of a nursing facility, an intermediate care facility for the mentally retarded, or services provided through a Home and Community Based Services (HCBS) waiver program.

(27) MCC (MANAGED CARE CONTRACTOR) shall mean:

(a) A managed care organization, pharmacy benefits manager, and/or a dental benefits manager which has signed a TennCare Contract with the State and operates a provider network and provides covered health services to TennCare enrollees; or (b) A pharmacy benefits manager, dental benefits manager, or behavioral health organization which subcontracts with a managed care organization to provide services; or (c) A State government agency (i.e., Department of Children’s Services and Division of Mental Retardation Services) that contracts with TennCare for the provision of services.

(28) MCO (MANAGED CARE ORGANIZATION) shall mean an appropriately licensed Health Maintenance Organization (HMO) contracted with the Bureau of TennCare to manage the delivery, provide for access, contain the cost, and ensure the quality of specified covered medical and behavioral benefits to TennCare enrollee-members through a network of qualified providers.

(29) MEDICAID shall mean the federal- and state-financed, state-run program of medical assistance pursuant to Title XIX of the Social Security Act.

(30) MEDICAL CONDITION shall mean a disorder or an abnormal condition of the body and/or mind.

(31) MEDICAL EVIDENCE shall mean Type I-IV analyses and studies and/or Type V evidence defined herein at “HIERARCHY OF EVIDENCE”.

(32) MEDICAL ITEM OR SERVICE shall mean an item or service that is provided, ordered, or prescribed by a licensed health care provider and is primarily intended for a medical and/or behavioral purpose and designed to achieve that medical and/or behavioral purpose.

(33) MEDICAL NECESSITY shall mean the quality of being “medically necessary” as defined by Tennessee Code Annotated, Section 71-5-144, and applies to TennCare enrollees.

Implementation of the term “medical necessity” is provided for in these rules, consistent with the statutory provisions, which control in case of ambiguity.

(34) MEDICAL NECESSITY DETERMINATION a decision made by the Chief Medical Officer of the Bureau of TennCare or his or her clinical designee or by the Medical Director of one of its Managed Care Contractors or his or her clinical designee regarding whether a requested medical item or service satisfies the definition of medical necessity contained in Tennessee Code Annotated, Section 71-5-144 and these rules as defined herein. Items or services that are not determined medically necessary shall not be paid for by TennCare.

(35) MEDICAL NECESSITY GUIDELINES shall mean evidence-based guidelines approved by the Chief Medical Officer of the Bureau of TennCare for the purpose of guiding medical necessity determinations for particular courses of diagnosis or treatment.

(36) MEDICALLY NECESSARY is defined by Tennessee Code Annotated, Section 71-5-144, and shall describe a medical item or service that meets the criteria set forth in that statute. The term “medically necessary,” as defined by Tennessee Code Annotated, Section 71-5-144, applies to TennCare enrollees. Implementation of the term “medically necessary” is provided for in these rules, consistent with the statutory provisions, which control in case of ambiguity.

No enrollee shall be entitled to receive and TennCare shall not be required to pay for any items or services that fail fully to satisfy all criteria of “medically necessary” items or services, as defined either in the statute or in these rules.

(37) MEDICAL RECORD shall mean all medical histories; records, reports and summaries; diagnoses; prognoses; records of treatment and medication ordered and given; x-ray and radiology interpretations; physical therapy charts and notes; lab reports; other individualized medical documentation in written or electronic format; and analyses of such information.

(38) META-ANALYSIS shall mean systematic methods that use statistical techniques for combining results from different studies to obtain a quantitative estimate of the overall effect of a particular intervention or variable on a defined outcome. This combination may produce a stronger conclusion than can be provided by any individual study.

(39) NON-CONTROLLED COHORT STUDY shall mean a longitudinal study in which a group of people who share a common characteristic or experience are tracked over time with observation of outcomes within the group.

(40) NON-COVERED SERVICE shall mean items and services that are not within the scope of defined benefits for which a beneficiary is eligible under TennCare, including cost-effective alternative services and medical items and services that are in excess of any applicable limits on such items or services that might otherwise be covered. With the exception of costeffective alternative services, non-covered services under TennCare, including medical items and services in excess of benefit limits, are never to be paid for by TennCare, even if they otherwise would qualify as “medically necessary,” regardless of the medical circumstances involved.

(41) NON-EXPERIMENTAL STUDY shall mean a study that is not randomized or controlled.

Examples of non-experimental studies include non-controlled cohort studies, case series or case reports.

(42) NON-RANDOMIZED CONTROLLED CLINICAL TRIAL shall mean a controlled clinical trial that assigns patients to intervention and control groups using a method that does not involve randomization, e.g., at the convenience of the investigators or some other technique such as alternate assignment. Controlled trials that are not randomized are subject to a variety of biases, including selection bias, in which persons who volunteer or are assigned by investigators to study groups may differ in characteristics other than the intervention itself.

(43) OFF-LABEL USE shall mean the use of a drug or biological product that has been approved for marketing by the United States Food and Drug Administration (FDA) but is proposed to be used for other than the FDA-approved purpose.

(44) PHYSICIAN shall mean a person licensed pursuant to Chapter 6 or 9 of Title 63 of the Tennessee Code Annotated.

(45) PREADMISSION SCREENING/RESIDENT REVIEW (PASRR). See definition in Rule 1200- 13-01-.02.

(46) PRIVATE DUTY NURSING SERVICES. See definition in Rule 1200-13-13-.01.

(47) QUASI-EXPERIMENTAL STUDY shall mean a study in which the investigator lacks full control over randomization of subjects (lacks full control over the allocation and/or timing of intervention) but nonetheless conducts the study as if it were an experiment, allocating subjects to groups. Examples of quasi-experimental studies include non-randomized controlled clinical trials, controlled cohort studies, or case-control studies.

(48) RANDOMIZED CONTROLLED CLINICAL TRIAL shall mean a clinical trial in which participants are assigned in a randomized fashion to a study group (which receives the intervention) or a control group (which receives a standard treatment, which may be no intervention or a placebo). Randomization enhances the comparability of the groups and provides a more valid basis for measuring statistical uncertainty. In this manner, differences in outcomes can be attributed to the intervention rather than to differences between the groups. Randomized controlled trials may or may not be blinded. In a blinded trial, the investigators, the subjects, or both (double-blinded study) are not told to which group they have been assigned, so that this knowledge will not influence their assessment of outcome.

(49) SCREEN shall mean to test for or examine for the presence of a medical problem or condition in the absence of signs and symptoms of disease.

(50) STUDY shall mean a careful examination or analysis applying scientific methodology and published in a peer-reviewed scientific journal or periodical.

(51) TENNCARE shall mean the TennCare waiver demonstration program(s) and/or Tennessee’s traditional Medicaid program.

(52) TREATING PHYSICIAN OR OTHER TREATING HEALTH CARE PROVIDER shall mean a licensed physician practicing within the scope of his or her license or other licensed health care provider practicing within the scope of his or her license who has personally examined a particular TennCare enrollee and who has provided diagnostic or treatment services for that particular enrollee (whether or not those services were covered by TennCare) for purposes of treating or supporting the treatment of a known or suspected medical condition of that particular enrollee. The term excludes all other providers, including those who have evaluated a particular enrollee’s medical condition primarily or exclusively for the purposes of supporting or participating in a decision regarding TennCare coverage.

(53) TREATMENT shall mean the provision of medical items or services based on the recommendation of a treating physician or other treating health care provider practicing within the scope of his or her license.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-209, 71-5-102, 71-5-105, 71-5-107, 71-5-109, 71-5-134, and 71-5-144 and Executive Order No. 23.
• Administrative History: Public necessity rule filed December 1, 2006; expires May 15, 2007. Original rule filed March 1, 2007; effective May 15, 2007. Amendment filed October 11, 2007; effective December 25, 2007. Public necessity rule filed September 8, 2008; effective through February 20, 2009. Amendment filed December 5, 2008; effective February 18, 2009. Amendments filed September 25, 2009; effective December 24, 2009. Amendments filed September 26, 2025; effective December 25, 2025.

Tenn. Comp. R. & Regs. 1200-13-14-.04 shall be deemed to be medically necessary if provided in connection with medically necessary items or services.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-209, 71-5-102, 71-5-105, 71-5-107, 71-5-109, 71-5-134, and 71-5-144 and Executive Order No. 23.
• Administrative History: Public necessity rule filed December 1, 2006; expires May 15, 2007. Original rule filed March 1, 2007; effective May 15, 2007. Amendment filed October 11, 2007; effective December 25, 2007. Public necessity rule filed September 8, 2008; effective through February 20, 2009. Amendment filed December 5, 2008; effective February 18, 2009. Amendments filed June 17, 2011; effective November 28, 2011. Amendments filed September 26, 2025; effective December 25, 2025.

Chapter 1200-13-17 TennCare Crossover Payments for Medicare Deductibles and Co-Insurance

Tenn. Comp. R. & Regs. 1200-13-17-.01 DEFINITIONS

(1) COST EFFECTIVE ALTERNATIVE SERVICE is defined at Rule 1200-13-13-.01.

(2) DUAL ELIGIBLE shall mean a person who is a Medicare beneficiary and who is entitled to some form of assistance from TennCare Medicaid.

(3) ENHANCED PAYMENT RATE shall mean the payment rate referred to in 42 U.S.C. § 1396a(a)(13)(C). Enhanced payment rates are made only to primary care providers and to providers of vaccine administration services, as defined in these rules. These rates are applicable only for dates of service between January 1, 2013, and December 31, 2014.

(4) FULL BENEFIT DUAL ELIGIBLE (FBDE) shall mean a Medicare beneficiary who also qualifies for TennCare benefits, except that Waiver Duals are not considered FBDEs.

(5) MANAGED CARE CONTRACTOR (MCC) is defined at Rule 1200-13-13-.01.

(6) MEDICARE ALLOWED AMOUNT shall mean the amount that Medicare considers reasonable for a Medicare-covered service, as defined on the claim for that service.

(7) MEDICARE BENEFITS shall mean the health care services available to Medicare beneficiaries through the Medicare program where payment for the services is either completely the obligation of the Medicare program or in part the obligation of the Medicare program, with the remaining payment (cost sharing) obligations belonging to the beneficiary, some other third party, or TennCare.

(8) MEDICARE COINSURANCE is defined as “Coinsurance” at Rule 1240-03-01-.02(1).

(9) MEDICARE COST-SHARING shall mean TennCare’s obligation for payment of certain Medicare beneficiaries’ Medicare deductibles and coinsurance.

(10) MEDICARE CROSSOVER CLAIM shall mean a claim that has been submitted to the Bureau of TennCare for Medicare cost sharing payments after the claim has been adjudicated by Medicare and paid by Medicare and Medicare has determined the enrollee’s liability. Claims denied by Medicare or not submitted to Medicare are not considered Medicare crossover claims.

(11) MEDICARE DEDUCTIBLE is defined as “Deductible” at Rule 1240-03-01-.02(1).

(12) MEDICARE PAID AMOUNT is defined as the amount Medicare actually paid on a claim, which is generally a percentage of the Medicare allowed amount. The Medicare paid amount on a Medicare Part C claim is the amount that the Part C plan paid.

(13) MEDICARE PART A is defined at Rule 1240-03-01-.02(1).

(14) MEDICARE PART B is defined at Rule 1240-03-01-.02(1).

(15) MEDICARE PART C refers to the Medicare Advantage program authorized under

Part C of Title XVIII of the Social Security Act, through which beneficiaries may choose to enroll in private managed care plans that contract with the Centers for Medicare and Medicaid Services (CMS). These plans may be HMO plans, PPO plans, or private fee-for-service plans. They offer combined coverage of Part A, Part B, and, in most cases, Part D benefits. Some Medicare Advantage plans offer additional benefits not otherwise covered by Medicare.

(16) MEDICARE PREMIUMS shall mean the Medicare Part A and/or Medicare Part B premiums for which TennCare is responsible, depending on the enrollee’s eligibility group. TennCare does not pay for Medicare Part C premiums, Medicare Part D premiums, or any other Medicare premiums.

(17) PHARMACY PROVIDERS shall mean providers enrolled with the Medicare program and with Medicaid to provide Medicare Part B pharmacy services.

(18) PHARMACY SERVICES shall mean outpatient prescription drugs provided through Medicare Part B.

(19) PRIMARY CARE PROVIDERS shall mean, for purposes of the enhanced payment rate, as defined in these rules, primary care providers practicing in family medicine, general internal medicine, pediatric medicine, and related subspecialists who meet requirements as described in 42 C.F.R. § 447.400(a). In accordance with policies set forth by the Bureau of TennCare, these providers must adequately demonstrate to an MCO or the Bureau of TennCare that they meet the minimum board certification requirements and/or that 60 percent of the services they provide represent the eligible codes identified in these rules as primary care or vaccine administration services.

(20) PRIMARY CARE SERVICES are services for which enhanced payment rates, as defined in these rules, will be paid for dates of service between January 1, 2013, and December 31, 2014. The procedure codes for these services, as published in the American Medical Association’s Current Procedural Terminology (2013 edition), are Evaluation and Management Codes 99201 through 99499, or their successor codes.

(21) PROFESSIONAL SERVICES shall mean the professional/technical component of Medicare services. These services are typically provided by non-institutional providers or suppliers such as physicians, outpatient clinics, and Durable Medical Equipment vendors. They are generally covered under Medicare Part B and billed on a CMS-1500 claim form. Services that are not billed on a CMS-1500 claim form or an ASC X12N 837P claim transaction are not considered part of this definition.

(22) QMB shall mean Qualified Medicare Beneficiary, as defined at Rule 1240-03-02- .02(2).

(23) SSI shall mean the federal Supplemental Security Income program that provides monthly income to low-income aged, blind, and disabled individuals. An “active” SSI recipient is one who is receiving monthly SSI checks.

(24) TENNCARE ALLOWABLE shall mean the lower of the TennCare maximum fee or 85% of the Medicare allowed amount on the claim.

(25) TENNCARE COVERED SERVICE shall mean any service that is listed as “covered” in Rules 1200-13-13-.04 and 1200-13-14-.04 and that is not listed specifically as an exclusion in Rules 1200-13-13-.10 and 1200-13-14-.10.

(26) TENNCARE MAXIMUM FEE shall mean the maximum amount considered by TennCare for reimbursement of a particular Medicare-covered service. The TennCare maximum fee is 85% of the Cigna Medicare fee schedule amount for participating providers that was in effect on January 1, 2008. For Medicare-covered services that were introduced after January 1, 2008, and that therefore had no Medicare fee schedule amount in effect on that date, the TennCare maximum fee is 85% of the Medicare fee schedule amount for the participating providers that was in effect on the date the service was introduced.

(27) TENNCARE PAYMENT AMOUNT shall mean the net amount paid by TennCare on a Medicare crossover claim. The TennCare payment amount will be the TennCare allowable, less the amount Medicare paid on the claim, less any third party liability.

The TennCare payment amount shall not exceed the enrollee’s liability on the claim.

(28) TENNCARE PHARMACY ALLOWABLE shall mean, for Medicare Part B pharmacy services provided to FBDEs by pharmacy providers, as defined in these rules, 100% of the Medicare allowed amount on the claim.

(29) TENNCARE PRIMARY CARE ALLOWABLE shall mean 100% of the designated Medicare Cost-Sharing amounts for primary care services provided by primary care providers as defined in these rules during Calendar Years (CY) 2013 and 2014.

(30) TENNCARE VACCINATION ADMINISTRATION ALLOWABLE shall mean 100% of the designated Medicare Cost-Sharing amounts for vaccine administration services provided by primary care providers as defined in these rules during Calendar Years (CY) 2013 and 2014.

(31) VACCINE ADMINISTRATION SERVICES are services for which enhanced payment rates, as defined in these rules, will be paid for dates of service between January 1, 2013, and December 31, 2014. The procedure codes for these services, as published in the American Medical Association’s Current Procedural Terminology (2013 edition), are Vaccine Administration Codes 90460, 90461, 90471, 90472, 90473, and 90474 or their successor codes.

(32) WAIVER DUAL shall mean a person who was enrolled in TennCare as of December 31, 2001, as an Uninsured or Uninsurable and who also had Medicare. This category was closed for adults 19 and older on April 29, 2005. Waiver Duals are not considered Full Benefit Dual Eligibles.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 4-5-209, 71-5-105, and 71-5-109.
• Administrative History: Public necessity rule filed July 1, 2008; effective through December 13, 2008. New rule filed September 24, 2008; effective December 8, 2008. Public necessity rules filed July 1, 2009; effective through December 13, 2009. Amendments filed September 11, 2009; effective December 10, 2009. Emergency rule filed June 21, 2013; effective through December 18, 2013. Amendment filed August 15, 2013; effective November 13, 2013.

Tenn. Comp. R. & Regs. 1200-13-17-.02 ELIGIBILITY FOR CROSSOVER PAYMENTS

(1) The following dual eligibles are eligible for TennCare to make Medicare crossover payments on all Medicare covered services, regardless of whether or not these services are also covered by TennCare:

(a) QMBs;

(b) Non-QMB FBDEs who are under age 21; and (c) Non-QMB FBDEs who are active SSI beneficiaries.

(2) Non-QMB FBDEs who are age 21 and older and who are not active SSI beneficiaries are eligible for TennCare to make Medicare crossover payments on all Medicare covered services that are also TennCare covered services. They are not eligible for TennCare to make Medicare crossover payments when the service on which the payment is requested is not a TennCare covered service.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, and 71-5-109.
• Administrative History: Public necessity rule filed July 1, 2008; effective through December 13, 2008. New rule filed September 24, 2008; effective December 8, 2008.

Tenn. Comp. R. & Regs. 1200-13-17-.03 THIRD PARTY RESOURCES

When a TennCare enrollee is covered by other third party payers, in addition to Medicare, TennCare is the payer of last resort. Whether or not Medicare is the primary payer, providers must bill all other third party payers prior to submitting a crossover claim to the Bureau of TennCare.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, and 71-5-109.
• Administrative History: Public necessity rule filed July 1, 2008; effective through December 13, 2008. New rule filed September 24, 2008; effective December 8, 2008.

Tenn. Comp. R. & Regs. 1200-13-17-.04 MEDICARE CROSSOVER PAYMENT METHODOLOGY

(1) On crossover claims for professional services and procedures with dates of service on or after July 1, 2008, TennCare will pay the lesser of (a) billed charges or (b) the TennCare allowable, as defined in these rules, less the Medicare paid amount, less any third party liability.

(2) On crossover claims for Medicare Part B pharmacy services provided by pharmacy providers, as defined in these rules, to non-FBDEs with dates of service on or after July 1, 2009, TennCare will pay the lesser of (a) billed charges or (b) the TennCare allowable, as defined in these rules, less the Medicare paid amount, less any third party liability.

(3) On crossover claims for Medicare Part B pharmacy services provided by pharmacy providers, as defined in these rules, to FBDEs with dates of service on or after July 1, 2009, TennCare will pay the lesser of (a) billed charges or (b) the TennCare pharmacy allowable, as defined in these rules, less the Medicare paid amount, less any third party liability.

(4) On crossover claims for primary care services, as defined in these rules, TennCare will pay an enhanced payment rate for dates of service between January 1, 2013, and December 31, 2014. The enhanced payment rate will be the lesser of (a) billed charges or (b) the TennCare primary care allowable, as defined in these rules, less the Medicare paid amount, less any third party liability.

(5) On crossover claims for vaccine administration services, as defined in these rules, TennCare will pay an enhanced payment rate for services between January 1, 2013, and December 31, 2014. The enhanced payment rate will be the lesser of (a) billed charges or (b) the TennCare vaccination administration allowable, as defined in these rules, less the Medicare paid amount, less any third party liability.

(6) In no circumstance will the TennCare payment exceed the enrollee’s liability on the Medicare crossover claim.

(7) Medicare crossover payments are normally made by the Bureau of TennCare separately from the Managed Care Contractors. Rules 1200-13-13-.08(12)(b) and 1200-13-14-.08(12)(b) set forth the guidelines for timely filing Medicare crossover claims. However, if an MCC should choose to authorize a non-covered TennCare service as a cost-effective alternative service for a non-QMB FBDE who is age 21 or older and not an SSI recipient, the MCC will be responsible for the Medicare crossover payment on that service. The calculation of this payment should be included by the MCC in its analysis of whether or not the non-covered TennCare service is a cost-effective alternative service.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 71-5-105, and 71-5-109.
• Administrative History: Public necessity rule filed July 1, 2008; effective through December 13, 2008. New rule filed September 24, 2008; effective December 8, 2008. Public necessity rule filed July 1, 2009; effective through December 13, 2009. Amendment filed September 11, 2009; effective December 10, 2009. Emergency rule filed March 1, 2010; effective through August 28, 2010. Amendment filed May 27, 2010; effective August 25, 2010. Emergency rule filed June 21, 2013; effective through December 18, 2013. Amendment filed August 15, 2013; effective November 13, 2013.

Tenn. Comp. R. & Regs. 1200-13-17-.05 PROVIDER ENROLLMENT AND PARTICIPATION REQUIREMENTS

(1) Medicare providers who are licensed professionals and who wish to bill for services provided to Medicare beneficiaries must enroll with the TennCare program and obtain TennCare Medicaid identification numbers.

(2) Participation in the TennCare/Medicare crossover program is limited to providers who maintain current Tennessee medical licenses and/or current licenses in the states in which they practice.

(3) Providers must be licensed and accredited according to the specific laws and regulations that apply to their service type.

(4) Health care providers who are required under Tennessee law to render services under the supervision of other health care providers will not be assigned TennCare identification numbers. These providers’ claims must be submitted by the licensed or certified health care providers who supervise them.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, and 71-5-109.
• Administrative History: Public necessity rule filed July 1, 2008; effective through December 13, 2008. New rule filed September 24, 2008; effective December 8, 2008.

Chapter 1200-13-18 TennCare Administrative Actions and Provider Appeals

Tenn. Comp. R. & Regs. 1200-13-18-.01 SCOPE AND AUTHORITY

(1) An approved provider of TennCare services may appeal the following administrative actions:

(a) An administrative action for recovery against a person other than an enrollee, recipient or applicant brought by the Bureau of TennCare upon written request of the Attorney General pursuant to the Tennessee Medicaid False Claims Act;

(b) An action proposed or taken by the Bureau of TennCare or its audit contractor to recover, recoup or withhold payment from a provider, as a result of any audit performed by or on behalf of the Centers for Medicare and Medicaid Services or the Bureau pursuant to state or federal law;

(c) A Bureau of TennCare determination to suspend payments to a provider due to a credible allegation of fraud for which an investigation is pending;

(d) A denial of eligibility for or a determination of the amount of an incentive payment pursuant to the federal Medicaid Electronic Health Record Incentive Program (EHR-IP); or, (e) Termination of an approved provider’s Tennessee Medicaid Provider Number by the Bureau, except when federal law mandates exclusion of the provider.

(2) A provider of services may not appeal the following administrative actions:

(a) An MCC’s refusal to contract with the provider;

(b) A decision by the Bureau to decline coverage of prescriptions not written by a provider with prescribing authority; or, (c) Termination or exclusion from the Program as required by federal law.

(3) In order to exercise the right to a hearing, a provider must submit his appeal and request for a hearing in writing to the Bureau. The notice of the Bureau action shall contain specific instructions concerning the right to appeal and the address for filing an appeal.

(4) Any request for an appeal must be received at the address contained in the notice of action no later than 35 days following the date of the notice.

(5) Provider appeals shall be conducted as contested case hearings by the Tennessee Department of State, Administrative Procedures Division, pursuant to the Tennessee Uniform Administrative Procedures Act (APA).

(6) The Uniform Rules of Procedure for Hearing Contested Cases Before State Administrative Agencies, Chapter 1360-04-01, promulgated under the APA, are adopted by the Bureau and incorporated by reference herein. The Uniform Rules shall govern the conduct of a provider appeal except where a specific contrary provision is adopted by the Bureau in this Chapter.

(7) For purposes of issuing an initial order, a contested case hearing shall be conducted by an administrative judge hearing the case alone.

Statutory Authority: T.C.A. §§ 4-5-202, 71-5-105 and 71-5-109. Administrative History: Emergency

rule filed February 18, 2011; effective through August 17, 2011. Original rule filed May 18, 2011; effective August 16, 2011.

Tenn. Comp. R. & Regs. 1200-13-18-.02 DEFINITIONS

(1) Administrative Judge. An employee or official of the Office of the Secretary of State who is licensed to practice law and authorized by law to conduct contested case proceedings.

(2) Administrative Procedures Act (APA). The Tennessee Uniform Administrative Procedures Act, as amended, codified at T.C.A. §§ 4-5-301, et seq.

(3) Approved Provider. A provider of health care services who has registered with and been approved by the Bureau and has been issued a Tennessee Medicaid Provider Number.

(4) Audit. The systematic process of objectively obtaining and evaluating evidence regarding assertions about economic actions and events to ascertain the degree of correspondence between those assertions and established criteria and communicating the results to interested parties. Audits are conducted in accordance with AICPA (American Institute of Certified Public Accountants) auditing or attestation engagement standards. For purposes of this chapter, audits are conducted of health care provider records, financial information, and statistical data according to principles of cost reimbursement to determine the reasonableness and allowance of costs reimbursable under the Program. Statistically valid random sampling is used to determine actual damages.

(5) Bureau of TennCare (Bureau). The division of the Tennessee Department of Finance and Administration, the single state Medicaid agency, that administers the TennCare Program.

For purposes of this Chapter, the Bureau shall represent the State of Tennessee.

(6) Civil Penalty. A monetary penalty assessed by the Bureau against a provider in an amount of not less than $1,000 nor more than $5,000 for each violation of the Tennessee Medicaid False Claims Act. T.C.A. § 71-5-183(h)(3).

(7) Claim. Any request or demand for money, property, or services made to any employee, officer, or agent of the state, or to any contractor, grantee, or other recipient, whether under contract or not, if any portion of the money, property, or services requested or demanded was issued from, or was provided by, the State.

(8) Commissioner. The chief administrative officer of the Tennessee Department where the Bureau is administratively located.

(9) Commissioner’s Designee. A person authorized by the Commissioner to review appeals of initial orders and to enter final orders pursuant to T.C.A. § 4-5-315, or to review petitions for stay or reconsideration of final orders.

(10) Contested Case. An administrative proceeding in which the legal rights, duties or privileges of a party are required by any statute or constitutional provision to be determined by an agency after an opportunity for a hearing.

(11) Credible Allegation of Fraud. Information which has been verified by the Bureau through judicious case-by-case review and found to contain indicia of reliability. This information may be from any source, including but not limited to hotline complaints, claims data mining, patterns identified through provider audits, civil false claims cases, or law enforcement investigations.

(12) Department. The Tennessee Department of Finance and Administration.

(13) Electronic Health Record Incentive Program (EHR-IP). The provisions of the American Recovery and Reinvestment Act of 2009 (ARRA) that provide for incentive payments to eligible professionals (EPs) and eligible hospitals (EHs), including acute care, children’s and critical access hospitals (CAHs) participating in Medicare and Medicaid programs that adopt, implement or update a certified system and successfully demonstrate meaningful use of certified electronic health record (EHR) technology as required by federal regulations.

(14) Enrollee. An individual eligible for and enrolled in the TennCare program.

(15) Error Rate. The percentage of claims in a sample population that was not billed properly and is actionable. Error rates can be applied to entire populations if the sample was the result of statically valid random sampling. The use of the term “error” does not indicate the intent of the person or entity submitting the claim.

(16) Findings of Fact. The factual findings issued by the Administrative Judge or Commissioner’s Designee following an administrative hearing. The factual findings are enumerated in the initial and/or final order. An order must include a concise and explicit statement of the underlying facts of record to support the findings.

(17) Final Agency Decision. A Final Order.

(18) Final Order. An initial order becomes a final order without further notice if not timely appealed, or if the initial order is appealed pursuant to T.C.A. § 4-5-315, the Commissioner or Commissioner’s Designee may render a final order. A statement of the procedures and time limits for seeking reconsideration or judicial review shall be included with the issuance of a final order.

(19) Good Cause Not to Suspend Payment. The Bureau may determine not to suspend payment or not to continue suspension of payment to a provider being investigated due to a credible allegation of fraud if:

(a) Law enforcement officials have specifically requested that a payment suspension not be imposed because such a payment suspension may compromise or jeopardize an investigation;

(b) Other available remedies implemented by the State more effectively or quickly protect Program funds;

(c) The Bureau determines, based upon the submission of written evidence by the provider that is the subject of the payment suspension, that the suspension should be removed;

(d) Enrollee access to items or services would be jeopardized by a payment suspension because the provider is the sole community physician, the sole source of essential specialized services in a community, or serves a large number of enrollees within a HRSA-designated medically underserved area;

(e) Law enforcement declines to certify that a matter continues to be under investigation; or (f) The Bureau determines that payment suspension is not in the best interests of the Program.

(20) Good Cause to Suspend Payment Only in Part. The Bureau may determine to suspend payments in part, or to convert a payment suspension previously imposed in whole to one only in part, to a provider being investigated due to a credible allegation of fraud if:

(a) Enrollee access to items or services would be jeopardized by a payment suspension in whole or part because the provider is the sole community physician, the sole source of essential specialized services in a community, or serves a large number of recipients within a HRSA-designated medically underserved area;

(b) The Bureau determines, based upon the submission of written evidence by the provider that is the subject of a whole payment suspension, that such suspension should be imposed only in part;

(c) The credible allegation focuses solely and definitively on only a specific type of claim or arises from only a specific business unit of a provider, and the Bureau determines and documents in writing that a payment suspension in part would effectively ensure that potentially fraudulent claims were not continuing to be paid;

(d) Law enforcement declines to certify that a matter continues to be under investigation; or (e) The Bureau determines that payment suspension only in part is in the best interests of the Program.

(21) Hearing. A contested case proceeding.

(22) Indicia of Reliability. Factors which the Bureau will examine in determining whether a credible allegation of fraud exists, requiring the suspension of payments to a provider, including but not limited to:

(a) Firsthand knowledge;

(b) Corroborating witness;

(c) Witness conflict (disgruntled employee);

(d) Prior bad acts;

(e) Pattern of bad acts;

(f) Documentary proof;

(g) Admission by provider;

(h) Expert opinion; or (i) Indictment by a court of competent jurisdiction.

(23) Initial Order. The decision issued by the administrative judge following a hearing. The initial order shall contain the decision, findings of fact, conclusions of law, the policy reasons for the decision and the remedy prescribed. It shall include a statement of the procedure for filing an appeal of the initial order as well as a statement of any circumstances under which the initial order may, without further notice, become a final order. A statement of the procedures and time limits for seeking reconsideration or other administrative relief and the time limits for seeking judicial review shall be included.

(24) Notice of Action. The document or letter sent by the Bureau to a provider detailing the action the Bureau intends to take against the provider. The notice shall include a statement of the reasons and authority for the action as well as a statement of the provider’s right to appeal the action, if applicable.

(25) Notice of Hearing. The pleading filed with the Administrative Procedures Division by the Bureau upon receipt of an appeal. It shall contain a statement of the time, place, nature of the hearing, and the right to be represented by counsel; a statement of the legal authority and jurisdiction under which the hearing is to be held, referring to the particular statutes and rules involved; and, a short and plain statement of the matters asserted, in compliance with the APA.

(26) Program. See TennCare.

(27) Provider with Prescribing Authority. A health care professional authorized by law or

regulation to order prescription medications for her patients and who:

(a) Participates in the provider network of the MCC in which the beneficiary is enrolled; or (b) Has received a referral of the beneficiary, approved by the MCC, authorizing her to treat the beneficiary; or, (c) In the case of a TennCare beneficiary who is also enrolled in Medicare, is authorized to treat Medicare patients.

(28) RAT-STATS. A widely accepted statistical software tool designed to assist the user in conducting statistically valid random sampling and evaluating audit results.

(29) Standard of Proof. A preponderance of the evidence.

(30) Statistically Valid Random Sampling. A method for determining error rates in healthcare billings using extrapolation. Typically used for large numbers of suspect claims or patients, a random sample of claims from a chosen population is selected using RAT-STATS or a similar program. That sample is then analyzed for errors. If the sample is the result of statistically valid random sampling, the error rate in the sample can be extrapolated to the entire population of claims.

(31) TennCare. The program administered by the Single State Agency as designated by the State and CMS pursuant to Title XIX of the Social Security Act and the Section 1115 Research and Demonstration Waiver granted to the State of Tennessee.

(32) Tennessee Medicaid Provider Number. The identifying number issued by the Bureau to an approved provider for the purpose of receiving payment in exchange for rendering services to TennCare enrollees.

(33) Tennessee Medicaid False Claims Act (Act). T.C.A. §§ 71-5-181, et seq.

(34) Termination. The deactivation of a provider’s Tennessee Medicaid Provider Number and the cessation of the provider’s TennCare billing privileges.

Statutory Authority: T.C.A. §§ 4-5-202, 71-5-105 and 71-5-109. Administrative History: Emergency

rule filed February 18, 2011; effective through August 17, 2011. Original rule filed May 18, 2011; effective August 16, 2011. Amendment filed January 15, 2013; effective April 15, 2013.

Tenn. Comp. R. & Regs. 1200-13-18-.03 ADMINISTRATIVE ACTION FOR RECOVERY UNDER THE TENNESSEE MEDICAID

FALSE CLAIMS ACT.

(1) The Attorney General, following an investigation of an approved provider’s claims, may determine that certain provider actions are appropriate for administrative action by the Bureau, pursuant to the Act. The Attorney General may refer any such matters to the Bureau Director, or his designee, along with the investigative file and a recommendation for action.

(2) The Attorney General shall not refer matters originally brought under T.C.A. § 71-5-183(b) or if any person has the right to participate in or recover from the proceeding pursuant to T.C.A. § 71-5-183(c)(5).

(3) Upon receipt of a written request from the Attorney General, the Bureau may commence a contested case proceeding on behalf of the State for recovery under the Act against any person other than an enrollee, recipient or applicant.

(4) The Bureau may initiate the recovery process by notice of action to the provider setting out:

(a) The assessment of damages, civil penalties and related costs;

(b) The name and contact information of an individual within the Bureau with knowledge of the claim(s) and the assessment who is authorized to discuss the matter with the provider; and (c) A statement of the right of the provider to appeal the assessment and the manner in which an appeal must be filed.

(5) Any appeal of a notice of action shall be conducted according to rule .01 of this chapter.

(6) The Bureau may recover actual damages in an amount no greater than twenty-five thousand dollars ($25,000). The amount of actual damages may be based upon a statistically valid random sample utilizing a software tool such as RAT-STATS.

(7) In addition to and not limited by the amount of actual damages, the Bureau may recover:

(a) Civil penalties of not less than one thousand dollars ($1,000) nor more than five thousand dollars ($5,000) for each claim found to be in violation of the Act;

(b) Costs of the administrative action; and (c) Treble the amount of actual damages.

(8) Any action for recovery shall not be brought:

(a) More than six (6) years following the date on which the violation of the Act is committed; or (b) More than three (3) years after the date when facts material to the right of action are known or reasonably should have been known by the state official charged with responsibility to act in the circumstances, but in no event not more than ten (10) years after the date the violation was committed, whichever occurs last.

(9) A subpoena issued by an administrative judge pursuant to the APA requiring the attendance of a witness at a hearing may be served by certified mail at any place in the United States.

(10) For purposes of rendering a final order pursuant to the APA, the Bureau is designated as the agency to review initial orders and issue final agency decisions. Orders issued by the Bureau shall have the effect of a final order pursuant to the APA.

(11) Judgment. A final order issued by the Bureau under this rule may be enforced as a final judgment, as follows:

(a) A notarized copy of the final order must be filed in the office of the Clerk of the Chancery Court of Davidson County;

(b) Upon filing with the Clerk, a final order shall be considered as a judgment by consent of the parties on the same terms and conditions as those recited in the order;

(c) The judgment shall be promptly entered by the Court;

(d) The judgment shall become final on the date of entry; and (e) A final judgment shall have the same effect, is subject to the same procedures and may be enforced or satisfied in the same manner as any other judgment of a court of record of the State of Tennessee.

Statutory Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109 and 71-5-183. Administrative History:

Emergency rule filed February 18, 2011; effective through August 17, 2011. Original rule filed May 18, 2011; effective August 16, 2011. Amendment filed January 15, 2013; effective April 15, 2013.

Tenn. Comp. R. & Regs. 1200-13-18-.04 RECOUPMENT OR WITHHOLD

(1) The Bureau is required by state and federal law to protect the integrity of the Medicaid program. This is accomplished in part by causing audits of provider claims to be conducted.

Audit findings are reported to the Bureau for the purpose of recovering incorrect payments, by recoupment or withhold.

(2) The Bureau shall notify a provider of its intent to recoup or withhold based upon audit findings by issuing a notice of action. Each notice of action sent to a provider shall contain the proposed recovery action and the following information:

(a) The name and contact information of an individual knowledgeable about the audit findings and who is authorized to discuss the proposed recovery action with the provider;

(b) The manner by which the provider may submit additional information to support his disagreement with the proposed recovery action;

(c) A statement that the provider has the right to appeal the proposed recovery action and the manner in which an appeal must be filed.

(3) Any appeal of a notice of action shall be conducted according to rule .01 of this chapter.

(4) The audit and the audit findings are not subject to appeal. (See NHC v. Snodgrass, 555 S.W.2d 403 (Tenn. 1977)).

Statutory Authority: T.C.A. §§ 4-5-202, 71-5-105 and 71-5-109. Administrative History: Emergency

rule filed February 18, 2011; effective through August 17, 2011. Original rule filed May 18, 2011; effective August 16, 2011.

Tenn. Comp. R. & Regs. 1200-13-18-.05 SUSPENSION OF PAYMENT

(1) Pursuant to 42 C.F.R. § 447.90, the Bureau is prohibited by federal law from receiving federal financial participation (FFP) for payment to a provider of medical items or services with respect to which there is a pending investigation of a credible allegation of fraud, absent good cause not to suspend payment or good cause to suspend payment only in part.

(2) The Bureau must provide written notice to the provider of a suspension of payments:

(a) Five (5) days after suspending payments unless a law enforcement agency has submitted a written request to delay the notice; or (b) Thirty (30) days after suspending payments when a delay was properly requested by law enforcement, except the delay may be renewed twice in writing not to exceed ninety (90) days.

(3) Written notice of suspension of payment must contain:

(a) A statement that payments are suspended according to this rule and federal regulation;

(b) The general allegations as to the nature of the suspension action, but need not disclose any specific information concerning an ongoing investigation;

(c) A statement that the suspension is temporary and the circumstances under which it will be terminated;

(d) If applicable, state the type(s) of TennCare/Medicaid claims to which suspension is effective;

(e) A statement that the provider has the right to submit written evidence for consideration by the Bureau; and (f) A statement that the provider has the right to appeal the suspension and the manner in which an appeal must be filed.

(4) Any appeal of a notice of suspension of payment shall be conducted according to rule .01 of this chapter.

(5) Any suspension of payment shall be temporary and shall not continue after:

(a) The Bureau or prosecuting authority determines there is insufficient evidence of fraud by the provider; or (b) Legal proceedings related to the provider’s alleged fraud are completed.

(6) The Bureau must document in writing the termination of a suspension of payment. Such document must include any applicable appeal rights available to the provider.

Statutory Authority: T.C.A. §§ 4-5-202, 71-5-105 and 71-5-109. Administrative History: Emergency

rule filed February 18, 2011; effective through August 17, 2011. Original rule filed May 18, 2011; effective August 16, 2011.

Tenn. Comp. R. & Regs. 1200-13-18-.06 ELECTRONIC HEALTH RECORD INCENTIVE PROGRAM (EHR-IP)

(1) An approved provider of TennCare services, upon receipt of a notice of action, may appeal the following issues related to the EHR-IP:

(a) Denial of an incentive payment;

(b) Incentive payment amount;

(c) Determination of eligibility for an incentive payment, including but not limited to measurement of patient volume;

(d) Determination of efforts to adopt, implement or upgrade to certified EHR technology during the first year of the EHR-IP or meaningful use of certified EHR technology in subsequent years;

(e) Whether the provider is hospital-based;

(f) Whether the provider is practicing predominantly in an FQHC or RHC;

(g) Whether a hospital qualifies as an acute care or children’s hospital; or, (h) Whether the provider is already participating in the Medicare incentive program or in the Medicaid incentive program of another state and therefore is ineligible for duplicate TennCare incentive program payments.

(2) Each notice of action sent to a provider of a determination of any matter listed in paragraph (1) shall contain the following:

(a) The contact information to reach an individual knowledgeable about the EHR-IP who is authorized to discuss the determination with which the provider disagrees;

(b) The manner by which the provider may submit additional information to support his disagreement with the determination; and (c) A statement that the provider has the right to appeal the determination with which he disagrees and the manner in which an appeal must be filed.

(3) Any appeal of a notice of action shall be conducted according to rule .01 of this chapter.

Statutory Authority: T.C.A. §§ 4-5-202, 71-5-105 and 71-5-109. Administrative History: Emergency

rule filed February 18, 2011; effective through August 17, 2011. Original rule filed May 18, 2011; effective August 16, 2011.

Tenn. Comp. R. & Regs. 1200-13-18-.07 TERMINATION OR EXCLUSION OF A PROVIDER FROM PROGRAM

PARTICIPATION.

(1) A provider may be terminated or excluded from participation in the TennCare program.

(2) Federal Mandatory Exclusion. The Bureau is required by federal law to exclude a provider from participation in the TennCare program upon notice from HHS or CMS under the following circumstances:

(a) Conviction of program-related crimes;

(b) Conviction relating to patient abuse;

(c) Felony conviction relating to health care fraud; or (d) Felony conviction relating to controlled substance.

(3) Federal Permissive Exclusion. Pursuant to federal law, the Bureau may exclude a provider from participation in the TennCare program under the following circumstances:

(a) Conviction related to fraud;

(b) Conviction related to obstruction of an investigation or audit;

(c) Misdemeanor conviction related to controlled substance;

(d) License revocation or suspension;

(e) Exclusion or suspension under federal or state health care program;

(f) Claims for excessive charges or unnecessary services and failure of certain organizations to furnish medically necessary services;

(g) Fraud, kickbacks, and other prohibited activities;

(h) Entities controlled by a sanctioned individual;

(i) Failure to disclose required information;

(j) Failure to supply requested information on subcontractors and suppliers;

(k) Failure to supply payment information;

(l) Failure to grant immediate access;

(m) Failure to take corrective action;

(n) Default on health education loan or scholarship obligations;

(o) Individuals controlling a sanctioned entity; or (p) Making false statements or misrepresentation of material facts.

(4) When a provider exclusion is mandatory, the notice of action shall state that the provider has no right to appeal the termination from program participation.

(5) When a provider exclusion is permissive, the notice of action shall include a statement that the provider has the right to appeal the termination from program participation and the manner in which an appeal must be filed.

Statutory Authority: T.C.A. §§ 4-5-202, 71-5-105 and 71-5-109. Administrative History: Emergency

rule filed February 18, 2011; effective through August 17, 2011. Original rule filed May 18, 2011; effective August 16, 2011.

Tenn. Comp. R. & Regs. 1200-13-18-.08 PROVIDER SANCTIONS

(1) Pursuant to the authority granted by T.C.A. § 71-5-118 to the Commissioner to impose sanctions against providers, the Commissioner, through the Bureau, may take the following actions against a provider upon a finding that such actions will further the purpose of the Tennessee Medical Assistance Act:

(a) Subject providers to stringent review and audit procedures which may include clinical evaluation of claim services and a prepayment requirement for documentation and for justification of each claim;

(b) Refuse to issue or terminate a Tennessee Medicaid Provider Number if any person who has an ownership or controlling interest in the provider, or who is an agent or managing employee of the provider, has been convicted of a criminal offense related to that person’s involvement in any program established under Medicare, Medicaid or the U.S. Title XX Services Program;

(c) Refuse to issue or terminate a Tennessee Medicaid Provider Number if a determination is made that the provider did not fully and accurately make any disclosure of any person who has ownership or controlling interest in the provider, or is an agent or managing employee of the provider and has been convicted of a criminal offense related to that person’s involvement in any program under Medicare, Medicaid or the U.S. Title XX Services Program since the inception of these programs;

(d) Refuse to issue or terminate a Tennessee Medicaid Provider Number if the appropriate State Board of Licensing or Certification fails to license or certify the provider at any time for any reason or suspends or revokes a license or certification;

(e) Refuse to issue or terminate a Tennessee Medicaid Provider Number upon notification by the U.S. Office of Inspector General Department of Health and Human Services that the provider is not eligible under Medicare or Medicaid for federal financial participation;

(f) Suspend or withhold payments to a provider in cases of fraud, willful misrepresentation, or flagrant noncompliance; or, (g) Recover from a provider any payments made by a recipient and/or his family for a covered service when evidence of recipient billing by the provider is determined by the Bureau and repayment by the provider to the recipient and/or his family is not made within 30 days of receiving notification from the Bureau to make repayment. If a provider knowingly bills a recipient and/or family for a TennCare covered service, in total or in part, except as otherwise permitted by State rules, the Bureau may terminate the provider from participation in the program.

(2) In addition to the grounds for sanctions set out in T.C.A. § 71-5-118, activities or practices which justify sanctions against a provider and may include recoupment of monies incorrectly paid shall include but not be limited to:

(a) Noncompliance with contractual terms;

(b) Billing for a service in a quantity which is greater than the amount provided;

(c) Billing for a service which is not provided or not documented;

(d) Knowingly providing incomplete, inaccurate, or erroneous information to TennCare or its agent(s);

(e) Continued provision of poor record keeping or inappropriate or inadequate medical care;

(f) Medical assistance of a quality below recognized standards;

(g) Suspension from the Medicare or Medicaid program(s) by the authorized U.S. enforcement agency;

(h) Partial or total loss (voluntary or otherwise) of a provider’s federal Drug Enforcement Agency (DEA) dispensing or prescribing certification;

(i) Restriction to or loss of practice by a state licensing board action;

(j) Acceptance of a pretrial diversion, in state or federal court, from a Medicaid or Medicare fraud charge or evidence from such charge;

(k) Violation of the responsible state licensing board license or certification rules;

(l) Conviction of any felony, any offense under state or federal drug laws, or any offense involving moral turpitude;

(m) Dispensing, prescribing, or otherwise distributing any controlled substance or any other drug not in the course of professional practice, or not in good faith to relieve pain and suffering, or not to cure an ailment, physical or mental infirmity or disease;

(n) Dispensing, prescribing, or otherwise distributing to any person a controlled substance or other drug if such person is addicted to the habit of using controlled substances without making a bona fide effort to cure the habit of such patient;

(o) Dispensing, prescribing or otherwise distributing any controlled substance or other drug to any person in violation of any law of the state or of the United States of America;

(p) Engaging in the provision of medical or dental service when mentally or physically unable to safely do so;

(q) Billing TennCare an amount that is greater than the provider’s usual and customary charge to the general public for that service;

(r) Falsifying or causing to be falsified dates of service, dates of certification or recertification or back dating any record which results in or could result in an inappropriate cost to TennCare;

(s) Fragmentation or submitting claims separately on the component parts of a procedure instead of claiming a single procedure code which includes the entire procedure or all component parts, when such approach results in TennCare paying a greater amount for the components than it would for the entire procedure; or, (t) Submitting claims for a separate procedure which is commonly carried out as a component part of a larger procedure, unless it is performed alone for a medically justified specific purpose.

Statutory Authority: T.C.A. §§ 4-5-202, 71-5-105 and 71-5-109. Administrative History: Original rule filed May 18, 2011; effective August 16, 2011.

Chapter 1200-13-19 Appeals of Certain Eligibility Determinations and TennCare Delay Hearings

Tenn. Comp. R. & Regs. 1200-13-19-.01 SCOPE AND AUTHORITY

This chapter governs all administrative hearings conducted for the purpose of reviewing eligibility determinations for the following categories which use the MAGI income methodology: Children Under 19, Pregnant Women, Caretaker Relatives, CHIP – Children and Pregnancy (CoverKids/HealthyTNBabies). Eligibility determination appeals for any other eligibility category will not be governed by this chapter. This chapter will govern all delay hearings for all eligibility categories. These rules preempt any other TennCare Rules to the extent that they are in conflict with this

chapter.

(1) The Tennessee Medical Assistance Act of 1968 and Executive Order Number 23, dated October 19, 1999, designate the Tennessee Department of Finance and Administration as the single state agency for purposes of administering Title XIX of the Social Security Act (Medicaid).

(2) The CoverKids Act of 2006 authorizes the Tennessee Department of Finance and Administration to establish and administer a program to provide health care coverage to uninsured children under Title XXI of the Social Security Act (State Children’s Health Insurance Program).

(3) Titles XIX and XXI of the Social Security Act, TennCare II Medicaid Section 1115 Demonstration Waiver, and 42 CFR Subpart E require the designated state agency to provide for appeals and fair hearings concerning eligibility determinations for applicants and recipients of assistance and services provided through the programs.

(4) The Commissioner of the Department of Finance and Administration has placed responsibility for eligibility determination appeal hearings in the Division of Health Care Finance and Administration (HCFA), except as specifically delegated to the Department of Human Services. HCFA employs Administrative Judges vested with full authority to conduct the hearing process, including authority to schedule and conduct a hearing; administer oaths; issue subpoenas; rule upon offers of proof; regulate the course of the hearing; set the time and place for continued hearings; enter an Initial Order; rule on petitions for reconsideration; and perform duties or actions that are necessary for the fair and timely management of the administrative hearing process.

(5) Tennessee Code Annotated § 71-5-112 requires any hearing concerning matters of eligibility for medical assistance to be conducted under the Tennessee Uniform Administrative Procedures Act.

(6) Any procedural matter not specifically addressed by these rules is to be resolved by consulting the following authorities in the order listed: the Tennessee Uniform Administrative Procedures Act (UAPA), the Uniform Rules of Procedure For Hearing Contested Cases Before State Administrative Agencies (UAPA Rules), and the Tennessee Rules of Civil Procedure (TRCP).

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.02 DEFINITIONS

(1) Administrative Judge. An impartial employee of the Agency who has no direct involvement in the action under consideration prior to the filing of the appeal; is licensed to practice law; is authorized to conduct administrative hearings; and, will hear contested cases and will enter Initial Orders as set out in T.C.A. §§ 4-5-301(a)(2) and 314(b).

(2) Agency. The TennCare Bureau or CoverKids, as applicable.

(3) Agency Record. The Agency record will consist solely of: notice of all proceedings; any prehearing order; any motions, pleadings, briefs, petitions, requests and intermediate rulings; evidence received or considered; a statement of matters officially noticed; proffers of proof and objections and rulings thereon; proposed findings, requested orders, and exceptions; the tape recording, stenographic notes or symbols, or transcript of the hearing; any Final Order, Initial Order, or order on reconsideration; staff memoranda or data submitted to the Agency unless prepared and submitted by personal assistants and not inconsistent with T.C.A. § 4-5- 304(b); and matters placed on the record after an ex parte communication. The record must be maintained for a period of time not less than three (3) years as required by T.C.A. § 4-5- 319(a). This will be the official record for the purposes of T.C.A. § 4-5-322.

(4) Appeal. The process of obtaining an administrative hearing as a result of an Agency action or inaction regarding matters affecting eligibility for TennCare or CoverKids, or the process of obtaining review of an Initial Order by the Commissioner’s Designee or judicial review of a Final Order.

(5) Appeal Request. Request for a hearing.

(6) Appellant. An applicant or enrollee whose appeal of an action or inaction of the Agency has been determined to present a valid factual dispute. The appellant bears the burden of proof in any hearing conducted under this chapter. Also referred to as the Petitioner.

(7) Applicant. An individual who submits an application for TennCare or CoverKids health coverage, or the Medicare Savings Program, or the person who acts as an authorized representative for the applicant.

(8) Burden of Proof. The minimum evidentiary standard required in order to prevail in an administrative hearing is a preponderance of the evidence. A “preponderance of the evidence” means the greater weight of the evidence or that, according to the evidence, the conclusion sought by the party with the burden of proof is the more probable conclusion. The appellant bears the burden of proof in any hearing conducted under this chapter.

(9) Children’s Health Insurance Program (CHIP). A program established and administered by a State, jointly funded with the Centers for Medicare and Medicaid Services (CMS), to provide health assistance to uninsured, low-income children through a separate child health program, a Medicaid expansion program, or a combination program.

(10) Clerk’s Office. The Agency Appeals Clerk’s Office.

(11) Commissioner. The chief administrative officer of the Tennessee department where the Bureau of TennCare is administratively located.

(12) Commissioner’s Designee. A person authorized by the Commissioner to review appeals of Initial Orders and to enter Final Orders under T.C.A. § 4-5-315, or to review Petitions for Stay or Reconsideration of Final Orders. Petitions for Reconsideration of an Initial Order will be disposed of by the same person who rendered the Initial Order, if available.

(13) Contested Case Proceeding. See “Hearing”.

(14) CoverKids. The Children’s Health Insurance Program in Tennessee.

(15) Delay Appeal. An appeal of an application that has been pending for longer than 45 days, or 90 days for CHOICES applications, with the sole purpose of determining whether the delay in processing is unreasonable.

(16) Ex Parte Communication. An exchange of information regarding an issue of fact in a contested case proceeding between one party and the Administrative Judge without including the opposing party. Communication may take place orally or in writing, by telephone, face-toface, or electronically. Communications between Agency members or their attorneys are not considered to be ex parte. An Administrative Judge, hearing officer, or Agency member may communicate with the Agency regarding any matter pending before the Agency if such persons do not receive ex parte communications of a type that the Administrative Judge, hearing officer, or Agency members would be prohibited from receiving, and do not furnish, augment, diminish, or modify the evidence in the record. Matters of scheduling, dismissal, withdrawal or other administrative issues are not ex parte communications.

(17) Fair Hearing. See “Hearing”.

(18) Findings of Fact. The factual findings following the administrative hearing, enumerated in the Initial and Final Order, which include a concise and explicit statement of the underlying facts of record to support the findings.

(19) Final Order. The Initial Order becomes a Final Order in fifteen (15) days without further notice if not appealed. If the Initial Order is reviewed under T.C.A. § 4-5-315, the Commissioner or Commissioner’s Designee may render a Final Order. The Final Order is binding upon all parties unless it is stayed, reversed or set aside according to applicable rules. A statement of the procedures and time limits for seeking reconsideration or judicial review must be included.

(20) Good Cause Review. An informal review conducted by the Agency for sufficient justification to accept an untimely appeal. A Good Cause Review is limited to oral or written information provided with a request for an appeal. A Good Cause Review decision is solely within the Agency’s discretion and does not entitle the appellant to additional due process, including notice and the right to a hearing. Sufficient justification includes, but is not limited to, agency error, hospitalization, or disability that prevented a timely appeal. Unsupported allegations that a notice was not received is not sufficient justification to accept an untimely appeal.

(21) Hearing. A contested case proceeding where evidence is heard by an Administrative Judge to render a decision regarding an applicant’s or enrollee’s delayed adjudication or eligibility appeal, conducted under this chapter. Also referred to as a Fair Hearing or a Contested Case Proceeding.

(22) Initial Order. The decision of the Administrative Judge following an administrative hearing.

The Initial Order must contain the decision, findings of fact, conclusions of law, the policy reasons for the decision and the remedy prescribed. It must include a statement of any circumstances under which the Initial Order may, without further notice, become a Final Order. A statement of the procedures and time limits for seeking reconsideration or other administrative relief and the time limits for seeking judicial review will be included.

(23) Modified Adjusted Gross Income (MAGI). Has the same meaning as is found in 42 C.F.R. § 435.603.

(24) Notice of Hearing. The pleading filed with the TennCare Administrative Hearing Unit by the Agency upon receipt of an appeal. It must contain a statement of the time, place, nature of the hearing, and the right to be represented by counsel or another authorized person of his choice; a statement of the legal authority and jurisdiction under which the hearing is to be held, referring to the particular statutes and rules involved; and a short and plain statement of the matters asserted, in compliance with T.C.A. § 4-5-307(b).

(25) Party. Each person or Agency named or admitted as a party, or properly seeking and entitled as of right to be admitted as a party.

(26) Petitioner. See Appellant.

(27) Pleadings. Written statements of the facts and law which constitute a party’s position or point of view in a contested case and which, when taken together with the other party’s pleadings, will define the issues to be decided in the case. Pleadings may be in legal form, such as a “Notice of Hearing,” “Petition for Hearing” or “Answer,” or, where not practicable to put them in legal form, letters or other papers may serve as pleadings in a contested case, if necessary to define what the parties’ positions are and what the issues in the case will be.

(28) Request for a Hearing. A clear expression by the applicant or beneficiary, or his authorized representative, that he wants the opportunity to present his case to a reviewing authority.

(29) Representative. An individual or organization, including legal counsel, a relative, a friend, or another spokesperson, authorized by an appellant to represent him during an appeal.

(30) Respondent. The party who is responding to the action brought by the petitioner, usually the Agency.

(31) Single State Agency. The Tennessee Department of Finance and Administration, designated by the State and CMS pursuant to Title XIX of the Social Security Act and the Section 1115 Research and Demonstration waiver granted to the State of Tennessee to administer TennCare.

(32) TennCare. The program administered by the Single State Agency as designated by the State and CMS pursuant to Title XIX of the Social Security Act and the Section 1115 Research and Demonstration waiver granted to the State of Tennessee.

(33) Valid Factual Dispute. A dispute that, if resolved in favor of the appellant, would prevent the state from taking the action that is the subject of the appeal.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 71-5-105, 71-5-109, 71-5-112, and 71-5-134; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015. Amendments filed December 4, 2025; effective March 4, 2026.

Tenn. Comp. R. & Regs. 1200-13-19-.03 ACCESSIBILITY

Information concerning the availability of language assistance must be provided to applicants and enrollees, including individuals with disabilities or who have limited English proficiency, in plain language and in a manner that is accessible and timely as required by the Americans with Disabilities Act and section 504 of the Rehabilitation Act.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.04 NOTICE OF ELIGIBILITY DETERMINATION

(1) The Agency must send each applicant a written notice of the Agency’s decision on his application, and if eligibility is denied, the reasons for the action, the specific regulation supporting the action, and an explanation of his right to request a hearing.

(2) Before an application is denied for lack of documentation or conflicting information, the Agency will notify the applicant of the type of documentary proof he must submit in order to meet the eligibility requirements set out in 42 C.F.R. Part 435.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.05 APPEAL RIGHTS, NOTICES AND PROCEDURES

(1) The Agency must grant an opportunity for a hearing to the following:

(a) Any applicant who requests it because his claim for services is denied or is not acted upon with reasonable promptness.

(b) Any beneficiary who requests it because he believes the Agency has taken an action erroneously.

(c) Any enrollee who is entitled to a hearing under 42 C.F.R. 438 subpart B.

(2) The Agency need not grant a hearing if the sole issue is a Federal or State law requiring an automatic change adversely affecting some or all beneficiaries.

(3) When the Agency receives an appeal from an appellant, the Agency will dismiss this appeal unless the appellant has established a valid factual dispute relating to the appeal. The Agency will screen all appeals submitted by appellants to determine if each appellant has presented a valid factual dispute. If the Agency determines that an appellant failed to present a valid factual dispute, the Agency will immediately provide the appellant with a notice informing him that he must provide additional information as identified in the notice. If the appellant does not provide this information within ten (10) days of the date of the notice, the appeal will be dismissed without the opportunity for a fair hearing. If the appellant adequately responds to this notice, the Agency will inform the appellant that the appeal will proceed to a hearing. If the appellant responds but fails to provide adequate information, the Agency will provide a notice to the appellant, informing him that the appeal is dismissed without the opportunity for a fair hearing. If the appellant does not respond, the appeal will be dismissed without the opportunity for a fair hearing, without further notice to the appellant.

(4) The Agency must provide notice of his right to a hearing; of the method by which he may obtain a hearing; and that he may represent himself or use a representative at the time:

(a) The individual applies for CoverKids or TennCare; and (b) Of any action affecting his eligibility.

(5) The notice of appeal rights and procedures must contain:

(a) A statement of what action the Agency intends to take;

(b) The reasons for the intended action;

(c) The specific rules that support, or the change in Federal or State law that requires, the action;

(d) An explanation of:

1. The individual’s right to request a hearing; or 2. In cases of an action based on a change in law, the circumstances under which a hearing will be granted; and 3. The circumstances under which Medicaid is continued if a hearing is requested.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.06 TIME

(1) In computing any period of time prescribed or allowed by statute, rule or order, the date of the act, event or default after which the designated period of time begins to run is not to be included. The last day of the time period is to be included unless it is a Saturday, a Sunday or a legal holiday, which extends the period until the end of the next day which is neither a Saturday, a Sunday nor a legal holiday. When the period of time prescribed or allowed is less than seven (7) days, intermediate Saturdays, Sundays and legal holidays are excluded in the computation. The Notice of Hearing shall provide notice of this provision or inform the applicant or recipient of the specific calendar dates by which certain actions must be taken.

(2) Except in regard to petitions for appeal, reconsideration or review under T.C.A. §§ 4-5-315, 4- 5-317 and 4-5-322, or where otherwise prohibited by law, when an act is required or allowed to be done at or within a specified time, the Agency or Administrative Judge may, at any time:

(a) With or without motion or notice, order the period enlarged if the request is made before the expiration of the period originally prescribed or as extended by previous order; or (b) Upon motion made after the expiration of the specified period, permit the act to be done late, where the failure to act was the result of excusable neglect. Nothing in this

section is to be construed to allow any ex parte communications concerning any issue in the proceeding that would be prohibited by T.C.A. § 4-5-304.

(3) An appeal or request for a hearing must be received by the Agency within forty (40) calendar days (inclusive of mail time) of the date of the Agency notice to the individual regarding the intended action or prior to the date of action specified in the notice, whichever is later. The agency will conduct a Good Cause Review of an appeal filed after the appeal deadline and may accept an untimely appeal at its sole discretion. Appeals closed as untimely are subject to judicial review pursuant to T.C.A. § 4-5-322.

(4) Any communication submitted electronically must be received by midnight of the designated date.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 71-5-105, 71-5-109, 71-5-112, and 71-5-134; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015. Amendments filed December 4, 2025; effective March 4, 2026.

Tenn. Comp. R. & Regs. 1200-13-19-.07 DISMISSAL OF APPEAL OR REQUEST FOR HEARING

(1) The Agency may close a request for a delay appeal upon making an eligibility determination.

(2) The Agency may dismiss a request for hearing if the appeal request has been withdrawn by the appellant in writing or through electronic or oral notification.

(3) Upon appropriate proof, the Agency may dismiss an appeal at any point in the hearing process for any of the reasons that the appeal might be denied by the Agency by rule or law, if such facts had been known by the Agency before the appeal was accepted for hearing.

(4) The Agency must dismiss an appeal or request for hearing if the appeal does not present a valid factual dispute and the appellant does not provide additional information or clarification to establish a valid factual dispute within fifteen (15) (inclusive of mail time) days of an Agency request. The Agency decision that an appeal does not raise a valid factual dispute is not appealable.

(5) When the Agency dismisses an appeal it must provide a timely notice of dismissal to the appellant, stating:

(a) The reason for dismissal;

(b) An explanation of the dismissal’s effect on the appellant’s eligibility; and (c) An explanation of how the dismissal may be reviewed.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 71-5-105, 71-5-109, 71-5-112, and 71-5-134; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective March 3, 2015. Amendments filed December 4, 2025; effective March 4, 2026.

Tenn. Comp. R. & Regs. 1200-13-19-.08 FILING AND SERVICE OF PLEADINGS AND OTHER MATERIALS

(1) After an appeal is filed, all pleadings and any other materials that are required to be filed by a time certain must be received by the Clerk’s Office by the specified time. The materials may be filed by delivering them to the Agency in person, electronically, by mail or by private carrier.

(2) Upon initiation of a contested case, all pleadings and other materials required to be filed or submitted prior to the hearing must be filed with the Clerk’s Office, where they will be stamped with the date of receipt.

(3) A petition for appeal of an Initial Order or for reconsideration or stay of an Initial or Final Order must be filed with the Agency.

(4) Discovery materials that are not actually introduced as evidence need not be filed, except as provided in this chapter.

(5) Copies of all materials filed with the Agency in a contested case shall also be served upon all parties, or upon their counsel, and contain a statement indicating that copies have been served upon all parties. Service may be by mail or equivalent carrier, by hand delivery, or in electronic format.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.09 TELEPHONIC AND ALTERNATE ELECTRONIC METHODS FOR CONDUCTING

PRE-HEARING CONFERENCES AND HEARINGS. In the discretion of the Administrative Judge, and with the concurrence of the parties, any pre-hearing conference or hearing may be conducted by telephone or other electronic means, if each participant in the conference or hearing has an opportunity to fully participate in the entire proceeding while it is taking place.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.10 COMMENCEMENT OF CONTESTED CASE PROCEEDINGS

(1) The appellant or his representative may request an appeal or a hearing by any clear expression, oral, written, or through other commonly available electronic means.

(2) Upon determination that an appeal or a request for a hearing contains a valid factual dispute, the Agency will issue a notice of hearing as defined in this chapter. The notice of hearing must:

(a) Contain a statement of the date, time, place, and nature of the hearing;

(b) Inform the appellant of the right to be represented by counsel or another authorized person of his choice;

(c) Contain a statement of the legal authority and jurisdiction under which the hearing will be held, including references to the specific statutes and rules involved;

(d) Contain instructions to the appellant to notify the Agency if he requires a change in the schedule;

(e) Provide a short and plain statement of the matters asserted and define the issues and refer to detailed statements of the matters involved, if available;

(f) Provide information about hearing procedures, including the right to present written evidence and testimony and to bring witnesses and members of his family to the hearing.

(g) Inform the appellant of his right to inspect the Agency file regarding the matter under appeal and to copy from the file.

(3) Service of Notice of Hearing.

(a) The Agency will provide the appellant or his representative with a copy of the notice of hearing by delivering it to the party electronically; by U.S. Mail; by certified mail; FedEx, UPS, or equivalent carrier; or by personal service. The notice will be sent a minimum of ten (10) days in advance of the date of the hearing. Delivery is presumed within five (5) days if sent by regular mail; the day following for expedited or overnighted delivery; the same day for electronic delivery and personal service.

(b) Service of the notice of hearing will be made at the address required to be kept current by the applicant or recipient with the Agency by T.C.A. §§ 71-5-106(l) and 110(c)(1), and at the address provided with the request for hearing, if different from the address on file with the Agency. The Agency must use the best address known to it, whether provided directly by the applicant or recipient or obtained indirectly.

(c) If there is a motion for default and there is no indication of actual service on a party, in determining whether to grant the default the Administrative Judge must consider the following:

1. Whether any other attempts at actual service were made;

2. Whether and to what extent actual service is feasible in any given case;

3. What attempts were made to make contact with the party electronically, by telephone, by regular mail, or otherwise; and 4. Whether the Agency has actual knowledge or reason to know that the party may be located at an address other than the address to which the notice was mailed.

(4) Supplemented Notice. In the event it is impractical or impossible to include every element required for notice in the notice of hearing, elements such as the time and place of the hearing may be supplemented in a later written notice.

(5) Filing of Documents. When a contested case is commenced in which an Administrative Judge will be conducting the proceedings, the Agency will provide all the papers that make up the notice of hearing and all pleadings, motions, and objections, formal or otherwise, that have been provided to or generated by the Agency. Legible copies may be filed in lieu of originals.

(6) Answer. The party may respond to the issues set out in the notice or other original pleading by filing a written answer with the Agency in which the party may:

(a) Object to the notice upon the ground that it does not state acts or omissions upon which the Agency may proceed;

(b) Object on the basis of lack of jurisdiction over the subject matter;

(c) Object on the basis of lack of jurisdiction over the person;

(d) Object on the basis of insufficiency of the notice;

(e) Object on the basis of insufficiency of service of the notice;

(f) Object on the basis of failure to join an indispensable party;

(g) Generally deny all the allegations contained in the notice or state that he is without knowledge as to each and every allegation, both of which shall be deemed a general denial of all charges;

(h) Admit in part or deny in part allegations in the notice and elaborate on or explain relevant issues of fact in a manner that will simplify the ultimate issues; and (i) Assert any available defense.

(7) Amendment to Notice. The notice or other original pleading may be amended within two (2) weeks from service of the notice and before an answer is filed, unless it is shown that undue prejudice will result from this amendment. Otherwise the notice or other original pleading may only be amended by written consent of the parties or by leave of the Administrative Judge, and leave shall be freely given when justice so requires. No amendment to the notice may introduce a new statutory or regulatory basis for denial or termination of enrollment without original service and running of times applicable to service of the original notice. The Administrative Judge shall not grant a continuance to amend the notice or original pleading if it would prejudice the right to a hearing and Initial Order within any mandatory time frames.

(8) Amendments to Conform to the Evidence. When issues not raised by the pleadings are tried by express or implied consent of the parties, they will be treated as if they had been raised in the pleadings. Such amendment of the pleadings as may be necessary to cause them to conform to the evidence and to raise these issues may be made upon motion of any party at any time; but failure to amend for this reason does not affect the result of the determination of these issues. If evidence is objected to at the hearing on the ground that it is not within the issues in the pleadings, the Administrative Judge may allow the pleadings to be amended unless the objecting party shows that the admission of such evidence would prejudice his defense. The Administrative Judge may grant a continuance to enable the objecting party to have reasonable notice of the amendments. However, when the individual is not represented by counsel, the burden is on the Administrative Judge to rule on whether to allow additional evidence and the need for continuances to enable the party additional time to address the new grounds.

(9) Pre-Hearing Conference.

(a) In any action set for hearing the Administrative Judge, upon his own motion or upon motion of a party or qualified representative, may direct the parties to appear before him for a conference to consider:

1. The simplification of issues;

2. The necessity or desirability of amendments to the pleadings;

3. The possibility of obtaining admissions of fact and of documents to avoid unnecessary proof;

4. The limitation of the number of expert witnesses; or 5. Other matters that may aid in the disposition of the action.

(b) The Administrative Judge will enter an order reciting the action taken at the conference, the amendments allowed to the pleadings, the agreements made by the parties to the matters considered, and limiting the issues for hearing to those not disposed of by the admissions or agreements of the parties. When entered such order controls the subsequent course of the action, unless modified at the hearing to prevent manifest injustice.

(c) If a pre-hearing conference is not held, the Administrative Judge may issue a prehearing order, based on the pleadings, to regulate the conduct of the proceedings.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.11 REPRESENTATION BY COUNSEL

(1) Any party to a contested case hearing may be advised and represented, at his own expense, by an attorney in good standing and possessing a current license to practice law in the state of Tennessee.

(2) Any party to a contested case hearing may represent himself or be represented by a nonattorney of his choice, such as a relative, friend or another spokesperson. If the party is represented by a non-attorney, he must provide valid written or oral attestation on the record authorizing representation.

(3) The Agency will notify all parties in a contested case hearing of the right to be represented by counsel. An appearance by a party at a hearing without counsel may be deemed a waiver of the right to counsel.

(4) Entry of an appearance by counsel will be made by the filing of pleadings, or of a formal or informal notice of appearance, or appearance as counsel at a pre-hearing conference or a hearing.

(5) After appearance of counsel has been made, all pleadings, motions, and other documents must be served upon counsel. If appearance is by a non-attorney representative, all documents must be served on both the party and the representative.

(6) Counsel wishing to withdraw must give written notice to the Agency and the Administrative Judge.

(7) Out-of-state attorneys shall comply with T.C.A. § 23-3-103(a) and Tenn. Sup. Ct. R. 19, except that the affidavit referred to in Rule 19 and a motion requesting pro hac vice admission shall be filed with the Clerk’s Office, and served upon the Board of Professional Responsibility according to Rule 19 not later than the first occasion in which the out-of-state attorney files any pleading or paper with the Clerk’s Office or otherwise personally appears.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.12 PRE-HEARING MOTIONS

(1) Motions. Parties to a contested case are encouraged to resolve matters on an informal basis prior to a contested case hearing. If efforts at informal resolution fail, any party may request relief in the form of a motion by serving a copy on all parties and by filing the motion with the Administrative Judge. The motion must contain a request for the relief sought and the grounds which entitle the moving party to relief. A motion is considered submitted for disposition seven (7) days after it was filed, unless oral argument is requested and granted, or unless a longer or shorter time is set by the Administrative Judge.

(2) Time Limits; Oral Argument. Each opposing party may file a written response to a motion within seven (7) days of the date the motion was filed. If oral argument is requested, the motion may be argued by conference telephone call. A brief memorandum of law submitted with the motion is preferable to oral argument.

(3) Affidavits; Briefs and Supporting Statements.

(a) Motions and responses to motions must be accompanied by supporting affidavits and briefs or supporting statements. Motions and responses to motions must be supported by affidavits for facts relied upon which are not of record or the subject of official notice.

Supporting affidavits must contain only facts admissible in evidence under T.C.A. § 4- 5-313, and to which the affiants are competent to testify. Properly verified copies of all papers or parts of papers referred to in the affidavits may be attached.

(b) In the discretion of the Administrative Judge, a schedule may be established for submitting briefs or supporting statements.

(4) Disposition of Motions; Drafting the Order. The Administrative Judge must render a decision on a motion by issuing an order or by instructing the prevailing party to prepare and submit an order within seven (7) days of the ruling on the motion, or as otherwise ordered by the Administrative Judge. After signing an order, the Administrative Judge will cause the order to be served upon the parties.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.13 CONTINUANCES

(1) Continuances may be granted for good cause in any stage of the proceeding. The need for a continuance must be brought to the attention of the Administrative Judge as soon as practicable by the appellant, by the Agency, or by mutual consent of the parties.

(2) If an appellant requests a continuance, any mandatory time limits or deadlines for conducting hearings and issuing Initial Orders by an Administrative Judge may be extended by a like period of time. The applicable time frame will be extended only by the number of days that the appellant delays the proceedings, either by his acts or omissions.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.14 DISCOVERY

(1) Any party to a contested case proceeding has the right to examine Agency manuals, the Agency case file regarding the matter being contested, and all documents and records used as evidence, at the Agency office during normal State office hours, except that records, the confidentiality of which is protected by law may not be inspected consistent with T.C.A. § 4-5- 311. A party or his representative may copy entries or documents to be introduced at the hearing as supporting evidence.

(2) Any party to a contested case proceeding has the right to reasonable discovery under T.C.A. § 4-5-311.

(3) The Administrative Judge will issue subpoenas to require the attendance of witnesses and the production of books, records, papers, or other tangible things necessary and proper for the hearing proceeding, when requested by a party involved in the case. Subpoenas may be served at any place within the State by certified mail in addition to means of service provided by the TRCP.

(4) The Administrative Judge may at or before the time specified in the subpoena for compliance:

(a) Void or modify a subpoena if it is unreasonable and oppressive, or (b) Tax the party making the request with reasonable costs in the production of books, papers, documents, or other tangible things.

(5) The parties should attempt to achieve discovery informally. Only if such attempts have failed or if the complexity of the case makes informal discovery impracticable shall discovery be sought and conducted under the TRCP.

(6) Upon motion of a party or upon the Administrative Judge’s own motion, the Administrative Judge may order that discovery be completed by a certain date.

(7) Any motion to compel discovery, motion to quash, motion for protective order, or other discovery related motion must:

(a) Quote verbatim the interrogatory, request, question, or subpoena at issue, or be accompanied by a copy of the interrogatory, request, subpoena, or excerpt of a deposition which shows the question and objection or response if applicable;

(b) State the reason or reasons supporting the motion; and (c) Be accompanied by a detailed statement certifying that the moving party or his counsel has made a good faith effort to resolve by agreement the issues raised and that agreement has not been achieved; such efforts must be set out with particularity in the statement.

(8) The Administrative Judge will decide any motion relating to discovery according to the UAPA, the UAPA Rules, or the TRCP.

(9) Other than as provided in paragraph (7) above, discovery materials need not be filed with the Clerk’s Office.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.15 ORDER OF PROCEEDINGS

(1) Hearings of contested cases, including reconsideration hearings, will be conducted as follows:

(a) The Administrative Judge may confer with the parties prior to a hearing to explain the order of proceedings, admissibility of evidence, number of witnesses and other matters.

(b) The hearing is called to order by the Administrative Judge.

(c) The Administrative Judge introduces himself and gives a very brief statement of the nature of the proceedings, including a statement of his role in making factual and legal rulings.

(d) The Administrative Judge then calls on the petitioner to ask if the petitioner is represented by counsel, and if so, counsel is introduced. The Administrative Judge then introduces the respondent’s counsel and any other officials who may be present at the hearing.

(e) The Administrative Judge states what documents the record contains.

(f) The Administrative Judge swears the witnesses.

(g) The parties are asked whether they wish to have all witnesses excluded from the hearing room except during their testimony. If so, all witnesses are instructed not to discuss the case during the pendency of the proceeding and asked to leave the hearing room. Individual parties are permitted to stay in the hearing room, and the State may have one appropriate individual, who may also be a witness, act as its party representative.

(h) Any preliminary motions, stipulations, or agreed orders are heard by the Administrative Judge.

(i) Opening statements are allowed by both parties.

(j) The petitioner, as the moving party, has the burden of proof, calls the first witness and questioning proceeds as follows:

1. Moving party questions.

2. State cross-examines.

3. Moving party redirects.

4. State re-cross-examines.

5. Administrative Judge may ask questions.

6. Further questions by parties as long as necessary to provide all pertinent testimony.

(k) State calls witnesses and questioning proceeds as follows:

1. State questions.

2. Moving party cross-examines.

3. State redirects.

4. Moving party re-cross-examines.

5. Administrative Judge may ask questions.

6. Further questions by parties as long as necessary to provide all pertinent testimony.

(l) The moving party and the other party are allowed to call appropriate rebuttal and rejoinder witnesses with examination proceeding as outlined above.

(m) Closing arguments are allowed to be presented by both parties.

(n) The Administrative Judge announces the decision or takes the case under advisement.

(2) The parties are informed that an Initial Order will be written and sent to the parties and that the Initial Order will inform the parties of their appeal rights.

(3) Paragraphs (1) and (2) of this rule are intended to be a general outline for the conduct of a contested case proceeding. A departure from the literal form or substance of this outline, in order to expedite or ensure the fairness of proceedings, is not a violation of this rule.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.16 DEFAULT AND UNCONTESTED PROCEEDINGS

(1) The failure of a party to attend or participate in a pre-hearing conference, hearing or other stage of contested case proceedings after appropriate notice of those actions is cause for holding that party in default under T.C.A. § 4-5-309. Failure to comply with any lawful order of the Administrative Judge, necessary to maintain the orderly conduct of the hearing, may be deemed a failure to participate in a stage of a contested case and is cause for a holding of default.

(2) If a party fails to attend or participate as provided in paragraph (1) above, the Administrative Judge will enter into the record evidence of service of notice to that party and determine whether the service of notice is sufficient as a matter of law, according to this chapter. If the notice is held to be sufficient, the Administrative Judge may do either of the following:

(a) Hold the party failing to attend or to participate in default and, after determining that the party in default has the burden of proof, adjourn the proceedings and enter an order of default stating the grounds for the default that will become a Final Order without further notice as provided in this chapter, unless a petition for reconsideration is timely filed; or (b) Hold the party failing to attend or to participate in default and, after determining that the party not in default has the burden of proof, conduct the proceedings without the participation of the defaulting party and include in the Initial Order a written notice of default stating the grounds for the default. The Initial Order will become a Final Order without further notice as provided in this chapter, unless a petition for reconsideration is timely filed.

(3) The Administrative Judge will serve the written notice of entry of default for failure to appear as provided in paragraph (2) above on all parties. The defaulting party, no later than fifteen (15) days after receipt of a notice of default, may file a petition for reconsideration as provided in this chapter and T.C.A. § 4-5-317, requesting that the default be set aside for good cause shown, and stating the grounds relied upon. The Administrative Judge may rule on the petition or take no action for twenty (20) days after which the petition is deemed denied. T.C.A. § 4-5-317.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.17 EVIDENCE

The Administrative Judge will consider the information used to determine the applicant’s eligibility as well as additional relevant information presented as evidence during the course of the appeal. The standard for admissibility of evidence is set out at T.C.A. § 4-5-313.

(1) The testimony of witnesses will be taken in open hearings, except that witnesses may be excluded from the hearing prior to their testimony.

(2) The Administrative Judge will admit and give probative effect to evidence admissible in a court. When necessary to establish facts not reasonably susceptible to proof under the rules of court, evidence may be admitted if it is of a type commonly relied upon by reasonably prudent persons in the conduct of their affairs. The Administrative Judge will give effect to the rules of privilege recognized by law and to state or federal statutes or regulations protecting the confidentiality of certain records and will exclude evidence which in his judgment is irrelevant, immaterial or unduly repetitious.

(3) Documentary evidence otherwise admissible may be received in the form of copies or excerpts, or by incorporation by reference to material already on file with the Agency. Upon request, parties will be given an opportunity to compare the copy with the original, if reasonably available.

(4) Official notice may be taken of:

(a) Any fact that could be judicially noticed in the courts of Tennessee;

(b) The record of other proceedings before the Agency;

(c) Technical or scientific matters within the Administrative Judge’s specialized knowledge; and (d) Codes or standards that have been adopted by an agency of the United States, of Tennessee or of another state, or by a nationally recognized organization or association. Parties will be notified before or during the hearing, or before the issuance of any Initial or Final Order that is based in whole or in part on facts or material noticed, of the specific facts or material noticed and the source, including any staff memoranda and data, and be given an opportunity to contest and rebut the facts or material so noticed.

(5) Every party has the right to present evidence, to make arguments, and to confront and crossexamine witnesses.

(6) Any party intending to introduce an affidavit into evidence must deliver a copy of the affidavit along with the notice described below to the opposing party at least ten (10) days prior to a hearing or a continued hearing. The opposing party has seven (7) days after delivery of the affidavit to deliver to the proponent a request to cross-examine the affiant or the right to cross-examination is waived and the affidavit, if introduced in evidence, will be given the same effect as if the affiant had testified orally. If an opportunity to cross-examine an affiant is not provided after a proper request is made, the affidavit will not be admitted into evidence.

Delivery means actual receipt, for purposes of this paragraph. The Administrative Judge may admit affidavits not submitted in compliance with this paragraph where necessary to prevent injustice.

(7) The notice required to accompany an affidavit must contain the following information and be substantially in the following form:

The accompanying affidavit of __________ (here insert name of affiant) will be introduced as evidence at the hearing in __________ (here insert title of proceeding). __________ (here insert name of affiant) will not be called to testify orally and you will not be entitled to question such affiant unless you notify __________ (here insert name of the proponent or the proponent’s attorney) at __________ (here insert address) that you wish to cross-examine such affiant. To be effective, your request must be mailed or delivered to __________ (here insert name of proponent or the proponent’s attorney) on or before __________ (here insert a date seven (7) days after the date of mailing or delivering the affidavit to the opposing party).

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.18 INITIAL AND FINAL ORDERS

(1) At the conclusion of the hearing, the Administrative Judge may allow the parties a designated amount of time to submit proposed findings of fact and conclusions of law.

(2) The Administrative Judge will issue an Initial Order which automatically becomes the Final Order fifteen (15) days after it is issued unless the Agency receives a timely filed petition for appeal, petition for reconsideration, or petition for a stay of effectiveness. The effective date of an Initial Order that becomes final by operation of law is its original date of entry. The Final Order is binding upon all parties unless it is stayed, reversed or set aside according to applicable rules.

(3) If the Administrative Judge becomes unavailable for any reason before issuing an Initial Order or Final Order, a substitute will be appointed as provided in T.C.A. § 4-5-302. The substitute must use the existing record and may conduct further proceedings as appropriate in the interest of justice.

(4) Contents of the Order.

(a) An Initial Order or a Final Order will include findings of fact, conclusions of law, the policy reasons for the decision, the remedy prescribed and, if applicable, the action taken on a petition for stay of effectiveness. The Agency member’s experience, technical competence, and specialized knowledge may be utilized to evaluate the evidence.

(b) Findings of fact are concise and explicit statements of the underlying facts of record that support the order and must be based exclusively upon the evidence of record from the hearing and on matters officially noticed in that proceeding.

(c) The Initial Order must include a statement that it will automatically become a Final Order without further notice unless a petition for reconsideration or petition for appeal is filed.

(d) The Initial Order or Final Order must include a statement of the procedures and time limits to request an appeal, reconsideration or stay of the Initial or Final Order and the time limits for seeking judicial review of the Final Order.

(5) The Administrative Judge must cause copies of the Initial Order to be sent to each party at the time the order is entered. If an Initial Order becomes final by operation of law, no further notice shall be provided.

(6) If a Final Order is issued, the Agency must cause copies of the Final Order to be sent to each party at the time the order is entered.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.19 APPEAL OF INITIAL ORDERS

(1) Written notice of the right to petition for stay, reconsideration, or appeal must accompany the Initial Order sent to the parties.

(2) If an Initial Order is subject to both a timely petition for reconsideration and a petition for appeal, the petition for reconsideration will be disposed of first and a new fifteen (15) day period will start to run.

(3) A petition for appeal from an Initial Order must be addressed to the Commissioner’s Designee and filed with the Clerk’s Office within fifteen (15) days after entry of an Initial Order and comply with T.C.A. § 4-5-315.

(4) A petition for appeal must state its basis.

(5) The Commissioner’s Designee, on his own motion, may review an Initial Order after giving written notice to the parties within fifteen (15) days after entry of an Initial Order.

(6) On appeal the parties will be permitted an opportunity to file briefs. The Agency may provide the parties an opportunity to present oral argument.

(7) The Commissioner’s Designee may enter a Final Order disposing of the proceeding or may remand the matter for further proceedings with instructions to the Administrative Judge who entered the Initial Order. When remanding a matter, the Commissioner’s Designee may order temporary relief if authorized and appropriate.

(8) A Final Order or an order remanding the matter for further proceedings will be entered in writing within sixty (60) days after receipt of briefs and oral argument, unless that period is waived or extended with the written consent of all parties or for good cause shown. The order will identify any differences from the Initial Order and include or incorporate by express reference to the Initial Order, all information required by paragraph .18(4).

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.20 RECONSIDERATION

(1) Written notice of the right to petition for stay, reconsideration, or appeal must accompany the Initial Order sent to the parties.

(2) If a separate Final Order is entered following the entry of an Initial Order, written notice of the right to petition for reconsideration of the Final Order will accompany the Final Order sent to the parties.

(3) A petition for reconsideration stating in detail the reasons for the request and the relief requested may be addressed to the Administrative Judge and filed with the Clerk’s Office by any party within fifteen (15) days after entry of an Initial Order or Final Order.

(4) If an Initial Order is subject to both a timely petition for reconsideration and a petition for appeal, the petition for reconsideration will be disposed of first and a new fifteen (15) day period will start to run.

(5) Filing a petition for reconsideration of the Final Order does not supersede or delay the effective date of the Final Order. The Final Order takes effect on the date entered by the Agency and continues in effect until the petition for reconsideration is granted or until the Final Order is stayed, superseded, modified, or set aside in a manner provided by law. If a change affecting benefits or services occurs while reconsideration is pending, action to implement that change is not delayed pending the decision concerning reconsideration of the Final Order.

(6) Within twenty (20) days of receiving a petition for reconsideration of the Initial or Final Order, the Administrative Judge who entered the Initial or Final Order will enter a written order as set out at T.C.A. § 4-5-317:

(a) Denying the petition;

(b) Granting the petition and setting the matter for further proceedings; or (c) Granting the petition and issuing a new Initial or Final Order.

(d) If no action is taken on the petition for reconsideration within twenty (20) days, the petition is deemed to be denied.

(7) An order granting a petition for reconsideration and setting the matter for further proceedings will contain:

(a) A statement of the extent and scope of the proceedings;

(b) A statement limiting the proceedings to argument upon the existing record; and (c) State that no new evidence will be introduced, unless the party proposing new evidence shows good cause for his failure to introduce the evidence in the original proceeding.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.21 STAY

(1) Written notice of the right to petition for stay, reconsideration, or appeal must accompany the Initial Order or Final Order sent to the parties.

(2) A petition for stay of effectiveness of an Initial Order or Final Order may be submitted to the Agency within seven (7) days after entry of the order. The Agency may take action on the petition for stay before or after the effective date of the Initial or Final Order.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.22 JUDICIAL REVIEW

(1) Written notice of the right to seek judicial review of the Final Order and the time within which to file a petition for judicial review of the Final Order must be included with the Initial and Final Order sent to the parties.

(2) Judicial review is initiated by filing a petition for review in a Chancery Court of Tennessee having jurisdiction within sixty (60) days after the Final Order is entered. T.C.A. § 4-5-322 sets out the judicial review information.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.23 CLERICAL MISTAKES

Prior to any appeal being perfected by either party to Chancery Court, clerical mistakes in orders or other parts of the record, and errors of oversight or omission may be corrected by the Administrative Judge or the Commissioner’s Designee at any time on his own initiative or on motion of any party and after such notice, if any, as the Administrative Judge or Commissioner’s Designee may require. The entry of a corrected order does not affect the dates of the original appeal time period.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.24 AGENCY RECORD

(1) The Agency record as defined in this chapter will remain on file in the Bureau of TennCare for not less than three (3) years and be available to the appellant or his representative at any reasonable time during business hours.

(2) Public access to Final Orders. Hearing decisions will be accessible to the public for inspection and copying, subject to the requirements of safeguarding information which is confidential under any provision of law or rule. Those portions of any record that contain confidential information may be deleted prior to providing access to the Final Order.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Tenn. Comp. R. & Regs. 1200-13-19-.25 CODE OF JUDICIAL CONDUCT, DISQUALIFICATION AND SEPARATION OF

FUNCTIONS. Administrative Judges must comply with the code of judicial conduct requirements set out in the UAPA Rules and the requirements of T.C.A. §§ 4-5-302 and 4-5-303 concerning disqualification of Administrative Judges and separation of functions. Complaints regarding an individual Administrative Judge’s conduct are to be made to the supervising Administrative Judge and complaints regarding the supervising Administrative Judge are to be made to the Commissioner.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-112; 42 U.S.C. §§ 1396a(a)(3), (5), and (8); 42 C.F.R. 431 Subpart E; and 42 C.F.R. § 435.912.
• Administrative History: Emergency rule filed November 7, 2014; effective through May 6, 2015. Original rule filed February 2, 2015; effective May 3, 2015.

Chapter 1200-13-20 TennCare Technical and Financial Eligibility

Tenn. Comp. R. & Regs. 1200-13-20-.01 SCOPE AND AUTHORITY

(1) This Chapter governs the processes for determining financial and categorical eligibility for the TennCare and CoverKids programs. This Chapter will refer to the programs collectively as TennCare, unless a specific process or requirement for TennCare Medicaid, TennCare Standard, the Medicare Savings Program, or CoverKids differs from the general TennCare process or requirement. This Chapter preempts any other TennCare Rules pertaining to eligibility determination to the extent that they are in conflict.

(2) The Tennessee Medical Assistance Act of 1968 and Executive Order Number 23, dated October 19, 1999, designate the Tennessee Department of Finance and Administration as the Single State Agency for purposes of administering Title XIX of the Social Security Act (Medicaid).

(3) The CoverKids Act of 2006 authorizes the Tennessee Department of Finance and Administration to establish and administer a program to provide health care coverage to uninsured children under Title XXI of the Social Security Act (State Children’s Health Insurance Program: “CHIP”).

(4) Titles XIX and XXI of the Social Security Act, TennCare Medicaid Section 1115 Demonstration Waiver as may be amended, extended, or renewed in the future, and 42 C.F.R. Parts 431 and 435 require the designated State agency to provide for eligibility determinations for applicants seeking assistance and services provided through the programs.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 71-5-105, 71-5-106, 71-5-110, 71-5-111, and 71-5-117.
• Administrative History: Emergency rule filed June 16, 2016; effective through December 13, 2016. New rules filed September 14, 2016; effective December 13, 2016. Amendments filed May 24, 2019; effective August 22, 2019.

Tenn. Comp. R. & Regs. 1200-13-20-.02 DEFINITIONS AND ACRONYMS

(1) Access to Health Insurance (TennCare). The opportunity an individual has to obtain group health insurance as defined elsewhere in these rules. If a person could have enrolled in workrelated or other group health insurance during an employer’s or group’s open enrollment period and chose not to enroll (or had the choice made for him by a family member) that person shall not be considered to lack access to insurance upon closure of the open enrollment period. Neither the cost of an insurance policy or health plan nor the fact that an insurance policy is not as comprehensive as that of the TennCare Program shall be considered in determining eligibility to enroll in any TennCare category where being uninsured is an eligibility prerequisite. Access to health insurance through the Federally Facilitated Marketplace (FFM) shall not constitute “access to insurance” for purposes of eligibility for TennCare.

(2) Achieving a Better Life Experience (ABLE) Account. An account established under 26 U.S.C.A. § 529A. ABLE accounts or 529A accounts are tax-advantaged savings accounts for individuals with disabilities that are established under a qualified ABLE program.

(3) Active SSI Recipient. An individual who has been found eligible to receive SSI benefits by the SSA.

(4) Aged. An individual age sixty-five (65) or older.

(5) Aid to Families With Dependent Children (AFDC). The name of the cash assistance program for families and children prior to the passage of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) in July 1996.

(6) Annuities. Contracts or agreements that, in exchange for a lump sum payment or series of payments, provide for the payment of income at regular intervals, e.g., monthly, quarterly, annually, etc. Annuities establish a source of income for a future period and are often used in retirement planning.

(7) Applicant. An individual who is seeking an eligibility determination for himself through an application submission or a transfer from another agency or insurance affordability program.

For purposes of this Chapter, applicant also includes an individual who is seeking an eligibility determination for himself through an application for Medicare Savings Programs (MSP).

(8) Application. The single, streamlined form developed for use for all insurance affordability programs, as required by 42 C.F.R. § 435.907(b).

(9) Application File Date. See Rule .05(5).

(10) At-Risk for Institutionalization. See definition in Rule 1200-13-01-.02.

(11) Authorized Representative. An Authorized Representative as defined at 42 C.F.R. § 435.923.

(12) Blind. An individual who is determined to be blind by the SSA or who has been determined to be blind by the Division of TennCare according to 42 C.F.R. §§ 435.530 and 435.531.

(13) Breast and Cervical Cancer (BCC). The Medicaid eligibility category defined at Section 1902(aa) of the Social Security Act (42 U.S.C. § 1396a(aa)). This eligibility category covers individuals who have been found to have breast or cervical cancer through the National Breast and Cervical Cancer Early Detection Program, who are under age sixty-five (65), do not otherwise have creditable coverage (including current enrollment in Medicaid), as the term is used under the Health Insurance Portability and Accountability Act (HIPAA) § 2701(c) of the PHS Act (42 U.S.C. § 300gg(c)), are not otherwise eligible for Medicaid or receiving TennCare Standard, and who are currently undergoing treatment for breast or cervical cancer.

(14) Bureau of TennCare (Bureau). The agency within the Division of TennCare which directly administers the TennCare program.

(15) Caretaker Relative. A relative of a dependent child by blood, adoption, or marriage with whom the child lives, assumes primary responsibility for the child’s care, and is one of the following:

(a) The child’s father, mother, grandfather, grandmother, brother, sister, stepfather, stepmother, stepbrother, stepsister, uncle, aunt, first cousin, nephew, or niece; or (b) The spouse of such caretaker relative, even after the marriage is terminated by death or divorce.

(16) Centers for Medicare & Medicaid Services (CMS). See definition in Rule 1200-13-13-.01.

(17) Child Support Enforcement. The enforcement of the child support program in the State of Tennessee by the Tennessee Department of Human Services Child Support Services Division under Title IV-D of the Social Security Act, as established by relevant state and federal statutes, and as outlined in Chapter 1240-02-04.01.

(18) Child Tax Credit Payment(s). A type of Federal Income tax refund (including any advance payments) that is excluded as a resource for a period of twelve (12) months following receipt.

(19) Children’s Health Insurance Program (CHIP). Established by Title XXI of the Social Security Act and administratively included in the Division of TennCare.

(20) CHOICES. TennCare CHOICES in Long-Term Services and Supports, as defined in Rule

Tenn. Comp. R. & Regs. 1200-13-20-.03 DELINEATION OF ROLES AND RESPONSIBILITIES

(1) Agencies’ Roles and Responsibilities.

(a) TennCare is responsible for determining eligibility for TennCare Medical Assistance and for conducting appeals of eligibility-related decisions, unless otherwise agreed to by the Single State Agency and CMS. TennCare is also responsible for coordinating the eligibility process for Medicaid and CHIP with the eligibility process for APTC/CSR in the FFM, in compliance with 42 C.F.R. §§ 435.1200 and 1205, unless otherwise agreed to by the Single State Agency and CMS.

(b) With respect to the eligibility of children applying for TennCare as medically eligible individuals, TennCare is responsible for determining the presence of a qualifying medical condition under TennCare Standard.

(c) The Tennessee Department of Children’s Services (DCS) is responsible for determining eligibility for Medicaid foster care and adoption assistance categories.

(d) The Tennessee Department of Health (DOH) is responsible for conducting presumptive eligibility determinations for Pregnant Women and individuals in the BCC category.

(e) Approved Qualified Hospital Presumptive Eligibility (HPE) Entities are responsible for conducting presumptive eligibility determinations for Former Foster Care, Child MAGI, Caretaker Relative MAGI and Pregnancy MAGI categories.

(f) Approved Qualified Entities who are cancer detection and treatment providers are responsible for conducting presumptive eligibility determinations for individuals in the BCC category.

(g) The SSA is responsible for determining eligibility for receipt of benefits from the SSI program and for determining TennCare Medicaid eligibility for individuals who are eligible for SSI benefits. 42 U.S.C. § 1383c(a). Individuals determined eligible for SSI benefits and TennCare Medicaid by SSA are automatically enrolled in TennCare Medicaid.

(h) The FFM is responsible for making TennCare Medicaid and CoverKids eligibility assessments for categories using MAGI income methodologies, based on an agreement between the State and the FFM. The FFM is also responsible for assessing applicants who may be eligible for other Medicaid eligibility categories and transmitting those applications to the State for full review.

(i) TennCare is responsible for notifying applicants of recovery for LTSS expenditures.

Section 1917 of the Social Security Act (42 U.S.C. § 1396p), 42 C.F.R. §§ 433.36 and 435.700, et seq., and T.C.A. § 71-5-116.

(2) Enrollee Roles and Responsibilities.

(a) Each enrollee is responsible for reporting to TennCare any material change in the information affecting eligibility. This information includes, but is not limited to, changes in address, income, household size, employment, or access to insurance. The applicant/enrollee may submit those changes and any required documentation of changes to TennCare via phone, mail, fax, in person, or electronically through TennCare’s online portal. Changes must be reported within ten (10) days of the occurrence.

(b) All verifications must be furnished within twenty (20) days of the notice requesting additional information unless otherwise specified by federal law.

(c) Each TennCare enrollee is responsible for reporting to his provider that he is a TennCare enrollee.

(d) By accepting medical assistance through the TennCare program, every enrollee is deemed to assign to the State of Tennessee all third party insurance benefits or other third party sources of medical support or benefits. Individuals applying as Caretaker Relatives under Medicaid (see Rule .07) must cooperate in establishing the paternity of dependent children and obtaining medical support. Failure to cooperate in securing or collecting third party medical insurance, benefits or support is grounds for denying or terminating TennCare eligibility.

(e) Upon receipt of a notification of the beginning date of eligibility, each enrollee is responsible for complying with the instructions contained in the notice for submitting requests for reimbursement of costs of covered services incurred during the period of eligibility within sixty (60) days of the date of the notification.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-208, 71-5-102, 71-5-105, 71-5-106, 71-5-109, 71-5-110, 71-5- 111, 71-5-112, 71-5-117, and 71-5-134.
• Administrative History: Emergency rule filed June 16, 2016; effective through December 13, 2016. New rules filed September 14, 2016; effective December 13, 2016. Amendments filed May 24, 2019; effective August 22, 2019. Amendments filed August 25, 2025; effective November 23, 2025.

Tenn. Comp. R. & Regs. 1200-13-20-.04 TECHNICAL ELIGIBILITY REQUIREMENTS

(1) State Residency. Individuals enrolled in TennCare must meet the requirements for State residency established in 42 C.F.R. § 435.403. Individuals applying for CoverKids must also meet the requirements specified at 42 C.F.R. § 457.320.

(a) Temporary absence. Individual may be “temporarily absent” from Tennessee but still considered a resident of the State for purposes of TennCare and CoverKids eligibility.

An individual who wishes to be considered temporarily absent from the State for continued eligibility purposes must provide the Bureau with an anticipated date of return. The Bureau will assess the continuation of an individual’s temporary absence status on the anticipated date of return. A temporary absence from the State will not preclude continued eligibility under the following circumstances:

1. The absence is for a specific purpose such as a temporary work assignment, visit, hospitalization, participation in an educational or rehabilitation program not available in Tennessee; or 2. The absence is for a child receiving specialized treatment out of state; and 3. The individual indicates his intent to return to Tennessee once the purpose for his absence is accomplished.

(b) Students.

1. Individuals who are dependents of a Tennessee resident and who attend school out of state will be considered Tennessee residents.

2. Individuals aged eighteen (18) to twenty-two (22) are not considered residents of the state if:

(i) Neither parent lives in the state;

(ii) The student is claimed as a tax dependent by someone in another state; and (iii) The student is applying on his own behalf.

(2) Citizenship. Individuals enrolled in TennCare must meet the requirements for citizenship or qualified non-citizen status established in 42 C.F.R. § 435.406 and in Tennessee’s Citizenship and Non-Citizen Eligibility State Plan Amendment. For CoverKids, unborn children are presumed to be U.S. citizens, regardless of the citizenship or immigration status of the mother.

(3) Social Security Number (SSN).

(a) Individuals enrolled in TennCare must meet the SSN requirements of 42 C.F.R. § 435.910.

(b) Unborn children enrolled in CoverKids Pregnant Women are not required to have an SSN.

(c) SSNs are not required for members of households who are not applying for TennCare coverage.

(4) Incarceration. Individuals who are incarcerated are eligible for TennCare in a suspended status pursuant to T.C.A. § 71-5-106(r), as long as all eligibility criteria are met. Individuals in a suspended status will be eligible for TennCare payments only for medical institution stays longer than twenty-four (24) hours. All other medical payments while in the suspended status are not subject to TennCare reimbursement. The suspended status will be removed once TennCare receives notice that the enrollee is no longer incarcerated. See also 42 C.F.R. § 435.1010.

(5) Residents of an Institution for Mental Disease (IMD). Individuals who are residents of an IMD are not eligible for FFP, except for those who are age sixty-five (65) or older and confined to an approved ward, or those who are under age twenty-two (22) and receiving inpatient psychiatric services. Confinement in an IMD does satisfy and establish institutional status for individuals under age sixty-five (65) and those confined to unapproved wards who are subsequently admitted to a nursing facility. See Section 1905 of the Social Security Act (42 U.S.C. § 1396d).

History

• Authority: T.C.A. §§ 4-5-202, 4-5-208, 71-5-105, 71-5-106, 71-5-110, 71-5-111, and 71-5-117.
• Administrative History: Emergency rule filed June 16, 2016; effective through December 13, 2016. New rules filed September 14, 2016; effective December 13, 2016. Amendments filed May 24, 2019; effective August 22, 2019.

Tenn. Comp. R. & Regs. 1200-13-20-.05 GENERAL APPLICATION REQUIREMENTS

(1) Right to apply.

(a) Any individual shall have the opportunity to apply for Medical Assistance without delay.

(b) Information about the TennCare or CoverKids program shall be provided to any individual requesting it pursuant to 42 C.F.R. § 435.905.

(c) Applications may be filed by the applicant, an individual listed in Rule .05(3)(b), his Authorized Representative or someone acting responsibly for him. See 42 C.F.R. § 435.923.

(d) Proof of eligibility is not required of an individual prior to filing an application.

(e) The right to file an application shall not be denied to any individual even if it is apparent that eligibility for Medical Assistance does not exist.

(2) Rights and responsibilities.

(a) By applying for Medical Assistance, an applicant grants permission and authorizes release of information to TennCare, or its designee, to investigate any and all information provided, or any information not provided if it could affect eligibility, to determine Medical Assistance eligibility; and if approved, what cost sharing, if any, may be required of the applicant. Information may be verified through, but not limited to, the following sources:

1. The United States Internal Revenue Service (IRS);

2. State income tax records for Tennessee or any other State where income is earned;

3. The Tennessee Department of Labor and Workforce Development, and other Employment Security offices within any State where the applicant may have received wages or been employed;

4. Credit bureaus;

5. Insurance companies; or, 6. Any other governmental agency or public or private source of information where such information may impact an applicant’s eligibility or cost sharing requirements for the TennCare or CoverKids Program. The Federal Data Services Hub, or “electronic service” referred to in 42 C.F.R. § 435.949, is an example of such an information source.

(b) It is a felony offense, pursuant to T.C.A. § 71-5-2601, to apply for Medical Assistance under false means or to help anyone obtain Medical Assistance under false means.

(c) By applying for Medical Assistance, an applicant agrees to provide information to TennCare, or its designee, about any third party coverage in which the applicant is enrolled.

(3) Submitting an application.

(a) TennCare will accept Valid Applications in compliance with 42 C.F.R. § 435.907 and, for CoverKids applicants, 42 C.F.R. § 457.330, or as otherwise agreed to by the Single State Agency and CMS.

(b) An application can be filed by one of the following individuals, as applicable:

1. Adult applicants or an adult who is in the applicant’s household as defined in 42 C.F.R. § 435.603(f);

2. An adult who is in the applicant’s family, as defined in the Internal Revenue Code at 26 U.S.C. § 36B(d)(1);

3. Applicants over age fourteen (14) but under age eighteen (18) who are emancipated or are considered sufficiently mature to make their own health care decisions;

4. A parent who has primary custody of a minor child;

5. Either parent of a minor child when custody is equally divided between legal parents;

6. The legal guardian or conservator;

7. An Authorized Representative;

8. If the applicant is a minor or incapacitated, someone acting responsibly for the applicant; or 9. A representative of the long term care facility where the individual resides.

(c) Applications received from Tennessee residents living out of state.

1. Applications filed for Tennessee residents who are temporarily out of state may be accepted.

2. The application of someone who is hospitalized in another state and planning to return to Tennessee when discharged may be processed in the usual manner.

(d) Out of state applicants.

1. Applications received from individuals residing in another state and not intending to reside in Tennessee will be denied.

2. Individuals who are in Tennessee for a temporary purpose, such as a visit, and who intend to return to their home out of state are not eligible for TennCare or CoverKids.

3. Applicants must always be given the right to submit an application if they wish to do so and receive a decision on their application.

(4) Assistance with submitting an application. TennCare is required to provide assistance to any individual seeking help with the application or redetermination process in person by Certified Application Counselors (CACs), over the phone, and online in a manner that is accessible to individuals with disabilities and those who have limited English proficiency. Assistance includes, but is not limited to, the following:

(a) Help with application or other TennCare form completion;

(b) Help with securing a representative, if needed, and/or allowing someone of the applicant’s choice to assist with the application and renewal process; and (c) Help in obtaining necessary information from third parties.

(5) Applications may be filed in any of the following ways:

(a) By mail.

1. Paper applications mailed to TennCare. The Application File Date for an application mailed to TennCare will be the date a Valid Application is received.

2. Paper applications mailed to the FFM. The Application File Date will be the date provided by the FFM.

(b) By phone.

1. Applicants may call TennCare to complete an application by phone. The Application File Date will be the date a Valid Application is completed telephonically.

2. The Application File Date for applications completed by phone through the FFM will be the date provided by the FFM.

(c) By fax. Paper applications may be faxed to TennCare. The Application File Date for applications faxed to TennCare will be the date a Valid Application is received.

(d) By online submission.

1. Applications may be submitted through TennCare’s online portal. The Application File Date will be the date a Valid Application is submitted.

2. The Application File Date for applications filed through the FFM will be the date provided by the FFM, unless documentary evidence of an earlier application date exists.

(e) In person at any DHS county office.

1. The Application File Date for paper applications submitted to DHS will be the date of receipt of a Valid Application at DHS.

2. Applicants may use kiosks provided at DHS to submit online applications.

Applicants may use phones provided at DHS offices to complete an application.

(f) Low Income Subsidy (LIS) applications through the SSA. The Application File Date will be the date provided by the SSA.

(6) Processing time. Eligibility will be timely determined in compliance with 42 C.F.R. § 435.912, or as otherwise agreed to by the Single State Agency and CMS.

(7) Retroactive Eligibility. TennCare will grant Retroactive Eligibility with Valid Applications for Pregnant Women or children under age nineteen (19) as described in Section 1902(I)(4) of the Social Security Act (42 U.S.C.§ 1396a(l)(4)) who meet the retroactive eligibility requirements described in 42 C.F.R. § 435.915.

(8) Disposition.

(a) Eligibility is determined based on information contained on the Valid Application as well as information secured during the application process.

(b) All applications will be subject to one (1) of the following actions:

1. Approval. When all eligibility factors are met, the application is approved.

2. Denial. When one or more eligibility factor(s) is not met, the application is denied.

(i) Death is not an appropriate reason to deny an application. If the applicant dies before a final eligibility determination is made, the application process must be continued to completion.

(ii) Applicants who do not respond to requests for verifications by the State in a timely manner will be denied for failure to respond to such requests.

(iii) Applicants who do not provide sufficient information in response to requests for verifications by the State will be denied.

(c) Withdrawal. When an applicant decides to withdraw his request for assistance during the application process, it is not necessary to complete any remaining verification and evaluation.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-208, 71-5-102, 71-5-105, 71-5-106, 71-5-109, 71-5-110, 71-5- 111, 71-5-117, and 71-5-134.
• Administrative History: Emergency rule filed June 16, 2016; effective through December 13, 2016. New rules filed September 14, 2016; effective December 13, 2016. Amendments filed May 24, 2019; effective August 22, 2019. Amendments filed May 13, 2022; effective August 11, 2022. Amendments filed August 25, 2025; effective November 23, 2025.

Tenn. Comp. R. & Regs. 1200-13-01-.02 .

(21) CHOICES 217-Like Group. See definition in Rule 1200-13-01-.02.

(22) CHOICES At-Risk Demonstration Group. See definition in Rule 1200-13-01-.02.

(23) Community Spouse. The legal spouse of an institutionalized individual. A community spouse may not reside in a medical institution or nursing facility.

(24) Completed Application. An application that meets the following criteria:

(a) All required fields have been completed;

(b) Is signed and dated by the applicant, the applicant’s parent or guardian, an individual acting on behalf of the applicant, or an authorized representative;

(c) Includes all supporting documentation required by the Bureau to determine TennCare, Medicare Savings Program or CoverKids eligibility, including technical and financial requirements as set out in this Chapter; and (d) If the application is for the TennCare Standard Medically Eligible category, it includes all supporting documentation required to prove TennCare Standard medical eligibility as set out in this Chapter.

(25) Comprehensive Aggregate Cap Waiver. See definition in Tennessee’s 1915(c) Home and Community Based Services Waiver.

(26) Continued Eligibility Group Part C. See definition in Rule 1200-13-01-.02.

(27) Continuous Eligibility. The period in which an enrollee’s coverage will not be terminated, regardless of changes in the enrollee’s circumstances. See Rule .09 for applicability and exceptions.

(28) Core Medicaid Population. Individuals eligible under Title XIX of the Social Security Act, 42 U.S.C. §§ 1396, et seq., with the exception of the following groups: active SSI recipients who are receiving benefits as determined by the SSA; individuals eligible for emergency services as an undocumented or ineligible alien; individuals in a presumptive eligibility period; and children in DCS custody, including DCS children who meet the criteria for immediate eligibility and those receiving adoption assistance payments.

(29) CoverKids. The Children’s Health Insurance Program (CHIP) in Tennessee under T.C.A. § 71-3-1101.

(30) CoverKids Pregnant Women (formerly referred to as “CoverKids Pregnant Women/Unborn Children”). Provides coverage for the unborn children of Pregnant Women with no source of coverage, who meet the CoverKids eligibility requirements.

(31) Deemed Newborn. An individual eligible in a Medicaid category authorized by Section 1902(e)(4) of the Social Security Act (42 U.S.C. § 1396a(e)(4)) and 42 C.F.R. § 435.117. A child is eligible for Medicaid in this category from birth until the child’s first birthday without application if, on the date of the child’s birth, the child’s mother was eligible for and received covered Medicaid services.

(32) Developmental Disability(ies) (DD). See definition in Rule 1200-13-01-.02.

(33) Disabled. An individual who has been determined to be disabled by the SSA or who has been determined to be disabled by the Division of TennCare according to 42 C.F.R. §§ 435.540 and 435.541.

(34) Disabled Adult Child (DAC). The Medicaid eligibility category defined in Section 1634(c) of the Social Security Act (42 U.S.C. § 1383c(c)).

(35) Division of TennCare. The Agency established within the Department of Finance and Administration to consolidate and administratively coordinate multiple health care programs, including the Bureau of TennCare and CoverKids.

(36) Earned Income. Earned income is compensation an individual receives for the performance of services or as a result of his own efforts either as an employee or through selfemployment.

(37) ECF CHOICES 217-Like Group. See definition in Rule 1200-13-01-.02.

(38) ECF CHOICES At-Risk Group. Individuals with I/DD who are otherwise ineligible for TennCare Medicaid or who are eligible in a TennCare Medicaid category that does not confer LTSS benefits, do not meet the Nursing Facility Level of Care (NF LOC) criteria, but who in the absence of ECF CHOICES, are At Risk for Institutionalization, have income at or below one hundred and fifty percent (150%) of the FPL and meet the resource limit for the ECF CHOICES 217-Like Group.

(39) ECF CHOICES Demonstration Group. One of the TennCare Demonstration categories that individuals with I/DD, who are not active SSI enrollees, must be enrolled in to qualify for Employment and Community First CHOICES. These groups include the ECF CHOICES 217- Like Group, the Interim ECF CHOICES At-Risk Group, the ECF CHOICES At-Risk Group, and the ECF CHOICES Working Disabled Group.

(40) ECF CHOICES Working Disabled Group. Working individuals with I/DD who meet the Nursing Facility Level of Care (NF LOC) criteria, or who in the absence of ECF CHOICES, are at risk for institutionalization, would be eligible for SSI but for their earned income, have income at or below two hundred and fifty percent (250%) of the FPL meet the resource limit for the ECF CHOICES 217-Like Group, and who are not otherwise eligible in a TennCare Medicaid category that confers LTSS benefits. Enrollment in this group shall be subject to the enrollment targets established for each applicable ECF CHOICES benefit group as specified in TennCare Rule 1200-13-01-.31.

(41) Economic-Impact Payments. Economic-Impact Payments received as direct payments from an agency of the federal government during the COVID-19 federal public health emergency.

(42) Effective Date. The first date of eligibility for purposes of health care services coverage and payment.

(43) Eligible. An individual who has been determined to meet the eligibility criteria for medical assistance under Tennessee’s State Plan or in any Tennessee federal Medicaid waiver program approved by the Secretary of the HHS pursuant to Sections 1115 or 1915 of the Social Security Act or in the CoverKids program. (42 U.S.C. §§ 1315 or 1396n).

(44) Employment and Community First CHOICES (ECF CHOICES). See definition in Rule 1200- 13-01-.02.

(45) Enrollee. An individual eligible for and enrolled in the TennCare program or in any Tennessee federal Medicaid waiver program approved by the Secretary of the HHS pursuant to Sections 1115 or 1915 of the Social Security Act or in the CoverKids program. (42 U.S.C. §§ 1315 or 1396n). For purposes of this Chapter, enrollee also includes individuals eligible for and enrolled in the Medicare Savings Programs (MSPs).

(46) Enrollment. The process by which a TennCare, CoverKids, or Medicare Savings Program eligible individual becomes enrolled in TennCare, CoverKids or a Medicare Savings Program.

(47) Estranged Spouse. A spouse who no longer shares a residence with the applicant, whose whereabouts are unknown and who cannot be contacted despite attempts to do so.

(48) Exchange. A governmental agency or non-profit entity that meets the applicable Federal standards and makes Qualified Health Plans (QHPs), including TennCare and CoverKids, available to qualified individuals and/or qualified employers. Unless otherwise identified, this term includes an Exchange serving the individual market for qualified individuals and a Small Business Health Options Program (SHOP) serving the small group market for qualified employers, regardless of whether the Exchange is established and operated by a State (including a regional Exchange or subsidiary Exchange) or by the HHS.

(49) Extended Medicaid. Medicaid eligibility authorized for enrollees who lose Child Modified Adjusted Gross Income (MAGI) or Caretaker Relative MAGI eligibility due to increased receipt of spousal support, whose household income prior to losing eligibility was at or below the current Caretaker Relative MAGI income standard for three (3) of the six (6) months preceding the month of the increase in income.

(50) Families First (FF). Tennessee’s Temporary Assistance for Needy Families (TANF) program.

(51) Federal Data Services Hub. An electronic service established by the HHS to facilitate sharing of data and other information between federal agencies, State agencies, and other entities involved in administering Insurance Affordability Programs.

(52) Federal Financial Participation (FFP). See definition in Rule 1200-13-13-.01.

(53) Federal Poverty Level (FPL). The poverty level established annually by HHS.

(54) Federally Facilitated Marketplace (FFM). See “Exchange.”

(55) Financially Responsible Relatives (FRR). Principle of financial responsibility that exists between spouses and of parents to their children which is used in determining household composition, income counting and resource counting for certain Medicaid categories.

(56) Former Foster Care Children Under 26. The Medicaid eligibility category defined at Section 1902(a)(10)(A)(i)(IX) of the Social Security Act (42 U.S.C. § 1396a(a)(10)(A)(i)(IX)). For purposes of the Medicaid eligibility category Former Foster Care Children Under 26, “state” means any of the 50 U.S. states, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.

(57) Group Health Insurance. An employee benefit plan to the extent that the plan provides medical care to employees or their dependents (as defined under the terms of the plan) directly through an insurance reimbursement mechanism. This definition includes those types of health insurance found in the Health Insurance Portability and Accountability Act of 1996, as amended, definition of creditable coverage (with the exception that the 50-or-more participants criteria do not apply), which includes Medicare and TRICARE. Health insurance benefits obtained through COBRA are included in this definition. It also covers group health insurance available to an individual through membership in a professional organization or a school.

(58) Health Insurance (for CoverKids).

(a) Health insurance, for purposes of determining eligibility for CoverKids under this

Chapter, shall mean:

1. Basic medical coverage (hospitalization plans);

2. Major medical insurance;

3. Comprehensive medical insurance;

4. Short-term medical policies;

5. Mini-medical plans;

6. High-deductible plans with health savings accounts; or 7. Other coverage including Medicare, TennCare, TRICARE, and employersponsored coverage.

(b) Health insurance, for purposes of determining eligibility for CoverKids under this

Chapter, shall not include the following:

1. AccessTN;

2. Catastrophic health insurance plans that only provide medical services after satisfying a deductible in excess of $3,000.00 (or the maximum allowed deductible for a health savings account plan);

3. Dental-only plans;

4. Vision-only plans;

5. Benefits provided by the U.S. Department of Veterans Affairs or the Indian Health Service;

6. Coverage under the State of Tennessee’s Children’s Special Services program; or 7. Medical insurance that is available to an enrollee pursuant either to the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986 (29 U.S.C. §§ 1161, et seq.) and which the individual declined, or to T.C.A. §§ 56-7-2312, et seq., and which the individual declined.

(c) Consistent with 42 U.S.C. § 1397jj(b)(2)(B) and 42 C.F.R. §§ 457.301 and 457.310(c)(1)(ii), health insurance shall not include State-administered or other medical coverage offered by means of a family member’s employment with a local education agency (LEA) if the LEA does not make more than a nominal contribution (as defined at 42 C.F.R. § 457.310(c)(1)(ii)) to the premium for the dependent, who is applying (or re-applying) for coverage through CoverKids.

(59) Health Insurance (for TennCare).

(a) Health insurance, for purposes of determining eligibility for TennCare under this

Chapter, shall mean:

1. Any hospital or medical expense-incurred policy;

2. Medicare;

3. TRICARE;

4. COBRA;

5. Medicaid;

6. State health high-risk pool;

7. Nonprofit health care service plan contract;

8. Health maintenance organization (HMO) subscriber contracts;

9. Group Health Insurance;

10. Coverage available to an individual through membership in a professional organization or a school;

11. Coverage under a policy covering one individual or all members of a family under a single policy where the contract exists solely between the individual and the insurance company;

12. Policies listed in parts 1. through 11. which include any of the following are health insurance:

(i) The policy contains a type of benefit (such as mental health benefits) which has been completely exhausted;

(ii) The policy contains a type of benefit (such as pharmacy) for which an annual limitation has been reached; or (iii) The policy has a specific exclusion or rider of non-coverage based on a specific prior existing condition or an existing condition or treatment of such a condition.

13. Any of the types of policies listed in this subparagraph will be considered Health Insurance even if one or more of the following circumstances exists:

(i) The policy contains fewer benefits than TennCare;

(ii) The policy costs more than TennCare; or (iii) The policy is one the individual could have bought during a specified period of time (such as COBRA) but chose not to do so.

(b) Health insurance, for purposes of determining eligibility under these Rules, shall not mean:

1. Short term coverage;

2. Accident coverage;

3. Fixed indemnity insurance;

4. Long-term care insurance;

5. Disability income contracts;

6. Limited benefits policies as defined elsewhere in this Rule;

7. Credit insurance;

8. School-sponsored sports-related injury coverage;

9. Coverage issued as a supplement to liability insurance;

10. Automobile medical insurance;

11. Insurance under which benefits are payable with or without regard to fault and which are statutorily required to be contained in any liability insurance policy or equivalent self-insurance;

12. A medical care program of the Indian Health Services (IHS) or a tribal organization;

13. Benefits received through the U.S. Department of Veterans Affairs; or 14. Health care provided through a government clinic or program such as, but not limited to, vaccinations, flu shots, mammograms, and care or services received through a disease- or condition-specific program such as, but not limited to, the Ryan White CARE Act.

(60) Health Insurance Marketplace, also referred to as the “Marketplace”, “Exchange” or “Federally Facilitated Marketplace.” See “Exchange.”

(61) Home and Community Based Services (HCBS). See definition in Rule 1200-13-01-.02.

(62) Hospital Presumptive Eligibility (HPE). Medicaid eligibility determined pursuant to 42 C.F.R. § 435.1110.

(63) Household Size. The number of individuals counted as members of an individual’s household for purposes of determining eligibility for TennCare.

(64) Immediate Eligibility (for DCS children only). An arrangement whereby children in the custody of the State who are presumed to be TennCare-eligible may gain TennCare eligibility while their applications are being processed.

(65) Inactive SSI Enrollee. Individuals whose SSI cash benefits have been terminated by SSA and who remain eligible for TennCare until they have been reviewed for coverage in other eligibility categories. Inactive SSI enrollees are not eligible for CHOICES.

(66) Incarcerated. The state of being involuntarily confined in a local, State, or federal prison, jail, youth development center, or other penal or correctional facility, including the state of being on furlough from such facility.

(67) Incurred Medical Expense. The term used in Tennessee to refer to the methodology for deducting expenses incurred for necessary medical or remedial care for institutionalized individuals in the post-eligibility phase of income. Previously known as “Item D.” See 42 C.F.R. §§ 435.725(c)(4), 435.726(c)(4) and 435.832(c)(4).

(68) Infants and Children Under Age 19. The Medicaid eligibility categories defined at Sections 1902(a)(10)(A)(i)(III), (IV), (VI), and (VII); 1902(a)(10)(A)(ii)(IV) and (IX); and 1931(b) and (d) of the Social Security Act. (42 U.S.C. §§ 1396a(a)(10)(A)(i)(III), (IV), (VI) and (VII); 1396a(a)(10)(A)(ii)(IV) and (IX); and 1396u-1(b) and (d)).

(69) Institutional Eligibility. The eligibility category defined at Section 1902(a)(10)(A)(ii)(V), (VI) and (VII) of the Social Security Act. (42 U.S.C. § 1396a(a)(10)(A)(ii)(V), (VI) and (VII)), including the CHOICES 217-Like Group, CHOICES At-Risk Demonstration Group, and the Program of All -Inclusive Care for the Elderly (PACE) where Enrollees qualify for eligibility under institutional income and resource rules.

(70) Institutional Spouse. An institutionalized individual who is the legal spouse of a Community Spouse.

(71) Insurance Affordability Program. A program that is one of the following:

(a) TennCare.

(b) CoverKids.

(c) APTC/CSR for participation in a QHP available through the FFM.

(72) Intellectual Disability(ies) (ID). See definition in Rule 1200-13-01-.02.

(73) Intellectual or Developmental Disability(ies) (I/DD). See definition in Rule 1200-13-01- .01(4)(v).

(74) Interim ECF CHOICES At-Risk Group. See definition in Rule 1200-13-01-.02.

(75) Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). An institution described at 42 C.F.R. Part 483, Subpart I.

(76) Joint Custody. Legal custody of a child held simultaneously by two (2) or more caretaker relatives. The caretaker relatives must exercise care and control of the child.

(77) Katie Beckett Group Part A. See definition in Rule 1200-13-01-.02.

(78) Katie Beckett Program. See definition in Rule 1200-13-01-.02.

(79) Level of Care (LOC). See definition in Rule1200-13-01-.02.

(80) Limited Benefits Policy. A policy of health coverage for a specific disease (e.g., cancer), or an accident occurring while engaged in a specified activity (e.g., school-based sports), or which provides for a cash benefit payable directly to the insured in the event of an accident or hospitalization (e.g., hospital indemnity).

(81) Long-Term Care. See “Long-Term Services and Supports” (LTSS).

(82) Long-Term Services and Supports (LTSS) Program. See definition in Rule 1200-13-01-.02.

(83) Marketplace. See “Exchange.”

(84) Medicaid. The federal- and state-financed, state-run program of medical assistance pursuant to Title XIX of the Social Security Act. Medicaid eligibility in Tennessee is determined by TennCare. Tennessee residents determined eligible for SSI benefits by the Social Security Administration are also enrolled in Tennessee’s TennCare Medicaid program.

(85) Medicaid Diversion Group Part B. See definition in Rule 1200-13-01-.02.

(86) Medicaid Income Cap (MIC). Three hundred percent (300%) of the SSI Federal Benefit Rate.

(87) Medicaid “Rollover” Enrollee. A TennCare Medicaid enrollee under the age of 19 who no longer meets eligibility requirements for Medicaid and who is afforded an opportunity to enroll in TennCare Standard according to the provisions of these Rules.

(88) Medical Assistance. All categories for which TennCare is authorized to make an eligibility determination, including Medicaid and MSP categories, CHIP, and categories granted under TennCare’s Demonstration Agreement with CMS.

(89) Medical Institution. See definition at 42 C.F.R. § 435.1010.

(90) Medically Needy. The Medicaid eligibility category described at Section 1902(a)(10)(C) of the Social Security Act (42 U.S.C. § 1396a(a)(10)(C)).

(91) Medically Needy Income Standard (MNIS). See definition at 42 C.F.R. § 435.811.

(92) Medicare. The program administered through the SSA pursuant to Title XVIII, available to most individuals upon attaining age sixty-five (65), to some disabled individuals under age sixty-five (65), and to some individuals that have End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), as determined by the SSA.

(93) Medicare Buy-In. The process by which TennCare “buys” Medicare beneficiaries into the Medicare program. The Medicare buy-in consists of paying for some or all of a beneficiary’s Medicare premiums, deductibles, or coinsurance.

(94) Medicare Savings Program (MSP). One of the programs under which low-income Medicare beneficiaries can get assistance from Medicaid for paying for some or all of their Medicare premiums, deductibles or coinsurance. These programs include the Qualified Medicare Beneficiary (QMB) program, the Specified Low Income Medicare Beneficiary (SLMB) program, the Qualifying Individual (QI1) program and the Qualified Disabled and Working Individual (QDWI) program.

(95) Miller Trust. See “Qualified Income Trust.”

(96) Modified Adjusted Gross Income (MAGI). See definition at 42 C.F.R. § 435.603(e).

(97) Nursing Facility (NF). See definition in Rule 1200-13-.01-.02.

(98) PACE Carryover Group. See definition in Rule 1200-13-01-.02.

(99) Patient Liability. See definition in Rule 1200-13-01-.02.

(100) Payment for Emergency Medical Services. Eligibility authorized by Section 1903(v) of the Social Security Act (42 U.S.C. § 1396b(v)).

(101) Personal Needs Allowance (PNA). A reasonable amount of money that is deducted by TennCare from the individual’s funds pursuant to federal and State law and the Medicaid State Plan in the application of post-eligibility provisions and the calculation of Patient Liability for LTSS. The PNA is set aside for clothing and other personal needs of the individual while in the institution (Institutional PNA), and to also pay room, board and other living expenses in the community (Community PNA).

(102) Pickle Passalong. The eligibility category defined at 42 C.F.R. § 435.135.

(103) Pregnant Woman (also Pregnant Women). See definition at 42 C.F.R. § 435.4.

(104) TennCare Pregnant Women. For purposes of this Chapter, the Medicaid eligibility category defined at Sections 1902(a)(10)(A)(i)(III), (IV) and (VII); 1902(a)(10)(A)(ii)(I), (IV), and (IX); and 1931(b) and (d) of the Social Security Act (42 U.S.C. §§ 1396a(a)(10)(A)(i)(III), (IV), and (VII); 1396a(a)(10)(A)(ii)(I), (IV) and (IX); and 1396u-1(b) and (d)); and 42 C.F.R. § 435.116.

For purposes of this Chapter, TennCare Pregnant Women also includes Pregnant Women determined eligible under Section 1902(a)(10)(A)(ii)(XX) of the Social Security Act (42 U.S.C. § 1396a(a)(10)(A)(ii)(XX)) and 42 C.F.R. § 435.218.

(105) Presumptive Eligibility for Individuals with Breast or Cervical Cancer. Individuals presumed to be eligible for coverage under the Medicaid category authorized by Section 1902(aa) of the Social Security Act (42 U.S.C. § 1396a(aa)) based on a determination by the Tennessee Department of Health or other qualified entity.

(106) Presumptive Eligibility for Pregnant Women. Pregnant Women presumed to be eligible for coverage in the category defined at Sections 1902(a)(10)(A)(i)(III), (IV) and (VII); 1902(a)(10)(A)(ii)(I), (IV) and (IX); and 1931(b) and (d) of the Social Security Act (42 U.S.C. §§ 1396a(a)(10)(A)(i)(III), (IV), and (VII); 1396a(a)(10)(A)(ii)(I), (IV) and (IX); and 1396u-1(b) and (d)); and in 42 C.F.R. § 435.1103 by the Tennessee Department of Health or other qualified entity. For purposes of this Chapter, Presumptive Eligibility for Pregnant Women also includes Pregnant Women determined eligible under Section 1902(a)(10)(A)(ii)(XX) of the Social Security Act (42 U.S.C. § 1396a(a)(10)(A)(ii)(XX)) and 42 C.F.R. § 435.218.

(107) Program of All-Inclusive Care for the Elderly (PACE). See definition in Rule 1200-13-01-.02.

(108) Qualified Disabled and Working Individual (QDWI). An individual who is under age sixty-five (65), has lost free Medicare Part A coverage due to substantial gainful activity, has a disabling impairment, has the option to purchase Medicare Part A for an indefinite period of time, and for whom Medicaid pays the Medicare Part A premium, if income is not more than two hundred percent (200%) of the FPL and resources are not more than twice the SSI limit and is not otherwise eligible for Medicaid. Eligibility is authorized by Sections 1905(p)(3)(A)(i) and (s); and 1902(a)(10)(E)(ii) of the Social Security Act (42 U.S.C. §§ 1396d(p)(3)(A)(i) and (s); and 1396a(a)(10)(E)(ii)).

(109) Qualified Health Plan (QHP). See definition at 42 U.S.C. § 18021.

(110) Qualified Income Trust (QIT). The trust defined at 42 U.S.C. § 1396p(d)(4)(B).

(111) Qualified Long-Term Care Insurance Partnership Policy (LTCP). A long-term care insurance policy issued on or after October 1, 2008, that has been pre-certified by the Tennessee Department of Commerce and Insurance pursuant to Rule 0780-01-61 as:

(a) A policy that meets all applicable Tennessee Long Term Care Partnership requirements; or (b) A policy that has been issued in another Partnership State and which is covered under a reciprocal agreement between that State and the State of Tennessee.

(112) Qualified Lottery Winnings. Monetary winnings from a sweepstakes, lottery, or pool received as a lump sum payment on or after January 1, 2018, in accordance with § 1902(e)(14)(K) of the Social Security Act.

(113) Qualified Lump Sum Income. Income that is received as a lump sum from monetary winnings from gambling received on or after January 1, 2018, in accordance with § 1902(e)(14)(K) of the Social Security Act.

(114) Qualified Medicare Beneficiary (QMB). An individual who is entitled to Medicare Part A and for whom Medicaid pays the Medicare Part A and Part B premium, coinsurance and deductible for Medicare-covered services, and whose income is not more than one hundred percent (100%) of the FPL. Eligibility is authorized by Sections 1905(p) and 1902(a)(10)(E)(i) of the Social Security Act (42 U.S.C. §§ 1396d(p) and 1396a(a)(10)(E)(i)).

(115) Qualifying Individual 1 (QI1). An individual who is entitled to Medicare Part A, for whom Medicaid pays Medicare Part B premiums on a first-come, first-served basis, and who has income at least one hundred and twenty percent (120%) of the FPL but less than one hundred and thirty-five percent (135%) of the FPL. Individuals are not enrolled in TennCare Medicaid or TennCare Standard. Eligibility is authorized by Section 1902(a)(10)(E)(iv) of the Social Security Act (42 U.S.C. § 1396a(a)(10)(E)(iv)) and 42 U.S.C. § 1396u-3.

(116) Qualifying Medical Condition. A medical condition included on a list of conditions established by TennCare which will render a qualified uninsured applicant medically eligible.

(117) Redetermination. The process by which TennCare evaluates the ongoing eligibility status of TennCare Medicaid enrollees who are considered a part of the Core Medicaid Population, as well as TennCare Standard, CoverKids, Katie Beckett Group Part A, Medicaid Diversion Group Part B, and Continued Eligibility Group Part C enrollees. This is a periodic process that is conducted at specified intervals. The process is conducted according to TennCare’s, or its designee’s, policies and procedures and is also referred to as “Renewal.” The Medicaid Diversion Group Part B, including redetermination of eligibility, will be administered by the Department of Intellectual and Developmental Disabilities (DIDD).

(118) Renewal. See “Redetermination.”

(119) Responsible Party(ies). The following individuals, who are representatives and/or relatives of recipients of medical assistance who are not financially eligible to receive benefits: parents, spouses, children, and guardians; as defined at T.C.A. § 71-5-103.

(120) Retroactive Eligibility. Eligibility granted prior to the Application File Date according to 42 C.F.R. 435.915 and TennCare’s 1115 Demonstration Waiver. Retroactive Eligibility is only available to individuals for which the requirement at 42 U.S.C. 1396a(a)(34) has not been waived under TennCare’s 1115 Demonstration Waiver.

(121) Single State Agency (CoverKids and TennCare). The Department of Finance and Administration.

(122) Specified Low-Income Medicare Beneficiary (SLMB). An individual who is eligible for Medicare Part A and for whom Medicaid pays Medicare Part B premiums, if income is at least one hundred percent (100%) but less than one hundred twenty percent (120%) of the FPL. Eligibility is authorized by Sections 1905(p)(3)(A)(ii) and 1902(a)(10)(E)(iii) of the Social Security Act (42 U.S.C. §§ 1396d(p)(3)(A)(ii) and 1396a(a)(10)(E)(iii)).

(123) Spenddown. The process by which excess income is utilized for recognized medical expenses until it is depleted, which results in a determination of eligibility if all other eligibility factors are met for the Medically Needy categories.

(124) SSI Federal Benefit Rate. The maximum dollar amount paid to an aged, blind, or disabled person who receives Social Security Disability Benefits under Supplemental Security Income (SSI).

(125) SSI – Related Groups. Individuals who have been found eligible in one of the following categories:

(a) Disabled Adult Children (DAC).

(b) Pickle Passalong.

(c) Widow/Widower.

(126) Standard Child Medically Eligible. An uninsured child under age nineteen (19) who is losing eligibility for Medicaid or currently enrolled in TennCare Standard, whose household income is two hundred and eleven percent (211%) of the FPL or higher, who does not have access to health insurance, and who has been determined medically eligible according to these Rules.

(127) Standard Child Uninsured. The TennCare Demonstration category defined as including individuals in the following groups:

(a) Uninsured children under age nineteen (19) who are losing eligibility for Medicaid, or are currently enrolled in TennCare Standard, who have household incomes below two hundred and eleven percent (211%) of the FPL, and who do not have access to health insurance; or (b) Uninsured children under age nineteen (19) who have been continuously enrolled in TennCare Standard since December 31, 2001, who have family incomes below two hundred and eleven percent (211%) of the FPL, and who have not purchased insurance even if they have access to it. This is a “grandfathered” eligibility category.

When an individual loses eligibility in this category, he will not be able to re-enroll in it.

(128) Student. A child under age twenty-one (21), unless otherwise specified in this Chapter, who is:

(a) Eligible for and attending grades kindergarten through twelve at a State-approved elementary or secondary school, or a course of vocational or technical training, or equivalent instruction from a homebound teacher; or (b) Eligible for and attending a college or university.

1. Full-time student means enrollment in at least twelve (12) credit hours per semester.

2. Part-time student means enrollment in at least six (6) but less than twelve (12) credit hours per semester.

(c) Student status is retained during official school vacations and breaks if the conditions or requirements prior to the vacation or break were met, and the student plans to return after the break.

(d) Regularly attending school, except when circumstances beyond the student’s control justify a reduced credit load or attendance, means:

1. College or university, at least 8 hours per week (semester or quarter system);

2. Grades 7–12, including home-schooled, at least 12 hours per week;

3. Training course preparing for a paying job, at least 12 hours per week or 15 hours per week if the course involves shop practice; or 4. Homebound courses given by a school grades 7–12, college, university or government agency when the student must stay home due to a disability and has a home visitor or tutor from school who directs the studying or training.

(e) Individuals participating in apprenticeships, correspondence courses, other courses of home study and rehabilitation programs other than academic, institutional, vocational or technical training are excluded from this definition of student for purposes of this

Chapter.

(129) Supplemental Security Income (SSI). A federal income supplement program funded by general tax revenues and is designed to help aged, blind and disabled individuals who have little or no income. Applications for SSI benefits are filed at the Social Security office.

Individuals who are eligible for SSI are automatically entitled to Medicaid (42 U.S.C. §§ 1382, et seq.).

(130) Temporary Assistance for Needy Families (TANF). A program created by the PRWORA in 1996. TANF became effective in July 1996 and replaced what was then commonly known as the AFDC program. The name given to Tennessee’s TANF program is Families First.

(131) TennCare. The program administered by the Single State agency as designated by the State and CMS pursuant to Title XIX of the Social Security Act and the Section 1115 Research and Demonstration waiver granted to the State of Tennessee; also, the name of the Division within the Department of Finance and Administration which includes the Bureau of TennCare and CoverKids; and, the name of the Bureau which directly administers the program.

(132) TennCare CHOICES in Long-Term Services and Supports. The program described in Rule

Tenn. Comp. R. & Regs. 1200-13-01-.05 . CHOICES is a benefit package available to TennCare enrollees who are eligible in the Institutional Medicaid category or who are active SSI enrollees and who meet the requirements of the program set out in Chapter 1200-13-01.

(133) TennCare Medicaid. That part of the TennCare program which covers individuals eligible for Medicaid under Tennessee’s Title XIX State Plan for Medical Assistance. The following individuals are eligible for TennCare Medicaid:

(a) Tennessee residents determined to be eligible for Medicaid according to this Chapter.

(b) Individuals who qualify as dually eligible for Medicare and Medicaid are enrolled in TennCare Medicaid.

(c) A Tennessee resident who is an uninsured individual, under age sixty-five (65), a US citizen or qualified alien, is not eligible for any other category of Medicaid, and has been diagnosed as the result of a screening at a Centers for Disease Control and Prevention (CDC) site with breast or cervical cancer, including pre-cancerous conditions.

(d) Tennessee residents determined eligible for SSI benefits and TennCare Medicaid by the SSA are automatically enrolled in TennCare Medicaid.

(134) TennCare Standard. That part of the TennCare Program which provides health coverage for Tennessee residents who are not eligible for Medicaid and who meet the eligibility criteria found in this Chapter.

(135) Termination. The discontinuance of an enrollee’s coverage under the Medical Assistance programs.

(136) Title IV-E. The section of the Social Security Act under which grants are made to States for implementation of foster care and adoption assistance programs. Eligibility is authorized by

Section 1902(a)(10)(A)(i)(I) of the Social Security Act (42 U.S.C. § 1396a(a)(10)(A)(i)(I)), 42 C.F.R. § 435.115, and 42 C.F.R. § 435.145.

(137) Transitional Medicaid. Medicaid authorized for enrollees who lose Child MAGI or Caretaker Relative MAGI eligibility due to increased earnings and whose household income prior to losing eligibility was at or below the current Caretaker Relative MAGI income standard for three (3) of the six (6) months immediately preceding the month eligibility is lost.

(138) Uninsured. Any individual who does not have health insurance directly or indirectly through another family member, or who does not have access to group health insurance. For purposes of the Medicaid eligibility category of women under age 65 requiring treatment for breast or cervical cancer, “uninsured” shall mean any individual who does not have health insurance or access to health insurance which covers treatment of breast or cervical cancer.

(139) Valid Application. The single streamlined application form for all insurance affordability programs. It must include contact information and be signed by the Applicant, a Responsible Party, or the Authorized Representative.

(140) Widow/Widower. The eligibility category defined at 42 C.F.R. § 435.138.

(141) ACRONYMS. Following is a list of the acronyms used in this Chapter.

(a) ABD – Aged, Blind or Disabled (b) AFDC – Aid to Families with Dependent Children (c) APTC – Advanced Premium Tax Credit (d) APTC/CSR – Advanced Premium Tax Credit/Cost Sharing Reductions (e) BCC – Breast and Cervical Cancer (f) BCSP – Breast and Cervical Screening Program (g) CCRC – Continuing Care Retirement Community (h) CHIP – Children’s Health Insurance Program (i) CHOICES – TennCare CHOICES in Long-Term Care (j) CMS – Centers for Medicare & Medicaid Services (k) COLA – Social Security Cost-of-Living Adjustment (l) CSIMA – Community Spouse Income Maintenance Allowance (m) CSRMA – Community Spouse Resource Maintenance Allowance (n) DAC – Disabled Adult Child (o) DCS – Department of Children’s Services (p) DIMA – Dependent Income Maintenance Allowance (q) ECF CHOICES – Employment and Community First CHOICES (r) FEMA – Federal Emergency Management Agency (s) FF – Families First (t) FFM – Federally Facilitated Marketplace (u) FFP – Federal Financial Participation (v) FPL – Federal Poverty Level (w) FRR – Financially Responsible Relatives (x) HCBS – Home and Community Based Services (y) HHS – United States Department of Health and Human Services (z) HPE – Hospital Presumptive Eligibility (aa) I/DD – Intellectual or Developmental Disability(ies)

(bb) ICF/IID – Intermediate Care Facility for Individuals with Intellectual Disabilities (cc) IRA – Individual Retirement Account (dd) LTCP – Qualified Long-Term Care Insurance Partnership Policy (ee) LTSS – Long-Term Services and Supports (ff) MAGI – Modified Adjusted Gross Income (gg) MIC – Medicaid Income Cap (hh) MNIS – Medically Needy Income Standard (ii) MSP – Medicare Savings Program (jj) OASDI – Old-Age, Survivors, and Disability Insurance (Social Security Benefits)

(kk) PACE – Program of All-Inclusive Care for the Elderly (ll) PASS – Plan to Achieve Self Support (mm) PNA – Personal Needs Allowance (nn) QDWI – Qualified Disabled and Working Individual (oo) QHP – Qualified Health Plan (pp) QIT – Qualified Income Trust (qq) QI1 – Qualifying Individual (rr) QMB – Qualified Medicare Beneficiary (ss) SLMB – Specified Low Income Medicare Beneficiary (tt) SSA – Social Security Administration (uu) SSI – Supplemental Security Income (vv) TANF – Temporary Assistance for Needy Families (ww) VISTA – Volunteers in Service to America (xx) WIOA – Workforce Innovation and Opportunity Act

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-208, 71-5-102, 71-5-105, 71-5-106, 71-5-109, 71-5-110, 71-5- 111, 71-5-112, 71-5-117, 71-5-134, and 71-5-164; TennCare II/III Section 1115(a) Medicaid Demonstration Waiver Extension; and TennCare III Section 1115(a) Medicaid Demonstration Waiver.
• Administrative History: Emergency rule filed June 16, 2016; effective through December 13, 2016. New rules filed September 14, 2016; effective December 13, 2016. Amendments filed May 24, 2019; effective August 22, 2019. Emergency rules filed November 20, 2020; effective through May 19, 2021. Amendments filed February 17, 2021; effective May 18, 2021. Amendments filed May 13, 2022; effective August 11, 2022. Amendments filed August 25, 2025; effective November 23, 2025.

Tenn. Comp. R. & Regs. 1200-13-20-.06 FINANCIAL ELIGIBILITY DETERMINATIONS

(1) Modified Adjusted Gross Income (MAGI) Financial Eligibility Determinations.

(a) All applicants for TennCare will have their income calculated for eligibility purposes according to the MAGI-based requirements at 42 C.F.R. § 435.603. The only exceptions are the Medicaid applicants at 42 C.F.R. §§ 435.603(j)(1)–(6).

1. Qualified Lottery Winnings and Qualified Lump Sum Income are counted as income for the individual who received such winnings or income:

(i) In the month in which such winnings or income (as applicable) is received if the amount of such winnings or income is less than $80,000;

(ii) In equal monthly installments over a period of two (2) months if the amount of such winnings or income (as applicable) is greater than or equal to $80,000 but less than $90,000;

(iii) In equal monthly installments over a period of three (3) months if the amount of such winnings or income (as applicable) is greater than or equal to $90,000 but less than $100,000; and (iv) In equal monthly installments over a period of three (3) months plus one (1) additional month for each increment of $10,000 of such winnings or income (as applicable) received, not to exceed a period of 120 months (for winnings or income of $1,260,000 or more), if the amount of such winnings or income is greater than or equal to $100,000.

2. Hardship Exemption. If an individual’s Qualified Lottery Winnings or Qualified Lump Sum Income causes them to exceed the MAGI income limit, the individual will continue to be eligible for MAGI coverage if TennCare determines that the denial of eligibility would cause an undue medical or financial hardship for the individual.

3. Qualified Lottery Winnings and Qualified Lump Sum Income are counted as income for other household members in the month received.

4. Any other monetary gambling winnings, including lottery winnings, that are not Qualified Lottery Winnings or Qualified Lump Sum Income are counted as income in the month received.

(b) In compliance with 42 C.F.R. § 435.603(g)(1), there is no resource or asset test for individuals whose income eligibility is required to be determined using MAGI income requirements.

(c) There is no resource or asset test for Pregnant Women or children enrolled in CoverKids.

(d) In compliance with 42 C.F.R. § 435.603(g)(2), there are no income or expense disregards for individuals whose eligibility is determined according to MAGI requirements, with the exception of those described at 42 C.F.R. §§ 435.603(d)(1) through (4).

(e) Household composition, for financial eligibility determination purposes, for Child MAGI, Pregnancy MAGI, Caretaker Relative MAGI, TennCare Standard Uninsured, TennCare Standard Medically Eligible, and CoverKids categories will be determined using the MAGI methodology in accordance with 42 C.F.R. § 435.603(f). Household composition for all other categories will be determined according to this Chapter. MAGI household composition methodology is based on federal tax rules and the principles of tax dependency, however the MAGI rules apply to both applicants who expect to file taxes or be claimed as tax dependents, and to those applicants who do not file taxes or are not claimed as tax dependents. Each applicant has his own household size constructed under MAGI rules, and it is permissible for applicants who live in the same household to have different household sizes.

1. Tax Filers.

(i) For applicants who expect to file taxes, the household includes the tax filer and any dependents the tax filer expects to claim.

(ii) For applicants claimed as tax dependents, the household is the same as the tax filer claiming the tax dependent. Tax dependents may include individuals not otherwise eligible for Medical Assistance, and who are not applying for benefits. If a non-custodial parent claims a child as a dependent, the dependent child will be included in the non-custodial parent’s household size.

(iii) For married couples who live together, each spouse will always be included in the other spouse’s household, regardless of the couple’s tax filing status.

(iv) For married couples who expect to file joint taxes but live separately, each spouse will be included in the other spouse’s household.

(v) There are three exceptions to the tax filer rule for applicants claimed as tax dependents. An applicant who meets any of the following is subject to the non-filer household composition rules:

(I) The tax filer is someone other than the applicant’s spouse, or natural, adopted or step parent; or (II) The applicant is under age nineteen (19), or twenty-one (21) if a fulltime student, and is claimed as a tax dependent by one parent, but her parents live together and do not file a joint tax return; or (III) The applicant is under age nineteen (19), or twenty-one (21) if a fulltime student, and expects to be claimed as a tax dependent by a non-custodial parent.

2. Non-Filers. Applicants who do not file taxes are subject to the non-filer household composition rules. The non-filer household includes the applicant and if living with the applicant:

(i) The applicant’s spouse;

(ii) The applicant’s natural, adopted and step children under age nineteen (19), or twenty-one (21) if a full-time student;

(iii) For applicants under age nineteen (19), or twenty-one (21) if a full-time student, the applicant’s natural, adopted or step parent; and (iv) For applicants under age nineteen (19), or twenty-one (21) if a full-time student, the applicant’s natural, adoptive and step siblings who are under age nineteen (19), or twenty-one (21) if a full-time student.

(f) The household size for a Pregnant Woman includes the number of children she is expected to deliver (the unborn child(ren)). The household size for other applicants in a Pregnant Woman’s household does not include the unborn child(ren).

(2) AFDC-Related Financial Determinations.

(a) Coverage groups whose financial eligibility is determined according to AFDC-based methodologies are:

1. Medically Needy Children; and 2. Qualified Medically Needy Pregnant Women.

(b) Income Determinations. Income for individuals described in this paragraph is calculated according to the AFDC cash assistance program’s income definitions and policies (Rules 1240-01-04-.12 and .14-.19, and 45 C.F.R. § 233.20). Unless otherwise specified below, these individuals are subject to the following income requirements:

1. ABLE Accounts. Contributions made by a third party, including a trust, and ABLE account earnings are excluded, except that contributions are not deducted from countable income of the individual making the contribution. Distributions from an ABLE account are not income of the designated beneficiary in any month regardless of whether the distribution is for non-housing QDEs, housing QDEs or non-qualified expenses. A distribution from an ABLE account is the conversion of a resource from one form to another.

2. Adoption Subsidies. Payments to an individual from state adoption assistance programs or Title IV-E funds for special needs children are excluded.

3. Alimony Received. Countable.

4. Annuity Payments. If the underlying annuity is an excluded resource, the periodic payments are countable unearned income. If the underlying annuity is a countable resource, payments are excluded.

5. Assistance Payment from another state. Countable.

6. Bonuses. Countable.

7. Cancelled Debts. Excluded.

8. Capital Gains. Countable.

9. Cash Inheritance. Countable.

10. Cash Support. Countable, unless excluded as infrequent or irregular income.

11. Census Payments. Excluded.

12. Child Support Payments. Countable, both current payments and arrears.

13. Child/Spousal Support Transferred to IV-D Agency. Payments transferred by the household to DCS as assigned support are excluded.

14. Child Tax Credit Payments. Excluded.

15. Combat Pay. Excluded.

16. Commissions. Countable.

17. CSIMA. Countable as unearned income only when the institutionalized individual is not in the community spouse’s household.

18. Contractual Payments. Countable.

19. Death Benefits. Countable income to an individual if the total amount exceeds the expense of the deceased person’s last illness and burial paid by the individual to whom the death benefit is issued.

20. Deferred Wages. Countable when the income would have normally been received if the wages are deferred at the employee’s request. Countable when received if the wages are deferred by the employer.

21. DIMA. Countable as unearned income only when the institutionalized individual is not in the dependent’s household.

22. Differential Payments. Countable.

23. Domestic Volunteer Service Act Payments. Payments made to volunteers under the Domestic Volunteer Service Act are excluded, unless the Corporation for National and Community Service (CNCS) determines that the value of the payments, based on the number of hours served, are equal to or greater than the federal or state minimum wage where the volunteer is serving, whichever is higher. This includes payments made to foster grandparents, senior companions, and persons serving in the Retired Senior Volunteer Program (RSVP) and Americorps VISTA.

24. Dwelling-Related Assistance. Excluded if housing assistance is provided by HUD or USDA’s Rural Housing Service.

25. Earned Income Tax Credits. Excluded.

26. Earned In-Kind Wages. Countable.

27. Economic-Impact Payments. Excluded.

28. Educational Income. Excluded. Includes: Pell Grants, Federal SEOG, Federal Student Loans, State Student Incentive Grants, Work Study, and any student financial assistance received under Title IV of the Higher Education Act of 1965, as amended, or under Bureau of Indian Affairs education assistance programs.

Other grants, scholarships, fellowships, or gifts are excluded to the extent they are used or set aside for educational expenses.

29. FF/TANF Payments. Excluded.

30. Farming Income. Countable.

31. Fishing Income. Countable.

32. Gambling Prizes and Awards. Countable.

33. Gifts. Cash gifts are countable unless excluded as infrequent or irregular income.

34. Income Not Pursued. Excluded.

35. Income Produced from Resources. Income generated by an excluded resource is countable unearned income. Income generated by a countable resource is excluded as income.

36. Inheritance Cash. Countable.

37. Interest Income. Interest earned on a countable resource is excluded as unearned income. Interest earned on an excluded resource is countable as income, unless specifically excluded under a Federal statute.

38. Interest on Burial Funds and Spaces. Excluded.

39. Irregular or Infrequent Income. Up to $30.00 of unearned or earned income received infrequently or irregularly per quarter is excluded.

40. Jury Duty Pay. Countable unless the income is turned over to an applicant’s employer.

41. Long Term Care (LTC) Insurance Payout. Payments from long term care insurance used for medical care are excluded.

42. Low Income Home Energy Assistance Payments (LIHEAP). Excluded.

43. Military Allowances. Cash allowances paid to active-duty service members and their families for housing, food, clothing and special circumstances count as earned income in the month of receipt. The basic allowance for subsistence (BAS), paid to military personnel to offset the cost of meals, counts as earned income. The basic allowance for housing (BAH) counts as earned income when the payment is made to military personnel living in private housing. When the BAH is paid to service members living on base or in privatized military housing and the allowance is paid and deducted from the service member’s pay in the same month or paid directly to the housing contractor, the BAH is excluded.

44. Older Americans Act Benefits. Count only wages and salaries paid to individuals as a result of their participation in a program funded under Title V of the Older Americans Act of 1965 as earned income. Benefits received under Title VII, Nutrition Program for the Elderly, of the Older Americans Act of 1965, as amended, are excluded.

45. PASS Income. Any earned or unearned income received and used to fulfill an approved plan to achieve self-support is excluded.

46. Payments from FEMA. FEMA payments issued as a result of presidentially declared emergency or major disaster are excluded. Payments made by comparable disaster assistance programs by States, local governments and disaster assistance organizations are also excluded. FEMA payments which are made to a household to pay for rent, food and utility assistance when there is no major disaster or emergency declaration are countable.

47. Pensions. Countable.

48. Protective Payee Payments. Funds received by a protective payee (conservator, authorized representative or representative payee) and used for the care and maintenance of a third party beneficiary (adult or child) who may or may not be a member of the protective payee’s household are excluded as income to the protective payee. Any part of the payment that is retained by the protective payee for her own use is countable income to the protective payee. Even if the protective payee retains a fee for her services, the entire payment issued on behalf of the beneficiary is countable income to the beneficiary.

49. Railroad Retirement Payments. Countable.

50. Reimbursements. Reimbursement of expenses an employee incurs in the performance of his duties for items other than normal living expenses are excluded.

51. Rental or Lease Income. Countable as earned income when the individual is actively engaged in producing such income, or bears some responsibility in earning the income. Countable as unearned income when the individual is not actively engaged in producing the income, or bears no responsibility in earning the income. Count the amount of income remaining after expenses related to maintaining the property are excluded.

52. Royalties and Honoraria. Countable.

53. Self-Employment Income. Net earnings are countable.

54. Settlements and Restitutions. The following settlements and restitution payments are excluded as unearned income:

(i) Agent Orange Settlement Payments;

(ii) Alaska Native Claims Settlement Act exclusions;

(iii) Criminal Victims Compensation Funds paid to crime victims;

(iv) Distribution of perpetual judgment funds to Indian tribes under the following:

(I) Black Feet and Gros Ventre Tribes (P.L. 92-254);

(II) Grand River Band of Ottawah Indiana in Indian Claims Commission Docket No. 40-K;

(III) Indian Judgment Funds Distribution (P.L. 93-134);

(IV) Receipts from land held in trust by the Federal government and distributed to certain Indian tribes under P.L. 94-114;

(V) Tribes or groups under P.L. 93-134; and (VI) Yakima Indian Nation or the Apache Tribe of the Mescalero Reservation (P.L. 95-433).

(v) Filipino Veterans Compensation Fund Payments. Lump sum payments made to certain veterans and spouses of veterans who served in the military of the Government of the Commonwealth of the Philippines during WWII;

(vi) German Reparation Payments;

(vii) Japanese-American and Aleutian Restitution Payments;

(viii) Payments made to individuals because of their status as victims of Nazi persecutions;

(ix) Payments to children born of Vietnam veterans diagnosed with spina bifida; and (x) Revenues from the Alaska Native Fund paid under section 21(a) of the Alaska Native Claims Settlement Act.

55. Severance. Countable.

56. Sheltered Workshop. Countable.

57. Sick/Disability Payments. Countable.

58. Social Security Payments. Countable.

59. Social Service Payments. Excluded.

60. SSI Payments. Excluded.

61. Supplemental Nutrition Assistance Program (SNAP). The value of a SNAP benefit is excluded. The value of free or reduced food under WIC or the National School Lunch Act is also excluded.

62. Temporary Disability Payments. Income is countable as unearned income to the extent it is not a reimbursement for specific costs and is paid directly to the applicant or any member of the applicant’s household.

63. Tips. Countable.

64. Trusts. Money withdrawn from the body of a trust or interest and dividends accrued to the trust and paid to the individual is countable.

65. Unemployment Compensation. Countable.

66. U.S. Department of Veterans Affairs Payments. Educational benefits, VA Aid & Attendance, and VA payments from Unusual Medical Expenses are excluded.

VA Disability and VA Pension payments made to a veteran are countable.

Augmented VA, Apportioned VA, and VA Survivor (DIC) payments are countable for the dependent spouse, child or parent for whom or to whom the benefits are paid.

67. Wages. Countable.

68. Work Study Payments. Excluded.

69. Workers’ Compensation. Countable as unearned income to the extent it is not earmarked and used for the purpose for which it is paid (i.e., medical bills or legal expenses).

(c) Resource Requirements. Resources for individuals described in this paragraph are calculated according to the AFDC cash assistance program’s resource definitions and policies (Rules 1240-01-04-.05, .07, .09 and .10; 42 C.F.R. §§ 435.840 and 435.845; and 45 C.F.R. § 233.20). Individuals described in this paragraph are subject to the following resource requirements:

1. ABLE Accounts. ABLE account balances and distributions from an ABLE account for a QDE are not a countable resource of the designated beneficiary.

Distributions from an ABLE account are countable as a resource when:

(i) Distributions are retained past the month of receipt for non-qualified disability expenses;

(ii) Qualified disability expenses (QDE) are expenses related to the blindness or disability of the designated beneficiary and for the benefit of the designated beneficiary. In general, a QDE includes, but is not limited to: education, housing, transportation, employment training and support, assistive technology and personal support services, health, prevention and wellness, financial management and administrative services, legal fees, funeral and burial expenses, and basic living expenses.

2. Annuities. An annuity is a countable resource when it is revocable, assignable, or if it can be sold.

(i) If an annuity is an excluded resource, payments being received from the annuity are countable unearned income. If the annuity is a countable resource, any payments being received from the annuity are excluded.

(ii) The countable resource value of an annuity is its Fair Market Value (FMV).

If the applicant is able to provide the FMV of the annuity, verified by two (2) credible sources in the legitimate business of selling and purchasing annuities, accept the verified value.

(iii) If the applicant does not provide two (2) credible statements of FMV, multiply the total annual payment by the period remaining to determine the countable value. If the period of the annuity is based on an annuitant’s lifetime, the annual payments are multiplied by the annuitant’s life expectancy, according to SSA’s Period Life Table. If the annuity is a “period certain” annuity, annual payments are multiplied by the annuitant’s life expectancy or the period certain, whichever is less. The calculated value of an annuity may be rebutted by providing two (2) credible statements of FMV amounts.

3. Business or Self-Employment. Excluded as essential for the production of earned income. Such excluded resources may include:

(i) Tools/equipment;

(ii) Stock or raw materials;

(iii) Personal property essential for income production;

(iv) Real property;

(v) Office equipment;

(vi) Business loans for the purchase of capital assets;

(vii) Inventory;

(viii) Machinery and equipment;

(ix) Business/commercial checking accounts; and (x) Life insurance.

4. Burial Contracts or Policies. Excluded. This does not include pre-paid or preneed burial agreements.

5. Burial Plot. Exclude one burial plot per household member.

6. Prepaid Burial Agreements or Burial Trusts. Exclude one burial agreement or burial trust with equity value of $1,500.00 or less per family member.

7. Cash. Countable.

8. Certificate of Deposit (CD). Countable if held in a personal account. The value of a CD is the net amount that could be received after penalties for early withdrawal, if applicable. Taxes are not deducted in determining value.

9. Checking Account. Personal checking accounts are countable. Other checking accounts may be excluded if designated for burial needs, educational income, Individual Development Accounts, PASS, prorated as income, proceeds from the sale of a home, disaster or settlement funds and retroactive SSA payments.

10. Child Tax Credit Payments. Excluded for twelve (12) months following receipt.

11. Contract for Deed or Mortgage. The value of a contract for deed or mortgage may be a countable asset depending on the circumstances of the loan, including the individual’s role as lender or borrower and the accessibility of the asset:

(i) When the individual is the lender for a contract for deed, the lender may sell or transfer the instrument to have immediate access to the unpaid principal. The value of the contract is the unpaid loan principal. Any portion of a payment that represents the loan principal is a conversion of a resource. Any portion of a payment that represents interest is considered unearned income in the month of receipt and a resource thereafter. The value of the contract may be excluded from countable resources if the individual can demonstrate that the contract cannot be sold without his realizing a net loss.

(ii) If the individual is the borrower, the property agreement is not a resource.

However, the property purchased may be a countable resource following the month of transaction.

12. Educational Income. All educational income is excluded as a resource, including student financial assistance received under Title IV of the Higher Education Act and the Bureau of Indian Affairs. The individual must be enrolled in school and attending classes to be considered a student. Grants, scholarships, fellowships and gifts other than those previously listed intended to pay for tuition, fees or educational expenses are excluded as a resource.

13. Farm, Business or other Equipment. The equity value of non-self-employment income-producing real property, other than the homestead, is countable. If the property is used for self-employment, it is excluded as Business or Self- Employment.

14. Home and Lot. The entire value of the home, whether on land or water, and lot and all adjoining land not separated by property owned by others and any related outbuildings are excluded in determining resource eligibility, as long as the home is the principal place of residence for the applicant/enrollee. Temporary absences from the home do not affect the home’s exemption, as long as the individual intends to return home at a specified time.

15. Household Goods and Personal Effects. Excluded.

16. Individual Development Account (IDA). Up to $5,000.00 in the account is disregarded as a resource as long as the individual complies with the IDA eligibility rules and continues to maintain or make contributions to the account.

17. Income-Producing Resource. Countable if accessible to the individual.

18. Sick and Disability Insurance. Excluded.

19. Burial Insurance. Excluded.

20. Items of Unusual Value. Exclude up to $2,000.00 of all total personal items of unusual value. If the individual’s equity value in one or more than one item of unusual value is greater than $2,000.00, the amount that exceeds $2,000.00 is countable towards the resource limit.

21. Life Estates:

(i) Property in which an individual holds a life estate is subject to the same exclusion rules as property the individual owns by title, subject to the following exceptions:

(I) A life estate will be excluded as the home when the property meets the home exemption.

(II) A life estate will be excluded when ownership is necessary for the production of earned income. See Business or Self-Employment in this Subparagraph.

(III) The terms of the life estate contract prevent the holder from selling her interest in the property.

(ii) If the life estate is not excluded based on the criteria above, the entire value of the life estate is a countable asset. The life estate value is determined by multiplying the fair market value of the property by the percentage listed in the “Life Estate Interest Table” for the age of the individual on whose lifetime the life estate is based. If more than one person owns the life estate, the value is based on the owner with the longest life expectancy.

22. Life Insurance. Excluded.

23. Livestock. The value of livestock necessary for business or self-employment, as a tool of the trade, or raised for home/personal consumption is an excluded resource. Income received is countable as self-employment income. Livestock that is used as non-business, income-producing property is countable.

24. Oil and Mineral Rights. May be included with land ownership or owned separately. If surface rights of the same property are excluded (for example, as a home) so are oil and mineral rights. Oil and mineral rights are countable when owned for personal use, or when the surface rights of the same property are countable (non-homestead, real property).

(i) If oil or mineral rights are producing income under a lease agreement, the owner may be constrained from selling or otherwise disposing of those rights. If the land is already excluded, then oil and mineral rights are also excluded.

(ii) If oil or mineral rights are producing income to the individual, and he is not actively engaged in the production of income, the equity value of the rights is countable.

25. Personal Use Resource. Countable unless excluded based on the terms of the asset. A personal resource is typically for the use of the individual and/or his family.

26. Personal Consumption. Exclude as a resource the equity value of a nonbusiness property used to produce goods or services essential to daily activities.

27. PASS. Income an SSI recipient places in an approved PASS account is excluded as a resource. The PASS account itself is also excluded. This exclusion expires when the PASS contract expires or ends, or when the individual is no longer an SSI recipient.

28. Proceeds from the Sale of a Home. Excluded to the extent that the funds are intended to be used to purchase another home subject to the homestead exclusion, and the funds are used for such a purpose within three (3) months of the date of receipt of the proceeds.

29. Promissory Note and Other Loans. A promissory note or other loan given by the household is considered personal property and is countable, unless the note/loan balance is inaccessible or the promissory note is held for reasons other than personal use. The lender holds legal interest and has the legal ability to make available her share in the note or loan. The equity value of the note/loan is countable.

30. Prorated as Income. Excluded.

31. Real Property. The equity value in all real property the individual owns individually or jointly is a countable asset with the following exceptions:

(i) Property excluded as the homestead;

(ii) The inaccessible equity value of real property;

(iii) Equity value of income-producing property;

(iv) Real property necessary for the production of earned income (see Business or Self-Employment in this Subparagraph); or (v) Real property excluded under a conditional assistance agreement between the individual and the State. The individual must make reasonable efforts to sell the property at its current market value and repay the State for medical expenses covered by TennCare during the exclusion period with the proceeds of the sale. Exemption of the real property is not to exceed nine (9) months. Only one (1) parcel of property may be excluded under a conditional assistance agreement per period of eligibility.

(I) Repayment of medical expenses covered by TennCare may not exceed the total of the net proceeds. Any proceeds remaining after repayment to the State are considered a resource.

(II) If the property remains unsold after nine (9) months, the property is considered inaccessible so long as reasonable efforts to sell the property continue.

32. Rental property. Countable if the individual who owns the property is not ‘in the business of’ renting property. Someone who is in the business of renting property is someone who materially participates in the operation and decision making of the rental business for at least twenty (20) hours per week.

33. Retirement Accounts and Pension Plans. Excluded up to $20,000.00. Money held in an IRA, 401(K), or Keogh in excess of $20,000.00 is countable, minus any penalty for early withdrawal. Pension funds that are not accessible are excluded as a resource. If the pension becomes accessible due to retirement or termination it becomes a countable resource.

34. Savings Account. Countable if it is characterized by personal use. If the current month’s income has been deposited into the account, it must be excluded when determining the current value of the account. A savings account may be excluded if it is used for one of the following purposes:

(i) Burial funds;

(ii) Business or Self-Employment;

(iii) Educational Income;

(iv) Individual Development Account;

(v) PASS;

(vi) Proceeds from the Sale of a Home (subject to time limits);

(vii) Prorated as Income;

(viii) Settlement or Disaster Payment, if Excluded by Policy; or (ix) SSI/SSA Retroactive Payment (subject to time limits).

35. Settlement or Disaster Payment. Payments or benefits provided under certain Federal statutes are excluded, if payments are not commingled with other funds.

Excluded settlement and/or disaster payments include:

(i) Agent Orange Settlement Payments (and interest from payments);

(ii) Disaster Relief Assistance received under the Disaster Relief Act of 1974;

(iii) Distribution of perpetual judgment funds to Indian tribes under the following:

(I) Indian Judgment Funds Distribution (P.L. 93-134);

(II) Black Feet and Gros Ventre Tribes (P.L. 92-254);

(III) Grand River Band of Ottawah Indiana in Indian Claims Commission Docket No. 40-K;

(IV) Tribes or groups under P.L. 93-134;

(V) Yakima Indian Nation or the Apache Tribe of the Mescalero Reservation (P.L. 95-433); and (VI) Receipts from land held in trust by the Federal government and distributed to certain Indian tribes under P.L. 94-114.

(iv) Factor VIII or IX Concentrate Blood Products Litigation. The settlement payments (and interest from payments) made as a result of the class action lawsuit to hemophilia patients infected with HIV through blood plasma products;

(v) Filipino Veterans Compensation Fund Payments. Lump sum payments (and interest from payments) made to certain veterans and spouses of veterans who served in the military of the Government of the Commonwealth of the Philippines during WWII;

(vi) Japanese-American and Aleutian Restitution Payments (and interest from payments);

(vii) Payments made to individuals because of their status as victims of Nazi persecutions (and interest from payments);

(viii) Payments to children born of Vietnam veterans diagnosed with spina bifida (and interest from payments);

(ix) Payments made under the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (interest is not excluded);

(x) Revenues from the Alaska Native Fund paid under Section 21(a) of the Alaska Native Claims Settlement Act;

(xi) Criminal Victims Compensation Funds paid to crime victims (excluded for nine (9) months); or (xii) Energy Employees Occupational Illness Compensation Program Act (EEOICPA).

36. SSI/SSA Retroactive Payments. Excluded for nine (9) months after the payment is received and countable after the nine (9) month exclusion period.

37. Stocks, Bonds and Mutual Funds. Countable if asset is held for personal use.

Stocks, bonds or mutual funds may be excluded if held for the purposes listed below:

(i) Burial;

(ii) Business or Self-Employment;

(iii) Educational Income;

(iv) Proceeds from the Sale of a Home;

(v) Prorated as Income; or (vi) Settlement or Disaster Payment, if Excluded by Policy.

38. Tools of the trade. Excluded when essential for the production of earned income.

39. Trusts. Countable or excluded, when the applicant or household member is either the trust’s trustee or beneficiary, based on the nature of the trust, the date the trust was created, the source of funds used to create the trust, plus other factors as specified in 42 U.S.C. § 1396p(d).

40. Uniform Gifts to Minors Act (UGMA) Assets or Property. Excluded for individuals who have not reached the age of majority (as established by the state law controlling such gift). Counted for individuals who have reached the age of majority (as established by the state law controlling such gift).

41. Uniform Transfers to Minors Act (UTMA) Assets or Property. Excluded for individuals who have not reached the age of majority (as established by the state law controlling such transfer). Counted for individuals who have reached the age of majority (as established by the state law controlling such transfer).

42. Vehicles. Exclude up to $4,600.00 of the equity value of one (1) vehicle in the applicant’s household. The equity value of any other vehicle is countable, unless the vehicle can be excluded based on its use. The equity value of recreational vehicles (boats, snowmobiles, jet skis, ATVs and aircraft) is a countable resource.

(d) Disregards and Expenses Allowed. For purposes of determining the income of individuals described in this paragraph, the following expenses will be disregarded from their income:

1. Child Support Disregard. Disregard $50.00 per month per household if a child living in the home receives child support payments (current only).

2. Earned Income Disregard. Disregard $90.00 per month from each household member’s total earned income.

3. Payments made on Behalf of Dependents within the Home. Disregard up to $175.00 per month of day care expenses per dependent age two (2) or older.

Disregard up to $200.00 per month of day care expenses per dependent under age two (2).

4. Student Income. Disregard the earnings of dependent children who are included in the household composition and are full-time or part-time students and are not working full time. Disregard the earnings of a part-time student who works parttime. Earnings of a part-time student who works full time are not to be disregarded.

(e) Household composition for TennCare Medicaid Medically Needy categories is based on the principle of FRR.

1. For unmarried applicants, the following individuals are included in the applicant’s household for Child Medically Needy, if living in the home:

(i) The applicant;

(ii) The applicant’s children under age twenty-one (21);

(iii) The applicant’s unborn child(ren);

(iv) The applicant’s natural or adoptive parents; and (v) The applicant’s siblings who are under age twenty-one (21) (including unborn children).

2. The Child Medically Needy applicant’s parent(s) are not included if the applicant is an emancipated minor.

3. For married applicants, the following individuals must be included in the applicant’s household for Child Medically Needy, if living in the home.

(i) The applicant;

(ii) The applicant’s children under age 21;

(iii) The applicant’s unborn child(ren); and (iv) The applicant’s spouse (if under age 21 and applying for Medical Assistance).

(v) When the applicant’s spouse is living in the home and is over age 21 or under age 21 and not applying for Medical Assistance, the spouse’s income and resources are deemed to the applicant. When income and resources are deemed from a spouse, the household size will be increased to account for the deemed spouse.

4. The Child Medically Needy applicant’s step parent living in the home is not included in the child’s household.

5. The following individuals must be included in the Medically Needy Qualified Pregnant Woman applicant’s household, if living in the home:

(i) The Pregnant Woman applicant;

(ii) The applicant’s unborn child(ren);

(iii) The applicant’s spouse, if under 21 and applying for Medical Assistance; and (iv) The applicant’s children under age twenty-one (21).

(v) If the applicant’s spouse is living in the home and is over age 21 or under age 21 and not applying for Medical Assistance, the spouse’s income and resources are deemed to the applicant. When income and resources are deemed from a spouse, the household size will be increased to account for the deemed spouse.

6. Parents of a Pregnant Woman applying for TennCare Medicaid Medically Needy Qualified Pregnant Woman coverage are not included in the applicant’s household.

(f) Spenddown.

1. Applicants must produce proof of relevant medical expenses in order to “spend down” monthly income to the TennCare Medically Needy Income Standard (MNIS) to be eligible in a Medically Needy category. If income is below the MNIS, spenddown will not be necessary. Applicants may reduce available monthly income with countable expenses, as listed below, in order to qualify for eligibility in the Medically Needy categories. The income limits for the Medically Needy category are published in the State Plan.

2. Countable Expenses. The following Rules apply to the expenses that may be used to meet spenddown:

(i) Countable expenses incurred during the month of application, whether paid or unpaid.

(ii) Countable expenses paid during the month of application, regardless of when such expenses were incurred.

(iii) Countable expenses incurred during the three (3) calendar months prior to the month of application, whether paid or unpaid.

(I) Expenses paid during the three calendar months prior to the month of application will not be counted unless such expenses were also incurred during those three calendar months.

(II) Any expenses incurred before the three (3) calendar months prior to the month of application will not be counted unless payment is made on those expenses during the month of application, in which case only the amount paid during the month of application is counted.

(III) When a Medically Needy enrollee has been eligible for twelve (12) months, he will be expected to meet spenddown again as described in this section, except verified expenses that are documented in the enrollee’s Medicaid record can be carried forward to the next year as long as the individual remains continuously eligible, the expenses remain unpaid, and the bills are not written off by the provider. Only the portions of expenses that were not previously used to meet spenddown can be carried forward to the next eligibility determination. If an enrollee loses eligibility at any point, the carry forward of unpaid medical expenses ends and the enrollee must meet spenddown as if he were a new applicant.

(iv) All medical expenses are considered incurred the date the service is provided with the following exception: medical expenses related to maternity care (e.g., global fee) are considered incurred the month the physician presents a bill once services have begun (i.e., initial examination by the physician at a minimum).

(v) If spenddown is not met by the medical bills incurred as of the date of application submission or as of the date of submission of a renewal application during redetermination, the daily countable medical expenses incurred during the application month will be added until spenddown liability is reached.

3. Incurred or paid expenses for the following individuals may be considered countable expenses for purposes of determining Medically Needy financial eligibility:

(i) The applicant;

(ii) Members of the applicant’s household;

(iii) The applicant’s FRRs or anyone for whom the applicant is financially responsible; and (iv) Individuals not living in the applicant’s home or eligible for inclusion if the applicant’s household member or the applicant’s FRR is legally obligated to pay their medical expenses.

4. Countable expenses are those for which the individual is still liable and that are:

(i) For medical or remedial care, including costs for over the counter medications and costs incurred for medical insurance premiums, copayments and deductibles. Health insurance premiums may be deducted as a spenddown expense only when payment is due, even if paid in another month;

(ii) Verifiable and for which the individual provides substantiation;

(iii) Incurred by eligible individuals and are the legal responsibility of a household member and not subject to payment in full or part by a third party;

(iv) Recognized under State law but not covered under the State’s TennCare Medicaid plan or waiver (continuously eligible individuals); or (v) Covered under TennCare Medicaid but incurred during the spenddown period (new applicants).

5. The following list includes but is not limited to the types of medical expenses that are considered Countable Medical Expenses for the Medically Needy categories:

(i) Acupuncture services.

(ii) Bed hold at a Long Term Care Facility (Medicaid rate).

(iii) Dental expenses.

(iv) Doctor’s fees. Includes fees from services rendered by practitioners and others providing medical services, physicians, surgeons, dentists, optometrists, chiropractors, osteopaths, podiatrists, psychiatrists, psychologists, and Christian Science providers.

(v) Drugs prescribed by a physician (prior to TennCare eligibility). Includes charges for medicines and drugs prescribed by a doctor incurred prior to establishing TennCare Medicaid eligibility and which remained unpaid or paid in the month under consideration (i.e., spenddown month).

(vi) Guide dogs. Guide dogs for the blind or deaf and the costs of their maintenance.

(vii) Hospital charges.

(viii) Medical care charges included in tuition costs. Charges for medical care included in the tuition fee of a college or private school which is paid on a monthly basis, provided that a breakdown of the charges is included in the bill or is furnished separately by the institution.

(ix) Nursing home costs.

(x) Nursing services. Nursing services include nursing care in an individual’s home, if for the purpose of treatment or alleviation of a physical, mental, or emotional disorder and ordered by a provider acting within the provider’s scope of practice. The care needed must be medical, e.g., administering medication or therapy. Cost of services solely domestic in nature, such as the preparation of meals and the performance of housework, is not deductible.

(xi) Organ transplant expenses.

(xii) Prosthetic devices. Artificial teeth, limbs, hearing aids and component parts, eyeglasses and crutches.

(xiii) Psychiatric care. Psychiatric care primarily for alleviating a mental illness or defect; the cost of maintaining a mentally ill individual at a specially equipped medical center where the individual receives continual medical care.

(xiv) Special education for handicapped. Special school for mentally or physically handicapped individuals if for the alleviation of handicap. The costs of meals and lodging, if supplied by the institution, and/or ordinary education furnished incidental to the special services are medical expenses.

(xv) Substance abuse treatment. Treatment at a therapeutic center for drug addicts or alcoholics, including meals and lodging furnished as a necessary incident to the treatment.

(xvi) Transportation for medical/remedial purposes. Transportation essential to medical care, including but not limited to bus, taxi, train, or plane fares, using the Internal Revenue Service’s standard mileage rate for business use for each mile that the individual’s car is used for medical purposes, in addition to parking fees and tolls.

(xvii) Over the counter (non-prescription) medicine. $10.00 per month is deducted for these expenses without verification, using only the applicant’s statement. All of these expenses must be verified if the amount is more than $10.00 per month.

6. The following are types of medical expenses that are not considered Countable Medical Expenses for the Medically Needy categories:

(i) Expenses that have been written off as uncollectible or have been forgiven by the provider.

(ii) Expenses that are covered by the state’s TennCare Medicaid plan and are incurred during a period of eligibility:

(I) Costs incurred during a period of TennCare eligibility due to co-pays or services not covered such as dental, hearing and eye care for adults are allowable as a medical expense.

(II) Bills incurred during TennCare eligibility which are subject to TennCare reimbursement are not considered outstanding for subsequent spenddown periods even if not paid by TennCare.

(3) ABD Financial Determinations.

(a) Coverage groups whose financial eligibility is determined based on SSI financial methodology are:

1. Individuals applying for SSI-Related categories.

2. MSP Applicants.

3. Individuals applying for Institutional Eligibility.

4. Individuals applying for ECF CHOICES.

(b) Income Determinations. Income countable for purposes of individuals described in this paragraph is defined at 20 C.F.R. §§ 416.1100, et seq., and as set forth below, except gross income, under the Institutional Eligibility category, in accordance with 42 C.F.R. § 435.1005, does not take into account the income exclusions under 20 C.F.R. § 416.1112 and 20 C.F.R. § 416.1124, unless specified under another Federal statute.

Unless otherwise specified in this rule, these individuals are subject to the following income requirements:

1. ABLE Accounts. Contributions made by a third party, including a trust, and ABLE account earnings are excluded, except that contributions are not deducted from countable income of the individual making the contribution. Distributions from an ABLE account are not income of the designated beneficiary in any month regardless of whether the distribution is for non-housing QDEs, housing QDEs or non-qualified expenses. Distribution from an ABLE account is the conversion of a resource from one form to another.

2. Adoption Subsidies. Countable to the child if intended for general living expenses. Excluded if for reimbursement of child care while the adult responsible for the child is at work or seeking employment, or for medical expenses.

3. Alimony. Countable.

4. Americorps and Americorps NCCC. Cash or in-kind payments are excluded.

5. Annuity Payments. If the underlying annuity is an excluded resource, the periodic payments are countable unearned income. If the underlying annuity is a countable resource, payments are excluded. Payments are also excluded if an annuity is paid by a state to an individual or spouse based on the state’s determination that the individual is a veteran who is aged, blind or disabled.

6. Bonuses. Countable.

7. Care and Contribution in Exchange for a Transferred Asset. Countable.

8. Canceled Debts. Excluded.

9. Capital Gains. Countable.

10. Cash Support. Countable, unless excluded as irregular or infrequent income.

11. Census Income. Excluded.

12. Child Support Arrearage. Countable to the child(ren) the payments are intended to support. Exclude one-third (1/3) of the child support arrearage payment paid by an absent parent to or for an eligible child under age 18 or under age twentytwo (22) if a student regularly attending school. The one-third (1/3) exclusion does not apply to ineligible children.

13. Child Support Payments. Countable to the child(ren) the payments are intended to support. Exclude one-third (1/3) of the child support payment paid by an absent parent to or for an eligible child under age 18 or under age twenty-two (22) if a student regularly attending school. The one-third (1/3) exclusion does not apply to ineligible children.

14. Child Tax Credit Payments. Excluded.

15. Commissions. Countable.

16. Combat Pay. Excluded.

17. CSIMA. Countable as unearned income only when the institutionalized individual is not in the community spouse’s household.

18. Contractual Payments. Countable.

19. Death Benefits. Countable income to an individual if the total amount exceeds the expense of the deceased person’s last illness and burial paid by the individual to whom the death benefit is issued.

20. DIMA. Countable as unearned income only when the institutionalized individual is not in the dependent’s household.

21. Differential Payments. Countable.

22. Domestic Volunteer Service Act Payments. Payments made to volunteers under the Domestic Volunteer Service Act are excluded, unless the Corporation for National and Community Service (CNCS) determines that the value of the payments, based on the number of hours served, are equal to or greater than the federal or state minimum wage where the volunteer is serving, whichever is higher. This includes payments made to foster grandparents, senior companions, and persons serving in the Retired Senior Volunteer Program (RSVP) and Americorps VISTA.

23. Earned Income Tax Credits. Excluded.

24. Earned In-Kind Not Food or Shelter. Excluded.

25. Earned In-Kind Wages. Countable.

26. Economic-Impact Payments. Excluded.

27. Educational Income. Excluded. Includes: Pell Grants, Federal SEOG, Federal Student Loans, State Student Incentive Grants, Work Study, and any student financial assistance received under Title IV of the Higher Education Act of 1965, as amended, or under Bureau of Indian Affairs education assistance programs.

Other grants, scholarships, fellowships, or gifts are excluded to the extent they are used or set aside for educational expenses.

28. Farming/Fishing Income. Countable.

29. Gambling Prizes and Awards. Countable.

30. Gifts. Countable.

31. Income Not Pursued. Countable.

32. Income Produced from Resources. Income generated by a resource that is excluded is countable unearned income. Income generated by a resource that is countable is excluded as income.

33. Inheritance Cash. Countable.

34. Interest Income. Interest earned on a countable resource is excluded as unearned income. Interest earned on an excluded resource is countable as income, unless specifically excluded under a Federal statute.

35. Interest on Excluded Burial Arrangements, Funds, and Spaces. Excluded.

36. Irregular or Infrequent Income. Exclude up to $60.00 per calendar quarter of unearned income when it is received infrequently or irregularly. Exclude up to $30.00 per calendar quarter of earned income when it is received infrequently or irregularly.

37. Jury Duty Pay. Countable unless the income is turned over to an applicant’s employer.

38. Long Term Care Insurance Payments. Countable if the payment is not assigned or provided to the nursing home, HCBS provider, or MCO.

39. Military Allowances. Countable. The basic allowance for housing (BAH) is counted as earned income when the payment is made to military personnel living in private housing. The BAH should be treated as unearned income in the form of in-kind support and maintenance (ISM) subject to the Presumed Maximum Value (PMV) rule for service members and their families who live on base or in privatized military housing.

40. Older Americans Act Payments. Count only wages or salaries.

41. PASS Payments. Any earned or unearned income received and used to fulfill an approved plan to achieve self-support is excluded.

42. Payments from FEMA. FEMA payments issued as a result of a presidentially declared emergency or major disaster are excluded. Payments made by comparable disaster assistance programs by States, local governments and disaster assistance organizations are also excluded. FEMA payments which are made to a household to pay for rent, food and utility assistance when there is no major disaster or emergency declaration are countable.

43. Pensions. Countable.

44. Protective Payee Payments. Funds received by a protective payee (conservator, authorized representative or representative payee) and used for the care and maintenance of a third party beneficiary (adult or child) who may or may not be a member of the protective payee’s household are excluded as income to the protective payee. Any part of the payment that is retained by the protective payee for her own use is countable income to the protective payee. Even if the protective payee retains a fee for her services, the entire payment issued on behalf of the beneficiary is countable income to the beneficiary.

45. Rental or Lease Income. Countable as earned income when the individual is in the business of renting or leasing property, i.e., self-employment. Countable as unearned income when the individual is not in the business of renting or leasing property. Count the amount of income remaining after expenses related to maintaining the property are applied.

46. Royalties and Honoraria. Countable.

47. Self-Employment. Net earnings are countable.

48. Settlements or Disaster Payments. The following settlements and disaster payments are excluded as unearned income:

(i) Agent Orange Settlement Payments (and interest from payments);

(ii) Disaster Relief Assistance received under the Disaster Relief Act of 1974;

(iii) Distribution of perpetual judgment funds to Indian tribes under the following:

(I) Indian Judgment Funds Distribution (P.L. 93-134);

(II) Black Feet and Gros Ventre Tribes (P.L. 92-254);

(III) Grand River Band of Ottawah Indiana in Indian Claims Commission Docket No. 40-K;

(IV) Tribes or groups under P.L. 93-134;

(V) Yakima Indian Nation or the Apache Tribe of the Mescalero Reservation (P.L. 95-433); and (VI) Receipts from land held in trust by the Federal government and distributed to certain Indian tribes under P.L. 94-114.

(iv) Factor VIII or IX Concentrate Blood Products Litigation. The settlement payments (and interest from payments) made as a result of the class action lawsuit to hemophilia patients infected with HIV through blood plasma products;

(v) Filipino Veterans Compensation Fund Payments. Lump sum payments (and interest from payments) made to certain veterans and spouses of veterans who served in the military of the Government of the Commonwealth of the Philippines during WWII;

(vi) Japanese-American and Aleutian Restitution Payments (and interest from payments);

(vii) Payments made to individuals because of their status as victims of Nazi persecutions (and interest from payments);

(viii) Payments to children born of Vietnam veterans diagnosed with spina bifida (and interest from payments);

(ix) Payments made under the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (interest is not excluded);

(x) Revenues from the Alaska Native Fund paid under section 21(a) of the Alaska Native Claims Settlement Act; and (xi) Criminal Victims Compensation Funds paid to crime victims.

49. Severance. Countable.

50. Sheltered Workshop Payments. Countable.

51. Sick/Disability Payments. Countable.

52. Social Security Payments. Countable.

53. Social Service Payments. Excluded.

54. SSI. Excluded.

55. Temporary Disability Insurance. Income is countable as unearned income to the extent it is not a reimbursement for specific costs and is paid directly to the household.

56. Tips. Tips that total more than $20.00 in a calendar month from any one employer are countable earned income. Tips totaling less than $20.00 in a calendar month are countable unearned income.

57. Trusts. Dividends, interest, rents and other income generated by a trust fund, unless otherwise excluded, that can be paid to the beneficiary or to a third party on the beneficiary’s behalf are countable income to the beneficiary for the period the fund is intended to cover, beginning the month the funds become available, regardless of whether the income is actually paid out to the beneficiary. When funds are withdrawn irregularly, the payments are countable in the month received.

(i) Monies withdrawn from the principal of an accessible (countable) trust fund are excluded as income to the beneficiary, because an accessible trust fund is a countable resource. Money cannot be considered income and a resource in the same month.

(ii) Monies disbursed from the principal of an inaccessible trust fund are counted as income because an inaccessible trust fund is an excluded resource.

(iii) Monies received by the trustee of a trust and used for the care and maintenance of a third party beneficiary (adult or child) are excluded as income for the trustee.

58. Unearned In-Kind Income or In-Kind Support and Maintenance. Unearned In- Kind income in the form of food and/or shelter may be countable or excluded depending on the source. If countable, it is subject to either the Value of the One- Third Reduction (VTR) rule or the Presumed Maximum Value (PMV) rule.

59. Unearned In-Kind Income, Not Food or Shelter. Excluded.

60. Unemployment Compensation. Countable.

61. U.S. Department of Veterans Affairs Payments:

(i) Aid and Attendance and Housebound Allowances. Excluded.

(ii) Apportioned. Payments made to a dependent spouse, child, or parent are countable for the individual to whom the benefits are paid.

(iii) Augmented Benefit. Payments received on behalf of a dependent spouse, child, or parent are countable for the individual for whom the benefits are paid.

(iv) Compensation. Countable.

(v) Death Benefit. Countable as unearned income to an individual if the total amount exceeds the expense of the deceased person’s last illness and burial paid by the individual to whom the death benefit is issued.

(vi) Dependency and Indemnity Compensation (DIC). Countable.

(vii) Educational Benefits. Excluded.

(viii) Payments for Unreimbursed Medical Expenses. Excluded.

(ix) Pension. Countable. If an institutionalized veteran receives a VA improved pension limited to $90.00 per month, the VA pension is excluded.

62. Wages. Countable.

63. Workers’ Compensation. Countable as unearned income to the extent it is not an expense attributable to obtaining the compensation.

64. WIOA Payments. Countable, unless the payments are for supportive services, such as child care, transportation, or job placement services. Wages earned by a student in the Job Corps program may be excluded under the student earned income exclusion.

65. Work Study Payments. Excluded.

(c) Resource Determinations. Resources countable for purposes of individuals described in this paragraph are defined at 20 C.F.R. §§ 416.1201, et seq. Unless otherwise specified below, individuals described in this paragraph are subject to the following resource requirements:

1. ABLE Accounts. Distributions from an ABLE account are excluded if used or intended to be used for QDEs as long as the distributions are identifiable.

Distributions from an ABLE account used for non-qualified expenses are excluded if spent in the month of receipt. Distributions from an ABLE account are countable as a resource when:

(i) Distributions are retained past the month of receipt and are used for or intended to be used for non-qualified disability expenses; or (ii) Distributions are retained past the month of receipt and were previously excluded because intended for a QDE, but used for a non-qualified expense. Count the amount of funds used as a resource the first of the month in which funds were spent; or (iii) Distributions are retained past the month of receipt, have not been spent, and the intent to use the funds for a QDE has changed. Count the retained funds as a resource the first of the following month.

(iv) Qualified disability expenses (QDE) are expenses related to the blindness or disability of the designated beneficiary and for the benefit of the designated beneficiary. In general, a QDE includes, but is not limited to: education, housing, transportation, employment training and support, assistive technology and personal support services, health, prevention and wellness, financial management and administrative services, legal fees, funeral and burial expenses, and basic living expenses.

2. Annuities are countable resources for individuals when accessible according to 20 C.F.R. § 416.1201. An annuity is a countable resource when it is revocable, assignable, or can be sold.

(i) If the annuity is an excluded resource, payments being received from the annuity will be countable unearned income, except as excluded at Subpart (v). If the annuity is a countable resource, any payments being received from the annuity are excluded.

(ii) Generally, annuities are revocable while in the accumulation phase though an owner will not receive a full refund, unless the annuity is cancelled during the free-look period. Once an annuity has been annuitized, the annuity is excluded as a resource if the funds are unavailable in a lump sum.

(iii) The countable value of an annuity during the free-look period is the purchase value. The countable value of an annuity during the accumulation phase is the cash value minus any withdrawals and surrender charges or penalty fees for early withdrawal. If an annuity contains a provision that allows an individual to cash in a contract after annuitization, the countable value of the annuity is the commuted cash value, i.e., the present value of all future payments.

(iv) Distributions from an annuity, such as systematic withdrawals and required minimum distributions (RMDs), are considered conversions of a resource rather than income.

(v) Any amount of an annuity held following the month of receipt is a countable resource, except when an annuity is a state annuity for certain veterans. A state annuity is an annuity paid by a state to an individual or an individual’s spouse based on the state’s determination that the individual is a veteran who is aged, blind or disabled.

(vi) Annuities that are funded by a pension or a retirement fund held by an employer or union should not be counted as a resource, while the individual is employed, if termination of employment would be necessary to access the funds.

(vii) Individuals applying for or receiving LTSS must meet additional requirements regarding asset transfers and exclusion of annuities at Rule .06(3)(h).

3. Business or Self-Employment. Excluded as essential for the production of earned income. Resources may include:

(i) Tools/equipment;

(ii) Stock or raw materials;

(iii) Personal property essential for income production;

(iv) Real property;

(v) Office equipment;

(vi) Business loans for the purchase of capital assets;

(vii) Inventory;

(viii) Machinery and equipment;

(ix) Business/commercial checking accounts; and (x) Life insurance.

4. Burial Funds.

(i) Burial funds which are not commingled are excluded resources when:

(I) The funds are used to purchase a life insurance policy which is then irrevocably assigned to a funeral provider. Either the ownership of the policy or proceeds may be assigned to the funeral provider. The

purpose of the assignment is to fund a burial contract.

(II) The funds are invested in an irrevocable pre-paid or pre-need burial contract established by a funeral provider and the contract meets the following conditions:

I. Both the individual and the funeral home representative have signed the document;

II. An itemized list of the services provided under the contract is provided;

III. The total dollar amount of the agreement is specified;

IV. The individual was neither a minor nor legally declared incompetent when the agreement was signed; and V. The agreement specifies in writing that the money is not refundable under any circumstances.

(III) The funds are invested in a burial trust established by the individual, and the total funds in the trust, including interest payments, do not exceed $6,000.00 per individual. Transport costs which cause the trust value to exceed $6,000.00 are excluded.

(ii) Burial funds are countable resources when:

(I) The funds are used to purchase a life insurance policy and a revocable assignment of the policy or proceeds is made to a funeral provider.

(II) The funds are invested in a revocable pre-paid or pre-need burial contract established by a funeral provider.

(III) Countable burial funds are eligible to be excluded as part of the individual’s burial reserve.

(iii) Burial Reserve. An individual is allowed to set aside $1,500.00 in resources to cover expenses connected to her burial, cremation or other funeral arrangements. Funds allowed to be excluded as part of the burial reserve include revocable, countable burial funds. These funds must not be commingled with other resources, and must be set aside for burial expenses. The $1,500.00 maximum amount of the burial reserve is first reduced by:

(I) Life insurance, if the total value of all life insurance owned by the individual is $1,500.00 or less; and (II) Funds in an irrevocable burial agreement or contract.

5. Burial Plots. Exclude the value of one burial space for each family member, e.g. spouse, child, parent, sibling, whether living in the home or not. Burial plots and spaces include a gravesite, crypt, mausoleum, niche or other repository for bodily remains, vaults, headstones, markers, plaques, containers and arrangement for opening and closing the gravesite.

6. Cash. Countable.

7. Certificates of Deposit (CD). Countable if held in a personal account. The value of a CD is the net amount that could be received after penalties for early withdrawal, if applicable. Taxes are not deducted in determining net value.

8. Checking Accounts. Personal checking accounts are countable. Some checking accounts that may be excluded include those designated for burial needs, educational income, Individual Development Accounts, PASS, prorated as income, proceeds from the sale of a home, disaster or settlement funds if excluded by policy, and retroactive SSA payments.

9. CCRC Deposit or Fee. The value of an entrance fee paid to a CCRC is a countable resource when it meets the following conditions:

(i) The entrance fee can be used to pay for care under the terms of the entrance contract should other resources of the individual be insufficient;

(ii) The entrance fee or its remaining portion is refundable when the individual dies or terminates the contract and leaves the CCRC; and (iii) The entrance fee does not confer any ownership interest in the community.

10. Child Tax Credit Payments. Excluded for twelve (12) months following receipt.

11. Christmas Club Accounts. Countable minus any withdrawals and surrender charges or penalty fees for early withdrawal.

12. Contracts for Deed or Mortgage. The value of a contract for deed or mortgage may be a countable asset dependent on the circumstances of the loan, including the individual’s role as lender or borrower and the accessibility of the asset.

(i) When the individual is the lender for a contract for deed, the lender may sell or transfer the instrument to have immediate access to the unpaid principal. The value of the contract is the unpaid loan principal. Any portion of a payment that represents the loan principal is a conversion of a resource. Any portion of the payment that represents interest is considered unearned income in the month of receipt and a resource thereafter. The value of the contract may be excluded from the countable resources if the individual can demonstrate that the contract cannot be sold without his realizing a net loss.

(ii) If the individual is the borrower the property agreement is not a resource.

However, the property purchased may be a countable resource following the month of transaction.

13. Economic-Impact Payments. Excluded.

14. Educational Income.

(i) Educational income received under Title IV of the Higher Education Act or under the Bureau of Indian Affairs is excluded as a resource.

(ii) Any portion of a VA educational benefit that is a withdrawal of a veteran’s own contribution is a countable resource if retained in the month following the month of receipt.

(iii) Other grants, scholarships, fellowships and gifts intended to pay for tuition, fees or educational expenses are excluded for nine (9) months beginning the month after the funds are received. The individual must be enrolled in school and attending classes to be considered a student.

15. Farm, Business, Other Equipment. The equity value of non-self-employment income-producing real property, other than the homestead, is a countable resource. Exclude up to $6,000.00 in equity and count only the amount that exceeds the limit, if the net income totals at least six percent (6%) of the equity value. If the property is used for self-employment, it is excluded as Business or Self-Employment.

16. Rental property is countable if the individual who owns the property is not in the business of renting property. Someone who is in the business of renting property is someone who materially participates in the operation and decision making of the rental business for at least (20) hours per week.

17. Homestead Exclusion. The entire value of the home, whether on land or water, all adjoining land not separated by property owned by others and any related outbuildings are excluded in determining resource eligibility as long as:

(i) The home is the principal place of residence for the individual and/or his spouse and/or dependent relatives; and (ii) If the individual resides in a long-term care facility, his intent to return to the home is established.

(iii) For an institutionalized individual, the home is excluded if Subparts (i) and (ii) above are true and the individual’s equity interest does not exceed the home equity limit established by CMS, with one exception: the home equity limit does not apply to an institutionalized individual if the spouse of the individual, the individual’s child under age twenty-one (21), or a blind or permanently and totally disabled child is residing in the home. An institutionalized individual whose home exceeds the home equity limit established by CMS and who does not have a spouse, a child under age twenty-one (21) or a disabled or blind child living in the home, is not eligible for payment of long term services and supports, unless it is determined undue hardship exists.

(iv) An individual must have lived in the home for it to be considered his home or principal place of residence.

(v) The value of the home and surrounding land will not be counted as a resource during the individual’s absence from an unoccupied home when he intends to return to the property. An absence from the home can be necessary to accomplish a specific purpose such as hospitalization, confinement in a nursing home or receipt of services, such as nursing or personal care services not available to the individual in his home.

(vi) An intent to return home is nullified by any efforts to sell or dispose of the property during the exemption period. The exemption based on the intent to return ends the first day of the month after the month efforts are made to sell or dispose of the homestead property.

(vii) Rental of a homestead which has been excluded because of intent to return does not nullify the exclusion. The homestead retains the exclusion as long as there is a clear, non-contradictory intent to return, and no efforts are made to sell or dispose of the property. The rent will be counted as unearned income in the month received.

(viii) The exemption based on residence of the enrollee’s dependent relative ends the first day of the month after the relative last lived in the homestead, if the relative does not intend to return. Real property located outside of Tennessee can be excluded from countable resources as homestead property, if there is substantiation of the individual’s intent to return to the home or the property is the principal residence of the individual’s spouse or dependent relatives.

18. Individual Development Account. Funds, including accrued interest, in the account are excluded as a resource as long as the individual complies with the IDA eligibility rules and continues to maintain or make contributions into the account.

19. Income-Producing Resource.

(i) For Institutional Eligibility financial determinations of individuals who are in an institution or seeking services under a 1915(c) HCBS waiver program and for MSP financial determinations, the equity value in business/nonbusiness resources (land, buildings, equipment, supplies, inventory, tools of a tradesperson, livestock of a farmer, cash on hands, accounts receivable, etc. which are used in the person’s trade or business, or in the employment of a family member or by the individual as an employee) used to produce income are excluded.

(ii) For all remaining ABD financial determinations, exclude up to $6,000.00 of an individual’s equity in an income-producing resource if it produces a net annual income to the individual of at least six percent (6%) of the property’s equity value. If the individual’s equity value is greater than $6,000.00, the amount that exceeds $6,000.00 is countable towards the resource limit.

(I) If an income-producing resource does not produce a net annual income of at least six percent (6%) of the resource’s equity value, the entire equity value of the resource is countable.

(II) If the individual owns more than one piece of income-producing resource and each produces income, each is reviewed to determine whether the six percent (6%) test is met. Then the amounts of the individual’s equity in all of those properties producing six percent (6%) are totaled to determine if the total equity of all properties is $6,000.00 or less. If the total equity value in the properties that meet the six percent (6%) rule is over the $6,000.00 equity limit, the amount exceeding $6,000.00 is counted as a resource.

20. Insurance. Exclude Sick and Disability Insurance and Burial Insurance.

21. Items of Unusual Value, Household Goods, and Personal Effects. In general, an item may be considered an item of unusual value if the item is not excluded as a household good or personal effect, and the equity value of the item is greater than $500.00. An item of unusual value that generates income for the individual is countable. The countable value is determined by applying the Rate of Return test (see Income-Producing Resource above). A personal item of unusual value is excluded. Household Goods and Personal Effects are also excluded.

22. Life Estates. Property in which an individual holds a life estate is subject to the same exclusion rules as property the individual owns by title, subject to the following exceptions:

(i) A life estate will be excluded as the home when the property meets the homestead exemption.

(ii) If the property is used in the passive production of income, then the life estate is subject to the Rate of Return test (see, Income-Producing Resource above).

(iii) A life estate will be excluded when ownership is necessary for the production of earned income.

(iv) The terms of the life estate contract prevent the holder from selling his interest in the property.

(v) If the life estate is not excluded based on the criteria (i)-(iv) above, the entire value of the life estate is a countable asset. The life estate value is determined by multiplying the Fair Market Value (FMV) of the property by the percentage listed in the SSA’s Life Estate and Remainder Interest Tables for the age of the individual on whose lifetime the life estate is based. If more than one person owns the life estate, the value is based on the owner with the longest life expectancy.

(vi) When an individual purchases, or, in some other way receives, as compensation in a transaction, a life estate in another individual’s home, the purchase of the life estate is considered an asset transfer subject to penalty, unless the individual then lives in the home for a period of at least one year after receiving the life estate.

(vii) If the individual does live in the home for a period of one year after receiving or purchasing the life estate, then the amount of the transfer is the entire amount used to purchase the life estate.

(viii) If an individual purchases a life estate in another individual’s home and then lives there for one year after the purchase, the life estate is an excluded resource while being used as the individual’s (or the individual’s spouse’s) home. However, if payment for a life estate exceeds the FMV of the life estate the difference between the amount paid and the FMV should be treated as an asset transfer. In addition, if an individual makes a gift or transfer of a life estate interest, the value of the life estate should be treated as a transfer of assets.

23. Life Insurance. Countable or excluded based on the type of life insurance owned by the individual and its intended use. Exclude all life insurance if the total face value of all policies does not exceed $1,500.00 per owner.

24. Livestock. The value of livestock necessary for business or self-employment, as a tool of the trade, or raised for home/personal consumption is an excluded resource. Income received is countable as self-employment income. The equity value of livestock that are pets is countable. Livestock that is used as nonbusiness income-producing property is countable, and subject to treatment as an Income-Producing Resource as described in this subparagraph.

25. Oil and Mineral Rights. May be included with land ownership or owned separately. If surface rights of the same property are excluded (for example, as a home) so are oil and mineral rights. Oil and mineral rights are countable when owned for personal use, or when the surface rights of the same property are countable (non-homestead, real property).

(i) If oil or mineral rights are producing income under a lease agreement, the owner may be constrained from selling or otherwise disposing of those rights. If the land is already excluded, the oil and mineral rights are excluded.

(ii) If oil or mineral rights are producing income to the individual, and he is not actively engaged in the production of income, the equity value of the rights is subject to the Rate or Return test. See Income-Producing Resource above.

26. Patient Trust Account. The balance of the account at the time of application and redetermination is a countable resource.

27. Personal Resource. Countable unless excluded based on the terms of the asset.

A personal resource is typically for the use of the individual and his family.

28. Personal Consumption. Exclude up to $6,000.00 of the equity value of nonbusiness property currently in use to produce goods or services essential to daily activities. Any portion of the property’s equity value in excess of $6,000.00 is a countable resource.

29. PASS. Any income an SSI recipient places in an approved PASS account is excluded as a resource. The PASS account itself is also excluded. This exclusion expires when the PASS contract expires or ends, or when the individual is no longer an SSI recipient.

30. Prepayment of Rent. Countable unless the individual cannot receive the money back under any circumstances (i.e., the lease agreement includes a no refund policy, or the landlord provides a statement that the funds will not be returned to the renter). Prepayment of an applicant’s mortgage is not considered a resource.

31. Prepayment of Nursing Home Care. Prepayment for care deposited by an applicant upon his admission to a TennCare Medicaid-participating long-term care facility is a countable resource for the individual who is subsequently approved for TennCare Medicaid benefits if the deposit was paid from the individual’s own funds.

32. Proceeds from the Sale of a Home. Excluded to the extent that the funds are intended to be used to purchase another home subject to the homestead exclusion, and the funds are used for such a purpose within three (3) months of the date of receipt of the proceeds.

33. Promissory Notes and other Loans. A promissory note or other loan given by the household is considered personal property and is countable, unless the note/loan balance is inaccessible or the promissory note is held for reasons other than personal use. The lender holds legal interest and has the legal ability to make available his share in the note or loan. The equity value of the note/loan is countable.

(i) If a household makes a loan that is considered inaccessible, or is shown to have a significantly lower market value than the unpaid balance of the loan, the loan will be considered to be an uncompensated transfer of assets. The uncompensated asset transfer will be considered to be the outstanding balance due on the loan as of the date of the lender’s application for long term services and supports (nursing facility or HCBS services).

(ii) In addition, the Deficit Reduction Act of 2005 (DRA) provides that funds used to purchase a promissory note, loan or mortgage must meet the following criteria, or the purchase will be treated as a transfer of assets for less than FMV:

(I) The repayment term must be actuarially sound (as determined by SSA standards);

(II) Payments must be made in equal amounts during the term of the loan with no deferral payment and no balloon payments; and (III) The promissory note, loan or mortgage must prohibit the cancellation of the balance upon the death of the lender.

(iii) If the above criteria are not met, the purchase of the promissory note or loan must be treated as a transfer of assets. The amount used to calculate a penalty will be the outstanding balance of the loan due as of the date of application for TennCare Medicaid.

(iv) Promissory notes that are made for purposes other than personal use are treated according to their use. Promissory notes may be made for the following purposes:

(I) Burial;

(II) Business or Self-Employment; and (III) Proceeds from the Sale of a Home.

34. Property that represents government authority to engage in an income-producing activity. Excluded if the property is used in trade, business or non-business income-producing activity. Exclude property that is currently not in use due to circumstances beyond the individual’s control and there is a reasonable expectation that the use will resume.

35. Prorated as Income. Excluded.

36. Qualified Tuition Savings Plan (529 Plans). Countable minus any early withdrawal penalties.

37. Real Property. The equity value in all real property the individual owns individually or jointly is a countable asset with the following exceptions:

(i) Property excluded as homestead;

(ii) The inaccessible equity value of real property;

(iii) Equity value of income-producing property (subject to the Rate of Return test);

(iv) Real property necessary for the production of earned income (see Business or Self-Employment); and (v) Property excluded under a conditional assistance agreement between the individual and the State.

38. Retirement Funds. Retirement funds owned by an individual and held in an IRA, 401(k), or other work-related plan are resources if an individual has the option of withdrawing funds in a lump sum. The value of a retirement fund is the amount of money that the individual can currently withdraw less any penalty for early withdrawal. Retirement funds are not counted as resources if termination of employment is necessary to access the funds or an individual is eligible for and receiving periodic benefits (e.g., pension or annuity). Distributions and systematic withdrawals from a retirement account are conversions of a resource rather than income when an individual can withdraw any of the remaining account balance in a lump sum. Retirement funds are excluded from deeming if owned by an ineligible spouse or an ineligible parent (for non-institutional categories only).

(i) Funds held in a 401(k) or 403(b) retirement account are countable when an individual is no longer job-attached. Funds in a 401(k), part of a profitsharing plan or stock bonus plan, or in a 403(b) retirement account are also countable when an individual reaches age 59 ½.

(ii) Funds held in an IRA are considered accessible any time. Count the equity value of an accessible IRA when determining eligibility. An IRA held in the form of an annuity will be evaluated as an annuity.

(iii) A Keogh plan established for a self-employed individual is considered accessible and is counted as a resource to the individual even if the household is not actually accessing the funds.

(iv) If the accessibility of a retirement fund cannot be determined based on the documentation received, the summary plan description or a written statement from the plan administrator shall be requested.

(v) Retirement funds are considered nonliquid resources unless there is evidence to suggest otherwise. An individual with excess retirement funds who is otherwise Medicaid-eligible may qualify for conditional assistance while waiting for retirement funds to become available, if the individual agrees in writing to use the funds to repay the medical assistance he received during the conditional assistance period.

39. Savings Accounts. Countable if it is characterized by personal use. If the current month’s income has been deposited into the account it must be excluded when determining the current value of the account. A savings account may be excluded if it is used for one of the following purposes:

(i) Burial funds;

(ii) Business or Self-Employment;

(iii) Educational Income;

(iv) Individual Development Account;

(v) PASS;

(vi) Proceeds from the Sale of a Home (subject to time limits);

(vii) Prorated as income;

(viii) Settlement or Disaster Payment, if excluded by policy; and (ix) SSI/SSA Retroactive Payment (subject to time limits).

40. Settlement or Disaster Payment. Payments or benefits provided under certain Federal statutes are excluded, if payments are not commingled with other funds.

Excluded settlement and/or disaster payments include:

(i) Agent Orange Settlement Payments;

(ii) Disaster Relief Assistance received under the Disaster Relief Act of 1974;

(iii) Distribution of perpetual judgment funds to Indian tribes under the following:

(I) Indian Judgment Funds Distribution (P.L. 93-134);

(II) Black Feet and Gros Ventre Tribes (P.L. 92-254);

(III) Grand River Band of Ottawa Indians in Indian Claims Commission Docket No. 40-K;

(IV) Tribes or groups under P.L. 93-134;

(V) Yakima Indian Nation or the Apache Tribe of the Mescalero Reservation (P.L. 95-433); and (VI) Receipts from land held in trust by the Federal government and distributed to certain Indian tribes under P.L. 94-114.

(iv) Factor VIII or IX Concentrate Blood Products Litigation. The settlement payments made to hemophilia patients infected with HIV through blood plasma products as a result of the class action lawsuit;

(v) Filipino Veterans Compensation Fund Payments. Lump sum payments made to certain veterans and spouses of veterans who served in the military of the Government of the Commonwealth of the Philippines during WWII;

(vi) Japanese-American and Aleutian Restitution Payments;

(vii) Payments made to individuals because of their status as victims of Nazi persecutions;

(viii) Payments to children born of Vietnam veterans diagnosed with spina bifida;

(ix) Payments made under the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (State and local payments are only excluded for nine (9) months);

(x) Revenues from the Alaska Native Fund paid under section 21(a) of the Alaska Native Claims Settlement Act;

(xi) Criminal Victims Compensation Funds paid to crime victims (excluded for nine (9) months); and (xii) Energy Employees Occupational Illness Compensation Program Act (EEOICPA).

41. Social Security Accounts. Countable. Social Security Accounts are checking accounts specifically designed and held for Social Security Benefits.

42. SSI/SSA Retroactive Payment. Excluded for nine (9) months after the payment is received and counted after that nine (9) month exclusion period.

43. Stocks/Bonds/Mutual Funds. Countable. Although personal mutual funds are countable, those held for purposes listed below are subject to different treatment:

(i) Burial;

(ii) Business or Self-Employment;

(iii) Educational Income;

(iv) Proceeds from the Sale of a Home;

(v) Prorated as Income; or (vi) Settlement or Disaster Payment, if excluded by policy.

44. Tools of the Trade. Excluded.

45. Trusts. Countable or excluded based on the nature of the trust, the date the trust was created, the source of funds used to create the trust, plus other factors as specified in 42 U.S.C. § 1396p(d).

46. Uniform Gifts to Minors Act (UGMA) Assets or Property. Excluded for individuals who have not reached the age of majority (as established by the state law controlling such gift). Counted for individuals who have reached the age of majority (as established by the state law controlling such gift).

47. Uniform Transfers to Minors Act (UTMA) Assets or Property. Excluded for individuals who have not reached the age of majority (as established by the state law controlling such transfer). Counted for individuals who have reached the age of majority (as established by the state law controlling such transfer).

48. Vehicles. One car, truck, motorcycle, camper, motor home, aircraft, snowmobile, watercraft, boat, or all-terrain vehicle is excluded regardless of its value if it is used for transportation of the individual or a member of his household. If an applicant owns more than one vehicle, the equity value of that second vehicle is countable when it is owned by the applicant or a deemed filing unit member, and it cannot be excluded under another provision. Boats, motorcycles, snowmobiles, jet skis, ATVs, and aircraft are generally considered recreational vehicles. The equity value of these recreational vehicles is a countable resource unless it can be excluded under other provisions.

(d) Conditional Assistance. Nonliquid resources, which are not exempt under another resource provision, are exempt as a resource if the individual enters into a conditional assistance agreement with the State. Nonliquid resources include real and personal property that cannot be converted to cash within twenty (20) days. The individual must dispose of the excess nonliquid resources at current market value within the time periods specified below and use the proceeds to repay the State for medical expenses covered by TennCare during the period of conditional assistance.

1. The exclusion period for real property is not to exceed nine (9) months. The exclusion period for personal property is not to exceed three (3) months, however a three (3) month extension may be granted if the individual is able to show a good cause for failure to dispose of the property. Property that remains unsold at the end of the exclusion period will be considered inaccessible so long as the individual continues to make reasonable efforts to sell the property.

2. Repayment of medical expenses covered by TennCare during the period of conditional assistance may not exceed the total net proceeds of the sale. Any proceeds remaining after the repayment of medical expenses is paid are considered a resource.

(e) Disregards and Expenses Allowed. Unless otherwise specified in Subparagraph (b) above, individuals described in Subparagraph (a) are subject to the following expense requirements.

1. Child Support Disregard. One-third (1/3) of child support payments (including child support arrearages) paid by an absent parent to or for a child under age 18, or under age twenty-two (22) and a student regularly attending school, is excluded per month.

2. General Deduction. A $20.00 monthly General Deduction is allowed per household, and is applied to unearned income. If any of the $20.00 deduction is not offset by unearned income, the remainder is applied to the spouse’s unearned income and then to the applicant or enrollee’s earned income.

3. Student Earned Income Exclusion (SEIE). Applies to the earnings of an individual who is under age twenty-two (22) and regularly attending school. The exclusion may apply to an eligible or ineligible individual, child, spouse, or parent(s). The SEIE monthly amount is determined by the SSA. The SEIE does not apply to children attending elementary school.

4. Earned Income Deduction. The first $65.00 of the earned income of each aged, blind or disabled individual is disregarded.

5. Impairment-Related and Blind Work Expenses:

(i) The gross countable earned income of each blind or disabled individual (not living in a medical institution) may be reduced by the amount of expenses attributable to earning the income. The allowable Blind Work Expenses (BWE) and allowable Impairment-Related Work Expenses (IRWE) are not the same. BWE and IRWE apply only to earned income. In order to deduct either BWE or IRWE, the individual must be:

(I) Blind, blind and disabled, or disabled; and under age sixty-five (65), or (II) Age sixty-five (65) and older; and received SSI payments due to blindness or disability the month before attaining age sixty-five (65).

(ii) These expenses do not apply to the Institutional Medicaid categories. Work expenses must not be payable or reimbursable by a third party, such as Medicaid, Medicare or other insurance.

6. One-Half Disregard. One-half of the remaining earned income in the month is disregarded. This disregard is deducted after Impairment-Related Work Expense (IRWE), but before deducting Blind Work Expenses (BWE).

(f) Mandatory deductions such as FICA and withholding tax on pensions and other unearned income are not included in gross income for Institutional Medicaid and the Medicare Savings Programs.

(g) Household Composition Rules. Household composition for the ABD categories is governed by the FRR principle. Financial responsibility is limited to spouse to spouse and parent to child. Household composition not only determines which income standard to use, but also how FRR income is “deemed” available, and the amount of income “deemed” or available to an individual. See 20 C.F.R. §§ 416.1160, et seq., and 42 C.F.R. § 435.602.

1. The following individuals are included in the applicant’s household, if living in the same household:

(i) The applicant; and (ii) The applicant’s eligible spouse, if applicable.

2. For Medicare Savings Programs (MSPs), include the applicant’s spouse if living in the home, the applicant’s natural born or adoptive children under age twentyone (21) in the household, and the applicant’s step-children under age twentyone (21) if the requirements of (g)3. below are met. If a spouse is living in the home of an MSP applicant who is receiving HCBS, the spouse is not included in the household composition, and the spouse’s income and resources are not considered.

3. Step-children are considered in household composition when they live in the home and their natural parent is the spouse of the applicant and is included in the applicant’s household.

4. Financial eligibility in the SSI-Related categories is determined based on a household size of one or two. Included household members are the applicant and if applicable, his spouse. If there are additional household members, they will be considered in deeming budgets, if appropriate.

5. Parent-to-child deeming applies when a blind or disabled child under age eighteen (18) is living with his parent(s), and a portion of the parent’s income and resources may be deemed available to the child and counted as unearned income to the child in determining his TennCare Medicaid eligibility. The parent receives income disregards and allocations in order to meet his own needs and the needs of other children that live in the household. The needs of step-parents and step-siblings are also considered when they live in the home with the applicant and natural or adopted parent, and the step-parent is married to the natural or adopted parent. Children for whom a child allocation is received must be unmarried and under age eighteen (18), or under age twenty-two (22) and a student. Child and parental allocations are deducted from the parent’s income before any income is deemed to the applicant/enrollee. Parental deeming applies to the following:

(i) Medicare Savings Program (QMB, SLMB, QI1 and QDWI);

(ii) SSI-Related Groups; and (iii) ECF CHOICES except those age 17 or older who meet institutional level of care, those enrolled prior to November 23, 2020, those who will be enrolled in ECF CHOICES Group 7 (Intensive Behavioral Family Supports), and those transitioning from ECF CHOICES Group 7 to ECF CHOICES Group 4 (Essential Family Supports) as defined in TennCare 1115 Demonstration Waiver III.

6. The countable income and resources of an applicant/enrollee’s TennCare Medicaid-ineligible spouse living in the home may be deemed available to the applicant/enrollee. Spousal deeming applies when the spouses share a living arrangement, i.e., live in the community or home together. The applicant/enrollee’s ineligible spouse is included in the household if the income of the spouse is deemed to the applicant/enrollee. Spousal deeming applies to the following:

(i) Medicare Savings Program (QMB, SLMB, QI, and QDWI); and (ii) SSI-Related Groups.

7. Financial eligibility for Institutional Eligibility categories and the ECF CHOICES Demonstration Groups is determined based on a household size of one. The only included household member is the applicant/enrollee. However, the Community Spouse and dependents do impact budgeting of the post-eligibility treatment of income (i.e. patient liability), and the community spouse’s resources are considered in the resource assessment.

(h) Qualifying Income Trusts (QIT) for Institutional and ECF CHOICES Applicants.

1. Individuals who are receiving or will receive nursing facility or ICF/IID services or Home and Community Based Services (HCBS) offered either through the CHOICES or ECF CHOICES program or through a Section 1915(c) HCBS waiver program and whose income exceeds the income limitations in Rule .08 may establish a QIT. Funds placed in a QIT that meets the standards set forth below are not treated as available resources or income for purposes of determining the individual’s TennCare eligibility.

2. A QIT is a trust consisting only of the individual’s pension income, SSI, and other monthly income created for the purpose of establishing income eligibility for TennCare coverage when an individual is or soon will be confined to a nursing facility or ICF/IID or will receive HCBS offered either through the CHOICES or ECF CHOICES program or through a Section 1915(c) HCBS waiver program.

3. An individual is eligible to establish a QIT if his income is above the level at which he would be financially eligible for nursing facility or ICF/IID services, HCBS offered either through the CHOICES or ECF CHOICES program, or through a

Section 1915(c) HCBS waiver program.

4. The amount of income that an applicant/recipient places in a QIT cannot be limited nor can it be counted when testing income against the income limitations in Rule .08. However, it is used in determining patient liability during posteligibility treatment of income. If the applicant/recipient’s income that is not placed in a QIT is over the income limitations in Rule .08, the individual is not financially eligible for the Institutional Eligibility category or ECF CHOICES.

5. A valid QIT must meet the following criteria:

(i) The trust must be irrevocable and cannot be modified or amended in whole or in part by the Grantor at any time. However, the Trustee or a court of competent jurisdiction shall have the right and jurisdiction to modify any provision of the trust to the extent necessary to maintain the eligibility of the Grantor for medical assistance.

(ii) Each month the trustee shall distribute the entire amount of income transferred into the Trust except for an amount not to exceed $20.00, or other verified amount, for a QIT maintenance fee.

(iii) The sole beneficiary of the Trust is the individual for whose benefit the Trust is established and the State of Tennessee. The Trust terminates upon the death of the individual, or when the Trust is no longer required to establish TennCare Medicaid eligibility in the State of Tennessee, or if nursing facility care or HCBS is no longer medically necessary for the individual, or if the individual is no longer receiving such services.

(iv) The Trust must provide that upon the death of the individual or termination of the Trust, whichever occurs sooner, the State of Tennessee shall receive all amounts remaining in the Trust up to the total amount of medical assistance paid by the State on behalf of the individual.

(v) Amounts remaining in the Trust that are owed to the State must be paid to TennCare within three (3) months after the death of the individual or termination of the Trust, whichever is sooner, along with an accounting of the payments from the Trust. TennCare may grant an extension if a written request is submitted within two (2) months of the termination of the Trust.

(vi) Allowable payments from the Trust include:

(I) Personal Needs Allowance (PNA). The amount the individual is allowed to retain for his personal needs under TennCare Medicaid policies.

I. Effective January 1, 2025, this amount is $70 for persons residing in a nursing facility or ICF/IID.

II. For persons receiving HCBS through CHOICES, ECF CHOICES, PACE, the Self-Determination Waiver, the Comprehensive Aggregate Cap (CAC) Waiver, and the Statewide Waiver, this amount is three hundred percent (300%) of the SSI/FBR.

(II) A deduction not to exceed $20.00, or other verified amount, for expenses necessary for managing the trust (i.e. bank charges).

(III) CSIMA or DIMA, if applicable.

(IV) Health Insurance Premiums. Allowed when the individual has health insurance other than TennCare Medicaid (for example, Medicare premium or a Medicare supplement policy).

(V) Incurred Medical Expenses. Payment for types of medical or remedial care recognized under State law, but not covered as medical assistance under TennCare Medicaid.

(vii) Any countable income not placed in the QIT and any Trust income remaining after allowable deductions are made shall be paid monthly to the nursing facility, HCBS provider, or MCO by the individual or from the Trust in an amount not to exceed the Medicaid reimbursement rate. Any excess income not distributed from the Trust shall accumulate in the Trust monthly.

(viii) No other deductions or expenses may be paid from the Trust. Expenses which cannot be paid from the Trust except as specifically provided herein include, but are not limited to, trustee fees, attorney fees and costs (including attorney fees and costs incurred in establishing the trust), accountant fees, court fees and costs, fees for guardians ad litem, funeral expenses, past due medical bills and other debts.

(i) Annuities.

1. Disclosure. Disclosure of annuities is required for all applicants pursuant to 42 U.S.C. § 1396p(e). If an individual or her spouse refuses to disclose information related to an annuity, the individual will be denied Medicaid eligibility based on the individual’s failure to cooperate.

2. Annuities and Transfer of Assets. An annuity will not be treated as a transfer of assets if the annuity meets the requirements of 42 U.S.C. § 1396p(c)(1)(G).

3. Requirement to name the State as the Remainder Beneficiary. The purchase of an annuity is subject to the transfer of assets provision unless it meets the requirements of 42 U.S.C. § 1396(c)(1)(F).

(i) Annuities purchased or converted by the individual or his spouse on or after February 8, 2006, must be changed prior to TennCare Medicaid approval or redetermination to name the State of Tennessee as the remainder beneficiary of the annuity. If the individual has a community spouse, or a minor or disabled child, the State may be named in the second position following one of these individuals. If the State is named in the second position following a community spouse or child, the annuity must also provide that the State becomes the remainder beneficiary in the first position if the community spouse, child, or their representative disposes of any of the remainder of the annuity for less than fair market value.

(ii) As a remainder beneficiary, the State may receive up to the total amount of medical assistance paid on behalf of the individual, including both long term services and supports and home and community based services. The State must notify the issuer of the State’s right as the preferred remainder beneficiary and the issuer must notify the State if there are any changes in the amount of income or principal being withdrawn.

(iii) An annuity may be amended to meet these criteria, so that the annuity purchase will not be treated as a transfer of assets for less than FMV.

4. Annuity Transactions. Certain annuity transactions may be treated as a transfer of assets for less than fair market value (FMV) according to 42 U.S.C. § 1396p(e).

(i) Annuity transactions made by an individual, or by someone acting on an individual’s behalf, are considered improper transfers if any of the individual’s assets are disposed of for less than FMV.

(ii) Transactions include any action that changes the course of payments to be made by an annuity or the treatment of the income or principal of an annuity. These actions include additions of principal, elective withdrawals, requests to change the distribution of an annuity, elections to annuitize the contract and other similar actions.

(iii) Routine changes (e.g., notification of an address change or death or divorce of a remainder beneficiary) and changes beyond an individual’s control are not considered transfers of assets for less than FMV.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-208, 71-5-102, 71-5-105, 71-5-106, 71-5-109, 71-5-110, 71-5- 111, 71-5-117, 71-5-134, and 71-5-147.
• Administrative History: Emergency rule filed June 16, 2016; effective through December 13, 2016. New rules filed September 14, 2016; effective December 13, 2016. Repeal and new rule filed May 24, 2019; effective August 22, 2019. Amendments filed May 13, 2022; effective August 11, 2022. Amendments filed August 25, 2025; effective November 23, 2025.

Tenn. Comp. R. & Regs. 1200-13-20-.07 FAMILY AND CHILD ELIGIBILITY GROUPS

(1) Caretaker Relatives.

(a) Definition: See Rule .02.

(b) Technical Requirements: See Rule .04.

(c) Special Eligibility Requirements: Individual must be a parent or caretaker relative of a dependent younger than age eighteen (18), or 18 and a full-time student, and must agree to cooperate with Child Support Enforcement to establish paternity and medical support, if applicable. Failure to cooperate or show good cause for not cooperating once eligible shall result in termination.

(d) Household size is based upon the MAGI household composition Rule .06.

(e) Income Limitation: Household income cannot exceed one hundred percent (100%) of the FPL.

(f) Resource Limitation: None.

(g) Effective Date of Eligibility: Eligibility begins on the Application File Date, according to

Rule .05, or the date all eligibility requirements are met, whichever is later. Retroactive Eligibility may be granted to eligible Pregnant Women.

(h) Other:

1. Individuals in this category may also be eligible for Extended Medicaid as described in 42 C.F.R. § 435.115 and Transitional Medicaid as described in 42 C.F.R. § 435.112.

2. An individual in this category may receive Continuous Eligibility if the individual is a child under age nineteen (19) or a Pregnant Woman. See Rule .09.

(2) TennCare Pregnant Women.

(a) Definition: See Rule .02.

(b) Technical Requirements: See Rule .04.

(c) Special Eligibility Requirements: Individual must be a Pregnant Woman. Selfattestation of pregnancy is accepted unless the State has information that is not reasonably compatible with such attestation.

(d) Household size is based upon the MAGI household composition Rule .06.

(e) Income Limitation: Household income cannot exceed two hundred fifty percent (250%) of the FPL. See Rule .06.

(f) Resource Limitation: None.

(g) Effective Date of Eligibility: Eligibility begins on the Application File Date, according to

Rule .05, or the date all eligibility requirements are met, whichever is later. Retroactive Eligibility may be granted to eligible applicants.

(h) Other:

1. An individual in this category may receive Continuous Eligibility. See Rule .09.

2. An individual in this category is eligible for all medically necessary covered services, other than LTSS, because TennCare considers all medically necessary covered services to be pregnancy-related. A Pregnant Woman could be eligible for LTSS if she is determined to meet the criteria for an Institutional Eligibility or ECF CHOICES category.

(3) Presumptive Eligibility for Pregnant Women.

(a) Definition: See Rule .02.

(b) Technical Requirements: See Rule .04. Self-attestation of citizenship, residency and Social Security Number (SSN) are accepted at application for presumptive eligibility.

(c) Special Eligibility Requirements: Individual must be a Pregnant Woman at the time of application. Self-attestation of pregnancy is accepted unless the State has information that is not reasonably compatible with such attestation.

(d) Household size is based upon the MAGI household composition Rule .06.

(e) Income Limitation: Household income cannot exceed two hundred fifty percent (250%) of the FPL. See Rule .06.

(f) Resource Limitation: None.

(g) Effective Date of Eligibility: The date of determination by the Tennessee Department of Health or other qualified entity. The presumptive eligibility period ends either the last day of the month following the month a presumptive eligibility determination was made, or if a full Medicaid application is submitted before the end of the month following the presumptive application, eligibility continues until a determination is made on a complete Medicaid application, or as otherwise agreed to by the Single State Agency and CMS. Only one presumptive period of eligibility is allowed for each pregnancy.

(4) Infants and Children under Age 19.

(a) Definition: See Rule .02.

(b) Technical Requirements: See Rule .04.

(c) Special Eligibility Requirements: Individual must be younger than nineteen (19) years of age.

(d) Household size is based upon the MAGI household composition Rule .06.

(e) Income Limitations:

1. Infants younger than age one (1): Household income cannot exceed one hundred ninety-five percent (195%) of the FPL.

2. Children from age one (1) to age five (5): Household income cannot exceed one hundred forty-two percent (142%) of the FPL.

3. Children from age six (6) to age nineteen (19): Household income cannot exceed one hundred thirty-three percent (133%) of the FPL. See Rule .06.

(f) Resource Limitations: None.

(g) Effective Date of Eligibility: Eligibility begins on the Application File Date, according to

Rule .05, or the date all eligibility requirements are met, whichever is later. Retroactive Eligibility may be granted to eligible applicants.

(h) Other:

1. Individuals in this category may also be eligible for Extended Medicaid as described in 42 C.F.R. § 435.115 and Transitional Medicaid as described in 42 C.F.R. § 435.112.

2. Infants born while enrolled in CoverKids will be enrolled in this category if household income is at or below one hundred ninety-five percent (195%) of the FPL.

3. An individual in this category may receive Continuous Eligibility if the individual is a child under age nineteen (19) or a Pregnant Woman or if the individual is receiving inpatient services and turns age nineteen (19) while hospitalized. See

Rule .09.

(5) Deemed Newborns.

(a) Definition: See Rule .02.

(b) Technical Requirements: See Rule .04, except Deemed Newborns are not subject to citizenship rules. Newborns without an SSN must be enumerated by age one (1) to remain eligible for another category, or before they can be approved in another category, whichever occurs first.

(c) Special Eligibility Requirements: Newborns must be twelve (12) months or younger. A baby born to a mother eligible for and receiving TennCare Medicaid shall be eligible for TennCare Medicaid for one (1) year from the date of birth, as long as the newborn remains a resident of Tennessee during that time.

(d) Income Limitations: None.

(e) Resource Limitations: None.

(f) Effective Date of Eligibility: The child’s date of birth, if mother was eligible for and receiving TennCare Medicaid at the time of birth.

(6) Former Foster Care Children up to Age 26.

(a) Definition: See Rule .02.

(b) Technical Requirements: See Rule .04.

(c) Special Eligibility Requirements: The individual must be under age twenty-six (26), must have been in foster care under the responsibility of a state until aging out at age eighteen (18) or older, and must have been enrolled in Medicaid at the time he aged out of custody. If an individual aged out of foster care in a state other than Tennessee, the individual must have turned age eighteen (18) on or after January 1, 2023, in order to qualify for this category. Self-attestation of status as Former Foster Care Children Under Age 26, as defined in Rule .02, is accepted unless the state has information that is not reasonably compatible with such attestation.

(d) Income Limitations: None.

(e) Resource Limitations: None.

(f) Effective Date of Eligibility: Eligibility begins on the Application File Date, according to

Rule .05, or the date all eligibility requirements are met, whichever is later.

(g) Other: An individual in this category may receive Continuous Eligibility if the individual is a child under age nineteen (19) or a Pregnant Woman. See Rule .09.

(7) Standard Child Uninsured.

(a) Definition: See Rule .02.

(b) Technical Requirements: See Rule .04.

(c) Special Eligibility Requirements: Must be a Medicaid “Rollover” enrollee as defined in

Rule .02, or currently enrolled in TennCare Standard, and does not have insurance or access to health insurance.

(d) Household size is based upon the MAGI household composition Rule .06.

(e) Income Limitations: Household income must be below two hundred eleven percent (211%) of the FPL.

(f) Resource Limitations: None.

(g) Effective Date of Eligibility: The day following the TennCare Medicaid coverage end date.

(h) Other:

1. Includes uninsured children under age nineteen (19) who have been continuously enrolled in TennCare Standard since December 31, 2001, who have family incomes below two hundred and eleven percent (211%) of the FPL, and who have not purchased insurance even if they have access to it. This is a “grandfathered” eligibility category. If an individual loses eligibility in this category, he will not be able to re-enroll in it.

2. An individual in this category may receive Continuous Eligibility if the individual is a child under age nineteen (19) or a Pregnant Woman. See Rule .09.

(8) Standard Child Medically Eligible.

(a) Definition: See Rule .02.

(b) Technical Requirements: See Rule .04.

(c) Special Eligibility Requirements: Must be an uninsured child under age nineteen (19) who is losing eligibility for Medicaid or being renewed as TennCare Standard, who does not have access to health insurance, and who has been determined to have a qualifying medical condition according to these rules.

(d) Special Application Procedures:

1. Must be a Medicaid “Rollover” enrollee as defined in Rule .02, or currently enrolled in TennCare Standard.

2. Applicants have three (3) options for proving medical eligibility:

(i) Option 1: Physician’s attestation on the Medically Eligible (ME) Packet of specific qualifying conditions.

(ii) Option 2: A completed ME packet and medical records to support a qualifying medical condition with a signed release for medical records in the event additional medical records are needed.

(iii) Option 3: An existing Medically Eligible determination in Interchange.

3. If a Medicaid enrollee under age nineteen (19) whose Medicaid eligibility is ending is determined to otherwise meet technical eligibility requirements for TennCare Standard, but is not eligible as uninsured because his income is two hundred eleven percent (211%) of the FPL or higher, he will be sent a ME packet.

4. TennCare will send the enrollee a ME packet with an explanation regarding how to apply for TennCare Standard as a medically eligible individual. The enrollee will have sixty (60) days from the date of the notice letter (inclusive of mail time) to submit his medical eligibility packet. If the individual is determined to qualify as medically eligible, coverage will be provided throughout the eligibility determination period and will continue with no break.

5. The required ME application information must be returned to the address specified within sixty (60) days from the date of the letter included in the packet.

A ME form and documentation received after that time will not be processed as it exceeds the timely filing requirement. Packets which are not completed by the sixtieth (60th) day will be denied with a notice of appeal rights.

(e) Household size is based upon the MAGI household composition Rule .06.

(f) Income Limitations: Household income must be at or above two hundred eleven percent (211%) of the FPL.

(g) Resource Limitations: None.

(h) Effective Date of Eligibility: The day following the TennCare Medicaid coverage end date.

(i) Other: An individual in this category may receive Continuous Eligibility. See Rule .09.

(9) CoverKids CHIP Children under Age 19.

(a) Definition: See Rule .02.

(b) Technical Requirements: See Rule .04.

(c) Special Eligibility Requirements: Includes children under age 19 who do not have Health Insurance, as defined in Rule .02.

(d) Household size is based upon the MAGI household composition Rule .06.

(e) Income Limitations: Must be ineligible for Medicaid and no more than two hundred fifty percent (250%) of the FPL. See Rule .06.

(f) Resource Limitations: None.

(g) Effective Date of Eligibility: Eligibility begins on the Application File Date, according to

Rule .05, or the date all eligibility requirements are met, whichever is later.

(h) Other: An individual in this category may receive Continuous Eligibility if the individual is a child under age nineteen (19). See Rule .09.

(10) CoverKids Pregnant Women.

(a) Definition: See Rule .02.

(b) Technical Requirements: See Rule .04. A CoverKids Pregnant Woman’s unborn child is presumed to be a U.S. citizen, regardless of the citizenship or immigration status of the mother. The mother is not required to provide proof of citizenship or immigration status.

(c) Special Eligibility Requirements: Includes Pregnant Women who do not have Health Insurance, as defined in Rule .02, or do not have maternity benefits or have exhausted maternity benefits.

(d) Household size is based upon the MAGI household composition Rule .06.

(e) Income Limitations: Must be ineligible for Medicaid and no more than two hundred fifty percent (250%) of the FPL. See Rule .06.

(f) Resource Limitations: None.

(g) Effective Date of Eligibility: Eligibility begins on the Application File Date, according to

Rule .05, or the date all eligibility requirements are met, whichever is later.

(h) Other: Eligibility for CoverKids Pregnant Women is continuous through the sixty (60) day postpartum period as defined at 42 C.F.R. § 435.4. See Rule .09. Eligibility for the newborn child continues twelve (12) months from the mother’s effective date of eligibility.

(11) IE Foster Care, Foster Care, and Adoption Assistance.

(a) Definition: Children in State foster care or in a subsidized adoptive home.

(b) Eligibility for these categories is determined by the Tennessee Department of Children’s Services.

(c) Other: Excluding IE Foster Care, an individual in these categories may receive Continuous Eligibility if the individual is a child under age nineteen (19) or a Pregnant Woman. See Rule .09.

(12) Transitional Medicaid.

(a) Definition: See Rule .02.

(b) Technical Requirements: See Rule .04.

(c) Special Eligibility Requirements for Children: Transitional Medicaid benefits are provided to children who lose Child MAGI eligibility when the following conditions are met:

1. The child’s parent or caretaker relative was previously eligible in a MAGI category with income under the Caretaker Relative income standard for three (3) of the previous six (6) months but lost eligibility due to an increase in earnings; and 2. The child was eligible and enrolled in a Child MAGI category for three (3) of the six (6) months immediately preceding the month the parent or caretaker relative lost eligibility.

(d) Special Eligibility Requirements for Caretaker Relatives: Transitional Medicaid benefits are provided to parents and caretaker relatives who lose Caretaker Relative MAGI eligibility when all of the following conditions are met:

1. The individual was eligible and enrolled in the Caretaker Relative MAGI category for three (3) of the six (6) months immediately preceding the month eligibility was lost;

2. Loss of eligibility was due to an increase in earnings; and 3. The parent or caretaker relative must continue to have a dependent child in the home in order to receive Transitional Medicaid.

(e) Household size is based upon the MAGI household composition Rule .06.

(f) Income Limitations: See Rule .06.

(13) Extended Medicaid.

(a) Definition: See Rule .02.

(b) Technical Requirements: See Rule .04.

(c) Special Eligibility Requirements: Eligible individuals must have been eligible for and receiving benefits for at least three (3) out of six (6) months immediately preceding the month of ineligibility.

(d) Special Eligibility Requirements for Children: Extended Medicaid benefits are provided to children who lose Child MAGI eligibility when the following conditions are met:

1. The child’s parent or caretaker relative was previously eligible in a MAGI category with income under the Caretaker Relative income standard for three (3) of the previous six (6) months but lost eligibility due to an increase in spousal support; and 2. The child was eligible and enrolled in a Child MAGI category for three (3) of the six (6) months immediately preceding the month the parent or caretaker relative lost eligibility.

(e) Special Eligibility Requirements for Caretaker Relatives: Extended Medicaid benefits are provided to parents and caretaker relatives who lose Caretaker Relative MAGI eligibility when the following conditions are met:

1. The individual was eligible and enrolled in the Caretaker Relative MAGI category for three (3) of the six (6) months immediately preceding the month eligibility was lost;

2. Loss of eligibility was due to an increase in spousal support; and 3. The parent or caretaker relative must continue to have a dependent child in the home in order to receive Extended Medicaid.

(f) Household size is based upon the MAGI household composition Rule .06.

(g) Income Limitations: See Rule .06.

(14) Hospital Presumptive Eligibility.

(a) Definition: See Rule .02.

(b) Technical Requirements: See Rule .04. Self-attestation of citizenship, residency and Social Security Number (SSN) are accepted at application for presumptive eligibility.

(c) Special Eligibility Requirements: Self-attestation of pregnancy or status as Former Foster Care Children Under 26, as defined in Rule .02, is accepted unless the State has information that is not reasonably compatible with such attestation.

(d) Household size is based upon the MAGI household composition Rule .06.

(e) Income Limitation: Household income must not exceed the income standard for the TennCare Medicaid category for which the individual’s presumptive eligibility is being determined.

(f) Resource Limitation: None.

(g) Effective Date of Eligibility: The date of determination by the qualified entity. The presumptive eligibility period ends either the last day of the month following the month a presumptive eligibility determination was made, or if a full Medicaid application is submitted before the end of the month following the presumptive application, eligibility continues until a determination is made on a complete Medicaid application, or as otherwise agreed to by the Single State Agency and CMS. Applicants are allowed one period of HPE every two (2) calendar years for non-pregnancy-related categories. For Pregnant Women, one (1) period of presumptive eligibility is allowed per pregnancy.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-208, 71-5-102, 71-5-105, 71-5-106, 71-5-109, 71-5-110, 71-5- 111, 71-5-117, and 71-5-134 and TennCare III Section 1115(a) Medicaid Demonstration Waiver.
• Administrative History: Emergency rule filed June 16, 2016; effective through December 13, 2016. New rules filed September 14, 2016; effective December 13, 2016. Amendments filed May 24, 2019; effective August 22, 2019. Amendments filed May 13, 2022; effective August 11, 2022. Amendments filed August 25, 2025; effective November 23, 2025.

Tenn. Comp. R. & Regs. 1200-13-20-.08 AGED, BLIND OR DISABLED CATEGORIES

(1) Supplementary Security Income (SSI) Cash recipient.

(a) Aged, blind or disabled individuals who are determined eligible for SSI payments by the SSA are eligible for TennCare Medicaid. Once SSI payments in Tennessee stop, the individual becomes an inactive SSI enrollee who must be reviewed for eligibility in all other categories.

(b) Effective date of eligibility: Date of eligibility as determined by the SSA.

(c) Other: An individual in this category may receive Continuous Eligibility if the individual is a child under age nineteen (19) or a Pregnant Woman. See Rule .09.

(2) Disabled Adult Child.

(a) Definition: See Rule .02.

(b) Technical Requirements: See Rule .04.

(c) Special Eligibility Requirements: Disabled adult children who lose SSI eligibility after July 1, 1987 because of the receipt of or increase in DAC payments under Title II of the Social Security Act will remain eligible for Medicaid if the initial entitlement or increase under Title II, whichever caused the ineligibility for SSI, and any subsequent COLA and non-COLA increases, were disregarded. Individuals must have been age 18 or older when SSI terminated.

(d) Income Limitations: SSI Federal Benefit Rate.

(e) Resource Limitations: $2,000.00 for an individual, $3,000.00 for a couple.

(f) Effective Date of Eligibility: Eligibility begins on the Application File Date, according to

Rule .05, or the date all eligibility requirements are met, whichever is later.

(g) Other: An individual in this category may receive Continuous Eligibility if the individual is a child under age nineteen (19) or a Pregnant Woman. See Rule .09.

(3) Pickle Passalong.

(a) Definition: See Rule .02.

(b) Technical Requirements: See Rule .04.

(c) Special Eligibility Requirements: TennCare Medicaid benefits are available to individuals who would be eligible for SSI payments if increases in their OASDI due to COLAs were disregarded. Individuals who meet all other non-financial and financial eligibility requirements remain eligible for TennCare Medicaid if they:

1. Currently receive OASDI authorized under Title II of the Social Security Act;

2. Are not currently receiving SSI;

3. Were entitled to both OASDI and SSI benefits in the same month after April 1977; and 4. Have countable income equal to or less than the current SSI Federal Benefit Rate after all COLAs received since the last month in which the individual was eligible for both OASDI and SSI have been deducted.

(d) Income Limitations: SSI Federal Benefit Rate.

(e) Resource Limitations: $2,000.00 for an individual, $3,000.00 for a couple.

(f) Effective Date of Eligibility: Eligibility begins on the Application File Date, according to

Rule .05, or the date all eligibility requirements are met, whichever is later.

(g) Other: An individual in this category may receive Continuous Eligibility if the individual is a child under age nineteen (19) or a Pregnant Woman. See Rule .09.

(4) Widow/Widower.

(a) Definition: See Rule .02.

(b) Technical Requirements: See Rule .04.

(c) Special Eligibility Requirements. A disabled widow/widower is eligible for TennCare Medicaid for any month in which he is entitled to a Social Security Widow/Widower benefit, but is not eligible for SSI, if he:

1. Was eligible for SSI based on his own disability;

2. Was entitled to the Social Security Widow/Widower benefit any time after the age of fifty (50);

3. Lost SSI eligibility in the first month that the Social Security Widow/Widower benefit was paid;

4. Would be eligible for SSI if the Widow/Widower entitlement and all subsequent COLAs were disregarded;

5. Is not entitled to Medicare Part A; and 6. Is at least age fifty (50) and under age sixty-five (65).

(d) Income Limitations: SSI Federal Benefit Rate.

(e) Resource Limitations: $2,000.00 for an individual, $3,000.00 for a couple.

(f) Effective Date of Eligibility: Eligibility begins on the Application File Date, according to

Rule .05, or the date all eligibility requirements are met, whichever is later.

(g) Other: An individual in this category may receive Continuous Eligibility if the individual is a Pregnant Woman. See Rule .09.

(5) Institutional Eligibility.

(a) Definition: See Rule .02.

(b) Technical Requirements: See Rule .04.

(c) Special Eligibility Requirements. To gain eligibility in this category, applicants must:

1. Be confined in a Medical Institution at least thirty (30) consecutive days and be either Aged, Blind, Disabled, a child under age twenty-one (21), or a Pregnant Woman;

2. Meet Nursing Facility Level of Care (NF LOC) according to Chapter 1200-13-01; or 3. Receive CHOICES HCBS and meet the medical Level of Care (LOC) eligibility criteria, according to Chapter 1200-13-01, to receive payments for LTSS through CHOICES.

3. An individual who receives hospice services in a nursing facility for any length of time or dies in a nursing facility or ICF/IID prior to thirty (30) days of continuous confinement meets the 30-day continuous confinement requirement.

(d) Household size is based upon the ABD household composition Rule .06.

(e) Income Limitations: Income shall not exceed three hundred percent (300%) of the SSI Federal Benefit Rate for an individual.

(f) Resource Limitations: Resources shall not exceed $2,000.00 for an individual.

(g) Effective Date of Eligibility:

1. For individuals described in Subparagraph (c)1., (c)2., and (c)4. above:

(i) Eligibility begins on the first day the individual was confined in a Medical Institution, provided that all other technical and financial eligibility criteria are met on that date.

(ii) If all other technical and financial eligibility criteria are not met on the first day the individual was confined in a Medical Institution, then eligibility begins on the first date that all other technical and financial eligibility criteria are met.

(iii) Notwithstanding (i) and (ii) of this part, eligibility cannot begin earlier than the first day of the third month prior to the Application File Date.

2. For individuals described in Subparagraph (c)3. above, eligibility begins on the Application File Date, according to Rule .05, or the date all eligibility requirements are met, whichever is later.

(h) Other: An individual in this category may receive Continuous Eligibility if the individual is a child under age nineteen (19) or a Pregnant Woman. See Rule .09.

(i) Special Asset Rules:

1. Asset Disregards for Qualified Long-Term Care Insurance Policies.

(i) Individuals who purchase a qualified long term care insurance policy may have assets disregarded in the determination of eligibility for TennCare.

TennCare shall disregard an individual’s assets up to the amount of payments made by the individual’s qualifying long-term care insurance policy for services covered under the policy at the time of TennCare application.

(ii) The amount of the individual’s assets properly disregarded under these provisions shall continue to be disregarded through the lifetime of the individual.

(iii) Assets disregarded during the TennCare Medicaid eligibility determination process because the enrollee purchased an LTCP policy are protected from estate recovery. When the amount of assets disregarded during the TennCare Medicaid eligibility determination process are less than the total benefits paid by the LTCP policy, additional assets up to the total amount of payments made by the LTCP policy may be protected during the estate recovery process.

2. Entrance Fees: Any contractual provision requiring the resident to deposit entrance fees must take into account the required allocation of resources or income to the community spouse before determining the resident’s cost of care.

In addition, the entrance fee paid to the Continuing Care Retirement Community (CCRC) or life care community is treated as a resource to an individual for purposes of determining Medicaid eligibility. The following three (3) conditions must be met in order for the entrance fee to be considered an available resource:

(i) Any portion of the entrance fee is refunded or used to pay for care under the terms of the entrance contract should other resources of the individual be insufficient;

(ii) The entrance fee, or any portion thereof, is refundable under the terms of the contract when the individual dies or terminates the contract and leaves the CCRC or life care community, whether or not any amount is actually refunded; and (iii) The entrance fee does not confer an ownership interest in the community.

3. Funds used to purchase a loan, mortgage or promissory note after February 8, 2006 must be treated as a transfer of assets unless it has a repayment term that is actuarially sound, provides for payments to be made in equal amounts during the term of the loan with no deferral or balloon payment, and prohibits cancellation of the balance upon the death of the lender. If a nursing home applicant uses his funds to purchase a loan, mortgage or promissory note and the purchase agreement does not meet the criteria of this part, the amount of the asset transfer will be the outstanding balance due on the loan, mortgage or promissory note as of the date of the application for Medicaid.

4. A life estate interest purchased by a nursing home applicant in another individual’s home shall be treated as a transfer of assets unless the nursing home applicant resides in the home for a period of at least one (1) year after the date of the purchase.

(j) Transfer of Assets. A transfer of assets is transferring ownership of a resource for less than fair market value (FMV). An applicant requesting payment for LTSS shall not transfer assets for less than FMV on or after the look-back date. The look-back date is sixty (60) months prior to the first date an individual has both applied for Medicaid and is institutionalized or is determined to have met the requirements for HCBS. If an individual is found to have transferred an asset for less than FMV, he will be ineligible for payments for LTSS.

1. An individual shall not receive a period of ineligibility to the extent that the transfer meets the requirements of 42 U.S.C. § 1396p(c)(2).

2. An individual shall not receive a period of ineligibility to the extent that the assets:

(i) Were transferred to a trust established solely for an individual under age 65 and that meets the requirements of 42 U.S.C. §1396p(d)(4)(A);

(ii) Were transferred to a trust that meets the requirements of 42 U.S.C. §1396p(d)(4)(B); or (iii) Were transferred to a trust established solely for the benefit of an individual under the age of 65 who is disabled according to the Social Security Administration and that meets the requirements of 42 U.S.C. §1396p(d)(4)(C). Trusts created pursuant to this section shall not include language disallowing repayment to the state in the event the claim exceeds the amount remaining in the trust.

(iv) All trusts may be subject to review annually or upon request for a full accounting by TennCare. Failure to respond to such requests or provide this information may result in the ineligibility of an individual.

3. The transfers indicated below, if occurring on or after February 8, 2006, may be considered a transfer of assets for less than FMV with respect to an individual applying for Medicaid based on institutionalization:

(i) If the transfer of assets occurs on or after the look-back date.

(ii) If the institutionalized individual, his spouse, or any person, court or administrative body with authority to act on behalf of, or at the direction or request of, the individual or his spouse, establishes a trust or similar device, which includes the individual’s assets and cannot be used by or for the individual’s benefit, if it occurred on or after the look-back date.

(iii) If an asset is held jointly by the institutionalized individual with another person and the individual or other owner reduces or eliminates the institutionalized individual’s ownership or control of the asset, if it occurred on or after the look-back date.

(k) Penalty for transfer of assets.

1. The institutionalized individual may be subject to penalty if the transfer was completed by the individual; the individual’s spouse; a person (including a court) or administrative body with legal authority to act in place of, or on behalf of, or at the direction or request of the institutionalized individual or his spouse.

2. Assets include all income and resources, including the home, unless transferred as indicated in subparagraph (i) above, of the institutionalized individual and his spouse, (including income and/or resources the individual is entitled to, but does not receive because of any action by the individual or his spouse or a person (including a court) or administrative body with legal authority to represent the individual, his spouse, or who acts at the direction or request of the individual and his spouse).

3. Penalty period: The period of ineligibility for payments for long-term services and supports in the CHOICES Program imposed for transfers of assets within sixty (60) months prior to application for long term care nursing services.

(i) The penalty period is determined by dividing the uncompensated value of the transferred asset by the average daily nursing home private pay rate.

In determining the penalty for a transfer a State may not round down or disregard any fractional period of ineligibility. There is no limit on the maximum months of ineligibility. The penalty continues until expired unless hardship is considered to exist.

(ii) The penalty period for individuals receiving nursing home care begins the date the individual is eligible for Medicaid and would otherwise be receiving LTSS through the CHOICES program but for a penalty or the first day of the month of the transfer, whichever is later. The penalty period for HCBS begins the date the individual meets all eligibility requirements and would otherwise be receiving LTSS through the CHOICES program but for a penalty or the first day of the month of the transfer, whichever is later. The penalty period runs consecutively even if the individual leaves the nursing home for a period of time and later returns. If a penalty period is imposed for new applicants, Medicaid requires a notice of penalty. If a penalty period is imposed on an individual who is already receiving Medicaid, a ten (10) day adverse action notice is required.

(iii) Applicants for, or enrollees in, nursing home coverage can still remain eligible in an Institutional Eligibility category while payments for LTSS are withheld. Applicants for, or enrollees in, HCBS cannot be eligible for an Institutional Eligibility category while subject to the period of ineligibility.

(iv ) Penalty periods for more than one transferred asset will run consecutively, not concurrently. Any uncompensated value from multiple transfers is added to the initial uncompensated value if penalty periods overlap to determine the consecutive penalty period.

(l) Undue hardship.

1. Undue Hardship shall exist only when:

(i) The individual has been denied LTSS payments due to one of the following reasons.

(I) The value of the homestead property exceeds the home equity limit;

(II) An Estranged Spouse’s failure to cooperate with the resource assessment process;

(III) A penalty period is applied due to the transfer of asset provision; or (IV) The applicant is resource ineligible due to the provisions of a trust, and the applicant is otherwise resource eligible.

(ii) The ineligibility for LTSS payments would deprive the individual of medical care, such that the individual’s health or life would be endangered, or of food, clothing, shelter, or other necessities of life;

(iii) The institutionalized individual has no available resources (other than the uncompensated value) in excess of the resource limitations, and (iv) The necessary care is not available from any other source.

2. The individual, the individual’s responsible party, or the facility in which an institutionalized individual resides may file an Undue Hardship claim on behalf of the applicant/recipient.

3. An Undue Hardship claim must be filed within ninety (90) days of the Application File Date, or no later than forty (40) days after the date of the denial or termination notice. However, an undue hardship claim can also be filed if an individual experiences a change in circumstances while in a penalty period.

4. TennCare will determine whether Undue Hardship exists and notify the Applicant within thirty (30) days of filing.

5. If Undue Hardship is determined not to exist, the denial of Undue Hardship may be appealed within forty (40) days.

(m) Patient Liability. Individuals determined eligible for institutional services are required to contribute to the cost of their care as a resident in a nursing facility or as a Home and Community Based Services (HCBS) recipient. Patient liability is calculated based on total income remaining after deductions in accordance with 42 C.F.R. § 435.725, 42 C.F.R. § 435.726, and the State Plan. Total income includes all amounts of income available to an individual from all sources, which are considered to be income for eligibility purposes, unless specifically excluded from post-eligibility under the State Plan or based on other Federal laws.

1. Post-Eligibility Treatment of Certain Payments from the Department of Veterans Affairs. VA improved pensions limited to $90 per month are not considered in the post-eligibility process. If an unmarried, childless veteran or the surviving, childless spouse of a veteran is in a state veterans home and receives a VA pension that exceeds $90 per month, the VA pension, including any payment made for aid and attendance or for unreimbursed medical expenses, is counted in total income and applied to the state veterans home’s cost of providing nursing home care to the veteran or surviving spouse.

2. Patient liability is determined by allowing the following deductions from an individual’s total income:

(i) A Personal Needs Allowance (PNA) for clothing and other personal needs while receiving Institutional Eligibility. Apply the appropriate PNA based on the type of long term services and supports the individual receives, as follows:

(I) Nursing Facility. Through December 31, 2024, subtract $50.00 PNA from the gross income of an individual in a nursing facility or ICF/IID.

Effective January 1, 2025, subtract $70.00 PNA from the gross income of an individual in a nursing facility or ICF/IID. For an individual with greater need who participates in a sheltered workshop, subtract up to $100 of earnings plus the PNA.

(II) Individuals receiving HCBS through CHOICES, ECF CHOICES, or a 1915(c) waiver, and PACE participants: PNA is three hundred percent (300%) of the SSI FBR.

(ii) An allowance equivalent to the monthly fee for maintenance of a QIT, if applicable.

(iii) A CSIMA for institutionalized individuals with a spouse residing in the community.

(iv ) A DIMA for institutionalized individuals with a dependent residing in the community.

(v) Health insurance premiums, coinsurance and deductibles.

(vi ) Expenses for medical services as defined at 42 C.F.R. §§ 435.725(c)(4) and 726(c)(4).

3. Community Spouse Income Maintenance Allowance (CSIMA). When determining an institutionalized individual’s patient liability, an allowance is deducted from his income for the needs of the community spouse. The CSIMA is allowed unless specifically refused by the institutionalized spouse. Funds must actually be transferred to the community spouse in order to be deducted.

(i) CSIMA is allowed under the following conditions:

(I) CSIMA is not allowed if both spouses are receiving Institutional Eligibility, unless one spouse is receiving HCBS.

(II) If the community spouse applies for TennCare Medicaid, the CSIMA will be counted as unearned income at the time of application.

(III) A community spouse receiving need-based assistance does not have to accept the total or any of the income allocation if it will result in the termination or decrease of those benefits.

(IV) If a couple is married but living separately, and considers themselves to be separated, the CSIMA may be allowed if both individuals agree to the allocation and the community spouse is not institutionalized.

(V) If the community spouse lives out of State, the CSIMA is allowed if the community spouse can be located and the couple is still married.

(ii) CSIMA Terms and Standards:

(I) Standard Maintenance Amount (SMA): The poverty level standard used to determine the community spouse’s monthly maintenance needs. The SMA is 150% of the FPL for a household of 2. This is subject to annual change by CMS and released with SSI and Spousal Impoverishment Standards.

(II) Maintenance Needs Standard: The minimum amount of monthly income necessary to meet the community spouse’s maintenance needs and prevent impoverishment. The Maintenance Needs Standard is determined by adding the SMA and the Excess Shelter Allowance (ESA). This is subject to annual change by CMS and released with SSI and Spousal Impoverishment Standards.

(III) Standard Utility Amount (SUA): The SUA is used when the community spouse is responsible for heating and/or cooling costs. If the SUA is used, then it is considered to cover all utilities, including garbage, water, lighting, etc. The SUA is subject to annual change by the Tennessee Department of Human Services.

(IV) Standard Housing Allowance (SHA): The SHA is used to determine whether the community spouse requires an Excess Shelter Allowance. This is subject to annual change by CMS and released with SSI and Spousal Impoverishment Standards.

(iii) CSIMA Calculation: The CSIMA is calculated using three steps:

(I) Determine Excess Shelter Allowance (ESA).

I. An ESA is allowed when the total shelter costs for rent, mortgage, taxes and insurance, maintenance charges and utility costs exceed the SHA. The SHA is thirty percent (30%) of the Standard Maintenance Amount.

II. The SUA is used when the community spouse is responsible for heating or cooling costs. If the SUA is used then it is considered to cover all utilities (no additional allowance for garbage, telephone, etc.). When there is no or reduced cost to the community spouse because the cost of a particular utility is paid by a third party (in cash or in-kind), reduce the amount of the SUA by the third party payment.

III. To determine the ESA, add rent, mortgages, taxes, insurance, etc., to the SUA, then subtract the SHA.

(II) Determine Community Spouse Net Income. Defined as income over which the Community Spouse has control and which is actually available to him. Child support payments and other types of courtordered payments made by the Community Spouse are not considered income available to the Community Spouse.

(III) Calculate CSIMA: The CSIMA is calculated by adding the SMA and the ESA, and then subtracting the Community Spouse’s net income.

4. Dependent Income Maintenance Allowance (DIMA): When determining patient liability, an allowance is deducted from the individual’s income for the needs of his dependents living at home.

(i) Dependent relatives include the individual’s or the spouse’s adult dependent children, parents, siblings, and minor children who are living at home.

(ii) A DIMA is not allowed for any dependent receiving HCBS or who is institutionalized.

(iii) Pursuant to the Medicare Catastrophic Coverage Act, a dependent does not have the option of declining all or a portion of the income allocation for any reason, even if needs-based benefits may be decreased or lost because of the allocation.

(iv ) The DIMA for each additional dependent family member living with the community spouse is equal to one-third of the difference between the SMA and the dependent’s gross income.

(v) DIMA Calculation: The dependent allocation(s) equals the SMA for the community spouse minus the dependent’s own gross countable income divided by 3.

(vi) The DIMA for dependent relatives living in the home without a community spouse is determined based on the MNIS.

(vii) DIMA Calculation: The dependent allocation is the MNIS for the household size if the total net countable income of the dependent(s) is less than the MNIS. No dependent allocation is given if the total net countable income of the dependent(s) is more than the MNIS for the household size.

5. Incurred Medical Expenses: Expenses for medical or remedial care not subject to third party payment as defined at 42 C.F.R. §§ 435.725(c)(4), 435.726(c)(4) and 435.832, and outlined in the State Plan are allowable deductions. Criteria for Deduction of an Incurred Medical Expense:

(i) The expense must not be subject to payment by a third party not expecting reimbursement, e.g., medical or health insurance, the individual’s spouse or family or medical trust fund, Medicare, etc.

(ii) The expense may be unpaid or paid by the individual during the month(s) of eligibility determination or paid by a member of the individual’s family and reimbursement is expected by the family member.

(iii) The expense must not have been allowed previously as an allowed necessary item.

(iv ) If payment for the item is outstanding, it must be considered collectible by the party who provided the medical service and one for which the individual is legally liable.

(v) Medical expenses incurred during a period of ineligibility and up to three months prior to the month of application may be allowable medical expenses.

(vi ) Deductions will be allowed in compliance with 42 C.F.R. §§ 435.725(c)(4), 435.726(c)(4), and 435.832, and the State Plan.

(n) Resource Assessment and CSRMA.

1. Resource Assessment: When determining eligibility for a married, institutionalized Applicant a calculated amount of the couple’s assets is allocated to the Community Spouse to be used for her own needs. The resource assessment is a snapshot of all countable assets owned by the couple at the time of the first period of continuous confinement but conducted upon application or when an assessment is requested prior to application. For applicants in a Medical Institution, it is a snapshot of the couple’s assets on the date of admission to a Medical Institution. For HCBS applicants, it is a snapshot on the effective date of the approved Pre-Admission Evaluation (PAE). If an application for HCBS is filed before a PAE has been approved, and the PAE is approved within 90 days of application, the snapshot date for the resource assessment is the Application File Date. All of the countable resources owned individually or jointly by both spouses are counted; resources excluded under the ABD resource rules are not counted in the resource assessment.

(i) Only one resource assessment will be completed for a married couple.

(ii) Under no circumstances can a resource assessment be completed prior to the first continuous period of institutionalization.

(iii) For residents in a Medical Institution, an assessment remains in effect until a TennCare application is filed, regardless of any interruptions in confinement. For HCBS, the effective date of the earliest approved PAE should be used to conduct the resource assessment, as long as the individual continues to meet the medical level of care at the time an application for HCBS is filed. If a resource assessment is completed and the individual applies for TennCare Medicaid, but is found ineligible, the original resource assessment is still valid if the individual applies again in the future.

2. Community Spouse Resource Maintenance Allowance: The CSRMA is based on the spouses’ combined countable resources documented in the Resource Assessment. The amount of the CSRMA is the greater of:

(i) One-half (1/2) of the total countable resources, but not less than the Minimum Resource Standard or greater than the Maximum Resource Standard (released in the SSI and Spousal Impoverishment Standards and subject to change annually);

(ii) The court-ordered amount; or (iii) The amount determined by an Administrative Judge due to a hardship situation (extreme financial duress).

3. When an application is filed by or on behalf of the spouse seeking LTSS, the CSRMA amount determined in the resource assessment is the amount allocated to the community spouse. This amount is deducted from the combined resources of both spouses as of the first day of the first month for which assistance is requested. None of the community spouse’s share of the resources is considered available to the individual seeking eligibility when determining her TennCare Medicaid eligibility.

4. Refusal of CSRMA. A community spouse who receives needs-based assistance may accept or decline all, some or none of the CSRMA if the allocation would cause the loss of or decrease in those program benefits. If the community spouse accepts only a portion of the CSRMA, the unclaimed portion of the CSRMA is counted as part of the institutionalized spouse’s resources.

5. Resource Transfer as a Result of Assessment.

(i) CSRMA “Grace Period.” Following a resource assessment and initial approval of eligibility, resources must be transferred within twelve (12) months of the approval. Both spouses must agree to the transfer in order to use the institutionalized spouse’s share in determining his eligibility. The transfer may require conveyance of resources from the institutionalized individual to the community spouse, or vice versa.

(ii) Transfer Refusal. When the community spouse refuses to transfer resources to the institutionalized individual, the institutionalized spouse may still be eligible if on appeal the State finds that undue hardship circumstances exist.

(I) If the community spouse has available assets over the CSRMA she is legally obligated to provide support.

(II) Hardship cannot be determined to exist unless assets have been reallocated as the result of an appeal decision or a court order.

(iii) CSRMA Appeals.

(I) When the Individual and/or Spouse Has Appeal Rights. Appeal rights are considered only after a TennCare application has been filed and either spouse alleges that the assessment or eligibility determination decision is not correct. An assessment completed exclusive of a filed application cannot be appealed, 42 U.S.C. § 1396r-5(e)(2)(A).

Revisions to the spousal allowance of resources can be made by an Administrative Judge or by court order.

(II) CSRMA Revisions. The amount of the CSRMA may only be revised by an Administrative Judge or by court order, and only if additional verification/documentation is provided. The CSRMA may only be revised when:

I. The initial assessment was alleged to be incorrect and the Administrative Judge confirms the allegations;

II. An Administrative Judge determines a larger CSRMA is necessary to raise the community spouse’s available income to the Maintenance Needs Standard or to an amount by which exceptional maintenance needs, established at a fair hearing, exceed the community spouse’s income; or III. A court order is received against an institutionalized spouse for the support of the community spouse and resources are transferred pursuant to the court order.

(III) Allocation of Additional Resources to the Community Spouse.

I. When Additional Resources May be Allocated to Community Spouse: In the event that the institutionalized spouse does not have enough income to provide the community spouse with sufficient income to meet the Maintenance Needs Standard and the CSRMA is not enough to offset the income shortfall, additional resources may be allocated to the community spouse by an Administrative Judge if the couple has additional resources above the community spouse’s protected amount (CSRMA).

II. The Deficit Reduction Act (DRA) of 2005 requires all States to allocate the maximum amount of available income of the institutionalized spouse to the community spouse before granting an increase in the CSRMA. This is referred to as the “income-first” method.

III. TennCare uses the Single Fixed Annuity model to address appeals when there is insufficient income to provide the community spouse with the Maintenance Needs Standard and the couple has additional resources. A single fixed annuity can turn a portion of an individual’s savings into income payments made for the rest of the individual’s life. The procedure for establishing a Single Fixed Annuity is listed below.

A. Additional resources may be allocated to the community spouse through the TennCare eligibility appeals process to make up any shortfall between the amount of income allocated from the institutional spouse to the community spouse and the Maintenance Needs Standard, if determined appropriate.

B. The amount of additional resources that are necessary to cover the income shortfall shall be determined in reference to the purchase of a Single Premium Annuity as follows:

(A) By calculating the shortfall between the amount of income allocated and the Maintenance Needs Standard, and then determining the amount of additional resources that must be invested in a single premium annuity in order to generate the income necessary to cover the shortfall.

(B) The amount of resources needed to cover the shortfall shall be determined in reference to an annuity calculator as adopted by TennCare.

(C) Additional Resources may be allocated to the community spouse if the amount of resources needed to cover the shortfall is greater than the CSRMA.

C. The additional resource allocation to the community spouse does not require the actual purchase of a Single Premium Annuity that is used for purposes of calculating the amount of the additional resource allocation.

D. If a single premium annuity is actually purchased pursuant to these rules, the annuity must comply with all other relevant requirements of state and federal law.

E. The amount of additional resources that are necessary to cover the shortfall shall not be determined in reference to any investment which contemplates the return of the entire principal at maturity.

(iv ) Transfer of Assets for Less than Fair Market Value.

(I) A transfer of assets for less than FMV is not considered to have occurred when resources are transferred from the institutionalized individual to the community spouse or vice versa according to a completed resource assessment.

(II) Should the spouse who received the allocation according to the resource assessment then transfer the resource to someone else for less than FMV, the transfer will not be treated as a transfer of assets since the resources of a couple are treated separately after the establishment of Institutional Medicaid eligibility.

(III) Transfer of assets for less than FMV is considered part of the application process whether or not a resource assessment has been requested previously or is requested at application. Transfer of assets is not considered if a resource assessment only (no TennCare Medicaid application filed concurrently) is requested.

(6) ECF CHOICES Demonstration Groups.

(a) ECF CHOICES 217-Like Group.

1. Definition: See Rule .02.

2. Technical Eligibility Requirements: See Rule .04.

3. Special Eligibility Requirements: To gain eligibility in this category, applicants must:

(i) Have an Intellectual Disability manifested before eighteen (18) years of age or a Developmental Disability manifested before twenty-two (22) years of age, as specified in T.C.A. § 33-1-101.

(ii) Be in one of the defined target populations specified in Chapter 1200-13- 01-.31.

(iii) Meet Nursing Facility Level of Care (NF LOC), as defined in Chapter 1200- 13-01-.02.

(iv) Qualify for an available slot in an ECF CHOICES Group defined at 1200- 13-01-.02(56) for which enrollment is currently open, or for an available reserve capacity slot, in accordance with Chapter 1200-13-01-.31.

(v) Receive ECF CHOICES.

4. Household size is based upon the ABD household composition Rule .06.

5. Income Limitations: Income shall not exceed three hundred percent (300%) of the SSI Federal Benefit Rate for an individual. Parent-to-child deeming rules shall apply for a child except for those age 17 or older who meet institutional level of care, those enrolled prior to November 23, 2020, those who will be enrolled in ECF CHOICES Group 7 (Intensive Behavioral Family Supports), and those transitioning from ECF CHOICES Group 7 to ECF CHOICES Group 4 (Essential Family Supports) as defined in TennCare 1115 Demonstration Waiver III.

6. Resource Limitations: Resources shall not exceed $2,000.00 for an individual.

Parent-to-child deeming rules shall apply for a child except for those age 17 or older who meet institutional level of care, those enrolled prior to November 23, 2020, those who will be enrolled in ECF CHOICES Group 7 (Intensive Behavioral Family Supports), and those transitioning from ECF CHOICES Group 7 to ECF CHOICES Group 4 (Essential Family Supports) as defined in TennCare 1115 Demonstration Waiver III.

7. Effective Date: Eligibility begins on the date all eligibility requirements are met.

8. Other: An individual in this category may receive Continuous Eligibility if the individual is a child under age nineteen (19) or a Pregnant Woman. See Rule .09.

9. Special Asset Rules: See Paragraph (5)(i).

10. Transfer of Assets: See Paragraph (5)(j).

11. Penalty for Transfer of Assets: See Paragraph (5)(k).

12. Undue Hardship: See Paragraph (5)(l).

13. Patient Liability: See Paragraph (5)(m).

14. Resource Assessment and CSRMA: See Paragraph (5)(n).

(b) Interim ECF CHOICES At-Risk Group.

1. Definition: See Rule .02.

2. Technical Eligibility Requirements: See Rule .04.

3. Special Eligibility Requirements: To gain eligibility in this category, applicants must:

(i) Not otherwise be eligible in a TennCare Medicaid category that confers LTSS benefits.

(ii) Have an Intellectual Disability manifested before eighteen (18) years of age or a developmental disability manifested before twenty-two (22) years of age, as specified in T.C.A. § 33-1-101.

(iii) Be in one of the defined target populations specified in Chapter 1200-13- 01-.31.

(iv) Be At-Risk for Institutionalization, as defined in Chapter 1200-13-01-.02.

(v) Qualify for an available slot in an ECF CHOICES Group defined at 1200- 13-01-.02(56) for which enrollment is currently open, or for an available reserve capacity slot, in accordance with Chapter 1200-13-01-.31.

(vi) Receive ECF CHOICES.

4. Household size is based upon the ABD household composition Rule .06.

5. Income Limitations: Income shall not exceed three hundred percent (300%) of the SSI Federal Benefit Rate for an individual. Parent-to-child deeming rules shall apply.

6. Resource Limitations: Resources shall not exceed $2,000.00 for an individual.

Parent-to-child deeming rules shall apply.

7. Effective Date: Eligibility begins on the date all eligibility requirements are met.

8. New enrollment into the Interim ECF CHOICES At-Risk Group closed upon implementation of Phase 2 of ECF CHOICES. Individuals enrolled in the Interim ECF CHOICES At-Risk Group prior to implementation of Phase 2 may remain enrolled in the interim group as long as they continue to meet the eligibility requirements and remain continuously enrolled in the interim group.

9. Other: An individual in this category may receive Continuous Eligibility if the individual is a child under age nineteen (19) or a Pregnant Woman. See Rule .09.

10. Special Asset Rules: See Paragraph (5)(i).

11. Transfer of Assets: See Paragraph (5)(j).

12. Penalty for Transfer of Assets: See Paragraph (5)(k).

13. Undue Hardship: See Paragraph (5)(l).

14. Patient Liability: See Paragraph (5)(m).

15. Resource Assessment and CSRMA: See Paragraph (5)(n).

(c) ECF CHOICES At-Risk Group.

1. Definition: See Rule .02.

2. Technical Eligibility Requirements: See Rule .04.

3. Special Eligibility Requirements: To gain eligibility in this category, applicants must:

(i) Not otherwise be eligible in a Medicaid category that confers LTSS benefits.

(ii) Have an Intellectual Disability manifested before eighteen (18) years of age or a developmental disability manifested before twenty-two (22) years of age, as specified in T.C.A. § 33-1-101.

(iii) Be in one of the defined target populations specified in Chapter 1200-13- 01-.31.

(iv) Be At-Risk for Institutionalization, as defined in Chapter 1200-13-01-.02.

(v) Qualify for an available slot in an ECF CHOICES Group defined at 1200- 13-01-.02(56) for which enrollment is currently open, or for an available reserve capacity slot, in accordance with Chapter 1200-13-01-.31.

(vi) Receive ECF CHOICES.

4. Household size is based upon the ABD household composition Rule .06.

5. Income Limitations: Income must be at or below 150% of the FPL for an individual. Parent-to-child deeming rules shall apply.

6. Resource Limitations: Resources shall not exceed $2,000.00 for an individual.

Parent-to-child deeming rules shall apply.

7. Effective Date: Eligibility begins on the date all eligibility criteria are met.

8. Other: An individual in this category may receive Continuous Eligibility if the individual is a child under age nineteen (19) or a Pregnant Woman. See Rule .09.

9. Special Asset Rules: See Paragraph (5)(i).

10. Transfer of Assets: See Paragraph (5)(j).

11. Penalty for Transfer of Assets: See Paragraph (5)(k).

12. Undue Hardship: See Paragraph (5)(l).

13. Patient Liability: See Paragraph (5)(m).

14. Resource Assessment and CSRMA: See Paragraph (5)(n).

(d) ECF CHOICES Working Disabled Group.

1. Definition: See Rule .02.

2. Technical Eligibility Requirements: See Rule .04.

3. Special Eligibility Requirements: To gain eligibility in this category, applicants must:

(i) Not otherwise be eligible in a TennCare Medicaid category that confers LTSS benefits.

(ii) Have an Intellectual Disability manifested before eighteen (18) years of age or a Developmental Disability manifested before twenty-two (22) years of age, as specified in T.C.A. § 33-1-101.

(iii) Be in one of the defined target populations specified in Chapter 1200-13- 01-.31.

(iv) Meet Nursing Facility Level of Care (NF LOC) or be At Risk for Institutionalization, as defined in Chapter 1200-13-01-.02.

(v) Be working and would be eligible for SSI if their Earned Income was disregarded.

(vi) Qualify for an available slot in an ECF CHOICES Group defined at 1200- 13-01-.02(56) for which enrollment is currently open, or for an available reserve capacity slot, in accordance with Chapter 1200-13-01-.31.

(vii) Receive ECF CHOICES.

4. Household size is based upon the ABD household composition Rule .06.

5. Income Limitations: Two separate income tests apply:

(i) Income must be at or below 250% of the FPL for an individual. Parent-tochild deeming rules shall apply for a child except for those age 17 or older who meet institutional level of care, those enrolled prior to November 23, 2020, those who will be enrolled in ECF CHOICES Group 7 (Intensive Behavioral Family Supports), and those transitioning from ECF CHOICES Group 7 to ECF CHOICES Group 4 (Essential Family Supports) as defined in TennCare 1115 Demonstration Waiver III.

(ii) Income must be less than the SSI Federal Benefit Rate after the applicant’s earned income is disregarded.

(I) Parent-to-child deeming rules and spouse-to-spouse deeming rules shall apply.

(II) When spouse-to-spouse income deeming occurs, the applicant’s income is compared against the SSI Federal Benefit Rate for a couple.

6. Resource Limitations: Resources shall not exceed $2,000.00 for an individual.

Parent-to-child deeming rules shall apply for a child except for those age 17 or older who meet institutional level of care, those enrolled prior to November 23, 2020, those who will be enrolled in ECF CHOICES Group 7 (Intensive Behavioral Family Supports), and those transitioning from ECF CHOICES Group 7 to ECF CHOICES Group 4 (Essential Family Supports) as defined in TennCare 1115 Demonstration Waiver III.

7. Effective Date: Eligibility begins on the date all eligibility criteria are met.

8. Other: An individual in this category may receive Continuous Eligibility if the individual is a child under age nineteen (19) or a Pregnant Woman. See Rule .09.

9. Special Asset Rules: See Paragraph (5)(i).

10. Transfer of Assets: See Paragraph (5)(j).

11. Penalty for Transfer of Assets: See Paragraph (5)(k).

12. Undue Hardship: See Paragraph (5)(l).

13. Patient Liability: See Paragraph (5)(m).

14. Resource Assessment and CSRMA: See Paragraph (5)(n).

(7) Medicare Savings Programs.

(a) QMB.

1. Definition: See Rule .02.

2. Eligibility for this program is not eligibility for Medicaid coverage. An individual eligible for QMB is eligible for TennCare Buy-in of his Medicare premiums, and payment of Medicare coinsurance and deductibles.

3. Technical Requirements: See Rule .04.

4. Household size is based upon the ABD household composition Rule .06.

5. Income Limitations: At or below one hundred percent (100%) of the FPL.

6. Resource Limitations: Limits for an individual and couple as determined by CMS.

7. Effective Date: First day of the month following the month in which the application is approved.

(b) SLMB.

1. Definition: See Rule .02.

2. Eligibility for this program is not eligibility for Medicaid coverage. An individual eligible for SLMB is eligible for TennCare Buy-in of his Medicare Part B premiums.

3. Technical Requirements: See Rule .04.

4. Household size is based upon the ABD household composition Rule .06.

5. Income Limitations: Over one hundred percent (100%) but less than one hundred twenty percent (120%) of the FPL.

6. Resource Limitations: Limits for an individual and couple as determined by CMS.

7. Effective Date: Eligibility begins on the Application File Date, according to Rule .05, or the date all eligibility requirements are met, whichever is later.

(c) QI1.

1. Definition: See Rule .02.

2. Eligibility for this program is not eligibility for Medicaid coverage. An individual eligible for QI1 is eligible for TennCare Buy-in of his Medicare Part B premiums, pursuant to State allocation of federal funds. The individual may not be receiving TennCare Medicaid.

3. Technical Requirements: See Rule .04.

4. Household size is based upon the ABD household composition Rule .06.

5. Income Limitations: Over one hundred twenty percent (120%) but less than one hundred thirty-five percent (135%) of FPL.

6. Resource Limitations: Limits for an individual and couple as determined by CMS.

7. Effective Date: Eligibility begins on the Application File Date, according to Rule .05, or the date all eligibility requirements are met, whichever is later.

(d) QDWI.

1. Definition: See Rule .02.

2. Eligibility for this program is not eligibility for Medicaid coverage. An individual eligible for QDWI is eligible for TennCare Buy-in of his Medicare Part A premiums, but not for Part B premiums.

3. Technical Requirements: See Rule .04.

4. Special Eligibility Requirements: An individual must be under age sixty-five (65), have a disabling impairment as determined by the SSA, and be eligible to enroll in Medicare Part A but no longer entitled to free Medicare Part A due to substantial gainful activity.

5. Household size is based upon the ABD household composition Rule .06.

6. Income Limitations: Two hundred percent (200%) of FPL.

7. Resource Limitations: Resources not exceeding twice the maximum for SSI for an individual or a couple, as applicable.

8. Effective Date: Eligibility begins on the Application File Date, according to Rule .05, or the date all eligibility requirements are met, whichever is later.

(8) Other.

(a) Medically Needy Children and Pregnant Women.

1. Definition: See Rule .02.

2. Technical Requirements: See Rule .04.

3. Special Eligibility Requirements: Applicants for the Medically Needy Pregnant Woman category must be pregnant at the time of application. Applicants for the Child Medically Needy category must be under age twenty-one (21).

4. Household size is based upon the AFDC-Related household composition information set out in Rule .06.

5. Income Limitations: Household income must be less than or equal to the MNIS, based on household size. When household income exceeds the MNIS, based on household size, the individual must meet a spenddown obligation as outlined in the State Plan. See Rule .06.

6. Resource Limitations: Medically Needy applicants are permitted to retain resources not to exceed $2,000.00 for an individual, $3,000.00 for two individuals and an additional $100.00 is added per additional individual. See Rule .06.

7. Effective Date of Eligibility: Eligibility begins on the Application File Date, according to Rule .05, or the date all eligibility requirements are met, whichever is later.

8. Other: An individual in this category may receive Continuous Eligibility if the individual is a Pregnant Woman. See Rule .09.

(b) Breast and Cervical Cancer Category of Eligibility.

1. Definition: See Rule .02.

2. Technical Requirements: See Rule .04.

3. Special Eligibility Requirements:

(i) Individuals must be younger than age sixty-five (65) and must lack health insurance that will cover treatment for breast and/or cervical cancer. Once third party coverage of cancer has been exhausted, the applicant will be considered to no longer have health insurance.

(ii) Individuals must first be screened and approved by the Department of Health’s BCSP.

(iii) Individuals must be actively undergoing treatment for breast or cervical cancer. A Treatment Plan Form signed by the applicant’s physician must be submitted to TennCare. Individuals who are determined to require only routine monitoring services for a precancerous breast or cervical condition are not considered to need treatment for purposes of this section.

Surveillance after treatment of cancer (breast or cervical) will not qualify as treatment for purposes of this section.

4. Income Limitations: Income cannot exceed two hundred fifty percent (250%) of the FPL, as determined by the Department of Health through its BCSP.

5. Resource Limitations: None.

6. Effective Date of Eligibility: Eligibility begins on the Application File Date, according to Rule .05, or the date all eligibility requirements are met, whichever is later.

7. Other: An individual in this category may receive Continuous Eligibility if the individual is a child under age nineteen (19) or a Pregnant Woman. See Rule .09.

(c) Presumptive Breast or Cervical Cancer.

1. Definition: See Rule .02.

2. Technical Requirements: See Rule .04.

3. Special Eligibility Requirements:

(i) Individual must be determined to be presumptively eligible by the Department of Health.

(ii) Individual must be younger than age sixty-five (65) and must lack health insurance that will cover treatment for breast and/or cervical cancer.

(iii) The presumptive eligibility period will last either until the end of the month following the month of application or determination of a full Medicaid application, as defined in 42 U.S.C. § 1396r-1b.

4. Income Limitations: Income cannot exceed two hundred fifty percent (250%) of the FPL, as determined by the Department of Health through its BCSP program.

5. Resource Limitations: None.

6. Effective Date of Eligibility: The date eligibility is determined by the Tennessee Department of Health.

(d) Payment for Emergency Medical Services.

1. Definition: See Rule .02.

2. Technical Requirements: See Rule .04. Individuals must meet eligibility requirements for a Medicaid category except for citizenship and enumeration.

3. Special Eligibility Requirements: Individuals who meet all eligibility criteria except citizenship and immigration status for the following TennCare categories of eligibility:

(i) Caretaker Relative;

(ii) Infants and Children Under Age 19;

(iii) TennCare Pregnant Women; or (iv ) Child or Qualified Pregnant Woman Medically Needy.

4. Individuals in one of the above categories may qualify for payment for emergency medical services in which the individual has a medical condition, including labor and delivery, manifested by acute symptoms of sufficient severity which, if not attended to immediately, could reasonably be expected to result in:

(i) Placing the patient’s health in serious jeopardy;

(ii) Severe impairment to bodily functions: or (iii) Serious dysfunction of any bodily organ or part.

5. Household size is based upon the appropriate TennCare category for which the enrollee is seeking coverage.

6. Income Limitations: Must meet financial criteria of one of the respective TennCare categories (Caretaker Relative, Infants and Children Under Age 19, TennCare Pregnant Woman, or Child or Qualified Pregnant Woman Medically Needy).

7. Resource Limitations: If an individual would be otherwise eligible for a Medically Needy category except for citizenship or immigration status, then the individual’s resource limits are identical to those found in Rule .06, AFDC-Related Financial Determinations. If an individual would be otherwise eligible for a MAGI category except for citizenship or immigration status, then the individual’s resources are not considered.

8. Effective Date of Eligibility: Eligibility will not begin prior to the date of admission, nor will coverage begin prior to the date of application, and will be limited to the length of time required to stabilize the emergent episode, as defined at 42 C.F.R. § 440.255. Only the services involved in the emergency itself will be reimbursed and coverage is only provided for the single episode of care.

(9) Katie Beckett Program-related Eligibility Groups.

(a) Katie Beckett Group Part A.

1. Definition: See Rule .02.

2. Technical Requirements: See Rule .04.

3. Special Eligibility Requirements:

(i) Individual must be younger than eighteen (18) years of age.

(ii) Individual must meet the medical level of care requirements according to

Rule 1200-13-01-.11.

(iii) Individual must not be financially eligible for any other category of TennCare Medicaid or TennCare Standard.

(iv) Third Party Liability (TPL).

(I) Katie Beckett Group Part A enrollees shall be covered by either employer-sponsored insurance or private insurance, at all times. The employer-sponsored insurance or private insurance plans must include minimum essential coverage, as defined by 45 CFR 156.110(a).

(II) If an eligible child attests to having TPL at the time of application, a notice requesting proof of TPL and the amount of the monthly TPL premium will be sent to the child. The child will have twenty (20) days from the date of the notice requesting proof of TPL and the amount of monthly TPL premiums to provide the requested information. If the requested information is not provided in a timely manner, the application will be denied for failure to respond.

(III) If an eligible child does not have TPL at the time of application, the child will be enrolled in Katie Beckett Group Part A and will be required to submit proof of TPL and the amount of the monthly TPL premiums.

I. The timeline for submitting proof of TPL will be as follows:

A. Katie Beckett Group Part A enrollees who are enrolled on or before October 1 will have until January 15 of the immediately following calendar year to submit proof of TPL.

B. Katie Beckett Group Part A enrollees who are enrolled between October 2 and December 31 will have until January 15 of the second following calendar year to submit proof of TPL.

II. Failure to timely submit proof of TPL.

A. Enrollees who fail to submit proof of TPL in accordance with the timelines provided in Subitem I. will receive an ex parte review of eligibility for other categories of TennCare Medicaid.

B. If the ex parte review does not result in enrollment in another category of eligibility, the enrollee will be sent a questionnaire to determine if the enrollee’s circumstances have changed since the last review that would result in eligibility for other categories of TennCare Medicaid. The questionnaire must be returned within twenty (20) days from the date of the questionnaire.

C. If the enrollee does not timely return the questionnaire or if the answers provided on the questionnaire do not result in enrollment in another category of eligibility, the enrollee will be sent a notice of termination informing the enrollee that Katie Beckett Group Part A coverage will be terminated twenty (20) days from the date of the termination notice if proof of TPL is not submitted prior to the date of termination.

(IV) Calculating an eligible child’s portion of monthly TPL premiums.

I. The eligible child’s portion of the family’s monthly TPL premium is calculated by dividing the total amount of the family’s monthly TPL premium by the number of individuals covered by the TPL.

II. If a parent of the eligible child is required to purchase TPL in order for the eligible child to have TPL coverage, the parent’s portion of the monthly TPL premium will be included in the child’s portion of the TPL when calculating the Katie Beckett Group Part A premium.

(V) Katie Beckett Group Part A enrollees must report any changes in TPL within ten (10) days of the change. Changes in TPL that must be reported include, but are not limited to:

I. Loss of TPL;

II. Change of TPL provider; or III. Change in monthly TPL premium.

(VI) Loss of TPL.

I. If a Katie Beckett Group Part A enrollee loses TPL coverage and notifies TennCare, the enrollee will receive a notice requiring proof of new TPL. The enrollee will have sixty (60) days from the date of notice to submit proof of the new TPL.

II. If the enrollee does not submit proof of TPL within 60 days of the date of the notice, the enrollee will be sent a questionnaire to determine if the enrollee’s circumstances have changed since the last review that would result in eligibility for other categories of TennCare Medicaid. The questionnaire must be returned within twenty (20) days from the date of the questionnaire.

III. If the enrollee does not timely return the questionnaire or if the answers provided on the questionnaire do not result in enrollment in another category of eligibility, the enrollee will be sent a notice of termination informing the enrollee that Katie Beckett Group Part A benefits will be terminated twenty (20) days from the date of the termination notice if proof of the new TPL is not submitted prior to the date of termination.

(VII) A Katie Beckett Group Part A enrollee who did not have TPL at the time of application and is disenrolled from Katie Beckett Group Part A for failing to timely submit proof of TPL will be eligible to transition to Medicaid Diversion Group Part B if a Medicaid Diversion Group

Part B slot is available.

(VIII) Katie Beckett Group Part A Hardship Exception for Assistance with Premium Payments.

I. If an eligible child applying for Katie Beckett Group Part A does not have TPL at the time of enrollment, the child may request assistance with premium payments through a hardship exception if the following hardship exception requirements are met:

A. The cost of the eligible child’s portion of all available employer-sponsored or private insurance exceeds five percent (5%) of the family’s household income according to MAGI methodology; or B. The child’s household income is less than four hundred percent (400%) of the FPL according to MAGI methodology and neither of the child’s parents have access to employer-sponsored insurance.

II. A hardship exception for assistance with premium payments shall not be available for an eligible child who has TPL at the time of enrollment, even if such coverage is later lost and new TPL coverage must be obtained.

III. Assistance with premium payments is limited to the lesser of the amount by which the child’s portion of the family’s monthly TPL premium exceeds the child’s Katie Beckett Group Part A premium, as detailed below, or the lowest cost silver level child only plan in the highest rating region in Tennessee offered through the Federally Facilitated Marketplace. The amount of TPL premium assistance may be appealed within forty (40) days of the date of the notice.

IV. Assistance with premium payments will begin on the date the hardship exception is approved or on the date the eligible child enrolls in TPL and the initial TPL premium has been paid, whichever is later. The effective date of premium assistance may be appealed within forty (40) days of the date of the hardship exception approval notice.

V. The denial of a request for a hardship exception for assistance with premium payments may be appealed within forty (40) days of the date of the denial notice.

VI. The loss of assistance with premium payments resulting from a change in an enrollee’s TPL may be appealed within forty (40) days of the date of the assistance with premium payments termination notice. If the termination of assistance with premium payments is appealed within twenty (20) days, the assistance with premium payments will continue until the conclusion of the appeal process.

(v) Katie Beckett Group Part A Premiums.

(I) Households with income above one hundred fifty percent (150%) of the FPL according to MAGI methodology will be required to pay a monthly premium through automatic electronic bank drafts. The amount of the premium will be based on a sliding scale. As set out in the table below, the family’s FPL percentage is determined based on their household income and household size according to MAGI methodology, and the amount of the monthly premium for each applicable FPL range is set to the percentage of the income of a household size of two.

Household Income (MAGI)

Premium % of income for a household size of two Monthly Premium > 150% - 250% FPL 1.5% $25 > 250% - 300% FPL 2.5% $75 > 300% - 400% FPL 3% $125 > 400% - 500 % FPL 4% $225 > 500% FPL - No limit 5% $350 + $70 for every 100% above 500% FPL (II) Katie Beckett Group Part A premiums, as described in the above table, will be reduced by the costs associated with the eligible child’s portion of the family’s monthly TPL premiums. If the total amount of the eligible child’s portion of the family’s TPL premium is more than the eligible child’s monthly Katie Beckett Group Part A premium, the child will not have Katie Beckett Group Part A premium obligations.

See Subpart (iv) above for calculating the eligible child’s portion of the family’s monthly TPL premium payment.

(III) Initial enrollment shall not occur until the first month’s Katie Beckett Group Part A premium has been paid in full and electronic automatic bank draft arrangements have been made for subsequent months unless the eligible child is not required to pay the monthly Katie Beckett Group Part A premium.

(IV) If the first month’s Katie Beckett Group Part A premium is not paid in full within sixty (60) days of the date of the notice detailing the amount of the monthly premium obligation, the application will be denied.

I. If a timely appeal is filed, the Katie Beckett Group Part A program slot will be held until the conclusion of the appeal process.

II. If a timely appeal is not filed, the Katie Beckett Group Part A program slot will be released and a new application for Katie Beckett Group Part A will be required.

(V) Continuous enrollment in Katie Beckett Group Part A is contingent on timely payments of the monthly Katie Beckett Group Part A premium unless the eligible child does not have Katie Beckett Group

Part A premium obligations.

(VI) If a Katie Beckett Group Part A enrollee is required to pay Katie Beckett Group Part A premiums after previously not having Katie Beckett Group Part A premium obligations, the enrollee will have sixty (60) days from the date of the notice detailing the amount of the monthly premium obligation to pay the first month’s Katie Beckett Group Part A premium in full and set up electronic automatic bank draft arrangements.

(VII) Once enrolled, if the Katie Beckett Group Part A premium payment is more than thirty (30) days in arrears, enrollees will be sent a notice of suspension informing the enrollee that Katie Beckett Group Part A benefits will be suspended twenty (20) days from the date of the suspension notice if premium payments are not paid in full prior to the date of suspension. If suspended, Katie Beckett Group Part A program benefits will return to active status retroactive to the date they were suspended if:

I. Past due premium payments are paid in full while the enrollee is in suspended status; or II. Benefits were suspended as the result of administrative error.

(VIII) If any part of a Katie Beckett Group Part A premium payment is more than sixty (60) days in arrears, enrollees will be sent a notice of termination informing the enrollee that Katie Beckett Group Part A benefits will be terminated twenty (20) days from the date of the termination notice if past due Katie Beckett Group Part A premium payments are not paid in full prior to the date of termination. If the outstanding premium amounts owed are paid in full at any point prior to the effective date of termination, program benefits will return to active status retroactive to the date they were suspended. A Katie Beckett Group Part A enrollee who is terminated from Katie Beckett Group Part A for failing to pay the monthly Katie Beckett Group Part A premium will be eligible to transition to Medicaid Diversion Group

Part B if a Medicaid Diversion Group Part B slot is available.

(IX) Once enrolled in Katie Beckett Group Part A, increases in the household income of an enrollee for Katie Beckett Group Part A premium purposes will not need to be reported until the annual renewal process in accordance with Rule .09. Enrollee income changes must be reported within ten (10) days of the occurrence in accordance with Rule .03(2)(a).

(X) If a Katie Beckett Group Part A enrollee reports a change in the household income that results in a change in the Katie Beckett Group Part A premium, the enrollee will receive a notice informing the enrollee of the new Katie Beckett Group Part A premium payment amount.

(vi) Eligibility and enrollment into Katie Beckett Group Part A is contingent upon a slot being available in accordance with Chapter 1200-13-01.

4. Eligibility will be based upon a household size of one (1).

5. Income Limitations: Income shall not exceed three hundred percent (300%) of the SSI Federal Benefit Rate for an individual. Parent-to-child deeming rules shall not apply.

6. Resource Limitations: Resources shall not exceed two thousand dollars ($2,000.00) for an individual. Parent-to-child deeming rules shall not apply.

7. Effective Date of Eligibility: Eligibility begins on the date that the first month’s Katie Beckett Group Part A premium is paid in full and electronic automatic bank draft arrangements have been made for subsequent months. If an eligible child is not required to pay Katie Beckett Group Part A premiums, eligibility begins on the date the individual is determined to be eligible.

8. Upon turning age eighteen (18), individuals enrolled in Katie Beckett Group Part A may remain enrolled in Katie Beckett Group Part A for up to twelve (12) months following the enrollee’s eighteenth (18th) birthday if an application for SSI is pending or in appeal status.

9. Other: An individual in this category may receive Continuous Eligibility if the individual is a child under age nineteen (19) or a Pregnant Woman. See Rule .09.

(b) Medicaid Diversion Group Part B.

1. Definition: See Rule .02.

2. Technical Requirements: See Rule .04.

3. Special Eligibility Requirements:

(i) Individual must be younger than eighteen (18) years of age.

(ii) Individual must meet the medical level of care requirements according to

Rule 1200-13-01-.11.

(iii) Individual must not be financially eligible for any other category of TennCare.

(iv) Eligibility and enrollment into Medicaid Diversion Group Part B is contingent upon a slot being available in accordance with Chapter 1200- 13-01.

4. Eligibility will be based upon a household size of one (1).

5. Income Limitations: Income shall not exceed three hundred percent (300%) of the SSI Federal Benefit Rate for an individual. Parent-to-child deeming rules shall not apply.

6. Resource Limitations: Resources shall not exceed two thousand dollars ($2,000.00) for an individual. Parent-to-child deeming rules shall not apply.

7. Effective Date of Eligibility: Eligibility begins on the Application File Date, according to Rule .05, or the date all eligibility requirements are met, whichever is later.

8. Medicaid Diversion Group Part B will be administered by the Department of Intellectual and Developmental Disabilities (DIDD).

(c) Continued Eligibility Group Part C.

1. Definition: See Rule .02 2. Technical Requirements: See Rule .04 3. Special Eligibility Requirements:

(i) Individual who was validly enrolled in TennCare Medicaid and is losing eligibility for TennCare Medicaid and who is younger than eighteen (18) years of age.

(ii) Individual must meet the medical level of care requirements according to

Rule 1200-13-01-.11.

(iii) Individual would be eligible to enroll in Katie Beckett Group Part A if a Katie Beckett Group Part A slot was available.

(iv) No Katie Beckett Group Part A slots are available.

4. Eligibility will be based upon a household size of one (1).

5. Income Limitations: Income shall not exceed three hundred percent (300%) of the SSI Federal Benefit Rate for an individual. Parent-to-child deeming rules shall not apply.

6. Resource Limitations: Resources shall not exceed $2,000.00 for an individual.

Parent-to-child deeming rules shall not apply.

7. If an enrollee is terminated from the Continued Eligibility Group Part C, the individual will have to reapply for Katie Beckett Group Part A with enrollment in Katie Beckett Group Part A being limited to slot availability.

8. If an enrollee is terminated from the Continued Eligibility Group Part C because of an administrative error, the individual will be eligible to re-enroll in the Continued Eligibility Group Part C.

9. Upon turning age eighteen (18), Continued Eligibility Group Part C enrollees may remain enrolled in the Continued Eligibility Group Part C for up to twelve (12) months following the eighteenth (18th) birthday if an application for SSI is pending or in appeal status.

10. Other: An individual in this category may receive Continuous Eligibility if the individual is a child under age nineteen (19) or a Pregnant Woman. See Rule .09.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-208, 71-5-102, 71-5-105, 71-5-106, 71-5-109, 71-5-110, 71-5- 111, 71-5-112, 71-5-117, 71-5-134, 71-5-147, and 71-5-164; TennCare II/III Section 1115(a) Medicaid Demonstration Waiver Extension; and TennCare III Section 1115(a) Medicaid Demonstration Waiver
• Administrative History: Emergency rule filed June 16, 2016; effective through December 13, 2016. New rules filed September 14, 2016; effective December 13, 2016. Amendments filed May 24, 2019; effective August 22, 2019. Emergency rules filed November 20, 2020; effective through May 19, 2021. Amendments filed February 17, 2021; effective May 18, 2021. Amendments filed May 13, 2022; effective August 11, 2022. Amendments filed August 25, 2025; effective November 23, 2025. Amendments filed January 23, 2026; effective April 23, 2026.

Tenn. Comp. R. & Regs. 1200-13-20-.09 REDETERMINATION AND TERMINATION

(1) Redetermination of eligibility for TennCare Medical Assistance.

(a) Redetermination or renewal is the process of verifying whether an enrollee continues to meet the eligibility requirements of a particular TennCare program.

(b) An enrollee must have eligibility redetermined once every twelve (12) months, and no more frequently than once every twelve (12) months according to 42 C.F.R. § 435.916, absent a waiver from CMS.

(c) Enrollees eligible for TennCare Medicaid as a result of being eligible for SSI benefits shall follow the Redetermination requirements of the SSA. Once SSI benefits are terminated, these enrollees will be reviewed by TennCare for eligibility in all other categories prior to termination.

(d) An enrollee’s TennCare Medical Assistance eligibility shall be redetermined as required by the appropriate category of Medical Assistance as described in this Rule, unless otherwise agreed to by the Single State Agency and CMS. Prior to the termination of TennCare Medical Assistance eligibility, eligibility will be redetermined according to the following process:

1. TennCare will redetermine eligibility prior to the expiration of the enrollee’s current eligibility period.

2. TennCare will complete an ex parte review of eligibility. A renewal packet will be issued when ex parte review does not result in a finding of eligibility. TennCare Medical Assistance enrollees will be given forty (40) days, inclusive of mail time, from the date the notice is mailed to return the completed renewal packet to TennCare. The mail date will be the date on the notice. The enrollee may provide information by the same modes permitted for filing an application specified at

Rule .05, or as otherwise agreed to by the Single State Agency and CMS.

3. TennCare will provide assistance with submitting a renewal form according to

Rule .05.

4. TennCare will use the individual’s responses in the renewal packet to complete redetermination. TennCare will request additional verification, as needed, to complete redetermination. The request for additional information or verification will provide the enrollee with twenty (20) days, inclusive of mail time, to submit the requested information.

5. If TennCare is able to renew eligibility in a TennCare Medical Assistance category based on information known to TennCare, or information provided in the renewal packet, and requested verifications, the agency will notify the enrollee and enroll him in the appropriate category.

6. Enrollees who respond to the renewal form within the forty (40) day period shall retain their eligibility (subject to any changes in covered services generally applicable to enrollees in their Medical Assistance category) while TennCare reviews their eligibility for open Medical Assistance categories. If TennCare determines that the enrollee is eligible for a TennCare Medical Assistance category, the agency will notify the individual as follows:

(i) If TennCare determines that the enrollee is eligible for an open TennCare Medicaid category, the agency will notify the enrollee and he will be enrolled in the appropriate category. If the individual is enrolled in a different TennCare Medicaid category of eligibility, the previous category will be closed with no further notice to the enrollee.

(ii) If TennCare determines that the enrollee is eligible for a TennCare Standard category, the agency will notify the enrollee and he will be enrolled in the appropriate category. Notification of enrollment into TennCare Standard will include notification of the denial of TennCare Medicaid eligibility.

(iii) If TennCare determines that the enrollee is eligible for CoverKids, the agency will notify the enrollee and he will be enrolled into the CoverKids program. Notification of enrollment into CoverKids will include the denial of TennCare Medicaid eligibility.

(iv) If TennCare determines that the enrollee is eligible for MSP, the agency will notify the enrollee and he will be enrolled into the appropriate MSP. If an individual is determined eligible for MSP and ineligible for TennCare Medicaid, notification of enrollment in an MSP will include notification of the denial of TennCare Medicaid. Notification of enrollment into SLMB or QI1 will include notification of the denial of QMB eligibility.

7. If an enrollee provides some but not all of the necessary information to TennCare to determine his eligibility for open Medical Assistance categories during the forty (40) day period following the mailing of the renewal packet, TennCare will request additional information or verification. The request for additional information or verification will provide the enrollee with twenty (20) days, inclusive of mail time, to submit the requested information.

8. Enrollees who do not respond to the renewal packet within forty (40) days, or enrollees who do not respond to a request for additional information or verification within twenty (20) days from the request for additional information or verification, will be sent a notice of termination informing the enrollee that coverage will be terminated twenty (20) days from the date of the termination notice.

9. If TennCare makes a determination that the enrollee is not eligible for any open Medical Assistance categories, the enrollee will be sent a notice of termination informing the enrollee that coverage will be terminated twenty (20) days from the date of the termination notice.

10. Enrollees who respond to the additional information or verification request after the requisite time period specified in those notices but before the date of termination shall retain their eligibility while TennCare reviews their eligibility.

11. Individuals may provide the renewal packet, or additional information and verifications specified in the request for additional information and verification notice, up to ninety (90) days after termination of eligibility. Renewal packets or additional information received during the ninety (90) day reconsideration period will be processed without requiring a new application. Individuals terminated for failure to respond and subsequently determined eligible during the ninety (90) day reconsideration period will have eligibility reinstated as of the date of termination, except for those determined eligible for QMB (whose effective date will be the first day of the month after the QMB approval).

(e) An individual who has been determined eligible for TennCare Medicaid under the rules for BCC shall annually recertify eligibility in terms of continuation of active treatment, address, and access to health insurance. If the individual is found to no longer be eligible through this review, the individual will be reviewed using the redetermination process set forth in this paragraph.

(f) An individual who has been determined eligible for TennCare under the rules for Katie Beckett Group Part A, Medicaid Diversion Group Part B, or Continued Eligibility Group

Part C will be required to verify continued eligibility annually. If the individual is found to no longer be eligible through this review, the individual will be reviewed using the redetermination process set forth in this paragraph.

(g) Consistent with 42 C.F.R. § 435.919, TennCare must promptly redetermine eligibility between regular renewals of eligibility whenever it receives information about a change in an enrollee’s circumstances that may affect eligibility.

(h) Continuous Eligibility for Children Under Age 19. Consistent with 42 C.F.R. § 435.926, Continuous Eligibility is provided to children under the age of 19 enrolled in TennCare Medicaid, in TennCare Standard, or in CoverKids, regardless of changes in circumstance, except for children enrolled in the following: a Medically Needy category, the IE Foster Care category, Transitional Medicaid, Extended Medicaid, or Katie Beckett Medicaid Diversion Group Part B. The Continuous Eligibility period begins on the effective date of the child’s most recent determination or Redetermination of eligibility and ends the last day of the month that the child turns age nineteen (19) or the end of a twelve (12) month period of Continuous Eligibility, whichever is earlier. The following are exceptions to Continuous Eligibility for children under the age nineteen (19):

1. The enrollee dies.

2. The enrollee or the enrollee’s representative voluntarily requests a termination of the child’s coverage.

3. The enrollee ceases to be a Tennessee resident.

4. TennCare determines that eligibility was determined incorrectly at the most recent determination or Redetermination of eligibility because of agency error or fraud, abuse or perjury attributed to the enrollee or the enrollee’s representative.

5. The enrollee is age nineteen (19) or over.

(i) Continuous Eligibility for Hospitalized Children. Consistent with 42 C.F.R. § 435.172, children enrolled in the MAGI Infants and Children Under Age 19 category will be provided Continuous Eligibility until the end of an inpatient stay for which inpatient services are covered by TennCare Medicaid if the child is receiving such inpatient services on the date the child turns age nineteen (19), and the child would have remained eligible for this category but for turning age nineteen (19).

(j) Continuous Eligibility for Pregnant Women.

1. Continuous Eligibility for a Sixty (60) Day Postpartum Period.

(i) Women enrolled in CoverKids Pregnant Women while pregnant will be provided Continuous Eligibility through a sixty (60) day postpartum period, beginning on the day pregnancy ends, regardless of changes in circumstance and regardless of how pregnancy ends, even if it has been more than 12 months since the enrollee’s last determination of eligibility or Redetermination of eligibility.

(ii) Women who apply and are approved for TennCare Medicaid with an Effective Date of eligibility that is after the end of their pregnancy will be provided Continuous Eligibility through a sixty (60) day postpartum period, beginning on the day pregnancy ends, regardless of changes in circumstance and regardless of how pregnancy ends, even if it has been more than twelve (12) months since the enrollee’s last determination of eligibility or Redetermination of eligibility.

2. Continuous Eligibility for a Twelve (12) Month Postpartum Period. Women enrolled in TennCare Medicaid, TennCare Standard, or CoverKids Children while pregnant (including during a period of retroactive eligibility) will be provided Continuous Eligibility through a twelve (12) month postpartum period, beginning on the day pregnancy ends, regardless of changes in circumstance and regardless of how pregnancy ends, even if it has been more than twelve (12) months since the enrollee’s last determination of eligibility or Redetermination of eligibility. An enrollee must remain in the same category of medical assistance she has on the day her pregnancy ends to remain eligible for Continuous Eligibility.

3. The following are exceptions to Continuous Eligibility for Pregnant Women:

(i) The enrollee dies.

(ii) The enrollee or the enrollee’s representative voluntarily requests termination of coverage.

(iii) The enrollee ceases to be a Tennessee resident.

(iv) TennCare determines that eligibility was determined incorrectly at the most recent determination or redetermination of eligibility because of agency error or fraud, abuse or perjury attributed to the enrollee or the enrollee’s representative.

(k) An individual in a presumptive eligibility period will not receive Continuous Eligibility.

(l) Individuals enrolled in the Institutional Medicaid category, an ECF CHOICES category, or the Katie Beckett Group Part A category may receive Continuous Eligibility for their Medicaid coverage; however, their LTSS-related services may end based on changes in circumstance.

(2) Termination of TennCare Medical Assistance.

(a) TennCare will send termination notices to all enrollees being terminated pursuant to state and federal law who are not determined to be eligible for any open category of Medical Assistance or who receive a change in benefits or services.

(b) Termination notices will be sent twenty (20) days in advance of the date the coverage will be terminated. When an enrollee requests termination, coverage will be terminated two (2) days after the request for termination is received, and a termination notice will be sent on the date coverage is terminated. Termination notices will be sent to the TennCare address of record.

(c) Termination notices will provide enrollees forty (40) days from the date of the notice to appeal the termination and will inform enrollees how they may request a hearing.

Appeals will be processed by TennCare in compliance with Chapter 1200-13-19.

(d) TennCare will reconsider eligibility after termination in compliance with 42 C.F.R. § 435.916(a)(3)(iii).

(e) Enrollees with a physical health problem, mental health problem, learning problem or a disability will be given the opportunity to request additional assistance for their appeal.

Enrollees with limited English proficiency will have the opportunity to request translation assistance for their appeal.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-208, 71-5-102, 71-5-105, 71-5-106, 71-5-109, 71-5-110, 71-5- 111, 71-5-112, 71-5-117, 71-5-134, and 71-5-164; TennCare II/III Section 1115(a) Medicaid Demonstration Waiver Extension; and TennCare III Section 1115(a) Medicaid Demonstration Waiver.
• Administrative History: Emergency rule filed June 16, 2016; effective through December 13, 2016. New rules filed September 14, 2016; effective December 13, 2016. Amendment filed February 12, 2018; effective May 13, 2018. Amendments filed May 24, 2019; effective August 22, 2019. Emergency rules filed November 20, 2020; effective through May 19, 2021. Amendments filed February 17, 2021; effective May 18, 2021. Amendments filed May 13, 2022; effective August 11, 2022. Amendments filed August 25, 2025; effective November 23, 2025.

Chapter 1200-13-21 CoverKids

Tenn. Comp. R. & Regs. 1200-13-21-.01 SCOPE AND AUTHORITY

(1) The CoverKids program was created by the CoverKids Act of 2006, T.C.A. §§ 71-3-1101, et seq., and placed under the authority of the Tennessee Department of Finance and Administration (“Department”).

(2) The Department is authorized to establish, administer and monitor the program, including contracting for the provision of services and adopting rules for governing the program.

(3) The Commissioner of the Tennessee Department of Finance and Administration placed the CoverKids Program into the Division of Health Care Finance & Administration under the oversight of the Deputy Commissioner/Director of TennCare on March 31, 2011, for the purposes of coordination of resources and to achieve greater effectiveness and efficiencies.

The Division was renamed the Division of TennCare effective August 7, 2017.

(4) The purpose of the CoverKids program is to provide health care coverage for uninsured children who are not eligible for TennCare coverage.

(5) The CoverKids program is a federal program, the “State Child Health Plan Under Title XXI of the Social Security Act State Children’s Health Insurance Program” and is distinct and separate from the Title XIX TennCare program.

History

• Authority: T.C.A. §§ 4-5-202, 71-3-1103 through 71-3-1108, and 71-3-1110 and the Tennessee Title XXI Children’s Health Insurance Program State Plan.
• Administrative History: Original rules filed November 28, 2018; effective February 26, 2018.

Tenn. Comp. R. & Regs. 1200-13-21-.02 DEFINITIONS

(1) Covered services. Benefits and services listed in this Chapter and provided for enrollees in the CoverKids program by an MCO, DBM, PPA or other entity under contract with the Division of TennCare.

(2) CoverKids. The program created by T.C.A. §§ 71-3-1101, et seq., its authorized employees and agents, as the context of this Chapter requires, and administered through the Division of TennCare, which provides health coverage for children under nineteen (19) years of age and pregnant women, who do not have health insurance and do not qualify for TennCare.

(3) CoverKids network. A group of health care providers that have entered into contracts with an MCO, DBM, PPA or other entity under contract with the Division of TennCare to furnish covered services to CoverKids enrollees.

(4) CoverKids Pregnant Women. The part of the CoverKids program that provides coverage for the unborn children of pregnant women with no source of health coverage who meet the CoverKids eligibility requirements.

(5) CoverKids provider. A health care provider who accepts as payment in full for furnishing benefits to a CoverKids enrollee the amounts paid pursuant to an approved agreement with a TennCare contractor. Such payment may include copayments from the enrollee or the enrollee’s responsible party. A CoverKids provider, including an Out-of-State Emergency Provider as defined in Rule 1200-13-13-.01, must be enrolled with TennCare and must abide by all CoverKids rules and regulations, including requirements regarding provider billing of patients as found in Rule .10. CoverKids providers must be appropriately licensed for the services they deliver and must not be providers who have been excluded from participation in the federal Medicare, Medicaid or CHIP programs.

(6) Days. Calendar days, not business days.

(7) Dental Benefits Manager (DBM). The entity responsible for the administrative services associated with providing covered dental services, preventive, routine and orthodontic, to CoverKids enrollees.

(8) Emergency services. Includes emergency medical, emergency mental health and substance abuse emergency treatment services, furnished by a provider qualified to furnish the services, needed to evaluate, treat, or stabilize an emergency medical condition manifested by the sudden and unexpected onset of acute symptoms of sufficient severity, including severe pain, that a prudent layperson with an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in:

(a) Placing the person’s (or with respect to a pregnant woman, her unborn child’s) health in serious jeopardy;

(b) Serious impairment to bodily functions; or (c) Serious dysfunction of any bodily organ or part.

(9) Managed Care Organization (MCO). An appropriately licensed Health Maintenance Organization (HMO) approved by the Division of TennCare as capable of providing medical, behavioral, and long-term care services which has signed a Contractor Risk Agreement, as defined in 1200-13-13-.01, with the Division of TennCare and operates a provider network to provide covered services to CoverKids enrollees.

(10) Medically necessary. A medical item or service which meets all the following criteria:

(a) Recommended by a licensed physician who is treating the enrollee or other licensed healthcare provider practicing within his scope of licensure who is treating the enrollee;

(b) Required in order to diagnose or treat an enrollee’s medical condition;

(c) Safe and effective;

(d) The least costly alternative course of diagnosis or treatment that is adequate for the medical condition of the enrollee; and (e) Not experimental or investigational.

(11) Non-CoverKids provider. A health care provider of non-emergency services that does not participate in the network of a TennCare-contracted MCO, DBM, or PPA or other entity contracted to administer CoverKids benefits.

(12) Parent. A natural or adoptive father or mother of a minor child; or, a guardian as defined by T.C.A. § 34-1-101, subject to court orders entered or recognized by the courts of the state of Tennessee.

(13) Pharmacy Plan Administrator (PPA). The entity responsible for the administrative services associated with providing pharmaceutical related covered services to CoverKids enrollees.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-204, 71-3-1106, and 71-3-1110; 42 U.S.C. §§ 1397aa, et seq.; and the Tennessee Title XXI Children’s Health Insurance Program State Plan.
• Administrative History: Original rules filed November 28, 2018; effective February 26, 2018. Amendments filed January 11, 2021; effective April 11, 2021.

Tenn. Comp. R. & Regs. 1200-13-21-.03 ELIGIBILITY

Financial and Technical Eligibility Requirements. See Chapter 1200-13- 20.

History

• Authority: T.C.A. §§ 4-5-202, 71-3-1106, and 71-3-1110 and the Tennessee Title XXI Children’s Health Insurance Program State Plan.
• Administrative History: Original rules filed November 28, 2018; effective February 26, 2018.

Tenn. Comp. R. & Regs. 1200-13-21-.04 filed January 11, 2021; effective April 11, 2021. Amendments filed January 11, 2021; effective April 11, 2021. Emergency rules filed August 7, 2024; effective through February 3, 2025.

Amendments filed November 4, 2024; effective February 2, 2025.

Tenn. Comp. R. & Regs. 1200-13-21-.05 BENEFITS

(1) The following benefits are covered by the CoverKids program for children under age 19 as medically necessary, subject to the limitations stated:

(a) Ambulance services, air and ground.

(b) Care coordination services.

(c) Case management services.

(d) Chiropractic care. Maintenance visits not covered when no additional progress is apparent or expected to occur.

(e) Clinic services and other ambulatory health care services.

(f) Dental benefits:

1. Dental services. Limited to a $1,000 annual benefit maximum per enrollee.

2. Orthodontic services. Limited to a $1,250 lifetime benefit maximum per enrollee.

Covered only after a 12-month waiting period.

(g) Disposable medical supplies.

(h) Durable medical equipment and other medically-related or remedial devices:

1. Limited to the most basic equipment that will provide the needed care.

2. Hearing aids are limited to one per ear per calendar year up to age 5, and limited to one per ear every two years thereafter.

(i) Emergency care.

(j) Home health services. Prior approval required. Limited to 125 visits per enrollee per calendar year.

(k) Hospice care.

(l) Inpatient hospital services, including rehabilitation hospital services.

(m) Inpatient mental health and substance abuse services.

(n) Laboratory and radiological services.

(o) Outpatient mental health and substance abuse services.

(p) Outpatient services.

(q) Physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders. Limited to 52 visits per calendar year per type of therapy.

(r) Physician services.

(s) Prenatal care and prepregnancy family services and supplies.

(t) Prescription drugs.

(u) Routine health assessments and immunizations.

(v) Skilled Nursing Facility services. Limited to 100 days per calendar year following an approved hospitalization.

(w) Surgical services.

(x) Vision benefits:

1. Annual vision exam including refractive exam and glaucoma screening.

2. Prescription eyeglass lenses. Limited to one pair per calendar year. $85 maximum benefit per pair.

3. Eyeglass frames. Coverage for replacement frames limited to once every two calendar years. $100 maximum benefit per pair.

4. Prescription contact lenses in lieu of eyeglasses. Limited to one pair per calendar year. $150 maximum benefit per pair.

(2) Mothers of eligible unborn children who are over age 19 receive all benefits listed in Paragraph (1), subject to the same limitations and as medically necessary, except chiropractic services, routine dental services, vision services, and hearing aids and cochlear implants are not covered for these enrollees.

(3) Infant Diapers, as defined in Rule 1200-13-13-.01, are covered for enrollees under age 2, as described in Rule 1200-13-13-.04.

(4) All services covered by CoverKids must be medically necessary.

(5) An MCO or DBM may provide non-covered items or services as cost effective alternatives to covered items or services. Such cost effective alternative services may be provided because they are either (1) alternatives to covered CoverKids services that, in the judgment of the MCO or DBM, are cost-effective or (2) preventative in nature and offered to avoid the development of conditions that, in the judgment of the MCO or DBM, would require more costly treatment in the future. Cost effective alternative services are not covered services and are provided only at the discretion of the MCO or DBM, subject to approval by the Division of TennCare.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-204, 4-5-208, 71-3-1104, 71-3-1106, and 71-3-1110; 42 U.S.C. §§ 1397aa, et seq.; and the Tennessee Title XXI Children’s Health Insurance Program State Plan.
• Administrative History: Original rules filed November 28, 2018; effective February 26, 2018. Rule was originally numbered 1200-13-21-.04 but was renumbered 1200-13-21-.05 with the introduction of new rule

Tenn. Comp. R. & Regs. 1200-13-21-.06 EXCLUSIONS

(1) The services and items set out in the TennCare Medicaid Exclusions Rule 1200-13-13-.10(1) and (3)(b) are excluded from coverage by the CoverKids program.

(2) In addition to the services and items excluded by Paragraph (1), the following services, products and supplies are also excluded from coverage by the CoverKids program:

(a) Audiological therapy or training (b) Beds and bedding equipment as follows:

1. Powered air flotation beds, air fluidized beds (including Clinitron beds), water pressure mattress, or gel mattress 2. Bead beds, or similar devices 3. Bed boards 4. Bedding and bed casings 5. Ortho-prone beds 6. Oscillating beds 7. Springbase beds 8. Vail beds, or similar beds (c) Biofeedback (d) Cushions, pads, and mattresses as follows:

2. Aquamatic K Pads 2. Elbow protectors 3. Heat and massage foam cushion pads 4. Heating pads 5. Heel protectors 6. Lamb’s wool pads 7. Steam packs (e) Diagnostic tests conducted solely for the purpose of evaluating the need for a service which is excluded from coverage under these rules (f) Ear plugs (g) Floor standers, meaning stationary devices not attached to a wheelchair base and not built into the operating system of a power wheelchair that are designed to hold in an upright position an enrollee who uses a wheelchair and who has limited or no ability to stand on his own (h) Food supplements and substitutes including formulas (i) Humidifiers (central or room) and dehumidifiers (j) Medical supplies, over-the-counter, as follows:

3. Alcohol, rubbing 2. Band-aids 3. Cotton balls 4. Eyewash 5. Peroxide 6. Q-tips or cotton swabs (k) Nutritional supplements and vitamins (l) Purchase, repair, or replacement of materials or equipment when the reason for the purchase, repair, or replacement is the result of enrollee abuse (m) Purchase, repair, or replacement of materials or equipment that has been stolen or destroyed except when the following documentation is provided:

4. Explanation of continuing medical necessity for the item, and 2. Explanation that the item was stolen or destroyed, and 3. Copy of police, fire department, or insurance report if applicable (n) Radial keratotomy (o) Reimbursement to a provider or enrollee for the replacement of a rented durable medical equipment (DME), as defined in 1200-13-13-.01, item that is stolen or destroyed (p) Repair of DME items not covered by CoverKids (q) Repair of DME items covered under the provider’s or manufacturer’s warranty (r) Repair of a rented DME item (s) Standing tables

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 71-3-1106, and 71-3-1110; 42 U.S.C. §§ 1397aa, et seq.; and the Tennessee Title XXI Children’s Health Insurance Program State Plan.
• Administrative History: New rule filed January 11, 2021; effective April 11, 2021.

Tenn. Comp. R. & Regs. 1200-13-21-.07 COST SHARING

(1) There are no premiums or deductibles required for participation in CoverKids.

(2) Copays.

(a) The following services are exempt from copays:

1. Ambulance services.

2. Emergency services.

3. Lab and x-ray services.

4. Routine health assessments (well-child visits) and immunizations given under American Academy of Pediatrics guidelines.

(b) The following copays are required, based on the enrollee’s household income:

Service Copay When Household Income Is Less than 200% FPL Copay When Household Income Is Between 200% FPL and 250% FPL MEDICAL BENEFITS Chiropractic care $5 per visit $15 per visit Emergency room $10 copay per use for non-emergency $50 copay per use for non-emergency Hospital admissions and other inpatient services $5 per admission (waived if readmitted within 48 hours for same episode) $100 per admission (waived if readmitted within 48 hours for same episode)

Inpatient mental health and substance abuse treatment $5 per admission (waived if readmitted within 48 hours for same episode) $100 per admission (waived if readmitted within 48 hours for same episode)

Outpatient mental health and substance abuse treatment $5 per session $15 per session Physical, speech, and occupational therapy $5 per visit $15 per visit Physician office visit $5 per visit (primary care); $5 per visit (specialist) $15 per visit (primary care); $20 per visit (specialist)

Prescription drugs $1 generic; $3 preferred brand; $5 non-preferred brand $5 generic; $20 preferred brand; $40 non-preferred brand Vision services $5 for lenses; $5 for frames (when lenses and frames are ordered at the same time, only one copay is charged) $15 for lenses; $15 for frames (when lenses and frames are ordered at the same time, only one copay is charged)

DENTAL BENEFITS

Dental services $5 per visit No copay for routine preventive oral exam, x-rays, and fluoride application $15 per visit No copay for routine preventive oral exam, x-rays, and fluoride application Orthodontic services $5 per visit $15 per visit (3) An enrollee’s annual cost sharing obligations shall not exceed five percent (5%) of his household’s annual income.

(4) Eligible children who do not pay a required copay remain enrolled in the program. An individual provider may at his discretion refuse service for non-payment of a copay unless a medical emergency exists. The state does not participate in collection action or impose any benefit limitations if enrollees do not pay their copays.

(5) Children receiving hospice services are exempt from all copay requirements.

(6) Pregnant enrollees are exempt from all copay requirements.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-204, 71-3-1106, and 71-3-1110; 42 U.S.C. §§ 1397aa, et seq.; and the Tennessee Title XXI Children’s Health Insurance Program State Plan.
• Administrative History: Original rules filed November 28, 2018; effective February 26, 2018. Rule was originally numbered 1200-13-21-.05 but was renumbered 1200-13-21-.07 with the introduction of new rules 1200- 13-21-.04 and 1200-13-01-.06 filed January 11, 2021; effective April 11, 2021. Amendments filed January 11, 2021; effective April 11, 2021.

Tenn. Comp. R. & Regs. 1200-13-21-.08 DISENROLLMENT

(1) Grounds for Disenrollment from CoverKids. Children enrolled in CoverKids at or below 250% of the FPL are financially eligible for 12 months, except in the following situations which will result in disenrollment from CoverKids coverage prior to the end of the 12 month period:

(a) An enrollee, through an authorized family member, requests disenrollment.

(b) Admission of a CoverKids enrollee into a correctional facility or an institution for mental disease.

(c) A CoverKids enrollee moves from the state.

(d) Death of a CoverKids enrollee.

(e) A CoverKids enrollee is enrolled in TennCare.

(f) A CoverKids enrollee meets a TennCare Medicaid spend-down.

(g) A CoverKids enrollee turns age 19.

(h) A woman 19 or older who was enrolled because of pregnancy is no longer eligible after the last day of the month in which the sixtieth postpartum day occurs.

(i) A CoverKids enrollee is discovered not to have been eligible for CoverKids at the time of enrollment. This includes, but is not limited to, enrollees whose enrollment was obtained by fraud or misrepresentation by an enrollee, parent, guardian, or representative.

(2) Procedures. Disenrollment shall be conducted as set out in Chapter 1200-13-19.

History

• Authority: T.C.A. §§ 4-5-202, 71-3-1106, 71-3-1110, and the Tennessee Title XXI Children’s Health Insurance Program State Plan.
• Administrative History: Original rules filed November 28, 2018; effective February 26, 2018. Rule was originally numbered 1200-13-21-.06 but was renumbered 1200-13-21-.08 with the introduction of new rules 1200-13-21-.04 and 1200-13-01-.06 filed January 11, 2021; effective April 11, 2021.

Tenn. Comp. R. & Regs. 1200-13-21-.09 REVIEW OF COVERKIDS DECISIONS

(1) Eligibility and Enrollment Matters. Administrative review of matters related to eligibility and enrollment shall be conducted as set out in Chapter 1200-13-19.

(2) Adverse Medical and Dental Benefit Determination Matters. A parent or authorized representative of a CoverKids enrollee may request review of a CoverKids action to delay, deny, reduce, suspend, or terminate medical and dental services, or a failure to approve, furnish, or provide payment for medical and dental services in a timely manner, according to

Rule 1200-13-13-.11, except that enrollees shall not be entitled to continuation of benefits pursuant to 42 CFR § 457.1260.

(3) Adverse Pharmacy Benefit Determination Matters. A parent or authorized representative of a CoverKids enrollee may request review of a CoverKids action to delay, deny, reduce, suspend, or terminate pharmacy services, or a failure to approve, furnish, or provide payment for pharmacy services in a timely manner, according to the following provisions:

(a) Notice. Any decision denying or delaying a requested pharmacy service, reducing, suspending or terminating an existing pharmacy service, or failu re to approve, furnish or provide payment for pharmacy services in a timely manner shall be in writing and must contain the reason for the determination, an explanation of review rights and procedures, the standard and expedited time frames for review, the manner of requesting a review, and the circumstances under which existing pharmacy services may continue pending review unless there is question that the existing pharmacy services are harmful.

(b) Pharmacy Plan Administrator (PPA) Review. A parent or authorized representative may commence the review process by submitti ng a written request to the PPA within 30 days of issuance of written notice of the action or, if no notice is provided, from the time the enrollee becomes aware of the action, not to exceed six (6) months from when the action occurred. The PPA will review this request and issue a written decision within 30 days of receipt of this request. Expedited reviews (within 72 hours) will be available for situations in which a benefit determination or a preauthorization denia l has been made prior to services being received and the attending medical professional determines the medical situation to be lif e threatening or would seriously jeopardize the enrollee’s life, physical or mental health, or ability to att ain, maintain or regain maximum function. This determination should be made in legible writing with an original signature.

(c) State Informal Review. After the PPA’s internal review is completed, the parent or authorized representative of an enrollee who disagrees with the decision may request further review by telephone or by submitti ng a letter or form to the Division of TennCare, CoverKids Appeals, which must be received within 8 days of the PPA’s decision. The Appeals Coordinator will review the matter and gather supplemental information from the family, physician, and/or insurer as needed. The Appeals Coordinator will request review by the state’s independent medical consultant and a written decision will be issued within 20 days of rece ipt of the request for further review.

(d) State Review Committee. If the informal review does not grant the relief requested by the parent or authorized representative, the request will be scheduled for review by the CoverKids Review Committee. The Committee will be composed of five members, including Division of TennCare staff and at least one independent licensed medical professional. The members of the Committee will not have been directly involved in the matter under review. The parent or authorized representative will be given the opportunity to review the file, be represented by a representative of the parent’s or authorized representative’s choice, and provide supplemental information. The Committee may allow the parent or authorized representative to appear in person if it finds that scheduling the appearance will not cause delay in the review process.

The Review Committee is not required to provide an in-person hearing or a contested case under the Uniform Administrative Procedures Act. The parent or authorized representative will receive written notification of the final decision stating the reasons for the decision. The decision of the CoverKids Review Committee is the final administrative recourse available to the mem ber.

(e) Time for Reviews. Review of all non-expedited pharmacy services appeals will be completed within 90 days of receipt of the initial request for review by the PPA.

Reviews by both the Appeals Coordinator and the Committee may be expedited (completed within 72 hours at each of the PPA and state levels) for situations in which a benefit determination or a preauthorization denial has been made prior to services being received and the attending medical professional determines the medical situation to be lif e threatening or would seriously jeopardize the enrollee’s life, physical or mental health, or ability to att ain, maintain or regain maximum function.

This determination should be made in legible writing with an original signature.

(4) Scope of Review. CoverKids will not provide a review process for a change in enrollment, eligibility, or coverage under the health benefits package required by a change in the state plan or federal and state law requiring an automatic change that affects all or a group of applic ants or enrollees without regard to their individual circumstances.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 71-3-1106, and 71-3-1110; 42 U.S.C. §§ 1397aa, et seq.; and the Tennessee Title XXI Children’s Health Insurance Program State Plan.
• Administrative History: Original rules filed November 28, 2018; effective February 26, 2018. Rule was originally numbered 1200-13-21- .07 but was renumbered 1200-13-21-.09 with the introduction of new rules 1200-13-21-.04 and 1200-13- 01-.06 filed January 11, 2021; effective April 11, 2021. Amendments filed January 11, 2021; effective April 11, 2021.

Tenn. Comp. R. & Regs. 1200-13-21-.10 PROVIDERS

(1) Payment in full.

(a) All CoverKids providers, as defined in this Chapter, must accept as payment in full for provision of covered services to a CoverKids enrollee, the amount paid by the MCO, DBM, or PPA, plus any copayment required by the CoverKids program to be paid by the individual.

(b) Any non-CoverKids providers who furnish CoverKids covered services by authorization from the MCO, DBM, or PPA must accept as payment in full for provision of covered services to CoverKids enrollees the amounts paid by the MCO, DBM, or PPA plus any copayment required by the CoverKids program to be paid by the individual.

(c) CoverKids will not pay for non-emergency services furnished by non-CoverKids providers unless these services are authorized by the MCO, DBM, or PPA. Any non- CoverKids provider who furnishes CoverKids Program covered non-emergency services to a CoverKids enrollee without authorization from the MCO, DBM, or PPA does so at his own risk. He may not bill the patient for such services except as provided in Paragraph (3).

(2) Non-CoverKids Providers.

(a) When the MCO, DBM, or PPA authorizes a service to be rendered by a non-CoverKids provider, payment to the provider shall be no less than 80% of the lowest rate paid by the MCO, DBM, or PPA to equivalent participating CoverKids network providers for the same service, consistent with the methodology contained in Rule 1200-13-13-.08(2)(a).

(b) Covered medically necessary outpatient emergency services, when provided to CoverKids enrollees by non-CoverKids network hospitals, shall be reimbursed at 74% of the 2006 Medicare rates for the services, consistent with the methodology contained in Rule 1200-13-13-.08(2)(b). Emergency care to enrollees shall not require preauthorization.

(c) Covered medically necessary inpatient hospital admissions required as the result of emergency outpatient services, when provided to CoverKids enrollees by non- CoverKids network hospitals, shall be reimbursed at 57% of the 2008 Medicare DRG rates (excluding Medical Education and Disproportionate Share components) determined according to 42 CFR § 412 for the services, consistent with the methodology contained in Rule 1200-13-13-.08(2)(c). Such an inpatient stay will continue until no longer medically necessary or until the patient can be safely transported to a network hospital, whichever comes first.

(3) Participation in the CoverKids program will be limited to providers who:

(a) Accept, as payment in full, the amounts paid by the MCO, DBM, or PPA, including copays from the enrollee, or the amounts paid in lieu of the MCO, DBM, or PPA by a third party (Medicare, insurance, etc.);

(b) Maintain Tennessee, or the state in which they practice, medical licenses and/or certifications as required by their practice, or licensure by the Tennessee Department of Mental Health and Substance Abuse Services, if appropriate;

(c) Are not under a federal Drug Enforcement Agency (DEA) restriction of their prescribing and/or dispensing certification for scheduled drugs (relative to physicians, osteopaths, dentists and pharmacists);

(d) Agree to maintain and provide access to the Division of TennCare and/or its agent all CoverKids enrollee medical records for ten (10) years from the date of service or upon written authorization from TennCare following an audit, whichever is shorter;

(e) Provide medical assistance at or above recognized standards of practice; and (f) Comply with all contractual terms between the provider and the MCO, DBM, or PPA (as appropriate) and CoverKids policies as outlined in federal and state rules and regulations and CoverKids provider manuals and bulletins.

(g) Failure to comply with any of the above provisions (a) through (f) may subject a provider to the following actions:

1. The provider may be subject to stringent review/audit procedures, which may include clinical evaluation of services and a prepayment requirement for documentation and justification for each claim.

2. The Division of TennCare may withhold or recover payments to an MCO, DBM, or PPA in cases of provider fraud, willful misrepresentation, or flagrant noncompliance with contractual requirements and/or CoverKids policies.

3. The Division of TennCare may refuse to approve or may suspend provider participation with a provider if any person who has an ownership or controlling interest in the provider, or who is an agent or managing employee of the provider, has been convicted of a criminal offense related to that person’s involvement in any program established under Medicare, Medicaid or the US Title XX Services Program.

4. The Division of TennCare may refuse to approve or may suspend provider participation if it determines that the provider did not fully and accurately make any disclosure of any person who has ownership or controlling interest in the provider, or is an agent or managing employee of the provider and has been convicted of a criminal offense related to that person’s involvement in any program under Medicare, Medicaid or the US Title XX Services Program since the inception of these programs.

5. The Division of TennCare shall refuse to approve or shall suspend provider participation if the appropriate State Board of Licensing or Certification fails to license or certify the provider at any time for any reason or suspends or revokes a license or certification.

6. The Division of TennCare shall refuse to approve or shall suspend provider participation upon notification by the US Office of Inspector General Department of Health and Human Services that the provider is not eligible under Medicare, Medicaid, or CHIP for federal financial participation.

7. The Division of TennCare may recover from an MCO, DBM, or PPA any payments made by an enrollee and/or his family for a covered service, in total or in part, except as permitted. If a provider knowingly bills an enrollee and/or his family for a covered service, in total or in part, except as permitted, the Division of TennCare may terminate the provider’s participation in CoverKids.

(4) Solicitations and Referrals (a) MCOs, DBMs, PPAs, and providers shall not solicit CoverKids enrollees by any method offering as enticements other goods and services (free or otherwise) for the opportunity of providing the enrollee with CoverKids-covered services that are not medically necessary and/or that overutilize the CoverKids program.

(b) An MCO, DBM, or PPA may request a waiver from this restriction in writing to the Division of TennCare. TennCare shall determine the value of a waiver request based upon the medical necessity and need for the solicitation. The MCO, DBM, or PPA may implement the solicitation only upon receipt of a written waiver approval from TennCare. This waiver is not transferable and may be canceled by TennCare upon written notice.

(c) CoverKids payments for services related to a non-waivered solicitation enticement shall be considered by the Division of TennCare as a non-covered service and recouped.

Neither the MCO, DBM, PPA nor the provider may bill the enrollee for non-covered services recouped under this authority.

(d) A provider shall not offer or receive remuneration in any form related to the volume or value of referrals made or received from or to another provider.

(5) Providers may seek payment from a CoverKids enrollee only under the following circumstances. These circumstances include situations where the enrollee may choose to seek a specific covered service from a non-CoverKids provider.

(a) If the services are not covered by the CoverKids program and, prior to providing the services, the provider informed the enrollee that the services were not covered.

(b) If the services are not covered because they are in excess of an enrollee’s benefit limit and one of the following circumstances applies:

1. The provider has information in her own records to support the fact that the enrollee has reached his benefit limit for the particular service being requested and, prior to providing the service, informs the enrollee that the service is not covered and will not be paid for by CoverKids. This information may include:

(i) A previous written denial of a claim on the basis that the service was in excess of the enrollee’s benefit limit for a service within the same benefit category as the service being requested, if the time period applicable to the benefit limit is still in effect;

(ii) That the provider had personally provided services to the enrollee in excess of his benefit limit within the same benefit category as the service being requested, if the time period applicable to that benefit period is still in effect; or (iii) The enrollee’s MCO, DBM, or PPA has provided confirmation to the provider that the enrollee has reached his benefit limit for the applicable service.

2. The provider submits a claim for service to the MCO, DBM, or PPA and receives a written denial of that claim on the basis that the service exceeds the enrollee’s benefit limit. After informing the enrollee and within the remainder of the period applicable to that benefit limit, the provider may bill the enrollee for services within that same exhausted benefit category without having to submit claims for those subsequent services for repeated MCO, DBM, or PPA denial. If the provider informed the enrollee prior to providing the service for which the claim was denied that the service would exceed the enrollee’s benefit limit and would not be paid for by CoverKids, the provider may bill the enrollee for that service.

3. The provider had previously taken the steps in Parts 1. or 2. above and determined that the enrollee had reached his benefit limit for the particular service being requested, if the time period applicable to the benefit limit is still in effect, and informs the enrollee, prior to providing the service, that the service is not covered and will not be paid for by CoverKids.

(c) If the services are covered only with prior authorization and prior authorization has been requested but denied, or is requested and a specified lesser level of care is approved, and the provider has given prior notice to the enrollee that the services are not covered, the enrollee may elect to receive those services for which prior authorization has been denied or which exceed the authorized level of care and be billed by the provider for such services.

(6) Providers may not seek payment from a CoverKids enrollee under the following conditions:

(a) The provider knew or should have known about the patient’s CoverKids enrollment prior to providing services.

(b) The claim submitted to the MCO, DBM, or PPA for payment was denied due to provider billing error or a CoverKids claim processing error.

(c) The provider accepted CoverKids assignment on a claim and it is determined that another payer paid an amount equal to or greater than the CoverKids allowable amount.

(d) The provider failed to comply with CoverKids policies and procedures or provided a service which lacks medical necessity or justification.

(e) The provider failed to submit or resubmit claims for payment within the time periods required by the MCO, DBM, PPA, or CoverKids.

(f) The provider failed to inform the enrollee prior to providing a service not covered by CoverKids that the service was not covered and the enrollee may be responsible for the cost of the service. Services which are non-covered by virtue of exceeding limitations are exempt from this requirement if the provider has complied with Paragraph (3) above.

(g) The enrollee failed to keep a scheduled appointment(s).

(7) Providers may seek payment from a person whose CoverKids eligibility is pending at the time services are provided if the provider informs the person that CoverKids assignment will not be accepted whether or not eligibility is established retroactively.

(8) Providers may seek payment from a person whose CoverKids eligibility is pending at the time services are provided. Providers may bill such persons at the provider’s usual and customary rate for the services rendered. However, all monies collected for CoverKids-covered services rendered during a period of CoverKids eligibility must be refunded when a claim is submitted to CoverKids if the provider agreed to accept CoverKids assignment once retroactive CoverKids eligibility was established.

(9) Providers of inpatient hospital services, outpatient hospital services, skilled nursing facility services, independent laboratory and x-ray services, hospice services, and home health agencies must be approved for Title XVIII Medicare in order to be certified as providers under the CoverKids program; in the case of hospitals, the hospital must meet state licensure requirements and be approved by the Division of TennCare as an acute care hospital as of the date of enrollment in CoverKids. Children’s hospitals and state mental hospitals may participate in CoverKids without having been Medicare approved; however, the hospital must be approved by the Joint Commission for Accreditation of Health Care Organizations as a condition of participation.

(10) Pharmacy providers may not waive pharmacy copayments for CoverKids enrollees as a means of attracting business to their establishments. This does not prohibit a pharmacy from exercising professional judgment in cases where an enrollee may have a temporary or acute need for a prescribed drug, but is unable, at that moment, to pay the required copayment.

(11) All claims must be filed with an MCO, DBM, or PPA and must be submitted in accordance with the requirements and timeframes set forth in the MCO, DBM, or PPA’s contract.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-203, 4-5-204, 71-3-1106, and 71-3-1110; 42 U.S.C. §§ 1397aa, et seq.; and the Tennessee Title XXI Children’s Health Insurance Program State Plan.
• Administrative History: Original rules filed November 28, 2018; effective February 26, 2018. Rule was originally numbered 1200-13-21-.08 but was renumbered 1200-13-21-.10 with the introduction of new rules 1200- 13-21-.04 and 1200-13-01-.06 filed January 11, 2021; effective April 11, 2021. Amendments filed January 11, 2021; effective April 11, 2021.

Chapter 1200-13-22 Supplemental Payment for Rural Health Clinics, Federally Qualified HealthCenters, and Federally Qualified Health Center Look-Alikes

Tenn. Comp. R. & Regs. 1200-13-22-.01 DEFINITIONS

(1) Administrative Costs. Expenses incurred in operating the clinic as a whole that are reasonable and related to the cost of administration and management of the clinic and are not directly associated with furnishing patient care. Administrative Costs include but are not limited to: office personnel salaries; office supplies; legal, accounting, or billing services; consulting services; insurance; telephone; fringe benefits; and payroll taxes.

(2) Allowable Costs. Costs that are reasonable in amount as described in this Chapter, are proper and necessary for the efficient delivery of RHC and FQHC services, and are incurred by a participating RHC or FQHC.

(3) Alternative Payment Methodology (APM). A Supplemental Payment Rate established under

Rule .09 of this Chapter. Alternative Payment Methodology includes APM rates established for an RHC or FQHC under the TennCare State Plan methodology in place prior to the effective date of this Chapter.

(4) Base Year. The first full fiscal year for the facility following a facility’s request to the Comptroller to have a Supplemental Payment Rate established under this Chapter. The data collected during the base year will provide the basis to determine the provider’s final Supplemental Payment Rate.

(5) Covered Services. See definition in Rule 1200-13-13-.01.

(6) Employee. Any individual who, under the common law rules that apply in determining the employer-employee relationship as defined by § 3121(d)(2) of the Internal Revenue Code of 1986 (26 U.S.C. § 3121(d)(2)), is considered to be employed by, or an employee of, an entity.

See 20 C.F.R. § 404.1007 and 26 C.F.R. § 31.3121(d)-1(c) for application of these common law rules.

(7) Federally Qualified Health Center (FQHC). An entity that meets the definition of 42 U.S.C.A. § 1396d(l)(2)(B) of the Social Security Act and has registered with TennCare as an FQHC. For purposes of this Chapter, this definition also includes Federally Qualified Health Center Look- Alikes.

QUALIFIED HEALTH CENTER LOOK-ALIKES

June, 2025 2 (8) Grand Division. See T.C.A. §§ 4-1-201–204.

(9) Interim Rate. A rate established for new facilities after registration with TennCare as an RHC or FQHC and prior to the establishment of a final Supplemental Payment Rate.

(10) Medicaid Cost Report. A cost report established by TennCare for use in the administration of the supplemental payment program contained in this Chapter. The Medicaid Cost Report template will be published on the TennCare website.

(11) Owner. A person, persons, or entities with an enforceable claim or title to the asset or property, and who or which is recognized as having such claim or title by law.

(12) Reimbursable Visit. A Visit (as defined in this Rule) that meets the requirements of Rule .05.

(13) Related Parties. A person, persons, or entities that are related to the Owner, if applicable, either by familial relationship or by a business association other than the RHC or FQHC itself.

(14) Rural Health Clinic (RHC). An entity that meets the definition of 42 U.S.C.A. § 1396d(l)(1)(A) of the Social Security Act and has registered with TennCare as an RHC.

(15) Supplemental Payment Rate. Supplemental Payment Rate shall refer to any of the following:

(a) A payment rate established under Rule .04 of this Chapter;

(b) A cost-based payment rate based on one (1) year of cost data established for an existing RHC or FQHC prior to the effective date of this Chapter; or (c) A payment rate established for an RHC based on the average rate of existing clinics in the same Grand Division with similar caseloads (“average caseload rate”) prior to the effective date of this Chapter.

A Supplemental Payment Rate may also refer to a separate service rate as outlined in Rule .11 of this Chapter.

(16) TennCare. The state governmental Medicaid agency administratively located within the Tennessee Department of Finance and Administration; TennCare includes references to the Division of TennCare, the Bureau of TennCare, and to all employees and subdivisions of the agency.

(17) Visit. A medically necessary (as defined in Rule 1200-13-16-.01) face-to-face medical, dental, or mental health encounter or a qualified preventive health encounter during which one or more qualified covered services are furnished between the patient and one of the following qualifying licensed providers:

(a) Physician;

(b) Nurse Practitioner (NP);

(c) Physician Assistant (PA);

(d) Certified Nurse Midwife (CNM);

(e) Clinical Psychologist (CP);

QUALIFIED HEALTH CENTER LOOK-ALIKES

June, 2025 3 (f) Clinical Social Worker (CSW);

(g) Licensed Professional Counselor (LPC);

(h) Certified Provider for Diabetes Self-Management Training/Medical Nutrition Therapy (DSMT/MNT);

(i) Dentist (DMD, DDS);

(j) Registered Dental Hygienist (RDH);

(k) Optometrist (OD);

(l) Pharmacist (PharmD);

(m) Licensed Marriage and Family Therapist (MFT); or (n) Licensed Mental Health Counselor (MHC).

An encounter involving only a registered nurse or licensed practical nurse is not included in the definition of Visit and does not qualify for supplemental payment under this Chapter. The faceto-face component of this definition may be satisfied via a telehealth encounter as long as the encounter meets the requirements of Rule .05(9) of this Chapter. Qualifying licensed providers must be registered with TennCare for a Visit to be a Reimbursable Visit.

(18) Acronyms. Following is a list of acronyms used in this Chapter:

(a) APM – Alternative Payment Method (b) CMS – Centers for Medicare and Medicaid Services (c) CPT – Current Procedural Terminology (d) FQHC – Federally Qualified Health Center (e) FTE – Full Time Equivalent (f) HRSA – Health Resources and Services Administration (g) MCC – Managed Care Contractor (h) MEI – Medicare Economic Index (i) PHS – Public Health Service (j) RHC – Rural Health Clinic

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-107, 71-5-109, and 71-5-130.
• Administrative History: New rules filed March 6, 2025; effective June 4, 2025.

Tenn. Comp. R. & Regs. 1200-13-22-.02 SUPPLEMENTAL PAYMENT SYSTEM FOR RHCS AND FQHCS

(1) TennCare establishes this Chapter for the management of the prospective payment system established under section 1902(bb) of the Social Security Act and the determination of the QUALIFIED HEALTH CENTER LOOK-ALIKES June, 2025 4 reimbursable per Visit cost for services provided to Medicaid recipients who receive services at an RHC or FQHC.

(2) Only a facility registered with TennCare as an RHC or FQHC may participate in and be reimbursed as a provider under this Chapter. In order to qualify for supplemental payments under this Chapter, facilities must submit to the Comptroller of the Treasury:

(a) Proof of its RHC or FQHC designation;

(b) Proof of its registration as a participating provider with TennCare as an RHC or FQHC;

(c) A request in writing that a Supplemental Payment Rate be established pursuant to Rule .04 of this Chapter.

RHCs and FQHCs participating in this program must at all times continue to meet state and federal requirements for qualification as an RHC or FQHC in order to receive supplemental payments.

(3) The specific items and services covered under the RHC or FQHC program shall be those defined and approved by TennCare. See Rules .01 and .05 of this Chapter. Medicaid services that are not RHC or FQHC services designated by TennCare may be provided and billed outside of the Supplemental Payment Rate or APM payment structure, provided the service is a covered service. TennCare shall reimburse a participating RHC or FQHC one hundred percent (100%) of its reasonable and Allowable Cost of providing services as defined in section 1902(a)(2) of the Social Security Act and included in the Tennessee State Plan as a Medicaidcovered service.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-107, 71-5-109, and 71-5-130.
• Administrative History: New rules filed March 6, 2025; effective June 4, 2025.

Tenn. Comp. R. & Regs. 1200-13-22-.03 MEDICAID COST REPORTING

(1) New and existing RHCs and FQHCs shall annually submit a Medicaid Cost Report, a template of which will be available on the TennCare website, to the Comptroller within one hundred and fifty (150) days of the RHC’s or FQHC’s end of fiscal year. An FHQC with multiple locations shall submit a single consolidated Medicaid Cost Report regardless of the number of locations, provided that an FQHC may choose to submit a separate Medicaid Cost Report for the first fiscal year of a new location.

(2) A change in scope may be initiated by TennCare based on review of a facility’s annual Medicaid Cost Report or other information available to the State. A TennCare-initiated change in scope may only be initiated by TennCare and will follow the process and be subject to the criteria outlined in Rule .07. Facilities must comply with requests for information from the Comptroller as part of a TennCare-initiated change in scope. TennCare will have one hundred and twenty (120) days from the date of submission of the Medicaid Cost Report to initiate a change in scope that is based on the information submitted in the cost report. Submission of an amended Medicaid Cost Report shall restart the timeframe for TennCare to initiate a change in scope under this Paragraph. Failure to participate in a change in scope initiated by TennCare will result in a suspension of payments under this Chapter until the change in scope can be processed.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-107, 71-5-109, and 71-5-130.
• Administrative History: New rules filed March 6, 2025; effective June 4, 2025. QUALIFIED HEALTH CENTER LOOK-ALIKES June, 2025 5

Tenn. Comp. R. & Regs. 1200-13-22-.04 SUPPLEMENTAL PAYMENT ESTABLISHMENT FOR A NEW RHC OR FQHC

(1) New RHCs or FQHCs are those facilities which meet the definition for the provider type in Rule .01 and meet the requirements of Rule .02(2) after the effective date of this Chapter. New facilities must make a request to the Comptroller to establish a Supplemental Payment Rate.

(2) Once a request to establish a Supplemental Payment Rate is received by the Comptroller, new facilities shall be reimbursed using an Interim Rate based on the rate of a similar entity (other FQHCs for an FQHC, or other RHCs for an RHC) with a similar caseload, if applicable, in the same Grand Division, or in the entire state if there are not enough similar entities in the same Grand Division. The Interim Rate shall be established by the Comptroller and shall be effective the first day of the calendar quarter following the request to establish a rate.

(3) To establish a final Supplemental Payment Rate, an RHC or FQHC must submit to the Comptroller a Medicaid Cost Report that contains twelve (12) full months of cost data for the designated base year.

(4) Upon receipt of a Medicaid Cost Report submitted by an RHC or FQHC to the Comptroller as required by Rule .03:

(a) The Comptroller shall review the Medicaid Cost Report.

(b) The Comptroller shall notify the RHC or FQHC if additional documentation is necessary.

(c) If additional documentation is necessary to establish a final Supplemental Payment Rate, the RHC or FQHC shall:

1. Provide the additional documentation to the Comptroller within sixty (60) days of the notification of need for additional documentation; or 2. Request an extension beyond sixty (60) days to provide the additional documentation. Extensions shall be granted at the discretion of the Comptroller.

An extension shall not exceed thirty (30) additional days.

(d) If the Comptroller requests additional documentation from the RHC or FQHC but does not receive additional documentation or an extension request within thirty (30) days, TennCare shall cease supplemental payments under an Interim Rate until:

1. The additional documentation has been received by the Comptroller; and 2. The Comptroller has established a final Supplemental Payment Rate or APM rate.

(e) If an RHC or FQHC fails to provide a Medicaid Cost Report containing a full year of cost data for the base year within one hundred and fifty (150) days of the end of the facility’s most recent fiscal year, TennCare shall cease supplemental payments under an Interim Rate until:

1. The RHC or FQHC submits Medicaid Cost Report to the Comptroller;

2. The RHC or FQHC has submitted any additional documentation required by the Comptroller; and 3. The Comptroller has established a final Supplemental Payment Rate or APM rate.

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June, 2025 6 (f) The Comptroller may review an RHC’s or FQHC’s paid claims listing for the period of time corresponding to the submitted Medicaid Cost Report.

(g) When an RHC or FQHC has submitted all necessary information to the Comptroller, within one hundred twenty (120) days, the Comptroller shall:

1. Establish a final Supplemental Payment Rate or APM rate for the RHC or FQHC; and 2. Notify the RHC or FQHC in writing of the RHC’s or FQHC’s final Supplemental Payment Rate and effective date of the final Supplemental Payment Rate or APM rate. The implementation date of the final Supplemental Payment Rate or APM rate shall the first day of the calendar quarter after the final rate is set by the Comptroller. The final Supplemental Payment Rate shall then be retroactive to the effective date of the interim for the purpose of reconciling payments made under the Interim Rate with the final Supplemental Payment Rate.

(h) Upon setting the final Supplemental Payment Rate, TennCare shall reconcile all supplemental payments made under the Interim Rate to the final Supplemental Payment Rate, adjusting payments upward or downward as necessary. In the event that supplemental payments under the Interim Rate ceased due to noncompliance with this

Rule, reconciliation will occur only for the months the Interim Rate was in effect. In any instance where payments under the Interim Rate ceased due to noncompliance with this

Rule, no supplemental payments will be made for the months in which the Interim Rate was not in effect, and supplemental payments will resume only as of the effective date of the final Supplemental Payment Rate.

(i) A new RHC or FQHC may appeal the final Supplemental Payment Rate within thirty-five (35) days of the date of the notice setting the final Supplemental Payment Rate. Appeals must be in accordance with Chapter 1200-13-18. Interim Rate determinations are not appealable.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-107, 71-5-109, and 71-5-130.
• Administrative History: New rules filed March 6, 2025; effective June 4, 2025.

Tenn. Comp. R. & Regs. 1200-13-22-.05 DETERMINATION OF A REIMBURSABLE VISIT

(1) Supplemental Payment Process.

(a) When calculating a facility’s supplemental payment, TennCare or its designee will multiply the number of Reimbursable Visits for the applicable time period, as determined in this Rule, times the established Supplemental Payment Rate or APM rate for that facility to calculate the total that should be received for services rendered. From that total, TennCare or its designee will subtract any reimbursement received for those services from TennCare MCCs and third-party payors less any special program payment provisions offered by TennCare as outlined in Paragraph (11) of this Rule, to calculate the supplemental payment amount.

(b) Each supplemental payment will be calculated by the Comptroller using paid claims data received from TennCare. Facilities must use the billing instructions provided by TennCare in the FQHC/RHC Supplemental Payment Manual, including the appropriate encounter code and procedure codes as outlined in Rule .05(2), to ensure the calculated supplemental payment is accurate.

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June, 2025 7 (c) An RHC or FQHC may self-report claims for Visits the facility believes were not included in the calculated payment to the Comptroller. Supplemental payment determinations for these Visits shall be made by TennCare or its designee. Self-reporting of Visits must adhere to the instructions for Visit reports provided in the FQHC/RHC Supplemental Payment Manual.

(d) Facilities must self-report all Visits associated with pregnancy and maternity services and provide documentation requested by the Comptroller’s office in order to receive supplemental payment for these Visits. Facilities must report these Visits, if applicable, no more frequently than monthly and no less frequently than once per quarter. Selfreporting of Visits must adhere to the instructions for Visit reports provided in the FQHC/RHC Supplemental Payment Manual.

(2) All claims associated with Reimbursable Visits must be submitted to a TennCare managed care contractor (MCC) for payment. RHCs or FQHCs shall only be reimbursed under this

Chapter for Visits paid by a TennCare managed care contractor (MCC). This applies to both the Supplemental Payment Rate and the APM rate. For claims that are denied by an MCC, facilities may self-report these claims to the Comptroller in writing for consideration as a Reimbursable Visit. Supplemental payment determinations for Visits based on claims denied by an MCC shall be made by TennCare or its designee. Self-reported claims submitted for reconsideration may not include claims denied for the following reasons: denial solely due to the RHC or FQHC’s failure to timely file; denial on the basis of medical necessity; or denial on the basis that the service was excluded under TennCare rules. Reconsideration determinations are not appealable; however, facilities may request review of MCC claims denials under the independent review process established by T.C.A. § 56-32-126(b)(2).

(3) TennCare shall adopt or amend a list of procedure codes that will be published on the TennCare website.

(a) The list of procedure codes will be presumed Reimbursable Visits for both the supplemental payment and APM methodologies and may be periodically updated with additions, deletions, or modifications.

(b) Inclusion of a procedure code on the list does not guarantee payment if its inclusion conflicts with federal or state law, including the rules promulgated under this Chapter.

(c) TennCare will post any amendments to the list of procedure codes on its website on a quarterly basis. When amendments to the procedure codes list become effective, any changes in payments to providers will become effective on the first day of the month the amended list of CPT codes is published.

(4) If an encounter between an RHC or FQHC provider and a TennCare enrollee involves a procedure code that is not on the TennCare procedure code list, the RHC or FQHC may request addition of the procedure code to the TennCare procedure code list. Requests for inclusion of a procedure code not on the TennCare codes list shall be made in writing to the Comptroller, and the decision regarding inclusion will be at the discretion of TennCare.

Determinations regarding the procedure code list are not appealable.

(5) The following shall not be considered a Reimbursable Visit under this Chapter under either a Supplemental Payment Rate or APM rate:

(a) An encounter for the sole purpose of medication therapy management, whether provided by a pharmacist or other provider.

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June, 2025 8 (b) Encounters for enrollees dually enrolled in both Medicaid and Medicare Part B (or any Medicare-approved plan which includes Medicare Part B, such as Medicare Advantage); however, dental Visits provided to dual enrollees with no dental coverage through either Medicare Part B or a Medicare Advantage Plan are Reimbursable Visits.

(c) Group services. Group services does not include family therapy Visits.

(d) Screening encounters or services unless:

1. The screening meets all other criteria under this Chapter to be considered a Reimbursable Visit; and 2. The claim includes an allowable procedure code as enumerated in the list of procedure codes published by TennCare pursuant to this Chapter.

(e) Visits for the sole purpose of administering a vaccine. Vaccine administration revenue is excluded under Paragraph (11)(c) of this Rule.

(6) TennCare may exclude Visits and/or revenue from the supplemental payment calculation for certain services where the fixed costs exceed the Supplemental Payment Rate or APM received by facilities. Specific exclusions include but are not limited to:

(a) Revenue received for Long-Acting Reversible Contraception (LARC) devices. Visits associated with the insertion or removal of LARC devices will qualify for supplemental payment provided all other applicable criteria for a Reimbursable Visit are met.

(b) Revenue received for dentures, including partial dentures. Visits associated with the provision of dentures, including partial dentures, will qualify for supplemental payment provided all other applicable criteria for a Reimbursable Visit are met.

(7) Encounters with more than one healthcare provider and/or multiple encounters with the same healthcare provider that take place on the same day will constitute a single Reimbursable Visit.

Facilities may bill for more than one Reimbursable Visit on the same day under either a Supplemental Payment Rate or APM rate in the following circumstances:

(a) If an encounter includes a combination of a medical Visit and/or a behavioral health Visit and/or dental Visit, the RHC or FQHC may request supplemental payment for each Visit category.

(b) An RHC or FQHC may request supplemental payment for more than one Reimbursable Visit on the same day when the enrollee, subsequent to the first Visit, suffers an illness or injury subsequent to the initial Visit that requires additional diagnosis or treatment on the same day.

(c) An RHC or FQHC shall not request supplemental payment for multiple procedure codes that comprised one (1) Visit as multiple Visits except when a minor child receives both a well-child Visit and a sick Visit at the same time. In such cases, each Visit may constitute a separate Visit for a maximum of two (2) Reimbursable Visits.

(8) Visit Setting.

(a) Visits must occur in an outpatient setting to be reimbursable under this Chapter.

Outpatient settings eligible for supplemental payment are the RHC or FQHC itself, the enrollee’s residence, school, or residential facility.

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June, 2025 9 (b) Consistent with 42 C.F.R. 405.2411(b)(4) and related guidance from the CMS, RHC and FQHC Visits cannot take place at an inpatient or outpatient hospital department, including a critical access hospital. Visits and revenue related for hospital Visits, including labor delivery Visits, are excluded from the supplement payment settlement.

(9) Telehealth Visits. Visits performed via telehealth are considered face-to-face Visits eligible for supplemental payment provided the following criteria are met:

(a) The Visit meets all other necessary criteria to be considered a Reimbursable Visit under this Chapter, including having an associated paid claim by the MCC as outlined in Paragraph (1) of this Rule; and (b) The Visit meets the definition of “provider-based telemedicine” as defined in T.C.A. § 56- 7-1003(a)(6)(A). Encounters in which the RHC or FQHC serves solely as the originating site are not considered Reimbursable Visits under this Chapter.

(10) For any Visits submitted by an RHC or FQHC outside of the supplemental payment methodology in Rule .05, the RHC or FQHC may submit Visit reports—or amend an already submitted Visit report—within twelve (12) months of the date of service. Facilities must submit a request to amend to the Comptroller and receive written approval to submit an amendment to a previously submitted Visit report. Self-reporting for Visits must adhere to the instructions for Visit reports provided in the FQHC/RHC Supplemental Payment Manual.

(11) The following rules apply to the revenue types that are included in the claims-based reimbursement already paid to the facility by the MCCs:

(a) All payments for ancillary services, screening services, and other services included in the federal definitions of FQHC and RHC services at 42 § U.S.C.A. 1396d(l) must be included in the determination of the settlement amount.

(b) All payments made on behalf of the TennCare member unless otherwise excluded under these rules. This includes MCC payments, including any capitated or other payment arrangement the facility may have with the MCC, and any third-party liability or patient liability payments.

(c) Vaccine administration revenue is excluded from the supplemental payment settlement.

(d) The following payments are not intended as part of the supplemental payment program under this Chapter and must not be included as part of received revenue for purposes of the supplemental payment calculation:

1. Patient-centered medical home (PCMH) program payments, including the activity payments, practice transformation payments, and outcome payments.

2. Tennessee Health Link program payments, including activity payments and outcome payments.

3. Other payment types received as a result of payment reform or value-based initiatives that may be implemented by TennCare, structured either as per member per month case rates or as outcome payments based on established performance criteria.

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June, 2025 10

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-107, 71-5-109, and 71-5-130.
• Administrative History: New rules filed March 6, 2025; effective June 4, 2025.

Tenn. Comp. R. & Regs. 1200-13-22-.06 DETERMINATION OF REASONABLE COSTS

(1) Only reasonable costs will be reimbursed under this Chapter. Reasonable cost determinations shall be made by TennCare or its designee in accordance with this Chapter and applicable Medicare cost principles established in 42 C.F.R. Part 413 and 45 C.F.R. Part 75, Subpart E.

Cost principles in Part 413 will control in instances where Part 413 and Part 75 conflict.

(2) The following specific criteria will be considered in determining reasonable costs:

(a) Fees paid by an RHC or FQHC pursuant to any contract to pay contingency fees for consulting, accounting, bookkeeping or similar services, or any contract to pay the vendor a percentage of the fees recovered from TennCare, will be presumed unreasonable and will not be reimbursed. Fees paid to billing vendors compensated on a fixed percentage basis known at the time of cost reporting are considered reasonable costs.

(b) Imputed salaries will be presumed unreasonable. All salary amounts must be reported on an IRS Form W-2 or an IRS Form 1099 to be considered for reasonableness. In circumstances where Internal Revenue Service policies do not allow for these forms of documentation, other documentation of earnings will be accepted.

(c) Salaried or contracted costs shall be accompanied by an FTE calculation. Facilities must annualize the FTE calculation based on hours work estimating a 2,080 hours per year as a full-time equivalency.

(d) If applicable, Owner’s compensation and compensation to any Related Parties claiming administrative salary or wages from the RHC or FQHC will be indexed to the Tennessee Occupational Employment and Wage Rates or other sources as determined by the Comptroller and will be paid only in circumstances as described in this Rule.

Compensation exceeding the indexed amount will be presumed unreasonable.

(e) For any Employee, contractor, or Owner whose job functions include responsibilities other than direct patient care, the RHC or FQHC will be required to report, if applicable, the total number of hours the Employee, contractor, or Owner spent performing functions that were not direct patient care.

(3) For supplemental payment purposes, a reasonable allowance or compensation for services of an Owner shall be subject to the following specific criteria:

(a) The services provided by the Owner must be a necessary function, meaning that had the Owner not rendered the services, the facility would have been required to employ or contract with another person to perform them. The services must be related to patient care or pertinent to the operation and sound management of the facility. TennCare or its designee shall be responsible for determining which services are related to patient care and pertinent to the operation and sound management of the facility.

(b) Total compensation to Owners must be listed on the Medicaid Cost Report. Where these amounts include items other than salaries, a schedule must be attached that identifies the amounts and the method of assigning values to these benefits.

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June, 2025 11 (c) TennCare or its designee will review these amounts and compare them with the allowable compensation ranges established by the Bureau of Labor Statistics for Medical and Health Services Managers and make necessary adjustments. TennCare or its designee will consider the duties, responsibilities, and managerial authority of the Owner as well as the services performed for other facilities and his engagements in other occupations. Only one-and-one-half (1.5) full-time positions, or the equivalent, will be allowed for each Owner. Individual Owner(s) and Related Party(ies) will be allowed no more than one (1.0) full-time position per facility, or the equivalent, for hours performing administrative functions. The duties performed, time spent, and compensation received by the Owner must be substantiated by appropriate records.

(4) Costs submitted by an RHC or FQHC for a final Supplemental Payment Rate determination or change in scope request that are not otherwise specifically addressed in this Rule will be reviewed by TennCare or its designee in accordance with Rule .06(1).

(5) This Rule applies to cost determinations made under Rules .05, .07, and .09 of this Chapter.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-107, 71-5-109, and 71-5-130.
• Administrative History: New rules filed March 6, 2025; effective June 4, 2025.

Tenn. Comp. R. & Regs. 1200-13-22-.07 CHANGE IN SCOPE AND FINAL SUPPLEMENTAL PAYMENT RATE OR APM RATE

ADJUSTMENT.

(1) Change in Scope Overview.

(a) An RHC may only request a rate adjustment based on a change in scope once per the facility’s fiscal year. An FQHC may only request a rate adjustment based on a change in scope once per the facility’s fiscal year for the FQHC’s Tax Identification Number (TIN).

In the case of a denial of a request of a change in scope, an RHC or FQHC must wait six (6) months from the date of the written denial to request a new change in scope.

(b) If an RHC or FQHC changes its scope of services after the base year rate is established, the Comptroller shall adjust its final Supplemental Payment Rate if the change in scope qualifies for an adjustment under this Rule, upon review and approval of the change in scope. Only the actual costs specifically attributable to the requested change in scope of services will be considered. Costs upon which the existing facility rate has already been set cannot be reassessed through the change in scope process.

(c) An adjustment to a final Supplemental Payment Rate resulting from a change in scope that occurred after a facility’s base year rate is established shall be effective from the beginning of the quarter that the change in scope request was submitted subject to the provisions of this Rule.

(d) A change in scope may be initiated by TennCare based on information available to the State. A TennCare-initiated change in scope may only be initiated by TennCare and will follow the process outlined in this Rule, and facilities must comply with requests for information from the Comptroller as part of the TennCare-initiated change in scope.

Failure to participate in a change in scope initiated by TennCare will result in a suspension of payments under this Chapter until the change in scope can be processed.

(e) An RHC whose Supplemental Payment Rate is set as an average caseload rate is not subject to the TennCare-initiated change in scope process; however, an RHC may submit a request for a change in its scope of services. Such requests will be subject to the following requirements in addition to the requirements under this Rule:

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June, 2025 12 1. Before the Comptroller can establish a change in scope, the RHC must submit annual cost reports for the most recent two full fiscal years prior to the request so that the Comptroller can establish a cost-based payment rate.

2. Once the Comptroller determines the cost-based payment rate and then the associated incremental rate change resulting from the requested change in scope of services, the RHC may choose to either:

(i) Move to the cost-based supplemental payment rate inclusive of the change in scope of services; or (ii) Continue to receive the average rate without a change in the scope of services.

3. If an RHC elects to move to a cost-based payment rate, then the RHC will be subject to the TennCare-initiated change in scope process set forth in Rule 1200- 13-22-.03(2) and Rule 1200-13-22-.07(1)(d) going forward.

(2) A change in scope of service means a change in the type, intensity, duration, and/or amount of services:

(a) Type. The RHC or FQHC has added or discontinued any service that:

1. Meets the definition of an FQHC or RHC service as provided in section 1905(a)(2)(B) and (C); and 2. Is included as a covered Medicaid service under the Medicaid state plan or TennCare’s 1115 Demonstration Waiver.

(b) Intensity, duration, and/or amount means a material change to the services provided in an average Visit. This includes a material change in the staff providing an existing service.

(c) A statutory or regulatory change that materially impacts the costs or Visits of an RHC or FQHC and otherwise meets the requirements of this Rule.

(3) The following items individually shall not constitute a change in scope without an associated change in costs that otherwise meets the requirements of this Rule:

(a) A general increase or decrease in the costs of existing services;

(b) A reduction or an expansion of hours of operation without a change in the duration or amount of services;

(c) A wage increase;

(d) A renovation or other capital expenditure;

(e) A change in ownership;

(f) An addition of a service provided by a non-licensed/certified professional or specialist; or (g) An increase or decrease in the total number of facility Visits.

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June, 2025 13 (4) A requested change in scope shall meet the following requirements:

(a) The change in scope of services must increase or decrease the existing final Supplemental Payment Rate or APM rate by at least five percent (5%). To determine if the 5% threshold is met, the portion of the provider’s cost-per-visit specifically attributable to the change in scope will be divided by the Supplemental Payment Rate in effect at the time the change in scope was submitted for approval.

(b) The change in scope of services must remain in effect for at least twelve (12) months in order to receive a final Supplemental Payment Rate and permanent change in scope rate adjustment.

(c) The change in scope of services must have been fully implemented for at least a full calendar quarter prior to submission of a change in scope request. Requests for a change in scope of services cannot be submitted prior to the first day of the calendar quarter after reaching at least ninety (90) days of implementation.

(d) To submit a request for a change in scope, an RHC or FQHC must provide notice to the Comptroller of its intent to submit a request for a change in scope and shall submit the following documents with the notice:

1. A written request describing in detail the change in scope, including the service(s) subject to change, the location(s) offering the service, the date the change in service was made, and a brief narrative of how the service change will benefit the patient population, if applicable;

2. A provisional Medicaid Cost Report or other TennCare designated change in scope report for the affected time period; and 3. Relevant documentation to support the request.

(5) The costs related to a change in the scope of services must be reasonable. Determinations of reasonable costs are determined by TennCare or its designee in accordance with the rules contained in this Chapter and the cost criteria identified in Rule .06 of this Chapter. Consistent with Rule .06, it is within the discretion of TennCare to determine what reasonable costs may be included in requests for changes in scope.

(6) TennCare or its designee shall use the most recent Visit counts for calculation of changes in scope except in cases of the discontinuation of a service. For discontinuation of a service, TennCare or its designee shall use the initial count of Visits on the first cost report which included the service. In addition, for a discontinuation of a service, TennCare or its designee shall use the cost attributable to the service at the time the service was originally added to the reimbursement rate, provided that those costs shall be trended forward with MEI, if applicable.

(7) Upon receipt of a valid request to change the scope of services:

(a) The Comptroller shall review the submitted documentation.

(b) The Comptroller shall notify the RHC or FQHC in writing of the:

1. Approval or denial of the request for change in scope within ninety (90) days from the date the Comptroller received all information necessary to make a determination; or QUALIFIED HEALTH CENTER LOOK-ALIKES June, 2025 14 2. Need for additional documentation from the RHC or FQHC to establish a final Supplemental Payment Rate or APM rate associated with the change in scope.

(c) The Comptroller may request additional information needed to process the request including but not limited to a trial balance, depreciation schedule, detailed general ledger, schedule listing allocations, total Visit log, schedule of Owner’s compensation, a schedule of all Employee’s salaries by title, a list of Related Parties, documentation for reclassification, documentation regarding usage of contractors, and adjustments. If the Comptroller requests additional documentation to calculate the final Supplemental Payment Rate or APM rate for a change in scope, the RHC or FQHC shall:

1. Provide the additional documentation to the Comptroller within sixty (60) days of the request for additional documentation; or 2. Request an extension beyond sixty (60) days to provide the additional documentation. An extension shall not exceed an additional thirty (30) days.

Extensions shall be at the discretion of the Comptroller.

(8) Failure by an RHC or FQHC to comply with the timelines in this Rule may result in the change in scope being denied.

(9) If the Comptroller approves the request for a change in scope after receiving all of the necessary documentation from an RHC or FQHC within the timelines established in this Rule, the RHC or FQHC shall begin receiving an Interim Rate for any newly approved service associated with the change in scope until a final Supplemental Payment Rate can be set. The effective date of the Interim Rate shall be the first day of the calendar quarter in which the change of scope was submitted.

(10) The Comptroller shall set the final Supplemental Payment Rate for an approved change in scope only after submission of a full fiscal year of actual cost data for the change in scope by the RHC or FQHC. The effective date of the final Supplemental Payment Rate for the approved change in scope shall be the first day of the first calendar quarter following approval of the final Supplemental Payment Rate. The final Supplemental Payment Rate shall then be retroactive to the effective date of the interim for the purpose of reconciling payments made under the Interim Rate with the final Supplemental Payment Rate.

(11) If an RHC or FQHC fails to provide a full year of cost data for the requested change in scope within 90 (ninety) days of twelve (12) months from the date of implementation of the change in scope, TennCare shall cease supplemental payments attributable to the change in scope under the Interim Rate until the final Supplemental Payment Rate is established. In any instance where payment under the Interim Rate ceased due to noncompliance with this Rule, no supplemental payments will be made for the months in which the Interim Rate was not in effect and supplemental payments will resume only as of the effective date of the final Supplemental Payment Rate. Facilities shall not be entitled to any reconciliation settlements for the time period the supplemental payments under the Interim Rate ceased.

(12) An RHC or FQHC may appeal the denial of a request for a change in scope or a final Supplemental Payment Rate adjustment due to a change in the scope of services. Appeals must be filed within thirty-five (35) days of the date of the notice denying the request or the date of the notice setting the final Supplemental Payment Rate resulting from a change in scope. Appeals must be in accordance with Chapter 1200-13-18. Interim rate determinations made while a change in scope is being processed are not appealable.

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June, 2025 15

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-107, 71-5-109, and 71-5-130.
• Administrative History: New rules filed March 6, 2025; effective June 4, 2025.

Tenn. Comp. R. & Regs. 1200-13-22-.08 SUPPLEMENTAL PAYMENT FOR AN EXISTING RHC OR FQHC

(1) Existing RHCs or FQHCs are those providers which met the definition for the provider type in

Rule .01 and received supplemental payments under a Supplemental Payment Rate or APM rate prior to the effective date of this Chapter.

(2) The Comptroller shall adjust a final Supplemental Payment Rate or APM rate of an existing clinic as follows:

(a) For RHCs, by the percentage increase in the MEI applicable to RHC services on July 1 of each year;

(b) For FQHCs, by the market basket measure for FQHC services; or (c) For RHCs and FQHCs, pursuant to a change in scope as outlined in Rule .07.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-107, 71-5-109, and 71-5-130.
• Administrative History: New rules filed March 6, 2025; effective June 4, 2025.

Tenn. Comp. R. & Regs. 1200-13-22-.09 ALTERNATIVE PAYMENT METHODOLOGY FOR AN RHC OR FQHC

(1) TennCare may offer to an RHC or FQHC, for which a final Supplemental Payment Rate exists, an alternative payment methodology. The RHC or FQHC, at its election, may receive the APM rate if it notifies TennCare in writing that it elects to receive the APM as its Supplemental Payment Rate.

(2) Establishment of base years and periodic updating.

(a) If the RHC or FQHC elects to use the alternative payment methodology, it will undergo establishment of a new rate based on the average of the two (2) most recent fiscal years of cost data for the facility. The Comptroller shall collect and review Medicaid Cost Report data from the previous two (2) fiscal years for the facility. If the RHC or FQHC has been in existence for fewer than two (2) years, then the facility will remain on the existing Supplemental Payment Rate until there is sufficient data to set the APM rate. Once the data is collected, the Comptroller will use this data to compute the APM rate.

(b) Following that reconciliation year, the APM rate for an RHC or FQHC shall be adjusted by the market basket measure applicable to RHC or FQHC services on July 1 of each year.

(c) The APM rate is subject to the requirements of Rule .06 of this Chapter.

(d) APM rates may be updated by TennCare and the Comptroller no more frequently than one (1) time every five (5) years by using the two (2) most recent fiscal years of Medicaid Cost Report data.

(e) The Comptroller may not offer, and an RHC or FQHC may not collect, the APM rate unless the total payments under the APM are equal to or higher than the total payments under the facility’s existing Supplemental Payment Rate as calculated according to this

Chapter.

QUALIFIED HEALTH CENTER LOOK-ALIKES

June, 2025 16 (f) The effective date of APM rate will be the first date of the calendar quarter after the date RHC or FQHC elects in writing to the Comptroller to receive the APM rate.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-107, 71-5-109, and 71-5-130.
• Administrative History: New rules filed March 6, 2025; effective June 4, 2025.

Tenn. Comp. R. & Regs. 1200-13-22-.10 AUDITING OF PROVIDER-REPORTED DATA

(1) The cost reports and any Visit reports filed under this Chapter by an RHC or FQHC, and all pertinent provider records shall be subject to audit by the Comptroller of the Treasury or his agents based on the criteria in this Chapter or the Medicare regulations, as applicable.

(2) The facility shall permit the Comptroller or his agents to examine any records and documents necessary to ascertain information pertinent to the determination of the proper amount of program payments due. Failure to comply with an audit of the Comptroller may result in the suspension of supplemental payments under this Chapter.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-107, 71-5-109, and 71-5-130.
• Administrative History: New rules filed March 6, 2025; effective June 4, 2025.

Tenn. Comp. R. & Regs. 1200-13-22-.11 SUPPLEMENTAL PAYMENT RATES FOR SEPARATE SERVICES

(1) RHCs or FQHCs are permitted to establish a separate Supplemental Payment Rate for dental services. Requests to establish a separate dental rate must be submitted to the Comptroller.

The requirements of this Chapter apply to dental service rates in the same manner as to the RHC’s or FQHC’s Supplemental Payment Rate or APM rate.

(2) As of the effective date of this Chapter, TennCare will no longer offer separate Supplemental Payment Rates for optometry or pharmacy services. Clinics with separate service rates for optometry or pharmacy services established prior to the effective date of this Chapter may elect to continue to receive a separate Supplemental Payment Rate for either service.

History

• Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-107, 71-5-109, and 71-5-130.
• Administrative History: New rules filed March 6, 2025; effective June 4, 2025.

1200-14 Bureau of Health Services Administration Division of Communicable and Environmental Disease Services AIDS Program Division

Chapter 1200-14-01 Communicable and Environmental Diseases

Tenn. Comp. R. & Regs. 1200-14-01-.01 DEFINITION OF TERMS

(1) For the purpose of these regulations the terms used herein are defined as follows:

(a) Carrier - A person who harbors, or who is reasonably believed by the Commissioner, health officer, or designee to harbor a specific pathogenic organism and who is potentially capable of spreading the organism to others, whether or not there are presently discernible signs and symptoms of the disease.

(b) Case - An instance of an individual or group of individuals who have contracted a reportable disease, health disorder or condition under investigation by CEDS.

(c) CEDS - Communicable and Environmental Disease Services in the Bureau of Health Services Administration of the Tennessee Department of Health, or its successor agency.

(d) Commissioner - Means the Commissioner of the Tennessee Department of Health or a designated representative.

(e) Communicable Disease - An illness due to an infectious agent or its toxic products which is transmitted directly or indirectly to a well person from an infected person or animal, or through the agency of an intermediate animal host, vector, or inanimate environment.

(f) Contact - Any person or animal known to have been in such association with a person or animal reasonably suspected of being infected with a disease-causing agent as to have had the opportunity of acquiring the infection.

(g) Contamination - The presence of a pathogenic agent on a body surface on or in an inanimate article or substance.

(h) Cultures or Specimens - Material taken from any source and cultured or otherwise examined for the purpose of determining the presence of an organism or organisms or other evidence of infection or disease.

(i) Department - All references to the Department in these regulations shall refer to the Tennessee Department of Health.

(j) Disinfestation - Any physical or chemical-process by which undesired animal forms, especially arthropods or rodents, present upon the person, the clothing, or in the environment of an individual or on domestic animals, may be destroyed upon the person, his clothing, upon the animal or in the environment of the person.

(k) Epidemic (or Disease Outbreak) - The occurrence in a community or region of one or more cases of illness that is in excess of normal expectancy.

(l) Event - An occurrence of public health significance and required by the Commissioner to be reported in the List.

(m) Healthcare Provider - All persons, facilities and entities regulated pursuant to the provisions of Title 63 and 68, including but not limited to medical doctors, chiropractors, dentists, nurses, nurse practitioners, osteopathic physicians, pharmacists, laboratory personnel, veterinarians, dispensing opticians, nursing home administrators, physician assistants, respiratory care practitioners, clinical perfusionists, and midwives.

(n) Inapparent or Subclinical Infection - A person or animal has an inapparent or subclinical infection when the infectious agent has so mild an effect that even though infection is present and identifiable by laboratory means, it is undetected clinically.

(o) Incidence - The number of cases of disease, of infection, or other event occurring during a prescribed time period, in relation to the unit of population in which they occur; thus the incidence of tuberculosis expressed as a rate is the number of new cases reported per 100,000 population per year.

(p) Infectious Agent - A viable pathogen capable of producing infection or disease.

(q) Infected Person - Infected persons include patients or sick persons, persons with inapparent (or subclinical) infection and carriers.

(r) Infection - The entry and development or multiplication of a particular pathogen in the body of man or animal.

(s) Isolation - The separation for the period of communicability of infected persons, or persons reasonably suspected to be infected, from other persons, in such places and under such conditions as will prevent the direct or indirect conveyance of the infectious agent from infected persons to other persons who are susceptible or who may spread the agent to others.

(t) List - Means the List of Reportable Disease and Reporting Mechanisms as set forth by the Commissioner.

(u) Local Health Authority - The administrative officer of the local health department appointed by the Commissioner with the duty of executing health programs and enforcing local and Departmental health regulations. If qualified, the health director may be designated also to serve as the health officer.

1. Local Health Director - The administrative officer of the local health department appointed by the Commissioner with the duty of executing health programs and enforcing local and Departmental health regulations. If qualified, the health director may be designated also to serve as the health officer.

2. Local Health Officer - A licensed doctor of medicine or osteopathy appointed by the Commissioner to provide medical direction and medical enforcement for the local health department.

3. Local Board of Health - An optional board established by local legislative bodies.

The board of health may adopt local rules and regulations to protect the general health and safety of citizens. The board of health has the duty to enforce local and Departmental rules and regulations through the local health director and/or the local health officer.

(v) Period of Communicability - The time during which an infectious agent may be transmitted from an infected person to others.

(w) Quarantine - Limitation of freedom of movement or isolation of a person, or preventing or restricting access to premises upon which the person, cause or source of a disease may be found, for a period of time as may be necessary to confirm or establish a diagnosis, to determine the cause or source of a disease, and/or to prevent the spread of a disease. These limitations may be accomplished by placing a person in a health care facility or a supervised living situation, by restricting a person to the person’s home, or by establishing some other situation appropriate under the particular circumstances.

(x) Reportable disease - Any disease which is communicable, contagious, subject to isolation or quarantine, or epidemic, and required by the Commissioner to be reported in the List.

(y) Reservoir of Infection - Reservoirs of infection are humans, animals, insects, plants, soil, or inanimate organic matter, in which an infectious agent lives and multiplies and depends primarily for survival, reproducing itself in such manner that it can be transmitted to man.

(z) Source of Infection - The person, animal, object, item, or substance from which an infectious agent passes immediately to a host.

(aa) Susceptible - A person or animal not known to be immune to a specific disease.

(bb) Suspect - A person whose medical history and symptoms, examination or diagnostic tests suggest may have or may be developing a reportable disease.

History

• Authority: T.C.A. §§ 4 -5-202, 68-1-103, 68-1-104, 68-1-201, and 68-5-104.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 14, 1977; effective May 16, 1977. Amendment filed April 20, 1987; effective June 4, 1987. Amendment filed July 10, 1995; effective November 28, 1995. Amendment filed March 30, 2004; effective July 29, 2004. Emergency rule filed October 8, 2009; effective through April 6, 2010. Amendment filed December 29, 2009; effective March 29, 2010.

Tenn. Comp. R. & Regs. 1200-14-01-.02 REPORTABLE DISEASES

(1) All healthcare providers and other persons knowing of or suspecting a case, culture, or specimen of a reportable disease or event shall report that occurrence to the Department of Health in the time and manner set forth by the Commissioner in the List.

(2) The Commissioner shall re-evaluate, update, and post the List at least annually and from time to time as appropriate. The Commissioner shall post the annual update on or before November 15th of each year and this new List shall become effective starting January 1st of the following year. If the Commissioner posts an updated List more frequently than on an annual basis, then the updated List will become effective on the date stated in the List. The List shall be available online at the Department of Health’s web page and in print.

History

• Authority: T.C.A. §§ 4 -5-202, 68-1-103, 68-1-104, 68-1-201, 68-5-101, 68-5-104, 68-5-104(a), 68-5-107, 68-5-112, 68-10-112, and 68-29-107.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987. Amendment filed July 10, 1995; effective November 28, 1995. Amendment filed December 19, 1998; effective April 30, 1998. Amendment filed March 31, 2000; effective June 14, 2000. Amendment filed August 29, 2003; effective December 29, 2003. Amendment filed March 30, 2004; effective July 29, 2004. Amendment to rule 1200-14-01-.02 filed July 30, 2004; effective November 26, 2004. Emergency rule filed October 8, 2009; effective through April 6, 2010. Amendment filed December 29, 2009; effective March 29, 2010.

Tenn. Comp. R. & Regs. 1200-14-01-.03 REPEALED

History

• Authority: T.C.A. § 68 -5-104(a).
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987. Amendment filed March 31, 2000; effective June 14, 2000. Emergency rule filed October 8, 2009; effective through April 6, 2010. Repeal filed December 29, 2009; effective March 29, 2010.

Tenn. Comp. R. & Regs. 1200-14-01-.04 REPEALED

History

• Authority: T.C.A. § 68 -5-104(a).
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987. Amendment filed March 31, 2000; effective June 14, 2000. Emergency rule filed October 8, 2009; effective through April 6, 2010. Repeal filed December 29, 2009; effective March 29, 2010.

Tenn. Comp. R. & Regs. 1200-14-01-.05 REPEALED

History

• Authority: T.C.A. § 68-5-104(a).
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987, effective June 4, 1987. Emergency rule filed October 8, 2009; effective through April 6, 2010. Repeal filed December 29, 2009; effective March 29, 2010.

Tenn. Comp. R. & Regs. 1200-14-01-.06 DUTIES OF PHYSICIANS

(1) It shall be the duty of the attending physician, immediately upon discovering a case or suspected case of communicable disease to inform the head of the household and appropriate healthcare facility personnel of this fact and to instruct these persons of such isolation of the patient and concurrent disinfection as may be necessary to prevent spread of the infection. It shall be the duty of persons so informed to comply with such instructions unless otherwise instructed by the local health officer or his authorized agent. Provided, this

regulation shall be construed to mean that only a physician, or other person/or persons duly authorized by applicable state law, has the authority to establish quarantine, or isolation, or remove established quarantine or isolation restrictions for communicable diseases.

(2) It shall be the duty of physicians to comply with disease control measures established by the Department to contain and control disease outbreaks that threaten the public health.

History

• Authority: T.C.A. §§ 4 -5-202, 68-1-103, 68-1-104, 68-1-201, and 68-5-104.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 14, 1977; effective May 16, 1977. Amendment filed April 20, 1987; effective June 4, 1987. Amendment filed March 30, 2004; effective July 29, 2004.

Tenn. Comp. R. & Regs. 1200-14-01-.07 REPEALED

History

• Authority: T.C.A. §§ 49-1769, 53-607, 53-621, 53-905, 53-1023, and 53-1109.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Repeal filed January 11, 1994; effective March 27, 1994.

Tenn. Comp. R. & Regs. 1200-14-01-.08 TUBERCULOSIS CASES RESTRICTED

(1) Any person declared to have tuberculosis in an infectious stage shall be prohibited from working in any place of employment where contact with other persons would constitute a public health hazard. Any owner or manager of any such establishment having knowledge or suspecting an employee or prospective employee of having this disease in an infectious stage shall not employ or continue to employ any such person or persons until the absence or noninfectiousness or the negligible likelihood of transmission of the suspected disease has been determined and certified by a physician holding an unlimited license to practice medicine in this State. Provided, however, that such certification must be acceptable to the local health officer, who, through State of local facilities, may require a physical, laboratory and/or x-ray examination without cost to the patient to determine the disease status.

(2) Any person declared to have tuberculosis in an infectious stage shall be prohibited from teaching or otherwise working in, or attending any private or public school. Any superintendent, principal, or teacher having knowledge of or suspecting a student or teacher of having tuberculosis in an infectious stage shall prohibit the attendance of such person or persons at a school until the absence or noninfectiousness of the suspected disease has been determined and certified to by a physician holding an unlimited license to practice medicine in this State. Provided, however, that such certification must be acceptable to the local health officer in the same manner and under the same conditions as stated in Part (1) of this Section.

History

• Authority: T.C.A. § 68-5-104(a).
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 14, 1977; effective May 16, 1977. Amendment filed April 20, 1987; effective June 4, 1987.

Tenn. Comp. R. & Regs. 1200-14-01-.09 PERSONS ADMITTED TO HOSPITALS OR NURSING HOMES DESIGNATED TO

ACCEPT STATE-SPONSORED TUBERCULOSIS PATIENTS.

All state-sponsored patients admitted to these hospitals shall be pre-authorized and be approved by a designated representative of the Department.

History

• Authority: T.C.A. § 68-5-104(a).
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987.

Tenn. Comp. R. & Regs. 1200-14-01-.10 SCOPE OF PAYMENT FOR TUBERCULOSIS PATIENTS

Payment for services rendered to approved tuberculosis patients, subject to the availability of funds and current Departmental policy, will be made only after the provider has made a reasonable effort to collect from third parties, either governmental provider has made a reasonable effort to collect from third parties, either governmental or private, as well as the individual or the person legally responsible for the debts of the patient. The Commissioner or his designee may utilize the definition of a person medically indigent as defined in these Regulations, in making the decision for whom the Division of Tuberculosis Control of the Tennessee Department of Health will expend funds.

History

• Authority: T.C.A. § 68-9-104.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987.

Tenn. Comp. R. & Regs. 1200-14-01-.11 INFECTIOUS TUBERCULOSIS

Patients are considered infectious as long as the specific causative organisms are discharged unless the patient has been on anti-tuberculous drugs for a sufficient length of time to be considered non-infectious by the attending physicians.

History

• Authority: T.C.A. § 68-9-104.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987.

Tenn. Comp. R. & Regs. 1200-14-01-.12 REPEALED

History

• Authority: T.C.A. § 68-9-104.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Repeal filed April 20, 1987; effective June 4, 1987.

Tenn. Comp. R. & Regs. 1200-14-01-.13 PERSONS ELIGIBLE FOR IN-PATIENT AND OUT-PATIENT SERVICES

Those persons with or suspected of having infectious tuberculosis now living in Tennessee are considered residents of Tennessee and are, therefore, eligible for services under this program.

History

• Authority: T.C.A. § 68-9-104(a).
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987.

Tenn. Comp. R. & Regs. 1200-14-01-.14 PERSONS WITH LEGAL RESIDENCE OUTSIDE OF TENNESSEE

Those persons with a legal residency outside the State of Tennessee and known to have infectious tuberculosis may be admitted temporarily to an approved hospital and receive other tuberculosis services to protect the public health of the citizens of the State of Tennessee.

History

• Authority: T.C.A. § 68-9-104(a).
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977.

Tenn. Comp. R. & Regs. 1200-14-01-.15 GENERAL MEASURES FOR THE EFFECTIVE CONTROL OF REPORTABLE

DISEASES.

(1) The local health officer or the Commissioner or a designated representative of the Commissioner, upon receiving a report of a reportable disease or of a suspected epidemic of disease or of a suspected case of a disease of public health significance or event, shall:

(a) Confer with the physician, laboratory, hospital, or person making the report;

(b) Collect such specimens for laboratory examination as may be necessary to confirm the diagnosis of the disease and/or to find the source of the infection or the epidemic;

(c) Obtain all names and information necessary to identify and contact all persons potentially exposed to the source of the disease outbreak as needed to protect the public health;

(d) Make a complete epidemiological investigation to include (but not limited to): review of appropriate medical and laboratory records of affected persons and controls, interviews of affected persons and controls, and recording of the findings on a communicable disease field record; and (e) Establish appropriate control measures which may include examination, treatment, isolation, quarantine, exclusion, disinfection, immunization, disease surveillance, closure of establishment, education, and other measures considered appropriate by medical experts for the protection of the public’s health.

(2) Medical and relevant non-medical records and information shall be made available when requested, for inspection and copying of, by a duly authorized representative of the Department while in the course of investigating a disease under these regulations. The original records shall not be removed from the facility and any information obtained shall be treated as confidential and sensitive.

(3) For the purpose of this section, appropriate medical experts shall mean the latest edition of the Report of the Committee on Infectious Diseases of the American Academy of Pediatrics or the Control of Communicable Diseases Manual by the American Public Health Association (latest edition). Consideration will also be given to recommendations of the Advisory Committee on Immunization Practices (ACIP) and other current recommendations issued by the Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Additionally, information provided directly from the Department by the Division of Communicable Disease Control or the Division of Tuberculosis Control shall be considered appropriate control measures for the protection of public health and may be used instead of the other cited references.

(4) Access to information necessary for the effective control of diseases: In the event an entity or person does not cooperate with the local health officer, Commissioner, or his designated representative by providing records or other information necessary to carry out the purposes of these Rules and/or 1200-14-04 et seq., the local health officer, the Commissioner or his designated representative may petition the General Sessions Court where the person or entity resides, is found, or is located to obtain a court order requiring disclosure of such information.

Such petition shall set forth the specific underlying facts and/or circumstances that demonstrate the information sought is necessary to carry out the purposes of these Rules and/or 1200-14-04-.01 et seq.

History

• Authority: T.C.A. §§ 4 -5-202, 68-1-103, 68-1-104, 68-1-201, 68-5-101, and 68-5-104.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987. Amendment filed March 30, 2004; effective July 29, 2004. Emergency rule filed October 8, 2009; effective through April 6, 2010. Amendment filed December 29, 2009; effective March 29, 2010.

Tenn. Comp. R. & Regs. 1200-14-01-.16 MINIMUM PERIODS OF COMMUNICABILITY

For the purpose of these regulations, the minimum periods of communicability for clinical or inapparent (subclinical) cases of the diseases named in these regulations shall be determined by the Commissioner, or his designated representative, using guidance in current resources named in section .15(3) and/or from medical consultants within the Department. The period of communicability of a specific disease shall be observed by local health officers in controlling spread of the disease and shall run from the onset of the earliest symptoms or laboratory evidence of an infectious state until the use of medications and/or laboratory tests and/or the course of the disease indicates that the person is no longer able to transmit the infection.

History

• Authority: T.C.A. § 68-5-104(q).
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987.

Tenn. Comp. R. & Regs. 1200-14-01-.17 CONFIDENTIALITY

All individually identifiable health information collected, created, and/or prepared by the Department is deemed confidential and shall not be considered a public record. The Department may disclose such information to those entities or persons as are necessary to carry out the purposes of these Rules and

Tenn. Comp. R. & Regs. 1200-14-01-.38 SALE OF TURTLES FOR SCIENTIFIC, EDUCATIONAL, OR FOOD PURPOSES

EXEMPTED.

Rule 1200-14-01-.36 does not apply to the sale of turtles to institutions for scientific or educational purposes, nor to the sale of turtles for food purposes.

History

• Authority: T.C.A. §§ 49-1769, 53-607, 53-621, 53-905, 53-1023, and 53-1109.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Rule was previously numbered 1200-14-01-.37 but was renumbered 1200-14-01-.38 with the addition of a new rule 1200-14-01-.37 filed March 23, 2016; effective June 21, 2016. 1200-14-01-39 SALE OF TURTLES OUTSIDE OF TENNESSEE EXEMPTED. Wholesale establishments in Tennessee dealing in the sale of turtles shall not be prohibited from selling turtles to other wholesale or retail establishments outside of the State of Tennessee. Authority: T.C.A. §§ 49-1769, 53-607, 53-621, 53-905, 53-102, and 53-1109.

Tenn. Comp. R. & Regs. 1200-14-01-.18 REPEALED

History

• Authority: T.C.A. § 68-5-104(a).
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Repeal filed April 20, 1987; effective June 4, 1987.

Tenn. Comp. R. & Regs. 1200-14-01-.19 REPEALED

History

• Authority: T.C.A. § 68-5-104(a).
• Administrative History: Original rule certified June 7, 1974 Repeal and new rule filed March 31, 1977; effective May 2, 1977. Repeal filed April 20, 1987; effective June 4, 1987.

Tenn. Comp. R. & Regs. 1200-14-01-.20 CONCURRENT DISINFECTIONS

It shall be the duty of the local health officer to give detailed instructions to the nurses or other persons caring for a case of communicable disease which has been officially isolated or quarantined in regard to the disinfection and disposal of all articles contaminated directly or indirectly by contact with the patient; it shall be the duty of the nurse or attendant and head of the household faithfully to carry out such disinfection throughout the communicable period of the disease.

History

• Authority: T.C.A. § 68-5-104(a).
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987.

Tenn. Comp. R. & Regs. 1200-14-01-.21 TERMINAL DISINFECTION

It shall be the duty of the local health officer, prior to the release from official isolation or quarantine of any case of communicable disease, to have instituted such terminal disinfection and cleansing measures as he may deem necessary. Terminal disinfection shall in no case be a substitute for concurrent disinfection throughout the course of the disease.

History

• Authority: T.C.A. §§ 49-1769, 53-607, 53-621, 53-905, 53-1023 and 53-1109.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987.

Tenn. Comp. R. & Regs. 1200-14-01-.22 SALE OF MILK AND MILK PRODUCTS FORBIDDEN IN CERTAIN CASES

(1) When a case of cholera, diphtheria, hepatitis type A, poliomyelitis, salmonellosis (including typhoid fever), shigellosis, campylobacteriosis, acute giardiasis, streptococcal infection, or a carrier of salmonella or shigella exists or resides on any farm or dairy producing milk, cream, butter, cheese, or other milk products, the local health officer:

(a) May prohibit the removal or sale of these products from such farm or dairy unless the handling or processing of the products be done in a manner which will preclude the possibility of contamination or the case is no longer considered infectious;

(b) Shall, if potentially contaminated products are being sold or consumed in another health jurisdiction. immediately report the situation to the local health officer concerned. Giving necessary information regarding the disease and the name and location of such farm or dairy and the place where these products are sold or consumed.

History

• Authority: T.C.A. § 68-5-104(a).
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987.

Tenn. Comp. R. & Regs. 1200-14-01-.43 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, and 68-1-104.
• Administrative History: Original rule filed July 10, 1995; effective November 28, 1995. Emergency rule filed October 8, 2009; effective through April 6, 2010. Repeal filed December 29, 2009; effective March 29, 2010. Rule was previously numbered 1200- 14-01-.42 but was renumbered 1200-14-01-.43 with the addition of a new rule 1200-14-01-.37 filed March 23, 2016; effective June 21, 2016.

Tenn. Comp. R. & Regs. 1200-14-04-.01 et seq. or as otherwise authorized or required by law.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-1-104, 68-1-201, and 68-5-104.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Repeal filed January 11, 1994; effective March 27, 1994. New rule filed March 30, 2004; effective July 29, 2004.

Tenn. Comp. R. & Regs. 1200-14-01-.23 EMPLOYMENT AS A FOODHANDLER RESTRICTED IN CERTAIN CASES

No person who is in an infectious stage with cholera, diphtheria, hepatitis type A, poliomyelitis, salmonellosis (including typhoid fever), shigellosis, campylobacteriosis, acute giardiasis or streptococcal infection shall serve or directly handle in any manner food intended for sale or public consumption.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-1-104, 68-1-201, and 68-5-104.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987. Amendment filed March 30, 2004; effective July 29, 2004.

Tenn. Comp. R. & Regs. 1200-14-01-.24 EXCLUSION FROM SCHOOL FOR SPECIAL DISEASES

(1) It shall be the duty of the school authorities for any public, private, or church-related school and day care or Head Start authorities to exclude from their facilities any child who is infected with or suspected of having the following diseases: measles, rubella, mumps, chickenpox and other illnesses designated by the local health officer as requiring exclusion.

(2) With respect to an infestation of pediculosis or scabies, it shall be the duty of school authorities for any public, private, or church-related school and day care or Head Start authorities to follow the guidelines promulgated by the U.S. Centers for Disease Control and Prevention. At any time the Department receives notice that those guidelines have been modified, it shall promptly notify the Department of Education.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-1-104, 68-1-201, and 68-5-104.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987. Amendment filed March 30, 2004; effective July 29, 2004. Repeal and new rule filed May 2, 2011; effective July 31, 2011.

Tenn. Comp. R. & Regs. 1200-14-01-.25 LOCAL AUTHORITIES MAY MAKE ADDITIONAL REQUIREMENTS

These regulations shall be considered the minimum requirements for the prevention and control of communicable diseases. Municipalities and local boards of health are authorized to make and enforce such additional ordinances, rules or regulations as they deem necessary and as herein set forth shall be enforced.

History

• Authority: T.C.A. §§ 49-1769, 53-607, 53-621, 53-905, 53-1023, and 53-1109.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977.

Tenn. Comp. R. & Regs. 1200-14-01-.26 OBSTRUCTING LOCAL HEALTH OFFICERS OR DEPARTMENTAL

REPRESENTATIVES.

No person shall interfere with or obstruct the entrance into any house or premises, or the inspection, examination, or interview of any occupant thereof or the examination of any relevant record, by the responsible health officer, his duly authorized agent or a representative of the Department in the proper discharge of his or her official duties under these Rules and 1200-14-04 et seq.

History

• Authority: T.C.A. §§ 4 -5-202, 68-1-103, 68-1-104, 68-1-201, and 68-5-104.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987. Amendment filed March 30, 2004; effective July 29, 2004.

Tenn. Comp. R. & Regs. 1200-14-01-.27 ENFORCEMENT

It shall be the duty of all local health authorities to obey and enforce the provisions of these regulations.

Whenever any local health authority willfully neglects, fails, or refuses to comply with the provisions of these regulations, and it is apparent that an epidemic of a communicable disease exists or threatens to invade other jurisdictions, it shall be the duty of the Department to carry out the provisions of the law in such municipality or county, and the necessary expenses incurred thereby shall be paid by the respective municipality or county as prescribed by law.

History

• Authority: T.C.A. §§ 4 -5-202, 68-1-103, 68-1-104, 68-1-201, and 68-5-104.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987. Amendment filed March 30, 2004; effective July 29, 2004.

Tenn. Comp. R. & Regs. 1200-14-01-.28 REPEALED

History

• Authority: T.C.A. §§ 4 -5-202, 68-1-103, 68-1-104, 68-1-201, and 68-5-104.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987. Amendment filed March 30, 2004; effective July 29, 2004. Repeal filed May 11, 2010; effective October 29, 2010.

Tenn. Comp. R. & Regs. 1200-14-01-.29 IMMUNIZATION AGAINST CERTAIN DISEASES PRIOR TO SCHOOL ATTENDANCE

IN TENNESSEE.

(1) Every nursery school, day care center, Head Start center, Kindergarten, or other pre-school, day care or grades Kindergarten through twelve of any public, private, or church related school shall obtain proof of adequate immunization against diphtheria, measles (rubeola), pertussis (whooping cough), poliomyelitis, rubella, mumps, hepatitis B and tetanus on the form prescribed by the Commissioner (unless otherwise exempted by law) prior to admitting a child. It shall be the duty of the school to enforce the provisions of this regulation, subject to the exemptions as set out in T.C.A. § 49-6-5001(b).

(2) The state and county health departments are authorized to provide proof of immunization to the admissions officer of any school in the state of Tennessee. For the purpose of this subsection, “school” shall include nursery schools, Kindergartens, other pre-schools, day care centers and facilities, after school day care facilities, grades Kindergarten through twelve of any public, private or church-related schools, vocational schools, technical schools, colleges and universities. The state and county health departments are further authorized to provide proof of immunization to physicians who are evaluating a school-aged patient’s immunization status.

(3) (a) The Department shall publish an official Certificate of Immunization (hereinafter “Certificate”). A Certificate may be signed by an individual licensed by the Board of Medical Examiners, the Board of Osteopathic Examiners, or an Advanced Practice Registered Nurse licensed by the Board of Nursing (hereinafter “providers”) or by a public health nurse employed by a local health department. The Certificate also may be qualified as complete without the signature of a provider if a certificate that has been validated by the Tennessee Immunization Registry is printed from the Registry, indicating the patient’s immunization records in the Registry meet all criteria for compliance with state requirements for that patient’s age and grade. The Certificate may include space to record vaccinations which are routinely recommended but not required by law. Certificates shall be available online to authorized users of the Tennessee Immunization Registry or in hard copy to providers from local health departments or from the Department’s central office. Tennessee Immunization Registry validated certificates may be produced by all authorized users of the Registry.

(b) As stated in subparagraph (3)(a), a certificate of immunization shall be considered “signed” by a qualified provider when it bears either 1. A hard copy signature of a qualified provider; or 2. An electronic validation of completed requirements, appropriate for the child’s age and education level, generated by the Tennessee Immunization Registry pursuant to a secure login process.

(4) For each disease identified in these rules, the Department adopts the recommended immunization schedule or the “catch-up” immunization schedule (when applicable), published by the Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC). An individual shall be presumed to be immunized against a particular disease when the individual has been immunized in a manner consistent with the recommendations of ACIP for that disease. The Department shall make the schedule available on its website and at local health departments, and shall revise the schedule from time to time in accordance with revisions published by ACIP, and shall publish the effective dates of any revisions.

(5) For children aged between 8 weeks and 19 months of age enrolling in child care facilities, a provider shall issue a Certificate showing a child is age-appropriately immunized in accordance with the ACIP schedule at the time of enrollment. For these children, a provider shall issue an updated Certificate at no later than 19 months of age.

(6) A provider may issue a Temporary Certificate for a child who has not received all required vaccines, but is in the process of completing required immunizations. A Temporary Certificate must have an expiration date that is one month after the date the next required immunization is due according to the minimum acceptable (“catch-up”) dose interval published on the Official Immunization Schedule. An expired Certificate is not valid proof of immunization. The school shall obtain a current Certificate no later than the expiration date of a Temporary Certificate.

(7) A provider shall certify adequate immunization against measles, mumps and rubella for admission into any child care facility and grades Kindergarten through twelve. For purposes of this paragraph adequate immunization is defined as:

(a) For children 12 months of age or older admitted to a child care facility, one dose of vaccine against measles, mumps and rubella administered no earlier than 4 days before the first birthday; or (b) For children admitted to grades Kindergarten through twelve, two doses of vaccine against measles, mumps and rubella, administered a minimum of 28 days apart and no earlier than 4 days before the first birthday; or (c) For children 12 months of age or older, laboratory evidence of immunity against each disease.

(8) A provider shall certify adequate immunization against Haemophilus influenza type B (“Hib”) for any child under the age of five years entering into any child care facility.

(9) A provider shall certify adequate immunization against varicella, or a history of varicella disease, prior to admission of a child aged 12 months or older in licensed child care facilities.

For purposes of this paragraph, adequate immunization is defined as:

(a) One dose of varicella vaccine administered no earlier than 4 days before the child‘s first birthday; or (b) Laboratory evidence of immunity; or (c) A history verified by a physician, advanced practice nurse, physician’s assistant or public health nurse employed by a local health department, of varicella disease.

Documentation of the past illness is not required to confirm a history of disease;

(10) A provider shall certify adequate immunization against varicella, or a history of the disease, prior to a child’s entry into Kindergarten.

(11) A provider shall certify adequate immunization against varicella for any child entering Kindergarten, and for new enrollees into any school. For purposes of this paragraph, adequate immunization is defined as one of the following:

(a) Two doses of varicella vaccine; administered at least 28 days apart and no earlier than 4 days before the child’s first birthday; or (b) Laboratory evidence of immunity; or (c) A history verified by a physician, advanced practice nurse, physician’s assistant or public health nurse employed by a local health department, of varicella disease.

Documentation of the past illness is not required to confirm a history of disease;

(12) Effective July 1, 2010, a provider shall certify adequate immunization against pneumococcal disease for enrollment of any child under the age of five years into any child care facility.

(13) Effective October 1, 2010, a provider shall certify continued adequate immunization against tetanus, diphtheria and pertussis for any child entering the 7th grade (or, in the case of students in ungraded classrooms, any child age 13). For the purposes of this paragraph, adequate immunization is defined as a complete primary tetanus and diphtheria-containing vaccine series and a dose of vaccine against tetanus, diphtheria and pertussis administered at or after age 10 years.

(14) Effective July 1, 2010, a provider shall certify adequate immunization against hepatitis A for any child aged 18 months or over, but under five (5) years, enrolling in child care facilities. For purposes of this paragraph, adequate immunization is defined as (a) One dose of hepatitis A vaccine; or (b) Documented laboratory evidence of immunity.

(15) Effective July 1, 2011, a provider shall certify adequate immunization against hepatitis A for any child enrolling in Kindergarten. For purposes of this paragraph, adequate immunization is defined as (a) Two doses of hepatitis A vaccine; or (b) Documented laboratory evidence of immunity.

(16) Unless exempted by law, any new full-time enrollee of a higher education institution with an enrollment greater than two hundred students who is not enrolled as a full-time distance learning student shall present proof of adequate immunization against the following diseases:

(a) Measles, provided that this requirement shall only apply to those students born on or after January 1, 1957; for purposes of this subparagraph, adequate immunization is defined as:

1. Two doses of measles-containing vaccine, administered at least 28 days apart and no earlier than 4 days before the first birthday; or 2. Laboratory evidence of immunity.

(b) Mumps, provided that this requirement shall only apply to those students born on or after January 1, 1957; for purposes of this subparagraph, adequate immunization is defined as:

1. Two doses of mumps-containing vaccine, administered at least 28 days apart and no earlier than 4 days before the first birthday; or 2. Laboratory evidence of immunity.

(c) Rubella, provided that this requirement shall only apply to those students born on or after January 1, 1957; for purposes of this subparagraph, adequate immunization is defined as:

1. Two doses of rubella-containing vaccine, administered at least 28 days apart and no earlier than 4 days before the first birthday; or 2. Laboratory evidence of immunity.

(d) Varicella, provided that this requirement shall only apply to those students born on or after January 1, 1980. For purposes of this subparagraph, adequate immunization is defined as follows:

1. Two doses of varicella-containing vaccine, administered at least 28 days apart; or 2. Laboratory evidence of immunity; or 3. A history verified by a physician, advanced practice nurse, physician’s assistant or public health nurse employed by a local health department, of varicella disease.

Documentation of the past illness is not required to confirm a history of disease.

(e) For purposes of this paragraph, “full time” means, for an undergraduate, enrolled in twelve (12) or more educational credit hours, and for a graduate student, enrolled in nine (9) or more educational credit hours, or such lesser number as may be deemed full time by the institution. Such students may be enrolled or registered after a single dose of all required vaccines, provided that the second dose is obtained within 2 months of registration, and at least 28 days after the first dose, and provided, further, that the institution has a procedure for identifying students who have failed to obtain the necessary immunizations and for taking appropriate action to ensure compliance.

(17) Effective July 1, 2011, unless exempted by law, any student enrolled in a higher education institution who is a student in a school of medicine, nursing, dentistry, laboratory technology or other allied health profession shall present proof of protection against hepatitis B before such trainee is expected to perform procedures with the potential to expose them to potentially infectious blood. For purposes of this paragraph adequate immunization is defined as:

(a) A complete hepatitis B vaccine series; or (b) Laboratory evidence of immunity or infection (18) An individual may be exempted from the requirements of this section only under the following circumstances:

(a) Where a physician licensed by the Board of Medical Examiners, the Board of Osteopathic Examiners or a public health nurse employed by a local Health Department determines that a particular vaccine is contraindicated for one of the following reasons:

1. The individual meets the criteria for contraindication set forth in the manufacturer’s vaccine package insert; or 2. The individual meets the criteria for contraindication published by the U.S.

Centers for Disease Control or the ACIP;

3. In the best professional judgment of the physician, based upon the individual’s medical condition and history, the risk of harm from the vaccine outweighs the potential benefit.

(b) An individual who has been exempted from a particular vaccination must comply with immunization requirements for any vaccines from which he/she has not been exempted.

(c) Where a parent or guardian, or in the case of an adult student, the student, provides to the school a written statement, affirmed under penalties of perjury, that vaccination conflicts with the religious tenets and practices of the parent or guardian, or in the case of an adult student, the student.

(19) If the Commissioner determines that insufficient vaccine is available to meet the terms of these rules, the Commissioner shall notify providers, the Commissioners of the Departments of Education and Human Services and the public of any necessary change in immunization requirements, consistent with any changes published by ACIP. The changes will be published as a temporary addendum to the Official Immunization Schedule and individuals vaccinated in accordance with that temporary schedule will be deemed adequately immunized until the Commissioner determines, in accordance with ACIP recommendations, that sufficient vaccine is again available. When sufficient vaccine is again available, Commissioner shall so notify providers, the Commissioners of Education and Human Services and the public and reinstate the Official Immunization Schedule. The reinstated Official Immunization Schedule shall not become effective until at least 2 months after the determination that sufficient vaccination is again available.

History

• Authority: T.C.A. §§ 4-5-202, 49-6-5001, 49-6-5002(a), 49-6-5003, 68-1-103, 68-5-103, and 68-5-105(a).
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987. Amendment filed April 21, 1988; effective June 5, 1998. Amendment filed June 8, 1990; effective July 23, 1990. Amendment filed August 26, 1998; effective November 9, 1998. Amendment filed July 29, 1999; effective October 9, 1999. Amendment filed July 10, 2001; effective September 23, 2001. Withdrawal filed September 21, 2001, 1200-14-01-.29(7). Amendment filed September 10, 2009; effective December 9, 2009. Amendments filed June 13, 2013; effective November 28, 2013. Amendments filed July 15, 2019; effective October 13, 2019.

Tenn. Comp. R. & Regs. 1200-14-01-.30 RABIES

The definition of “dog,” “cat,” “owner,” and “vaccination” as defined in T.C.A. § 68-8-102, shall be applicable in these regulations.

History

• Authority: T.C.A. § 68-8-105.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987.

Tenn. Comp. R. & Regs. 1200-14-01-.31 PUBLIC RABIES VACCINATION CLINICS

It shall be the duty of each local health department to provide vaccination of dogs and cats against rabies.

In addition to the registration fee as provided for in Section 68-8-104, Tennessee Code Annotated, dog and cat owners may be required to pay the cost for each dog and cat vaccinated, which shall include the cost of the vaccine and the services for the vaccination. Nothing herein shall be construed as not permitting a veterinarian to charge his regular fee outside of health department sponsored vaccination clinics.

History

• Authority: T.C.A. § 68-8-105.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987.

Tenn. Comp. R. & Regs. 1200-14-01-.32 AUTHORIZED RABIES VACCINE SOURCES AND TYPES

It shall be the duty of any person authorized to vaccinate dogs and cats to select and properly use a rabies vaccine of either a killed virus or modified live virus tissue culture type which is licensed by and in accordance with the standards prescribed by the United States Department of Agriculture for interstate sale and use. To insure proper vaccination and to provide proof of current vaccination status, T.C.A. 68-8- 103 requires that all rabies vaccinations be given by or under the direct supervision of a veterinarian licensed in the State. It shall be prohibited to sell rabies vaccine for use in dogs and cats to persons other than licensed veterinarians unless the purchaser possesses a prescription for the vaccine from a veterinarian duly licensed in Tennessee. These regulations apply only to the rabies vaccinations of domestic dogs and cats. The most recent Compendium of Animal Rabies Vaccines published by the Association of State Public Health Veterinarians shall be used as a guideline by public health officials and veterinarians for the selection of approved rabies vaccines and their appropriate use (site and route of inoculation, duration of immunity, species application, etc.). A State-furnished rabies vaccination tag and certificate shall be issued to every owner whose dog or cat is vaccinated and a copy of the certificate provided by the veterinarian to the local health department.

History

• Authority: T.C.A. § 68-8-105.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987.

Tenn. Comp. R. & Regs. 1200-14-01-.33 RABIES VACCINATION SCHEDULE OF DOGS AND CATS

It shall be the duty of every owner to have his dog or cat vaccinated against rabies after the dog reaches three months of age, the cat six months of age. Regardless of the type of licensed vaccine used or the age of the animal at the time of the first (primary) vaccination, the animal shall be revaccinated one year later. Following the first two vaccinations, booster vaccinations will be due at either one or three year intervals in accordance with the approved duration of immunity of the specific vaccine used and the species vaccinated. The required due date for revaccination shall be placed on the certificate by the veterinarian administering the vaccine. As part of their registration and rabies control programs, local jurisdictions may have more stringent requirements, such as annual rabies vaccinations regardless of vaccine type used. For purposes of animal control programs and medical decisions regarding human antirabies treatments, a dog or cat shall be considered currently vaccinated only if a valid certificate exists and the revaccination date on the certificate has not been reached.

History

• Authority: T.C.A. § 68-4-405.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987.

Tenn. Comp. R. & Regs. 1200-14-01-.34 RABIES VACCINATION CERTIFICATE

The current vaccination certificate identifying the animal, the vaccine used. the due date for revaccination and other information as required in T.C.A. § 68-8-104 shall be kept by the person who owns, keeps or harbors the said dog or cat at all times subject to the inspection of the proper county officer. Copies of the current certificate shall also be kept by the local health department and by the veterinarian administering the vaccine.

History

• Authority: T.C.A. § 68-8-105.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendment filed April 20, 1987; effective June 4, 1987.

Tenn. Comp. R. & Regs. 1200-14-01-.35 TURTLES, TORTOISES, AND TERRAPINS

(1) “Turtle” means any reptile of the order Chelonia.

(2) “Institution” means a school, college, university, research laboratory or other facility having a bonafide research or teaching interest in turtles. Zoos supported by public funds are also defined as “institutions”.

History

• Authority: T.C.A. §§ 49-1769, 53-607, 53-621, 53-905, 53-1023, and 53-1109.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977.

Tenn. Comp. R. & Regs. 1200-14-01-.36 SALE OF TURTLES

(1) Except as otherwise provided in this chapter, it shall be unlawful to import, sell, barter or otherwise exchange or distribute to the public, any live turtle(s) with a carapace length of less than four (4) inches. This includes offering them for adoption or for free with or without the purchase of pet supplies (e.g., turtle tanks, food, etc.).

(2) It shall be unlawful to sell turtles to anyone under eighteen (18) years of age.

(3) The Commissioner or the Commissioner’s designated representative may order the removal to institutions for scientific or educational purposes, exportation, or humane destruction of any turtle(s) that are unlawfully imported, sold, bartered, exchanged or offered for sale or distribution to the public in violation of paragraph (1) and/or paragraph (2) above.

(4) The Commissioner or the Commissioner’s designated representative may quarantine turtles or take samples of tank water or any other appropriate samples of or from turtles offered for sale or distribution for the purpose of testing for salmonella or other organisms which may cause or have caused disease in humans. The Commissioner or the Commissioner’s designated representative may order the immediate removal to institutions for scientific or educational purposes, exportation, or humane destruction of any turtle(s) found contaminated with salmonella or other organisms which may cause or have caused disease in humans.

(5) The following warning shall be posted conspicuously for buyer information at every display of turtles for retail sale or distribution or where the public may come in contact with turtles:

CAUTION: Children under 5 years old and people with weak immune systems (such as chemotherapy patients or those with HIV/AIDS) should avoid contact with reptiles.

These people can get very sick from a germ, called salmonella, that reptiles carry.

Reptiles include lizards, snakes, alligators, and turtles. Wash hands thoroughly after handling turtles or material that had contact with turtles. Do not allow water or any other substance that had contact with turtles to come in contact with food or areas where food is prepared. Do not bathe turtles or clean their tanks in your kitchen or bathroom and do not have close contact with turtles which could allow direct contamination of the mouth (e.g., kissing, etc.).

(6) Receipts and record keeping required:

(a) For each sale of turtle(s) at retail, a sales receipt shall be issued by the seller to the purchaser at the time of the sale. The sales receipt shall have printed legibly on its front or shall be accompanied by an informational sheet with the warning statement contained in paragraph (5) above.

(b) The seller shall keep a complete record of all purchases, losses, and other dispositions of turtles. The Commissioner or the Commissioner’s designated representative may request these records at any time.

History

• Authority: T.C.A. §§ 49-1769, 53-607, 53-621, 53-905, 53-102, 53-1109, 4-5-202, 68-1-103, and 68-1- 104.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Amendments filed March 23, 2016; effective June 21, 2016.

Tenn. Comp. R. & Regs. 1200-14-01-.37 TURTLES IN PRE-KINDERGARTEN SCHOOLS, DAYCARE CENTERS, AND

CHILDCARE CENTERS.

It shall be unlawful for any pre-kindergarten school, daycare center, or childcare center to have turtles on their premises unless such school, daycare center or childcare center shall have given the parents of enrolled children written guidance conforming with the language set forth in Rule 1200-14-01-.36(5).

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, and 68-1-104.
• Administrative History: New rule filed March 23, 2016; effective June 21, 2016.

Tenn. Comp. R. & Regs. 1200-14-01-.40 REPEAL OF THE CONFLICTING REGULATIONS

All rules, regulations, and by-law of the State Department of Public Health previously adopted which are in conflict with the provisions of these regulations are hereby repealed.

History

• Authority: T.C.A. §§ 49-1769, 53-607, 53-621, 53-905, 53-1023, and 53-1109.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Rule was previously numbered 1200-14-01-.39 but was renumbered 1200-14-01-.40 with the addition of a new rule 1200-14-01-.37 filed March 23, 2016; effective June 21, 2016.

Tenn. Comp. R. & Regs. 1200-14-01-.41 VALIDATION AND ENDORSEMENT OF REGULATIONS

If for any reason regulation or part of a regulation shall be held to be unconstitutional or invalid, then that fact shall not invalidate any other part of these regulations, but the same shall be enforced without reference to the part so held to be invalid.

History

• Authority: T.C.A. §§ 49-1769, 53-607, 53-621, 53-905, 53-1023, and 53-1109.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed March 31, 1977; effective May 2, 1977. Rule was previously numbered 1200-14-01-.40 but was renumbered 1200-14-01-.41 with the addition of a new rule 1200-14-01-.37 filed March 23, 2016; effective June 21, 2016.

Tenn. Comp. R. & Regs. 1200-14-01-.42 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 37-1-403(G), 68-1-103, 68-1-106, 68-10-101, 68-10-112, 68-10-113, and 68-29-107.
• Administrative History: Original Rule filed April 20, 1987; effective June 4, 1987. Amendment filed December 16, 1991; effective January 30, 1992. Amendment filed March 31, 2000; effective June 14, 2000. Emergency rule filed October 8, 2009; effective through April 6, 2010. Repeal filed December 29, 2009; effective March 29, 2010. Rule was previously numbered 1200-14-01-.41 but was renumbered

Chapter 1200-14-02 AIDS Drug Assistance Program Rules

Tenn. Comp. R. & Regs. 1200-14-02-.02 PURPOSE AND ADMINISTRATION OF ADAP FUNDS

(1) HDAP

Through HDAP, the Department shall:

(a) Provide applications and instructional forms regarding eligibility criteria, the Formulary, and other guidelines for participation;

(b) Determine which medications shall be included in the Formulary;

(c) Purchase Formulary medications for Clients;

(d) Contract licensed pharmacists to Provide Formulary medications to Clients pursuant to prescriptions by providers; and (e) Coordinate with TennCare to ensure that Clients do not receive benefits from both programs simultaneously.

(2) IAP

Through IAP, the Department shall:

(a) Provide applications and instructional forms regarding eligibility criteria, the Formulary, and other guidelines for participation;

(b) Provide assistance paying health insurance premiums, co-payments, and/or deductibles for eligible Clients.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-1-106, and 68-10-109.
• Administrative History: Original rule filed March 31, 1988; effective May 15, 1988. Amendment filed January 26, 1990; effective March 12, 1990. Amendment filed December 29, 1995; effective April 29, 1996. Repeal and new rule filed January 3, 2012; effective June 30, 2012.

Tenn. Comp. R. & Regs. 1200-14-02-.03 ELIGIBILITY CRITERIA

(1) To qualify for Ryan White Program services, an applicant must submit a completed and signed Ryan White Program application including evidence that applicant meets the following eligibility requirements:

(a) Is a resident of Tennessee;

(b) Meets the generally accepted medical criteria for HIV disease;

(c) An income level and total liquid assets that do not exceed the limits set by the Department and posted semiannually on its website; and (d) For ADAP applicants, presents certification that applicant has no other source of third party reimbursement for prescription drugs.

(2) For purposes of establishing income and assets the following shall apply:

(a) For applicants 18 years and older, only the income and assets of the applicant and the applicant’s legal spouse with whom the applicant resides will be considered.

(b) For applicants less than 18 years of age, the income and assets of the applicant and the legal parent or parents with whom the applicant resides will be considered. Income and assets of step-parents and legal guardians shall not be considered.

(3) In order to continue to receive any Ryan White Program services, a Client must submit the following every six (6) months:

(a) Confirmation that the Client continues to meet the eligibility criteria; and (b) A completed and signed recertification application.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-1-106, and 68-10-109.
• Administrative History: Original rule filed March 31, 1988; effective May 15, 1988. Amendment filed January 26, 1990; effective March 12, 1990. Repeal and new rule filed January 3, 2012; effective June 30, 2012. Emergency rule filed December 23, 2015 effective through June 20, 2016. Amendment filed December 23, 2015; effective March 22, 2016.

Tenn. Comp. R. & Regs. 1200-14-02-.04 PROGRAM LIMITED TO AVAILABLE FUNDS

(1) The availability of funds limits the number of Clients receiving ADAP services. The Department shall cease approval of applications if funding is insufficient to sustain additional recipients.

(2) Current Clients shall have priority for funding.

(3) Eligible applicants who are denied ADAP enrollment due to a funding shortage shall be placed on a waiting list managed by the Ryan White Program.

(4) Individuals on the ADAP waiting list in one of the following Priority Groups shall be provided with temporary emergency ADAP services as follows:

(a) Pregnant women shall be eligible for ADAP services during pregnancy and up to 90 days post partum; and (b) Infants up to one year of age shall be eligible for ADAP services for up to 180 days of coverage.

(5) The Department shall review available funding by March 31 and September 30 of each year, at which time it shall notify all current clients of the maximum income level and liquid assets for program eligibility. The Department will also post this information on its website.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-1-106, and 68-10-109.
• Administrative History: Original rule filed March 31, 1988; effective May 15, 1988. Amendment filed January 26, 1990; effective March 12, 1990. Repeal and new rule filed January 3, 2012; effective June 30, 2012. Emergency rule filed December 23, 2015 effective through June 20, 2016. Amendment filed December 23, 2015; effective March 22, 2016.

Tenn. Comp. R. & Regs. 1200-14-02-.01 DEFINITIONS

(1) For the purpose of these regulations the terms used herein are defined as follows:

(a) “ADAP” means the AIDS Drug Assistance Program, the federal earmark in the Ryan White Part B grant providing funding for HIV Clients’ medications, which encompasses HDAP and IAP.

(b) “AIDS” means Acquired Immune Deficiency Syndrome or Acquired Immunodeficiency Syndrome.

(c) “Certification” means the determination that an applicant meets the eligibility criteria to receive assistance through the Ryan White Program.

(d) “Client” means a person enrolled in the Ryan White Program.

(e) “Department” means the Tennessee Department of Health.

(f) “FDA” means the U.S. Food and Drug Administration.

(g) “Formulary” means the HDAP Formulary, which lists the FDA approved medications provided by Tennessee’s HDAP Program.

(h) “HDAP” means the HIV Drug Assistance Program, a program through which the Department provides Formulary medications to Clients.

(i) “HIV” means Human Immunodeficiency Virus.

(j) “IAP” means Insurance Assistance Program, a program through which the Department provides assistance paying health insurance premiums, co-payments, and/or deductibles for eligible Clients.

(k) “Priority Group” means those eligible for temporary emergency access to HDAP or IAP services if there is a waiting list.

(l) “Program Director” means the Department employee responsible for the overall management of grants and programs in the HIV/AIDS/STD Section of the Department.

(m) “Provider” means a health care professional with prescriptive authority, licensed pursuant to Title 63 of the Tennessee Code.

(n) “Ryan White Program“ means the Departmental program that receives federal Ryan White Part B funding and provides medical services, medications, and support services to eligible individuals.

(o) “TennCare” means Tennessee’s State Medicaid Program.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-1-106, and 68-10-109.
• Administrative History: Original rule filed March 31, 1988; effective May 15, 1988. Amendment filed January 26, 1990; effective March 12, 1990. Repeal and new rule filed January 3, 2012; effective June 30, 2012.

Tenn. Comp. R. & Regs. 1200-14-02-.05 CERTIFICATION OF COVERAGE BY PROGRAM

(1) The Department will notify applicants whether certification of coverage has been awarded.

Applicants for whom coverage is certified are not guaranteed ADAP services beyond the federal fiscal year of the current grant.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-1-106, and 68-10-109.
• Administrative History: Original rule filed March 31, 1988; effective May 15, 1988. Amendment filed January 26, 1990; effective March 12, 1990. Repeal and new rule filed January 3, 2012; effective June 30, 2012.

Tenn. Comp. R. & Regs. 1200-14-02-.06 RECONSIDERATION OF DENIAL

(1) Applicants denied or removed from participation in HDAP or IAP may request reconsideration.

(a) The applicant must request reconsideration in writing, directed to the Program Director, within twenty one (21) calendar days of denial or removal. The Program Director will issue a reconsidered decision in writing within fourteen (14) days of the request for reconsideration. The Program Director’s review is limited to a determination of whether or not the applicant meets eligibility criteria. The decision of the Program Director is final.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-1-106, and 68-10-109.
• Administrative History: Original rule filed March 31, 1988; effective May 15, 1988. Amendment filed January 26, 1990; effective March 12, 1990. Repeal and new rule filed January 3, 2012; effective June 30, 2012.

Tenn. Comp. R. & Regs. 1200-14-02-.07 CONFIDENTIALITY OF RECORDS

All applicant or recipient identifying information or records of the ADAP program shall be considered confidential as required by the federal legislation authorizing funding assistance to the program. Such information or records shall not be disclosed by the program except for those purposes for which a signed release is provided by the person served. All correspondence containing the identity of program applicants or recipients shall be sealed and marked “CONFIDENTIAL”.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-1-106, and 68-10-109.
• Administrative History: Original rule filed March 31, 1988; effective May 15, 1988. Amendment filed January 26, 1990; effective March 12, 1990. Repeal and new rule filed January 3, 2012; effective June 30, 2012.

Chapter 1200-14-03 Repealed

Tenn. Comp. R. & Regs. 1200-14-03-.01 REPEALED

History

• Authority: T.C.A. §§ 4-5-204, 63-1-120, 63-1-120(8), 63-1-136, 63-6-219, 68-1-101, 68-1-103, 68-1-106, 68-10-101, 68-10-109, 68-10-112, 68-10-113, 68-10-114, and 68-29-107, and Public Law 102-141, Section 633.
• Administrative History: Original rule filed August 20, 1993; effective November 3, 1993. Amendments filed July 3, 2019; effective October 1, 2019. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-14-03-.03 REPEALED

History

• Authority: T.C.A. §§ 4-5-204, 63-1-120, 63-1-120(8), 63-1-136, 63-6-219, 68-1-101, 68-1-103, 68-1-106, 68-10-101, 68-10-109, 68-10-112, 68-10-113, 68-10-114, and 68-29-107, and Public Law 102-141, Section 633.
• Administrative History: Original rule filed August 20, 1993; effective November 3, 1993. Amendments filed July 3, 2019; effective October 1, 2019. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-14-03-.02 REPEALED

History

• Authority: T.C.A. §§ 4-5-204, 63-1-120, 63-1-120(8), 63-1-136, 63-6-219, 68-1-101, 68-1-103, 68-1-106, 68-10-101, 68-10-109, 68-10-112, 68-10-113, 68-10-114, and 68-29-107, and Public Law 102-141, Section 633.
• Administrative History: Original rule filed August 20, 1993; effective November 3, 1993. Amendments filed July 3, 2019; effective October 1, 2019. Repeal filed June 24, 2024; effective September 22, 2024.

Chapter 1200-14-04 Disease Control Health Threat Procedures

Tenn. Comp. R. & Regs. 1200-14-04-.01 INTRODUCTION

This chapter outlines procedures to be followed by the Commissioner, health officers, and their designees, in carrying out disease control enforcement activities involving persons or premises that pose a health threat to others.

History

• Authority: T.C.A. §§ 4-3-1803(1), (3), (4), and (10); 4-5-202; 68-1-103; 68-1-104; 68-1-201; and 68-5- 104.
• Administrative History: Original rule filed January 11, 1994; effective March 27, 1994. Repeal and new rule filed March 30, 2004; effective July 29, 2004.

Tenn. Comp. R. & Regs. 1200-14-04-.02 DEFINITIONS

(1) Approved health care facility: a hospital or other health care facility approved by the Commissioner as having appropriate and necessary facilities, staff, and services for the diagnosis and treatment of people with a communicable disease.

(2) Carrier: a person who harbors, or who the Commissioner, a health officer, or a designee reasonably believes to harbor, a specific pathogenic organism and who is potentially capable of spreading the organism to others, whether or not there are presently discernible signs and symptoms of the disease.

(3) Chief Medical Officer: the State Health Officer who is appointed by the Commissioner of Health (as provided by T.C.A. § 68-1-102(c) to advise the Commissioner on all matters of state health policy or a physician who is the State Health Officer’s designee.

(4) Clear and convincing evidence: evidence which is positive and explicit, and which directly establishes the point to which it is adduced. It means greater than a preponderance of the evidence standard but less than a beyond a reasonable doubt standard.

(5) Commissioner: the Commissioner of Health, or his designee, as provided at T.C.A. § 68-1- 102(b) and (c).

(6) Communicable Disease: a disease or condition resulting from infection by a pathogenic organism (infectious agent) that may cause serious illness, disability, or death and which may be transmitted from one person to another.

(7) Competent medical experts: physicians who are trained and experienced in the diagnosis, treatment and control of infectious/communicable disease and rely on known clinical or epidemiological evidence. Generally, the standard for determining the existence of a significant risk to others is the reasonable medical judgment of the public health authorities.

(8) Department: the Tennessee Department of Health.

(9) Emergency: a person or premises is a health threat to others and there is a clear and imminent danger to the public health unless the person is immediately separated from other persons or access to the premises is prevented or restricted, because no less restrictive alternatives exist which would reasonably protect the public health.

(10) Health directive: a written statement (or, in compelling circumstances, an oral statement followed by a written statement), based on clinical or epidemiological evidence of the kind relied upon by competent medical experts, that is issued by the Commissioner or health officer, requiring a person to cooperate with health authorities’ efforts to prevent or control transmission of a disease that poses a health threat to others.

(11) Health Officer: the Chief Medical Officer for the State of Tennessee; a licensed physician who is authorized by the Department to function as a county, district, or regional health officer in Tennessee, a licensed physician who serves as the health director or health officer of any metropolitan public health department in Tennessee; a licensed physician in the central office of the Department’s Health Services Administration.

(12) Health threat to others: the direct threat of endangerment to others due to the presence of a cause or source of a disease on premises, or due to the inability, unwillingness, or failure of a carrier to act in such a manner as to not place others, without their consent, at significant risk of exposure to, based on the reasonable medical judgment and clinical or epidemiological understanding of public health authorities, a disease that may cause serious illness, disability, or death. A determination of whether or not premises or a person poses a health threat to others may include, but is not necessarily limited to, assessing the cause, source, and/or nature of a disease, the likelihood of infection, the modes of transmission, the risk of transmission, and the severity of harm that might result due to transmission of a disease.

With respect to carriers, such a determination is not based solely on a person’s past behavior but also involves an assessment of a person’s current situation, including the effects of educational efforts and statements of intent. A person having a disease, such as active tuberculosis, even though rendered temporarily not capable of transmission because of receiving therapy, who discontinues treatment prior to reaching a curative result, may continue to be a health threat to others.

(13) Isolation: the separation for the period of communicability of infected persons, or persons reasonably suspected to be infected, from other persons, in such places and under such conditions as will prevent the direct or indirect conveyance of the infectious agent from infected persons to other persons who are susceptible or who may spread the agent to others.

(14) Least restrictive alternative: use of means sufficient to protect the public health but tailored to infringe upon any legally protected liberty interests, privacy interests, property interests, and/or association interests of a person or premises determined to be a health threat to others in the least restrictive manner.

(15) Petitioner: the Commissioner or health officer who commences an action in General Sessions Court pursuant to these Rules.

(16) Public health measure: a measure or measures, consistent with the purpose of these Rules, imposed by a General Sessions Court against a carrier or owner or operator of premises in order to prevent the spread of a disease that poses a health threat to others.

(17) Quarantine: limitation of freedom of movement or isolation of a person, or preventing or restricting access to premises upon which the person, cause or source of a disease may be found, for a period of time as may be necessary to confirm or establish a diagnosis, to determine the cause or source of a disease, and/or to prevent the spread of a disease. These limitations may be accomplished by placing a person in a health care facility or a supervised living situation, by restricting a person to the person’s home, or by establishing some other situation appropriate under the particular circumstances.

(18) Respondent: a person against whom an action in General Sessions Court is commenced pursuant to these Rules.

(19) Transmission: the transfer of an infectious agent from one person to another, including, but not limited to, airborne transmission, bloodborne transmission, foodborne transmission, sexual transmission, skin contact transmission, or waterborne transmission.

History

• Authority: T.C.A. §§ 4-3-1803, 4-5-202, 68-1-103, 68-1-104, 68-1-201, and 68-5-104 and Executive Order No. 14 (2020).
• Administrative History: Original rule filed January 11, 1994; effective March 27, 1994. Repeal and new rule filed March 30, 2004; effective July 29, 2004. Emergency rules filed March 17, 2020; effective through September 13, 2020. Emergency rules expired effective September 14, 2020, and the rules reverted to their previous statuses.

Tenn. Comp. R. & Regs. 1200-14-04-.03 REPORTING A HEALTH THREAT TO OTHERS

(1) Any person licensed by the State of Tennessee to practice a healing art who has reasonable cause to believe that a person is or may be a health threat to others [as defined in 1200-14- 04-.02(12) of these Rules] because the person is unable, is unwilling, or is failing to act in such a manner as to not place others at significant risk of exposure to infection that causes serious illness, disability, or death shall report that information to the Commissioner or a health officer.

(2) In the event a carrier of a disease that poses a health threat to others uses interstate or international flight to avoid treatment and/or isolation and/or quarantine in Tennessee, such individual shall be deemed to have waived confidentiality as to his health status, and Tennessee health authorities can contact health authorities in the jurisdiction to which the individual fled regarding the health threat presented by the carrier.

History

• Authority: T.C.A. §§ 4-3-1803(1), (3), (4), and (10); 4-5-202; 68-1-103; 68-1-104; 68-1-201; and 68-5- 104.
• Administrative History: Original rule filed January 11, 1994; effective March 27, 1994. Amendment filed December 16, 1999; effective February 29, 2000. Repeal and new rule filed March 30, 2004; effective July 29, 2004.

Tenn. Comp. R. & Regs. 1200-14-04-.04 HEALTH DIRECTIVE

(1) If the Commissioner or health officer reasonably believes, based upon clinical or epidemiological evidence of the kind relied upon by competent medical experts, that a health threat to others exists, then he/she shall have the authority to issue a health directive pursuant to the conditions set forth in these Rules, in order to protect the public health. A health directive shall be a written statement or, in compelling circumstances, an oral statement followed within three (3) days by a written statement. A health directive shall be individual and specific and shall not be issued to a class of persons. The purpose of a health directive is to direct a carrier or owner or operator of premises to cooperate with health authorities’ efforts to prevent or control transmission of a disease that poses a health threat to others.

(2) A health directive may include, but is not necessarily limited to, participation in education and counseling, medical tests and examinations to verify carrier status, participation in treatment programs, isolation and/or or quarantine, or preventing or restricting access to premises upon which a person, cause or source of a disease may be found, for a period of time as may be necessary to confirm or establish a diagnosis, to determine the cause or source of a disease, and/or to prevent the spread of a disease. In no case may a person be isolated, held or detained, pursuant to these Rules, in a correctional facility.

(3) If a carrier or owner or operator of premises refuses to undergo tests or examinations ordered in a health directive, the Commissioner or health officer may be limited in his or her ability to obtain sufficient evidence to evaluate a potential health threat to others and he/she, lacking the necessary tests or examinations, may be compelled to conclude for the sake of the public health that a health threat to others is present. Then the carrier must undergo testing sufficient to prove the health threat to others does not exist.

(4) Inability, unwillingness, or failure of a carrier or owner or operator of premises to comply with a health directive shall be grounds for proceeding with a petition in the General Sessions Court for a temporary hold in emergency situations and/or a public health measure.

(5) Medical information contained in a health directive or in any other statement from the Commissioner or health officer or designee to a carrier pursuant to these Rules is confidential, except to the extent necessary for the administration and enforcement of public health laws and rules, and is not subject to public disclosure without appropriate authorization in accordance with state and/or federal law.

(6) Prior to issuing a health directive, the Commissioner or health officer should review the written medical and other records pertinent to the matter, along with any measures that have been taken, and make findings using clinical or epidemiological evidence of the kind relied upon by competent medical experts. These findings should be included in the health directive itself.

(7) When a health directive is issued to a carrier or owner or operator of premises, such person may request a review of the decision. Any request for review must be submitted to the Office of the Chief Medical Officer. Within five (5) business days of the receipt of the request, the Chief Medical Officer or his designee shall review the underlying facts with the health officer issuing the directive and shall notify the person in writing of the review decision. A person against whom a health directive has been issued may also request that the conditions of the directive be obtained in the form of a public health measure. The health directive should be considered as remaining in force during the review process. Health directives should contain sufficient information to enable a person to avail himself of discussion and review, and a copy of these Rules should be attached to the health directive.

(8) A health directive shall employ the least restrictive alternative, based on the reasonable medical judgment of competent medical experts relying on clinical or epidemiological evidence, that will adequately protect the public health and prevent the spread of a disease that poses a health threat to others.

(9) Nothing in this Rule shall preclude a person to whom a health directive is issued from consulting with and being assisted by legal counsel.

History

• Authority: T.C.A. §§ 4-3-1803, 4-5-202, 68-1-103, 68-1-104, 68-1-201, and 68-5-104 and Executive Order No. 14 (2020).
• Administrative History: Original rule filed January 11, 1994; effective March 27, 1994. Repeal and new rule filed March 30, 2004; effective July 29, 2004. Emergency rules filed March 17, 2020; effective through September 13, 2020. Emergency rules expired effective September 14, 2020, and the rules reverted to their previous statuses.

Tenn. Comp. R. & Regs. 1200-14-04-.05 TEMPORARY HOLD IN EMERGENCY SITUATIONS

(1) In the case of an emergency, the Commissioner or health officer may petition the General Sessions Court of the county where the person lives or is to be found, or where the premises is located, to either: (1) order a peace officer to make a civil arrest and take the person to an appropriate health care facility for examination, isolation and/or appropriate treatment; or (2) prevent or restrict access to premises. The Commissioner or health officer shall set forth in an affidavit the specific facts upon which the order is sought, indicating why reasonable cause exists (upon the basis of sound clinical or epidemiological evidence of the type relied upon by competent medical experts) to believe that there is a substantial likelihood that the carrier or premises poses an imminent health threat to others, and the types of relief sought.

If the carrier is already institutionalized, the court may be petitioned to order the facility to continue to hold the carrier.

(2) A person shall not be held, or premises quarantined, under temporary emergency hold for more than five working (5) days (excluding Saturdays, Sundays and legal State holidays) without a hearing being held before the General Sessions Court, unless the person so held, or owner or operator of premises quarantined, consents to delay the hearing. At this hearing the Commissioner or health officer may petition for a public health measure pursuant to

Tenn. Comp. R. & Regs. 1200-14-04-.06 PETITION TO THE COURT FOR A PUBLIC HEALTH MEASURE

(1) To protect the public against a disease that poses a health threat to others, the Commissioner or health officer shall have the authority to file a petition for relief in the form of a public health measure with the General Sessions Court in the county where the carrier lives or is to be found, or where the premises is located, setting forth in an affidavit the specific facts upon which the order is sought and what type of relief is sought. The Department shall have the burden of proving that reasonable cause exists, based on sound clinical or epidemiological evidence, to believe that there is a substantial likelihood that the carrier or premises poses a health threat to others by clear and convincing evidence.

(2) The petition shall set forth the grounds and underlying facts that demonstrate the carrier or premises poses a health threat to others, the proposed public health measure is the least restrictive alternative, and the type of relief sought. Public health measures may include, but are not limited to, the following:

(a) Participation in a designated education program or a designated counseling program;

(b) Notification of the carrier of appearance of the carrier before designated health officials for verification of carrier status or infectiousness, testing, treatment, or other purposes consistent with monitoring or communicable disease control;

(c) Medical tests and examinations necessary to verify carrier status or infectiousness or for diagnosis, treatment, or confirmation of compliance with therapy;

(d) Medically-accepted treatment necessary to make the carrier noninfectious or completion of the full course of a medically-accepted treatment program of sufficient duration to render the carrier noninfectious and to be curative;

(e) Ceasing and desisting the actions or conduct that constitutes a health threat to others;

(f) Living part time or full time in a setting supervised by the Commissioner for a designated period of time and under designated conditions;

(g) Commitment to the custody of the Commissioner for placement in an appropriate institutional facility or other supervised living situation for a designated period and under designated conditions until the carrier is made noninfectious or until released based on a determination by the Chief Medical Officer, or the Chief Medical Officer’s physician designee, that the carrier is appropriate for release to continue treatment as a voluntary patient in an approved health care facility or other appropriate supervised setting, whichever occurs first, unless good cause is shown for continued commitment;

(h) Commitment to the custody of the Commissioner for placement in an appropriate institutional facility or other supervised living situation for a designated period and under designated conditions until the carrier completes the full course of a medicallyaccepted curative treatment program or until released based on a determination by the Chief Medical Officer or his/her physician designee that the carrier is appropriate for release to continue the treatment program in a less restrictive setting, whichever comes first;

(i) Preventing or restricting access to premises for such time as is necessary to prevent the spread of a disease that poses a health threat to others; and/or (j) Requiring tests or examinations on premises to determine the source or cause of a disease that may pose a health threat to others.

(3) The hearing on the petition for a public health measure shall not be set prior to five (5) days, excluding Saturdays, Sundays and legal State holidays, from the date the petition is served without the consent of the affected person. The notice of hearing shall contain the following information:

(a) The time, date, and place of the hearing;

(b) The person’s right to appear at the hearing and to subpoena, present and crossexamine witnesses;

(c) The person’s right to have a personally-selected physician perform an examination and the right to review the results of any examination or test being used to support the petition; and (d) The person’s right to counsel, including the right, if indigent, to counsel appointed by the court.

(4) A person may appeal an adverse General Sessions Court decision or file a petition for a writ of habeas corpus in a court of competent jurisdiction or the Department may appeal the General Sessions Court decision; however, the person’s status as determined by the General Sessions Court shall remain unchanged and any remedy or relief ordered by the court shall remain in force while the appeal or writ of habeas corpus is pending.

History

• Authority: T.C.A. §§ 4-3-1803, 4-5-202, 68-1-103, 68-1-104, 68-1-201, and 68-5-104 and Executive Order No. 14 (2020).
• Administrative History: Original rule filed January 11, 1994; effective March 27, 1994. Repeal and new rule filed March 30, 2004; effective July 29, 2004. Emergency rules filed March 17, 2020; effective through September 13, 2020. Emergency rules expired effective September 14, 2020, and the rules reverted to their previous statuses.

Tenn. Comp. R. & Regs. 1200-14-04-.07 COMMITMENT TO THE CUSTODY OF THE COMMISSIONER

(1) Review prior to a petition for commitment. Before petitioning the General Sessions Court to commit a person to the custody of the Commissioner pursuant to Section 1200-14-04- .06(2)(g)-(h), the health officer seeking the petition shall notify the Chief Medical Officer or his/her physician designee from the Health Services Administration and shall present the underlying facts upon which the commitment is sought. This notification shall occur prior to petitioning the court, except in compelling extreme and unusual circumstances, in which event the notification shall occur as soon as possible thereafter. The Chief Medical Officer or designated physician from the Health Services Administration shall review the underlying facts, obtain consultations as necessary, and shall promptly (i.e., within twenty-four (24) hours) make a determination regarding the need to submit a petition for commitment.

(2) Review after an order of commitment. When the General Sessions Court orders a person to be committed to the custody of the Commissioner for placement in an approved health care facility or other supervised living situation, the Chief Medical Officer or his/her physician designee shall review the treatment plan and written progress reports with the appropriate health officer and shall make a determination regarding the need for continued commitment or supervised living. At least every ninety-two (92) days (or more frequently if ordered by the court), the Chief Medical Officer or his/her physician designee shall send a written notification to the person or to the person’s legal guardian or representative and to the appropriate health officer regarding the determination as to whether continued commitment or supervised living is needed.

(3) Duration of Commitment. A person shall not be committed to the custody of the Commissioner for placement in an institutional facility or other supervised living situation for a period longer than six (6) months unless a petition for continued commitment is filed with the General Sessions Court having jurisdiction of the matter, in which case the commitment shall continue until a hearing on the petition has been held and the court has issued an order. The Commissioner or health officer may petition the court for an order of continued commitment for as many times as necessary for the protection of the public health, and the court may order continued commitment if reasonable cause exists, based on sound clinical or epidemiological evidence, to believe that there is a substantial likelihood that the carrier poses a health threat to others, by clear and convincing evidence, if released.

History

• Authority: T.C.A. §§ 4-3-1803, 4-5-202, 68-1-103, 68-1-104, 68-1-201, and 68-5-104 and Executive Order No. 14 (2020).
• Administrative History: Original rule filed January 11, 1994; effective March 27, 1994. Repeal and new rule filed March 30, 2004; effective July 29, 2004. Emergency rules filed March 17, 2020; effective through September 13, 2020. Emergency rules expired effective September 14, 2020, and the rules reverted to their previous statuses.

Tenn. Comp. R. & Regs. 1200-14-04-.08 PATIENT BILL OF RIGHTS

The following are the rights of any patient pursuant to this chapter:

(1) Neither mail nor other communication to or from a patient in any approved treatment facility may be intercepted, read, or censored. The approved treatment facility may adopt reasonable policies regarding the use of the telephone in the facility.

(2) Patients in any approved facility shall be granted opportunities for visitation and communication with their families and friends consistent with an effective treatment program.

Patients shall be permitted to consult with counsel at any time.

(3) Any patient confined pursuant to the provisions of these Rules may be given treatment only with the patient’s consent, or if the patient is adjudicated incompetent, then the consent of the guardian must be obtained. Patients must understand that refusal to cooperate with treatment will compel continued actions on the part of the health officer to protect the public’s health.

(4) Isolation of the patient from other patients in the confinement of an approved treatment facility setting shall be used only when medically necessary to prevent serious harm to others because the patient is infectious and there is an imminent danger that the patient will engage in high-risk behaviors. Isolation shall not be used when the condition no longer exists or there is no longer an imminent danger that the patient will engage in the behavior justifying isolation. Any use of isolation, together with the reasons therefor and the duration of its use, shall be made a part of the medical record of the patient.

(5) No patient placed in confinement pursuant to these Rules shall, solely by reason of such placement, be denied the right to dispose of property, execute instruments, make purchases, enter into contractual relationships, and vote, to the extent that such activities can be undertaken without jeopardizing the public health and unless such patient has been adjudicated incompetent by a court of competent jurisdiction and has not been restored to legal capacity.

(6) A patient shall be provided the maximum freedom possible. Limitations on a patient’s freedom are permitted only when reasonably necessary to protect the health of others in the facility or the public health. The patient shall be allowed, within these constraints, to exercise, recreate, and go outdoors for a reasonable period of time on a daily basis.

(7) No mechanical restraint shall be applied in the care, training, or treatment of any person unless required by the person’s medical or treatment needs. Only physicians may prescribe such restraint. Such restraint shall be removed whenever the condition justifying its use no longer exists. Any use of a mechanical restraint, together with the reasons therefor, and the duration of its use, shall be made a part of the medical or rehabilitation record of the person.

Patients shall not be abused nor neglected nor administered corporal punishment.

Mechanical restraints shall not be used in lieu of, or in place of, appropriate medical management for conditions such as drug or alcohol intoxication, habituation or addiction.

(8) Confidentiality.

(a) 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 or former patient shall be kept confidential and shall not be disclosed by any person except insofar as any of the following consent:

1. The individual identified who is fourteen (14) years of age or over;

2. The legal guardian on behalf of the adult individual identified;

3. The parent, guardian, or custodian of a minor;

4. The executor, administrator or personal representative on behalf of a deceased patient or resident or former patient or resident; or 5. As a court may direct upon its determination that disclosure is necessary for the conduct of proceedings before it and that failure to make such disclosure would be contrary to public interest or to the detriment of either party to the proceedings, consistent with the provisions of T.C.A. §§ 10-7-504(a) or 68-10- 113.

(b) Nothing in this paragraph shall prohibit disclosure of medical record information of a patient or resident to the Commissioner or to health officers.

(c) Nothing in this paragraph shall prohibit disclosure, upon proper inquiry and with the patient’s consent, of information as to the current medical condition of a patient or resident to any members of the family of a patient or resident or to his relatives or friends.

(9) Health directives and public health measures should be written in non-technical, patientappropriate language and should include the reasons for the health directive or public health measure (including a statement of actions the Department has taken prior to the directive or court order), tests and/or treatments expected, anticipated duration of the directive/public health measure, and rights of review or appeal as set out in these Rules.

History

• Authority: T.C.A. §§ 4-3-1803(1), (3), (4), and (10); 4-5-202; 68-1-103; 68-1-104; 68-1-201; and 68-5- 104.
• Administrative History: Original rule filed January 11, 1994; effective March 27, 1994. Repeal and new rule filed March 30, 2004; effective July 29, 2004.

Tenn. Comp. R. & Regs. 1200-14-04-.09 RESERVED

History

• Authority: T.C.A. §§ 4-5-208(a)(1) and (a)(5); and 14-4-101.
• Administrative History: Emergency rule filed December 22, 2021; effective through June 20, 2022. Emergency rule expired effective June 21, 2022, and the rule reverted to its previous status.

Chapter 1200-14-05 Procedures for Notifying Emergency Response Workers of Exposure to Certain Communicable Diseases

Tenn. Comp. R. & Regs. 1200-14-05-.01 INTRODUCTION

(1)During the course of providing emergency medical care or emergency public safety services, if an Emergency Response Employee experiences a direct threat of a significant risk of exposure to a potentially life-threatening infectious disease, the Emergency Response Employee may submit a request for a determination as to whether the ERE has been exposed to an infectious disease as defined herein during the course of normal authorized job duties.

(2)The term “Emergency Response Employees (ERE’s)” includes firefighters, first response workers, paramedics, emergency medical technicians, and volunteers making an authorized emergency response who respond to emergencies.

History

• Authority: T.C.A. §§4-3-1803(1),(10), 4-5-209, and 68-10-117.
• Administrative History: Original rule filed August 4, 1998; effective October 18, 1998.

Tenn. Comp. R. & Regs. 1200-14-05-.02 DEFINITIONS

(1)“Aerosol” means small particles of matter that float on air currents.

(2)“Airborne Transmission” means person-to-person transmission of an infectious agent by an aerosol.

(3)“Bloodborne Transmission” means person-to-person transmission of an infectious agent through contact with an infected person’s blood.

(4)“County medical examiner” means any licensed physician appointed or employed by the county governing body to act in that capacity.

(5)“Designated Exposure Control Officer” means an individual designated by an ERE employer to manage exposure determinations.

(6)“Emergency” means an injury or illness perceived to need immediate medical care in order to prevent loss of life, limb, significant body function or aggravation of illness or injury.

(7)“Emergency Response Employees” (ERE’s) means firefighters, paramedics, emergency medical technicians, first response workers, and volunteers making an authorized emergency response during the course of normal, authorized job duties.

(8)“Employer of Emergency Response Employee” means an entity which employs individuals or utilizes volunteers who in the course of professional duties and exercising principles and skills for emergency medical care or emergency public safety activities respond to emergencies.

(9)“Exposed” means with respect to HIV disease or any other infectious disease, to be in circumstances in which there is a direct threat of significant risk of becoming infected with the etiologic agent for the disease involved.

(10)“Exposure” incorporates the definition of “exposure” as defined by the Occupational Safety and Health Agency in its Bloodborne Pathogens Standard (29 CFR 1910.1030): “specific eye, mouth, or other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duties.

(11)“Health care facility” means any entity, agency, institution, facility, or place, whether publicly or privately owned or operated, which provides health services or which maintains medical records, including, but not limited, to the Department of Health or the local health departments.

(12)“Health care provider” means an individual who is licensed, certified, or otherwise authorized by virtue of education and training to provide health care to someone who suffers illness or injury.

(13)“Local health officer” means a physician employed by the State or a metropolitan Department of Health at the regional health department level.

(14)“Patient” means a person experiencing an emergency who has been aided by an Emergency Response Employee and has been transported to a medical facility.

(15)“Potentially life-threatening infectious disease” means an infectious disease that can cause death in a healthy, susceptible host.

(16)“Responding agency” means the same as “An employer of Emergency Response Employees.”

(17)“Routinely transmitted by aerosol” means a disease that is usually transmitted through the air.

(18)“Significant Risk” means a finding of facts relating to a human exposure to an etiologic agent for a particular disease, based on reasonable medical judgments given the state of medical knowledge, about:

(a)the nature of the risk (how the disease is transmitted);

(b)the duration of the risk (how long an infectious person may be infectious);

(c)the severity of the risk (what is the potential harm to others); and (d)the probabilities the disease will be transmitted and will cause varying degrees of harm.

(19)“Victim” means any individual suffering an illness or injury, regardless of whether the injury was accidental or intentional.

(20)“Volunteer personnel or volunteer” means a person, operating under the direction of an Emergency Response Employer, who provides emergency medical care or emergency public safety services without expectation of remuneration, who does not receive payment for services rendered, and who does not depend on the provisions of emergency care for their livelihood or a substantial portion of their livelihood.

History

• Authority: T.CA. §§4-3-1803(1),(10), 4-5-209, 68-10-117, 68-140-202 (5), and 68-140-502.
• Administrative History: Original rule filed August 4, 1998; effective October 18, 1998.

Tenn. Comp. R. & Regs. 1200-14-05-.03 APPOINTMENT OF DESIGNATED EXPOSURE CONTROL OFFICERS

(1)ERE employers shall designate an individual to serve as a Designated Exposure Control Officer for the

purpose of managing exposure determinations. Preference should be given to individuals who are trained in the provision of health care or the control of infectious diseases.

(2)ERE employers shall publish and implement policies and procedures to stipulate how ERE’s may submit exposure determination requests to the Designated Exposure Control Officer, as well as publish and implement policies and procedures specifying how the Designated Exposure Control Officer is to proceed in processing the request. All such policies and procedures shall be consistent with T.C.A. 68- 10-117 and all laws pertaining to medical records.

(3)A county medical examiner may be designated to serve as a Designated Exposure Control Officer.

History

• Authority: T.CA. §§4-3-1803(1),(10), 4-5-209, 68-10-117, 68-140-509 and 68-140-518.
• Administrative History: Original rule filed August 4, 1998; effective October 18, 1998.

Tenn. Comp. R. & Regs. 1200-14-05-.04 POTENTIALLY LIFE-THREATENING DISEASES TO WHICH ERE’S MAY BE

EXPOSED

(1)Airborne Diseases: 1) Infectious pulmonary tuberculosis (disease caused by Mycobacterium tuberculosis), (2)Bloodborne Diseases: 1) Hepatitis B and (2) Human Immunodeficiency Virus (HIV) infection (including the Acquired Immunodeficiency Syndrome or AIDS).

History

• Authority: T.CA. §§4-3-1803(1),(10), 4-5-209, 68-10-117, 68-140-509, and 68-140-158.
• Administrative History: Original rule filed August 4, 1998; effective October 18, 1998.

Tenn. Comp. R. & Regs. 1200-14-05-.05 DETERMINING EXPOSURE

These diseases include, but are not limited to, the following:

(1)Airborne Diseases.

(a)Occupational exposure to airborne pathogens may occur when an ERE shares air space with a patient who has an infectious disease caused by an agent communicable by airborne transmission.

(2)Bloodborne Diseases.

(a)Occupational exposure to bloodborne pathogens may occur as the result of contact during the performance of normal job duties with blood or other body fluids to which universal precautions apply. When ERE’s have contact with body fluids under emergency circumstances in which differentiation between fluid types is difficult, if not impossible, all body fluids are considered potentially hazardous.

(b)Universal Precautions, as outlined in “Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health-Care and Public-Safety-Workers”, as produced by the Centers for Disease Control Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health-Care and Public-Safety Workers, [Morbidity and Mortality Weekly Report 23 June 1989, 38 (S-6)] are recommended for all ERE’s to reduce the risk of exposure to bloodborne pathogens.

History

• Authority: T.CA. §§4-3-1803(1),(10), 4-5-209, 68-10-117, 68-140-509, and 68-140-518.
• Administrative History: Original rule filed August 4, 1998; effective October 18, 1998.

Tenn. Comp. R. & Regs. 1200-14-05-.06 PROCEDURE FOR REQUESTING MEDICAL RECORDS

(1)An ERE may submit a request for a determination as to whether the ERE has been exposed to an infectious disease as defined herein during the course of assigned job duties. The request shall be submitted to the ERE employer’s Designated Exposure Control Officer (DECO), or county medical examiner.

(2)The Designated Exposure Control Officer (DECO) or county medical examiner is responsible for collecting the facts regarding the circumstances of the potential exposure, as well as evaluating the situation to determine whether or not exposure could have occurred. If a significant exposure clearly and unquestionably occurred, the ERE should be referred promptly to his/her private health provider for proper evaluation and management.

(3)If the Designated Exposure Control Officer or county medical examiner determines that exposure could possibly have occurred, that individual will send to any relevant medical facility or health care provider a signed written request for assistance in determining whether or not the ERE has been exposed to one or more of the diseases described in section 1200-14-5-.04 of these rules in the course of providing services for the named injury or illness victim. If the DECO or county medical examiner cannot determine the risk of exposure, the local health officer should be consulted for assistance in making such determination. All such requests shall be kept confidential by the recipient of the request.

(4)Upon receipt of a proper request in writing for patient information needed to determine if the victim had such infection and could have transmitted it to the ERE, a medical facility or health care provider shall provide the information to the requesting authority no later than 48 hours after receipt of the request. The information which may consist of a summary statement of facts or a valid copy of pertinent components of existing records shall be marked “confidential”.

(5)When replying to an exposure determination request, the response of the medical facility or the health care provider shall contain the name of the infectious disease to which exposure may have occurred and the date on which the potentially infectious patient was a patient of the facility or the provider.

(6)The DECO or county medical examiner shall inform the requesting ERE of the nature of the risk of exposure or infection and recommend appropriate follow-up action.

(7)Any costs related to the provision of the requested medical information shall be paid by the entity for which the ERE was performing the emergency services.

History

• Authority: T.CA. §§4-3-1803(1),(10), 4-5-209, 68-5-103, 68-10-109, and 68-10-117.
• Administrative History: Original rule filed August 4, 1998; effective October 18, 1998.

Tenn. Comp. R. & Regs. 1200-14-05-.07 CONFIDENTIALITY OF PATIENT INFORMATION

(1)Nothing in these rules shall be interpreted to mean that patient information may be released by an ERE, a Designated Exposure Control Officer, a County Medical Examiner, a medical facility, a health care provider, or a public health officer without the patient’s written consent.

History

• Authority: T.CA. §§4-3-1803(1),(10), 4-5-209, 68-5-103, 68-10-113, 68-10-117, and 68-140-518.
• Administrative History: Original rule filed August 4, 1998; effective October 18, 1998.

Tenn. Comp. R. & Regs. 1200-14-05-.08 TESTING RESTRICTIONS

(1)Nothing in these rules shall be interpreted as authorization for a medical facility or health care provider to conduct testing for any infectious disease or any victim of an emergency without the patient’s written consent. If a patient refuses consent for testing, the attempt to obtain consent should be documented.

History

• Authority: T.C.A. §§4-3-1803(1),(10), 4-5-209, 68-9-104, 68-10-109, 68-10-117, and 68-140-511(8).
• Administrative History: Original rule filed August 4, 1998; effective October 18, 1998.

Tenn. Comp. R. & Regs. 1200-14-05-.09 FAILURE TO PROVIDE EMERGENCY SERVICES

(1)Nothing in these rules shall be interpreted as authorization for any ERE to fail to respond or to deny services to any victim of an emergency.

History

• Authority: T.C.A. §§4-3-1803(1),(10), 4-5-209, 68-10-117, and 68-140-511.
• Administrative History: Original rule filed August 4, 1998; effective October 18, 1998.

1200-15 Bureau of Health Services Division of Community Health Services Division of Maternal and Child Health

Chapter 1200-15-01 Newborn Hearing Testing, Screening for Metabolic/Genetic Disorders and Critical Congenital Heart Disease

Tenn. Comp. R. & Regs. 1200-15-01-.01 TESTS

The Department of Health will designate the prescribed effective screening tests and examinations which will be performed on newborns in accordance with Rule 1200-15-01-.02 for the detection of hearing loss, critical congenital heart disease and metabolic/genetic disorders as designated by the Department of Health.

(1) Exemptions for religious beliefs. Nothing in this part shall be construed to require the testing of or medical treatment for the minor child of any person who shall file with the Department of Health a signed, written statement that such tests or medical treatment conflict with such person’s religious tenets and practices, affirmed under penalties of perjury pursuant to T.C.A. § 68-5-403. The newborn screening refusal form provided by the State should be completed, filed with the Department and retained in the medical record for the period of time defined by the hospital or provider policy.

(2) Failure to have a child tested for the detection of hearing loss and metabolic/genetic disorders as designated by the Department of Health is a Class C misdemeanor pursuant to T.C.A. § 68-5-404.

History

• Authority: T.C.A. §§ 4-5-202; 68-5-401, et seq.; 68-5-501, et seq.; and 68-5-901, et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed September 1, 1982; effective October 1, 1982. Amendment filed September 16, 1996; effective January 28, 1997. Repeal and new rule filed December 30, 1999; effective March 14, 2000. Repeal and new rule filed September 26, 2003; effective January 28, 2004. Repeal and new rule filed December 13, 2012; effective May 31, 2013.

Tenn. Comp. R. & Regs. 1200-15-01-.02 PERSONS AND/OR INSTITUTIONS RESPONSIBLE FOR TESTS FOR NEWBORN

INFANTS. The following persons or institutions shall be responsible for hearing testing, critical congenital heart disease screening and blood specimen collection for metabolic/genetic disorders as designated by the Department of Health. Specimens and results shall be submitted in a manner as directed by the Department of Health; procedures are located on the Department’s web page.

(1) Every chief administrative officer of a hospital and the attending physician in each instance shall:

(a) Submit a satisfactory specimen of blood to the State Public Health Laboratory, Department of Health. This sample shall be collected between twenty-four and thirty-six (24-36) hours of age and mailed within twenty-four (24) hours of collection. In some cases, it may be necessary to collect a specimen prior to twenty-four (24) hours of age if the infant is going to be discharged, transferred or transfused.

1. Recollect a specimen of blood if the infant was initially screened before twentyfour (24) hours of age. This repeat sample shall be collected between twenty-four and seventy-two (24-72) hours of age and mailed within twenty-four (24) hours of collection. If the infant has been discharged, instruct every parent, guardian, or custodian to bring the infant back to the hospital or to a physician or the nearest local health department to be re-screened (b) Perform a physiologic hearing screen. The result of the hearing screen is to be reported to the Department of Health and should be done before hospital discharge or prior to one (1) month of age.

(c) Perform pulse oximetry tests on all newborns to screen for critical congenital heart disease between twenty-four and thirty-six (24-36) hours of age. The recommended protocol for screening is available online at the Department of Health’s web page.

(2) Any health care provider(s) of delivery services in a non-hospital setting shall:

(a) Submit a satisfactory specimen of blood to the State Public Health Laboratory, Department of Health, in a manner as directed by the Department. This sample shall be collected between twenty-four and thirty-six (24-36) hours of age and mailed within twenty-four (24) hours of collection. In some cases, it may be necessary to collect a specimen prior to twenty-four (24) hours of age if the infant is going to be discharged, transferred or transfused.

1. Recollect a specimen of blood if the infant was initially screened before twentyfour (24) hours of age. This repeat sample shall be collected between twenty-four and seventy-two (24-72) hours of age and mailed within twenty-four (24) hours of collection. If the infant has been discharged, instruct every parent, guardian, or custodian to bring the infant back to the hospital or to a physician or the nearest local health department to be re-screened (b) Instruct the parent, guardian or custodian to obtain a physiologic hearing screen prior to one (1) month of age. A referral may be made to the State Department of Health to assist in locating a hearing provider.

(c) Perform pulse oximetry tests on all newborns to screen for critical congenital heart disease between twenty-four and thirty-six (24-36) hours of age. The recommended protocol for screening is available online at the Department of Health’s web page.

(3) Any parent, guardian, or custodian residing in Tennessee, of an infant born in Tennessee, outside a Tennessee health care facility and without the assistance of a health care provider, shall:

(a) Between twenty-four to thirty-six (24-36) hours of age present said infant to a primary care provider or local health department for blood specimen collection.

(b) Obtain a physiologic hearing screen prior to one (1) month of age. A referral may be made to the State Department of Health to assist in locating a hearing provider.

(c) Between twenty-four and thirty-six (24-36) hours of age present said infant to a primary care provider to perform pulse oximetry tests to screen for critical congenital heart disease. The recommended protocol for screening is available online at the Department of Health’s web page.

History

• Authority: T.C.A. §§ 4-5-202; 68-5-401, et seq.; 68-5-501, et seq.; and 68-5-901, et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed September 1, 1982; effective October 1, 1982. Amendment filed September 16, 1996; effective January 28, 1997. Repeal and new rule filed December 30, 1999; effective March 14, 2000. Repeal and new rule filed September 26, 2003; effective January 28, 2004. Repeal and new rule filed December 12, 2012; effective May 31, 2013. Amendments filed July 23, 2021; effective October 21, 2021.

Tenn. Comp. R. & Regs. 1200-15-01-.03 NEWBORN SCREENING PAMPHLET PROVIDED TO PARENTS

The chief administrative officer of each birthing facility shall order the distribution of a pamphlet to every parent, guardian or custodian of an infant screened. The pamphlet, distributed by the Department of Health, educates and prepares the family for newborn testing on their infant. If an infant’s blood specimen was collected earlier than twenty-four (24) hours after birth and the patient is discharged home, the birthing facility must review the information on the back of the pamphlet with the family prior to discharge; the information requires the family to present the infant to the hospital, physician or health department within 24-72 hours for a repeat blood specimen. The pamphlet will have a perforated page that may be signed by the parent and placed in the medical record as documentation that the pamphlet was provided.

History

• Authority: T.C.A. §§ 4-5-202; 68-5-401, et seq.; 68-5-501, et seq.; and 68-5-901, et seq.
• Administrative History: Original rule certifie d June 7, 1974. Repeal and new rule filed September 1, 1982; effective October 1, 1982. Amendment filed September 16, 1996; effective January 28, 1997. Repeal and new rule filed December 30, 1999; effective March 14, 2000. Repeal and new rule filed September 26, 2003; effective January 28, 2004. Repeal and new rule filed December 13, 2012; effective May 31, 2013.

Tenn. Comp. R. & Regs. 1200-15-01-.04 MEDICAL PROVIDERS AND LOCAL HEALTH DEPARTMENTS MUST ASSIST THE

DEPARTMENT OF HEALTH.

(1) The primary care provider’s responsibil ity is to:

(a) Ensure that all newborn screening tests were conducted and provide necessary follow up, if needed, as instructed by the Newborn Screening Program.

(b) Recollect a blood specimen before two (2) weeks of age, as instructed by the program or tertiary center staff, or send the infant to the local Health Department for recollection.

(c ) Assist the Department of Health in contacting families, submitting follow up information, making appropriate referrals and/or notifying the Department immediat ely if they are not the provider. The Newborn Screening Program outlines the providers’ responsibilities in the practitioner guide which is available online at the Department of Health’s web page.

(d) Obtain further hearing tests prior to three (3) months of age if the infant did not pass the hearing screen. A referral may be made to the State Department of Health to assist in locating a hearing provider.

(e) Submit the critical congenital heart disease follow-up form on infants who did not pass the pulse oximetry screen.

(2) Audiologists shall submit the hearing follow-up form on infants referred to them for further testing through the newborn screening process.

(3) Cardiologists shall submit the critical congenital heart disease follow-up form on infants referred to them through the newborn screening process.

(4) Each local health department shall assist the Department of Health in contacting all parents or guardians of infants who are in need of further testing to confirm or disprove the presumptive screening results based on the prescribed effective tests and examinations designed to detect genetic disorders as determined by the Department of Health.

History

• Authority: T.C.A. §§ 4-5-202; 68-5-401, et seq.; 68-5-501, et seq.; and 68-5-901, et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed September 1, 1982; effective October 1, 1982. Amendment filed September 16, 1996; effective January 28, 1997. Repeal and new rule filed December 30, 1999; effective March 14, 2000. Repeal and new rule filed September 26, 2003; effective January 28, 2004. Repeal and new rule filed December 13, 2012; effective May 31, 2013.

Tenn. Comp. R. & Regs. 1200-15-01-.05 FEE FOR TESTING

(1) Fee. A fee shall be due and payable to the Department of Health for conducting any one or all tests on a patient blood sample submitted to the Department for metabolic/genetic tests as designated by the Department of Health.

The Commissioner shall re-evaluate, update, and post the fee at least annually and from time to time as appropriate. The Commissioner shall post the annual update on or before November 15th of each year, and this new fee shall become effective starting January 1st of the following year. If the Commissioner posts an updated fee more frequently than on an annual basis, then the updated fee will become effective on the date stated in the fee notice.

The fee shall be available online at the Department of Health’s web page and in print.

(2) Procedure. The health care facility collecting the blood sample for the purpose of receiving any or all of the tests set forth in paragraph (1) shall be billed by the State Public Health Laboratory, Department of Health.

(3) Waiver. The fee shall be waived for patients who are unable to pay, based on information obtained at the time of admission to the health care facility, as determined by the health care provider.

History

• Authority: T.C.A. §§ 4-5-202; 68-5-401, et seq.; and 68-5-501, et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed September 1, 1982; effective October 1, 1982. Repeal and new rule filed December 30, 1999; effective March 14, 2000. Repeal and new rule filed September 26, 2003; effective January 28, 2004. Amendment filed August 9, 2007; effective December 28, 2007. Repeal and new rule filed December 13, 2012; effective May 31, 2013.

Tenn. Comp. R. & Regs. 1200-15-01-.06 DEPARTMENT OF EDUCATION AND DEPARTMENT OF HEALTH

RESPONSIBILITIES.

(1) In compliance with T.C.A. §§ 68-5-901 et seq. and the Individuals with Disabilities Education Act (IDEA) Child Find, the Tennessee Department of Health Newborn Hearing Screening program shall notify the Department of Education, IDEA Part C, Tennessee Early Intervention System (TEIS) of newborns identified to be in need of further hearing testing or who have been diagnosed with hearing loss.

(2) The Department of Education, IDEA Part C, Tennessee Early Intervention System (TEIS), shall contact the health care provider, hearing provider, and/or family of the newborn to determine if further hearing testing has been completed or if the family is in need of assistance to obtain further testing to determine if there is a hearing loss.

(3) The Department of Education, IDEA Part C, Tennessee Early Intervention System (TEIS) program shall report the results of follow-up to the Department of Health Newborn Hearing Screening program as outlined in policy developed in cooperation between the programs.

(4) The Tennessee Early Intervention System (TEIS) will assist the Newborn Hearing Screening Program in tracking children identified with risk indicators for hearing loss until three (3) years of age as outlined in policy developed in cooperation between the programs.

History

• Authority: T.C.A. §§ 4-5-202; 68-5-401, et seq.; 68-5-501, et seq.; and 68-5-901, et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed September 1, 1982; effective October 1, 1982. Repeal filed December 30, 1999; effective March 14, 2000. New rule filed September 26, 2003; effective January 28, 2004. Repeal and new rule filed December 13, 2012; effective May 31, 2013.

Tenn. Comp. R. & Regs. 1200-15-01-.07 REPEALED

History

• Authority: T.C.A. §§ 4-5-202; 53-626; 68-5-401, et seq.; and 68-5-501, et seq.
• Administrative History: Original rule certified June 7, 1974. Repeal and new rule filed September 1, 1982; effective October 1, 1982. Repeal filed December 30, 1999; effective March 14, 2000.

Chapter 1200-15-02 Special Supplemental Nutrition Program for Women, Infants, and Children

Tenn. Comp. R. & Regs. 1200-15-02-.01 DEFINITIONS

(1) The following definitions shall apply to this part and all contracts, guidelines, instructions, forms and other documents related hereto.

(a) “7 CFR Part 246” means the section of the Code of Federal Regulations (CFR) which governs the operation of the WIC Program.

(b) “Administrative review” means the process by which a vendor or participant may appeal adverse actions taken against them by the Department. All formal hearings will be held in accordance with the Uniform Administrative Procedures Act, T.C.A. §4-5-101, et seq, and administrative reviews will be held in accordance with 7 CFR 246.18 and as provided in these rules.

(c) “Adjunctive eligibility” means automatic income eligibility for WIC, based on eligibility for another federal Program, as defined in 7 CFR Part 246.7(d)(2)(vi).

(d) “Approved foods” means types, brands, or varieties of foods meeting the Program requirements established under the federal regulations found in 7 CFR Part 246.10. Foods selected by the Department for the Program in Tennessee can be further limited due to cost, availability, packaging, or other reasons as defined in the current Tennessee Food Package Policy and as provided by Central Office to food manufacturers and other interested parties needing this information.

(e) “Breastfeeding woman” means a participant who is breastfeeding her baby up to twelve months after delivery.

(f) “Central Office” means the office site operated by the Department which is responsible for the overall operation of the Program.

(g) “Child” means a person five (5) years of age or younger.

(h) “Civil money penalty” means a monetary penalty assessed in lieu of disqualification.

(i) “Claim” means a request for reimbursement of Program funds realized by the Department resulting from the detection of any questionable voucher redeemed by a vendor, suspected vendor overcharges, or other errors by the vendor, either intentional or unintentional, or an intentional participant violation that affects the receipt of Program benefits by the participant.

(j) “Commissioner” means the Commissioner of the Tennessee Department of Health or the Commissioner’s designee.

(k) “Competitive prices” means shelf prices for approved foods that are competitive with the WIC vendors in the same peer group and region within the state.

(l) “Department” means the Tennessee Department of Health.

(m) “Disqualification” means the withdrawal of authorization as a WIC vendor as a result of fraud, abuse, violation of federal regulations, or continued failure to meet Program requirements prior to the expiration of a WIC Vendor Agreement.

(n) “Dual participation” means simultaneous participation in either the Program in more than one clinic and/or region, or participation in the Program and in the Commodity Supplemental Food Program, or in another WIC Program in another state.

(o) “Food instrument” means a negotiable check with a limited period of validity used by a Program participant to purchase approved foods at an authorized WIC vendor.

(p) “Food package” means the types and amounts of approved foods based on the nutritional needs of the participant.

(q) “Grocery store” means a retail store, open to the general public, that derives the majority (i.e., greater than 50%) of its annual total gross sales from staple foods. Its purpose is to provide Program participants with a selection of Program approved foods that meets the Program's minimum stock requirement. It must also offer a full market basket of foods to provide the opportunity for price comparison shopping and for nutrition information comparison. At least one other form of payment (i.e., bank debit or credit card, personal check, or cash) must be accepted in addition to Food Stamp Program transactions and Tennessee WIC vouchers.

(r) “Income” means gross income before taxes. Source of income is further defined in the WIC Manual.

(s) “Infant” means a baby up to twelve (12) months of age.

(t) “Lock-in status” means vouchers must be presented to a vendor specified by the Program, on a specific day, mutually agreed upon between the Program and the participant.

(u) “Minimum stock requirement” means the types, varieties, brands, and quantities of approved foods a grocery store is required to keep available as established by the Department for the Program.

(v) “Nutritional risk” as defined by federal regulation means:

1. detrimental or abnormal nutritional conditions detectable by biochemical or anthropometric measurements; or 2. other documented nutritionally related medical conditions, such as (i) dietary deficiencies that impair or endanger health; or (ii) conditions that predispose persons to inadequate nutritional patterns or nutritionally related medical conditions.

(w) “Overcharge” means an act committed by a vendor of seeking and/or accepting more Program funds for approved foods than is permitted under the WIC Vendor Agreement. Such an act may result in a sanction whether it is intentional or unintentional.

(x) “Parent/caretaker” means a parent of an infant or child participant or a person other than a parent, who is responsible for the care of the infant or child and who enrolls them in the Program.

(y) “Participant” means a pregnant woman, breastfeeding woman, postpartum woman, infant, or child who is receiving supplemental foods or food instruments under the Program.

(z) “Participation” means a monthly count of persons who have received supplemental foods or food instruments.

(aa) “Pattern” means an act that occurs two (2) or more times.

(bb) “Peer group” means a group of WIC vendors who have common characteristics, including, but not limited to, type of business, type of ownership, total sales volume, and pricing of approved foods and are located in the same geographic region.

(cc) “Pharmacy” means a retail establishment licensed by the State of Tennessee to operate as a pharmacy. Its purpose for authorization in the Program is to provide Special Formulas defined in the WIC Manual. These formulas are issued to a participant when prescribed by written order from a physician or nurse clinician under physician supervision.

(dd) “Postpartum woman” means a participant who is not breastfeeding her baby, but may remain on the Program for up to six months after delivery.

(ee) “Program” means the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) authorized by Section 17 of the Child Nutrition Act of 1966, as amended.

(ff) “Proxy” means a person designated, in writing, by the participant or parent/caretaker to receive the vouchers when issued and shop for the supplemental foods issued on the voucher. Parents or caretakers applying on behalf of child and infant participants are not proxies.

(gg) “Redemption” means the procedure during which the vendor receives payment for vouchers previously submitted following the requirements of the WIC Vendor Agreement.

(hh) “Regional Office” means an administrative site operated by or under contract with the Department to provide Program services for its designated geographic area.

(ii) “Sanction” means a disciplinary action taken by the Department as described in sections 1200- 15-2-.06 Participant Program Violations and 1200-15-2-.08 Vendor Program Violations.

(jj) “Staple Foods” means the variety of foods carried by an authorized WIC grocery store consisting of, but not limited to, infant formula and other baby food products, eggs, dairy products, bread and bakery products, pastas, fresh produce and vegetables, frozen and canned fruits and vegetables, frozen and canned juices, seafood, meat and poultry. Staple foods do not include any prepared foods or accessory foods such as candy, condiments, spices, tea, coffee, cocoa, or carbonated and uncarbonated drinks.

(kk) “Transaction” or “transacted” means the procedure during which the participant, parent/caretaker or proxy presents a voucher to an authorized WIC vendor in exchange for the approved foods listed on the voucher.

(ll) “USDA” means the United States Department of Agriculture.

(mm) “Vendor” means a retail grocery store or pharmacy that agrees to abide by applicable policies and procedures as delineated in 7 CFR Part 246.12, Department rules, the WIC Vendor Agreement, and the WIC Vendor Handbook. A vendor is authorized by the Department to accept vouchers and provide the supplemental foods issued on the voucher. A vendor encompasses both a business entity and the physical location of a business.

(nn) “Vendor Application for Authorization to Participate in the Tennessee WIC Program” means the standard application form and attachments required by the Department for a potential vendor to participate in the Program. The application must be signed by the Department’s authorized designee, as well as an owner or an owner’s authorized designee.

(oo) “Vendor Representative” means the regional office staff person who is responsible for contracting the WIC vendor and assuring compliance with the WIC Vendor Agreement.

(pp) “Violation” means each act of non-compliance that occurs or a series of acts that together equate to a violation.

(qq) “Voucher stamp” means a device provided by the Department which imprints the WIC vendor’s name and assigned number on redeemed vouchers.

(rr) “Voucher” - see “Food instrument”

(ss) “WIC food”-see “Approved foods”

(tt) “WIC Food List” means the current list of approved foods as provided by the Department to participants and contracted grocery stores.

(uu) “WIC Grocer Price Report Card” means the form submitted by contracted grocery stores at time of application and then on a periodic basis as required by the Department to report prices of specific approved foods.

(vv) “WIC Manual” means the current publication produced by the Department that contains Program information, policies, procedures, sample reports, and forms for use by Program staff in the regional offices and local health department clinics.

(ww) “WIC Vendor Agreement” means the standard written departmental agreement that specifies the terms and conditions for a WIC vendor to participate in the Program. (The agreement must be signed by an owner or an owner’s authorized designee and the Department’s authorized designee. See Vendor Application.)

(xx) “WIC Vendor Handbook” means the current publication produced by the Department that contains Program information, policies, and procedures to be followed by WIC vendors.

(yy) “WIC Vendor Management Manual” means the current publication produced by the Department that contains Program information, policies, procedures, sample reports and forms for use by Program staff in the Central Office and the Regional Offices.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, and 68-1-106.
• Administrative History: Original rule filed June 20, 1985; effective July 20, 1985. Repealed and new rule filed August 24, 2000; effective November 7, 2000. Repeal and new rule filed February 8, 2002; effective April 24, 2002. Amendment filed July 1, 2004; effective September 14, 2004.

Tenn. Comp. R. & Regs. 1200-15-02-.02 PURPOSE

(1) WIC is the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) administered by the Tennessee Department of Health. The purpose of the Program is to provide supplemental foods, nutrition education, and breastfeeding promotion to eligible persons. The Program serves as an adjunct to good health care during critical times of human growth and development.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, and 68-1-106.
• Administrative History: Original rule filed June 20, 1985; effective July 20, 1985. Repeal and new rule filed August 24, 2000; effective November 7, 2000. Repeal and new rule filed February 8, 2002; effective April 24, 2002.

Tenn. Comp. R. & Regs. 1200-15-02-.03 ELIGIBILITY

(1) In order to participate in the Program, an applicant must:

(a) be a resident of the state of Tennessee, and (b) have income per family size not exceeding 185% of the USDA poverty income guidelines most recently published in the Federal Register or have adjunctive eligibility, and (c) be found to be at nutritional risk.

(d) When resources are limited, participants will be served within priority groups as defined in 7 CFR Part 246 and published in the WIC Manual.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, and 68-1-106.
• Administrative History: Original rule filed June 20, 1985; effective July 20, 1985. Amendment filed January 3, 1986; effective February 2, 1986. Amendment filed September 30, 1987; effective October 14, 1987. Repeal and new rule filed August 24, 2000; effective November 7, 2000. Repeal and new rule filed February 8, 2002; effective April 24, 2002.

Tenn. Comp. R. & Regs. 1200-15-02-.04 ISSUANCE OF VOUCHERS

(1) Vouchers shall only be issued to a participant, a parent/caretaker, or an authorized proxy designated by the participant or parent/caretaker in writing in accordance with policy as described in the WIC Manual.

(2) Vouchers shall be issued for specific food packages based on the nutritional needs of participants in accordance with policies as described in the WIC Manual.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, and 68-1-106.
• Administrative History: Original rule filed June 20, 1985; effective July 20, 1985. Repeal and new rule filed August 24, 2000; effective November 7, 2000. Repeal and new rule filed February 8, 2002; effective April 24, 2002.

Tenn. Comp. R. & Regs. 1200-15-02-.05 VOUCHER TRANSACTIONS AND REDEMPTION

(1) Vouchers must be transacted only for approved foods as described in the WIC Manual. Cash and/or credit, including rainchecks, may not be provided in exchange for vouchers.

(2) Vouchers must be transacted only up to the amount of food specified.

(3) Prices charged for approved foods must be the same or lower than the current prices charged to other customers, excluding sales tax which may not be charged.

(4) No exchanges of approved foods are allowed following completion of a transaction, except for an exact exchange for food items that are defective, spoiled, or exceed their “sell/use by” date.

(5) The participant, parent/caretaker, or proxy must transact vouchers within the month for which they are valid. Vouchers must be submitted for redemption within the time period specified in 7 CFR Part 246 and the WIC Vendor Agreement, as may be amended from time to time.

(6) The purchase price and redeemed date must be entered on the voucher before it is signed in the presence of vendor staff.

(7) The vendor shall not collect payment from participants for vouchers that are returned from the bank unpaid.

(8) The cost of a food package redeemed by a WIC vendor is controlled by the prices submitted periodically by the WIC vendor, as described in WIC Vendor Agreement.

(9) Vouchers can be redeemed only up to the amount of the prices submitted by the WIC vendor to the Program.

(10) The Department may submit a claim to the vendor for Program violations resulting in unjustified overcharges. These claims will be for redeeming a voucher over the vendor’s reported prices or over the “Do Not Exceed” amount of the voucher, charging WIC participants more for WIC foods than non-WIC customers, charging for items not received by the participant, charging for items not authorized, or charging more than the current shelf price. When questioned by the Department, the vendor shall be given the opportunity to justify or correct the overcharge. The claim for reimbursement is not subject to a hearing or administrative review as stated in 7 CFR Part 246.18(a)(1)(iii) and the WIC Vendor Agreement.

(11) The Department may make price adjustments to vouchers containing errors in the purchase price once the voucher has been presented to the Department for validation. The price adjustment must comply with the price limitations as stated in the WIC Vendor Agreement. The price adjustment is not subject to a hearing or administrative review as stated in 7 CFR Part 246.18(a)(1)(iii) and the WIC Vendor Agreement, although the vendor shall be given an opportunity to explain or justify the error in question.

(12) The vendor may not appeal to the Department any voucher payment disputes.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, and 68-1-106.
• Administrative History: Original rule filed June 20, 1985; effective July 20, 1985. Repeal and new rule filed August 24, 2000; effective November 7, 2000. Repeal and new rule filed February 8, 2002; effective April 24, 2002. Amendment filed July 1, 2004; effective September 14, 2004.

Tenn. Comp. R. & Regs. 1200-15-02-.06 PARTICIPANT PROGRAM VIOLATIONS

(1) The Department shall submit to the participant or parent/caretaker a claim requiring repayment of the value of any Program benefits obtained or disposed of improperly. This includes dishonesty in the use of vouchers; providing false information for certification including dual participation; sale of supplemental food or food instruments to, or exchange with, other individuals or entities; receipt from WIC vendors of cash or credit toward purchase of unauthorized food or other items; or physical abuse or threat of physical abuse of health department or vendor staff. The participant or parent/caretaker accepts responsibility for understanding the preceding situations upon signing the Department’s “Informed Consent/Signature Sheet” during the procedures for determining eligibility in the Program.

(2) A participant may be disqualified up to twelve months for proven claims of less than $100, except for dual participation or a second or subsequent claim for which the disqualified period must be one-year.

When the participant is an infant or child, and the parent/caretaker is guilty of the violations set forth in item (1) of this section, further participation by the infant or child shall be as a lock-in status.

(3) A participant must be disqualified for one-year for proven claims of $100 or more. However, the disqualification may be waived by the Department if full repayment is made or a payment schedule agreed upon within thirty (30) days of receipt of the letter demanding repayment. If a participant is an infant, child, or a woman under age eighteen (18), the disqualification may be waived without full repayment or a payment schedule agreed upon if the Department approves a designated proxy.

Repeated violations of this nature may result in disqualification.

(4) A participant may be given an opportunity to reapply for the Program before the end of a mandatory one-year disqualification if full payment is made or a payment schedule is agreed upon within thirty (30) days of receipt of the letter demanding repayment. If a participant is an infant, child, or a woman under age eighteen (18), an opportunity to reapply for the Program before the end of a mandatory oneyear disqualification may be offered without full repayment or a payment schedule being agreed upon if the Department approves a designated proxy.

(5) The Department may provide warnings to the participant, parent or caretaker of an infant or child participant, or proxy before issuing a sanction.

(6) A participant will be given an opportunity for a hearing following the Fair Hearing Procedure (WIC/CSFP Programs) of the Tennessee Department of Health, posted in each clinic, prior to any adverse action. The participant must request a hearing within ninety (90) days of the notice of the adverse action. All hearings will be conducted in accordance with the Uniform Administrative Procedures Act, T.C.A. §4-5-101, et seq.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, and 68-1-106.
• Administrative History: Original rule filed June 20, 1985; effective July 20, 1985. Repeal and new rule filed August 24, 2000; effective November 7, 2000. Repeal and new rule filed February 8, 2002; effective April 24, 2002.

Tenn. Comp. R. & Regs. 1200-15-02-.07 VENDOR AGREEMENTS

(1) The Department utilizes a retail purchase food delivery system in which participants obtain approved foods by transacting vouchers at local WIC vendors. The WIC vendor must comply with federal regulations and the policies and procedures found in the WIC Vendor Handbook. The Department is not obligated to pay for any voucher accepted by a vendor who was not authorized at the time of the voucher was accepted.

(2) A potential WIC vendor must be a grocery store or pharmacy as defined in 1200-15-2-.01, Definitions, which operates at a permanent fixed location. Each such location requires a separate vendor agreement. Apart from initial authorization, a grocery store must also be actively participating in, and currently conducting, Food Stamp Program transactions in accordance with the regulations in 7 CFR

Part 278 before authorization by the Department as a WIC vendor. Any authorized WIC vendor, participating in the WIC Program as of January 1, 2004, who does not meet these requirements shall have up to six (6) months to comply. Failure to comply shall result in termination of the WIC Vendor Agreement. The Program requires a WIC vendor, at both initial and subsequent authorizations, not be under a disqualification or civil money penalty issued by the Food Stamp Program, another State WIC Agency, or the Tennessee WIC Program, unless denying such authorization would create an undue hardship for participants attempting to transact vouchers. Such decision related to hardship shall rest solely with the Department per 7 CFR Part 246.18(a)(1)(iii)(B) which prohibits the WIC vendor’s right to appeal. The Department does not require pharmacies to participate in the Food Stamp Program. If, however, a pharmacy was previously disqualified from the Food Stamp Program or is currently authorized and it has been issued a civil money penalty, it must inform the Department when applying for authorization as a WIC vendor.

(3) A potential vendor may apply by submitting a completed and signed Vendor Application for Authorization to Participate in the Tennessee WIC Program to the designated Program staff person in the appropriate region. Pharmacies receive written notification of waived requirements. Initial applications may be submitted at anytime.

(4) An incomplete or inaccurate application shall be returned within fifteen (15) calendar days of its receipt, unless the only item missing is the Food Stamp Authorization, which has been applied for but not received. The application shall be processed, but the vendor shall not be authorized until a copy of the Food Stamp Authorization has been provided. If the potential vendor does not resubmit a corrected application within fifteen (15) calendar days from receipt of the return letter, the application shall be considered denied. Receipt of the return letter shall be presumed to occur within three (3) business days of the date of mailing unless undeniable proof of later receipt is presented. If a resubmitted application is returned two (2) additional times for being incomplete or inaccurate, it shall be considered denied. In each instance, when an application has been denied, a new application shall not be accepted for six (6) months from the date of the denial.

(5) A potential vendor must demonstrate good business integrity, based on facts known by the Department and representations made on the application. Unless denying authorization as a vendor would create a hardship for participants’ vouchers to be redeemed, if any owner, officer, or manager has been convicted of or had a civil judgment entered against them within the previous six (6) years for any activity indicating a lack of business integrity, the application shall be denied.

(6) The Department has established appropriate criteria, including those described in paragraph (7) below, to use in the decision to determine authorization of a vendor. The potential vendor may not ask the Department for a hearing or administrative review regarding the appropriateness of these criteria, which include, but are not limited to: competitive price and price limitations, minimum variety and quantity of approved foods, business integrity, status of Food Stamp Program authorization, the majority of annual total gross sales being in staple food, and a history of Food Stamp Program transactions (except for initial authorization). However, the vendor may appeal a decision to deny authorization as a vendor as described in section 1200-15-2-.10, Appeals and Administrative Reviews.

Pharmacies are exempt from the staple food requirement.

(7) The application is subject to verification of the minimum stock requirement, competitive prices with other vendors of similar size in a peer group, and a positive compliance history with sanitation authorities. If the minimum stock is not available and/or competitive prices can not be verified during the Vendor Representative’s first visit to the store’s location, there will be a second unannounced visit within fifteen (15) calendar days. If the minimum stock requirement and/or verification of competitive prices are still not met, the application will be considered denied and a new application will not be accepted again for six (6) months from the date of the denial. Pharmacies are exempt from minimum stock and competitive pricing requirements.

(8) The Department may not authorize a potential vendor if it determines that the previous ownership has sold the store in order to circumvent a WIC sanction. This includes selling to a relative by blood or marriage or to any individual or organization for less than the fair market value. The subsequent buyer cannot be authorized as a vendor, unless such sale was conducted as an arms length transaction.

(9) The final decision to approve or deny the application will be made within sixty (60) days from the date of receipt of the completed application.

(10) Once approved, the store must execute a WIC Vendor Agreement with the Department. The vendor will be authorized to accept vouchers fifteen (15) days following the completion of WIC training provided by the Department. The training must be attended by an owner or an owner’s authorized designee.

(11) At least one person representing the vendor must participate in annual training.

(12) The WIC Vendor Agreement will be terminated if the Department determines the vendor provided false information in connection with its application.

(13) The Department may reassess any authorized vendor at any time during the current WIC Vendor Agreement period using the vendor selection criteria in effect at the time of the reassessment. The agreement for a vendor that does not meet the selection criteria must be terminated as stated in 7 CFR

Part 246.12(h)(3)(xxiv) and the WIC Vendor Agreement.

(14) The WIC Vendor Agreement does not constitute a license or a property interest. If the vendor wishes to continue to be authorized beyond the period of its current agreement, the vendor must reapply for authorization.

(15) The WIC Vendor Agreement shall be terminated if the vendor is disqualified from the Program.

(16) The Department must provide the vendor with as much advance notice as possible regarding changes to federal and State Program statutes, rules, and regulations, before implementing such changes.

(17) The Department will provide not less than fifteen (15) calendar days advance written notice of expiration prior to the expiration date of the WIC Vendor Agreement. The vendor must apply for reauthorization prior to this expiration date. However, neither the Department nor the WIC vendor has an obligation to enter into a new agreement. The Department shall consider the vendor’s satisfactory compliance with the previous agreement before making its’ decision.

(18) The vendor may not ask the Department for an administrative review regarding either the expiration of the WIC Vendor Agreement or the appropriateness of the current criteria used by the Department at the time of reauthorization as stated in 7 CFR Part 246.18(a)(1)(iii) and the WIC Vendor Agreement.

(19) During the term of the WIC Vendor Agreement, either the Department or the WIC vendor may terminate for cause, after providing not less than fifteen (15) calendar days advance written notice.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, and 68-1-106.
• Administrative History: Original rule filed June 20, 1985; effective July 20, 1985. Repeal and new rule filed August 24, 2000; effective November 7, 2000. Repeal and new rule filed February 8, 2002; effective April 24, 2002. Amendment filed July 1, 2004; effective September 14, 2004.

Tenn. Comp. R. & Regs. 1200-15-02-.08 VENDOR PROGRAM VIOLATIONS

(1) The Department may take actions such as disqualification, civil money penalties (CMP) in lieu of disqualification and claims, for Program violations and non-compliance with the WIC Vendor Agreement as described in this section. The vendor shall be given the opportunity to appeal any adverse action following procedures in 1200-15-2-.10.

(2) The vendor is responsible for its owners, officers, managers, agents, and employees who commit vendor violations.

(3) The vendor shall make inventory and other required records and all vouchers on hand available upon request of the Department.

(4) The WIC Vendor Agreement will be terminated, if the Department identifies a conflict of interest between the vendor and Program staff who administer the Program on behalf of USDA and the Department.

(5) Compliance with the WIC Vendor Agreement will be verified by activities conducted by Program staff. This includes on-site routine monitoring visits, the auditing of the vendor’s invoices to confirm sufficient stock was on hand to transact vouchers, and computer monitoring of food prices and voucher redemption activity. In addition, investigators from Department staff, or under contract with the Department, may pose as participants to conduct compliance purchases.

(6) Non-compliance is cause for sanctions against the WIC vendor, as described in the WIC Vendor Handbook. These sanctions include disqualification, a civil money penalty (CMP) in lieu of disqualification, in addition to other remedies available by law. Prior warning is not required before sanctions are issued. The Program may use installment plans for the collection of CMP’s. However, if the WIC vendor does not honor an installment plan for a CMP, the WIC vendor shall be disqualified for the same corresponding length of time as the original disqualification. Specific sanctions and periods of enforcement are found in the WIC Vendor Handbook. The following is a description of these sanctions. Subparts (a)-(d) are federally mandated; (e)-(f) are State established.

(a) Permanent disqualification for:

1. conviction by a court of competent jurisdiction of trafficking in WIC vouchers, or 2. conviction by a court of competent jurisdiction of selling firearms, ammunition, explosives, or controlled substances, as defined in section 102 of the Controlled Substances Act (21 U.S.C. 802), in exchange for WIC vouchers.

(b) Six-year disqualification for:

1. one or more incidences of investigative finding of trafficking in WIC vouchers; or 2. one or more incidences of investigative finding of selling firearms, ammunition, explosives, or controlled substances.

(c) Three-year disqualification for:

1. one or more incidence of investigative finding of the sale of alcohol, alcoholic beverages, or tobacco products in exchange for WIC vouchers;

2. a pattern of claiming reimbursement for more of a WIC food item than the vendor’s documented inventory shows was on hand for a specific time period;

3. a pattern of overcharging;

4. a pattern of receiving, transacting, and/or redeeming WIC vouchers outside of authorized channels including a vendor’s location not contracted to accept WIC vouchers and/or from someone other than the person who signed the WIC voucher at the WIC Clinic;

5. a pattern of charging for WIC foods not provided to the participant at the time of the transaction; or 6. a pattern of providing credit or non-food items (e.g., paper towels, tissues) in exchange for WIC vouchers, (other than alcohol, alcoholic beverages, tobacco products, cash, firearms, ammunition, explosives, or controlled substances, which only require one (1) incidence).

(d) One-year disqualification for:

1. a pattern of providing non-WIC foods and/or a quantity of WIC food greater than allowed on the WIC vouchers.

(e) One-year disqualification for first violation for:

1. providing false information on the “Vendor Application for Authorization to Participate in the Tennessee WIC Program”;

2. providing false information on the WIC Grocer Price Report Card;

3. failing to allow any authorized WIC representative the right to inspect vouchers on hand;

4. failing to withhold deposit of WIC vouchers for up to seven (7) days upon request of an authorized WIC representative; or 5. failing to produce bills of lading or invoices upon request of an authorized WIC representative.

(f) Six-month disqualification for first violation and one-year disqualification for second violation for:

1. failing to reimburse the WIC Program for a claim of reimbursement regarding one or more WIC vouchers;

2. failing to lower prices on approved WIC foods upon request of an authorized WIC representative;

3. failing to allow employee training on WIC procedures including having in place an effective policy and program to prevent trafficking;

4. failing of ownership/management to be knowledgeable of WIC procedures and be accountable for employee actions;

5. collecting reimbursement from a WIC participant(s) for a voucher(s) returned unpaid from the WIC Program’s bank contractor;

6. failing to treat all WIC participants the same regardless of race, color, national origin, age, gender, disability, religious or political belief;

7. failing to meet minimum stock requirements for approved WIC foods including having stock within eligible product dates;

8. failing to provide suitable hours and an environment for participant access including, but not limited to, not restricting the hours to redeem WIC vouchers, not keeping WIC participants from using a check-out available to all other customers, and not acting in a way that abuses or embarrasses a WIC participant;

9. failing to offer WIC participants any courtesies offered other customers including, but not limited to, bonus cards, multiplying of coupon values, and additional products for free;

10. requiring WIC participants to sign WIC vouchers without first entering the redeemed date and/or redeemed amount;

11. failing to obtain a signature on WIC vouchers at the time of the transaction;

12. redeeming WIC vouchers not valid for the month in which they are redeemed; or 13. failing to conduct WIC transactions only on the vendor’s premises.

(7) WIC vendors who are disqualified by the Food Stamp Program or another State WIC Agency may also be disqualified by the Program for the same length of time, unless doing so would place a hardship on participants, and is not subject to administrative or judicial review under the WIC Program.

(8) A civil money penalty may be imposed when disqualification would place a hardship upon participants who normally redeemed their vouchers at that particular location. This includes a decision for disqualification made by the Program, the Food Stamp Program or another State WIC Agency. The participant access determination must be made in writing by the Department and is not subject to challenge by the vendor. This determination is to be based on the availability of at least one other vendor within a reasonable distance of the vendor to be disqualified. The other vendor(s) must be reachable by participants using available transportation such as automobile, public transit, and/or walking without geographic barriers. Such barriers might include, but are not limited to, interstate highways, rivers, bridges not open to foot traffic, and steep terrain. A civil money penalty issued in lieu of permanent disqualification shall be $10,000. For any other period of disqualification, the CMP shall be based on ten (10) percent of the vendor’s average WIC redeemed dollar amount for the previous six-month period multiplied by the number of months the vendor would have been disqualified but shall not exceed $10,000 for each violation or $40,000 for multiple violations.

(9) When a vendor previously assessed a federally mandated sanction for any of the one, three, or six-year periods is to be sanctioned again for any of these violations, the disqualification period shall be doubled. If a CMP is to be issued, the amount of the CMP shall be doubled up to the $40,000 maximum stated in (8) above. When a vendor previously assessed a federally mandated sanction twice for any of these violations commits any one of them for the third time or greater, the disqualification period shall be doubled. A CMP shall not be issued in these situations.

(10) When a vendor previously assessed a State established sanction for any of the six-month or one-year periods is to be sanctioned again for any of these violations and a CMP is to be issued, the CMP shall be doubled up to the limits stated in (8) above. A CMP shall not be issued in lieu of disqualification for the third time or greater.

(11) A WIC vendor committing fraud or abuse of the Program is subject to prosecution under applicable federal, State, or local laws.

(12) Except for vendor name, address, and authorization status, the Department must restrict the use or disclosure of confidential vendor information to those entities listed in 7 CFR Part 246.26(e).

History

• Authority: T.C.A. §§4-5-202, 4-5-204, and 68-1-106.
• Administrative History: Original rule filed August 24, 2000; effective November 7, 2000. Repeal and new rule filed February 8, 2002; effective April 24, 2002. Amendment filed July 1, 2004; effective September 14, 2004.

Tenn. Comp. R. & Regs. 1200-15-02-.09 NON-DISCRIMINATION

(1) The Program is governed by the following USDA non-discrimination statement for participation in the Program as either a participant or WIC vendor:

(2) “The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, or marital or family status. (Not all prohibited bases apply to all programs.)

Persons with disabilities who require alternative means for communication of program information (e.g., Braille, large print, audiotape) should contact USDA’S TARGET Center at (202) 720-2600 (voice and TDD).

(3) To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 14th and Independence Avenue, SW, Washington, DC 20250-9410 or call (202) 720-5964 (voice and TDD). USDA is an equal opportunity provider and employer.”

History

• Authority: T.C.A. §§4-5-202, 4-5-204, and 68-1-106.
• Administrative History: Original rule filed June 20, 1985; effective July 20, 1985. Repeal and new rule filed August 24, 2000; effective November 7, 2000. Repeal and new rule filed February 8, 2002; effective April 24, 2002.

Tenn. Comp. R. & Regs. 1200-15-02-.10 APPEALS AND ADMINISTRATIVE REVIEWS

(1) Vendors may appeal any adverse actions taken by the Department, except as provided in paragraph (4)(a) of this section.

(a) The Department shall provide the vendor with written notice of the adverse action fifteen (15) calendar days prior to the effective date of the action. The written notice shall contain:

1. the adverse action being taken;

2. the cause(s) for the action;

3. effective date of the action;

4. procedures to file for a hearing or administrative review;

5. time period allowed to request a hearing or administrative review; and 6. any other pertinent information.

(b) The vendor’s request for a review (either a hearing or an administrative review) in order to appeal the actions of the WIC Program must be received within fifteen (15) calendar days from the date of receipt of the notice.

(2) Adverse actions subject to hearings shall be in accordance with the Uniform Administrative Procedures Act, T.C.A. §4-5-101, et seq.

(a) The vendor will be provided an opportunity to request a hearing for the following reason(s):

1. denial of authorization: based on the vendor selection criteria for competitive price or for minimum variety and quantity of authorized supplemental foods or for requiring the majority of annual total gross sales to be derived from staple foods or on a determination that the vendor is attempting to circumvent a sanction;

2. termination of an agreement for cause;

3. disqualification; or 4. imposition of a civil money penalty in lieu of disqualification.

(b) The Department shall make arrangements for a hearing before an administrative judge from the Administrative Procedures Division of the Office of the Secretary of State. The vendor shall also be given the following:

1. written notification of the adverse action, the procedures to follow to obtain a full administrative review, and the cause(s) for and the effective date of the action (When a vendor is disqualified due in whole or in part to violations in 1200-15-2-.08(6) Subparts (a)-(d), such notification must include the following statement: “This disqualification from WIC may result in disqualification as a retailer in the Food Stamp Program. Such disqualification is not subject to administrative or judicial review under the Food Stamp Program.”);

2. the opportunity to appeal the adverse action within fifteen (15) calendar days of receipt of the notification of adverse action;

3. adequate advance notice of the time and place of the hearing to provide sufficient time to prepare for the hearing;

4. the opportunity to present its case and at least one opportunity to reschedule the hearing date upon specific request;

5. the opportunity to cross-examine adverse witnesses (When necessary to protect the identity of WIC Program investigators, such examination may be conducted behind a protective screen or other device.);

6. the opportunity to be represented by counsel;

7. the opportunity to examine prior to the review the evidence upon which the Program’s action is based;

8. an impartial decision-maker (administrative judge), whose determination is based solely on whether the Program has correctly applied Federal and State statutes, regulations, policies, and procedures governing the Program, according to the evidence presented at the hearing; and 9. written notification of the review decision, including the basis for the decision, within ninety (90) days from the date of receipt of a vendor’s request for a hearing. (These timeframes are only administrative requirements and do not provide a basis for overturning the Program’s adverse action, if a decision is not made within the specified timeframe.)

(3) Adverse actions subject to administrative review in accordance with 7 CFR 246.18(a)(1)(ii) are as follows.

(a) The vendor will be provided an opportunity to request an administrative review for the following reason(s):

1. denial of authorization: based on the vendor selection criteria for business integrity or for a current Food Stamp Program disqualification or civil money penalty for hardship;

2. denial of authorization: based on a Program-established vendor selection criterion if the

basis of the denial is a WIC vendor sanction or a Food Stamp Program withdrawal of authorization or disqualification;

3. termination of an agreement because of a change in ownership or location or cessation of operations;

4. disqualification based on a trafficking conviction;

5. disqualification based on the imposition of a Food Stamp Program civil money penalty for hardship; or 6. disqualification or a civil money penalty imposed in lieu of disqualification based on a mandatory sanction imposed by another WIC State Program.

(b) The Department shall conduct all administrative reviews pursuant to 7 CFR 246.18(c). The vendor shall also be given the following:

1. written notification of the adverse action, the procedures to follow to obtain an administrative review, the cause(s) for and the effective date of the action, and an opportunity to provide a written response;

2. a decision-maker, appointed by the Commissioner, who is someone other than the person who rendered the initial decision on the action and whose determination is based solely on whether the Program has correctly applied Federal and State statutes, regulations, policies, and procedures governing the Program, according to the information provided to the vendor concerning the cause(s) for the adverse action and the vendor’s response; and 3. written notification of the review decision, including the basis for the decision, within ninety (90) days of the date of receipt of the request for an administrative review. (These timeframes are only administrative requirements and do not provide a basis for overturning the Program’s adverse action if a decision is not made within the specified timeframe.)

(4) Adverse actions not subject to administrative reviews.

(a) The Department will not provide administrative reviews to vendors that appeal the following adverse actions:

1. the validity or appropriateness of the Program’s vendor limiting or selection criteria;

2. the validity or appropriateness of the Program’s participant access criteria and the Program’s participant access determinations;

3. the Program’s determination whether a vendor had an effective policy and program in effect to prevent trafficking and that the ownership of the vendor was not aware of, did not approve of, and was not involved in the conduct of the violation;

4. the expiration of the vendor’s agreement;

5. disputes regarding food instrument payments and vendor claims (other than the opportunity to justify or correct a vendor overcharge or other error); or 6. disqualification of a vendor as a result of disqualification from the Food Stamp Program.

(5) Effective date of adverse actions against vendors.

(a) The Department will make denials of authorization and permanent disqualification imposed for violations contained in 1200-15-2-.08(6)(a) of this Chapter effective on the date of receipt of the notice of adverse action.

(b) The Department will make all other adverse actions effective after fifteen (15) calendar days after the date of the notice of adverse action is received by the vendor, unless a request for a hearing or administrative review is received from the vendor within fifteen (15) calendar days.

(c) The Department will make the adverse action effective the date the vendor receives the final determination on actions which were subject to a hearing or administrative review.

(6) Continuing responsibilities. Appealing an adverse action does not relieve a vendor that is permitted to continue program operations while its’ appeal is in process from the responsibility of continued compliance with the terms of the written agreement with the Program.

(7) The Department shall accept the decisions rendered under the hearing and administrative review as the final Program action. If the adverse action under review has not already taken effect, the Program will make the action effective on the date of receipt of the review decision by the vendor.

(8) Judicial review. If the review decision upholds the adverse action against the vendor, the Department will inform the vendor that it may be able to pursue judicial review of the decision in the Chancery Court for Davidson County, Tennessee.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, and 68-1-106.
• Administrative History: Original rule filed February 8, 2002; effective April 24, 2002. Amendment filed July 1, 2004; effective September 14, 2004.

Chapter 1200-15-03 Investigations of Sudden, Unexplained Infant and Child Deaths

Tenn. Comp. R. & Regs. 1200-15-03-.01 PURPOSE

The purpose of this chapter is to establish minimum standards for conducting and completing an investigation, including an autopsy if deemed necessary, into sudden, unexplained infant and child deaths.

History

• Authority: T.C.A. §§ 68-1-1101, 68-1-1102, and 68-1-1103.
• Administrative History: Original rule filed May 11, 2010; effective October 29, 2010; however on October 28, 2010 the Department of Health withdrew the rules. Original rule filed January 24, 2012; effective June 30, 2012.

Tenn. Comp. R. & Regs. 1200-15-03-.02 DEFINITIONS

For purposes of this chapter, (1) “Autopsy” means the post mortem examination of a deceased infant or child by a licensed pathologist to determine cause of death.

(2) “Child” means a person who is at least one year of age and has not reached his or her eighteenth birthday.

(3) “Department” means the Tennessee Department of Health.

(4) “Infant” means a baby who was born alive and has not reached his or her first birthday.

(5) “Sudden, unexplained infant or child death” means the unexpected death of an infant or a child with no known or apparent cause.

History

• Authority: T.C.A. §§ 68-1-1101, 68-1-1102, and 68-1-1103.
• Administrative History: Original rule filed May 11, 2010; effective October 29, 2010; however on October 28, 2010 the Department of Health withdrew the rules. Original rule filed January 24, 2012; effective June 30, 2012.

Tenn. Comp. R. & Regs. 1200-15-03-.03 STANDARDS FOR INVESTIGATIONS

(1) The standards for conducting and completing an investigation, including performance of an autopsy, into a sudden, unexplained infant death shall include the standards applicable to infants found in T.C.A. § 68-1-1102, and the standards authorized or required by Tennessee Code Annotated Title 38, Chapter 7. The same standards shall apply to sudden, unexplained child death.

(2) In addition to the standards found in T.C.A. § 68-1-1102 and Title 38, Chapter 7, the standards for conducting and completing an investigation, including performance of an autopsy, into a sudden, unexplained infant or child death shall be those found in the most current version of the Centers for Disease Control and Prevention’s publication, “Sudden, Unexplained Infant Death Investigation Reporting Form,” for infants, and the Department’s “Sudden, Unexplained Child Death Investigation Reporting Form,” for children. The Department shall provide access to these publications upon request. The pathologist performing the autopsy shall complete the appropriate form.

History

• Authority: T.C.A. §§ 68-1-1101, 68-1-1102, 68-1-1103, and 68-3-502.
• Administrative History: Original rule filed May 11, 2010; effective October 29, 2010; however on October 28, 2010 the Department of Health withdrew the rules. Original rule filed January 24, 2012; effective June 30, 2012.

Tenn. Comp. R. & Regs. 1200-15-03-.04 REIMBURSEMENT OF COUNTY GOVERNMENTS

The Department shall reimburse county governments for the cost of each autopsy performed for an investigation into a sudden, unexplained infant or child death that is carried out in accordance with the investigation standards in this chapter. The Department shall reimburse up to the maximum allowable of $1,250.00 per autopsy, including travel costs. The Tennessee Department of Finance and Administration’s Comprehensive Travel Regulations shall govern the reimbursement rate for travel costs.

History

• Authority: T.C.A. §§ 68-1-1101, 68-1-1102, and 68-1-1103.
• Administrative History: Original rule filed May 11, 2010; effective October 29, 2010; however on October 28, 2010 the Department of Health withdrew the rules. Original rule filed January 24, 2012; effective June 30, 2012.

Chapter 1200-15-04 Maternal Mortality Review and Prevention

Tenn. Comp. R. & Regs. 1200-15-04-.01 PURPOSE

The purpose of this chapter is to establish minimum standards for reporting and reviewing maternal deaths.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, and 68-3-601, et seq.
• Administrative History: Original rules filed May 8, 2017; effective August 6, 2017.

Tenn. Comp. R. & Regs. 1200-15-04-.02 DEFINITIONS

(1) “Ad Hoc Team Member” means a team member appointed by the Commissioner to assist the State Team on a particular case or cases.

(2) “Department” means the Department of Health.

(3) “Commissioner” means the Commissioner of the Department of Health, or designee.

(4) “Ex Officio Team Members” means (a) The Commissioner of health or the Commissioner’s designee;

(b) The state maternal and child health director or the director's designee;

(c) The chief medical examiner or the examiner's designee;

(d) The chair of the health and welfare committee of the senate, or the chair's designee; and (e) The chair of the health committee of the house of representatives, or the chair's designee.

(5) “Maternal Mortality” means a case in which a woman has died within the State of Tennessee while pregnant or within 365 days of having been pregnant.

(6) “Staff” means employees of the Department assigned to provide administrative assistance to the State Team.

(7) “State Team” or “Team” means the team of professionals appointed by the Commissioner to review reportable cases.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, and 68-3-601, et seq.
• Administrative History: Original rules filed May 8, 2017; effective August 6, 2017.

Tenn. Comp. R. & Regs. 1200-15-04-.03 STATE TEAM MEMBER APPOINTMENTS

(1) The Commissioner will be responsible for appointing members other than Ex Officio Team Members to the State Team.

(2) Initial appointees shall be appointed as follows: one-third of the members shall be appointed for one year, one-third for two years, and one-third for three years. Thereafter, all State Team members will be appointed for terms of three years, provided, however, that a State Team member at the end of his or her term may continue to serve until a replacement State Team member has been appointed.

(3) In the event that the Commissioner determines that a particular case or cases require(s) expertise not already present on the State Team, the Commissioner may appoint an Ad Hoc Team Member for that specific case.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, and 68-3-601, et seq.
• Administrative History: Original rules filed May 8, 2017; effective August 6, 2017.

Tenn. Comp. R. & Regs. 1200-15-04-.04 REVIEW PROCEDURES

(1) Upon receipt of a report of a maternal mortality, staff may conduct interviews and request information and records from health care providers, law enforcement, medical examiners, employers or other individuals or entities believed to have information about the decedent and the circumstances surrounding the decedent's death, including, but not limited to, records related to any individual, entity or object whose history is determined by the Team to be germane to the death to be reviewed.

(2) Individuals and entities who receive requests for records shall comply within fifteen (15) calendar days. In the event that records are not forthcoming, the Commissioner may seek enforcement as provided by law.

(3) Staff shall have authority to request records related to a particular case at any time until the review of that case has been completed by the Team.

(4) The State Team shall meet at least two (2) times per year to review cases of maternal mortality. State Team members may participate via webinar or conference call. Meetings will be closed to the public.

(5) Upon completion of a review, all copies of records related to that case will be collected from Team members and destroyed.

(6) Upon completion of a review, staff shall prepare a narrative summary of the case and shall enter data from the case into a secure database.

(7) A review shall be deemed completed at such time as it is entered into the annual report of the State Team.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, and 68-3-601, et seq.
• Administrative History: Original rules filed May 8, 2017; effective August 6, 2017. Amendments filed April 4, 2023; effective July 3, 2023.

Tenn. Comp. R. & Regs. 1200-15-04-.05 CONFIDENTIALITY OF DATA

All individual, potentially identifying data obtained in conjunction with the review of a case shall remain confidential and not subject to subpoena or other disclosure. The State Team may share de-identified data with public health authorities, and may cooperate with public health authorities in assembling deidentified, aggregate reports of maternal mortality including cases outside the jurisdiction of the State Team.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, and 68-3-601, et seq.
• Administrative History: Original rules filed May 8, 2017; effective August 6, 2017.

Tenn. Comp. R. & Regs. 1200-15-04-.06 ANNUAL REPORT

The State Team will prepare an annual report for distribution to the Governor and General Assembly.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, and 68-3-601, et seq.
• Administrative History: Original rules filed May 8, 2017; effective August 6, 2017.

Chapter 1200-16-01 Family Planning

Tenn. Comp. R. & Regs. 1200-16-01-.01 DEFINITION OF TERMS

For the purposes of these rules and regulations and as used herein:

(1) “Advanced Practice Registered Nurse” means a licensed registered nurse with a master’s degree or higher in a nursing specialty who has national specialty certification under T.C.A. § 63-7-126.

(2) “Department” means the Tennessee Department of Health.

(3) “Commissioner” means the Commissioner of the Tennessee Department of Health.

(4) “Family Planning Provider” means a physician or physician assistant, an advanced practice registered nurse, a registered nurse, a pharmacist, or a clinic that is approved to provide family planning services to eligible clients according to the most recent clinical guidelines from the Office of Population Affairs (OPA) and Centers for Disease Control and Prevention (CDC).

(5) “Physician” means any doctor of medicine or doctor of osteopathy duly licensed to practice the profession in Tennessee or the state in which s/he resides and lawfully practices such physician’s profession.

(6) “Centers for Disease Control and Prevention (CDC)” is a federal agency under the Department of Health and Human Services.

(7) “Contraceptive Procedures” means any medically approved procedure designed to prevent conception.

(8) “Contraceptive Supplies” means those FDA approved or exempted items designed to prevent conception through chemical, mechanical or other means.

(9) “Contraceptive Services” means all medically approved contraceptive procedures, supplies, and information designed to prevent conception.

(10) “County Health Department” means any county health agency functioning pursuant to T.C.A. § 68-2-603 and providing family planning services.

(11) “Registered Nurse” means a licensed registered nurse under T.C.A. § 63-7-105.

(12) “Office of Population Affairs (OPA)” is a part of the United States Department of Health and Human Services, which oversees the Title X program.

History

• Authority: T.C.A. §§ 63-7-105, 63-7-126, 68-34-102, and 68-34-106.
• Administrative History: Original rule filed January 27, 1975, effective February 26, 1975. Amendments filed January 21, 2020; effective April 20, 2020.

Tenn. Comp. R. & Regs. 1200-16-01-.02 POLICY

It shall be the policy of the Department in implementing The Family Planning Act of 1971 T.C.A. §§ 68-34- 101 et seq., that:

(1) All contraceptive services and information thereof, shall be provided by county health department to any eligible patient under the supervision of the Department.

(2) Family planning providers employed by the Department acting pursuant to the Department’s

authority, shall from now on provide such services as requested and voluntarily consented to by the patient.

(3) The Department or any agency acting pursuant to the Department’s authority may, subject to the availability of funds, arrange for a patient to undergo a permanent sterilization procedure at a licensed healthcare facility provided such procedure is requested and voluntarily consented to by the patient.

(4) In accord with the provisions of T.C.A. § 68-34-104(3), nothing shall prohibit a family planning provider from refusing to furnish any contraceptive procedures or supplies where such refusal is for medical reasons.

History

• Authority: T.C.A. §§ 68-34-104 and 68-34-106.
• Administrative History: Original rule filed January 27, 1975, effective February 26, 1975. Amendments filed January 21, 2020; effective April 20, 2020.

Tenn. Comp. R. & Regs. 1200-16-01-.03 ELIGIBILITY FOR CONTRACEPTIVE SERVICES

All medically approved contraceptive procedures, supplies and information shall be readily and practicably available to each and every person desirous of the same regardless of religion, race, color, national origin, citizenship, disability, income, age, sex, number of pregnancies, or marital status in accordance with fee schedules which shall be available at each family planning site.

History

• Authority: T.C.A. §§ 68-34-102, 68-34-103, 68-34-104, and 68-34-106.
• Administrative History: Original rule filed January 27, 1975, effective February 26, 1975. Amendments filed January 21, 2020; effective April 20, 2020.

Tenn. Comp. R. & Regs. 1200-16-01-.04 NOTICE

The general public served by each local health department shall be reasonably notified of the date, time and place contraceptive services will be made available.

History

• Authority: T.C.A. § 68-34-106.
• Administrative History: Original rule filed January 27, 1975, effective February 26, 1975. Rule was previously numbered 1200-16-01-.05 but was renumbered 1200-16-01-.04 with the deletion of original rule 1200-16-01-.04 filed January 21, 2020; effective April 20, 2020.

Tenn. Comp. R. & Regs. 1200-16-01-.05 PROCEDURES TO BE FOLLOWED IN PROVIDING CONTRACEPTIVE SUPPLIES

Any eligible patient requesting contraceptive supplies shall be provided such services according to guidance from Title X and OPA.

History

• Authority: T.C.A. §§ 68-34-105 and 68-34-106.
• Administrative History: Original rule filed January 27, 1975, effective February 26, 1975. Amendment filed January 14, 1976, effective February 13, 1976. Amendment filed June 14, 1976, effective July 14, 1976. Rule was previously numbered 1200-16-01-.07 but was renumbered 1200-16-01-.05 with the deletion of original rules 1200-16-01-.04 and 1200-16-01- .06 filed January 21, 2020; effective April 20, 2020. Amendments filed January 21, 2020; effective April 20, 2020.

1200-17 Bureau of Administrative Services

Chapter 1200-17-01 Repealed

Tenn. Comp. R. & Regs. 1200-17-01-.01 REPEALED

History

• Authority: T.C.A.. §§53-103, 68-1-103, 68-1-301 et seq., 68-1-401, 68-1-702, 68-1-804(7), 68-5-105, 68-5-603, 68- 9-112, 68-12-103, 68-12-104, 68-41-104, 68-49-103, 4-3-1802, 4-3-1803(1), 4-3-1803(6), 4-3-1803(9), 4-3- 1803(10), 4-3-1803(l]), and 11-1-101(f).
• Administrative History: Original rule filed December 13, 1974; effective January 12, 1975. Amendment filed August 10, 1990; effective September 24, 1990. Repeal filed January 4, 2001; effective May 31, 2001.

Tenn. Comp. R. & Regs. 1200-17-01-.06 REPEALED

History

• Authority: T.C.A. §§68-13-403(a)(2), 4-5-201 et seq., 68-1-103, 68-1-301 et seq., 68-1-401, 68-1-702,68-1-804(7), 68-3-10.5, 68-.5-603, 68-9-112, 68-12-103, 68-12-104, 68-41-104, 68-49-103, 4-5-202, and 11-1-101(f).
• Administrative History: Original rule filed December 13, 1974; effective January 12, 1975. Amendment filed February 4, 1982; effective March 22, 1982. Amendment filed April 13, 1984; effective July 14, 1984. Amendment filed August 6, 1984; effective November 13, 1984. Amendment filed September 17, 1986; effective November 1, 1986. Amendment filed August 10, 1990; effective September 24, 1990. Amendment filed August 15, 1990; effective September 29, 1990. Amendment filed March 20, 1991; effective May 4, 1991. Repeal filed January 4, 2001; effective May 31, 2001.

Tenn. Comp. R. & Regs. 1200-17-01-.02 THROUGH 1200-17-.05 REPEALED

History

• Authority: T.C.A. §§11-1-101(f) and 53-103.
• Administrative History: Original Rule filed December 13, 1974; effective January 12, 1975. Repeal filed January 4, 2001; effective May 31, 2001.

Chapter 1200-17-02 Rules and Regulations Governing Fees for Services

Tenn. Comp. R. & Regs. 1200-17-02-.01 DEFINITIONS

Unless otherwise specifically indicated by the context, for the purposes of these rules and regulations, the terms used herein are defined as follows:

(1)Bureau - The Bureau of Health Services.

(2)Commissioner - The Commissioner of the Tennessee Department of Health or the Commissioner’s designee.

(3)Department - The Tennessee Department of Health including all regional and rural county health departments.

(4)Federal Poverty Guidelines - Guidelines established by the U.S. Department of Health and Human Services and published annually in the Federal Register that determine a patient’s or family’s income relative to the federal poverty level.

(5)Medicaid - The federal medical assistance program.

(6)Metropolitan Health Department - The Davidson, Hamilton, Knox, Shelby, Madison, and Sullivan County health departments.

(7)Patients/Client - All individuals, agencies, corporations, or others requesting or receiving services from the Department.

(8)TennCare - The State medical assistance program.

History

• Authority: T.C.A. §§68-1-103, 68-1-106, 68-1-301 et seq., 68-1-401, 68-1-702, 68-1-804(7), 68-2-601, 68-5-105, 68-5-603, 68-9-112, 68-12-103, 68-12-104, 68-41-104, 68-49-103, 4-3-1802, 4-3-1803(1), 4-3-1803(6), 4-3- 1803(9), 4-3-1803(10), 4-3-1803(11), and 4-5-202.
• Administrative History: Original rule filed January 26, 1990; effective March 12, 1990. Amendment filed August 29, 1991; effective October 13, 1991. Amendment filed July 22, 1992; effective October 28, 1992. Repealed and new rule filed September 29, 1999; effective December 8, 1999. (Formerly rule 1200-17-2-.02).

Tenn. Comp. R. & Regs. 1200-17-02-.02 SCOPE

(1)These rules and regulations apply to all patients/clients requesting or receiving public health services provided by the bureau and are consistent with federal regulations.

(2)All patients/clients will be billed the fee for the particular service provided unless exempted by section

Tenn. Comp. R. & Regs. 1200-17-02-.03 ESTABLISHMENT OF FEES

(1)Fees will be established by the Department according to determinable costs incurred in providing services. If the determinable costs cannot be established, fees will be based upon a reasonable alternative method approved by the Commissioner.

(2)The Commissioner may establish a minimum charge which shall be applied to some or all services, regardless of the sliding fee scale established in section 1200-17-2-.05. A metropolitan health department may establish a minimum charge which shall be applied to some or all services.

(3)Fees may be waived by the Commissioner, if doing so would promote and protect the health, safety, or welfare of the public.

(4)A metropolitan health department may establish fees that are different from those set by the Commissioner in accordance with these rules and regulations, if the fees are established according to the following standards:

(a)the fees established do not exceed the cost of providing the services;

(b)the fees are established by an ordinance enacted by the appropriate municipal and/or county legislative governing body or the fees are adopted by the County Board of Health in accordance with T.C.A. §68-2-601;

(c)the listing of fees is submitted to the Department; and (d) the fee structure includes a sliding fee scale based on the patient or family income as a percentage of the federal poverty guidelines.

History

• Authority: T.C.A. §§68-1-103, 68-1-301 et seq., 68-1-401, 68-1-702, 68-1-804(7), 68-2-601, 68-5-105, 68-5-603, 68-9-112, 68-12-103, 68-12-104, 68-41-104, 68-49-103, 4-3-1802, 4-3-1803(1), 4-3-1803(6), 4-3-1803(9), 4-3- 1803(10), 4-3-1803(11), and 4-5-202.
• Administrative History: Original rule filed January 26, 1990; effective March 12, 1990. Amendment filed August 29, 1991; effective October 13, 1991. Repealed and new rule filed September 29, 1999; effective December 8, 1999. (Formerly rule 1200-17-2-.04).

Tenn. Comp. R. & Regs. 1200-17-02-.04 EXEMPTIONS FROM FEES

(1)The following patients/clients shall be exempt from fees as a personal obligation:

(a)those receiving any vaccine provided by the Department’s Immunization Program (This exemption applies only to the vaccine and not to other charges associated with the visit.);

(b)those with active tuberculosis or those participating in Tuberculosis Control case-finding activities and treatment;

(c)those receiving treatment for sexually transmitted diseases or those participating in sexually transmitted disease case-finding activities and treatment;

(d)those receiving treatment for other communicable diseases designated as reportable or those participating in case-finding activities and treatment for reportable communicable diseases;

(e)those who have been certified by the Tennessee Department of Human Services or the Social Security Administration as eligible for Medicaid shall be exempt from all fees for TennCare covered services; and (f)those enrolled in TennCare as uninsured or uninsurable with incomes below the federal poverty level and who have no responsibility for co-insurance shall be exempt from all fees for TennCare covered services.

(2)The established fees for these exempt patients/clients may be collected from any third party insurance, benefits, or funding that may be available.

History

• Authority: T.C.A. §§68-1-103, 68-1-301 et seq., 68-1-401, 68-1-702, 68-1-804(7), 68-5-105, 68-5-603, 68-9-112, 68-12-103, 68-12-104, 68-41-104, 68-49-103, 4-3-1802, 4-3-1803(1), 4-3-1803(6), 4-3-1803(9), 4-3-1803(10), 4- 3-1803(11), and 4-5-202.
• Administrative History: Original rule filed January 26, 1990; effective March 12, 1990. Amendment filed August 29, 1991; effective October 13, 1991. Repealed and new rule filed September 29, 1999; effective December 8, 1999. (Formerly rule 1200-17-2-.05).

Tenn. Comp. R. & Regs. 1200-17-02-.05 SLIDING SCALE FOR FEES

(1)For patients/clients not otherwise exempt from payment of fees for services, a sliding fee scale established by the bureau and approved by the Commissioner shall apply. This scale will be based upon patient or family income as a percentage of the federal poverty guidelines. The Commissioner may waive the sliding fee scale for certain services established in health departments to address an identified health need of the area for which there are no funds mandated for the service.

History

• Authority: T.C.A. §§68-1-102(b), 68-1-103, 68-1-301 et seq., 68-1-401, 68-1-702, 68-1-804(7), 68-5-105, 68-5- 603, 68-9-112, 68-12-103, 68-12-104, 68-41-104, 68-49-103, 4-3-1802, 4-3-1803(1), 4-3-1803(6), 4-3-1803(9), 4- 3-1803(10), 4-3-1803(11), and 4-5-202.
• Administrative History: Original rule filed January 26, 1990; effective March 12, 1990. Amendment filed August 29, 1991; effective October 13, 1991. Repealed and new rule filed September 29, 1999; effective December 8, 1999. (Formerly rule 1200-17-2-.06).

Tenn. Comp. R. & Regs. 1200-17-02-.06 PUBLICATION OF FEES

(1)All fees shall be published annually and shall be available in the public area of each local, regional, or metropolitan health department. A sign shall be posted in each health department informing patients that the listing of fees is available.

History

• Authority: T.C.A. §§4-5-202 and 68-1-103.
• Administrative History: Original rule filed September 29, 1999; effective December 8, 1999.

Tenn. Comp. R. & Regs. 1200-17-02-.07 REPEALED

History

• Authority: T.C.A. §§4-3-1803, 4-5-202, 68-1-102(b)(2), 68-2-103, 68-2-607, 71-5-102, 71-5-104, 71-5-105, 71-5- 106, and 71-5-134.
• Administrative History: Original rule filed June 22, 1994; effective October 28, 1994. Repeal filed September 29, 1999; effective December 8, 1999.

Tenn. Comp. R. & Regs. 1200-17-02-.08 REPEALED

History

• Authority: T.C.A. §§4-3-1803, 4-5-202, 68-1-102(b)(2), 68-2-103, 68-2-607, 71-5-102, 71-5-104, 71-5-105, 71-5- 106, and 71-5-134.
• Administrative History: Original rule filed January 26, 1990; effective March 12, 1990. (Formerly 1200-17-2-.07). Amendment filed June 22, 1994; effective October 28, 1994. Repeal filed September 29, 1999; effective December 8, 1999.

Chapter 1200-18-01 Repealed

Tenn. Comp. R. & Regs. 1200-18-01 Repealed

RULES

OF TENNESSEE DEPARTMENT OF PUBLIC HEALTH

DIVISION OF LEGAL SERVICES

Authority: T.C.A. §§4-5-202, 4-509, and 68-1-103. Administrative History: Original rule filed February 5, 1976; effective March 8, 1976. Repeal filed January 27, 2000; effective May 30, 2000.

Chapter 1200-19-01 Determination of Physician Shortage Areas

Tenn. Comp. R. & Regs. 1200-19-01-.01 DEFINITIONS

(1)Physician is defined as a person licensed to practice medicine or surgery in Tennessee and a person licensed to practice osteopathy in Tennessee.

(2)Physician to Population Ratio: The ratio derived by dividing the population of the area by the number of physicians providing medical service in the area. Only physicians spending 50% or more of their time giving direct patient care, in an office or facility-based practice, and who are under 65 years of age in the year that the ratio is determined, shall be counted; interns, residents and federal physicians are excluded.

(3)Physician Shortage Area (PSA): An area in the State of Tennessee designated by the Commissioner of the Tennessee Department of Health, as an area where there is a shortage of primary care physicians.

(4)Population: The number of persons residing in an area according to the most recent census of most current issue of “Current Population Reports” as determined and published by the U.S. Department of Commerce/Bureau of Census.

(5)Primary Care: Basic level of health care generally rendered by general practitioners, family practitioners, internists, obstetricians, and pediatricians. This type of care emphasizes caring for the patient’s general health needs as opposed to a more specialized or fragmented approach to medical care. This care is usually rendered in an outpatient setting.

(6)Health Manpower Shortage Area (HMSA): An area which is designated by the Secretary of the U.S.

Department of Health and Human Services pursuant to 42 CFR 5.3(d) as having an acute shortage of health providers.

History

• Authority: T.C.A. §49-50-106.
• Administrative History: Original rule filed June 29, 1983; effective July 29, 1983.

Tenn. Comp. R. & Regs. 1200-19-01-.02 DESIGNATION OF SHORTAGE AREAS

(1)The Commissioner of the Tennessee Department of Health will determine whether an area is eligible to be designated a PSA through the application of criteria and procedures outlined herein. If the Commissioner determines that an area is eligible to be a PSA, the Commissioner will so designate the areas as a PSA. The Commissioner may also de-designate an area when he determines that an area no longer meets the criteria. Upon the designation or de-designation of an area as a PSA, the Commissioner will notify the Tennessee Student Assistance Corporation of his actions.

(2)Physicians who locate in a designated area are eligible for loan forgiveness which shall continue so long as they practice in the area regardless of a subsequent de-designation. Physicians who are located in an area which subsequently is designated as a PSA shall be eligible for loan forgiveness from the date of designation for the remainder of the loan.

(3)The promulgation of these Rules notwithstanding, physicians receiving financial assistance under the Medical Scholarship Loan Program who have already received official notification of forgiveness under this program, shall continue to have their forgiveness effective and shall not be affected by any changes in designation of a PSA.

History

• Authority: T.C.A. §49-50-106.
• Administrative History: Original rule filed June 29, 1983; effective July 29, 1983.

Tenn. Comp. R. & Regs. 1200-19-01-.03 CRITERIA FOR DETERMINATION OF PHYSICIAN SHORTAGE AREAS

(1)To be designated a PSA, the Commissioner of the Tennessee Department of Health will consider whether:

(a)The area is a rational area for the delivery of primary medical care. 1.The following areas will be considered rational areas for the delivery of primary medical care services:

(i)A county, or a group of contiguous counties whose population centers are within 30 minutes travel time of each other.

(ii)A portion of a county, or an area made up of portions of more than one county, whose population, because of topography, market or transportation patterns, distinctive population characteristics or other factors, has limited access to contiguous area resources, as measured generally by a travel time greater than 30 minutes to such resources.

(iii)Established neighborhoods and communities within metropolitan areas which displays a strong self-identity (as indicated by a homogeneous socioeconomic or demographic structure and/or a tradition of interaction or interdependency), have limited interaction with contiguous areas, and which, in general, have a minimum population of 20,000. 2.The following distances will be used as guidelines in determining distance corresponding to 30 minutes travel time:

(i)Under normal conditions with primary roads available: 20 miles.

(ii)In mountainous terrain or in areas with only secondary roads available: 15 miles.

(iii)Within inner portions of metropolitan areas, information on the public transportation system will be used to determine the distance corresponding to 30 minutes travel time.

(b)The area has a population to full-time-equivalent primary care physician ratio of at least 2,300:1:

(c)All Health Manpower Shortage Areas for Primary Care will also be accepted as a PSA for the purposes of the implementation of this act.

History

• Authority: T.C.A. §49-50-106.
• Administrative History: Original rule filed June 29, 1983.

Tenn. Comp. R. & Regs. 1200-19-01-.04 EXCEPTIONS

These criteria permit exceptions to the ratio specified above only in the case of obstetrical care. If an area meets the criteria outlined herein as a rational area for the delivery of primary medical services it can be designated as a PSA for Obstetrics if the ratio of the total population (all ages and sexes) to the physicians who perform obstetrical deliveries as part of their normal practice exceeds 15,000:1. This designation as a PSA for Obstetrics would enable a Family Practitioner or Obstetrician who will agree to perform deliveries as part of their normal practice to locate in a PSA for Obstetrics and receive loan forgiveness as specified in Section 49-50-106, Tennessee Code Annotated.

History

• Authority: T.C.A. §49-50-106.
• Administrative History: Original rule filed June 29, 1983; effective July 29, 1983.

Tenn. Comp. R. & Regs. 1200-19-01-.05 PROCESS FOR REQUESTS FOR DESIGNATION OF A PHYSICIAN SHORTAGE AREA

(1)Any citizen, organization, or local governing body of an area that includes any part of a rational area for the delivery of primary medical care that feel that their area deserves designation as a PSA may request designation through the Commissioner of the Tennessee Department of Health. In order to initiate this process, a written request from the individual or community representative should be forwarded to the Commissioner of Health giving the data necessary for designation. These data must include area identification, reference the applicable paragraphs above, and contain all information required by the applicable paragraphs.

(2)Any denial of a request to be designated a PSA may be appealed through the procedure established by the Uniform Administrative Procedures Act, Section 4-5-101, et. seq., Tennessee Code Annotated.

History

• Authority: T.C.A. §49-50-106.
• Administrative History: Original rule filed June 29, 1983; effective July 29, 1983.

1200-20 Bureau of Health Systems Development Primary Health Care Advisory Board

Chapter 1200-20-01 Repealed

Tenn. Comp. R. & Regs. 1200-20-01 Repealed

RULES

OF TENNESSEE DEPARTMENT OF HEALTH

Chapter 1200-20-02 Repealed

Tenn. Comp. R. & Regs. 1200-20-02-.01 REPEALED

History

• Authority: T.C.A. §§ 4-3-1803, 68-1-103, and 68-1-702.
• Administrative History: Original rule filed June 17, 1988; effective September 28, 1988. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-20-02-.07 REPEALED

History

• Authority: T.C.A. §§ 4-3-1803, 68-1-103, and 68-1-702.
• Administrative History: Original rule filed June 17, 1988; effective September 28, 1988. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-20-02-.02 REPEALED

History

• Authority: T.C.A. §§ 4-3-1803, 68-1-103, and 68-1-702.
• Administrative History: Original rule filed June 17, 1988; effective September 28, 1988. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-20-02-.03 REPEALED

History

• Authority: T.C.A. §§ 4-3-1803, 68-1-103, and 68-1-702.
• Administrative History: Original rule filed June 17, 1988; effective September 28, 1988. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-20-02-.04 REPEALED

History

• Authority: T.C.A. §§ 4-3-1803, 68-1-103, and 68-1-702.
• Administrative History: Original rule filed June 17, 1988, effective September 28, 1988. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-20-02-.05 REPEALED

History

• Authority: T.C.A. §§ 4-3-1803, 68-1-103, and 68-1-702.
• Administrative History: Original rule filed June 17, 1988; effective September 28, 1988. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-20-02-.06 REPEALED

History

• Authority: T.C.A. §§ 4-3-1803, 68-1-103, and 68-1-702.
• Administrative History: Original rule filed June 17, 1988; effective September 28, 1988. Repeal filed June 24, 2024; effective September 22, 2024.

Chapter 1200-20-03 Repealed

Tenn. Comp. R. & Regs. 1200-20-03-.01 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 66-29-151, 68-1-102(b), and 68-1-103.
• Administrative History: Original rule filed October 24, 1990, effective December 12, 1990. Amendment filed December 3, 1991; effective January 17, 1992. Repeal and new rule filed April 19, 1994; effective July 3, 1994. Repeal and new rule filed April 19, 2000; effective July 3, 2000. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-20-03-.09 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 66-29-151, 68-1-102(b), and 68-1-103.
• Administrative History: Original rule filed October 24, 1990; effective December 12, 1990. Amendment filed December 3, 1991; effective January 17, 1992. Repealed and new rule filed April 19, 1994, effective July 3, 1994. Repeal and new rule filed April 19, 2000; effective July 3, 2000. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-20-03-.02 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 66-29-151, 68-1-102(b), and 68-1-103.
• Administrative History: Original rule filed October 24, 1990; effective December 12, 1990. Amendment filed December 3, 1991; effective January 17, 1992. Repeal and new rule filed April 19, 1994; effective July 3, 1994. Repeal and new rule filed April 19, 2000; effective July 3, 2000. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-20-03-.03 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 66-29-151, 68-1-102(b), and 68-1-103.
• Administrative History: Original rule filed October 24, 1990, effective December 12, 1990. Amendment filed December 3, 1991; effective January 17, 1992. Repeal and new rule filed April 19, 1994; effective July 3, 1994. Repeal and new rule filed April 19, 2000; effective July 3, 2000. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-20-03-.04 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 20-13-103, 66-29-151, 68-1-102(b), and 68-1-103.
• Administrative History: Original rule filed October 24, 1990; effective December 12, 1990. Amendment filed December 3, 1991; effective January 17, 1992. Repeal and new rule filed April 19, 1994; effective July 3, 1994. Repeal and new rule filed April 19, 2000; effective July 3, 2000. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-20-03-.05 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 66-29-151, 68-1-102(b), and 68-1-103.
• Administrative History: Original rule filed October 24, 1990; effective December 12, 1990. Amendment filed December 3, 1991; effective January 17, 1992. Repeal and new ruled filed April 19, 1994; effective July 3, 1994. Repeal and new rule filed April 19, 2000; effective July 3, 2000. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-20-03-.06 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 66-29-151, 68-1-102(b), and 68-1-103.
• Administrative History: Original rule filed October 24, 1990, effective December 12, 1990. Amendment filed December 3, 1991; effective January 17, 1992. Repeal and new rule filed April 19, 1994; effective July 3, 1994. Repeal and new rule filed April 19, 2000; effective July 3, 2000. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-20-03-.07 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 66-29-151, 68-1-102(b), and 68-1-103.
• Administrative History: Original rule filed October 24, 1990; effective December 12, 1990. Amendment filed December 3, 1991; effective January 17, 1992. Repeal and new rule filed April 19, 1994; effective July 3, 1994. Repeal and new rule filed April 19, 2000; effective July 3, 2000. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-20-03-.08 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-301, et seq., 66-29-151, 68-1-102(b), and 68-1-103.
• Administrative History: Original rule filed October 24, 1990; effective December 12, 1990. Amendment filed December 3, 1991; effective January 17, 1992. Repeal and new rule filed April 19, 1994; effective July 3, 1994. Repeal and new rule filed April 19, 2000; effective July 3, 2000. Repeal filed June 24, 2024; effective September 22, 2024.

Chapter 1200-20-04 Reserved

Tenn. Comp. R. & Regs. 1200-20-04 Reserved

RULES

OF TENNESSEE DEPARTMENT OF HEALTH

BUREAU OF HEALTH SERVICES

CHAPTERS 1200-20-4 THROUGH 1200-20-9 ARE RESERVED

Chapter 1200-20-10 Reserved

Tenn. Comp. R. & Regs. 1200-20-10 Reserved

RULES

OF THE

TENNESSEE DEPARTMENT OF HEALTH

BUREAU OF HEALTH SERVICES ADMINISTRATION

RESERVED

Chapter 1200-20-11 Rules and Regulations Governing the State Conrad J-1 Visa Waiver Program

Tenn. Comp. R. & Regs. 1200-20-11-.01 INTRODUCTION

The Department is committed to assuring all Tennesseans have access to quality, affordable health care. The Department will support and facilitate the placement of primary care physicians and physician specialists in accordance with the criteria outlined in these rules. Physicians who are placed must provide medical care to underserved Tennesseans. The Department is positioned to cooperate with and assist any federal agency in its sponsoring and review of requests to waive the foreign residency requirement on behalf of health care physicians holding J-1 visas who will practice in an acceptable location.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-1-103, and Public Acts of 2003; Chapter 117.
• Administrative History: Original rule filed May 30, 1997; effective September 28, 1997. Repeal and new rule filed April 28, 2000; effective July 12, 2000. Repeal and new rule filed December 12, 2003; effective February 25, 2004.

Tenn. Comp. R. & Regs. 1200-20-11-.02 DEFINITIONS

As used in these rules, the terms below shall have the following meanings:

(1) Complete application - submittal, by certified mail, of all forms and information outlined by the Department in the policies and procedures for the State Conrad J-1 Visa Waiver Program to the Nashville, Tennessee office of the State Conrad J-1 Visa Waiver Program.

(2) Conrad Waiver - see State Conrad J-1 Visa Waiver Program.

(3) Critical Access Hospital (CAH) - a federally designated hospital that is very small with staffing flexibility under Medicare rules for providing emergency, outpatient, and short-stay inpatient services.

(4) Department - Tennessee Department of Health.

(5) Health Professional Shortage Area (HPSA) - a geographical area designated by the Secretary of the U.S. Department of Health and Human Services as having a shortage of health manpower (formerly Health Manpower Shortage Area).

(6) Health Resource Shortage Area (HRSA) - an area designated annually by the Commissioner of the Department as having inadequate resources in place to ensure access to primary, pediatric, obstetric or TennCare Services. It includes State designated Health Resource Shortage Areas for Primary, Pediatric, Obstetrical Care and TennCare.

(7) Indigent patients - patients who are at or below two-hundred percent (200%) of the federal poverty level with no comprehensive third-party coverage.

(8) Managed Care Organization (MCO) - an entity rendering or arranging necessary medical services to persons who are eligible for Medicaid or TennCare Standard and who are enrolled in the TennCare managed care program. MCO’s are paid by the State of Tennessee authorized and consistent with a

Section 1115 waiver of the Social Security Act granted by the Health Care Financing Administration (renamed in 2001 as the “Centers for Medicare and Medicaid Services or “CMS”), U.S. Department of Health and Human Services.

(9) Medicare Dependent Hospital – a federally designated hospital that is a small rural hospital for which Medicare patients comprise a significant percentage of their patients and their revenues.

(10) Medically Underserved Area (MUA) - a geographical area which is designated by the Secretary of the U.S. Department of Health and Human Services as having a shortage of health care services using several factors, in addition to the availability of health care providers, including infant mortality rate, poverty rate, and percentage of population aged sixty five (65) or over.

(11) Primary care physician - a physician who has completed a residency in Family Practice, General Pediatrics, Obstetrics, or General Internal Medicine and who is also supported by a sponsoring employer.

(12) Primary health care - services which emphasize first contact patient care. The provider assumes overall and ongoing responsibility for the patient in both health maintenance and treatment of illness, emphasizing continuity of care over the entire spectrum of health care services.

(13) Physician specialist - a physician who has completed a residency in Family Practice Adolescent Medicine or Geriatric Medicine; or Internal Medicine Adolescent Medicine, Cardiovascular Disease, Critical Care Medicine, Endocrinology, Diabetes, & Metabolism, Emergency Medicine, Gastroenterology, Geriatric Medicine, Hematology, Hospitalists, Infectious Disease, Interventional Cardiology, Oncology, Nephrology, Neurology, Pulmonary Disease, Rheumatology; or Obstetrics & Gynecology Critical Care Medicine or Gynecologic Oncology; or Pediatric Adolescent Medicine, Developmental-Behavioral Pediatrics, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology-Oncology, Pediatric Infectious Disease, Pediatric Nephrology, Pediatric Pulmonology, or Pediatric Critical Care Medicine; or Addiction Psychiatry, Child & Adolescent Psychiatry, or Geriatric Psychiatry; or General Orthopedic Surgery or General Surgery. If all slots permitted by federal law are not filled by June 30 th of each year, at the Commissioner’s discretion, a “specialist” may also include a physician who has completed a residency in a medical specialty or subspecialty other than one listed above, if the specialty or subspecialty is among those recognized by the American Board of Medical Specialties at the time the physician applies for placement through the J-1 visa waiver program.

(14) Rural areas - all counties in Tennessee, excluding Shelby, Davidson, Knox and Hamilton.

(15) Rural Hospital – a federally designated hospital meeting the requirements for placement of primary care physicians. Rural Hospitals which are located in counties containing federally designated health professional shortage areas (HPSAs) and/or medically underserved areas (MUAs), either of which must also be located within the top thirty (30) state designated health resource shortage areas (HRSAs) for TennCare, primary care, obstetrics or pediatrics.

(16) Rural Referral Center (RRC) - a federally designated hospital that is authorized under the Tax Equity and Fiscal Responsibility Act of 1982. These are rural hospitals with generally high volume whose costs more closely resemble those of urban hospitals because they treat regionally or nationally referred complex cases.

(17) Sole Community Hospital (SCH) - a federally designated hospital that is the only provider of hospital care in its market area either because it is geographically isolated or because severe weather or travel conditions prevent travel to another hospital offering similar services.

(18) Sponsoring employer - a health care facility or physician practice located in qualifying communities which provides primary health care to underserved residents. Examples of these facilities are hospitals, primary care clinics, community health clinics, local health departments, or private physician offices which routinely accept TennCare and indigent patients.

(19) State Conrad J-1 Visa Waiver Program - the enactment of the Immigration and Nationality Technical Corrections Act of 1994 (Pub. L. 103-416) has provided an additional basis upon which a foreign medical graduate may seek a waiver of the two-year home residence requirement. Section 220(a) of that Act added a provision that authorizes a State Department of Public Health or its equivalent to request the Director of the United States Information Agency to recommend that Immigration and Naturalization Service grant the waiver.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-1-103, 68-1-121, Public Acts of 2003; Chapter 117, and Public Acts of 2004, Chapter 572.
• Administrative History: Original rule filed May 30, 1997; effective September 28, 1997. Repeal and new rule filed April 28, 2000; effective July 12, 2000. Amendment filed January 31, 2003; effective May 30, 2003. Repeal and new rule filed December 12, 2003; effective February 25, 2004. Amendments filed January 12, 2005; effective May 31, 2005. Public necessity rules filed May 19, 2006; effective through October 31, 2006. Amendments filed May 31, 2006; effective September 28, 2006.

Tenn. Comp. R. & Regs. 1200-20-11-.03 NECESSITY OF LICENSE AND PROFESSIONAL CREDENTIALS

An applicant for a State Conrad J-1 Visa Waiver must be eligible for and obtain an unencumbered Tennessee license to practice the candidate’s profession in the State of Tennessee. In addition, the physician must be board eligible or board certified in the specialty in which the practitioner proposes to practice in the State.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-1-103, and Public Acts of 2003; Chapter 117.
• Administrative History: Original rule filed May 30, 1997; effective September 28, 1997. Repeal and new rule filed April 28, 2000; effective July 12, 2000. Repeal and new rule filed December 12, 2003; effective February 25, 2004.

Tenn. Comp. R. & Regs. 1200-20-11-.04 ELIGIBILITY

(1) The State Conrad J-1 Visa Waiver Program in Tennessee is limited to those primary care physicians who have completed a residency in one of the following medical specialties: Family Practice, General Pediatrics, Obstetrics, or General Internal Medicine. The State Conrad J-1 Visa Waiver Program is limited to those physician specialists who have completed a residency in Family Practice Adolescent Medicine or Geriatric Medicine; or Internal Medicine Adolescent Medicine, Cardiovascular Disease, Critical Care Medicine, Emergency Medicine, Endocrinology, Diabetes, & Metabolism, Gastroenterology, Geriatric Medicine, Hematology, Hospitalists, Infectious Disease, Interventional Cardiology, Oncology, Nephrology, Neurology, Pulmonary Disease, Rheumatology; or Obstetrics & Gynecology, Critical Care Medicine or Gynecologic Oncology; or Pediatric Adolescent Medicine, Developmental Behavioral Pediatrics, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology- Oncology, Pediatric Infectious Disease, Pediatric Nephrology, Pediatric Pulmonology, or Pediatric Critical Care Medicine; or Addiction Psychiatry, Child & Adolescent Psychiatry, or Geriatric Psychiatry; or General Orthopedic Surgery or General Surgery.

(2) Health care practitioners who are placed must provide medical care to underserved Tennesseans. Each applicant must be supported by a sponsoring employer. A sponsoring employer will be considered for a J-1 visa waiver placement if the primary purpose of the placement is the provision of health care services to those who live in underserved communities based on the criteria set forth herein.

(3) J-1 primary care physicians are placed only in rural areas of the State. At the discretion of the Department, the Department will support and facilitate the placement of primary care physicians in at least seventy percent (70%) of the slots permitted by federal law each federal fiscal year in health care practice sites which are located in federally designated Health Professional Shortage Areas (HPSAs) and/or Medically Underserved Areas (MUAs), either of which must also be located within the top thirty (30) State designated Health Resource Shortage Areas (HRSAs). Each primary care physician must agree to practice primary health care at that site for a minimum of forty (40) hours per week and for a minimum of three (3) years.

(4) At the discretion of the Department, the Department will also support and facilitate the placement of one (1) physician specialist per hospital in up to thirty percent (30%) of the slots permitted by federal law between October 1 and June 30 of each federal fiscal year in affiliation with the following hospitals, as designated by the Department, that are located in a HPSA or MUA: one of the top twenty (20) non-psychiatric hospitals with the highest percentage of total adjusted patient days for TennCare patients; or a Rural Referral Center hospital; or a Sole Community hospital; or a Medicare dependent hospital; or a rural hospital meeting the requirements for placement of a primary care physician. The top twenty non-psychiatric hospital list will be updated on an annual basis.

In addition, in accordance with 8 U.S.C.A. § 1184(l)(1)(D)(ii), the Department may also facilitate the placement of physician specialists in up to five (5) of the federally-permitted slots annually in affiliation with hospitals not located in a HPSA or MUA. A hospital requesting participation under 8 U.S.C.A. § 1184(l)(1)(D)(ii) must demonstrate that fifty percent (50%) or more of its patients served reside in a HPSA or MUA.

Each physician specialist must agree to practice his or her specialty in affiliation with the hospital for a minimum of forty (40) hours per week and for a minimum of three (3) years. If the full complement of thirty percent (30%) of the slots for physician specialists has not been committed by April 1, an additional application from a facility which has already received a physician specialist slot between October 1 and March 31 will be accepted and applications for a physician specialist will also be accepted from Critical Access Hospitals located in a HPSA or MUA from April 1 to June 30 of each federal fiscal year. No more than one-third of the specialist slots may be granted in an urban HPSA from October 1 to June 30 of each year.

If the full complement of slots permitted by the federal law has not been committed by June 30, the percentage limitations on the number of slots allocated to specialty physicians and on the placement of specialty physicians, set forth above, shall no longer be applicable. After June 30, all slots permitted by the federal law shall be opened to all eligible sponsoring employers for primary care physicians and specialist physicians as previously described, for the final quarter of the year. Additionally, if all slots permitted by federal law are not filled by June 30 th of each year, at the Commissioner’s discretion, a physician who has completed a residency in a medical specialty or subspecialty other than one listed in (1) may be considered eligible for placement if the specialty or subspecialty is among those recognized by the American Board of Medical Specialties at the time the physician applies for placement through the J-1 visa waiver program. During the final quarter, priority for the specialist slots is given to specialists but primary care provider applications will be accepted if specialist slots are available and no other specialist provider application has been received and deemed eligible.

(5) A physician specialist who requests placement as a primary care physician under the State Conrad J-1 Visa Waiver Program will be required to adhere to all rules and regulations herein specific to primary care physicians.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-1-103, 68-1-121, Public Acts of 2003; Chapter 117, and Public Acts of 2004, Chapter 572.
• Administrative History: Original rule filed May 30, 1997; effective September 28, 1997. Repeal and new rule filed April 28, 2000; effective July 12, 2000. Amendment filed January 31, 2003; effective May 30, 2003. Repeal and new rule filed December 12, 2003; effective February 25, 2004. Amendments filed January 12, 2005; effective May 31, 2005. Public necessity rules filed May 19, 2006; effective through October 31, 2006. Amendments filed May 31, 2006; effective September 28, 2006.

Tenn. Comp. R. & Regs. 1200-20-11-.05 APPLICATION REVIEW, APPROVAL, DENIAL

(1) The Department will only consider a complete application that has arrived by certified mail submitted by the sponsoring employer on behalf of the physician. Submittal by any other means, including, but not limited to, hand delivered or incomplete applications, will be rejected and the application will be returned COD/certified to the sponsoring employer. The HRSAs will be designated annually.

Applications for primary care practitioners will only be accepted for the HRSAs in effect at the time the complete application is received. For the federal fiscal year 2003 only, physician specialist applications will be accepted until September 30, 2003.

(2) If an employer proposes to utilize the J-1 primary care physician at more than one (1) site located within a HPSA and/or MUA, either of which must also be located within a HRSA, or if an employer proposes to utilize the physician specialist in affiliation with more than one (1) hospital within a HPSA or MUA or the qualifying location, the name and location of each facility and a schedule of the days and hours that the physician will be available at each site must be included in the application.

(3) Completed applications will be considered in the order in which they were received. All completed applications received beyond the maximum number of placements permitted by federal law per year will be held in a pending file to be reconsidered before any other applications at the beginning of the new federal fiscal year. In order to receive such reconsideration, however, an applicant must submit a request, in writing, setting forth his/her desire to be reconsidered, and such request must be received by the Department prior to the commencement of the Department’s reconsideration process. Upon the Department’s receipt of a written request for reconsideration, each applicant will be contacted by the Department to confirm its receipt of the request and confirm the applicant’s continued desire for reconsideration.

(4) The Department will review each waiver application to ensure that the proposed placement will not adversely affect or compromise delivery of health care in the HPSA or MUA in a HRSA service area.

The Department is wholly responsible for the interpretation of this policy.

(5) Once it is determined the application is complete and the applicant meets all of the appropriate requirements, a number will be assigned to the application which indicates that the Department has accepted the application as one of its allowable placements. A certified letter will be sent to the sponsoring employer notifying the sponsoring employer that the application has been forwarded to the appropriate federal agency for processing.

(6) If the applicant does not meet State requirements, the Department will notify the sponsoring employer by certified mail. Notification of a failure to meet federal requirements will be made by the federal agency directly to the Department which, in turn, will notify the sponsoring employer.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-1-103, 68-1-121, and Public Acts of 2003; Chapter 117.
• Administrative History: Original rule filed May 30, 1997; effective September 28, 1997. Repeal and new rule filed April 28, 2000; effective July 12, 2000. Amendment filed January 31, 2003; effective May 30, 2003. Repeal and new rule filed December 12, 2003; effective February 25, 2004. Public necessity rule filed May 19, 2006; effective through October 31, 2006. Amendment filed May 31, 2006; effective September 28, 2006.

Tenn. Comp. R. & Regs. 1200-20-11-.06 PROGRAM REQUIREMENTS

(1) The primary care physician or physician specialist seeking a J-1 visa waiver and the Chief Executive Officer of the sponsoring employer must each submit semi-annual reports to the Department which assure that the sponsoring employer and the physician are complying with the rules and regulations of the program. The first reports must be submitted within thirty (30) days after employment begins and every six (6) months thereafter, until the three-year commitment is complete. Reporting forms will be supplied to the physician and the sponsoring employer by the Department.

(2) All primary care physicians and physician specialists who have been granted a J-1 visa waiver are required to grant Department representatives, who shall maintain full confidentiality, reasonable access to all records maintained by the physician’s practice which are pertinent to ascertaining compliance with these rules and regulations, including, but not limited to, patient files and payment records. From time to time, audits for compliance with these rules and regulations may be performed by staff of the Department.

(3) At all times, the primary care physician or physician specialist who has been granted a J-1 visa waiver must operate the practice consistent with established standards recognized or adopted by the appropriate medical specialty.

(4) A primary care physician and physician specialist who has been granted a J-1 visa waiver is not permitted to transfer from one site to another unless such physician receives prior written approval from the Department. An unapproved transfer may result in, among other things, cancellation of the visa waiver.

(5) All primary care physicians and physician specialists who have been granted a J-1 visa waiver must complete an exit interview within ninety (90) days of the completion of his/her three-year obligation, or at such point that the employment contract is terminated by the sponsoring site, the physician, or the Department. The Department will conduct the exit interview, which will concentrate on the physician’s experiences in Tennessee and his/her future plans for practicing at the current location or another location.

(6) All primary care physicians and physician specialists who have been granted a J-1 visa waiver must agree to enroll with a sufficient number of MCOs which serve at least fifty-one percent (51%) of the TennCare enrolled population in the physician’s primary county of practice. In the event that one (1) or more MCO’s have closed enrollment to new providers which would not allow the physician to meet this criteria, the physician must demonstrate to the Department that a good faith effort was made and that the physician has enrolled in all other MCO’s accepting new providers.

(7) All primary care physicians and physician specialists who have been granted a J-1 visa waiver must agree, without exception, to provide services to indigent patients as long as the provider’s total number of indigent patient visits does not exceed fifteen percent (15%) of the provider’s total practice visits.

(8) All primary care physicians and physician specialists who have been granted a J-1 visa waiver must accept assignment under Section 1842(b)(3)(ii) of the Social Security Act as full payment for all services for which payment may be made under Part B of Title XVIII of such Act (Medicare). All primary care physicians and physician specialists must also accept TennCare payment as payment in full for TennCare patients.

(9) The sponsoring employer must make known to the community that primary care physicians and physician specialists who have been granted a J-1 visa waiver will comply with the terms and conditions stated in these rules and regulations by posting a notice stating the terms and conditions in a conspicuous place in the public waiting area of the facility.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-1-103, and Public Acts of 2003; Chapter 117.
• Administrative History: Original rule filed May 30, 1997; effective September 28, 1997. Repeal and new rule filed April 28, 2000; effective July 12, 2000. Repeal and new rule filed December 12, 2003; effective February 25, 2004.

Tenn. Comp. R. & Regs. 1200-20-11-.07 NONCOMPLIANCE

Failure on the part of the sponsoring employer or the primary care physician or physician specialist who has been granted a J-1 visa waiver to comply with the rules and regulations of this program will result in a report of noncompliance to the Immigration and Naturalization Service and may, among other things, make the site ineligible for future placements for a period of time to be determined by the Department.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-1-103, and Public Acts of 2003; Chapter 117.
• Administrative History: Original rule filed May 30, 1997; effective September 28, 1997. Repeal and new rule filed April 28, 2000; effective July 12, 2000. Repeal and new rule filed December 12, 2003; effective February 25, 2004.

Tenn. Comp. R. & Regs. 1200-20-11-.08 WAIVER OF RESPONSIBILITY

(1) The Department is not responsible for exceptions to or interpretations of these rules and regulations which have occurred without the written approval of the Immigration and Naturalization Service or its designee.

(2) The Department is not responsible for any practice arrangements or contractual obligations entered into by primary care physicians or physician specialists prior to approval of a J-1 visa waiver request.

However, all such arrangements and all related contracts must be provided to the Department to ensure compliance with the requirements of these rules.

(3) The Department assumes no responsibility for future actions taken by the Immigration and Naturalization Service or any potential investigation that may be conducted by the Office of Inspector General. It is the responsibility of all primary care physicians, physician specialists who have been granted a J-1 visa waiver and the employers to meet any reporting requirements of the Immigration and Naturalization Service or the Department.

History

• Authority: T.C.A. §§4-5-202, 4-5-204, 68-1-103, and Public Acts of 2003; Chapter 117.
• Administrative History: Original rule filed May 30, 1997; effective September 28, 1997. Repeal and new rule filed April 28, 2000; effective July 12, 2000. Repeal and new rule filed December 12, 2003; effective February 25, 2004.

Chapter 1200-20-12 Repealed

Tenn. Comp. R. & Regs. 1200-20-12-.01 REPEALED

History

• Authority: T.C.A. §§4-5-202 and 68-1-904.
• Administrative History: Original rule filed August 21, 1998; effective November 4, 1998. Repeal filed August 28, 2015; effective November 26, 2015. Rule renumbered 0465-01-03.

Tenn. Comp. R. & Regs. 1200-20-12-.02 REPEALED

History

• Authority: T.C.A. §§4-5-202 and 68-1-904.
• Administrative History: Original rule filed August 21, 1998; effective November 4, 1998. Repeal filed August 28, 2015; effective November 26, 2015. Rule renumbered 0465-01-03.

Tenn. Comp. R. & Regs. 1200-20-12-.03 REPEALED

History

• Authority: T.C.A. §§4-5-202 and 68-1-904.
• Administrative History: Original rule filed August 21, 1998; effective November 4, 1998. Repeal filed August 28, 2015; effective November 26, 2015. Rule renumbered 0465-01-03.

Tenn. Comp. R. & Regs. 1200-20-12-.04 REPEALED

History

• Authority: T.C.A. §§4-5-202 and 68-4-904.
• Administrative History: Original rule filed August 21, 1998; effective November 4, 1998. Repeal filed August 28, 2015; effective November 26, 2015. Rule renumbered 0465-01-03.

Tenn. Comp. R. & Regs. 1200-20-12-.05 REPEALED

History

• Authority: T CA. §§4-5-202 and 68-1-904.
• Administrative History: Original rule filed August 21, 1998; effective November 4, 1998. Repeal filed August 28, 2015; effective November 26, 2015. Rule renumbered 0465-01-03.

Tenn. Comp. R. & Regs. 1200-20-12-.06 REPEALED

History

• Authority: T.C.A. §§4-5-202 and 68-1-904.
• Administrative History: Original rule filed August 21, 1998; effective November 4, 1998. Repeal filed August 28, 2015; effective November 26, 2015. Rule renumbered 0465-01-03.

Tenn. Comp. R. & Regs. 1200-20-12-.07 REPEALED

History

• Authority: T.C.A. §§4-5-202 and 68-1-904.
• Administrative History: Original rule filed August 21, 1998; effective November 4, 1998. Repeal filed August 28, 2015; effective November 26, 2015. Rule renumbered 0465-01-03. (Rule 1200-20-12-.08)

Tenn. Comp. R. & Regs. 1200-20-12-.08 REPEALED

History

• Authority: T.C.A. §§4-5-202 and 68-1-904.
• Administrative History: Original rule filed August 21, 1998; effective November 4, 1998. Repeal filed August 28, 2015; effective November 26, 2015. Rule renumbered 0465-01-03.

Chapter 1200-20-13 Traumatic Brain Injury Registry

Tenn. Comp. R. & Regs. 1200-20-13-.01 DEFINITIONS

(1)“Advisory Council” means the Traumatic Brain Injury Council established by T.C.A. 68—55—102.

(2)“Commissioner” means the Commissioner of the Department of Health.

(3)“County of injury” is the county in which the patient was injured. If the patient was injured out-of-state, “Out-of-State” is acceptable instead of the county name.

(4)“County of residence” is the county in which the patient lives. If the patient lives out-of-state, “Out-of- State” is acceptable instead of the county name.

(5)“Date of Birth” (month, day, and year) should be reported; if date of birth is unavailable, age must be reported.

(6)“Department” means the Department of Health.

(7)“Discharge disposition” refers to the disposition of the patient with the traumatic brain injury.

(8)“External causes” (E-Code) is used to permit the classification of environmental events, circumstances, and conditions as the cause of the injury, poisoning, and other adverse effects.

(9)“Hospital” shall be defined as in T.C.A. 68—11—201(21).

(10) “Inconsistent data” is defined as data that is incomplete or inconsistent with the specifications in the Traumatic Brain Injury Data System procedure manual.

(11) “Medical record number” means the unique number assigned to the patient by the hospital and should not be confused with the financial reporting number unless they are the same.

(12) “Patient identifiers” shall be defined to include the following data elements: medical record number assigned by the hospital, social security number, name, and date of birth.

(13) “Principal diagnosis” means the primary reason the patient was admitted to the hospital; however, this code does not have to be a traumatic brain injury code. The reason for admission may be more life threatening than the brain injury.

(14) “Race/Ethnicity” is a combination field including race and ethnicity. Hispanic origin is an ethnic group, not a race.

(15) “Reportable case” means the patient must have at least one traumatic brain injury code (ICD-9-CM) and must stay in the hospital greater than 24 hours, except patients who expired. If the patient had at least one traumatic brain injury code and expired as a result of the accident, they must be reported regardless of the length of stay. After receiving written notification from the Department subsequent to the promulgation of these rules, traumatic brain injury cases which are seen only in a hospital emergency room shall be considered to be reportable cases.

(16) “Reporting requirement” means that all hospitals are required to report information regarding patients seen due to traumatic brain injury for the appropriate time period to the Office of Health Statistics and Research. Hospitals with no traumatic brain injury cases must report that they had “zero” cases.

(17) “State Hospital I.D. Number” means the unique number assigned to the hospital by the Office of Health Statistics and Research.

(18) “Traumatic Brain Injury” means an acquired injury to the brain caused by an external physical force resulting in total or partial disability or impairment. Such term includes open and closed head injuries that may result in seizures, and/or in mild, moderate, or severe impairments in one or more areas including cognition, language, memory, attention, reasoning, abstract thinking, judgment, problem-solving, sensory, perceptual and motor abilities, psychosocial behavior, physical functions, information processing, and speech. Such term does not include brain injuries caused by birth trauma, but may include brain injuries caused by anoxia and other related causes, infectious disease not of a degenerative nature, brain tumor, toxic chemical or drug reactions.

(19) “Traumatic Brain Injury Code” means the codes defined in ICD-9-CM (International Classification of Diseases - 9th Revision - Clinical Modification). Included are ICD-9-CM Codes 800.0-800.9, 803.0- 804.9, 850.0-854.1, 959.01.

(20) “Traumatic Brain Injury Coordinator” means the person designated by the Commissioner pursuant to T.C.A. 68—55—201.

(21) “Type of care” received describes the type of medical care or evaluation received by the injured person.

(22) “Work related injury” is an occupation related injury.

History

• Authority: T.C.A. 4—5—202, 68—55—101 et seq., and 68—55—201 et seq.
• Administrative History: Original rule filed April 17, 2000; effective July 1, 2000.

Tenn. Comp. R. & Regs. 1200-20-13-.02 REQUIRED DATA ELEMENTS

(1) The Tennessee Department of Health, Office of Health Statistics and Research will prepare the Traumatic Brain Injury Data System procedure manual. The manual will include the variables to be reported, their descriptions and reporting format, and other information associated with data submission. Reporting entities will be notified by the Department of all revisions. Revisions become effective 60 days following the date of notification. At that time, failure to meet the amended requirements are subject to penalties as prescribed by T.C.A. 68—55—204.

(2) Data Elements (a)Patient’s hospital medical record number (b)Patient’s social security number (c)Patient’s name - first, middle, last and generation I.D.

(d)Patient’s address - street, city, and zip code (e)Patient’s county of residence (f)Patient’s date of birth (g)Patient’s age (if date of birth is unavailable)

(h)Patient’s sex (i)Patient’s race/ethnicity (j)Patient’s principal diagnosis code (k)Traumatic brain injury ICD-9-CM Codes (l)External causes of injury ICD-9-CM Codes (E-Code)

(m)Date of injury (n)Admission date (o)State of injury (p)Was the injury work related (q)County of injury (r)Type of care received (s)Date of discharge (t)Discharge disposition (u)Name and telephone number of hospital staff member responsible for reporting the traumatic brain injury data (3) The required data elements must be submitted on a media and format provided by the Department.

(4) All patients discharged when their length of stay was greater than 24 hours with at least one traumatic brain injury code are required to be reported. If the patient had at least one traumatic brain injury code and expired as a result of the accident, they must be reported regardless of the length of stay. This includes pre-hospital deaths. After receiving written notification from the Department subsequent to the promulgation of these rules, traumatic brain injury cases which are seen only in a hospital emergency room shall be considered to be reportable cases.

(5) All required data should be received by the Department the first Monday six weeks following the close of the quarter.

(6) All hospitals, which are required by T.C.A. 68—55—204(a) to report data, shall designate one staff member to be responsible for reporting to Health Statistics and Research.

(7) All hospitals which are required by T.C.A. 68—55—204(a) to report data shall notify Health Statistics and Research on a form supplied by Health Statistics and Research of the name, title, work address, and work telephone number of the designated staff member.

History

• Authority: T.C.A. 4—5—202, 68—55—201 et seq., and 68—55—204.
• Administrative History: Original rule filed April 17, 2000; effective July 1, 2000.

Tenn. Comp. R. & Regs. 1200-20-13-.03 SUBMISSION TIME FRAME

(1) Frequency of data submission is as follows: report monthly or quarterly.

(2) Health Statistics and Research must receive all required data the first Monday six weeks following the end of the month or the close of the quarter.

Reporting Schedule MonthlyDate DueDayQuarterlyDate DueDay JanuaryMid MarchMonday FebruaryMid AprilMonday MarchMid MayMondayJan- MarchMid MayMonday AprilMid JuneMonday MayMid JulyMonday JuneMid Aug.MondayApril-JuneMid Aug.Monday JulyMid Sept.Monday AugustMid Oct.Monday SeptemberMid Nov.MondayJuly-Sept.Mid Nov.Monday OctoberMid Dec.Monday NovemberMid Jan.Monday DecemberMid Feb.MondayOct.-Dec.Mid Feb.Monday

History

• Authority: T.C.A. 4—5—202 and 68—55—204.
• Administrative History: Original rule filed April 17, 2000; effective July 1, 2000.

Tenn. Comp. R. & Regs. 1200-20-13-.04 PENALTY ASSESSMENT

(1) A treating hospital, which intentionally fails to comply with reporting or confidentiality and disclosure requirements, is subject to a civil penalty. The penalty is for failure to report and is not based on the number of individual records. The penalty assessment will be based on the following: Not more than one hundred dollars for the first violation; not more than one thousand dollars for the second; not more than two thousand dollars for the third; not more than three thousand dollars for the fourth; not more than four thousand dollars for the fifth; and not more than five thousand for all subsequent violations.

(2) Penalties will be initially assessed for all records due to be reported on the current quarter and every quarter thereafter.

(3) Upon receipt of the penalty assessment, the hospital has the right to an informal conference with the Commissioner. A written request for an informal conference must be received by the Commissioner within thirty (30) days of the assessment with a copy being sent to the Director of Health Statistics and Research within the same time frame.

(4) The penalty assessment will accrue for subsequent delinquent data until the records are received.

(5) The Commissioner may grant a waiver from penalties to a hospital in cases of extraordinary circumstances clearly beyond the control of the hospital. The hospital must make a written request for the waiver and an informal conference within thirty (30) days following notification of the assessment which will not be subject to the Uniform Administrative Procedures Act.

(6) After the conference with the Commissioner or the time frame for requesting a conference has expired, the Commissioner can collect the penalty fees unless the hospital appeals the Commissioner’s decision. If the hospital wishes to appeal the decision of the Commissioner, a written request for a hearing before an Administrative Law Judge must be sent to the Commissioner within ten (10) business days of the receipt of the Commissioner’s written determination. Issues involving collection of penalties directly from hospitals resolved by an Administrative Law Judge will be in accordance with the Uniform Administrative Procedures Act.

History

• Authority: T.C.A. 4—5—202 and 68—55—204.
• Administrative History: Original rule filed April 17, 2000; effective July 1, 2000.

Tenn. Comp. R. & Regs. 1200-20-13-.05 PROCESSING AND VERIFICATION

(1) If errors, inconsistencies, or incomplete elements are identified by Health Statistics and Research. Health Statistics shall report the errors to the hospital in writing. Upon receiving written notification of errors, the hospital facility shall investigate the problem and shall supply correct information within thirty (30) days from notification. Failure to submit corrected data within thirty (30) days of receiving a notification will be considered an intentional failure to comply with reporting requirements, thereby subjecting the hospital to the penalties prescribed in T.C.A. 68—55—204(e).

(2) Data reported in an incorrect format or with elements inconsistent with T.C.A. 68—55—204 will be considered in error and returned to the reporting entity.

(3) Reported data will be compared to Vital Statistics Death System to identify persons who may have died at a later date from the injury or from other causes. These records are marked accordingly and will remain in the file, but will not be included in subsequent traumatic brain injury mailings.

(4) Data will be compared to the Hospital Discharge data set at the appropriate time to determine if the numbers reported are within acceptable limits. Hospitals with significant discrepancies will be contacted regarding the differences.

History

• Authority: T.C.A. 4—5—202 and 68—55—204.
• Administrative History: Original rule filed April 17, 2000; effective July 1, 2000.

Tenn. Comp. R. & Regs. 1200-20-13-.06 REGISTRY MAINTENANCE

(1) The maintenance of the registry is the responsibility of the Office of Health Statistics and Research.

(2) Records are keyed immediately upon receipt and checked for inconsistencies.

(3) Hospitals will be notified immediately of the discrepancies and requested to respond within thirty (30) days.

History

• Authority: T.C.A. 4—5—202, 68—55—202, and 68—55—203.
• Administrative History: Original rule filed April 17, 2000; effective July 1, 2000.

Tenn. Comp. R. & Regs. 1200-20-13-.07 DATA AVAILABILITY

(1) Within ninety (90) days following the receipt of the data for each quarter, statewide data of a nonconfidential nature will be released in provisional format to the hospitals and selected users within the state. The data will also be available to other users upon request.

(2) The data will be available at all times to the Traumatic Brain Injury Coordinator in order to fulfill the functions of the Traumatic Brain Injury Program. No information on individuals who expired will be released to anyone except in tabulation form.

(3) The Commissioner has the authority to delay release of any particular data element(s), if it is determined that the quality or completeness of the information is not acceptable.

(4) Consistent with T.C.A. 10—7—504 (a) (1), selected data of a non-confidential nature will be released to the public following verification and editing by Health Statistics and Research.

History

• Authority: T.C.A. 4—5—202 and 68—55—204.
• Administrative History: Original rule filed April 17, 2000; effective July 1, 2000.

Tenn. Comp. R. & Regs. 1200-20-13-.08 CONFIDENTIAL INFORMATION

(1) The Department of Health will not release information to the public in violation of Title 68, Chapter 55, or any other statutory provision for confidentiality of health records.

(2) The department may use or authorize use of the compiled data for purposes that are necessary to provide for or protect the health of the population and as permitted by law. Patient identifier information shall only be used for the purpose of providing services to those individuals. However, for departmental internal use only, such information may be used to verify deaths reported to the Division of Vital Records.

History

• Authority: T.C.A. 4—5—202, 68—55—203, and 68—55—204.
• Administrative History: Original rule filed April 17, 2000; effective July 1, 2000.

Chapter 1200-21-01 Repealed

Tenn. Comp. R. & Regs. 1200-21-01-.01 REPEALED

History

• Authority: T.C.A. §§ 68-1-1101, 68-1-1102, 68-1-1103.
• Administrative History: Original rule filed August 27, 1984; effective September 26, 1984. Repeal of rule filed May 11, 2010; to be effective October 29, 2010; however rule was withdrawn on October 28, 2010 by the Department of Health. Repeal filed January 24, 2012; effective June 30, 2012.

Tenn. Comp. R. & Regs. 1200-21-01-.02 REPEALED

History

• Authority: T.C.A. §§ 68-1-1101, 68-1-1102, 68-1-1103.
• Administrative History: Original rule filed August 27, 1984; effective September 26, 1984. Repeal of rule filed May 11, 2010; to be effective October 29, 2010; however rule was withdrawn on October 28, 2010 by the Department of Health. Repeal filed January 24, 2012; effective June 30, 2012.

Tenn. Comp. R. & Regs. 1200-21-01-.03 REPEALED

History

• Authority: T.C.A. §§ 68-1-1101, 68-1-1102, 68-1-1103.
• Administrative History: Original rule filed August 27, 1984; effective September 26, 1984. Repeal of rule filed May 11, 2010; to be effective October 29, 2010; however rule was withdrawn on October 28, 2010 by the Department of Health. Repeal filed January 24, 2012; effective June 30, 2012.

Tenn. Comp. R. & Regs. 1200-21-01-.04 REPEALED

History

• Authority: T.C.A. §§ 68-1-1101, 68-1-1102, 68-1-1103.
• Administrative History: Original rule filed August 27, 1984; effective September 26, 1984. Repeal of rule filed May 11, 2010; to be effective October 29, 2010; however rule was withdrawn on October 28, 2010 by the Department of Health. Repeal filed January 24, 2012; effective June 30, 2012.

1200-22 Division of Community Assistance

Chapter 1200-22-01 Repealed (Transferred to 0400-46-01)

Tenn. Comp. R. & Regs. 1200-22-01-.01 REPEALED

History

• Authority: T.C.A. §§ 68-221-801 et seq., 68-221-1001 et seq., and 4-5-201 et seq.
• Administrative History: Original rule fined August 30, 1985; effective September 29, 1985. Amendment filed September 26, 1986; effective November 10, 1986. Amendment filed November 20, 1987; effective January 4, 1988. Amendment filed September 18, 1989; effective November 2, 1989. Repealed and new rule filed September 17, 1992; effective November 2, 1992. Repeal and new rule filed January 2, 2008; effective March 17, 2008. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-01.

Tenn. Comp. R. & Regs. 1200-22-01-.02 REPEALED

History

• Authority: T.C.A. §§ 68-221-801 et seq., 68-221-1001 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 30, 1985; effective September 29, 1985. Amendment filed November 20, 1987; effective January 4, 1988. Amendment filed August 12, 1988; effective September 26, 1988. Amendment filed September 18, 1989; effective November 2, 1989. Repealed and new rule filed September 17, 1992; effective November 2, 1992. Repeal and new rule filed January 2, 2008; effective March 17, 2008. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-01.

Tenn. Comp. R. & Regs. 1200-22-01-.03 REPEALED

History

• Authority: T.C.A. §§ 68-221-801 et seq., 68-221-1001 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 30, 1985; effective September 29, 1985. Amendment filed September 26, 1986; effective November 10, 1986. Amendment filed November 20, 1987; effective January 4, 1988. Amendment filed August 12, 1988; effective September 26, 1988. Amendment filed September 18, 1989; effective November 2, 1989. Repealed and new rule filed September 17, 1992; effective November 2, 1992. Repeal and new rule filed January 2, 2008; effective March 17, 2008. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-01.

Tenn. Comp. R. & Regs. 1200-22-01-.04 REPEALED

History

• Authority: T.C.A. §§ 68-221-801 et seq., 68-221-1001 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed august 30, 1985; effective September 29, 1985. Amendment filed September 26, 1986; effective November 10, 1986. Amendment filed November 20, 1987; effective January 4, 1988. Amendment filed August 12, 1988; effective September 26, 1988. Amendment filed September 18, 1989; effective November 2, 1989. Repealed and new rule filed September 17, 1992; effective November 2, 1992. Repeal filed January 2, 2008; effective March 17, 2008. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-01.

Chapter 1200-22-02 Repealed (Transferred to 0400-46-02)

Tenn. Comp. R. & Regs. 1200-22-02-.01 REPEALED

History

• Authority: T.C.A. §§ 68-221-801 et seq., 68-221-1001 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 30, 1985; effective September 29, 1985. Amendment filed July 14, 1987; effective August 29, 1987. Amendment filed September 18, 1989; effective November 2, 1989. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-02.

Tenn. Comp. R. & Regs. 1200-22-02-.02 REPEALED

History

• Authority: T.C.A. §§ 68-221-801 et seq., 68-221-1001 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 30, 1985; effective September 29, 1985. Amendment filed July 14, 1987; effective August 29, 1987. Amendment file June 27, 1988; effective August 11, 1988. Amendment filed September 18, 1989; effective November 2, 1989. Repeal filed September 16, 2013; effective December 15, 2013. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-02.

Tenn. Comp. R. & Regs. 1200-22-02-.03 REPEALED

History

• Authority: T.C.A. §§ 68-221-801 et seq., 68-221-1001 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 30, 1985; effective September 29, 1985. Amendment filed July 14, 1987; effective August 29, 1987. Amendment filed June 27, 1988; effective August 11, 1988. Amendment filed September 18, 1989; effective November 2, 1989. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-02.

Tenn. Comp. R. & Regs. 1200-22-02-.04 REPEALED

History

• Authority: T.C.A. §§ 68-221-801 et seq., 68-221-1001 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 30, 1985; effective September 29, 1985. Amendment filed July 14, 1987; effective August 29, 1987. Amendment filed June 27, 1988; effective August 11, 1988. Amendment filed September 18, 1989; effective November 2, 1989. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-02.

Tenn. Comp. R. & Regs. 1200-22-02-.05 REPEALED

History

• Authority: T.C.A. §§ 68-221-801 et seq., 68-221-1001 et seq., and 4-5-201 et seq.
• Administrative History: Original rule August 30, 1985; effective September 29, 1985. Amendment filed July 14, 1987; effective August 29, 1987. Amendment filed June 27, 1988; effective August 11, 1988. Amendment filed (Rule 1200-22-02-.05, continued September 18, 1989; effective November 2, 1989. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-02.

Tenn. Comp. R. & Regs. 1200-22-02-.06 REPEALED

History

• Authority: T.C.A. §§ 68-221-801 et seq., 68-221-1001 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 30, 1985; effective September 29, 1985. Amendment filed July 14, 1987; effective August 29, 19987. Amendment filed June 27, 1988; effective August 11, 1988. Amendment filed September 18, 1989; effective November 2, 1989. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-02.

Tenn. Comp. R. & Regs. 1200-22-02-.07 REPEALED

History

• Authority: T.C.A. §§ 68-221-801 et seq., 68-221-1001 et seq., and 4-5-201 et seq
• Administrative History: Original rule filed August 30, 1985; effective September 29, 1985. Amendment filed June 27, 1988; effective August 11, 1988. Amendment filed September 18, 1989; effective November 2, 1989. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-02.

Tenn. Comp. R. & Regs. 1200-22-02-.08 REPEALED

History

• Authority: T.C.A. §§ 68-221-801 et seq., 68-221-1001 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 30, 1985; effective September 29, 1985. Amendment filed July 14, 1987; effective August 29, 1987. Amendment filed September 18, 1989; effective November 2, 1989. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-02.

Tenn. Comp. R. & Regs. 1200-22-02-.09 REPEALED

History

• Authority: T.C.A. §§ 68-221-801 et seq., 68-221-1001 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 30, 1985; effective September 29, 1985. Amendment filed July 14, 1987; effective August 29, 1987. Amendment filed June 27, 1988; effective August 11, 1988. Amendment filed September 18, 1989; effective November 2, 1989. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-02.

Tenn. Comp. R. & Regs. 1200-22-02-.10 REPEALED

History

• Authority: T.C.A. §§ 68-221-801 et seq., 68-221-1001 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 30, 1985; effective September 29, 1985. Amendment filed September 18, 1989; effective November 2, 1989. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-02.

Tenn. Comp. R. & Regs. 1200-22-02-.11 REPEALED

History

• Authority: T.C.A. §§ 68-221-801 et seq., 68-221-1001 et seq., and 4-5-201 et seq.
• Administrative History: Original rule filed August 30, 1985; effective September 29, 1985. Amendment filed July 14, 1987; effective August 29, 1987. Amendment filed June 27, 1988; effective August 11, 1988. Amendment filed September 18, 1989; effective November 2, 1989. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-02.

Chapter 1200-22-03 Repealed (Transferred to 0400-46-03)

Tenn. Comp. R. & Regs. 1200-22-03 Repealed (Transferred to 0400-46-03)

RULES

OF TENNESSEE DEPARTMENT OF HEALTH AND ENVIRONMENT

REPEALED

Authority: T.C.A. §§ 68-221-801 et seq., 68-221-1001 et seq., and 4-5-201 et seq. Administrative

History: Repeal filed September 16, 2013; effective December 15, 2013.

Chapter 1200-22-04 Repealed (Transferred to 0400-46-04)

Tenn. Comp. R. & Regs. 1200-22-04-.01 REPEALED

History

• Authority: T.C.A. §§ 68-221-201 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed September 11, 1987; effective October 31, 1987. Repeal filed September 16, 2013; effective December 15, 2013. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46- 04.

Tenn. Comp. R. & Regs. 1200-22-04-.02 REPEALED

History

• Authority: T.C.A. §§ 68-221-201 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed September 11, 1987; effective October 31, 1987. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-04.

Tenn. Comp. R. & Regs. 1200-22-04-.03 REPEALED

History

• Authority: T.C.A. § §4-5-202, 68-13-201 et seq., and 68-13-204.
• Administrative History: Original rule filed September 11, 1987; effective October 31, 1987. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-04.

Tenn. Comp. R. & Regs. 1200-22-04-.04 REPEALED

History

• Authority: T.C.A. §§ 68-221-201 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed September 11, 1987; effective October 31, 1987. Repeal filed September 16, 2013; effective December 15, 2013.

Chapter 1200-22-05 Reserved

Tenn. Comp. R. & Regs. 1200-22-05 Reserved

RULES

OF TENNESSEE DEPARTMENT OF HEALTH AND ENVIRONMENT

DIVISION OF COMMUNITY ASSISTANCE

Authority: T.C.A. §§4-5-202 and 68-13-1007 through 68-13-1013, inclusive. Administrative History: Original

rule filed August 26, 1988; effective October 10, 1988. Chapter 1200-22-5 moved to 1740-1 by the Secretary of State under the authority of Public Chapter 86 of Acts of 2007.

Chapter 1200-22-06 Repealed (Transferred to 0400-46-06)

Tenn. Comp. R. & Regs. 1200-22-06-.01 REPEALED

History

• Authority: T.C.A. §§ 68-221-1001 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repealed and new rule filed September 17, 1992; effective November 2, 1992. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-06.

Tenn. Comp. R. & Regs. 1200-22-06-.02 REPEALED

History

• Authority: T.C.A.. §§ 68-221-1001 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repealed and new rule filed September 17, 1992; effective November 2, 1992. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-06.

Tenn. Comp. R. & Regs. 1200-22-06-.03 REPEALED

History

• Authority: .T.C.A. §§ 68-221-1001 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repealed and new rule filed September 17, 1992; effective November 2, 1992. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-06.

Tenn. Comp. R. & Regs. 1200-22-06-.04 REPEALED

History

• Authority: T.C.A. §§ 68-221-1001 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Amendment filed February 14, 1989; effective March 31, 1989. Repealed and new rule filed September 17, 1992; effective November 2, 1992. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-06.

Tenn. Comp. R. & Regs. 1200-22-06-.05 REPEALED

History

• Authority: T.C.A. §§ 68-221-1001 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988 effective August 25, 1988. Repealed and new rule filed September 17, 1992; effective November 2, 1992. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-06.

Tenn. Comp. R. & Regs. 1200-22-06-.06 REPEALED

History

• Authority: T.C.A. §§ 68-221-1001 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repealed and new rule filed September 17, 1992; effective November 2, 1992. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-06.

Tenn. Comp. R. & Regs. 1200-22-06-.07 REPEALED

History

• Authority: T.C.A. §§ 68-221-1001 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repealed and new rule filed September 17, 1992; effective November 2, 1992. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-06. 1200-2206-.08 REPEALED. Authority: T.C.A. §§ 68-221-1001 et seq. and 4-5-201 et seq.

Tenn. Comp. R. & Regs. 1200-22-06-.09 REPEALED

History

• Authority: T.C.A. §§ 68-221-1001 et seq. and 4-5-201 et seq.
• Administrative History: Original rule filed July 11, 1988; effective August 25, 1988. Repeal filed September 17, 1992; effective November 2, 1992. Repeal filed September 16, 2013; effective December 15, 2013. Rule renumbered 0400-46-06.

Chapter 1200-22-07 Transferred to 1715-01

Tenn. Comp. R. & Regs. 1200-22-07 Transferred to 1715-01

RULES

OF THE TENNESSEE DEPARTMENT OF HEALTH AND ENVIRONMENT

DIVISION OF COMMUNITY ASSISTANCE

Authority: T.C.A. §§4-5-202, 7-82-701 through 7-82-708, and Executive Order Number 21 (dated June 28, 1988).

Administrative History: Original rule filed June 13, 1989; effective July 28,1989. Amendment filed August 2, 1994; effective December 29, 1994. Chapter 1200-22-7 moved to 1715-1 by the Secretary of State under the

authority of Public Chapter 86 of Acts of 2007.

Chapter 1200-22-08 Transferred to 1715-03

Tenn. Comp. R. & Regs. 1200-22-08-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202 and 7-82-702.
• Administrative History: Original rule filed March 7, 1990; effective April 21, 1990. Transferred to chapter 1715-03 on November 3, 2022, pursuant to Public Chapter 86 of 2007.

Tenn. Comp. R. & Regs. 1200-22-08-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202 and 7-82-702.
• Administrative History: Original rule filed March 7, 1990; effective April 21, 1990. Transferred to chapter 1715-03 on November 3, 2022, pursuant to Public Chapter 86 of 2007.

Tenn. Comp. R. & Regs. 1200-22-08-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202 and 7-82-702.
• Administrative History: Original rule filed March 7, 1990; effective April 21, 1990. Transferred to chapter 1715-03 on November 3, 2022, pursuant to Public Chapter 86 of 2007.

1200-23 Division of General Environmental Health

Chapter 1200-23-01 Food Service Establishment

Tenn. Comp. R. & Regs. 1200-23-01-.01 DEFINITIONS

(1) Accredited Program.

(a) “Accredited program” means a food protection manager certification program that has been evaluated and listed by an accrediting agency as conforming to national standards for organizations that certify individuals.

(b) “Accredited program” refers to the certification process and is a designation based upon an independent evaluation of factors such as the sponsor’s mission; organizational structure; staff resources; revenue sources; policies; public information regarding program scope, eligibility requirements, re-certification, discipline and grievance procedures; and test development and administration.

(c) “Accredited program” does not refer to training functions or educational programs.

(2) Additive.

(a) “Food additive” has the meaning stated in the Federal Food, Drug, and Cosmetic Act, § 201(s) and 21 CFR § 170.3(e)(1).

(b) “Color additive” has the meaning stated in the Federal Food, Drug, and Cosmetic Act, § 201(t) and 21 CFR § 70.3(f).

(3) “Adulterated” has the meaning stated in the Federal Food, Drug, and Cosmetic Act, § 402.

(4) “Approved” means acceptable to the department based on a determination of conformity with principles, practices, and generally recognized standards that protect public health.

(5) Asymptomatic.

(a) “Asymptomatic” means without obvious symptoms; not showing or producing indications of a disease or other medical condition, such as an individual infected with a pathogen but not exhibiting or producing any signs or symptoms of vomiting, diarrhea, or jaundice.

(b) “Asymptomatic” includes not showing symptoms because symptoms have resolved or subsided, or because symptoms never manifested.

(6) “AW” means water activity which is a measure of the free moisture in a food, is the quotient of the water vapor pressure of the substance divided by the vapor pressure of pure water at the same temperature, and is indicated by the symbol AW.

(7) “Balut” means an embryo inside a fertile egg that has been incubated for a period sufficient for the embryo to reach a specific stage of development after which it is removed from incubation before hatching.

(8) “Beverage” means a liquid for drinking, including water.

(9) “Bottled drinking water” means water that is sealed in bottles, packages, or other containers and offered for sale for human consumption, including bottled mineral water.

(10) “Casing” means a tubular container for sausage products made of either natural or artificial (synthetic) material.

(11) “Certification number” means a unique combination of letters and numbers assigned by a shellfish control authority to a molluscan shellfish dealer according to the provisions of the National Shellfish Sanitation Program.

(12) “CFR” means Code of Federal Regulations. Citations in this Chapter to the CFR refer sequentially to the Title, Part, and Section numbers, such as 40 CFR § 180.194 refers to Title 40, Part 180, Section 194.

(13) CIP.

(a) “CIP” means cleaned in place by the circulation or flowing by mechanical means through a piping system of a detergent solution, water rinse, and sanitizing solution onto or over equipment surfaces that require cleaning, such as the method used, in

part, to clean and sanitize a frozen dessert machine.

(b) “CIP” does not include the cleaning of equipment such as band saws, slicers, or mixers that are subjected to in-place manual cleaning without the use of a CIP system.

(14) “Commingle” means:

(a) To combine shellstock harvested on different days or from different growing areas as identified on the tag or label, or (b) To combine shucked shellfish from containers with different container codes or different shucking dates.

(15) “Comminuted” means:

(a) “Comminuted” means reduced in size by methods including chopping, flaking, grinding, or mincing.

(b) “Comminuted” includes fish or meat products that are reduced in size and restructured or reformulated such as gefilte fish, gyros, ground beef, and sausage; and a mixture of 2 or more types of meat that have been reduced in size and combined, such as sausages made from 2 or more meats.

(16) “Commissary” means a food establishment that services a mobile food unit or a pushcart.

(17) “Conditional employee” means a potential food employee to whom a job offer is made, conditional on responses to subsequent medical questions or examinations designed to identify potential food employees who may be suffering from a disease that can be transmitted through food and done in compliance with Title I of the Americans with Disabilities Act of 1990.

(18) “Confirmed disease outbreak” means a foodborne disease outbreak in which laboratory analysis of appropriate specimens identifies a causative agent and epidemiological analysis implicates the food as the source of the illness.

(19) “Consumer” means a person who is a member of the public, takes possession of food, is not functioning in the capacity of an operator of a food establishment or food processing plant, and does not offer the food for resale.

(20) Core Item.

(a) “Core item” means a provision in this Chapter that is not designated as a priority item or a priority foundation item.

(b) “Core item” includes an item that usually relates to general sanitation, operational controls, sanitation standard operating procedures (ssops), facilities or structures, equipment design, or general maintenance.

(21) “Corrosion-resistant material” means a material that maintains acceptable surface cleanability characteristics under prolonged influence of the food to be contacted, the normal use of cleaning compounds and sanitizing solutions, and other conditions of the use environment.

(22) “Counter-mounted equipment” means equipment that is not portable and is designed to be mounted off the floor on a table, counter, or shelf.

(23) “Critical control point” means a point or procedure in a specific food system where loss of control may result in an unacceptable health risk.

(24) “Critical limit” means the maximum or minimum value to which a physical, biological, or chemical parameter must be controlled at a critical control point to minimize the risk that the identified food safety hazard may occur.

(25) “Cut leafy greens” means fresh leafy greens whose leaves have been cut, shredded, sliced, chopped, or torn. The term “leafy greens” includes iceberg lettuce, romaine lettuce, leaf lettuce, butter lettuce, baby leaf lettuce (i.e., immature lettuce or leafy greens), escarole, endive, spring mix, spinach, cabbage, kale, arugula and chard. The term “leafy greens” does not include herbs such as cilantro or parsley.

(26) “Dealer” means a person who is authorized by a shellfish control authority for the activities of shellstock shipper, shucker-packer, repacker, reshipper, or depuration processor of molluscan shellfish according to the provisions of the National Shellfish Sanitation Program.

(27) “Disclosure” means a written statement that clearly identifies the animal-derived foods which are, or can be ordered, raw, undercooked, or without otherwise being processed to eliminate pathogens, or items that contain an ingredient that is raw, undercooked, or without otherwise being processed to eliminate pathogens.

(28) Drinking Water.

(a) “Drinking water” means water that meets criteria as specified in 40 CFR Part 141 National Primary Drinking Water Regulations.

(b) “Drinking water” is traditionally known as “potable water.”

(c) “Drinking water” includes the term “water” except where the term used connotes that the water is not potable, such as “boiler water,” “mop water,” “rainwater,” “wastewater,” and “nondrinking” water.

(29) “Dry storage area” means a room or area designated for the storage of packaged or containerized bulk food that is not potentially hazardous (time/temperature control of safety food) and dry goods such as single-service items.

(30) Easily Cleanable.

(a) “Easily cleanable” means a characteristic of a surface that:

1. Allows effective removal of soil by normal cleaning methods;

2. Is dependent on the material, design, construction, and installation of the surface; and 3. Varies with the likelihood of the surface’s role in introducing pathogenic or toxigenic agents or other contaminants into food based on the surface’s approved placement, purpose, and use.

(b) “Easily cleanable” includes a tiered application of the criteria that qualify the surface as easily cleanable as specified in subparagraph (a) of this definition to different situations in which varying degrees of cleanability are required such as:

1. The appropriateness of stainless steel for a food preparation surface as opposed to the lack of need for stainless steel to be used for floors or for tables used for consumer dining; or 2. The need for a different degree of cleanability for a utilitarian attachment or accessory in the kitchen as opposed to a decorative attachment or accessory in the consumer dining area.

(31) “Easily movable” means:

(a) Portable; mounted on casters, gliders, or rollers; or provided with a mechanical means to safely tilt a unit of equipment for cleaning; and (b) Having no utility connection, a utility connection that disconnects quickly, or a flexible utility connection line of sufficient length to allow the equipment to be moved for cleaning of the equipment and adjacent area.

(32) Egg.

(a) “Egg” means the shell egg of avian species such as chicken, duck, goose, guinea, quail, ratites or turkey.

(b) “Egg” does not include:

1. A balut;

2. The egg of reptile species such as alligator; or 3. An egg product.

(33) Egg Product.

(a) “Egg product” means all, or a portion of, the contents found inside eggs separated from the shell and pasteurized in a food processing plant, with or without added ingredients, intended for human consumption, such as dried, frozen or liquid eggs.

(b) “Egg product” does not include food that contains eggs only in a relatively small proportion such as cake mixes.

(34) “EPA” means the U.S. Environmental Protection Agency.

(35) Equipment.

(a) “Equipment” means an article that is used in the operation of a food establishment or farmers market food unit such as a beverage cooler, dish pans, food and beverage dispensing equipment, freezer, grinder, hood, ice maker, meat block, mixer, oven, reach-in refrigerator, scale, sink, slicer, stove, table, temperature measuring device for ambient air, or ware washing machine.

(b) “Equipment” does not include apparatuses used for handling or storing large quantities of packaged foods that are received from a supplier in a cased or overwrapped lot, such as hand trucks, forklifts, dollies, pallets, racks, and skids.

(36) “Exclude” means to prevent a person from working as an employee in a food establishment or entering a food establishment as an employee.

(37) “FDA” means the U.S. Food and Drug Administration.

(38) Fish.

(a) “Fish” means fresh or saltwater finfish, crustaceans and other forms of aquatic life (including alligator, frog, aquatic turtle, jellyfish, sea cucumber, and sea urchin and the roe of such animals) other than birds or mammals, and all mollusks, if such animal life is intended for human consumption.

(b) “Fish” includes an edible human food product derived in whole or in part from fish, including fish that have been processed in any manner.

(39) “Food” means a raw, cooked, or processed edible substance, ice, beverage, or ingredient used or intended for use or for sale in whole or in part for human consumption, or chewing gum.

(40) “Foodborne disease outbreak” means the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food.

(41) “Food-contact surface” means:

(a) A surface of equipment or a utensil with which food normally comes into contact; or (b) A surface of equipment or a utensil from which food may drain, drip, or splash:

1. Into a food, or 2. Onto a surface normally in contact with food.

(42) “Food employee” means an individual working with unpackaged food, food equipment or utensils, or food-contact surfaces.

(43) Food Processing Plant.

(a) “Food processing plant” means a commercial operation that manufactures, packages, labels, or stores food for human consumption, and provides food for sale or distribution to other business entities such as food processing plants or food establishments.

(b) “Food processing plant” does not include a food establishment.

(44) Game Animal.

(a) “Game animal” means an animal, the products of which are food, that is not classified as livestock, sheep, swine, goat, horse, mule, or other equine in 9 CFR § 301.2 Definitions, or as poultry, or fish.

(b) “Game animal” includes mammals such as reindeer, elk, deer, antelope, water buffalo, bison, rabbit, squirrel, opossum, raccoon, nutria, or muskrat, and nonaquatic reptiles such as land snakes.

(c) “Game animal” does not include ratites.

(45) “General use pesticide” means a pesticide that is not classified by EPA for restricted use as specified in 40 CFR § 152.175 Pesticides classified for restricted use.

(46) “Good repair” means equipment and utensils shall be maintained in a state of repair and condition that meets the requirements specified under 1200-23-01-.04.

(47) “Grade A standards” means the requirements of the United States Public Health Service/FDA “Grade A Pasteurized Milk Ordinance” with which certain fluid and dry milk and milk products comply.

(48) “HACCP plan” means a written document that delineates the formal procedures for following the hazard analysis and critical control point principles developed by The National Advisory Committee on Microbiological Criteria for Foods.

(49) Handwashing Sink.

(a) “Handwashing sink” means a lavatory, a basin or vessel for washing, a wash basin, or a plumbing fixture especially placed for use in personal hygiene and designed for the washing of the hands.

(b) “Handwashing sink” includes an automatic handwashing facility.

(50) “Hazard” means a biological, chemical, or physical property that may cause an unacceptable consumer health risk.

(51) “Health practitioner” means a physician licensed to practice medicine, or if allowed by law, a nurse practitioner, or physician assistant.

(52) “Hermetically sealed container” means a container that is designed and intended to be secure against the entry of microorganisms and, in the case of low acid canned foods, to maintain the commercial sterility of its contents after processing.

(53) “Highly susceptible population” means persons who are more likely than other people in the general population to experience foodborne disease because they are:

(a) Immunocompromised; preschool age children, or older adults; and (b) Obtaining food at a facility that provides services such as custodial care, health care, or assisted living, such as a child or adult day care center, kidney dialysis center, hospital or nursing home, or nutritional or socialization services such as a senior center.

(54) “In Shell Product” means non-living processed shellfish with one or both shells present.

(55) “Injected” means manipulating meat to which a solution has been introduced into its interior by processes that are referred to as “injecting,” “pump marinating,” or “stitch pumping”.

(56) “Intact Meat” means a cut of whole muscle(s) meat that has not undergone comminution, mechanical tenderization, vacuum tumbling with solutions, reconstruction, cubing, or pounding.

(57) Juice.

(a) “Juice” means the aqueous liquid expressed or extracted from one or more fruits or vegetables, purées of the edible portions of one or more fruits or vegetables, or any concentrates of such liquid or purée.

(b) “Juice” does not include, for purposes of HACCP, liquids, purées, or concentrates that are not used as beverages or ingredients of beverages.

(58) “Kitchenware” means food preparation and storage utensils.

(59) “Law” means applicable local, state, and federal statutes, regulations, and ordinances.

(60) “Linens” means fabric items such as cloth hampers, cloth napkins, table cloths, wiping cloths, and work garments including cloth gloves.

(61) Major Food Allergen.

(a) “Major food allergen” means:

1. Milk, egg, fish (such as bass, flounder, cod, and including crustacean shellfish such as crab, lobster, or shrimp), tree nuts (such as almonds, pecans, or walnuts), wheat, peanuts, sesame, and soybeans; or 2. A food ingredient that contains protein derived from a food, as specified in part (a)1. of this definition.

(b) “Major food allergen” does not include:

1. Any highly refined oil derived from a food specified in part (a)1. of this definition and any ingredient derived from such highly refined oil; or 2. Any ingredient that is exempt under the petition or notification process specified in the Food Allergen Labeling and Consumer Protection Act of 2004 (Public Law 108-282).

(62) “Meat” means the flesh of animals used as food including the dressed flesh of cattle, swine, sheep, or goat, other edible animals except fish, poultry, and wild game animals as specified under 1200-23-01-.03(a)3. and 4.

(63) Mechanically Tenderized.

(a) Means manipulating meat by piercing with a set of needles, pins, blades or any mechanical device, which breaks up muscle fiber and tough connective tissue, to increase tenderness. This includes INJECTION, scoring, and processes which may be referred to as “blade tenderizing,” “jaccarding,” “pinning,” or “needling.”

(64) “mg/L” means milligrams per liter, which is the metric equivalent of parts per million (ppm).

(65) “Mobile food unit” means a food establishment designed to be readily moved and vend food.

(66) “Molluscan shellfish” means any edible species of fresh or frozen oysters, clams, mussels, and scallops or edible portions thereof, except when the scallop product consists only of the shucked adductor muscle. Molluscan shellfish includes shellstock, shucked shellfish, and in shell products.

(67) Non-Continuous Cooking.

(a) “Non-continuous cooking” means the cooking of food in a food establishment using a process in which the initial heating of the food is intentionally halted so that it may be cooled and held for complete cooking at a later time prior to sale or service.

(b) “Non-continuous cooking” does not include cooking procedures that only involve temporarily interrupting or slowing an otherwise continuous cooking process.

(68) “Occasional Sales” means sales conducted at infrequent or irregular intervals by persons not typically engaged in a FSE business or that do not regularly make food sales.

(69) Packaged.

(a) “Packaged” means bottled, canned, cartoned, securely bagged, or securely wrapped, whether packaged in a food establishment or a food processing plant.

(b) “Packaged” does not include a wrapper, carry-out box, or other nondurable container used to containerize food with the purpose of facilitating food protection during service and receipt of the food by the consumer.

(70) “Permit” means the document issued by the department that authorizes a person to operate a food establishment.

(71) “Permit holder” means the entity that:

(a) Is legally responsible for the operation of the food establishment such as the owner, the owner’s agent, or other person; and (b) Possesses a valid permit to operate a food establishment.

(72) Personal Care Items.

(a) “Personal care items” means items or substances that may be poisonous, toxic, or a source of contamination and are used to maintain or enhance a person’s health, hygiene, or appearance.

(b) “Personal care items” include items such as medicines; first aid supplies; and other items such as cosmetics, and toiletries such as toothpaste and mouthwash.

(73) “pH” means the symbol for the negative logarithm of the hydrogen ion concentration, which is a measure of the degree of acidity or alkalinity of a solution. Values between 0 and 7 indicate acidity and values between 7 and 14 indicate alkalinity. The value for pure distilled water is 7, which is considered neutral.

(74) “Physical facilities” means the structure and interior surfaces of a food establishment including accessories such as soap and towel dispensers and attachments such as light fixtures and heating or air conditioning system vents.

(75) “Plumbing fixture” means a receptacle or device that:

(a) Is permanently or temporarily connected to the water distribution system of the premises and demands a supply of water from the system; or (b) Discharges used water, waste materials, or sewage directly or indirectly to the drainage system of the premises.

(76) “Plumbing system” means the water supply and distribution pipes; plumbing fixtures and traps; soil, waste, and vent pipes; sanitary and storm sewers and building drains, including their respective connections, devices, and appurtenances within the premises; and watertreating equipment.

(77) “Poisonous or toxic materials” means substances that are not intended for ingestion and are included in 4 categories:

(a) Cleaners and sanitizers, which include cleaning and sanitizing agents and agents such as caustics, acids, drying agents, polishes, and other chemicals;

(b) Pesticides, except sanitizers, which include substances such as insecticides and rodenticides;

(c) Substances necessary for the operation and maintenance of the establishment such as nonfood grade lubricants and personal care items that may be deleterious to health; and (d) Substances that are not necessary for the operation and maintenance of the establishment and are on the premises for retail sale, such as petroleum products and paints.

(78) “Poultry” means:

(a) Any domesticated bird (chickens, turkeys, ducks, geese, guineas, ratites, or squabs), whether live or dead, as defined in 9 CFR § 381.1 Poultry Products Inspection Regulations Definitions, Poultry, and (b) Any migratory waterfowl or game bird, pheasant, partridge, quail, grouse, or pigeon, whether live or dead, as defined in 9 CFR § 362.1 Voluntary Poultry Inspection Regulations, Definitions.

(79) “Premises” means:

(a) The physical facility, its contents, and the contiguous land or property under the control of the permit holder; or (b) The physical facility, its contents, and the land or property not described in subparagraph (a) of this definition if its facilities and contents are under the control of the permit holder and may impact food establishment personnel, facilities, or operations, and a food establishment is only one component of a larger operation such as a health care facility, hotel, motel, school, recreational camp, or prison.

(80) “Primal cut” means a basic major cut into which carcasses and sides of meat are separated, such as a beef round, pork loin, lamb flank, or veal breast.

(81) Priority Item.

(a) “Priority item” means a provision in this Chapter whose application contributes directly to the elimination, prevention or reduction to an acceptable level, of hazards associated with foodborne illness or injury and there is no other provision that more directly controls the hazard.

(b) “Priority item” includes items with a quantifiable measure to show control of hazards such as cooking, reheating, cooling, handwashing; and (c) “Priority item” is an item that is denoted in this Chapter with (P).

(82) Priority Foundation Item.

(a) “Priority foundation item” means a provision in this Chapter whose application supports, facilitates or enables one or more priority items.

(b) “Priority foundation item” includes an item that requires the purposeful incorporation of specific actions, equipment or procedures by industry management to attain control of risk factors that contribute to foodborne illness or injury such as personnel training, infrastructure or necessary equipment, HACCP plans, documentation or record keeping, and labeling; and (c) “Priority foundation item” is an item that is denoted in this Chapter with (Pf).

(83) “Public water system” has the meaning stated in 40 CFR Part 141 National Primary Drinking Water Regulations.

(84) “Ratite” means a flightless bird such as an emu, ostrich, or rhea.

(85) “Ready-to-eat food” means food that:

(a) Is in a form that is edible without additional preparation to achieve food safety, as specified under one of the following 1200-23-01-.03(4)(a)1.(i) or (ii), 1200-23-01- .03(4)(a)2., or 1200-23-01-.03(4)(b)1. or as specified in 1200-23-01-.03(4)(a)1.(iii); or (b) Is a raw or partially cooked animal food and the consumer is advised as specified in 1200-23-01-.03(4)(a)1.(iv)(I) and (III); or (c) Is prepared in accordance with a variance that is granted as specified in 1200-23-01- .03(4)(a)1.(iv)(IV); and (d) May receive additional preparation for palatability or aesthetic, epicurean, gastronomic, or culinary purposes.

(e) “Ready-to-eat food” includes:

1. Raw animal food that is cooked as specified under or 1200-23-01-.03(4)(a)1., or frozen as specified under 1200-23-01-.03(4)(b);

2. Raw fruits and vegetables that are washed as specified under or 1200-23-01- .03(3)(b)5.;

3. Plant foods that are cooked for hot holding, as specified under or 1200-23-01- .03(4)(a)3.;

4. All time/temperature control for safety food that is cooked to the temperature and time required for the specific food under or 1200-23-01-.03(4) and cooled as specified under or 1200-23-01-.03(5)(a)4.;

5. Plant food for which further washing, cooking, or other processing is not required for food safety, and from which rinds, peels, husks, or shells, if naturally present are removed;

6. Substances derived from plants such as spices, seasonings, and sugar;

7. A bakery item such as bread, cakes, pies, fillings, or icing for which further cooking is not required for food safety;

8. The following products that are produced in accordance with USDA guidelines and that have received a lethality treatment for pathogens: dry, fermented sausages, such as dry salami or pepperoni; salt-cured meat and poultry products, such as prosciutto ham, country cured ham, and Parma ham; and dried meat and poultry products, such as jerky or beef sticks; and 9. Food manufactured as specified in 21 CFR Part 113, Thermally Processed Low- Acid Foods Packaged in Hermetically Sealed Containers.

(f) “Ready-to-eat food” does not include:

1. Commercially packaged food that bears a manufacturer’s cooking instructions; and 2. Food for which the manufacturer has provided information that it has not been processed to control pathogens.

(86) Reduced Oxygen Packaging.

(a) “Reduced oxygen packaging” means:

1. The reduction of the amount of oxygen in a package by removing oxygen; displacing oxygen and replacing it with another gas or combination of gases; or otherwise controlling the oxygen content to a level below that normally found in the atmosphere (approximately 21% at sea level); and 2. A process as specified in part (a)1. of this definition that involves a food for which the hazards Clostridium botulinum or Listeria monocytogenes require control in the final packaged form.

(b) “Reduced oxygen packaging” includes:

1. Vacuum packing, in which air is removed from a package of food and the package is hermetically sealed so that a vacuum remains inside the package;

2. Modified atmosphere packaging, in which the atmosphere of a package of food is modified so that its composition is different from air but the atmosphere may change over time due to the permeability of the packaging material or the respiration of the food. Modified atmosphere packaging includes reduction in the proportion of oxygen, total replacement of oxygen, or an increase in the proportion of other gases such as carbon dioxide or nitrogen;

3. Controlled atmosphere packaging, in which the atmosphere of a package of food is modified so that until the package is opened, its composition is different from air, and continuous control of that atmosphere is maintained, such as by using oxygen scavengers or a combination of total replacement of oxygen, nonrespiring food, and impermeable packaging material;

4. Cook chill packaging, in which cooked food is hot filled into impermeable bags that are then sealed or crimped closed. The bagged food is rapidly chilled and refrigerated at temperatures that inhibit the growth of psychrotrophic pathogens; or 5. Sous vide packaging, in which raw or partially cooked food is vacuum packaged in an impermeable bag, cooked in the bag, rapidly chilled, and refrigerated at temperatures that inhibit the growth of psychrotrophic pathogens.

(87) “Refuse” means solid waste not carried by water through the sewage system.

(88) “Reminder” means a written statement concerning the health risk of consuming animal food raw, undercooked, or without otherwise being processed to eliminate pathogens.

(89) “Re-service” means the transfer of food that is unused and returned by a consumer after being served or sold and in the possession of the consumer, to another person.

(90) “Restrict” means to limit the activities of a food employee so that there is no risk of transmitting a disease that is transmissible through food and the food employee does not work with exposed food, clean equipment, utensils, linens, or unwrapped single-service or single-use articles.

(91) “Restricted egg” means any check, dirty egg, incubator reject, inedible, leaker, or loss as defined in 9 CFR § 590.5.

(92) “Restricted use pesticide” means a pesticide product that contains the active ingredients specified in 40 CFR § 152.175 Pesticides classified for restricted use, and that is limited to use by or under the direct supervision of a certified applicator.

(93) “Risk” means the likelihood that an adverse health effect will occur within a population as a result of a hazard in a food.

(94) “Safe material” means:

(a) An article manufactured from or composed of materials that may not reasonably be expected to result, directly or indirectly, in their becoming a component or otherwise affecting the characteristics of any food;

(b) An additive that is used as specified in § 409 of the Federal Food, Drug, and Cosmetic Act; or (c) Other materials that are not additives and that are used in conformity with applicable regulations of the Food and Drug Administration.

(95) “Sanitization” means the application of cumulative heat or chemicals on cleaned food-contact surfaces that, when evaluated for efficacy, is sufficient to yield a reduction of 5 logs, which is equal to a 99.999% reduction, of representative disease microorganisms of public health importance.

(96) “Sealed” means free of cracks or other openings that allow the entry or passage of moisture.

(97) “Service animal” means an animal such as a guide dog, signal dog, or other animal individually trained to provide assistance to an individual with a disability.

(98) “Servicing area” means an operating base location to which a mobile food establishment or transportation vehicle returns regularly for such things as vehicle and equipment cleaning, discharging liquid or solid wastes, refilling water tanks and ice bins, and boarding food.

(99) “Sewage” means liquid waste containing animal or vegetable matter in suspension or solution and may include liquids containing chemicals in solution.

(100) “Shellfish control authority” means a state, federal, foreign, tribal, or other government entity legally responsible for administering a program that includes certification of molluscan shellfish harvesters and dealers for interstate commerce.

(101) “Shellstock” means raw, in shell molluscan shellfish.

(102) “Shiga toxin-producing Escherichia coli (STEC) means any E. coli capable of producing Shiga toxins (also called verocytotoxins). STEC infections can be asymptomatic or may result in a spectrum of illness ranging from mild non-bloody diarrhea, to hemorrhagic colitis (i.e., bloody diarrhea), to hemolytic uremic syndrome (HUS - a type of kidney failure). Examples of serotypes of STEC include: E. coli O157:H7; E. coli O157:NM; E. coli O26:H11; E. coli O145:NM; E. coli O103:H2; and E. coli O111:NM. STEC are sometimes referred to as VTEC (verocytotoxigenic E. coli) or as EHEC (Enterohemorrhagic E. coli). EHEC are a subset of STEC which can cause hemorrhagic colitis or HUS.

(103) “Shucked shellfish” means molluscan shellfish that have one or both shells removed.

(104) “Single-service articles” means tableware, carry-out utensils, and other items such as bags, containers, placemats, stirrers, straws, toothpicks, and wrappers that are designed and constructed for one time, one person use after which they are intended for discard.

(105) Single-Use Articles.

(a) “Single-use articles” means utensils and bulk food containers designed and constructed to be used once and discarded.

(b) “Single-use articles” includes items such as wax paper, butcher paper, plastic wrap, formed aluminum food containers, jars, plastic tubs or buckets, bread wrappers, pickle barrels, ketchup bottles, and number 10 cans which do not meet the materials, durability, strength, and cleanability specifications under 1200-23-01-.04(1)(a), (2)(a), and (b) for multiuse utensils.

(106) “Slacking” means the process of moderating the temperature of a food such as allowing a food to gradually increase from a temperature of -23°C (-10°F) to -4°C (25°F) in preparation for deep-fat frying or to facilitate even heat penetration during the cooking of previously blockfrozen food such as shrimp.

(107) “Smooth” means:

(a) A food-contact surface having a surface free of pits and inclusions with a cleanability equal to or exceeding that of (100 grit) number 3 stainless steel;

(b) A nonfood-contact surface of equipment having a surface equal to that of commercial grade hot-rolled steel free of visible scale; and (c) A floor, wall, or ceiling having an even or level surface with no roughness or projections that render it difficult to clean.

(108) “Tableware” means eating, drinking, and serving utensils for table use such as flatware including forks, knives, and spoons; hollowware including bowls, cups, serving dishes, and tumblers; and plates.

(109) “Temperature measuring device” means a thermometer, thermocouple, thermistor, or other device that indicates the temperature of food, air, or water.

(110) Time/Temperature Control for Safety Food.

(a) “Time/temperature control for safety food” means a food that requires time/temperature control for safety (TCS) to limit pathogenic microorganism growth or toxin formation.

(b) “Time/temperature control for safety food” includes:

1. An animal food that is raw or heat-treated; a plant food that is heat-treated or consists of raw seed sprouts, cut melons, cut leafy greens, cut tomatoes or mixtures of cut tomatoes that are not modified in a way so that they are unable to support pathogenic microorganism growth or toxin formation, or garlic-in-oil mixtures that are not modified in a way so that they are unable to support pathogenic microorganism growth or toxin formation; and 2. Except as specified in subpart 3.(iv) of this definition, a food that because of the interaction of its AW and pH values is designated as Product Assessment Required (PA) in Table A or B of this definition: Table A. Interaction of pH and AW for control of spores in food heat-treated to destroy vegetative cells and subsequently packaged AW values pH values Table A. Interaction of pH and AW for control of spores in food heat-treated to destroy vegetative cells and subsequently packaged AW values pH values 4.6 or less > 4.6 - 5.6 > 5.6 <0.92 non-TCS food* non-TCS food non-TCS food > 0.92 - .95 non-TCS food non-TCS food PA** > 0.95 non-TCS food PA PA * TCS food means Time/Temperature Control for Safety food ** PA means Product Assessment required Table B. Interaction of pH and AW for control of vegetative cells and spores in food not heattreated or heat-treated but not packaged AW values pH values < 4.2 4.2 - 4.6 > 4.6 - 5.0 > 5.0 < 0.88 non-TCS food* non-TCS food non-TCS food non-TCS food 0.88 - 0.90 non-TCS food non-TCS food non-TCS food PA** > 0.90 - 0.92 non-TCS food non-TCS food PA PA > 0.92 non-TCS food PA PA PA * TCS food means Time/Temperature Control for Safety food ** PA means Product Assessment required 3. “Time/temperature control for safety food” does not include:

(i) An air-cooled hard-boiled egg with shell intact, or an egg with shell intact that is not hard boiled, but has been pasteurized to destroy all viable salmonellae;

(ii) A food in an unopened hermetically sealed container that is commercially processed to achieve and maintain commercial sterility under conditions of non-refrigerated storage and distribution;

(iii) A food that because of its pH or AW value, or interaction of AW and pH values, is designated as a non-TCS food in Table A or B of this definition;

(iv) A food that is designated as Product Assessment Required (PA) in Table A or B of this definition and has undergone a Product Assessment showing that the growth or toxin formation of pathogenic microorganisms that are reasonably likely to occur in that food is precluded due to:

(I) Intrinsic factors including added or natural characteristics of the food such as preservatives, antimicrobials, humectants, acidulants, or nutrients, (II) Extrinsic factors including environmental or operational factors that affect the food such as packaging, modified atmosphere such as reduced oxygen packaging, shelf life and use, or temperature range of storage and use, or (III) A combination of intrinsic and extrinsic factors; or (v) A food that does not support the growth or toxin formation of pathogenic microorganisms in accordance with one of the subparts 3.(i)–3.(iv) of this definition even though the food may contain a pathogenic microorganism or chemical or physical contaminant at a level sufficient to cause illness or injury.

(111) “USDA” means the U.S. Department of Agriculture.

(112) “Utensil” means a food-contact implement or container used in the storage, preparation, transportation, dispensing, sale, or service of food, such as kitchenware or tableware that is multiuse, single-service, or single-use, gloves used in contact with food; temperature sensing probes of food temperature measuring devices; and probe-type price or identification tags used in contact with food.

(113) “Variance” means a written document issued by the department that authorizes a modification or waiver of one or more requirements of this Chapter if, in the opinion of the department, a health hazard or nuisance will not result from the modification or waiver.

(114) “Warewashing” means the cleaning and sanitizing of utensils and food-contact surfaces of equipment.

(115) “Whole-muscle, intact beef” means whole-muscle beef that is not injected, mechanically tenderized, reconstructed, or scored and marinated, from which beef steaks may be cut.

History

• Authority: T.C.A. §§ 68-14-701 through 68-14-729.
• Administrative History: Original rule filed March 26, 1987; effective May 9, 1987. Amendment filed February 14, 1989; effective March 21, 1989. Amendment filed January 2, 1991; effective May 1, 1991. Repeal and new rule filed August 24, 2000; effective November 7, 2000. Amendment filed October 22, 2004; effective January 5, 2005. Repeal and new rule filed April 17, 2015; effective July 16, 2015. Emergency rules filed April 9, 2024; effective through October 6, 2024. Amendments filed July 1, 2024; effective September 29, 2024. Amendments filed March 16, 2026; effective June 14, 2026.

Tenn. Comp. R. & Regs. 1200-23-01-.02 MANAGEMENT AND PERSONNEL

(1) Supervision.

(a) Responsibility.

1. Assignment.

(i) The permit holder shall be the person in charge or shall designate a person in charge and shall ensure that a person in charge is present at the food establishment during all hours of operation. (Pf)

(ii) In a food establishment with two or more separately permitted departments that are the legal responsibility of the same permit holder and that are located on the same premises, the permit holder may designate a single person in charge who is present on the premises during all hours of operation and who is responsible for each separately permitted food establishment on the premises.

(b) Knowledge.

1. Demonstration.

(i) Based on the risks inherent to the food operation, during inspections and upon request the person in charge shall demonstrate to the department knowledge of foodborne disease prevention, application of the Hazard Analysis and Critical Control Point principles, and the requirements of these rules. The Person in Charge shall demonstrate this knowledge by:

(I) Complying with these rules by having no violations of Priority Items during the current inspection; (Pf)

(II) Being a certified food protection manager who has shown proficiency of required information through passing a test that is part of an Accredited Program; (Pf) or (III) Responding correctly to the inspector’s questions as they relate to the specific food operation. The areas of knowledge include:

I. Describing the relationship between the prevention of foodborne disease and the personal hygiene of a food employee; (Pf)

II. Explaining the responsibility of the person in charge for preventing the transmission of foodborne disease by a food employee who has a disease or medical condition that may cause foodborne disease; (Pf)

III. Describing the symptoms associated with the diseases that are transmissible through food; (Pf)

IV. Explaining the significance of the relationship between maintaining the time and temperature of time/temperature control for safety food and the prevention of foodborne illness;

(Pf)

V. Explaining the hazards involved in the consumption of raw or undercooked meat, poultry, eggs, and fish; (Pf)

VI. Stating the required food temperatures and times for safe cooking of time/temperature control for safety food including meat, poultry, eggs, and fish; (Pf)

VII. Stating the required temperatures and times for the safe refrigerated storage, hot holding, cooling, and reheating of potentially hazardous food time/temperature control for safety food; (Pf)

VIII. Describing the relationship between the prevention of foodborne illness and the management and control of the following:

A. Cross contamination, (Pf)

B. Hand contact with ready-to-eat foods, (Pf)

C. Handwashing; (Pf) and D. Maintaining the food establishment in a clean condition and in good repair; (Pf)

IX. Describing foods identified as major food allergens and the symptoms that a major food allergen could cause in a sensitive individual who has an allergic reaction. (Pf)

X. Explaining the relationship between food safety and providing equipment that is:

A. Sufficient in number and capacity; (Pf) and B. Properly designed, constructed, located, installed, operated, maintained, and cleaned; (Pf)

XI. Explaining correct procedures for cleaning and sanitizing utensils and food-contact surfaces of equipment; (Pf)

XII. Identifying the source of water used and measures taken to ensure that it remains protected from contamination such as providing protection from backflow and precluding the creation of cross connections; (Pf)

XIII. Identifying poisonous or toxic materials in the food establishment and the procedures necessary to ensure that they are safely stored, dispensed, used, and disposed of according to law; (Pf)

XIV. Identifying critical control points in the operation from purchasing through sale or service that when not controlled may contribute to the transmission of foodborne illness and explaining steps taken to ensure that the points are controlled in accordance with the requirements of these regulations; (Pf)

XV. Explaining the details of how the person in charge and food employees comply with the HACCP plan if a plan is required by the law, this Chapter, or an agreement between the department and the food establishment; (Pf)

XVI. Explaining the responsibilities, rights, and authorities assigned by these regulations to the:

A. Food employee, (Pf)

B. Conditional employee, (Pf)

C. Person in charge, (Pf)

D. Department; (Pf) and XVII. Explaining how the person in charge, food employees, and conditional employees comply with reporting responsibilities and exclusion or restriction of food employees. (Pf)

2. Food Protection Manager Certification.

(i) A Person in Charge who demonstrates knowledge by being a food protection manager certified by a food protection manager certification program evaluated and listed by a Conference for Food Protectionrecognized accrediting agency as conforming to the Conference for Food Protection Standards for Accreditation of Food Protection Manager Certification Programs is deemed to comply with 1200-23-01- .02(1)(b)(i) 1.(III).

(c) Duties.

1. Person in Charge. The person in charge shall ensure that:

(i) Food establishment operations are not conducted in a private home or in a room used as living or sleeping quarters as specified under 1200-23-01- .06(2)(b)9. and 10.; (Pf)

(ii) Persons unnecessary to the food establishment operation are not allowed in the food preparation, food storage, or warewashing areas, except that the person in charge may authorize brief visits and tours if steps are taken to ensure that exposed food; clean equipment, utensils, and linens; and unwrapped single-service and single-use articles are protected from contamination; (Pf)

(iii) Employees and other persons such as delivery and maintenance persons and pesticide applicators entering the food preparation, food storage, and warewashing areas comply with these regulations; (Pf)

(iv) Employees are effectively cleaning their hands, by routinely monitoring the employees’ handwashing; (Pf)

(v) Employees are visibly observing foods as they are received to determine that they are from approved sources, delivered at the required temperatures, protected from contamination, unadulterated, and accurately presented, by routinely monitoring the employees’ observations and periodically evaluating foods upon their receipt; (Pf)

(vi) Employees are verifying that foods delivered to the food establishment during non-operating hours are from approved sources and are placed into appropriate storage locations such that they are maintained at the required temperatures, protected from contamination, unadulterated and accurately presented;

(vii) Employees are properly cooking time/temperature control for safety food, being particularly careful in cooking those foods known to cause severe foodborne illness and death, such as eggs and comminuted meats, through daily oversight of the employees’ routine monitoring of the cooking temperatures using appropriate temperature measuring devices properly scaled and calibrated as specified under 1200-23-01-.04(2)(c) or 1200-23- 01-.04(5)(b); (Pf)

(viii) Employees are using proper methods to rapidly cool potentially hazardous foods (time/temperature control for safety foods) that are not held hot or are not for consumption within 4 hours, through daily oversight of the employees’ routine monitoring of food temperatures during cooling; (Pf)

(ix) Consumers who order raw or partially cooked ready-to-eat foods of animal origin are informed as specified under 1200-23-01-.03(6)(c) that the food is not cooked sufficiently to ensure its safety; (Pf)

(x) Employees are properly sanitizing cleaned multiuse equipment and utensils before they are reused, through routine monitoring of solution temperature and exposure time for hot water sanitizing, and chemical concentration, pH, temperature, and exposure time for chemical sanitizing;

(Pf)

(xi) Consumers are notified that clean tableware is to be used when they return to self-service areas such as salad bars and buffets as specified under 1200-23-01-.03(3)(d)6.; (Pf)

(xii) Except when approval is obtained from the department as specified in 1200-23-01-.03(3)(a)1.(v), employees are preventing cross-contamination of ready-to-eat food with bare hands by properly using suitable utensils such as deli tissue, spatulas, tongs, single-use gloves, or dispensing equipment; (Pf)

(xiii) Employees are properly trained in food safety, including food allergy awareness, as it relates to their assigned duties; (Pf)

(xiv) Food employees and conditional employees are informed of their responsibility to report in accordance with law, to the person in charge, information about their health and activities as they relate to diseases that are transmissible through food, as specified under part (2)(a)1.; (Pf) and (xv) Written procedures and plans, where established by this rule and as developed by the food establishment are maintained and implemented as required.

(2) Employee Health.

(a) Responsibility of Permit Holder, Person in Charge, and Conditional Employees.

1. The permit holder shall require food employees and conditional employees to report to the person in charge information about their health and activities as they relate to diseases that are transmissible through food. A food employee or conditional employee shall report the information in a manner that allows the person in charge to reduce the risk of foodborne disease transmission, including providing necessary additional information, such as the date of onset of symptoms and illness, or of a diagnosis without symptoms, if the food employee or conditional employee:

(i) Has any of the following symptoms:

(I) Vomiting, (P)

(II) Diarrhea, (P)

(III) Jaundice, (P)

(IV) Sore throat with fever, (P) or (V) A lesion containing pus such as a boil or infected wound that is open or draining and is:

I. On the hands or wrists, unless an impermeable cover such as a finger cot or stall protects the lesion and a single-use glove is worn over the impermeable cover, (P)

II. On exposed portions of the arms, unless the lesion is protected by an impermeable cover, (P) or III. On other parts of the body, unless the lesion is covered by a dry, durable, tight-fitting bandage; (P)

(ii) Has an illness diagnosed by a health practitioner due to:

(I) Norovirus, (P)

(II) Hepatitis A virus, (P)

(III) Shigella spp., (P)

(IV) Enterohemorrhagic or Shiga toxin-producing Escherichia coli, (P) or (V) Typhoid Fever or non-Typhi; (P)

(iii) Had a previous illness, diagnosed by a health practitioner, within the past 3 months due to Typhoid Fever, without having received antibiotic therapy, as determined by a health practitioner; (P)

(iv) Has been exposed to, or is the suspected source of, a confirmed disease outbreak, because the food employee or conditional employee consumed or prepared food implicated in the outbreak, or consumed food at an event prepared by a person who is infected or ill with: (P)

(I) Norovirus within the past 48 hours of the last exposure, (P)

(II) Enterohemorrhagic or Shiga toxin-producing Escherichia coli, or Shigella spp. within the past 3 days of the last exposure, (P)

(III) Typhoid Fever within the past 14 days of the last exposure, (P) or (IV) Hepatitis A virus within the past 30 days of the last exposure; (P) or (v) Has been exposed by attending or working in a setting where there is a confirmed disease outbreak, or living in the same household as, and has knowledge about, an individual who works or attends a setting where there is a confirmed disease outbreak, or living in the same household as, and has knowledge about, an individual diagnosed with an illness caused by:

(I) Norovirus within the past 48 hours of the last exposure, (P)

(II) Enterohemorrhagic or Shiga toxin-producing Escherichia coli, (P) or Shigella spp. within the past 3 days of the last exposure, (III) Typhoid Fever within the past 14 days of the last exposure, (P) or (IV) Hepatitis A virus within the past 30 days of the last exposure. (P)

2. The person in charge shall notify the department when a food employee is:

(i) Jaundiced, (Pf) or (ii) Diagnosed with an illness due to a pathogen as specified under items 1.(ii)(I)–(V) of this subparagraph. (Pf)

3. The person in charge shall ensure that a conditional employee:

(i) Who exhibits or reports a symptom, or who reports a diagnosed illness as specified under subparts 1.(i)–1.(iii) of this subparagraph, is prohibited from becoming a food employee until the conditional employee meets the criteria for the specific symptoms or diagnosed illness as specified under 1200-23-01-.02(2)(c); (P) and (ii) Who will work as a food employee in a food establishment that serves a highly susceptible population and reports a history of exposure as specified under subparts 1.(iv)–1.(v) of this subparagraph, is prohibited from becoming a food employee until the conditional employee meets the criteria as specified under 1200-23-01-.02(2)(c). (P)

4. The person in charge shall ensure that a food employee who exhibits or reports a symptom, or who reports a diagnosed illness or a history of exposure as specified under subparts 1.(i)–1.(v) of this subparagraph is:

(i) Excluded as specified under 1200-23-01-.02(2)(b)1.–3., and subparts 4.(i), 5.(i), 6.(i), or 7.(i) and in compliance with the provisions specified under 1200-23-01-.02(2)(c)1.–7.; (P) or (ii) Restricted as specified under 1200-23-01-.02(2)(b), and subparts 4.(ii), 5.(ii), 6.(ii), 7.(ii), or 1200-23-01-.02(2)(b)8. or 9. and in compliance with the provisions specified under 1200-23-01-.02(2)(c)4.–9. (P)

5. A food employee or conditional employee shall report to the person in charge the information as specified under part 1. of this subparagraph. (Pf)

6. A food employee shall:

(i) Comply with an exclusion as specified under 1200-23-01-.02(2)(b)1.–3., subparts 4.(i), 5.(i), 6.(i), or 7.(i) and with the provisions specified under 1200-23-01-.02(2)(c)4.–9.; (P) or (ii) Comply with a restriction as specified under 1200-23-01-.02(2)(b)4.(ii), 5.(ii), 6.(ii), 7.(ii), or 1200-23-01-.02(2)(b)8. or 9. and comply with the provisions specified under 1200-23-01-.02(2)(c)4.–9. (P)

(b) Exclusions and Restrictions. The person in charge shall exclude or restrict a food employee from a food establishment in accordance with the following:

1. Except when the symptom is from a noninfectious condition, exclude a food employee if the food employee is:

(i) Symptomatic with vomiting or diarrhea; (P) or (ii) Symptomatic with vomiting or diarrhea and diagnosed with an infection from Norovirus, Shigella spp., or Enterohemorrhagic or Shiga toxinproducing E. coli. (P)

2. Exclude a food employee who is:

(i) Jaundiced and the onset of jaundice occurred within the last 7 calendar days, unless the food employee provides to the person in charge written medical documentation from a health practitioner specifying that the jaundice is not caused by hepatitis A virus or other fecal-orally transmitted infection; (P)

(ii) Diagnosed with an infection from hepatitis A virus within 14 calendar days from onset of any illness symptoms, or within 7 calendar days of the onset of jaundice; (P) or (iii) Diagnosed with an infection from hepatitis A virus without developing symptoms. (P)

3. Exclude a food employee who is diagnosed with an infection from Typhoid Fever, or reports a previous infection with Typhoid Fever within the past 3 months as specified under subpart 1200-23-01-.02(2)(a)1.(iii).(P)

4. If a food employee is diagnosed with an infection from Norovirus and is asymptomatic:

(i) Exclude the food employee who works in a food establishment serving a highly susceptible population; (P) or (ii) Restrict the food employee who works in a food establishment not serving a highly susceptible population. (P)

5. If a food employee is diagnosed with an infection from Shigella spp. and is asymptomatic:

(i) Exclude the food employee who works in a food establishment serving a highly susceptible population; (P) or (ii) Restrict the food employee who works in a food establishment not serving a highly susceptible population. (P)

6. If a food employee is diagnosed with an infection from Enterohemorrhagic or Shiga toxin-producing E. coli, and is asymptomatic:

(i) Exclude the food employee who works in a food establishment serving a highly susceptible population; (P) or (ii) Restrict the food employee who works in a food establishment not serving a highly susceptible population. (P)

7. If a food employee is ill with symptoms of acute onset of sore throat with fever:

(i) Exclude the food employee who works in a food establishment serving a highly susceptible population; (P) or (ii) Restrict the food employee who works in a food establishment not serving a highly susceptible population. (P)

8. If a food employee is infected with a skin lesion containing pus such as a boil or infected wound that is open or draining and not properly covered as specified under 1200-23-01-.02(2)(a)1.(i)(V), restrict the food employee. (P)

9. If a food employee is exposed to a foodborne pathogen as specified under 1200- 23-01-.02(2)(a)1.(iv) and (v), restrict the food employee who works in a food establishment serving a highly susceptible population. (P)

(c) Removal, Adjustment, or Retention of Exclusions and Restrictions. The person in charge shall adhere to the following conditions when removing, adjusting, or retaining the exclusion or restriction of a food employee:

1. Except when a food employee is diagnosed with an infection from hepatitis A virus or Typhoid Fever:

(i) Reinstate a food employee who was excluded as specified under 1200-23- 01-.02(2)(b)1.(i) if the food employee:

(I) Is asymptomatic for at least 24 hours; (P) or (II) Provides to the person in charge written medical documentation from a health practitioner that states the symptom is from a noninfectious condition. (P)

(ii) If a food employee was diagnosed with an infection from Norovirus and excluded as specified under 1200-23-01-.02(2)(b)1.(ii):

(I) Restrict the food employee, who is asymptomatic for at least 24 hours and works in a food establishment not serving a highly susceptible population, until the conditions for reinstatement as specified under subparts 4.(i) or (ii) of this subparagraph are met; (P) or (II) Retain the exclusion for the food employee, who is asymptomatic for at least 24 hours and works in a food establishment that serves a highly susceptible population, until the conditions for reinstatement as specified under subparts 4.(i) or (ii) of this subparagraph are met.

(P)

(iii) If a food employee was diagnosed with an infection from Shigella spp. and excluded as specified under 1200-23-01-.02(2)(b)1.(ii):

(I) Restrict the food employee, who is asymptomatic for at least 24 hours and works in a food establishment not serving a highly susceptible population, until the conditions for reinstatement as specified under subparts 5.(i) and (ii) of this subparagraph are met;

(P) or (II) Retain the exclusion for the food employee, who is asymptomatic for at least 24 hours and works in a food establishment that serves a highly susceptible population, until the conditions for reinstatement as specified under subparts 5.(i) and (ii), or 5.(i) and (iii) of this subparagraph are met. (P)

(iv) If a food employee was diagnosed with an infection from Enterohemorrhagic or Shiga toxin-producing Escherichia coli and excluded as specified under 1200-23-01-.02(2)(b)1.(ii):

(I) Restrict the food employee, who is asymptomatic for at least 24 hours and works in a food establishment not serving a highly susceptible population, until the conditions for reinstatement as specified under subparts 6.(i) or (ii) of this subparagraph are met; (P) or (II) Retain the exclusion for the food employee, who is asymptomatic for at least 24 hours and works in a food establishment that serves a highly susceptible population, until the conditions for reinstatement as specified under subparts 6.(i) or (ii) are met. (P)

(v) If a food employee was diagnosed with an infection from nontyphoidal Salmonella and excluded as specified under 1200-23-01-.02(2)(b)1.(ii):

(I) Restrict the food employee, who is asymptomatic, for at least 30 days until conditions for reinstatement as specified under subparts 6.(i) or (ii) of this subparagraph are met; (P) or (II) Retain the exclusion for the food employee who is symptomatic, until conditions for reinstatement as specified under subparts 6.(i) or (ii) of this subparagraph are met; (P)

2. Reinstate a food employee who was excluded as specified under 1200-23-01- .02(2)(b)2. if the person in charge obtains approval from the department and one of the following conditions is met;

(i) The food employee has been jaundiced for more than 7 calendar days; (P)

(ii) The anicteric food employee has been symptomatic with symptoms other than jaundice for more than 14 calendar days; (P) or (iii) The food employee provides to the person in charge written medical documentation from a health practitioner stating that the food employee is free of a hepatitis A virus infection. (P)

3. Reinstate a food employee who was excluded as specified under 1200-23-01- .02(2)(b)3. if:

(i) The person in charge obtains approval from the department; (P) and (ii) The food employee provides to the person in charge written medical documentation from a health practitioner that states the food employee is free from S. Typhi infection. (P)

4. Reinstate a food employee who was excluded as specified under 1200-23-01- .02(2)(b)1.(ii) or 4.(i) who was restricted under 1200-23-01-.02(2)(b)4.(ii) if the person in charge obtains approval from the department and one of the following conditions is met:

(i) The excluded or restricted food employee provides to the person in charge written medical documentation from a health practitioner stating that the food employee is free of a Norovirus infection; (P)

(ii) The food employee was excluded or restricted after symptoms of vomiting or diarrhea resolved, and more than 48 hours have passed since the food employee became asymptomatic; (P) or (iii) The food employee was excluded or restricted and did not develop symptoms and more than 48 hours have passed since the food employee was diagnosed. (P)

5. Reinstate a food employee who was excluded as specified under 1200-23-01- .02(2)(b)1.(ii) or 5.(i) or who was restricted under 1200-23-01-.02(2)(b)5.(ii) if the person in charge obtains approval from the department and one of the following conditions is met:

(i) The excluded or restricted food employee provides to the person in charge written medical documentation from a health practitioner stating that the food employee is free of a Shigella spp. infection based on test results showing 2 consecutive negative stool specimen cultures that are taken:

(I) Not earlier than 48 hours after discontinuance of antibiotics, (P) and (II) At least 24 hours apart; (P)

(ii) The food employee was excluded or restricted after symptoms of vomiting or diarrhea resolved, and more than 7 calendar days have passed since the food employee became asymptomatic; (P) or (iii) The food employee was excluded or restricted and did not develop symptoms and more than 7 calendar days have passed since the food employee was diagnosed. (P)

6. Reinstate a food employee who was excluded or restricted as specified under 1200-23-01-.02(2)(b)1.(ii) or 6.(i) or who was restricted under 1200-23-01- .02(2)(b)6.(ii) if the person in charge obtains approval from the department and one of the following conditions is met:

(i) The excluded or restricted food employee provides to the person in charge written medical documentation from a health practitioner stating that the food employee is free of an infection from Enterohemorrhagic or Shiga toxin-producing Escherichia coli based on test results that show 2 consecutive negative stool specimen cultures that are taken:

(I) Not earlier than 48 hours after discontinuance of antibiotics; (P) and (II) At least 24 hours apart; (P)

(ii) The food employee was excluded or restricted after symptoms of vomiting or diarrhea resolved and more than 7 calendar days have passed since the food employee became asymptomatic; (P) or (iii) The food employee was excluded or restricted and did not develop symptoms and more than 7 days have passed since the food employee was diagnosed. (P)

7. Reinstate a food employee who was excluded as specified under 1200-23-01- .02(2)(b) or who was restricted as specified under 1200-23-01-.02(2)(b) if the person in charge receives approval from the department and one of the following conditions is met (i) The excluded or restricted food employee provides to the person in charge written medical documentation from a health practitioner stating that the food employee is free of nontyphoidal Salmonella infection based on test results showing two consecutive negative stool specimen cultures that are taken:

(I) Not earlier than 48 hours after the discontinuance of antibiotics (P); and (II) At least 24 hours apart; (P)

(ii) The food employee was excluded or restricted after symptoms of vomiting or diarrhea resolved and more than 7 calendar days have passed since the food employee became asymptomatic; (P) or (iii) The food employee was excluded or restricted and did not develop symptoms and more than 7 days have passed since the food employee was diagnosed. (P)

8. Reinstate a food employee who was excluded or restricted as specified under 1200-23-01-.02(2)(b)7.(i) or (ii) if the food employee provides to the person in charge written medical documentation from a health practitioner stating that the food employee meets one of the following conditions:

(i) Has received antibiotic therapy for Streptococcus pyogenes infection for more than 24 hours; (P)

(ii) Has at least one negative throat specimen culture for Streptococcus pyogenes infection; (P) or (iii) Is otherwise determined by a health practitioner to be free of a Streptococcus pyogenes infection. (P)

9. Reinstate a food employee who was restricted as specified under 1200-23-01- .02(2)(b)8. if the skin, infected wound, cut, or pustular boil is properly covered with one of the following:

(i) An impermeable cover such as a finger cot or stall and a single-use glove over the impermeable cover if the infected wound or pustular boil is on the hand, finger, or wrist; (P)

(ii) An impermeable cover on the arm if the infected wound or pustular boil is on the arm; (P) or (iii) A dry, durable, tight-fitting bandage if the infected wound or pustular boil is on another part of the body. (P)

10. Reinstate a food employee who was restricted as specified under 1200-23-01- .02(2)(b)9. and was exposed to one of the following pathogens as specified under 1200-23-01-.02(2)(a)1.(iv) or (v):

(i) Norovirus and one of the following conditions is met:

(I) More than 48 hours have passed since the last day the food employee was potentially exposed; (P) or (II) More than 48 hours have passed since the food employee’s household contact became asymptomatic. (P)

(ii) Shigella spp. or Enterohemorrhagic or Shiga toxin-producing Escherichia coli and one of the following conditions are met:

(I) More than 3 calendar days have passed since the last day the food employee was potentially exposed; (P) or (II) More than 3 calendar days have passed since the food employee’s household contact became asymptomatic. (P)

(iii) Typhoid Fever and one of the following conditions are met:

(I) More than 14 calendar days have passed since the last day the food employee was potentially exposed; (P) or (II) More than 14 calendar days have passed since the food employee’s household contact became asymptomatic. (P)

(iv) Hepatitis A virus and one of the following conditions is met:

(I) The food employee is immune to hepatitis A virus infection because of a prior illness from hepatitis A; (P)

(II) The food employee is immune to hepatitis A virus infection because of vaccination against hepatitis A; (P)

(III) The food employee is immune to hepatitis A virus infection because of IgG administration; (P)

(IV) More than 30 calendar days have passed since the last day the food employee was potentially exposed; (P)

(V) More than 30 calendar days have passed since the food employee’s household contact became jaundiced; (P) or (VI) The food employee does not use an alternative procedure that allows bare hand contact with ready-to-eat food until at least 30 days after the potential exposure, as specified in items 9.(iv)(IV) and (V) of this subpart, and the food employee receives additional training about:

I. Hepatitis A symptoms and preventing the transmission of infection, (P)

II. Proper handwashing procedures, (P) and III. Protecting ready-to-eat food from contamination introduced by bare hand contact. (P)

(3) Personal Cleanliness.

(a) Clean Condition. Food employees shall keep their hands and exposed portions of their arms clean. (P)

(b) Cleaning Procedure.

1. Except as specified in 4. of this subparagraph, food employees shall clean their hands and exposed portions of their arms, including surrogate prosthetic devices for hands or arms for at least 20 seconds, using a cleaning compound in a handwashing sink that is equipped as specified under 1200-23-01-.05(2)(b)2. and/or 1200-23-01-.06(3)(a). (P)

2. Food employees shall use the following cleaning procedure in the order stated to clean their hands and exposed portions of their arms, including surrogate prosthetic devices for hands and arms:

(i) Rinse under clean, running warm water; (P)

(ii) Apply an amount of cleaning compound recommended by the cleaning compound manufacturer; (P)

(iii) Rub together vigorously for at least 10 to 15 seconds while:

(I) Paying particular attention to removing soil from underneath the fingernails during the cleaning procedure, (P) and (II) Creating friction on the surfaces of the hands and arms or surrogate prosthetic devices for hands and arms, finger tips, and areas between the fingers; (P)

(iv) Thoroughly rinse under clean, running warm water; (P) and (v) Immediately follow the cleaning procedure with thorough drying using a method as specified under 1200-23-01-.06(3)(a)3. (P)

3. To avoid recontaminating their hands or surrogate prosthetic devices, food employees may use disposable paper towels or similar clean barriers when touching surfaces such as manually operated faucet handles on a handwashing sink or the handle of a restroom door.

4. If approved and capable of removing the types of soils encountered in the food operations involved, an automatic handwashing facility may be used by food employees to clean their hands or surrogate prosthetic devices.

(c) When to Wash. Food employees shall clean their hands and exposed portions of their arms as specified under 1200-23-01-.02(3)(b) immediately before engaging in food preparation including working with exposed food, clean equipment and utensils, and unwrapped single-service and single-use articles (P) and:

1. After touching bare human body parts other than clean hands and clean, exposed portions of arms; (P)

2. After using the toilet room; (P)

3. After caring for or handling service animals or aquatic animals as specified in 1200-23-01-.02(4)(d)2.; (P)

4. Except as specified in 1200-23-01-.02(4)(a)2., after coughing, sneezing, using a handkerchief or disposable tissue, using tobacco, eating, or drinking; (P)

5. After handling soiled equipment or utensils; (P)

6. During food preparation, as often as necessary to remove soil and contamination and to prevent cross contamination when changing tasks; (P)

7. When switching between working with raw food and working with ready-to-eat food; (P)

8. Before donning gloves for working with food; (P) and 9. After engaging in other activities that contaminate the hands. (P)

(d) Where to Wash. Food employees shall clean their hands in a handwashing sink or approved automatic handwashing facility and may not clean their hands in a sink used for food preparation or warewashing, or in a service sink or a curbed cleaning facility used for the disposal of mop water and similar liquid waste. (Pf)

(e) Hand Antiseptics.

1. A hand antiseptic used as a topical application, a hand antiseptic solution used as a hand dip, or a hand antiseptic soap shall:

(i) Comply with one of the following:

(I) Be an approved drug that is listed in the FDA publication Approved Drug Products with Therapeutic Equivalence Evaluations as an approved drug based on safety and effectiveness; (Pf) or (II) Have active antimicrobial ingredients that are listed in the FDA monograph for OTC Health-Care Antiseptic Drug Products as an antiseptic handwash, (Pf) and (ii) Comply with one of the following:

(I) Have components that are exempted from the requirement of being listed in federal food additive regulations as specified in 21 CFR § 170.39 - Threshold of regulation for substances used in food-contact articles; (Pf) or (II) Comply with and be listed in:

I. 21 CFR Part 178 - Indirect Food Additives: Adjuvants, Production Aids, and Sanitizers as regulated for use as a food additive with conditions of safe use, (Pf) or II. 21 CFR Part 182 - Substances Generally Recognized as Safe, 21 CFR Part 184 - Direct Food Substances Affirmed as Generally Recognized as Safe, or 21 CFR Part 186 - Indirect Food Substances Affirmed as Generally Recognized as Safe for use in contact with food, (Pf) and III. Be applied only to hands that are cleaned as specified under 1200-23-01-.02(3)(b). (Pf)

2. If a hand antiseptic or a hand antiseptic solution used as a hand dip does not meet the criteria specified under (e)1.(ii) of this paragraph, use shall be:

(i) Followed by thorough hand rinsing in clean water before hand contact with food or by the use of gloves; (Pf) or (ii) Limited to situations that involve no direct contact with food by the bare hands.

3. A hand antiseptic solution used as a hand dip shall be maintained clean and at a strength equivalent to at least 100 mg/L chlorine. (Pf)

(f) Maintenance.

1. Food employees shall keep their fingernails trimmed, filed, and maintained so the edges and surfaces are cleanable and not rough. (Pf)

2. Unless wearing intact gloves in good repair, a food employee may not wear fingernail polish or artificial fingernails when working with exposed food. (Pf)

(g) Prohibition. Except for a plain ring such as a wedding band, while preparing food, food employees may not wear jewelry including medical information jewelry on their arms and hands.

(h) Clean Condition. Food employees shall wear clean outer clothing to prevent contamination of food, equipment, utensils, linens, and single-service and single-use articles.

(4) Hygienic Practices.

(a) Eating, Drinking, or Using Tobacco.

1. Except as specified in part 2. of this subparagraph, an employee shall eat, drink, or use any form of tobacco only in designated areas where the contamination of exposed food; clean equipment, utensils, and linens; unwrapped single-service and single-use articles; or other items needing protection cannot result.

2. A food employee may drink from a closed beverage container if the container is handled to prevent contamination of:

(i) The employee’s hands;

(ii) The container; and (iii) Exposed food; clean equipment, utensils, and linens; and unwrapped single-service and single-use articles.

(b) Discharges from the Eyes, Nose, and Mouth. Food employees experiencing persistent sneezing, coughing, or a runny nose that causes discharges from the eyes, nose, or mouth may not work with exposed food; clean equipment, utensils, and linens; or unwrapped single-service or single-use articles.

(c) Effectiveness.

1. Except as provided in part 2. of this subparagraph, food employees shall wear hair restraints such as hats, hair coverings or nets, beard restraints, and clothing that covers body hair, that are designed and worn to effectively keep their hair from contacting exposed food; clean equipment, utensils, and linens; and unwrapped single-service and single-use articles.

2. This subparagraph does not apply to food employees such as counter staff who only serve beverages and wrapped or packaged foods, hostesses, and wait staff if they present a minimal risk of contaminating exposed food; clean equipment, utensils, and linens; and unwrapped single-service and single-use articles.

(d) Handling Prohibition.

1. Except as specified in part 2. of this subparagraph, food employees may not care for or handle animals that may be present such as patrol dogs, service animals, or pets that are allowed as specified in subparts 1200-23-01-.06(5)(o)2.(i) –(v).

(Pf)

2. Food employees with service animals may handle or care for their service animals and food employees may handle or care for fish in aquariums or molluscan shellfish or crustacean in display tanks if they wash their hands as specified under 1200-23-01-.02(3)(b) and 1200-23-01-.02(3)(c)3.

(5) Responding to Contamination Events.

(a) Clean-up of vomiting and diarrheal events.

1. A food service establishment shall have written procedures for employees to follow when responding to vomiting or diarrheal events that involve the discharge of vomitus or fecal matter onto surfaces in the food service establishment. The procedures shall address the specific actions employees must take to minimize the spread of contamination and the exposure of employees, consumers, food, and surfaces to vomitus and fecal matter.

History

• Authority: T.C.A. §§ 68-14-701 through 68-14-729.
• Administrative History: Original rule filed March 26, 1987; effective May 9, 1987. Repeal and new rule filed August 24, 2000; effective November 7, 2000. Amendment filed October 22, 2004; effective January 5, 2005. Repeal and new rule filed April 17, 2015; effective July 16, 2015. Amendments filed March 16, 2026; effective June 14, 2026.

Tenn. Comp. R. & Regs. 1200-23-01-.03 FOOD

(1) Condition - Safe, Unadulterated, and Honestly Presented. Food shall be safe, unadulterated, and, as specified under 1200-23-01-.03(6)(a)2., honestly presented. (P)

(2) Sources, Specifications and Original Containers and Records (a) Sources 1. Compliance with Food Law.

(i) Food shall be obtained from sources that comply with law. (P)

(ii) Food from an Unlicensed Home Facility. Food from an unlicensed home facility shall not be served in a food establishment.

(iii) Packaged food shall be labeled as specified in law, including 21 CFR Part 101 Food Labeling, 9 CFR Part 317 Labeling, Marking Devices, and Containers, and 9 CFR Part 381 subpart N Labeling and Containers, and as specified under 1200-23-01-.03(2)(b)7. and 8. (Pf)

(iv) Fish, other than those specified in subpart 1200-23-01-.03(4)(a)1.(iv), that are intended for consumption in raw or undercooked form and allowed as specified in 1200-23-01-.03(4)(a)1.(ii)–(iv), may be offered for sale or service if they are obtained from a supplier that freezes the fish as specified under 1200-23-01-.03(4)(b); or if they are frozen on the premises as specified under 1200-23-01-.03(4)(b) and records are retained as specified under 1200-23-01-.03(4)(b)2.

(v) Whole-muscle, intact beef steaks that are intended for consumption in an undercooked form without a consumer advisory as specified in 1200-23- 01-.03(4)(a)1.(iii) shall be:

(I) Obtained from a food processing plant that, does not mechanically tenderize, vacuum tumble with solutions, reconstruct, cube or pound these whole-muscle, intact beef steaks; (PF) or (II) Deemed acceptable by the department based on other evidence, such as written buyer specifications or invoices, that indicates that the steaks meet the definition of whole-muscle, intact beef; (Pf) and (III) If individually cut in a food establishment:

I. Cut from whole-muscle, intact beef that is received from a food processing plant as specified in item (v)(I) or identified as specified in item (v)(II). (Pf)

II. Prepared so they remain intact. (Pf)

(vi) Meat and poultry that is not a ready-to-eat food and is in a packaged form when it is offered for sale or otherwise offered for consumption, shall be labeled to include safe handling instructions as specified in law, including 9 CFR § 317.2(l) and 9 CFR § 381.125(b).

(vii) Eggs that have not been specifically treated to destroy all viable salmonellae shall be labeled to include safe handling instructions as specified in law, including 21 CFR § 101.17(h).

2. Food in a Hermetically Sealed Container. Food in a hermetically sealed container shall be obtained from a food processing plant that is regulated by the food regulatory agency that has jurisdiction over the plant. (P)

3. Fluid Milk and Milk Products. Fluid milk and milk products shall be obtained from sources that comply with Grade A standards as specified in law. (P)

4. Fish.

(i) Fish that are received for sale or service shall be: (P)

(I) Commercially and legally caught or harvested; (P) or (II) Approved for sale or service. (P)

(ii) Molluscan shellfish that are recreationally caught may not be received for sale or service. (P)

5. Molluscan Shellfish.

(i) Molluscan shellfish shall be obtained from sources according to law and the requirements specified in the U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration, National Shellfish Sanitation Program Guide for the Control of Molluscan Shellfish.

(P)

(ii). Molluscan shellfish received in interstate commerce shall be from sources that are listed in the Interstate Certified Shellfish Shippers List. (P)

6. Wild Mushrooms.

(i) Except as specified in subpart (ii) of this part, mushroom species picked in the wild shall be obtained from sources where each mushroom is individually inspected and found to be safe by an approved mushroom identification expert. (P)

(ii) This section does not apply to:

(I) Cultivated wild mushroom species that are grown, harvested, and processed in an operation that is regulated by the food regulatory agency that has jurisdiction over the operation; or (II) Wild mushroom species if they are in packaged form and are the product of a food processing plant that is regulated by the food regulatory agency that has jurisdiction over the plant.

7. Game Animals.

(i) If game animals are received for sale or service they shall be:

(I) Commercially raised for food (P) and:

I. Raised, slaughtered, and processed under a voluntary inspection program that is conducted by the agency that has animal health jurisdiction, (P) or II. Under a routine inspection program conducted by a regulatory agency other than the agency that has animal health jurisdiction, (P) and III. Raised, slaughtered, and processed according to:

A. Laws governing meat and poultry as determined by the agency that has animal health jurisdiction and the agency that conducts the inspection program, (P) and B. Requirements which are developed by the agency that has animal health jurisdiction and the agency that conducts the inspection program with consideration of factors such as the need for antemortem and postmortem examination by an approved veterinarian or veterinarian’s designee; (P)

(II) Under a voluntary inspection program administered by the USDA for game animals such as exotic animals (reindeer, elk, deer, antelope, water buffalo, or bison) that are “inspected and approved” in accordance with 9 CFR Part 352 Exotic animals; voluntary inspection of rabbits that are “inspected and certified” in accordance with 9 CFR Part 354 Voluntary inspection of rabbits and edible products thereof; (P)

(III) As allowed by law, for wild game animals that are live-caught:

I. Under a routine inspection program conducted by a regulatory agency such as the agency that has animal health jurisdiction, (P) and II. Slaughtered and processed according to:

A. Laws governing meat and poultry as determined by the agency that has animal health jurisdiction and the agency that conducts the inspection program, (P) and B. Requirements which are developed by the agency that has animal health jurisdiction and the agency that conducts the inspection program with consideration of factors such as the need for antemortem and postmortem examination by an approved veterinarian or veterinarian’s designee; (P) or (IV) As allowed by law, for field-dressed wild game animals under a routine inspection program that ensures the animals:

I. Receive a postmortem examination by an approved veterinarian or veterinarian’s designee, (P) or II. Are field-dressed and transported according to requirements specified by the agency that has animal health jurisdiction and the agency that conducts the inspection program, (P) and III. Are processed according to laws governing meat and poultry as determined by the agency that has animal health jurisdiction and the agency that conducts the inspection program. (P)

(ii) A game animal may not be received for sale or service if it is a species of wildlife that is listed in 50 CFR Part 17 Endangered and threatened wildlife and plants.

(b) Specifications for Receiving 1. Temperature.

(i) Except as specified in subpart 1.(ii) of this subparagraph, refrigerated, time/temperature control for safety food shall be at a temperature of 5°C (41°F) or below when received. (P)

(ii) If a temperature other than 5°C (41°F) for a time/temperature control for safety food is specified in law governing its distribution, such as laws governing milk and molluscan shellfish, the food may be received at the specified temperature.

(iii) Raw eggs shall be received in refrigerated equipment that maintains an ambient air temperature of 5°C (41°F) or less. (P)

(iv) Time/temperature control for safety food that is cooked to a temperature and for a time specified under 1200-23-01-.03(6)(a)1.–3. and received hot shall be at a temperature of 57°C (135°F) or above. (P)

(v) A food that is labeled frozen and shipped frozen by a food processing plant shall be received frozen. (Pf)

(vi) Upon receipt, time/temperature control for safety food shall be free of evidence of previous temperature abuse. (Pf)

2. Additives. Food may not contain unapproved food additives or additives that exceed amounts specified in 21 CFR Parts 170-180 relating to food additives, generally recognized as safe or prior sanctioned substances that exceed amounts specified in 21 CFR Parts 181-186, substances that exceed amounts specified in 9 CFR Subpart C § 424.21(b) Food ingredients and sources of radiation, or pesticide residues that exceed provisions specified in 40 CFR Part 180 Tolerances and exemptions for pesticide chemical residues in food. (P)

3. Eggs. Eggs shall be received clean and sound and may not exceed the restricted Egg tolerances for U.S. Consumer Grade B as specified in United States Standards, Grades, and Weight Classes for Shell Eggs, AMS 56.200 et seq., administered by the Agricultural Marketing Service of USDA. (P)

4. Eggs and Milk Products, Pasteurized.

(i) Egg Products shall be obtained pasteurized. (P)

(ii) Fluid and dry milk and milk products shall:

(I) Be obtained pasteurized; (P) and (II) Comply with Grade A standards as specified in law. (P)

(iii) Frozen milk products, such as ice cream, shall be obtained pasteurized as specified in 21 CFR Part 135 - Frozen desserts. (P)

(iv) Cheese shall be obtained pasteurized unless alternative procedures to pasteurization are specified in the CFR, such as 21 CFR Part 133 - Cheeses and related cheese products, for curing certain cheese varieties.

(P)

5. Package Integrity. Food packages shall be in good condition and protect the integrity of the contents so that the Food is not exposed to adulteration or potential contaminants. (Pf)

6. Ice. Ice for use as a food or a cooling medium shall be made from drinking water.

(P)

7. Shucked Shellfish, Packaging and Identification.

(i) Raw shucked shellfish shall be obtained in nonreturnable packages which bear a legible label that identifies the: (Pf)

(I) Name, address, and certification number of the shucker, packer or re-packer of the molluscan shellfish; (Pf) and (II) The “sell by” or “best if used by” date for packages with a capacity of less than 1.89 L (one-half gallon) or the date shucked for packages with a capacity of 1.89 L (one-half gallon) or more. (Pf)

(ii) A package of raw shucked shellfish that does not bear a label or which bears a label which does not contain all the information as specified under

subpart 7.(i) of this subparagraph shall be subject to a hold order, as allowed by law, or seizure and destruction in accordance with 21 CFR

Subpart D § 1240.60(d) - Specific Administrative Decisions Regarding Interstate Shipments, Molluscan shellfish.

8. Shellstock Identification.

(i) Shellstock shall be obtained in containers bearing legible source identification tags or labels that are affixed by the harvester or dealer that depurates, ships, or reships the shellstock, as specified in the National Shellfish Sanitation Program Guide for the Control of Molluscan Shellfish, and that list: (Pf)

(I) Except as specified under subitem (III) of this item, on the harvester’s tag or label, the following information in the following order: (Pf)

I. The harvester’s identification number that is assigned by the shellfish control authority, (Pf)

II. The date of harvesting, (Pf)

III. The most precise identification of the harvest location or aquaculture site that is practicable based on the system of harvest area designations that is in use by the shellfish control

authority and including the abbreviation of the name of the state or country in which the shellfish are harvested, (Pf)

IV. The type and quantity of shellfish, (Pf) and V. The following statement in bold, capitalized type: “This tag is required to be attached until container is empty or retagged and thereafter kept on file for 90 days”; (Pf) and (II) Except as specified in subpart (iv) of this part, on each dealer’s tag or label, the following information in the following order: (Pf)

I. The dealer’s name and address, and the certification numbers assigned by the shellfish control authority, (Pf)

II. The original shipper’s certification number including the abbreviation of the name of the state or country in which the shellfish are harvested, (Pf)

III. The same information as specified for a harvester’s tag under subitems (i)(I)II.–IV. of this subpart, (Pf) and IV. The following statement in bold, capitalized type: “This tag is required to be attached until container is empty and thereafter kept on file for 90 days.” (Pf)

(ii) A container of shellstock that does not bear a tag or label or that bears a tag or label that does not contain all the information as specified under

subpart (i) of this part shall be subject to a hold order, as allowed by law, or seizure and destruction in accordance with 21 CFR Subpart D § 1240.60(d) Specific Administrative Decisions Regarding Interstate Shipments.

(iii) If a place is provided on the harvester’s tag or label for a dealer’s name, address, and certification number, the dealer’s information shall be listed first.

(iv) If the harvester’s tag or label is designed to accommodate each dealer’s identification as specified under items (i)(I) and (II) of this part, individual dealer tags or labels need not be provided.

9. Shellstock, Condition: When received by a food establishment, shellstock shall be reasonably free of mud, dead shellfish, and shellfish with broken shells. Dead shellfish or shellstock with badly broken shells shall be discarded.

10. Juice - Commercially Processed: Pre-packaged juice shall:

(i) Be obtained from a processor with a HACCP system as specified in 21 CFR Part 120 Hazard Analysis and Critical Control (HACCP) Systems; (Pf) and (ii) Be obtained pasteurized or otherwise treated to attain a 5 log reduction of the most resistant microorganism of public health significance as specified in 21 CFR § 120.24 Process Controls. (P)

(c) Original Containers and Records 1. Molluscan Shellfish, Original Container.

(i) Except as specified in (ii)–(iv) of this part, molluscan shellfish may not be removed from the container in which they are received other than immediately before sale or preparation for service.

(ii) For display purposes, shellstock may be removed from the container in which they are received, displayed on drained ice, or held in a display container, and a quantity specified by a consumer may be removed from the display or display container and provided to the consumer if:

(I) The source of the shellstock on display is identified as specified under 1200-23-01-.03(2)(b)8. and recorded as specified under 1200- 23-01-.03(2)(c)1.(v)(II); and (II) The shellstock are protected from contamination.

(iii) Shucked shellfish may be removed from the container in which they were received and held in a display container from which individual servings are dispensed upon a consumer’s request if:

(I) The labeling information for the shellfish on display as specified under 1200-23-01-.03(2)(b)8. is retained and correlated to the date when, or dates during which, the shellfish are sold or served; and (II) The shellfish are protected from contamination.

(iv) Shucked shellfish may be removed from the container in which they were received and repacked in consumer self-service containers where allowed by law if:

(I) The labeling information for the shellfish is on each consumer selfservice container as specified under 1200-23-01-.03(2)(b)7. and 1200-23-01-.03(6)(b)1. and 2.(i)–(v);

I. The labeling information as specified under 1200-23-01- .03(2)(b)7. is retained and correlated with the date when, or dates during which, the shellfish are sold or served;

II. The labeling information and dates specified under (v)(II) of this part are maintained for 90 days; and III. The shellfish are protected from contamination.

(v) Shellstock, Maintaining Identification.

(I) Except as specified under subitem (III)II. of this subpart, shellstock tags or labels shall remain attached to the container in which the shellstock are received until the container is empty. (Pf)

(II) The date when the last shellstock from the container is sold or served shall be recorded on the tag or label. (Pf)

(III) The identity of the source of shellstock that are sold or served shall be maintained by retaining shellstock tags or labels for 90 calendar days from the date that is recorded on the tag or label, as specified under (II) of this subpart, by: (Pf)

I. Using an approved record keeping system that keeps the tags or labels in chronological order correlated to the date that is recorded on the tag or label, as specified under item (II) of this

subpart; (Pf) and II. If shellstock are removed from its tagged or labeled container:

A. Preserving source identification by using a record keeping system as specified under subpart 1.(ii) of this

part, (Pf) and B. Ensuring that shellstock from one tagged or labeled container are not commingled with shellstock from another container with different certification numbers; different harvest dates; or different growing areas as identified on the tag or label before being ordered by the consumer. (Pf)

(d) Food Donation 1. Food stored, prepared, packaged, displayed, and labeled in accordance to Law and this Chapter may be offered for donation.

(3) Protection from Contamination after Receiving (a) Preventing Contamination by Employees 1. Preventing Contamination from Hands.

(i) Food employees shall wash their hands as specified under 1200-23-01- .02(3)(b).

(ii) Except when washing fruits and vegetables as specified under 1200-23- 01-.03(3)(b)5. or as specified in (v) of this part, food employees may not contact exposed, ready-to-eat food with their bare hands and shall use suitable utensils such as deli tissue, spatulas, tongs, single-use gloves, or dispensing equipment. (P)

(iii) Food employees shall minimize bare hand and arm contact with exposed food that is not in a ready-to-eat form. (Pf)

(iv) Subpart (ii) of this section does not apply to a food employee that contacts exposed, ready-to-eat food with bare hands at the time the ready-to-eat food is being added as an ingredient to a food that:

(I) Contains a raw animal food and is to be cooked in the food establishment to heat all parts of the food to the minimum temperatures specified in .03(4)(a)1.; or (II) Does not contain a raw animal food but is to be cooked in the food establishment to heat all parts of the food to a temperature of at least 63°C (145°F).

(v) Food employees not serving a highly susceptible population may contact exposed, ready-to-eat food with their bare hands if:

(I) The permit holder obtains prior approval from the department;

(II) Written procedures are maintained in the food establishment and made available to the department upon request that include:

I. For each bare hand contact procedure, a listing of the specific ready-to-eat foods that are touched by bare hands, II. Diagrams and other information showing that handwashing facilities, installed, located, equipped, and maintained as specified under 1200-23-01-.05(2)(c)1., 1200-23-01- .05(2)(d)1., 1200-23-01-.05(2)(e)1., 1200-23-01-.06(3)(a)1., 1200-23-01-.06(3)(a)3., and 1200-23-01-.06(3)(a)5., are in an easily accessible location and in close proximity to the work station where the bare hand contact procedure is conducted;

(III) A written employee health policy that details how the food establishment complies with 1200-23-01-.02(2)(a), (b), and (c) including:

I. Documentation that food employees and conditional employees acknowledge that they are informed to report information about their health and activities as they relate to gastrointestinal symptoms and diseases that are transmittable through food as specified under 1200-23-01-.02(2)(a)1;

II. Documentation that food employees and conditional employees acknowledge their responsibilities as specified under 1200-23-01-.02(2)(a)4. and 5.; and III. Documentation that the person in charge acknowledges the responsibilities as specified under 1200-23-01-.02(2)(a)2., 3., and 4., and 1200-23-01-.02(2)(b) and 1200-23-01-.02(2)(c);

(IV) Documentation that food employees acknowledge that they have received training in:

I. The risks of contacting the specific ready-to-eat foods with bare hands, II. Proper handwashing as specified under 1200-23-01-.02(3)(b), III. When to wash their hands as specified under 1200-23-01- .02(3)(c), IV. Where to wash their hands as specified under 1200-23-01- .02(3)(d), V. Proper fingernail maintenance as specified under 1200-23-01- .02(3)(f), VI. Prohibition of jewelry as specified under 1200-23-01-.02(3)(g), and VII. Good hygienic practices as specified under 1200-23-01- .02(4)(a) and 1200-23-01-.02(4)(b);

(V) Documentation that hands are washed before food preparation and as necessary to prevent cross contamination by food employees as specified under 1200-23-01-.02(3)(a), 1200-23-01-.02(3)(b), 1200- 23-01-.02(3)(c), and 1200-23-01-.02(3)(d) during all hours of operation when the specific ready-to-eat foods are prepared;

(VI) Documentation that food employees contacting ready-to-eat food with bare hands use two or more of the following control measures to provide additional safeguards to hazards associated with bare hand contact:

I. Double handwashing, II. Nail brushes, III. A hand antiseptic after handwashing as specified under 1200- 23-01-.02(3)(e), IV. Incentive programs such as paid sick leave that assist or encourage food employees not to work when they are ill, or V. Other control measures approved by the department; and VI. Documentation that corrective action is taken when items (I) – (VI) of this subpart are not followed.

2. Preventing Contamination When Tasting. A food employee may not use a utensil more than once to taste food that is to be sold or served. (P)

(b) Preventing Food and Ingredient Contamination 1. Packaged and Unpackaged Food - Separation, Packaging and Segregation.

(i) Food shall be protected from cross contamination by:

(I) Except as specified in subitem III. below, separating raw animal foods during storage, preparation, holding, and display from:

I. Raw ready-to-eat including other raw animal food such as fish for sushi or molluscan shellfish, or other raw ready-to-eat food such as fruits and vegetables, (P) and II. Cooked ready-to-eat food; (P)

III. Fruits and vegetables before they are washed; (P)

IV. Frozen, commercially processed and packaged raw animal food may be stored or displayed with or above frozen, commercially processed and packaged, ready-to-eat food.

(II) Except when combined as ingredients, separating types of raw animal foods from each other such as beef, fish, lamb, pork, and poultry during storage, preparation, holding, and display by:

I. Using separate equipment for each type, (P) or II. Arranging each type of food in equipment so that cross contamination of one type with another is prevented, (P) and III. Preparing each type of food at different times or in separate areas;

(III) Cleaning equipment and utensils as specified under 1200-23-01- .04(6)(b)1.(i) and sanitizing as specified under 1200-23-01-.04(7)(c);

(IV) Except as specified under 1200-23-01-.03(5)(a)5.(ii)(II) and in part 2. of this subparagraph, storing the food in packages, covered containers, or wrappings;

(V) Cleaning hermetically sealed containers of food of visible soil before opening;

(VI) Protecting food containers that are received packaged together in a case or overwrap from cuts when the case or overwrap is opened;

(VII) Storing damaged, spoiled, or recalled food being held in the food establishment as specified under 1200-23-01-.06(4)(d); and (VIII) Separating fruits and vegetables, before they are washed, as specified under 1200-23-01-.03(5) from ready-to-eat foods.

(ii) Item (i)(IV) does not apply to:

(I) Whole, uncut, raw fruits and vegetables and nuts in the shell, that require peeling or hulling before consumption;

(II) Primal cuts, quarters, or sides of raw meat or slab bacon that are hung on clean, sanitized hooks or placed on clean, sanitized racks;

(III) Whole, uncut, processed meats such as country hams, and smoked or cured sausages that are placed on clean, sanitized racks;

(IV) Food being cooled as specified under 1200-23-01-.03(5)(a)5.(ii)(II); or (V) Shellstock.

2. Food Storage Containers, Identified with Common Name of Food. Except for containers holding food that can be readily and unmistakably recognized such as dry pasta, working containers holding food or food ingredients that are removed from their original packages for use in the food establishment, such as cooking oils, flour, herbs, potato flakes, salt, spices, and sugar shall be identified with the common name of the food.

3. Pasteurized Eggs, Substitute for Raw Eggs for Certain Recipes: Pasteurized eggs or egg product shall be substituted for raw eggs in the preparation of foods such as Caesar salad, hollandaise or Béarnaise sauce, mayonnaise, meringue, eggnog, ice cream, and egg-fortified beverages that are not:

(i) Cooked as specified under 1200-23-01-.03(4)(a)1.(i)(I) or (II); (P) or (ii) Included in 1200-23-01-.03(4)(a)1.(iv). (P)

4. Protection from Unapproved Additives.

(i) Food shall be protected from contamination that may result from the addition of, as specified in 1200-23-01-.03(2)(b)2.:

(I) Unsafe or unapproved food or color additives; (P) and (II) Unsafe or unapproved levels of approved and color additives. (P)

(ii) A food employee may not:

(I) Apply sulfiting agents to fresh fruits and vegetables intended for raw consumption or to a food considered to be a good source of vitamin B1; (P) or (II) Except for grapes, serve or sell food specified under (i) of this part that is treated with sulfiting agents before receipt by the food establishment. (P)

5. Washing Fruits and Vegetables.

(i) Except as specified in subpart (ii) of this part and except for whole, raw fruits and vegetables that are intended for washing by the consumer before consumption, raw fruits and vegetables shall be thoroughly washed in water to remove soil and other contaminants before being cut, combined with other ingredients, cooked, served, or offered for human consumption in ready-to-eat form.

(ii) Fruits and vegetables may be washed by using chemicals as specified under 1200-23-01-.07(2)(d)2. and a test kit or other device that accurately measure the active ingredient concentration of the fruit and vegetable wash solution may be provided.

(iii) Devices used for on-site generation of chemicals meet the requirements specified in 21 CFR 173.315. Chemicals used in the washing or to assist in the peeling of fruits and vegetables, for the washing of raw, whole fruits and vegetables shall be used in accordance with the manufacturer’s instructions (Pf).

(c) Preventing Contamination from Ice Used as Coolant 1. Ice Used as Exterior Coolant, Prohibited as Ingredient. After use as a medium for cooling the exterior surfaces of food such as melons or fish, packaged foods such as canned beverages, or cooling coils and tubes of equipment, ice may not be used as food. (P)

2. Storage or Display of Food in Contact with Water or Ice.

(i) Packaged food may not be stored in direct contact with ice or water if the food is subject to the entry of water because of the nature of its packaging, wrapping, or container or its positioning in the ice or water.

(ii) Except as specified in subparts (iii) and (iv) of this part, unpackaged food may not be stored in direct contact with undrained ice.

(iii) Whole, raw fruits or vegetables; cut, raw vegetables such as celery or carrot sticks or cut potatoes; and tofu may be immersed in ice or water.

(iv) Raw poultry and raw fish that are received immersed in ice in shipping containers may remain in that condition while in storage awaiting preparation, display, service, or sale.

(d) Preventing Contamination from Equipment, Utensils and Linens 1. Food Contact with Equipment and Utensils. Food shall only contact:

(i) Equipment and utensils that are cleaned as specified under 1200-23-01- .04(6) of this Chapter and sanitized as specified under 1200-23-01-.04(7) of this Chapter; (P) or (ii) Single-service and single-use articles. (P)

(iii) Linens, such as cloth napkins, as specified under 1200-23-01-.03(3)(d)3. that are laundered as specified under 1200-23-01-.04(8)(b) of this Chapter.

2. In-Use Utensils, Between-Use Storage. During pauses in food preparation or dispensing, food preparation and dispensing utensils shall be stored:

(i) Except as specified under subpart (ii) of this part, in the food with their handles above the top of the food and the container;

(ii) In food that is not time/temperature control for safety food with their handles above the top of the food within containers or equipment that can be closed, such as bins of sugar, flour, or cinnamon;

(iii) On a clean portion of the food preparation table or cooking equipment only if the in-use utensil and the food-contact surface of the food preparation table or cooking equipment are cleaned and sanitized at a frequency specified under 1200-23-01-.04(6)(b) and 1200-23-01-.04(7)(b);

(iv) In running water of sufficient velocity to flush particulates to the drain, if used with moist food such as ice cream or mashed potatoes;

(v) In a clean, protected location if the utensils, such as ice scoops, are used only with a food that is not time/temperature control for safety food; or (vi) In a container of water if the water is maintained at a temperature of at least 57°C (135°F) and the container is cleaned at a frequency specified under 1200-23-01-.04(6)(b)1.(iv)(VII).

3. Linens and Cloth Napkins, Use Limitation. Linens and cloth napkins may not be used in contact with food unless they are used to line a container for the service of foods and the linens and napkins are replaced each time the container is refilled for a new consumer.

4. Wiping Cloths, Use Limitation.

(i) Cloths in-use for wiping food spills from tableware and carry-out containers that occur as food is being served shall be:

(I) Maintained dry; and (II) Used for no other purpose.

(ii) Cloths in-use for wiping counters and other equipment surfaces shall be:

(I) Held between uses in a chemical sanitizer solution at a concentration specified under 1200-23-01-.04(5)(a)14.; and (II) Laundered daily as specified under 1200-23-01-.04(8)(b)4.

(iii) Cloths in-use for wiping surfaces in contact with raw animal foods shall be kept separate from cloths used for other purposes.

(iv) Dry wiping cloths and the chemical sanitizing solutions specified in item (ii)(I) of this part in which wet wiping cloths are held between uses shall be free of food debris and visible soil.

(v) Containers of chemical sanitizing solutions specified in item (ii)(I) of this

part in which wet wiping cloths are held between uses shall be stored off the floor and used in a manner that prevents contamination of food, equipment, utensils, linens, single-service, or single-use articles.

(vi) Single-use disposable sanitizer wipes shall be used in accordance with EPA-approved manufacturer’s label use instructions.

5. Gloves, Use Limitation.

(i) If used, single-use gloves shall be used for only one task such as working with ready-to-eat or with raw animal food, used for no other purpose, and discarded when damaged or soiled, or when interruptions occur in the operation. (P)

(ii) Except as specified in subpart (iii) of this part, slash-resistant gloves that are used to protect the hands during operations requiring cutting shall be used in direct contact only with food that is subsequently cooked as specified under 1200-23-01-.03(4)(a)–(b) such as frozen food or a primal cut of meat.

(iii) Slash-resistant gloves may be used with ready-to-eat food that will not be subsequently cooked if the slash-resistant gloves have a smooth, durable, and nonabsorbent outer surface; or if the slash-resistant gloves are covered with a smooth, durable, nonabsorbent glove, or a single-use glove.

(iv) Cloth gloves may not be used in direct contact with food unless the food is subsequently cooked as required under 1200-23-01-.03(4)(a)–(b) such as frozen food or a primal cut of meat.

6. Using Clean Tableware for Second Portions and Refills.

(i) Except for refilling a consumer’s drinking cup or container without contact between the pouring utensil and the lip-contact area of the drinking cup or container, food employees may not use tableware, including single-service articles, soiled by the consumer, to provide second portions or refills.

(ii) Except as specified in (iii) of this part, self-service consumers may not be allowed to use soiled tableware, including single-service articles, to obtain additional food from the display and serving equipment.

(iii) Drinking cups and containers may be reused by self-service consumers if refilling is a contamination-free process as specified under 1200-23-01- .04(2)(d)3.(i), (ii) and (iv).

7. Refilling Returnables.

(i) A take-home food container returned to a food establishment may not be refilled at a food establishment with a time/temperature control for safety food.

(ii) Except as specified in subpart (iii) of this subpart, a take-home food container refilled with food that is not time/temperature control for safety food shall be cleaned as specified under 1200-23-01-.04(6)(c)7.(ii).

(iii) Personal take-out beverage containers, such as thermally insulated bottles, nonspill coffee cups, and promotional beverage glasses, may be refilled by employees or the consumer if refilling is a contamination-free process as specified under 1200-23-01-.04(2)(d)3.(i), (ii) and (iv).

(e) Preventing Contamination from the Premises 1. Food Storage.

(i) Except as specified in subparts (ii) and (iii) of this part, food shall be protected from contamination by storing the food:

(I) In a clean, dry location;

(II) Where it is not exposed to splash, dust, or other contamination; and (III) At least 15 cm (6 inches) above the floor.

(ii) Food in packages and working containers may be stored less than 15 cm (6 inches) above the floor on case lot handling equipment as specified under 1200-23-01-.04(9)(c)1.(iv).

(iii) Pressurized beverage containers, cased food in waterproof containers such as bottles or cans, and milk containers in plastic crates may be stored on a floor that is clean and not exposed to floor moisture.

2. Food Storage, Prohibited Areas. Food may not be stored:

(i) In locker rooms;

(ii) In toilet rooms; (Pf)

(iii) In dressing rooms;

(iv) In garbage rooms;

(v) In mechanical rooms;

(vi) Under sewer lines that are not shielded to intercept potential drips;

(vii) Under leaking water lines, including leaking automatic fire sprinkler heads, or under lines on which water has condensed;

(viii) Under open stairwells; or (ix) Under other sources of contamination.

3. Food Preparation. During preparation, unpackaged food shall be protected from environmental sources of contamination.

(f) Preventing Contamination by Consumers 1. Food Display. Except for nuts in the shell and whole, raw fruits and vegetables that are intended for hulling, peeling, or washing by the consumer before consumption, food on display shall be protected from contamination by the use of packaging; counter, service line, or salad bar food guards; display cases; or other effective means. (P)

2. Condiments, Protection. Condiments shall be protected from contamination by being kept in dispensers that are designed to provide protection, protected food displays provided with the proper utensils, original containers designed for dispensing, or individual packages or portions.

3. Consumer Self-Service Operations.

(i) Raw, unpackaged animal food, such as beef, lamb, pork, poultry, and fish may not be offered for consumer self-service. This paragraph does not apply to:

(I) Consumer self-service of ready-to-eat foods at buffets or salad bars that serve foods such as sushi or raw shellfish;

(II) Ready-to-cook individual portions for immediate cooking and consumption on the premises such as consumer-cooked meats or consumer-selected ingredients for Mongolian barbecue; or (III) Raw, frozen, shell-on shrimp, or lobster.

(ii) Consumer self-service operations for ready-to-eat foods shall be provided with suitable utensils or effective dispensing methods that protect the food from contamination. (Pf)

(iii) Consumer self-service operations such as buffets and salad bars shall be monitored by food employees trained in safe operating procedures. (Pf)

4. Returned Food and Re-Service of Food.

(i) Except as specified in subpart (ii) of this part, after being served or sold and in the possession of a consumer, food that is unused or returned by the consumer may not be offered as food for human consumption. (P)

(ii) Except as specified under 1200-23-01-.03(8)(g), a container of food that is not time/temperature control for safety food may be re-served from one consumer to another if:

(I) The food is dispensed so that it is protected from contamination and the container is closed between uses, such as a narrow-neck bottle containing catsup, steak sauce, or wine; or (II) The food, such as crackers, salt, or pepper, is in an unopened original package and is maintained in sound condition.

5. Preventing Contamination from Other Sources - Miscellaneous Sources of Contamination. Food shall be protected from contamination that may result from a factor or source not specified under 1200-23-01-.03(3)(a)–(f).

(4) Destruction of Organisms of Public Health Concern (a) Cooking 1. Raw Animal Foods.

(i) Except as specified under subparts (ii), (iii) and (iv) of this part, raw animal foods such as eggs, fish, meat, poultry, and foods containing these raw animal foods, shall be cooked to heat all parts of the food to a temperature and for a time that complies with one of the following methods based on the food that is being cooked:

(I) 63°C (145°F) or above for 15 seconds for: (P)

I. Raw eggs that are broken and prepared in response to a consumer’s order and for immediate service, (P) and II. Except as specified under items (i)(II) and (i)(III) and subparts (ii), and (iii) of this part, fish and meat including game animals commercially raised for food as specified under 1200-23-01- .03(2)(a)7.(i) and game animals under a voluntary inspection program as specified under 1200-23-01-.03(2)(a)7.(ii); (P)

(II) 68°C (155°F) for 17 seconds or the temperature specified in the following chart that corresponds to the holding time for ratites, mechanically tenderized, and injected meats; the following if they are comminuted: fish, meat, game animals commercially raised for food as specified under 1200-23-01-.03(2)(a)7.(i), and game animals under a voluntary inspection program as specified under 1200-23- 01-.03(2)(a)7.(i)(II) and raw eggs that are not prepared as specified under 1.(i)(I)I. of this subparagraph: (P) or Minimum Temperature Time °C (°F) 63 (145) 3 minutes 66 (150) 1 minute 70 (158) < 1 second (instantaneous)

Oven Type Oven Temperature Based on Roast Weight Less than 4.5 kg (10lbs) 4.5 kg (10 lbs) or More Still Dry 177°C (350°F) or more 121°C (250°F) or more Convection 163°C (325°F) or more 121°C (250°F) or more High Humidity 121°C (250°F) or less 121°C (250°F) or less 1Relative humidity greater than 90% for at least 1 hour as measured in the cooking chamber or exit of the oven; or in a moisture-impermeable bag that provides 100% humidity.

(III) 74°C (165°F) or above for 1 second for poultry, baluts, wild game animals as specified under 1200-23-01-.03(2)(a)7.(iii) and (iv), stuffed fish, stuffed meat, stuffed pasta, stuffed poultry, stuffed ratites, or stuffing containing fish, meat, poultry, or ratites. (P)

(ii) Whole meat roasts including beef, corned beef, lamb, pork, and cured pork roasts such as ham shall be cooked:

(I) In an oven that is preheated to the temperature specified for the roast’s weight in the following chart and that is held at that temperature: (P); and (II) As specified in the following chart, to heat all parts of the food to a temperature and for the holding time that corresponds to that temperature: (P)

( Temperature °C (°F)

Time in Minutes Temperature °C (°F)

Time in Seconds 54.4 (130) 112 63.9 (147) 134 55.0 (131) 89 65.0 (149) 85 56.1 (133) 56 66.1 (151) 54 57.2 (135) 36 67.2 (153) 34 57.8 (136) 28 68.3 (155) 22 58.9 (138) 18 69.4 (157) 14 60.0 (140) 12 70.0 (158) 0 61.1 (142) 8 62.2 (144) 5 62.8 (145) 4 Holding time may include postoven heat rise.

(iii) A raw or undercooked whole-muscle, intact beef steak may be served or off ered for sale in a ready-to-eat form if:

(I) The food establishment serves a population that is not a highly susceptible population, (II) The steak is labeled to indicate that it meets the definition of “wholemuscle, intact beef” as specified under 1200-23-01-.03(2)(a)1.(v), and (III) The steak is cooked on both the top and bottom to a surface temperature of 63°C (145°F) or above and a cooked color change is achieved on all external surfaces.

(iv) A raw animal food such as raw egg, raw fish, raw-marinated fish, raw molluscan shellfish, or steak tartare; or a partially cooked food such as lightly cooked fish, soft cooked eggs, or rare meat other than wholemuscle, intact beef steaks as specified in (iii) of this part, may be served or offered for sale upon consumer request or selection in a ready-to-eat form if:

(I) As specified under 1200-23-01-.03(8)(c)1. and 2., the food establishment serves a population that is not a highly susceptible population;

(II) The food, if served or offered for service by consumer selection from a children’s menu, does not contain comminuted; (Pf) and (III) The consumer is informed as specified under 1200-23-01-.03(6)(c) that to ensure its safety, the food should be cooked as specified under subparts (i) or (ii) of this part; or (IV) The department grants a variance from (i) or (ii) of this part as specified in 1200-23-01-.08(1)(d)1. based on a HACCP plan that:

I. Is submitted by the permit holder and approved as specified under 1200-23-01-.08(1)(d)2., II. Documents scientific data or other information showing that a lesser time and temperature regimen results in a safe food, and III. Verifies that equipment and procedures for food preparation and training of food employees at the food establishment meet the conditions of the variance.

2. Microwave Cooking. Raw animal foods cooked in a microwave oven shall be:

(i) Rotated or stirred throughout or midway during cooking to compensate for uneven distribution of heat;

(ii) Covered to retain surface moisture;

(iii) Heated to a temperature of at least 74°C (165°F) in all parts of the food; and (iv) Allowed to stand covered for 2 minutes after cooking to obtain temperature equilibrium.

3. Plant Food Cooking for Hot Holding. Fruits and vegetables cooked for hot holding shall be cooked to a temperature of 57°C (135°F). (Pf)

4. Non-Continuous Cooking of Raw Animal Foods. Raw animal foods cooked using a non-continuous cooking process shall be:

(i) Subject to an initial heating process that is no longer than sixty minutes in duration; (P)

(ii) Immediately after initial heating, cooled according to the time and temperature parameters specified for cooked time /temperature control for safety food under 1200-23-01-.03(5)(a)4.; (P)

(iii) After cooling, held frozen or cold, as specified for time/temperature control for safety food under 1200-23-01-.03(5)(a)6.(i); (P)

(iv) Prior to sale or service, cooked using a process that heats all parts of the food to a temperature and a time as specified under 1200-23-01- .03(4)(a)1.(i)–(iii); (P)

(v) Cooled according to the time and temperature parameters specified for cooked time/temperature control for safety food under 1200-23-01- .03(5)(a)4. if not either hot held as specified under 1200-23-01-.03(5)(a)6., served immediately, or held using time as a public health control as specified under 1200-23-01-.03(5)(a)9. after complete cooking; (P) and (vi) Prepared and stored according to written procedures that:

(I) Have obtained prior approval from the department; (Pf)

(II) Are maintained in the food establishment and are available to the department upon request; (Pf)

(III) Describe how the requirements specified under (i)–(v) of this part are to be monitored and documented by the permit holder and the corrective actions to be taken if the requirements are not met; (Pf)

(IV) Describe how the foods, after initial heating, but prior to complete cooking, are to be marked or otherwise identified as foods that must be cooked as specified under subpart (iv) of this part prior to being offered for sale or service; (Pf) and (V) Describe how the foods, after initial heating but prior to cooking as specified under subpart (iv) of this part, are to be separated from ready-to-eat foods as specified under 1200-23-01-.03(5)(c). (Pf)

5. Manufacturer Cooking Instructions.

(i) Commercially packaged food that bears a manufacturer’s cooking instructions shall be cooked according to those instructions before use in ready-to-eat foods or offered in unpackaged form for human consumption unless the manufacturer’s instructions specify that the food may be consumed without cooking. (P)

(ii) Food for which the manufacturer has provided information that it has not been processed to control pathogens, when used in ready-to-eat foods or offered for human consumption, shall be cooked according to a time and temperature appropriate for the food. (P)

(b) Freezing 1. Parasite Destruction.

(i) Except as specified in (ii) of this part, before service or sale in ready-to-eat form, raw, raw-marinated, partially cooked, or marinated-partially cooked fish shall be:

(l) Frozen and stored at a temperature of -20°C (-4°F) or below for a minimum of 168 hours (7 days) in a freezer; (P)

(II) Frozen at -35°C (-31°F) or below until solid and stored at -35°C (- 31°F) or below for a minimum of 15 hours; (P) or (III) Frozen at -35°C (-31°F) or below until solid and stored at -20°C (- 4°F) or below for a minimum of 24 hours. (P)

(ii) Subpart (i) of this part does not apply to:

(I) Molluscan shellfish;

(II) Tuna of the species Thunnus alalunga, Thunnus albacares (Yellowfin tuna), Thunnus atlanticus, Thunnus maccoyii (Bluefin tuna, Southern), Thunnus obesus (Bigeye tuna), Scallops consisting only of the shucked abductor muscle, or Thunnus thynnus (Bluefin tuna, Northern); or (III) Aquacultured fish, such as salmon, that:

I. If raised in open water, are raised in net-pens, or II. Are raised in land-based operations such as ponds or tanks, and III. Are fed formulated feed, such as pellets, that contains no live parasites infective to the aquacultured fish.

(IV) Fish eggs that have been removed from the skein and rinsed.

2. Records, Creation and Retention.

(i) Except as specified in 1200-23-01-.03(4)(b)1.(ii) and (ii) of this part, if raw, raw-marinated, partially cooked, or marinated-partially cooked fish are served or sold in ready-to-eat form, the person-in-charge shall record the freezing temperature and time to which the fish are subjected and shall retain the records of the food establishment for 90 calendar days beyond the time of service or sale of the fish. (Pf)

(ii) If the fish are frozen by a supplier, a written agreement or statement from the supplier stipulating that the fish supplied are frozen to a temperature and for a time specified under 1200-23-01-.03(4)(b)1. may substitute for the records specified under subpart (i) of this part.

(iii) If raw, raw-marinated, partially cooked, or marinated-partially cooked fish are served or sold in ready-to-eat form, and the fish are raised and fed as specified in 1200-23-01-.03(4)(b)1.(ii)(III), a written agreement or statement from the supplier or aquaculturist stipulating that the fish were raised and fed as specified in 1200-23-01-.03(4)(b)1.(ii)(III) shall be obtained by the person in charge and retained in the records of the food establishment for 90 calendar days beyond the time of service or sale of the fish. (Pf)

3. Preparation for Immediate Service. Cooked and refrigerated food that is prepared for immediate service in response to an individual consumer order, such as a roast beef sandwich au jus, may be served at any temperature.

(c) Reheating for Hot Holding 1. Except as specified under parts 2., 3. and 5. of this subparagraph, time/temperature control for safety food) that is cooked, cooled, and reheated for hot holding shall be reheated so that all parts of the food reach a temperature of at least 74°C (165°F) for 15 seconds. (P)

2. Except as specified under part 3. of this subparagraph, time/temperature control for safety food reheated in a microwave oven for hot holding shall be reheated so that all parts of the food reach a temperature of at least 74°C (165°F) and the food is rotated or stirred, covered, and allowed to stand covered for 2 minutes after reheating. (P)

3. Ready-to-eat taken from a commercially processed, heremetically sealed container, or from an intact package from a food processing plant that is inspected by the food department that has jurisdiction over the plant, shall be heated to a temperature of at least 57°C (135°F) for hot holding. (P)

4. Reheating for hot holding as specified under parts 1. through 3. of this subparagraph shall be completed within 2 hours and the time the food is between 5°C (41°F) or 7°C (45°F) and the temperatures specified under 1. through 3. of this subparagraph may not exceed 2 hours. (P)

5. Remaining unsliced portions of meat roasts that are cooked as specified under 1200-23-01-.03(4)(a)1.(ii) may be reheated for hot holding using the oven parameters and minimum time and temperature conditions specified under 1200- 23-01-.03(4)(a)1.(ii).

(d) Treating Juice. Juice packaged in a food establishment shall be:

1. Treated under a HACCP PLAN as specified in 1200-23-01-.08(2)(d) to attain a 5log reduction, which is equal to a 99.999% reduction, of the most resistant microorganism of public health significance; (P) or 2. Labeled, if not treated to yield a 5-log reduction of the most resistant microorganism of public health significance: (Pf)

(i) As specified under 1200-23-01-.03(6)(b), (Pf) and (ii) As specified in 21 CFR § 101.17(g) Food labeling, warning, notice, and safe handling statements, juices that have not been specifically processed to prevent, reduce, or eliminate the presence of pathogens with the following, “WARNING: This product has not been pasteurized and, therefore, may contain harmful bacteria that can cause serious illness in children, the elderly, and persons with weakened immune systems.” (Pf )

(5) Limitation of Growth of Organisms of Public Health Concern (a) Temperature and Time Control 1. Frozen Food. Stored frozen foods shall be maintained frozen.

2. Time/Temperature Control for Safety Food, Slacking. Frozen time/temperature control for safety food that is slacked to moderate the temperature shall be held:

(i) Under refrigeration that maintains the food temperature at 5°C (41°F) or less.

(ii) At any temperature if the food remains frozen.

3. Thawing. Except as specified in subpart (iv) of this part, time/temperature control for safety food shall be thawed:

(i) Under refrigeration that maintains the food temperature at 5°C (41°F) or less.

(ii) Completely submerged under running water:

(I) At a water temperature of 21°C (70°F) or below, (II) With sufficient water velocity to agitate and float off loose particles in an overflow, (III) For a period of time that does not allow portions of ready-to-eat food to rise above 5°C (41°F), (Pf) and (IV) For a period of time that does not allow thawed portions of a raw animal food requiring cooking as specified under 1200-23-01- .03(4)(a)1.(i) or (ii), thawed portions are not above 5°C (41°F), for more than 4 hours including:

I. The time the food is exposed to the running water and the time needed for preparation for cooking, or II. The time it takes under refrigeration to lower the food temperature to 5°C (41°F);

(iii) As part of a cooking process if the food that is frozen is:

(I) Cooked as specified under 1200-23-01-.03(4)(a)1.(i) or (ii) or under 1200-23-01-.03(4)(a)2.(i), or (II) Thawed in a microwave oven and immediately transferred to conventional cooking equipment, with no interruption in the process; or (iv) Using any procedure if a portion of frozen ready-eat-food is thawed and prepared for immediate service in response to an individual consumer’s order.

(v) Reduced oxygen packaged fish that bears a label indicating that is to be kept frozen until time of use shall be removed from reduced oxygen environment;

(I) Prior to its thawing under refrigeration as specified in subpart (5)(a)3.(i) of this rule.

(II) Prior to, and immediately upon completion of, its thawing using procedures specified in subpart (5)(a)3.(ii) of this rule.

4. Cooling.

(i) Cooked time/temperature control for safety food shall be cooled:

(I) Prior to its thawing under refrigeration as specified in subpart (5)(a)3.(i) of this rule.

(II) Prior to, and immediately upon completion of, its thawing using procedures specified in subpart (5)(a)3.(ii) of this rule.

(ii) Time/temperature control for safety food shall be cooled within 4 hours to 5°C (41°F) or less, if prepared from ingredients at ambient temperature such as reconstituted foods and canned tuna. (P)

(iii) Except as specified under subpart (iv) of this part, a time/temperature control for safety food received in compliance with laws allowing a temperature above 5°C (41°F) during shipment from the supplier as specified under 1200-23-01-.03(2)(b)1.(ii), shall be cooled within 4 hours to 5°C (41°F) or less. (P)

(iv) Raw eggs shall be received as specified under under 1200-23-01- .03(2)(b)3. and immediately placed in refrigerated equipment that maintains an ambient air temperature of 5°C (41°F) or less. (P)

5. Cooling Methods.

(i) Cooling shall be accomplished in accordance with the time and temperature criteria specified under 1200-23-01-.03(5)(a)4. by using one or more of the following methods based on the type of food being cooled:

(I) Placing the food in shallow pans; (Pf)

(II) Separating the food into smaller or thinner portions; (Pf)

(III) Using rapid cooling equipment; (Pf)

(IV) Stirring the food in a container placed in an ice water bath; (Pf)

(V) Using containers that facilitate heat transfer; (Pf)

(VI) Adding ice as an ingredient; (Pf) or (VII) Other effective methods. (Pf)

(ii) When placed in cooling or cold holding equipment, food containers in which food is being cooled shall be:

(I) Arranged in the equipment to provide maximum heat transfer through the container walls; and (II) Loosely covered, or uncovered if protected from overhead contamination as specified under 1200-23-01.03(3)(e)1.(i)(I), during the cooling period to facilitate heat transfer from the surface of the food.

6. Time/Temperature Control for Safety Food, Hot and Cold Holding.

(i) Except during preparation, cooking, or cooling, or when time is used as the public health control as specified under 1200-23-01-.03(5)(a)9., and except as specified under (ii) and in (iii) of this part, time/temperature control for safety food shall be maintained:

(I) At 57°C (135°F) or above, except that roasts cooked to a temperature and for a time specified under 1200-23-01-.03(4)(a)1.(ii) or reheated as specified in 1200-23-01-.03(4)(c)5. may be held at a temperature of 54°C (130°F) or above; (P) or (II) At 5°C (41°F) or less (P).

(ii) Eggs that have not been treated to destroy all viable Salmonellae shall be stored in refrigerated equipment that maintains an ambient air temperature of 5°C (41°F) or less. (P)

(iii) Time/temperature control for safety food in a homogenous liquid form may be maintained outside of the temperature control requirements, as specified under (i) of this part, while contained within specially designed equipment that complies with the design and construction requirements as specified under 1200-23-01-.04(2)(d)3.(v).

7. Ready-to-Eat, Time/Temperature Control for Safety Food Date Marking.

(i) Except when packaging food using a reduced oxygen packing method as specified under 1200-23-01-.03(5)(c), and except as specified in subpart (v) of this part, refrigerated, ready-to-eat, time/temperature control for safety food prepared and held in a food establishment for more than 24 hours shall be marked to indicate the date or day by which the food shall be consumed on the premises, sold, or discarded, based on the temperature and time combination of 5°C (41°F) or less for a maximum of 7 days. The day of preparation shall be counted as day 1. (Pf)

(ii) Except as specified in (v)–(vi) of this part, refrigerated, ready-to-eat, time/temperature control for safety food prepared and packaged by a food processing plant shall be clearly marked, at the time the original container is opened in a food establishment and if the food is held for more than 24 hours, to indicate the date or day by which the food shall be consumed on the premises, sold, or discarded, based on the temperature and time combinations specified in (i) of this part and: (Pf)

(I) The day the original container is opened in the food establishment shall be counted as day 1; (Pf) and (II) The day or date marked by the food establishment may not exceed a manufacturer’s use-by date if the manufacturer determined the useby date based on food safety. (Pf)

(iii) A refrigerated, ready-to-eat, time/temperature control for safety food ingredient or a portion of a refrigerated, ready-to-eat, time/temperature control for safety food that is subsequently combined with additional ingredients or portions of food shall retain the date marking of the earliestprepared or first-prepared ingredient. (Pf)

(iv) A date marking system that meets the criteria stated in subparts (i) and (ii) of this part may include:

(I) Using a method approved by the department for refrigerated, readyto-eat time/temperature control for safety food that is frequently rewrapped, such as lunchmeat or a roast, or for which date marking is impractical, such as soft serve mix or milk in a dispensing machine;

(II) Marking the date or day of preparation, with a procedure to discard the food on or before the last date or day by which the food must be consumed on the premises, sold, or discarded as specified under

subpart (i) of this part;

(III) Marking the date or day the original container is opened in a food establishment, with a procedure to discard the food on or before the last date or day by which the food must be consumed on the premises, sold, or discarded as specified under subpart (ii) of this

part; or (IV) Using calendar dates, days of the week, color-coded marks, or other effective marking methods, provided that the marking system is disclosed to the department upon request.

(v) Subparts (i) and (ii) of this part do not apply to individual meal portions served or repackaged for sale from a bulk container upon a consumer’s request.

(vi) Subpart (ii) of this part does not apply to the following foods prepared and packaged by a food processing plant inspected by a department:

(I) Deli salads, such as ham salad, seafood salad, chicken salad, egg salad, pasta salad, potato salad, and macaroni salad, manufactured in accordance with 21 CFR Part 110 Current good manufacturing practice in manufacturing, packing, or holding human food;

(II) Hard cheeses containing not more than 39% moisture as defined in 21 CFR Part 133 Cheeses and related cheese products, such as cheddar, gruyere, parmesan and reggiano, and romano;

(III) Semi-soft cheeses containing more than 39% moisture, but not more than 50% moisture, as defined in 21 CFR Part 133 Cheeses and related cheese products, such as blue, edam, gorgonzola, gouda, and monterey jack;

(IV) Cultured dairy products as defined in 21 CFR Part 131 Milk and cream, such as yogurt, sour cream, and buttermilk;

(V) Preserved fish products, such as pickled herring and dried or salted cod, and other acidified fish products as defined in 21 CFR Part 114 Acidified foods;

(VI) Shelf stable, dry fermented sausages, such as pepperoni and Genoa salami that are not labeled “Keep Refrigerated” as specified in 9 CFR Part 317 Labeling, marking devices, and containers, and which retain the original casing on the product; and (VII) Shelf stable salt-cured products such as prosciutto and Parma (ham) that are not labeled “Keep Refrigerated” as specified in 9 CFR Part 317 Labeling, marking devices, and containers.

8. Ready-to-Eat, time/temperature control for safety food, Disposition.

(i) A food specified in 1200-23-01-.03(5)(a)7.(i) or (ii) shall be discarded if it:

(I) Exceeds the temperature and time combination specified in 1200-23- 01-.03(5)(a)7.(i), except time that the product is frozen; (P)

(II) Is in a container or package that does not bear a date or day; (P) or (III) Is appropriately marked with a date or day that exceeds a temperature and time combination as specified in 1200-23-01- .03(5)(a)7.(i). (P)

(ii) Refrigerated, ready-to-eat, potentially hazardous foods time/temperature control for safety food prepared in a food establishment and dispensed through a vending machine with an automatic shutoff control shall be discarded if it exceeds a temperature and time combination as specified in 1200-23-01-.03(5)(a)7.(i).

9. Time as a Public Health Control.

(i) Except as specified under subpart (iv) of this part, if time without temperature control is used as the public health control for a working supply of time/temperature control for safety food before cooking, or for ready-to-eat time/temperature control for safety food that is displayed or held for sale or service:

(I) Written procedures shall be prepared in advance, maintained in the food establishment and made available to the department upon request that specify: (Pf)

I. Methods of compliance with items (ii)(I)–(IV) or (iii)(I)–(V) of this part; (Pf) and II. Methods of compliance with 1200-23-01-.03(5)(a)4. for food that is prepared, cooked, and refrigerated before time is used as a public health control. (Pf)

(ii) If time without temperature control is used as the public health control up to a maximum of 4 hours:

(I) Except as specified in (II) immediately below, the food shall have an initial temperature of 5°C (41°F) or less when removed from cold holding temperature control, or 57°C (135°F) or greater when removed from hot holding temperature control; (P)

(II) The food may have an initial temperature of 21°C (70°F) or less if;

I. It is a ready-to-eat fruit or vegetable that upon cutting is rendered a time/temperature control for safety food as defined in 1200-23-01-.01(110); or, II. It is a ready-to-eat hermetically sealed food that upon opening is rendered a time/temperature control for safety food as defined in 1200-23-01-.01(110);

III. The food does not exceed 21°C (70°F) within a maximum time period of 4 hours from the time it was rendered a time/temperature control for safety food; and, IV. The food is marked or otherwise identified to indicate the time that is 4 hours past the point in time when the food is rendered a time/control for safety food as specified in items (I) and (II) within this subsection.

(III) The food shall be marked or otherwise identified to indicate the time that is 4 hours past the point in time when the food is removed from temperature control; (Pf)

(IV) The food shall be cooked and served, served at any temperature if ready-to-eat, or discarded, within 4 hours from the point in time when the food is removed from temperature control; (P) and (V) The food in unmarked containers or packages, or marked to exceed a 4-hour limit shall be discarded. (P)

(iii) If time without temperature control is used as the public health control up to a maximum of 6 hours:

(I) The food shall have an initial temperature of 5°C (41°F) or less when removed from temperature control and the food temperature may not exceed 21°C (70°F) within a maximum time period of 6 hours; (P)

(II) The food shall be monitored to ensure the warmest portion of the food does not exceed 21°C (70°F) during the 6-hour period, unless an ambient air temperature is maintained that ensures the food does not exceed 21°C (70°F) during the 6-hour holding period; (Pf)

(III) The food shall be marked or otherwise identified to indicate: (Pf)

I. The time when the food is removed from 5°C (41°F) or less cold holding temperature control, (Pf) and II. The time that is 6 hours past the point in time when the food is removed from cold holding temperature control; (Pf)

(IV) The food shall be:

I. Discarded if the temperature of the food exceeds 21°C (70°F), (P) or II. Cooked and served, served at any temperature if ready-to-eat, or discarded within a maximum of 6 hours from the point in time when the food is removed from 5°C (41°F) or less cold holding temperature control; (P) and (V) The food in unmarked containers or packages, or marked with a time that exceeds the 6-hour limit shall be discarded. (P)

(iv) A food establishment that serves a highly susceptible population may not use time as specified under subparts (i), (ii) or (iii) of this part as the public health control for raw eggs.

(b) Specialized Processing Methods: Variance Requirement. A food establishment shall obtain a variance from the department as specified in 1200-23-01-.08(1)(d)1. and under 1200-23-01-.08(1)(d)2. before: (Pf)

1. Smoking food as a method of food preservation rather than as a method of flavor enhancement; (Pf)

2. Curing food; (Pf)

3. Using food additives or adding components such as vinegar: (Pf)

(i) As a method of food preservation rather than as a method of flavor enhancement, (Pf) or (ii) To render a food so that it is not time/temperature control of safety food;

(Pf)

4. Packaging time/temperature control for safety food using a reduced oxygen packing method except where the growth of and toxin formation by Clostridium botulinum and the growth of Listeria monocytogenes are controlled as specified under 1200-23-01-.03(5)(c); (Pf)

5. Operating a molluscan shellfish life-support system display tank used to store or display shellfish that are offered for human consumption; (Pf)

6. Custom processing animals that are for personal use as food and not for sale or service in a food establishment; (Pf)

7. Preparing food by another method that is determined by the department to require a variance; (Pf) or 8. Sprouting seeds or beans. (Pf)

(c) Clostridium botulinum and Listeria moncytogenes Controls. - Reduced Oxygen Packaging Without a Variance, Criteria.

1. Except for a food establishment that obtains a variance as specified under 1200- 23-01-.03(5)(b)4., a food establishment that packages time/temperature control for safety food using a reduced oxygen packaging method shall control the growth and toxin formation of Clostridium botulinum and the growth of Listeria monocytogenes. (P)

2. A food establishment that packages time/temperature control for safety food using a reduced oxygen method shall have a HACCP plan that contains the information specified under 1200-23-01-.08(2)(d)5. and that: (Pf)

(i) Identifies the food to be packaged; (Pf)

(ii) Except as specified under parts 3.–5. of this subparagraph, requires that the packaged food shall be maintained at 5°C (41°F) or less and meet at least one of the following criteria: (Pf)

(I) Has an A W of 0.91 or less, (Pf)

(II) Has a pH of 4.6 or less, (Pf)

(III) Is a meat or poultry product cured at a food processing plant regulated by the USDA using substances specified in 9 CFR § 424.21, Use of food ingredients and sources of radiation, and is received in an intact package, (Pf) or (IV) Is a food with a high level of competing organisms such as raw meat, raw poultry, or raw vegetables; (Pf)

(iii) Describes how the package shall be prominently and conspicuously labeled on the principal display panel in bold type on a contrasting background, with instructions to: (Pf)

(I) Maintain the food at 5°C (41°F) or below, (Pf) and (II) Discard the food if within 30 calendar days of its packaging it is not served for on-premises consumption, or consumed if served or sold for off-premises consumption; (Pf)

(iv) Limits the refrigerated shelf life to no more than 30 calendar days from packing to consumption, except the time the product is maintained frozen, or the original manufacturer’s “sell by” or “use by” date, whichever occurs first; (P)

(v) Includes operational procedures that:

(I) Prohibit contacting ready-to-eat food with bare hands as specified under 1200-23-01-.03(3)(a)1.(ii), (Pf)

(II) Identify a designated work area and the method by which: (Pf)

I. Physical barriers or methods of separation of raw foods and ready-to-eat foods minimize cross contamination, (Pf) and II. Access to the processing equipment is limited to responsible trained personnel familiar with the potential hazards of the operation, (Pf) and III. Delineate cleaning and sanitation procedures for food-contact surfaces; (Pf) and (vi) Describes the training program that ensures that the individual responsible for the reduced oxygen packaging operation understands the: (Pf)

(I) Concepts required for a safe operation, (Pf)

(II) Equipment and facilities, (Pf) and (III) Procedures specified under subpart 2(v) of this part and 1200-23-01- .08(2)(d)4. (Pf)

3. Except for fish that is frozen before, during, and after packaging and bears a label indicating that it is to be kept frozen until time of use, a food establishment may not package fish using a reduced oxygen packaging method. (P)

4. Except as specified under part 3. of this subparagraph, a food establishment that packages food using a cook-chill or sous vide process shall:

(i) Implement a HACCP plan that contains the information as specified under 1200-23-01-.08(2)(d)5.; (Pf)

(ii) Ensure the food is:

(I) Prepared and consumed on the premises, or prepared and consumed off the premises but within the same business entity with no distribution or sale of the packaged product to another business entity or the consumer, (Pf)

(II) Cooked to heat all parts of the food to a temperature and for a time as specified under 1200-23-01-.03(4)(a)1., (Pf)

(III) Protected from contamination before and after cooking as specified under 1200-23-01-.03(3)–(5), (P)

(IV) Placed in a package with an oxygen barrier and sealed before cooking, or placed in a package and sealed immediately after cooking and before reaching a temperature below 57°C (135°F), (P)

(V) Cooled to 5°C (41°F) in the sealed package or bag as specified under 1200-23-01-.03(5)(a)4. and subsequently; (P)

I. Cooled to 1°C (34°F) within 48 hours of reaching 5°C (41°F) and held at that temperature until consumed or discarded within 30 days after the date of packaging; (P)

II. Held at 5°C (41°F) or less for no more than 7 days, at which time the food must be consumed or discarded; (P)

III. Cooled to 1°C (34°F) within 48 hours of reaching 5°C (41°F), removed from refrigeration equipment that maintains a 1°C (34°F) food temperature and then held at 5°C (41°F) or less for no more than 7 days, at which time the food must be consumed or discarded; (P)

IV. Held frozen with no shelf life restriction while frozen until consumed or used. (P)

(VI) Held in a refrigeration unit that is equipped with an electronic system that continuously monitors time and temperature and is visually examined for proper operation twice daily, (Pf)

(VII) If transported off-site to a satellite location of the same business entity, equipped with verifiable electronic monitoring devices to ensure that times and temperatures are monitored during transportation, (Pf) and (VIII) Labeled with the product name and the date packaged; (Pf)

(iii) Maintain the records required to confirm that cooling and cold holding refrigeration time/temperature parameters are required as part of the HACCP plan and:

(I) Make such records available to the department upon request (Pf); and (II) Hold such records for at least 6 months; (Pf) and (iv) Implement written operational procedures as specified under subpart 2.(v) of this subparagraph and a training program as specified under subpart 2.(vi) of this subparagraph.

5. A food establishment that packages cheese using a reduced oxygen packaging method shall:

(i) Limit the cheeses packaged to those that are commercially manufactured in a food processing plant with no ingredients added in the food establishment and that meet the Standards of Identity as specified in 21 CFR § 133.150 Hard cheeses, 21 CFR § 133.169 Pasteurized process cheese or 21 CFR § 133.187 Semisoft cheeses; (P)

(ii) Have a HACCP plan that contains the information specified under 1200- 23-01-.08(2)(d)4. and as specified under subparts 2.(i), 2.(v) and 2.(vi) and item (2)(iii)(l) of this subparagraph; (Pf)

(iii) Labels the package on the principal display panel with a “use by” date that does not exceed 30 days from its packaging or the original manufacturer’s “sell by” or “use by” date, whichever occurs first; (Pf) and (iv) Discards the reduced oxygen packaged cheese if it is not sold for offpremises consumption or consumed within 30 calendar days of its packaging. (Pf)

6. A HACCP plan is not required when a food establishment uses a reduced oxygen packaging method to package time/temperature control for safety food that is always:

(i) Labeled with the production time and date, (ii) Held at 5°C (41°F) or less during refrigerated storage, and, (ii) Removed from its package in the food establishment within 48 hours after packaging.

(6) Food Identity, Presentation, and On-Premises Labeling (a) Accurate Representation.

1. Standards of Identity. Packaged food shall comply with standard of identity requirements in 21 CFR Parts 131-169 and 9 CFR Part 319 Definitions and standards of identity or composition, and the general requirements in 21 CFR

Part 130 – Food Standards: General and 9 CFR Part 319 Subpart A – General Provisions.

2. Honestly Presented.

(i) Food shall be offered for human consumption in a way that does not mislead or misinform the consumer.

(ii) Food or color additives, colored overwraps, or lights may not be used to misrepresent the true appearance, color, or quality of a food.

(b) Labeling.

1. Food packaged in a food establishment, shall be labeled as specified in law, including 21 CFR Part 101 – Food labeling, and 9 CFR Part 317 Labeling, marking devices, and containers.

2. Label information shall include:

(i) The common name of the food, or absent a common name, an adequately descriptive identity statement;

(ii) If made from two or more ingredients, a list of ingredients in descending order of predominance by weight, including a declaration of artificial color or flavor and chemical preservatives, if contained in the food;

(iii) An accurate declaration of the quantity of contents;

(iv) The name and place of business of the manufacturer, packer, or distributor; and (v) The name of the food source for each major food allergen contained in the food unless the food source is already part of the common or usual name of the respective ingredient (Effective January 1, 2006). (Pf)

(vi) Except as exempted in the Federal Food, Drug, and Cosmetic Act § 403(Q)(3)–(5), nutrition labeling as specified in 21 CFR Part 101 – Food Labeling and 9 CFR Part 317 Subpart B Nutrition Labeling.

(vii) For any salmonid fish containing canthaxanthin or astaxanthin as a color additive, the labeling of the bulk fish container, including a list of ingredients, displayed on the retail container or by other written means, such as a counter card, that discloses the use of canthaxanthin or astaxanthin.

3. Bulk food that is available for consumer self-dispensing shall be prominently labeled with the following information in plain view of the consumer:

(i) The manufacturer’s or processor’s label that was provided with the food; or (ii) A card, sign, or other method of notification that includes the information specified under subparts 2.(i), (ii), and (v) of this part.

4. Bulk, unpackaged foods such as bakery products and unpackaged foods that are portioned to consumer specification need not be labeled if:

(i) A health, nutrient content, or other claim is not made;

(ii) There are no state or local laws requiring labeling; and (iii) The food is manufactured or prepared on the premises of the food establishment or at another food establishment or a food processing plant that is owned by the same person and is regulated by the food regulatory agency that has jurisdiction.

5. Other Forms of Information.

(i) If required by law, consumer warnings shall be provided.

(ii) Food establishment or manufacturers’ dating information on foods may not be concealed or altered.

(iii) The permit holder shall notify consumers by written notification of presence of major food allergens as an ingredient in unpackaged food items that are served or sold to the consumer.

(c) Consumer Advisory - Consumption of Animal Foods that are Raw, Undercooked, or Not Otherwise Processed to Eliminate Pathogens.

1. Except as specified in 1200-23-01-.03(4)(a)1.(iii) and 1200-23-01- .03(4)(a)1.(iv)(IV) and under 1200-23-01-.03(8)(c), if an animal food such as beef, eggs, fish, lamb, milk, pork, poultry, or shellfish is served or sold raw, undercooked, or without otherwise being processed to eliminate pathogens, either in ready-to-eat form or as an ingredient in another ready-to-eat food, the permit holder shall inform consumers of the significantly increased risk of consuming such foods by way of a disclosure and reminder, as specified in parts and 3. of this subparagraph using brochures, deli case or menu advisories, label statements, table tents, placards, or other effective written means. (Pf)

2. Disclosure shall include:

(i) A description of the animal-derived foods, such as “oysters on the half shell (raw oysters),” “raw-egg Caesar salad,” and “hamburgers (can be cooked to order)”; (Pf) or (ii) Identification of the animal-derived foods by asterisking them to a footnote that states that the items are served raw or undercooked, or contain (or may contain) raw or undercooked ingredients. (Pf)

3. Reminder shall include asterisking the animal-derived foods requiring disclosure to a footnote that states:

(i) Regarding the safety of these items, written information is available upon request; (Pf)

(ii) Consuming raw or undercooked meats, poultry, seafood, shellfish, or eggs may increase your risk of foodborne illness; (Pf) or (iii) Consuming raw or undercooked meats, poultry, seafood, shellfish, or eggs may increase your risk of foodborne illness, especially if you have certain medical conditions. (Pf)

(7) Contaminated Food - Disposition. Discarding or Reconditioning Unsafe, Adulterated, or Contaminated Food.

(a) A food that is unsafe, adulterated, or not honestly presented as specified under 1200- 23-01-.03(1) shall be discarded or reconditioned according to an approved procedure.

(P)

(b) Food that is not from an approved source as specified under 1200-23-01-.03(2)(a)–(d) shall be discarded. (P)

(c) Ready-to-eat food that may have been contaminated by an employee who has been restricted or excluded as specified under 1200-23-01-.02(2)(b) shall be discarded. (P)

(d) Food that is contaminated by food employees, consumers, or other persons through contact with their hands, bodily discharges, such as nasal or oral discharges, or other means shall be discarded. (P)

(8) Special Requirements for Highly Susceptible Populations - Pasteurized Foods, Prohibited Re-Service, and Prohibited Food. In a food establishment that serves a highly susceptible population:

(a) The following criteria apply to juice:

1. For the purposes of this paragraph only, children who are age 9 or less and receive food in a school, day care setting, or similar facility that provides custodial care are included as highly susceptible populations;

2. Prepackaged juice or a prepackaged beverage containing juice, that bears a warning label as specified in 21 CFR § 101.17(g) Food labeling, warning, notice, and safe handling statements, juices that have not been specifically processed to prevent, reduce, or eliminate the presence of pathogens, or a packaged juice or beverage containing juice, that bears a warning label as specified under 1200- 23-01-.03(4)(d)2. may not be served or offered for sale; (P) and 3. Unpackaged juice that is prepared on the premises for service or sale in a readyto-eat form shall be processed under a HACCP plan that contains the information specified under 1200-23-01-.08(2)(d) and as specified in 21 CFR Part 120 – Hazard Analysis and Critical Control Point (HACCP) Systems, Subpart B Pathogen Reduction, § 120.24 Process controls. (P)

(b) Pasteurized eggs or egg products shall be substituted for raw eggs in the preparation of: (P)

1. Foods such as Caesar salad, hollandaise or Béarnaise sauce, mayonnaise, meringue, eggnog, ice cream, and egg-fortified beverages, (P) and 2. Except as specified in (f) of this paragraph, recipes in which more than one egg is broken and the eggs are combined; (P)

(c) The following foods may not be served or offered for sale in a ready-to-eat form: (P)

1. Raw animal foods such as raw fish, raw-marinated fish, raw molluscan shellfish, and steak tartare, (P)

2. A partially cooked animal food such as lightly cooked fish, rare meat, soft-cooked eggs that are made from raw eggs, and meringue; (P)

3. Raw seed sprouts; (P) and 4. Packaged food as specified under 1200-23-01-.03(4)(a)5.

(d) Food employees may not contact ready-to-eat food as specified under 1200-23-01- .03(3)(a)1.(ii) and (iv). (P)

(e) Time only, as the public health control as specified under 1200-23-01-.03(5)(a)9.(iv), may not be used for raw eggs.

(f) Subparagraph (b)2. of this paragraph does not apply if:

1. The raw eggs are combined immediately before cooking for one consumer’s serving at a single meal, cooked as specified under 1200-23-01-.03(4)(a)1.(i)(I), and served immediately, such as an omelet, soufflé, or scrambled eggs; (P)

2. The raw eggs are combined as an ingredient immediately before baking and the eggs are thoroughly cooked to a ready-to-eat form, such as a cake, muffin, or bread; or 3. The preparation of the food is conducted under a HACCP plan that:

(i) Identifies the food to be prepared, (ii) Prohibits contacting ready-to-eat food with bare hands, (iii) Includes specifications and practices that ensure:

(I) Salmonella Enteritidis growth is controlled before and after cooking, and (II) Salmonella Enteritidis is destroyed by cooking the eggs according to the temperature and time specified in 1200-23-01-.03(4)(a)1.(i)(II), (iv) Contains the information specified under 1200-23-01-.08(2)(d)5. including procedures that:

(I) Control cross contamination of ready-to-eat food with raw eggs, and (II) Delineate cleaning and sanitization procedures for food-contact surfaces, and (v) Describes the training program that ensures that the food employee responsible for the preparation of the food understands the procedures to be used.

(g) Except as specified in subparagraph (h) of this paragraph, food may be re-served as specified under 1200-23-01-.03(3)(f)4.(ii)(I) and (II).

(h) Food may not be re-served under the following conditions:

1. Any food served to patients or clients who are under contact precautions in medical isolation or quarantine, or protective environment isolation may not be re-served to others outside.

2. Packages of food from any patients, clients, or other consumers should not be re-served to persons in protective environment isolation.

History

• Authority: T.C.A. §§ 68-14-701 through 68-14-729.
• Administrative History: Original rule filed March 26, 1987; effective May 9, 1987. Amendment filed January 4, 1995; effective March 20, 1995. Withdrawal of 1200-23-.03(3)(d) filed November 3, 2000. Repeal and new rule filed August 24, 2000; effective November 7, 2000. Amendment filed October 22, 2004; effective January 5, 2005. Repeal and new rule filed April 17, 2015; effective July 16, 2015. Amendments filed January 4, 2018; effective April 4, 2018. Amendments filed March 16, 2026; effective June 14, 2026.

Tenn. Comp. R. & Regs. 1200-23-01-.04 EQUIPMENT, UTENSILS, AND LINENS

(1) Materials for Construction and Repair (a) Multiuse 1. Characteristics (i) Materials that are used in the construction of utensils and food-contact surfaces of equipment may not allow the migration of deleterious substances or impart colors, odors, or tastes to food and under normal use conditions shall be:

(P)

(I) Safe;

(P)

(II) Durable, corrosion-resistant, and nonabsorbent;

(III) Sufficient in weight and thickness to withstand repeated warewashing;

(IV) Finished to have a smooth, easily cleanable surface; and (V) Resistant to pitting, chipping, crazing, scratching, scoring, distortion and decomposition.

(ii) Cast Iron, Use Limitation.

(I) Except as specified in items (II) and (III) of this subpart, cast iron may not be used for utensils or food-contact surfaces of equipment.

(II) Cast iron may be used as a surface for cooking.

(III) Cast iron may be used in utensils for serving food if the utensils are used only as part of an uninterrupted process from cooking through service.

(iii) Lead, Use Limitation.

(I) Ceramic, china, and crystal utensils, and decorative utensils such as hand painted ceramic or china that are used in contact with food shall be lead-free or contain levels of lead not exceeding the limits of the following utensil categories (P)

(II) Pewter alloys containing lead in excess of 0.05% may not be used as a food-contact surface.

(P)

(III) Solder and flux containing lead in excess of 0.2% may not be used as a food-contact surface.

(iv) Copper, Use Limitation.

(I) Except as specified in item (II) of this subpart, copper and copper alloys such as brass may not be used in contact with a food that has a pH below 6 such as vinegar, fruit juice, or wine or for a fitting or tubing installed between a backflow prevention device and a carbonator.

(II) Copper and copper alloys may be used in contact with beer brewing ingredients that have a pH below 6 in the prefermentation and fermentation steps of a beer brewing operation such as a brewpub or microbrewery.

(v) Galvanized Metal, Use Limitation. Galvanized metal may not be used for utensils or food-contact surfaces of equipment that are used in contact with acidic food.

(vi) Sponges, Use Limitation. Sponges may not be used in contact with cleaned and sanitized or in-use food-contact surfaces.

(vii) Wood, Use Limitation.

(I) Except as specified in items (II), (III) and (IV) of this subpart, wood and wood wicker may not be used as a food-contact surface.

Utensil Category Ceramic Article Description Maximum Lead Mg/L Beverage Mugs, Cups, Pitchers Coffee Mugs 0.5 Large Hollowware (excluding pitchers)

Bowls > 1.1 Liter (1.16 Quart)

Small Hollowware (excluding cups & mugs)

Bowls < 1.1 Liter (1.16 Quart) 2.0 Flat Tableware Plates, Saucers 3.0 (II) Hard maple or an equivalently hard, close-grained wood may be used for:

I. Cutting boards; cutting blocks; bakers’ tables; and utensils such as rolling pins, doughnut dowels, salad bowls, and chopsticks; and II. Wooden paddles used in confectionery operations for pressure scraping kettles when manually preparing confections at a temperature of 110°C (230°F) or above.

(III) Whole, uncut, raw fruits and vegetables, and nuts in the shell may be kept in the wood shipping containers in which they were received, until the fruits, vegetables, or nuts are used.

(IV) If the nature of the food requires removal of rinds, peels, husks, or shells before consumption, the whole, uncut, raw food may be kept in:

I. Untreated wood containers; or II. Treated wood containers if the containers are treated with a preservative that meets the requirements specified in 21 CFR § 178.3800 Preservatives for wood.

(viii) Nonstick Coatings, Use Limitation. Multiuse kitchenware such as frying pans, griddles, sauce pans, cookie sheets, and waffle bakers that have a perfluorocarbon resin coating shall be used with nonscoring or nonscratching utensils and cleaning aids.

(ix) Nonfood-Contact Surfaces. Nonfood-contact surfaces of equipment that are exposed to splash, spillage, or other food soiling or that require frequent cleaning shall be constructed of a corrosion-resistant, nonabsorbent, and smooth material.

(b) Single Service and Single-Use 1. Characteristics. Materials that are used to make single-service and single-use articles:

(i) May not:

(I) Allow the migration of deleterious substances, (P) or (II) Impart colors, odors, or tastes to food; and (ii) Shall be:

(I) Safe, (P) and (II) Clean.

(2) Design and Construction (a) Durability and Strength 1. Equipment and Utensils. Equipment and Utensils shall be designed and constructed to be durable and to retain their characteristic qualities under normal use conditions.

2. Food temperature measuring devices may not have sensors or stems constructed of glass, except that thermometers with glass sensors or stems that are encased in a shatterproof coating such as candy thermometers may be used.

(P)

(b) Cleanability 1. Food-Contact Surfaces.

(i) Multiuse food-contact surfaces shall be:

(I) Smooth;

(Pf)

(II) Free of breaks, open seams, cracks, chips, inclusions, pits, and similar imperfections;

(Pf)

(III) Free of sharp internal angles, corners, and crevices;

(Pf)

(IV) Finished to have smooth welds and joints;

(Pf) and (V) Except as specified in subpart (ii) of this part, accessible for cleaning and inspection by one of the following methods:

I. Without being disassembled, (Pf)

II. By disassembling without the use of tools, (Pf) or III. By easy disassembling with the use of handheld tools commonly available to maintenance and cleaning personnel such as screwdrivers, pliers, open-end wrenches, and Allen wrenches.

(Pf)

(ii) Item (i)(V) of this part does not apply to cooking oil storage tanks, distribution lines for cooking oils, or beverage syrup lines or tubes.

2. CIP Equipment.

(i) CIP equipment shall meet the characteristics specified under 1200-23-01- .04(2)(a) and shall be designed and constructed so that:

(I) Cleaning and sanitizing solutions circulate throughout a fixed system and contact all interior food-contact surfaces, (Pf) and (II) The system is self-draining or capable of being completely drained of cleaning and sanitizing solutions; and (ii) CIP equipment that is not designed to be disassembled for cleaning shall be designed with inspection access points to ensure that all interior foodcontact surfaces throughout the fixed system are being effectively cleaned.

3. “V” Threads, Use Limitation. - Except for hot oil cooking or filtering equipment, “V” type threads may not be used on food-contact surfaces.

4. Hot Oil Filtering Equipment. - Hot oil filtering equipment shall meet the characteristics specified under 1200-23-01-.04(2)(a) and shall be readily accessible for filter replacement and cleaning of the filter.

5. Can Openers. - Cutting or piercing parts of can openers shall be readily removable for cleaning and for replacement.

6. Nonfood-contact surfaces. - Nonfood-contact surfaces shall be free of unnecessary ledges, projections, and crevices, and designed and constructed to allow easy cleaning and to facilitate maintenance.

7. Kick Plates, Removable. - Kick plates shall be designed so that the areas behind them are accessible for inspection and cleaning by being:

(i) Removable by one of the methods specified under subparagraph 1200-23- 01-.04 (2)(b)1.(i)(V) or capable of being rotated open; and (ii) Removable or capable of being rotated open without unlocking equipment doors.

8. Ventilation Hood Systems, Filters. - Filters or other grease extracting equipment shall be designed to be readily removable for cleaning and replacement if not designed to be cleaned in place.

(c) Accuracy 1. Temperature Measuring Devices, Food.

(i) Food temperature measuring devices that are scaled only in Celsius or dually scaled in Celsius and Fahrenheit shall be accurate to ±1 ° C in the intended range of use.

(Pf)

(ii) Food temperature measuring devices that are scaled only in Fahrenheit shall be accurate to ±2 ° F in the intended range of use.

(Pf)

2. Temperature Measuring Devices, Ambient Air and Water.

(i) Ambient air and water temperature measuring devices that are scaled in Celsius or dually scaled in Celsius and Fahrenheit shall be designed to be easily readable and accurate to ±1.5 ° C in the intended range of use.

(Pf)

(ii) Ambient air and water temperature measuring devices that are scaled only in Fahrenheit shall be accurate to ±3 ° F in the intended range of use.

(Pf)

3. Pressure Measuring Devices, Mechanical Warewashing Equipment. - Pressure measuring devices that display the pressures in the water supply line for the fresh hot water sanitizing rinse shall have increments of 7 kilopascals (1 pound per square inch) or smaller and shall be accurate to ±14 kilopascals (±2 pounds per square inch) in the range indicated on the manufacturer’s data plate.

(d) Functionality 1. Ventilation Hood Systems, Drip Prevention. - Exhaust ventilation hood systems in food preparation and warewashing areas including components such as hoods, fans, guards, and ducting shall be designed to prevent grease or condensation from draining or dripping onto food, equipment, utensils, linens, and singleservice and single-use articles.

2. Equipment Openings, Closures and Deflectors.

(i) A cover or lid for equipment shall overlap the opening and be sloped to drain.

(ii) An opening located within the top of a unit of equipment that is designed for use with a cover or lid shall be flanged upward at least 5 millimeters (two-tenths of an inch).

(iii) Except as specified under subpart (iv) of this part, fixed piping, temperature measuring devices, rotary shafts, and other parts extending into equipment shall be provided with a watertight joint at the point where the item enters the equipment.

(iv) If a watertight joint is not provided:

(I) The piping, temperature measuring devices, rotary shafts, and other parts extending through the openings shall be equipped with an apron designed to deflect condensation, drips, and dust from openings into the food; and (II) The opening shall be flanged as specified under (ii) of this part.

3. Dispensing Equipment, Protection of Food. - In equipment that dispenses or vends liquid food or ice in unpackaged form:

(i) The delivery tube, chute, orifice, and splash surfaces directly above the container receiving the food shall be designed in a manner, such as with barriers, baffles, or drip aprons, so that drips from condensation and splash are diverted from the opening of the container receiving the food;

(ii) The delivery tube, chute, and orifice shall be protected from manual contact such as by being recessed;

(iii) The delivery tube or chute and orifice of equipment used to vend liquid food or ice in unpackaged form to self-service consumers shall be designed so that the delivery tube or chute and orifice are protected from dust, insects, rodents, and other contamination by a self-closing door if the equipment is:

(I) Located in an outside area that does not otherwise afford the protection of an enclosure against the rain, windblown debris, insects, rodents, and other contaminants that are present in the environment, or (II) Available for self-service during hours when it is not under the fulltime supervision of a food employee; and (iv) The dispensing equipment actuating lever or mechanism and filling device of consumer self-service beverage dispensing equipment shall be designed to prevent contact with the lip-contact surface of glasses or cups that are refilled.

(v) Dispensing equipment in which time/temperature control for safety food in a homogenous liquid form is maintained outside of the temperature control requirements as specified under 1200-23-01-.03(5)(a)6. shall:

(I) Be specifically designed and equipped to maintain the commercial sterility of aseptically packaged food in a homogenous liquid form for a specified duration from the time of opening the packaging within the equipment;

(P) and (II) Conform to the requirements for this equipment as specified in NSF/ANSI 18-2006 - Manual Food and Beverage Dispensing Equipment.

(P)

4. Bearings and Gear Boxes, Leakproof. - Equipment containing bearings and gears that require lubricants shall be designed and constructed so that the lubricant cannot leak, drip, or be forced into food or onto food-contact surfaces.

5. Beverage Tubing, Separation. - Except for cold plates that are constructed integrally with an ice storage bin, beverage tubing and cold-plate beverage cooling devices may not be installed in contact with stored ice.

6. Ice Units, Separation of Drains. - Liquid waste drain lines may not pass through an ice machine or ice storage bin.

7. Condenser Unit, Separation. - If a condenser unit is an integral component of equipment, the condenser unit shall be separated from the food and food storage space by a dustproof barrier.

8. Molluscan Shellfish Tanks.

(i) Except as specified under subpart (ii) of this part, molluscan shellfish life support system display tanks may not be used to store or display shellfish that are offered for human consumption and shall be conspicuously marked so that it is obvious to the consumer that the shellfish are for display only. (P)

(ii) Molluscan shellfish life-support system display tanks that are used to store or display shellfish that are offered for human consumption shall be operated and maintained in accordance with a variance granted by the department as specified in 1200-23-01-.08(1)(d)1. and a HACCP plan that:

(Pf)

(I) Is submitted by the permit holder and approved as specified under 1200-23-01-.08(2);

(Pf) and (II) Ensures that:

I. Water used with fish other than molluscan shellfish does not flow into the molluscan tank, (Pf)

II. The safety and quality of the shellfish as they were received are not compromised by the use of the tank, (Pf) and III. The identity of the source of the shellstock is retained as specified under 1200-23-01-.03(2)(c)1.

(Pf)

9. Temperature Measuring Devices.

(i) In a mechanically refrigerated or hot food storage unit, the sensor of a temperature measuring device shall be located to measure the air temperature or a simulated product temperature in the warmest part of a mechanically refrigerated unit and in the coolest part of a hot food storage unit.

(ii) Except as specified in (iii) of this part, cold or hot holding equipment used for time/temperature control for safety food shall be designed to include and shall be equipped with at least one integral or permanently affixed temperature measuring device that is located to allow easy viewing of the device’s temperature display.

(iii) Subpart (ii) of this part does not apply to equipment for which the placement of a temperature measuring device is not a practical means for measuring the ambient air surrounding the food because of the design, type, and use of the equipment, such as calrod units, heat lamps, cold plates, bainmaries, steam tables, insulated food transport containers, and salad bars.

(iv) Temperature measuring devices shall be designed to be easily readable.

(v) Food temperature measuring devices and water temperature measuring devices on warewashing machines shall have a numerical scale, printed record, or digital readout in increments no greater than 1 ° C or 2 ° F in the intended range of use.

(Pf)

10. Warewashing Machines, Data Plate Operating Specifications. - A warewashing machine shall be provided with an easily accessible and readable data plate affixed to the machine by the manufacturer that indicates the machine’s design and operation specifications including the:

(i) Temperatures required for washing, rinsing, and sanitizing;

(ii) Pressure required for the fresh water sanitizing rinse unless the machine is designed to use only a pumped sanitizing rinse; and (iii) Conveyor speed for conveyor machines or cycle time for stationary rack machines.

11. Warewashing Machines, Internal Baffles. - Warewashing machine wash and rinse tanks shall be equipped with baffles, curtains, or other means to minimize internal cross contamination of the solutions in wash and rinse tanks.

12. Warewashing Machines, Temperature Measuring Devices. - A warewashing machine shall be equipped with a temperature measuring device that indicates the temperature of the water:

(i) In each wash and rinse tank; (Pf) and (ii) As the water enters the hot water sanitizing final rinse manifold or in the chemical sanitizing solution tank.

(Pf)

13. Manual Warewashing Equipment, Heaters and Baskets. - If hot water is used for sanitation in manual warewashing operations, the sanitizing compartment of the sink shall be:

(i) Designed with an integral heating device that is capable of maintaining water at a temperature not less than 77 ° C (171 ° F);

(Pf) and (ii) Provided with a rack or basket to allow complete immersion of equipment and utensils into the hot water.

(Pf)

14. Warewashing Machines, Automatic Dispensing of Detergents and Sanitizers. - A warewashing machine that is installed after adoption of these regulations, shall be equipped to:

(i) Automatically dispense detergents and sanitizers;

(Pf) and (ii) Incorporate a visual means to verify that detergents and sanitizers are delivered or a visual or audible alarm to signal if the detergents and sanitizers are not delivered to the respective washing and sanitizing cycles.

(Pf)

15. Warewashing Machine Flow Pressure Device.

(i) Warewashing machines that provide a fresh hot water sanitizing rinse shall be equipped with a pressure gauge or similar device such as a transducer that measures and displays the water pressure in the supply line immediately before entering the warewashing machine; and (ii) If the flow pressure measuring device is upstream of the fresh hot water sanitizing rinse control valve, the device shall be mounted in a 6.4 millimeter or one-fourth inch Iron Pipe Size (IPS) valve.

(iii) Subparts (i) and (ii) of this part do not apply to a machine that uses only a pumped or recirculated sanitizing rinse.

16. Warewashing Sinks and Drainboards, Self-Draining. - Warewashing sinks and drainboards of warewashing sinks and machines shall be self-draining.

17. Equipment Compartments, Drainage. - Equipment compartments that are subject to accumulation of moisture due to conditions such as condensation, food or beverage drip, or water from melting ice shall be sloped to an outlet that allows complete draining.

18. Case Lot Handling Apparatuses, Movability. - Apparatuses, such as dollies, pallets, racks, and skids used to store and transport large quantities of packaged foods received from a supplier in a cased or overwrapped lot, shall be designed to be moved by hand or by conveniently available apparatuses such as hand trucks and forklifts.

(e) Acceptability 1. Food equipment that is certified or classified for sanitation by an American National Standards Institute (ANSI)-accredited certification program is deemed to comply with 1200-23-01-.04.

(3) Numbers and Capacities (a) Equipment 1. Cooling, Heating, and Holding Capacities. - Equipment for cooling and heating food, and holding cold and hot food, shall be sufficient in number and capacity to provide food temperatures as specified under Rule 1200-23-01-.03. (Pf)

2. Manual Warewashing, Sink Compartment Requirements.

(i) A sink with at least 3 compartments shall be provided for manually washing, rinsing, and sanitizing equipment and utensils. (Pf)

(ii) Sink compartments shall be large enough to accommodate immersion of the largest equipment and utensils. If equipment or utensils are too large for the warewashing sink, a warewashing machine or alternative equipment as specified in (iii) of this subsection shall be used. (Pf)

(iii) Alternative manual warewashing equipment may be used when there are special cleaning needs or constraints, and its use is approved. Alternative warewashing equipment may include:

(I) High-pressure detergent sprayers;

(II) Low or lien pressure spray detergent foamers;

(III) Other task-specific cleaning equipment;

(IV) Brushes or other implements;

(V) Two compartment sinks as specified under (iv) and (v) of this subsection; or, (VI) Receptacles that substitute for the compartments of multicompartment sink.

(iv) Before a two compartment sink is used:

(I) The permit holder shall have its use approved; and, (II) The permit holder shall limit the number of kitchenware items cleaned and sanitized in the two compartment sink and shall limit warewashing to batch operations for cleaning kitchenware such as between cutting one type of raw meat and another or cleanup at the end of a shift, and shall:

I. Make up the cleaning and sanitizing solutions immediately before use and drain them immediately after use, and, II. Use a detergent-sanitizer to sanitize and apply the detergentsanitizer in accordance with the manufacturer’s label instructions and as specified under 1200-23-01-.04(5)(a)15., or, III. Use a hot water sanitization immersion step as specified under 1200-23-01-.04(5)(a)11.

(v) A two compartment sink may not be used for warewashing operations where cleaning and sanitizing solutions are used for continuous or intermittent flow of kitchenware or tableware in an going warewashing process.

(vi) For farmers market food units, at least three (3) dish pans that are large enough to submerge the largest equipment/utensils shall be present at all farmers markets. The dish pans shall be used to wash, rinse and sanitize equipment and utensils. Clean water, dish soap, approved sanitizers and sanitizer test strips shall be utilized and available for inspection.

3. Drainboards. - Drainboards, utensil racks, or tables large enough to accommodate all soiled and cleaned items that may accumulate during hours of operation shall be provided for necessary utensil holding before cleaning and after sanitizing.

4. Ventilation Hood Systems, Adequacy. - Ventilation hood systems and devices shall prevent grease or condensation from collecting on equipment, walls, and ceilings.

5. Clothes Washers and Dryers.

(i) Except as specified in (ii) of this part, if work clothes or linens are laundered on the premises, a mechanical clothes washer and dryer shall be provided and used.

(ii) If on-premises laundering is limited to wiping cloths intended to be used moist, or wiping cloths are air-dried as specified under 1200-23-01- .04(9)(a), a mechanical clothes washer and dryer need not be provided.

(b) Utensils, Temperature Measuring Devices, and Testing Devices.

1. Utensils, Consumer Self-Service. - A food dispensing utensil shall be available for each container displayed at a consumer self-service unit such as a buffet or salad bar. (Pf)

2. Food Temperature Measuring Devices.

(i) Food temperature measuring devices shall be provided and readily accessible for use in ensuring attainment and maintenance of food temperatures as specified under 1200-23-01-.03.

(Pf)

(ii) A temperature measuring device with a suitable small-diameter probe that is designed to measure the temperature of thin masses shall be provided and readily accessible to accurately measure the temperature in thin foods such as meat patties and fish filets.

(Pf)

3. Temperature Measuring Devices, Manual Warewashing. - In manual warewashing operations, a temperature measuring device shall be provided and readily accessible for frequently measuring the washing and sanitizing temperatures.

4. In hot water mechanical warewashing operations, an irreversible registering temperature indicator shall be provided and readily accessible for measuring the utensil surface temperature. (Pf)

5. Sanitizing Solutions, Testing Devices. - A test kit or other device that accurately measures the concentration in mg/L of sanitizing solutions shall be provided. (Pf)

6. Cleaning agents that are used to clean equipment and utensils as specified under 1200-23-01-.04(6) shall be provided and available for use during all hours of operation. (Pf)

7. Except for those that generate on-site at the time of use, chemical sanitizers that are used to sanitize equipment and utensils as specified under 1200-23-01- .04(7), shall be provided and available for use during all hours of operation. (Pf)

(4) Location and Installation (a) Location 1. Equipment, Clothes Washers and Dryers, and Storage Cabinets, Contamination Prevention.

(i) Except as specified in subpart (ii) of this part, equipment, a cabinet used for the storage of food, or a cabinet that is used to store cleaned and sanitized equipment, utensils, laundered linens, and single-service and single-use articles may not be located:

(I) In locker rooms;

(II) In toilet rooms;

(III) In garbage rooms;

(IV) In mechanical rooms;

(V) Under sewer lines that are not shielded to intercept potential drips;

(VI) Under leaking water lines including leaking automatic fire sprinkler heads or under lines on which water has condensed;

(VII) Under open stairwells; or (VIII) Under other sources of contamination.

(ii) A storage cabinet used for linens or single-service or single-use articles may be stored in a locker room.

(iii) If a mechanical clothes washer or dryer is provided, it shall be located so that the washer or dryer is protected from contamination and only where there is no exposed food; clean equipment, utensils, and linens; and unwrapped single-service and single-use articles.

(b) Installation 1. Fixed Equipment, Spacing or Sealing.

(i) Equipment that is fixed because it is not easily movable shall be installed so that it is:

(I) Spaced to allow access for cleaning along the sides, behind, and above the equipment;

(II) Spaced from adjoining equipment, walls, and ceilings a distance of not more than 1 millimeter or one thirty-second inch; or (III) Sealed to adjoining equipment or walls, if the equipment is exposed to spillage or seepage.

(ii) Counter-mounted equipment that is not easily movable shall be installed to allow cleaning of the equipment and areas underneath and around the equipment by being:

(I) Sealed; or (II) Elevated on legs as specified under 1200-23-01-.04(4)(b)2.(iv).

2. Fixed Equipment, Elevation or Sealing.

(i) Except as specified in subparts (ii) and (iii) of this part, floor-mounted equipment that is not easily movable shall be sealed to the floor or elevated on legs that provide at least a 15 centimeter (6 inch) clearance between the floor and the equipment.

(ii) If no part of the floor under the floor-mounted equipment is more than 15 centimeters (6 inches) from the point of cleaning access, the clearance space may be only 10 centimeters (4 inches).

(iii) This subsection does not apply to display shelving units, display refrigeration units, and display freezer units located in the consumer shopping areas of a retail food store, if the floor under the units is maintained clean.

(iv) Except as specified in (v) of this part, counter-mounted equipment that is not easily movable shall be elevated on legs that provide at least a 10 centimeter (4 inch) clearance between the table and the equipment.

(v) The clearance space between the table and counter-mounted equipment may be:

(I) 7.5 centimeters (3 inches) if the horizontal distance of the table top under the equipment is no more than 50 centimeters (20 inches) from the point of access for cleaning; or (II) 5 centimeters (2 inches) if the horizontal distance of the table top under the equipment is no more than 7.5 centimeters (3 inches) from the point of access for cleaning.

(5) Maintenance and Operation (a) Equipment 1. Good Repair and Proper Adjustment.

(i) Equipment shall be maintained in a state of repair and condition that meets the requirements specified under 1200-23-01-.04(1) and 1200-23-01-.04(2)

(ii) Equipment components such as doors, seals, hinges, fasteners, and kick plates shall be kept intact, tight, and adjusted in accordance with manufacturer’s specifications.

(iii) Cutting or piercing parts of can openers shall be kept sharp to minimize the creation of metal fragments that can contaminate food when the container is opened.

2. Cutting Surfaces. - Surfaces such as cutting blocks and boards that are subject to scratching and scoring shall be resurfaced if they can no longer be effectively cleaned and sanitized, or discarded if they are not capable of being resurfaced.

3. Microwave Ovens. - Microwave ovens shall meet the safety standards specified in 21CFR § 1030.10 Microwave ovens.

4. Warewashing Equipment, Cleaning Frequency. - A warewashing machine; the compartments of sinks, basins, or other receptacles used for washing and rinsing equipment, utensils, or raw foods, or laundering wiping cloths; and drainboards or other equipment used to substitute for drainboards as specified under 1200- 23-01-.04(3)(a)3. shall be cleaned:

(i) Before use;

(ii) Throughout the day at a frequency necessary to prevent recontamination of equipment and utensils and to ensure that the equipment performs its intended function; and (iii) If used, at least every 24 hours.

5. Warewashing Machines, Manufacturers’ Operating Instructions.

(i) A warewashing machine and its auxiliary components shall be operated in accordance with the machine’s data plate and other manufacturer’s instructions.

(ii) A warewashing machine’s conveyor speed or automatic cycle times shall be maintained accurately timed in accordance with manufacturer’s specifications.

6. Warewashing Sinks, Use Limitation.

(i) A warewashing sink may not be used for handwashing as specified under 1200-23-01-.02(3)(d).

(ii) If a warewashing sink is used to wash wiping cloths, wash produce, or thaw food, the sink shall be cleaned as specified under 1200-23-01- .04(5)(a)4. before and after each time it is used to wash wiping cloths or wash produce or thaw food. Sinks used to wash or thaw food shall be sanitized as specified under 1200-23-01-.04(7) before and after using the sink to wash produce or thaw food.

7. Warewashing Equipment, Cleaning Agents. - When used for warewashing, the wash compartment of a sink, mechanical warewasher, or wash receptacle of alternative manual warewashing equipment as specified in 1200-23-01- .04(3)(a)2. shall contain a wash solution of soap, detergent, acid cleaner, alkaline cleaner, degreaser, abrasive cleaner, or other cleaning agent according to the cleaning agent manufacturer’s label instructions.

(Pf)

8. Warewashing Equipment, Clean Solutions. - The wash, rinse, and sanitize solutions shall be maintained clean.

9. Manual Warewashing Equipment, Wash Solution Temperature. - The temperature of the wash solution in manual warewashing equipment shall be maintained at not less than 43°C (110 o F) or the temperature specified on the cleaning agent manufacturer’s label instructions.

(Pf)

10. Mechanical Warewashing Equipment, Wash Solution Temperature.

(i) The temperature of the wash solution in spray type warewashers that use hot water to sanitize may not be less than:

(I) For a stationary rack, single temperature machine, 74°C (165°F);

(Pf)

(II) For a stationary rack, dual temperature machine, 66°C (150°F); (Pf)

(III) For a single tank, conveyor, dual temperature machine, 71°C (160°F);

(Pf) or (IV) For a multitank, conveyor, multitemperature machine, 66°C (150°F).

(Pf)

(ii) The temperature of the wash solution in spray-type warewashers that use chemicals to sanitize may not be less than 49°C (120°F).

(Pf)

11. Manual Warewashing Equipment, Hot Water Sanitization Temperatures. - If immersion in hot water is used for sanitizing in a manual operation, the temperature of the water shall be maintained at 77°C (171°F) or above. (P)

12. Mechanical Warewashing Equipment, Hot Water Sanitization Temperatures.

(i) Except as specified in subpart (ii) of this part, in a mechanical operation, the temperature of the fresh hot water sanitizing rinse as it enters the manifold may not be more than 90°C (194°F), or less than:

(Pf)

(I) For a stationary rack, single temperature machine, 74°C (165°F);

(Pf) or (II) For all other machines, 82°C (180°F).

(Pf)

(ii) The maximum temperature specified under subpart (i) of this part, does not apply to the high pressure and temperature systems with wand-type, handheld, spraying devices used for the in-place cleaning and sanitizing of equipment such as meat saws.

13. Mechanical Warewashing Equipment, Sanitization Pressure. - The flow pressure of the fresh hot water sanitizing rinse in a warewashing machine, as measured in the water line immediately downstream or upstream from the fresh hot water sanitizing rinse control value, shall be within the range specified on the machine manufacturer’s data plate and may not be less than 35 kilopascals (5 pounds per square inch) or more than 200 kilopascals (30 pounds per square inch).

14. Manual and Mechanical Warewashing Equipment, Chemical Sanitization - Temperature, pH, Concentration, and Hardness. - A chemical sanitizer used in a sanitizing solution for a manual or mechanical operation at contact times specified under 1200-23-01-.04(7)(c) shall meet the criteria specified under 1200-23-01-.07(2)(d)1. Sanitizers, Criteria, shall be used in accordance with the EPA-registered label use instructions, and shall be used as follows (P):

(i) A chlorine solution shall have a minimum temperature based on the concentration and pH of the solution as listed in the following chart; ( P)

Concentration Range Minimum Temperature mg/L pH 10 or less °C (°F) pH 8 or less °C (°F) 25-49 49 (120) 49 (120) 50-99 38 (100) 24 (75) 100 13 (55) 13 (55)

(ii) An iodine solution shall have a:

(I) Minimum temperature of 20°C (68°F), (P)

(II) A pH of 5.0 or less or a pH no higher than the level for which the manufacturer specifies the solution is effective, (P) and (III) Concentration between 12.5 mg/L and 25 mg/L;

(P)

(iii) A quaternary ammonium compound solution shall:

(I) Have a minimum temperature of 24°C (75°F), (P)

(II) Have a concentration as specified under 1200-23-01-.07(2)(d)1. and as indicated by the manufacturer’s use directions included in the labeling, (P) and (III) Be used only in water with 500 mg/L hardness or less or in water having a hardness no greater than specified by the EPA-registered label use instructions;

(P)

(iv) If another solution of a chemical specified under subparts (i)–(iii) of this

part is used, the permit holder shall demonstrate to the department that the solution achieves sanitization and the use of the solution shall be approved;

(P) or (v) If a chemical sanitizer other than chlorine, iodine, or a quaternary ammonium compound is used, it shall be applied in accordance with the EPA-registered label use instructions.

(P)

(vi) If a chemical sanitizer is generated by a device located on-site at the food establishment, it shall be used as specified in (i)–(iv) of this subsection and shall be produced by a device that:

(I) Complies with regulations as specified in §§ 2(q)(1) and 12 of the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA), (P);

(II) Complies with 40 CFR 152.500 Requirement for Devices and 40 CFR 156.10 Labeling Requirements;

(III) Displays the EPA device manufacturing facility registration number on the device; (Pf) and, (IV) Is operated and maintained in accordance with manufacturer’s instructions (Pf).

15. Manual Warewashing Equipment, Chemical Sanitization Using Detergent- Sanitizers. - If a detergent-sanitizer is used to sanitize in a cleaning and sanitizing procedure where there is no distinct water rinse between the washing and sanitizing steps, the agent applied in the sanitizing step shall be the same detergent-sanitizer that is used in the washing step.

16. Warewashing Equipment, Determining Chemical Sanitizer Concentration. - Concentration of the sanitizing solution shall be accurately determined by using a test kit or other device.

(Pf)

(b) Utensils and Temperature and Pressure Measuring Devices 1. Good Repair and Calibration.

(i) Utensils shall be maintained in a state of repair or condition that complies with the requirements specified under 1200-23-01-.04(1) and 1200-23-01- .04(2) or shall be discarded.

(ii) Food temperature measuring devices shall be calibrated in accordance with manufacturer’s specifications as necessary to ensure their accuracy.

(Pf)

(iii) Ambient air temperature, water pressure, and water temperature measuring devices shall be maintained in good repair and be accurate within the intended range of use.

2. Single-Service and Single-Use Articles, Required Use. - A food establishment without facilities specified under 1200-23-01-.04(6) and 1200-23-01-.04(7) for cleaning and sanitizing kitchenware and tableware shall provide only single-use kitchenware, single-service articles, and single-use articles for use by food employees and single-service articles for use by consumers. (P)

3. Single-Service and Single-Use Articles, Use Limitation.

(i) Single-service and single-use articles may not be reused.

(ii) The bulk milk container dispensing tube shall be cut on the diagonal leaving no more than one inch protruding from the chilled dispensing head.

4. Shells, Use Limitation. - Mollusk and crustacean shells may not be used more than once as serving containers.

(6) Cleaning of Equipment and Utensils (a) Objective 1. Equipment, Food-Contact Surfaces, Nonfood-Contact Surfaces, and Utensils.

(i) Equipment food-contact surfaces and utensils shall be clean to sight and touch. (Pf)

(ii) The food-contact surfaces of cooking equipment and pans shall be kept free of encrusted grease deposits and other soil accumulations.

(iii) Nonfood-contact surfaces of equipment shall be kept free of an accumulation of dust, dirt, food residue, and other debris.

(b) Frequency 1. Equipment Food-Contact Surfaces and Utensils.

(i) Equipment food-contact surfaces and utensils shall be cleaned:

(I) Except as specified in (ii) of this part, before each use with a different type of raw animal food such as beef, fish, lamb, pork, or poultry;

(P)

(II) Each time there is a change from working with raw foods to working with ready-to-eat foods; (P)

(III) Between uses with raw fruits and vegetables and with time/temperature control for safety food;

(P)

(IV) Before using or storing a food temperature measuring device; (P) and (V) At any time during the operation when contamination may have occurred. (P)

(ii) Item (i)(I) of this part does not apply if the food-contact surface or utensil is in contact with a succession of different raw animal foods each requiring a higher cooking temperature as specified under 1200-23-01-.03(4)(a)1. than the previous food, such as preparing raw fish followed by cutting raw poultry on the same cutting board.

(iii) Except as specified in subpart (iv) of this part, if used with time/temperature control for safety food, equipment food-contact surfaces and utensils shall be cleaned throughout the day at least every 4 hours. (P)

(iv) Surfaces of utensils and equipment contacting time/temperature control for safety food may be cleaned less frequently than every 4 hours if:

(I) In storage, containers of time/temperature control for safety food and their contents are maintained at temperatures specified under 1200- 23-01-.03 and the containers are cleaned when they are empty;

(II) Utensils and equipment are used to prepare food in a refrigerated room or area that is maintained at one of the temperatures in the following chart and:

I. The utensils and equipment are cleaned at the frequency in the following chart that corresponds to the temperature; and Temperature Cleaning Frequency 5.0°C (41°F) or less 24 hours >5.0°C - 7.2°C 20 hours (>41°F - 45°F) >7.2°C - 10.0°C 16 hours (>45°F- 50°F) >10.0°C - 12.8°C 10 hours (>50°F - 55°F)

II. The cleaning frequency based on the ambient temperature of the refrigerated room or area is documented in the food establishment.

(III) Containers in serving situations such as salad bars, delis, and cafeteria lines hold ready-to-eat time/temperature control for safety food that is maintained at the temperatures specified under 1200-23- 01-.03, are intermittently combined with additional supplies of the same food that is at the required temperature, and the containers are cleaned at least every 24 hours;

(IV) Temperature measuring devices are maintained in contact with food, such as when left in a container of deli food or in a roast, held at temperatures specified under 1200-23-01-.03;

(V) Equipment is used for storage of packaged or unpackaged food such as a reach-in refrigerator and the equipment is cleaned at a frequency necessary to preclude accumulation of soil residues;

(VI) The cleaning schedule is approved based on consideration of:

I. Characteristics of the equipment and its use, II. The type of food involved, III. The amount of food residue accumulation, and IV. The temperature at which the food is maintained during the operation and the potential for the rapid and progressive multiplication of pathogenic or toxigenic microorganisms that are capable of causing foodborne disease; or (VII) In-use utensils are intermittently stored in a container of water in which the water is maintained at 57°C (135°F) or more and the utensils and container are cleaned at least every 24 hours or at a frequency necessary to preclude accumulation of soil residues.

(v) Except when dry cleaning methods are used as specified under 1200-23- 01-.04(6)(c)1., surfaces of utensils and equipment contacting food that is not time/temperature control for safety food shall be cleaned:

(I) At any time when contamination may have occurred;

(II) At least every 24 hours for iced tea dispensers and consumer selfservice utensils such as tongs, scoops, or ladles;

(III) Before restocking consumer self-service equipment and utensils such as condiment dispensers and display containers; and (IV) In equipment such as ice bins and beverage dispensing nozzles and enclosed components of equipment such as ice makers, cooking oil storage tanks and distribution lines, beverage and syrup dispensing lines or tubes, coffee bean grinders, and water vending equipment:

I. At a frequency specified by the manufacturer, or II. Absent manufacturer specifications, at a frequency necessary to preclude accumulation of soil or mold.

2. Cooking and Baking Equipment.

(i) The food-contact surfaces of cooking and baking equipment shall be cleaned at least every 24 hours. This subsection does not apply to hot oil cooking and filtering equipment if it is cleaned as specified in 1200-23-01- .04(6)(b)1.(iv)(VI).

(ii) The cavities and door seals of microwave ovens shall be cleaned at least every 24 hours by using the manufacturer’s recommended cleaning procedure.

3. Nonfood-Contact Surfaces. - Nonfood-contact surfaces of equipment shall be cleaned at a frequency necessary to preclude accumulation of soil residues.

(c) Methods 1. Dry Cleaning.

(i) If used, dry cleaning methods such as brushing, scraping, and vacuuming shall contact only surfaces that are soiled with dry food residues that are not time/temperature control for safety food.

(ii) Cleaning equipment used in dry cleaning food-contact surfaces may not be used for any other purpose.

2. Precleaning.

(i) Food debris on equipment and utensils shall be scrapped over a waste disposal unit or garbage receptacle or shall be removed in a warewashing machine with a prewash cycle.

(ii) If necessary for effective cleaning, utensils and equipment shall be preflushed, presoaked, or scrubbed with abrasives.

3. Loading of Soiled Items, Warewashing Machines. - Soiled items to be cleaned in a warewashing machine shall be loaded into racks, trays, or baskets or onto conveyors in a position that:

(i) Exposes the items to the unobstructed spray from all cycles; and (ii) Allows the items to drain.

4. Wet Cleaning.

(i) Equipment, food-contact surfaces and utensils shall be effectively washed to remove or completely loosen soils by using the manual or mechanical means necessary such as the application of detergents containing wetting agents and emulsifiers; acid, alkaline, or abrasive cleaners; hot water; brushes; scouring pads; high-pressure sprays; or ultrasonic devices.

(ii) The washing procedures selected shall be based on the type and purpose of the equipment or utensil, and on the type of soil to be removed.

5. Washing, Procedures for Alternative Manual Warewashing Equipment. - If washing in sink compartments or a warewashing machine is impractical such as when the equipment is fixed or the utensils are too large, washing shall be done in accordance with the following procedures:

(i) Equipment shall be disassembled as necessary to allow access of the detergent solution to all parts;

(ii) Equipment components and utensils shall be scrapped or rough cleaned to remove food particle accumulation; and (iii) Equipment and utensils shall be washed as specified under 1200-23-01- .04(6)(c)4.(i).

6. Rinsing Procedures. - Washed utensils and equipment shall be rinsed so that abrasives are removed and cleaning chemicals are removed or diluted through use of water or a detergent-sanitizer solution by using one of the following procedures:

(i) Use of a distinct, separate water rinse after washing and before sanitizing if using:

(I) A three compartment sink;

(II) Alternative manual warewashing equipment equivalent to a three compartment sink as specified in 1200-23-01-.04(3)(a)2.(iii); or, (III) A three-step washing, rinsing, and sanitizing procedure in a warewashing system for CIP equipment.

(ii) Use of a detergent-sanitizer as specified under 1200-23-01.04(5)(a)15. if using:

(I) Alternative warewashing equipment as specified in 1200-23- 01.04(3)(a)2.(iii) that is approved for use with detergent-sanitizer; or, (II) A warewashing system for CIP equipment.

(iii) Use of a nondistinct water rinse that is integrated in the hot water sanitization immersion step of a two compartment sink;

(iv) If using a warewashing machine that does not recycle the sanitizing solution as specified under (v) of this subsection, or alternative manual warewashing equipment such as sprayers, use of nondistinct water rise that is:

(I) Integrated in the application of the sanitizing solution; and, (II) Wasted immediately after each application; or (v) If using a warewashing machine that recycles the sanitizing solution for use in the next wash cycle, use of a nondistinct water rinse that is integrated in the application of the sanitizing solution.

(7) Sanitization of Equipment and Utensils (a) Objective – Food-Contact Surfaces and Utensils. - Equipment, food-contact surfaces and utensils shall be sanitized.

(b) Frequency – Before Use After Cleaning. - Utensils and food-contact surfaces of equipment shall be sanitized before use after cleaning. (P)

(c) Methods – Hot Water and Chemical. - After being cleaned, equipment, food-contact surfaces and utensils shall be sanitized in:

1. Hot water manual operations by immersion for at least 30 seconds and as specified under 1200-23-01-.04(5)(a)11.; (P)

2. Hot water mechanical operations by being cycled through equipment that is set up as specified under 1200-23-01-.04(5)(a)5., 1200-23-01-.04(5)(a)12., and 1200-23-01-.04(5)(a)13. and achieving a utensil surface temperature of 71°C (160°F) as measured by an irreversible registering temperature indicator; (P) or 3. Chemical manual or mechanical operations, including the application of sanitizing chemicals by immersion, manual swabbing, brushing, or pressure spraying methods, using a solution as specified under 1200-23-01-.04(5)(a)14. Contact times shall be consistent with those on EPA-registered label use instructions by providing:

(i) Except as specified under part (c)2. of this subparagraph, a contact time of at least 10 seconds for a chlorine solution specified under 1200-23-01- .04(5)(a)14.(i) , (P)

(ii) A contact time of at least 7 seconds for a chlorine solution of 50 mg/L that has a pH of 10 or less and a temperature of at least 38°C (100°F) or a pH of 8 or less and a temperature of at least 24°C (75°F), (P)

(iii) A contact time of at least 30 seconds for other chemical sanitizing solutions, (P) or (iv) A contact time used in relationship with a combination of temperature, concentration, and pH that, when evaluated for efficacy, yields sanitization as defined in 1200-23-01-.01. (P)

(8) Laundering (a) Objective – Clean Linens. - Clean linens shall be free from food residues and other soiling matter.

(b) Frequency – Specifications.

1. Linens that do not come in direct contact with food shall be laundered between operations if they become wet, sticky, or visibly soiled.

2. Cloth gloves used as specified in 1200-23-01-.03(3)(d)5. shall be laundered before being used with a different type of raw animal food such as beef, fish, lamb, pork or poultry.

3. Linens and cloth napkins that are used as specified under 1200-23-01-.03(3)(d)3. and cloth napkins shall be laundered between each use.

4. Wet wiping cloths shall be laundered daily.

5. Dry wiping cloths shall be laundered as necessary to prevent contamination of food and clean serving utensils.

(c) Methods.

1. Storage of Soiled Linens. - Soiled linens shall be kept in clean, nonabsorbent receptacles or clean, washable laundry bags and stored and transported to prevent contamination of food, clean equipment, clean utensils, and singleservice and single-use articles.

2. Mechanical Washing.

(i) Except as specified in (ii) of this part, linens shall be mechanically washed.

(ii) In food establishments in which only wiping cloths are laundered as specified in 1200-23-01-.04(3)(a)5.(ii) the wiping cloths may be laundered in a mechanical washer, sink designated only for laundering wiping cloths, or a warewashing or food preparation sink that is cleaned as specified under 1200-23-01-.04(5)(a)14.

3. Use of Laundry Facilities.

(i) Except as specified in subpart (ii) of this part, laundry facilities on the premises of a food establishment shall be used only for the washing and drying of items used in the operation of the establishment.

(ii) Separate laundry facilities located on the premises for the purpose of general laundering such as for institutions providing boarding and lodging may also be used for laundering food establishment items.

(9) Protection of Clean Items (a) Drying 1. Equipment and Utensils, Air-Drying Required. - After cleaning and sanitizing, equipment and utensils:

(i) Shall be air-dried or used after adequate draining as specified in the first paragraph of 40 CFR § 180.940 Tolerance exemptions for active and inert ingredients for use in antimicrobial formulations (food-contact surface sanitizing solutions), before contact with food; and (ii) May not be cloth dried except that utensils that have been air-dried may be polished with cloths that are maintained clean and dry.

2. Wiping Cloths, Air-Drying Locations. Wiping cloths laundered in a food establishment that does not have a mechanical clothes dryer as specified in 1200-23-01-.04(3)(a)5.(ii) shall be air-dried in a location and in a manner that prevents contamination of food, equipment, utensils, linens, and single-service and single-use articles and the wiping cloths. This subsection does not apply if wiping cloths are stored after laundering in a sanitizing solution as specified under 1200-23-01-.04(5)(a)14.

(b) Lubricating and Reassembling 1. Food-Contact Surfaces. Lubricants as specified under 1200-23-01-.07(2)(e) shall be applied to food-contact surfaces that require lubrication in a manner that does not contaminate food-contact surfaces.

2. Equipment. Equipment shall be reassembled so that food-contact surfaces are not contaminated.

(c) Storing 1. Equipment, Utensils, Linens, and Single-Service and Single-Use Articles.

(i) Except as specified in subpart (iv) of this part, cleaned equipment and utensils, laundered linens, and single-service and single-use articles shall be stored:

(I) In a clean, dry location;

(II) Where they are not exposed to splash, dust, or other contamination; and (III) At least 15 cm (6 inches) above the floor.

(ii) Clean equipment and utensils shall be stored as specified under (i) of this

part and shall be stored:

(I) In a self-draining position that allows air drying; and (II) Covered or inverted.

(iii) Single-service and single-use articles shall be stored as specified under (i) of this part and shall be kept in the original protective package or stored by using other means that afford protection from contamination until used.

(iv) Items that are kept in closed packages may be stored less than 15 cm (6 inches) above the floor on dollies, pallets, racks, and skids that are designed as specified under 1200-23-01-.04(2)(d)18.

2. Prohibitions.

(i) Except as specified in subpart (ii) of this part, cleaned and sanitized equipment, utensils, laundered linens, and single-service and single-use articles may not be stored:

(I) In locker rooms;

(II) In toilet rooms;

(III) In garbage rooms;

(IV) In mechanical rooms;

(V) Under sewer lines that are not shielded to intercept potential drips;

(VI) Under leaking water lines including leaking automatic fire sprinkler heads or under lines on which water has condensed;

(VII) Under open stairwells; or (VIII) Under other sources of contamination.

(ii) Laundered linens and single-service and single-use articles that are packaged or in a facility such as a cabinet may be stored in a locker room.

(d) Preventing Contamination 1. Kitchenware and Tableware.

(i) Single-service and single-use articles and cleaned and sanitized utensils shall be handled, displayed, and dispensed so that contamination of foodand lip-contact surfaces is prevented.

(ii) Knives, forks, and spoons that are not prewrapped shall be presented so that only the handles are touched by employees and by consumers if consumer self-service is provided.

(iii) Except as specified under subpart (ii) of this part, single-service articles that are intended for food- or lip-contact shall be furnished for consumer self-service with the original individual wrapper intact or from an approved dispenser.

2. Soiled and Clean Tableware. Soiled tableware shall be removed from consumer eating and drinking areas and handled so that clean tableware is not contaminated.

3. Preset Tableware.

(i) Except as specified in subpart (ii) of this part, tableware that is preset shall be protected from contamination by being wrapped, covered, or inverted.

(ii) Preset tableware may be exposed if:

(I) Unused settings are removed when a consumer is seated; or (II) Settings not removed when a consumer is seated are cleaned and sanitized before further use.

4. Rinsing Equipment and Utensils after Cleaning and Sanitizing. After being cleaned and sanitized, equipment and utensils shall not be rinsed before air drying or use unless:

(i) The rinse is applied directly from a potable water supply by a warewashing machine that is maintained and operated as specified under 1200-23-01- .04(2)(d) and 1200-23-01-.04(5); and (ii) The rinse is applied only after the equipment and utensils have been sanitized by the application of hot water or by the application of a chemical sanitizer solution whose EPA-registered label use instructions call for rinsing off the sanitizer after it is applied in a commercial warewashing machine.

History

• Authority: T.C.A. §§ 68-14-701 through 68-14-729.
• Administrative History: Original rule filed March 26, 1987; effective May 9, 1987. Amendment filed February 14, 1989; effective March 31, 1989. Repeal filed March 13, 2000; effective May 27, 2000. New rule filed August 24, 2000; effective November 7, 2000. Amendment filed October 22, 2004; effective January 5, 2005. Repeal and new rule filed April 17, 2015; effective July 16, 2015. Emergency rules filed April 9, 2024; effective through October 6, 2024. Amendments filed July 1, 2024; effective September 29, 2024. Amendments filed March 16, 2026; effective June 14, 2026.

Tenn. Comp. R. & Regs. 1200-23-01-.05 WATER, PLUMBING, AND WASTE

(1) Water (a) Source 1. Approved System. - Drinking water shall be obtained from an approved source that is:

(i) A public water system; (P) or (ii) A nonpublic water system that is constructed, maintained, and operated according to law. (P)

2. System Flushing and Disinfection. A drinking water system shall be flushed and disinfected before being placed in service after construction, repair, or modification and after an emergency situation, such as a flood, that may introduce contaminants to the system. (P)

3. Bottled Drinking Water. Bottled drinking water used or sold in a food establishment shall be obtained from approved sources in accordance with 21 CFR Part 129 - Processing and Bottling of Bottled drinking water. (P)

(b) Quality 1. Standards. Except as specified under 1200-23-01-.05(1)(b)2.:

(i) Water from a public water system shall meet 40 CFR Part 141 - National Primary Drinking Water Regulations and state drinking water quality standards; and (P)

(ii) Water from a nonpublic water system shall meet state drinking water quality standards. (P)

2. Nondrinking Water.

(i) A nondrinking water supply shall be used only if its use is approved (P).

(ii) Nondrinking water shall be used only for nonculinary purposes such as air conditioning, nonfood equipment cooling, and fire protection. (P)

3. Sampling. Except when used as specified under 1200-23-01-.05(1)(b)2., water from a nonpublic water system shall be sampled and tested at least annually and as required by state water quality regulations. (Pf)

4. Sample Report. The most recent sample report for the nonpublic water system shall be retained on file in the food establishment or the report shall be maintained as specified by state water quality regulations.

(c) Quantity and Availability 1. Capacity.

(i) The water source and system shall be of sufficient capacity to meet the peak water demands of the food establishment. (Pf)

(ii) Hot water generation and distribution systems shall be sufficient to meet the peak hot water demands throughout the food establishment. (Pf)

2. Pressure. Water under pressure shall be provided to all fixtures, equipment, and nonfood equipment that are required to use water except that water supplied as specified under 1200-23-01-.05(1)(d)2.(i) and (ii) to a temporary food establishment or in response to a temporary interruption of a water supply need not be under pressure. (Pf)

(d) Distribution, Delivery, and Retention 1. System. Water shall be received from the source through the use of:

(i) An approved public water main (Pf); or (ii) One or more of the following that shall be constructed, maintained, and operated according to law: (Pf)

(I) Nonpublic water main, water pumps, pipes, hoses, connections, and other appurtenances, (Pf)

(II) Water transport vehicles, (Pf) or (III) Water containers. (Pf)

2. Alternative Water Supply. Water meeting the requirements specified under 1200- 23-01-.05(1)(a), 1200-23-01-.05(1)(b), and 1200-23-01-.05(1)(c) shall be made available for a mobile facility, for a temporary food establishment without a permanent water supply, and for a food establishment with a temporary interruption of its water supply through:

(i) A supply of containers of commercially bottled drinking water; (Pf)

(ii) One or more closed portable water containers; (Pf)

(iii) An enclosed vehicular water tank; (Pf)

(iv) An on-premises water storage tank; or (Pf)

(v) Piping, tubing, or hoses connected to an adjacent approved source. (Pf)

(2) Plumbing System (a) Materials - Approved 1. A plumbing system and hoses conveying water shall be constructed and repaired with approved materials according to law. (P)

2. A water filter shall be made of safe materials. (P)

(b) Design, Construction, and Installation 1. Approved System and Cleanable Fixtures.

(i) A plumbing system shall be designed, constructed, and installed according to law. (P)

(ii) A plumbing fixture such as a handwashing sink, toilet, or urinal shall be easily cleanable.

2. Handwashing Sink, Installation.

(i) A handwashing sink shall be equipped to provide water at a temperature of at least 30°C (85°F) through a mixing valve or combination faucet. (Pf)

(ii) A steam-mixing valve may not be used at a handwashing sink.

(iii) A self-closing, slow-closing, or metering faucet shall provide a flow of water for at least 15 seconds without the need to reactivate the faucet.

(iv) An automatic handwashing facility shall be installed in accordance with manufacturer’s instructions.

3. Backflow Prevention, Air Gap. An air gap between the water supply inlet and the flood level rim of the plumbing fixture equipment, or nonfood equipment shall be at least twice the diameter of the water supply inlet and may not be less than 25 mm (1 inch). (P)

4. Backflow Prevention Device, Design Standard. A backflow or backsiphonage prevention device installed on a water supply system shall meet American Society of Sanitary Engineering (A.S.S.E.) standards for construction, installation, maintenance, inspection, and testing for that specific application and type of device. (P)

5. Conditioning Device, Design. A water filter, screen, and other water conditioning device installed on water lines shall be designed to facilitate disassembly for periodic servicing and cleaning. A water filter element shall be of the replaceable type.

(c) Numbers and Capacities 1. Handwashing Sinks.

(i) Except as specified in subpart (ii) of this part, at least 1 handwashing sink, a number of handwashing sinks necessary for their convenient use by employees in areas specified under 1200-23-01-.05(2)(d)1., and not fewer than the number of handwashing sinks required by law shall be provided.

(Pf)

(ii) If approved and capable of removing the types of soils encountered in the food operations involved, automatic handwashing facilities may be substituted for handwashing sinks in a food establishment that has at least 1 handwashing sink.

2. Toilets and Urinals. At least 1 toilet and not fewer than the toilets required by law shall be provided. If the food service establishment has more than 16 seats, two restrooms must be available. If authorized by law and urinals are substituted for toilets, the substitution shall be done as specified in law.

3. Service Sink.

(i) At least 1 service sink or 1 curbed cleaning facility equipped with a floor drain shall be provided and conveniently located for the cleaning of mops or similar wet floor cleaning tools and for the disposal of mop water and similar liquid waste.

(ii) Toilets and urinals may not be used as a service sink for the disposal of mop water and similar liquid waste.

4. Backflow Prevention Device, When Required. A plumbing system shall be installed to preclude backflow of a solid, liquid, or gas contaminant into the water supply system at each point of use at the food establishment, including on a hose bibb if a hose is attached or on a hose bibb if a hose is not attached and backflow prevention is required by law, by:

(i) Providing an air gap as specified under 1200-23-01-.05(2)(b)3.; (P) or (ii) Installing an approved backflow prevention device as specified under 1200-23-01-.05(2)(b)4. (P)

5. Backflow Prevention Device, Carbonator.

(i) If not provided with an air gap as specified under 1200-23-01-.05(2)(b)3., a dual check valve with an intermediate vent preceded by a screen of not less than 100 mesh to 25.4 mm (100 mesh to 1 inch) shall be installed upstream from a carbonating device and downstream from any copper in the water supply line.

(ii) A dual check valve attached to the carbonator need not be of the vented type if an air gap or vented backflow prevention device has been otherwise provided as specified under subpart (i) of this part.

(d) Location and Placement 1. Handwashing sinks shall be located:

(i) To allow convenient use by employees in food preparation, food dispensing, and warewashing areas; (Pf) and (ii) In, or immediately adjacent to, toilet rooms. (Pf)

2. Backflow Prevention Device, Location. A backflow prevention device shall be located so that it may be serviced and maintained.

3. Conditioning Device, Location. A water filter, screen, and other water conditioning device installed on water lines shall be located to facilitate disassembly for periodic servicing and cleaning.

(e) Operation and Maintenance 1. Using a Handwashing Sink.

(i) A handwashing sink shall be maintained so that it is accessible at all times for employee use. (Pf)

(ii) A handwashing sink may not be used for purposes other than handwashing. (Pf)

(iii) An automatic handwashing facility shall be used in accordance with manufacturer’s instructions. (Pf)

2. Prohibiting a Cross Connection.

(i) A person may not create a cross connection by connecting a pipe or conduit between the drinking water system and a nondrinking water system or a water system of unknown quality. (P)

(ii) The piping of a nondrinking water system shall be durably identified so that it is readily distinguishable from piping that carries drinking water. (Pf)

3. Scheduling Inspection and Service for a Water System Device. A device such as a water treatment device or backflow preventer shall be scheduled for inspection and service, in accordance with manufacturer’s instructions and as necessary to prevent device failure based on local water conditions, and records demonstrating inspection and service shall be maintained by the person in charge. (Pf)

4. Water Reservoir of Fogging Devices, Cleaning.

(i) A reservoir that is used to supply water to a device such as a produce fogger shall be:

(I) Maintained in accordance with manufacturer’s specifications; (P) and (II) Cleaned in accordance with manufacturer’s specifications or according to the procedures specified under subpart (ii) of this part, whichever is more stringent. (P)

(ii) Cleaning procedures shall include at least the following steps and shall be conducted at least once a week:

(I) Draining and complete disassembly of the water and aerosol contact parts; (P)

(II) Brush-cleaning the reservoir, aerosol tubing, and discharge nozzles with a suitable detergent solution; (P)

(III) Flushing the complete system with water to remove the detergent solution and particulate accumulation; (P) and (IV) Rinsing by immersing, spraying, or swabbing the reservoir, aerosol tubing, and discharge nozzles with at least 50 MG/L hypochlorite solution. (P)

5. System Maintained in Good Repair. A plumbing system shall be:

(i) Repaired according to law; (P) and (ii) Maintained in good repair. (P)

(3) Mobile Water Tanks and Mobile Food Establishment Water Tanks (a) Materials that are used in the construction of a mobile water tank, mobile food establishment water tank, and appurtenances shall be:

1. Safe; (P)

2. Durable, corrosion-resistant, and nonabsorbent; and 3. Finished to have a smooth, easily cleanable surface.

(b) Design and Construction 1. Enclosed System, Sloped to Drain. A mobile water tank shall be:

(i) Enclosed from the filling inlet to the discharge outlet; and (ii) Sloped to an outlet that allows complete drainage of the tank.

2. Inspection and Cleaning Port, Protected and Secured. If a water tank is designed with an access port for inspection and cleaning, the opening shall be in the top of the tank and:

(i) Flanged upward at least 13 mm (one-half inch); and (ii) Equipped with a port cover assembly that is:

(I) Provided with a gasket and a device for securing the cover in place, and (II) Flanged to overlap the opening and sloped to drain.

3. “V” Type Threads, Use Limitation. A fitting with “V” type threads on a water tank inlet or outlet shall be allowed only when a hose is permanently attached.

4. Tank Vent, Protected. If provided, a water tank vent shall terminate in a downward direction and shall be covered with:

(i) 16 mesh to 25.4 mm (16 mesh to 1 inch) screen or equivalent when the vent is in a protected area; or (ii) A protective filter when the vent is in an area that is not protected from windblown dirt and debris.

5. Inlet and Outlet, Sloped to Drain.

(i) A water tank and its inlet and outlet shall be sloped to drain.

(ii) A water tank inlet shall be positioned so that it is protected from contaminants such as waste discharge, road dust, oil, or grease.

6. Hose, Construction and Identification. A hose used for conveying drinking water from a water tank shall be:

(i) Safe; (P)

(ii) Durable, corrosion-resistant, and nonabsorbent;

(iii) Resistant to pitting, chipping, crazing, scratching, scoring, distortion, and decomposition;

(iv) Finished with a smooth interior surface; and (v) Clearly and durably identified as to its use if not permanently attached.

(c) Number and Capacities 1. Filter, Compressed Air. A filter that does not pass oil or oil vapors shall be installed in the air supply line between the compressor and drinking water system when compressed air is used to pressurize the water tank system. (P)

2. Protective Cover or Device. A cap and keeper chain, closed cabinet, closed storage tube, or other approved protective cover or device shall be provided for a water inlet, outlet, and hose.

3. Mobile Food Establishment Tank Inlet. A mobile food establishment’s water tank inlet shall be:

(i) 19.1 mm (three-fourths inch) in inner diameter or less; and (ii) Provided with a hose connection of a size or type that will prevent its use for any other service.

(d) Operation and Maintenance 1. System Flushing and Sanitization. A water tank, pump, and hoses shall be flushed and sanitized before being placed in service after construction, repair, modification, and periods of nonuse. (P)

2. Using a Pump and Hoses, Backflow Prevention. A person shall operate a water tank, pump, and hoses so that backflow and other contamination of the water supply are prevented.

3. Protecting Inlet, Outlet, and Hose Fitting. If not in use, a water tank and hose inlet and outlet fitting shall be protected using a cover or device as specified under 1200-23-01-.05(3)(c)2.

4. Tank, Pump, and Hoses, Dedication.

(i) Except as specified in subpart (ii) of this part, a water tank, pump, and hoses used for conveying drinking water shall be used for no other

purpose.

(ii) Water tanks, pumps, and hoses approved for liquid foods may be used for conveying drinking water if they are cleaned and sanitized before they are used to convey water.

(4) Sewage, Other Liquid Waste, and Rainwater (a) Mobile Holding Tank. Capacity and Drainage. A sewage holding tank in a mobile food establishment shall be:

1. Sized 15 percent larger in capacity than the water supply tank; and 2. Sloped to a drain that is 25 mm (1 inch) in inner diameter or greater, equipped with a shut-off valve.

(b) Retention Drainage and Delivery 1. Establishment Drainage System. Food establishment drainage systems, including grease traps, that convey sewage shall be designed and installed as specified under 1200-23-01-.05(2)(b).

2. Backflow Prevention.

(i) Except as specified in subparts (ii), (iii), and (iv) of this part, a direct connection may not exist between the sewage system and a drain originating from equipment in which food, portable equipment, or utensils are placed.

(ii) Subpart (i) of this part does not apply to floor drains that originate in refrigerated spaces that are constructed as an integral part of the building.

(iii) If allowed by law, a warewashing machine may have a direct connection between its waste outlet and a floor drain when the machine is located within 1.5 m (5 feet) of a trapped floor drain and the machine outlet is connected to the inlet side of a properly vented floor drain trap.

(iv) If allowed by law, a warewashing or culinary sink may have a direct connection.

3. Grease Trap. If used, a grease trap shall be located to be easily accessible for cleaning.

4. Conveying Sewage. Sewage shall be conveyed to the point of disposal through an approved sanitary sewage system or other system, including use of sewage transport vehicles, waste retention tanks, pumps, pipes, hoses, and connections that are constructed, maintained, and operated according to law. (P)

5. Removing Mobile Food Establishment Wastes. Sewage and other liquid wastes shall be removed from a mobile food establishment at an approved waste servicing area or by a sewage transport vehicle in such a way that a public health hazard or nuisance is not created. (Pf)

6. Flushing a Waste Retention Tank. A tank for liquid waste retention shall be thoroughly flushed and drained in a sanitary manner during the servicing operation.

(c) Approved Sewage Disposal System 1. Sewage shall be disposed through an approved facility that is:

(i) A public sewage treatment plant; (P) or (ii) An individual sewage disposal system that is sized, constructed, maintained, and operated according to law. (P)

2. Other Liquid Wastes and Rainwater. Condensate drainage and other nonsewage liquids and rainwater shall be drained from point of discharge to disposal according to law.

(5) Refuse, Recyclables, and Returnables (a) Facilities on the Premises 1. Indoor Storage Area. If located within the food establishment, a storage area for refuse, recyclables, and returnables shall meet the requirements specified under 1200-23-01-.06(1)(a)1., 1200-23-01-.06(2)(a)1., 1200-23-01-.06(2)(a)8., 1200- 23-01-.06(2)(b)5., and 1200-23-01-.06(2)(b)6.

2. Outdoor Storage Surface. An outdoor storage surface for refuse, recyclables, and returnables shall be constructed of nonabsorbent material such as concrete or asphalt and shall be smooth, durable, and sloped to drain.

3. Outdoor Enclosure. If used, an outdoor enclosure for refuse, recyclables, and returnables shall be constructed of durable and cleanable materials.

4. Receptacles.

(i) Except as specified in subpart (ii) of this part, receptacles and waste handling units for refuse, recyclables, and returnables and for use with materials containing food residue shall be durable, cleanable, insect- and rodent-resistant, leakproof, and nonabsorbent.

(ii) Plastic bags and wet strength paper bags may be used to line receptacles for storage inside the food establishment, or within closed outside receptacles.

5. Outside Receptacles.

(i) Receptacles and waste handling units for refuse, recyclables, and returnables used with materials containing food residue and used outside the food establishment shall be designed and constructed to have tightfitting lids, doors, or covers.

(ii) Receptacles and waste handling units for refuse and recyclables such as an on-site compactor shall be installed so that accumulation of debris and insect and rodent attraction and harborage are minimized and effective cleaning is facilitated around and, if the unit is not installed flush with the base pad, under the unit.

6. Storage Areas, Rooms, and Receptacles, Capacity and Availability.

(i) An inside storage room and area and outside storage area and enclosure, and receptacles shall be of sufficient capacity to hold refuse, recyclables, and returnables that accumulate.

(ii) A receptacle shall be provided in each area of the food establishment or premises where refuse is generated or commonly discarded, or where recyclables or returnables are placed.

(iii) If disposable towels are used at handwashing lavatories, a waste receptacle shall be located at each lavatory or group of adjacent lavatories.

7. Toilet Room Receptacle, Covered. A toilet room used by females shall be provided with a covered receptacle for sanitary napkins.

8. Cleaning Implements and Supplies.

(i) Except as specified in subpart (ii) of this part, suitable cleaning implements and supplies such as high pressure pumps, hot water, steam, and detergent shall be provided as necessary for effective cleaning of receptacles and waste handling units for refuse, recyclables, and returnables.

(ii) If approved, off-premises-based cleaning services may be used if onpremises cleaning implements and supplies are not provided.

9. Storage Areas, Redeeming Machines, Receptacles and Waste Handling Units, Location.

(i) An area designated for refuse, recyclables, returnables, and, except as specified in (ii) of this part, a redeeming machine for recyclables or returnables shall be located so that it is separate from food, equipment, utensils, linens, and single-service and single-use articles and a public health hazard or nuisance is not created.

(ii) A redeeming machine may be located in the packaged food storage area or consumer area of a food establishment if food, equipment, utensils, linens, and single-service and single-use articles are not subject to contamination from the machines and a public health hazard or nuisance is not created.

(iii) The location of receptacles and waste handling units for refuse, recyclables, and returnables may not create a public health hazard or nuisance or interfere with the cleaning of adjacent space.

10. Storing Refuse, Recyclables, and Returnables. Refuse, recyclables, and returnables shall be stored in receptacles or waste handling units so that they are inaccessible to insects and rodents.

11. Areas, Enclosures, and Receptacles, Good Repair. Storage areas, enclosures, and receptacles for refuse, recyclables, and returnables shall be maintained in good repair.

12. Outside Storage Prohibitions.

(i) Except as specified in subpart (ii) of this part, refuse receptacles not meeting the requirements specified under 1200-23-01-.05(5)(a)4.(i) such as receptacles that are not rodent-resistant, that consist of unprotected plastic bags and paper bags, or baled units that contain materials with food residue, may not be stored outside.

(ii) Cardboard or other packaging material that does not contain food residues and that is awaiting regularly scheduled delivery to a recycling or disposal site may be stored outside without being in a covered receptacle if it is stored so that it does not create a rodent harborage problem.

13. Covering Receptacles. Receptacles and waste handling units for refuse, recyclables, and returnables shall be kept covered:

(i) Inside the food establishment if the receptacles and units:

(I) Contain food residue and are not in continuous use; or (II) After they are filled; and (ii) With tight-fitting lids or doors if kept outside the food establishment.

14. Using Drain Plugs. Drains in receptacles and waste handling units for refuse, recyclables, and returnables shall have drain plugs in place.

15. Maintaining Refuse Areas and Enclosures. A storage area and enclosure for refuse, recyclables, or returnables shall be maintained free of unnecessary items, as specified under 1200-23-01-.06(5)(n), and clean.

16. Cleaning Receptacles.

(i) Receptacles and waste handling units for refuse, recyclables, and returnables shall be thoroughly cleaned in a way that does not contaminate food, equipment, utensils, linens, or single-service and single-use articles, and waste water shall be disposed of as specified under 1200-23-01- .05(4)(b)4.

(ii) Soiled receptacles and waste handling units for refuse, recyclables, and returnables shall be cleaned at a frequency necessary to prevent them from developing a buildup of soil or becoming attractants for insects and rodents.

(b) Removal 1. Frequency. Refuse, recyclables, and returnables shall be removed from the premises at a frequency that will minimize the development of objectionable odors and other conditions that attract or harbor insects and rodents.

2. Receptacles or Vehicles. Refuse, recyclables, and returnables shall be removed from the premises by way of:

(i) Portable receptacles that are constructed and maintained according to law; or (ii) A transport vehicle that is constructed, maintained, and operated according to law.

(c) Facilities for Disposal and Recycling. Community or Individual Facility. Solid waste not disposed of through the sewage system such as through grinders and pulpers shall be recycled or disposed of in an approved public or private community recycling or refuse facility; or solid waste shall be disposed of in an individual refuse facility such as a landfill or incinerator which is sized, constructed, maintained, and operated according to law.

History

• Authority: T.C.A. §§ 68-14-701 through 68-14-729.
• Administrative History: Original rule filed March 26, 1987; effective May 9, 1987. Amendment filed February 14, 1989; effective March 21, 1989. Amendment filed April 23, 1990; effective July 29, 1990. Repeal filed March 13, 2000; effective May 27, 2000. New rule filed August 24, 2000; effective November 7, 2000. Repeal and new rule filed April 17, 2015; effective July 16, 2015. Amendments filed March 16, 2026; effective June 14, 2026.

Tenn. Comp. R. & Regs. 1200-23-01-.06 PHYSICAL FACILITIES

(1) Materials for Construction and Repair.

(a) Indoor Areas. Surface Characteristics.

1. Except as specified in part 2. of this subparagraph, materials for indoor floor, wall, and ceiling surfaces under conditions of normal use shall be:

(i) Smooth, durable, and easily cleanable for areas where food establishment operations are conducted;

(ii) Closely woven and easily cleanable carpet for carpeted areas; and (iii) Nonabsorbent for areas subject to moisture such as food preparation areas, walk-in refrigerators, warewashing areas, toilet rooms, mobile food establishment servicing areas, and areas subject to flushing or spray cleaning methods.

2. In a temporary food establishment and farmers market food unit:

(i) If graded to drain, a floor may be concrete, machine-laid asphalt, or dirt or gravel if it is covered with mats, removable platforms, duckboards, or other approved materials that are effectively treated to control dust and mud; and (ii) Walls and ceilings may be constructed of a material that protects the interior from the weather and windblown dust and debris.

(b) Outdoor Areas. Surface Characteristics.

1. For all food service establishments except farmers market food units, the outdoor walking and driving areas shall be surfaced with concrete, asphalt, or gravel or other materials that have been effectively treated to minimize dust, facilitate maintenance, and prevent muddy conditions.

2. Exterior surfaces of buildings and mobile food establishments shall be of weather-resistant materials and shall comply with law.

3. Outdoor storage areas for refuse, recyclables, or returnables shall be of materials specified under 1200-23-01-.05(5)(a)2. and 1200-23-01-.05(5)(a)3.

(2) Design, Construction, and Installation.

(a) Cleanability.

1. Floors, Walls, and Ceilings. Except as specified under part 4. of this subparagraph and except for antislip floor coverings or applications that may be used for safety reasons, floors, floor coverings, walls, wall coverings, and ceilings shall be designed, constructed, and installed so they are smooth and easily cleanable.

2. Floors, Walls, and Ceilings, Utility Lines.

(i) Utility service lines and pipes may not be unnecessarily exposed.

(ii) Exposed utility service lines and pipes shall be installed so they do not obstruct or prevent cleaning of the floors, walls, or ceilings.

(iii) Exposed horizontal utility service lines and pipes may not be installed on the floor.

3. Floor and Wall Junctures, Coved, and Enclosed or Sealed.

(i) In food establishments in which cleaning methods other than water flushing are used for cleaning floors, the floor and wall junctures shall be coved and closed to no larger than 1 mm (one thirty-second inch).

(ii) The floors in food establishments in which water flush cleaning methods are used shall be provided with drains and be graded to drain, and the floor and wall junctures shall be coved and sealed.

4. Floor Carpeting, Restrictions, and Installation.

(i) A floor covering such as carpeting or similar material may not be installed as a floor covering in food preparation areas, walk-in refrigerators, warewashing areas, toilet room areas where handwashing lavatories, toilets, and urinals are located, refuse storage rooms, or other areas where the floor is subject to moisture, flushing, or spray cleaning methods.

(ii) If carpeting is installed as a floor covering in areas other than those specified under subpart (i) of this part, it shall be:

(I) Securely attached to the floor with a durable mastic, by using a stretch and tack method, or by another method; and (II) Installed tightly against the wall under the coving or installed away from the wall with a space between the carpet and the wall and with the edges of the carpet secured by metal stripping or some other means.

5. Floor Covering, Mats and Duckboards. Mats and duckboards shall be designed to be removable and easily cleanable.

6. Wall and Ceiling Coverings and Coatings.

(i) Wall and ceiling covering materials shall be attached so that they are easily cleanable.

(ii) Except in areas used only for dry storage, concrete, porous blocks, or bricks used for indoor wall construction shall be finished and sealed to provide a smooth, nonabsorbent, easily cleanable surface.

7. Walls and Ceilings, Attachments.

(i) Except as specified in subpart (ii) of this part, attachments to walls and ceilings such as light fixtures, mechanical room ventilation system components, vent covers, wall mounted fans, decorative items, and other attachments shall be easily cleanable.

(ii) In a consumer area, wall and ceiling surfaces and decorative items and attachments that are provided for ambiance need not meet this requirement if they are kept clean.

8. Walls and Ceilings, Studs, Joists, and Rafters. Except for temporary food establishments and farmers market food units, studs, joists, and rafters may not be exposed in areas subject to moisture.

(b) Functionality.

1. Light Bulbs, Protective Shielding.

(i) Except as specified in subpart (ii) of this part, light bulbs shall be shielded, coated, or otherwise shatter-resistant in areas where there is exposed food; clean equipment, utensils, and linens; or unwrapped single-service and single-use articles.

(ii) Shielded, coated, or otherwise shatter-resistant bulbs need not be used in areas used only for storing food in unopened packages, if:

(I) The integrity of the packages cannot be affected by broken glass falling onto them; and (II) The packages are capable of being cleaned of debris from broken bulbs before the packages are opened.

(iii) An infrared or other heat lamp shall be protected against breakage by a shield surrounding and extending beyond the bulb so that only the face of the bulb is exposed.

2. Heating, Ventilating, Air Conditioning System Vents. Heating, ventilating, and air conditioning systems shall be designed and installed so that make-up air intake and exhaust vents do not cause contamination of food, food-contact surfaces, equipment, or utensils.

3. Insect Control Devices, Design and Installation.

(i) Insect control devices that are used to electrocute or stun flying insects shall be designed to retain the insect within the device.

(ii) Insect control devices shall be installed so that:

(I) The devices are not located over a food preparation area; and (II) Dead insects and insect fragments are prevented from being impelled onto or falling on exposed food, clean equipment, utensils, and linens, and unwrapped single-service and single-use articles.

4. Toilet Rooms, Enclosed. Except where a toilet room is located outside a food establishment and does not open directly into the food establishment such as a toilet room that is provided by the management of a shopping mall, a toilet room located on the premises shall be completely enclosed and provided with a tightfitting and self-closing door.

5. Outer Openings, Protected.

(i) Except as specified in subparts (ii), (iii), (iv), (v) and (vi) of this part, outer openings of a food establishment shall be protected against the entry of insects and rodents by:

(I) Filling or closing holes and other gaps along floors, walls, and ceilings;

(II) Closed, tight-fitting windows; and (III) Solid, self-closing, tight-fitting doors.

(ii) Subpart (i) of this part does not apply if a food establishment opens into a larger structure, such as a mall, airport, or office building, or into an attached structure, such as a porch, and the outer openings from the larger or attached structure are protected against the entry of insects and rodents.

(iii) Subpart (i) of this part does not apply to outdoor farmers markets.

(iv) Exterior doors used as exits need not be self-closing if they are:

(I) Solid and tight-fitting;

(II) Designated for use only when an emergency exists, by the fire protection authority that has jurisdiction over the food establishment; and (III) Limited-use so they are not used for entrance or exit from the building for purposes other than the designated emergency exit use.

(v) Except as specified in subparts (ii) and (vi) of this part, if the windows or doors of a food establishment, or of a larger structure within which a food establishment is located, are kept open for ventilation or other purposes or a temporary food establishment is not provided with windows and doors as specified under subpart (i) of this part, the openings shall be protected against the entry of insects and rodents by:

(I) 16 mesh to 25.4 mm (16 mesh to 1 inch) screens;

(II) Properly designed and installed air curtains to control flying insects; or (III) Other effective means.

(vi) Subpart (v) of this part does not apply if flying insects and other pests are absent due to the location of the establishment, the weather, or other limiting condition.

6. Exterior Walls and Roofs, Protective Barrier. Perimeter walls and roofs of a food establishment shall effectively protect the establishment from the weather and the entry of insects, rodents, and other animals.

7. Outdoor Walking and Driving Surfaces, Graded to Drain. Exterior walking and driving surfaces shall be graded to drain.

8. Outdoor Refuse Areas, Curbed and Graded to Drain. Outdoor refuse areas shall be constructed in accordance with law and shall be curbed and graded to drain to collect and dispose of liquid waste that results from the refuse and from cleaning the area and waste receptacles.

9. Private Homes and Living or Sleeping Quarters, Use Prohibition. A private home, except as provided by T.C.A. § 53-8-117, a room used as living or sleeping quarters, or an area directly opening into a room used as living or sleeping quarters may not be used for conducting food establishment operations.

10. Living or Sleeping Quarters, Separation. Living or sleeping quarters located on the premises of a food establishment such as those provided for lodging registration clerks or resident managers shall be separated from rooms and areas used for food establishments operations by complete partitioning and solid self-closing doors.

(3) Number and Capacities.

(a) Handwashing Sinks.

1. Handwashing sinks shall be provided as specified under 1200-23-01-.05(2)(c)1.

2. Handwashing Cleanser, Availability. Each handwashing sink or group of 2 adjacent handwashing sinks shall be provided with a supply of hand cleaning liquid, powder, or bar soap.

3. Hand Drying Provision. Each handwashing sink or group of adjacent handwashing sinks shall be provided with:

(i) Individual, disposable towels;

(ii) A continuous towel system that supplies the user with a clean towel; or (iii) A heated-air hand drying device; or (iv) A hand drying device that employs an air-knife system that delivers high velocity, pressurized air at ambient temperatures.

4. Handwashing Aids and Devices, Use Restrictions. A sink used for food preparation or utensil washing, or a service sink or curbed cleaning facility used for the disposal of mop water or similar wastes, may not be provided with the handwashing aids and devices required for a handwashing sink as specified under 1200-23-01-.06(3)(a)2. and 1200-23-01-.06(3)(a)3. and 1200-23-01- .05(5)(a)6.

5. Handwashing Signage. A sign or poster that notifies food employees to wash their hands shall be provided at all handwashing sinks used by food employees and shall be clearly visible to food employees.

6. Disposable Towels, Waste Receptacle. A handwashing sink or group of adjacent handwashing sinks that is provided with disposable towels shall be provided with a waste receptacle as specified under 1200-23-01-.05(5)(a)6.

7. Improvised handwashing equipment shall be available for farmers market food units. Specifically, farmers market food units are required, at a minimum, to provide a beverage cooler which has at least a five (5) gallon capacity and a spigot, or an equivalent alternative, for handwashing. Handwashing soap and disposable towels shall be provided with a waste receptacle. A five (5) gallon container must be available to collect used waste water.

(b) Toilets and Urinals.

1. Toilets and urinals shall be provided as specified under 1200-23-01-.05(2)(c)2.

2. A supply of toilet tissue shall be available at each toilet. (Pf)

(c) Lighting. The light intensity shall be:

1. At least 108 lux (10 foot candles) at a distance of 75 cm (30 inches) above the floor, in walk-in refrigeration units and dry food storage areas and in other areas and rooms during periods of cleaning;

2. At least 215 lux (20 foot candles):

(i) At a surface where food is provided for consumer self-service such as buffets and salad bars or where fresh produce or packaged foods are sold or offered for consumption, (ii) Inside equipment such as reach-in and under-counter refrigerators; and (iii) At a distance of 75 cm (30 inches) above the floor in areas used for handwashing, warewashing, and equipment and utensil storage, and in toilet rooms; and 3. At least 540 lux (50 foot candles) at a surface where a food employee is working with food or working with utensils or equipment such as knives, slicers, grinders, or saws where employee safety is a factor.

(d) Ventilation. If necessary to keep rooms free of excessive heat, steam, condensation, vapors, obnoxious odors, smoke, and fumes, mechanical ventilation of sufficient capacity shall be provided.

(e) Dressing Areas and Lockers.

1. Dressing rooms or dressing areas shall be designated if employees routinely change their clothes in the establishment.

2. Lockers or other suitable facilities shall be provided for the orderly storage of employees’ clothing and other possessions.

(f) A service sink or curbed cleaning facility shall be provided as specified under 1200-23- 01-.05(2)(c)3.(i).

(4) Location and Placement.

(a) Handwashing sinks shall be conveniently located as specified under 1200-23-01- .05(2)(d)1.

(b) Toilet rooms shall be conveniently located and accessible to employees during all hours of operation.

(c) For purposes of farmers market food units, improvised handwashing equipment must be available for use in a location which does not contaminate food.

(d) Employee Accommodations.

1. Areas designated for employees to eat, drink, and use tobacco shall be located so that food, equipment, linens, and single-service and single-use articles are protected from contamination.

2. Lockers or other suitable facilities shall be located in a designated room or area where contamination of food, equipment, utensils, linens, and single-service and single-use articles cannot occur.

(e) Distressed Merchandise. Products that are held by the permit holder for credit, redemption, or return to the distributor, such as damaged, spoiled, or recalled products, shall be segregated and held in designated areas that are separated from food, equipment, utensils, linens, and single-service and single-use articles. (Pf)

(f) Refuse, Recyclables, and Returnables. Units, receptacles, and areas designated for storage of refuse and recyclable and returnable containers shall be located as specified under 1200-23-01-.05(5)(a)9.

(5) Maintenance and Operation.

(a) Physical facilities shall be maintained in good repair.

(b) Cleaning, Frequency and Restrictions.

1. Physical facilities shall be cleaned as often as necessary to keep them clean.

2. Except for cleaning that is necessary due to a spill or other accident, cleaning shall be done during periods when the least amount of food is exposed such as after closing.

(c) Cleaning Floors, Dustless Methods.

1. Except as specified in part 2. of this subparagraph, only dustless methods of cleaning shall be used, such as wet cleaning, vacuum cleaning, mopping with treated dust mops, or sweeping using a broom and dust-arresting compounds.

2. Spills or drippage on floors that occur between normal floor cleaning times may be cleaned:

(i) Without the use of dust-arresting compounds; and (ii) In the case of liquid spills or drippage, with the use of a small amount of absorbent compound such as sawdust or diatomaceous earth applied immediately before spot cleaning.

(d) Cleaning Ventilation Systems, Nuisance and Discharge Prohibition.

1. Intake and exhaust air ducts shall be cleaned and filters changed so they are not a source of contamination by dust, dirt, and other materials.

2. If vented to the outside, ventilation systems may not create a public health hazard or nuisance or unlawful discharge.

(e) Cleaning Maintenance Tools, Preventing Contamination. Food preparation sinks, handwashing sinks, and warewashing equipment may not be used for the cleaning of maintenance tools, the preparation or holding of maintenance materials, or the disposal of mop water and similar liquid wastes.

(f) Drying Mops. After use, mops shall be placed in a position that allows them to air-dry without soiling walls, equipment, or supplies.

(g) Absorbent Materials on Floors, Use Limitation. Except as specified in 1200-23-01- .06(5)(c)2., sawdust, wood shavings, granular salt, baked clay, diatomaceous earth, or similar materials may not be used on floors.

(h) Cleaning of Plumbing Fixtures. Plumbing fixtures such as handwashing sinks, toilets, and urinals shall be cleaned as often as necessary to keep them clean.

(i) Closing Toilet Room Doors. Except during cleaning and maintenance operations, toilet room doors as specified under 1200-23-01-.06(2)(b)4. shall be kept closed.

(j) Using Dressing Rooms and Lockers.

1. Dressing rooms shall be used by employees if the employees regularly change their clothes in the establishment.

2. Lockers or other suitable facilities shall be used for the orderly storage of employee clothing and other possessions.

(k) Controlling Pests. The premises shall be maintained free of insects, rodents, and other pests. The presence of insects, rodents, and other pests shall be controlled to eliminate their presence on the premises by:

1. Routinely inspecting incoming shipments of food and supplies;

2. Routinely inspecting the premises for evidence of pests;

3. Using methods, if pests are found, such as trapping devices or other means of pest control as specified under 1200-23-01-.07(2)(b)2. and 1200-23-01-.07(2)(f); and 4. Eliminating harborage conditions.

(l) Removing Dead or Trapped Birds, Insects, Rodents, and Other Pests. Dead or trapped birds, insects, rodents, and other pests shall be removed from control devices and the premises at a frequency that prevents their accumulation, decomposition, or the attraction of pests.

(m) Storing Maintenance Tools. Maintenance tools such as brooms, mops, vacuum cleaners, and similar items shall be:

1. Stored so they do not contaminate food, equipment, utensils, linens, and singleservice and single-use; and 2. Stored in an orderly manner that facilitates cleaning the area used for storing the maintenance tools.

(n) Maintaining Premises, Unnecessary Items and Litter. The premises shall be free of:

1. Items that are unnecessary to the operation or maintenance of the establishment such as equipment that is nonfunctional or no longer used; and 2. Litter.

(o) Prohibiting Animals.

1. Except as specified in parts 2. and 3. of this subparagraph, live animals may not be allowed on the premises of a food establishment.

2. Live animals are allowed in the following situations if the owner or operator does not permit animals to physically contact food, serving dishes, utensils, tableware, linens, unwrapped single-service and single-use articles or other food service items that may result in contamination of food or food-contact surfaces and does not permit animals to physically contact employees engaged in the preparation or handling of food:

(i) Fish or crustacea in aquariums or display tanks;

(ii) Patrol dogs accompanying police or security officers in offices and dining, sales, and storage areas; and sentry dogs in outside fenced areas;

(iii) Service animals accompanying persons with disabilities in areas that are not used for food preparation;

(iv) Dogs (Canis lupus familiaris) and cats (Felis catus) in outdoor dining areas; provided that dogs and cats are physically restrained, and do not pass through any indoor areas of the food establishment. Except for service animals described in subpart (iii) of this part, nothing in this Chapter prohibits a food establishment from prohibiting dogs and cats in outdoor dining areas;

(v) In areas that are not used for food preparation, storage, sales, display, or dining, in which there are caged animals or animals that are similarly confined, such as in a variety store that sells pets or a tourist park that displays animals; and (vi) In outdoor farmers markets.

3. Live or dead fish bait may be stored if contamination of food, clean equipment, utensils, and linens, and unwrapped single-service and single-use articles cannot result.

(p) Dogs in Outdoor Dining Areas Notwithstanding subparagraph (o) of this paragraph, where a county or municipality has passed an ordinance or resolution under T.C.A. § 6-54-135 authorizing individual restaurants to permit dogs in outdoor dining areas and to charge permit holders a reasonable permit fee, dogs other than service dogs may be permitted in outside areas of a food establishment, provided, however:

1. Except as provided in subparagraph (o), no dog shall be present in the interior of any restaurant or in any area where food is prepared;

2. The food establishment shall have the right to refuse to serve the owner of a dog if the owner fails to exercise reasonable control over the dog or the pet dog is otherwise behaving in a manner that compromises or threatens to compromise the health or safety of any person present in the food establishment;

3. The person in charge shall not permit dogs to physically contact food, serving dishes, utensils, tableware, linens, unwrapped single-service and single-use articles or other food service items that may result in contamination of food or food-contact surfaces and shall not permit animals to physically contact employees engaged in the preparation or handling of food;

4. The person in charge shall instruct employees and patrons that dogs shall not be allowed to come into contact with serving dishes, utensils, tableware, linens, paper products or any other items involved in food service operations;

5. Patrons shall keep their dogs on a leash at all times and keep their dogs under reasonable control;

6. Dogs shall not be allowed on tables, chairs or other furnishings;

7. The person in charge shall ensure that any accidents involving dog waste are cleaned immediately and the area sanitized with an approved product. A kit with the appropriate materials for this purpose shall be kept near the designated outdoor area.

8. The permit holder shall post a sign or signs reminding employees and patrons of the applicable rules on the premises in a manner and in such place(s) as determined by the local permitting authority; and 9. Pet dogs shall not be permitted to travel through indoor or nondesignated portions of the food establishment, and ingress and egress to the designated outdoor portions of the food establishment shall not require entrance into nor passage through any indoor area of the food establishment.

History

• Authority: T.C.A. §§ 6-54-135, 53-8-117, and 68-14-701 through 68-14-729.
• Administrative History: Original rule filed March 26, 1987; effective date May 9, 1987. Repeal filed March 13, 2000; effective May 27, 2000. New rule filed August 24, 2000; effective November 7, 2000. Repeal and new rule filed April 17, 2015; effective July 16, 2015. Emergency rules filed April 9, 2024; effective through October 6, 2024. Amendments filed July 1, 2024; effective September 29, 2024. Amendments filed March 16, 2026; effective June 14, 2026.

Tenn. Comp. R. & Regs. 1200-23-01-.07 POISONOUS OR TOXIC MATERIALS

(1) Labeling and Identification.

(a) Original Containers. Containers of poisonous or toxic materials and personal care items shall bear a legible manufacturer’s label.

(b) Working containers used for storing poisonous or toxic materials such as cleaners and sanitizers taken from bulk supplies shall be clearly and individually identified with the common name of the material. (Pf)

(2) Operational Supplies and Applications.

(a) Storage. Poisonous or toxic materials shall be stored so they cannot contaminate food, equipment, utensils, linens, and single-service and single-use articles by:

1. Separating the poisonous or toxic materials by spacing or partitioning; (P) and 2. Locating the poisonous or toxic materials in an area that is not above food, equipment, utensils, linens, and single-service or single-use articles. This part does not apply to equipment and utensil cleaners and sanitizers that are stored in warewashing areas for availability and convenience if the materials are stored to prevent contamination of food, equipment, utensils, linens, and single-service and single-use articles. (P)

(b) Presence and Use.

1. Restriction.

(i) Only those poisonous or toxic materials that are required for the operation and maintenance of a food establishment, such as for the cleaning and sanitizing of equipment and utensils and the control of insects and rodents, shall be allowed in a food establishment.

(ii) Subpart (i) of this part does not apply to packaged poisonous or toxic materials that are for retail sale.

2. Conditions of Use. Poisonous or toxic materials shall be:

(i) Used according to:

(I) Law and this Chapter, (II) Manufacturer’s use directions included in labeling, and, for a pesticide, manufacturer’s label instructions that state that use is allowed in a food establishment, (P)

(III) The conditions of certification, if certification is required, for use of the pest control materials, (P) and (IV) Additional conditions that may be established by the department; and (ii) Applied so that:

(I) A hazard to employees or other persons is not constituted, (P) and (II) Contamination including toxic residues due to drip, drain, fog, splash or spray on food, equipment, utensils, linens, and single-service and single-use articles is prevented, and for a restricted use pesticide, this is achieved by: (P)

I. Removing the items, (P)

II. Covering the items with impermeable covers, (P) or III. Taking other appropriate preventive actions, (P) and IV. Cleaning and sanitizing equipment and utensils after the application. (P)

(iii) A general use or restricted use pesticide shall be applied only by an applicator certified as defined in 7 USC § 136(e), Certified Applicator, of the Federal Insecticide, Fungicide, and Rodenticide Act and Tennessee

Rule Chapter 0080-06-16 Regulations Governing Use of Restricted Use Pesticides. (Pf)

(c) Container Prohibitions. Poisonous or Toxic Material Containers. A container previously used to store poisonous or toxic materials may not be used to store, transport, or dispense food. Sanitizing solutions shall not be stored in or dispensed from containers previously containing other poisonous or toxic materials. Equipment, utensils, and single service items shall not be stored in or dispensed from containers previously containing other poisonous or toxic materials. (P)

(d) Chemicals.

1. Chemical sanitizers including chemical sanitizing solutions generated on-site, and other chemical antimicrobials applied to food-contact surfaces shall:

(i) Meet the requirements specified in 40 CFR § 180.940 Tolerance exemptions for active and inert ingredients for use in antimicrobial formulations (food-contact surface sanitizing solutions); (P) or (ii) Meet the requirements as specified in 40 CFR 180.2020 Pesticide Chemicals Not Requiring a Tolerance or Exemption from Tolerance-Nonfood determination. (P)

2. Chemicals for Washing, Treatment, Storage and Processing Fruits and Vegetables, Criteria.

(i) Chemicals, including those generated on-site, used to wash or peel raw, whole fruits and vegetables or used in the treatment, storage of processing of fruits and vegetables shall:

(I) Be an approved food additive listed for this intended use in 21 CFR 173, (P) or (II) Be generally recognized as safe (GRAS) for this intended use, (P) or (III) Be subject of an effective food contact notification for this intended use (only effective for the manufacturer or supplier identified in the notification) (P) and, (IV) Meet the requirements in 40 CFR 156 Labeling Requirements for Pesticides and Devices. (P)

3. Boiler Water Additives, Criteria. Chemicals used as boiler water additives shall meet the requirements specified in 21 CFR § 173.310 Boiler water additives. (P)

4. Drying Agents, Criteria. Drying agents used in conjunction with sanitization shall:

(i) Contain only components that are listed as one of the following:

(I) Generally recognized as safe for use in food as specified in 21 CFR

Part 182 - Substances Generally Recognized as Safe, or 21 CFR

Part 184 - Direct Food Substances Affirmed as Generally Recognized as Safe, (P)

(II) Generally recognized as safe for the intended use as specified in 21 CFR Part 186 - Indirect Food Substances Affirmed as Generally Recognized as Safe, (P)

(III) Generally recognized as safe for the intended use as determined by experts qualified in scientific training and experience to evaluate the safety of substances added, directly or indirectly, to food as described in 21 CFR 170.30 Eligibility for classification as generally recognized as safe (GRAS), (P)

(IV) Subject of an effective Food Contact Notification as described in the Federal Food Drug and Cosmetic Act (FFDCA) Section 409(h), (P)

(V) Approved for use as a drying agent under a prior sanction as described in the Federal Food Drug and Cosmetic Act (FFDCA) 201(s)(4); (P)

(VI) Specifically regulated as an indirect food additive for use as a drying agent as specified in 21 CFR Parts 174 through 178, (P) or (VII) Approved for use as a drying agent under the threshold of regulation process established by 21 CFR § 170.39 Threshold of regulation for substances used in food-contact articles. (P)

(ii) When sanitization is with chemicals, the approval required under (i)(III) or (i)(V) of this part or the regulation as an indirect food additive required under (i)(IV) of this part, shall be specifically for use with chemical sanitizing solutions. (P)

(e) Lubricants shall meet the requirements specified in 21 CFR § 178.3570 Lubricants with incidental food contact, if they are used on food-contact surfaces, on bearings and gears located on or within food-contact surfaces, or on bearings and gears that are located so that lubricants may leak, drip, or be forced into food or onto food-contact surfaces. (P)

(f) Pesticides.

1. Restricted use pesticides specified under 1200-23-01-.07(2)(b)2.(iii) shall meet the requirements specified in 40 CFR Part 152 Subpart I – Classification of Pesticides. (P)

2. Rodent Bait Stations. Rodent bait shall be placed outside and contained in a covered, tamper-resistant bait station. (P)

3. Tracking Powders, Pest Control and Monitoring.

(i) Except as specified in (ii) of this part, a tracking powder pesticide may not be used in a food establishment. (P)

(ii) If used, a nontoxic tracking powder such as talcum or flour may not contaminate food, equipment, utensils, linens, and single-service and single-use articles.

(g) Medicines.

1. Restriction and Storage.

(i) Except for medicines that are stored or displayed for retail sale, only those medicines that are necessary for the health of employees shall be allowed in a food establishment. (Pf)

(ii) Medicines that are in a food establishment for the employees’ use shall be labeled as specified under 1200-23-01-.07(1) and located to prevent the contamination of food, equipment, utensils, linens, and single-service and single-use articles. (P)

2. Refrigerated Medicines, Storage. Medicines belonging to employees or to children in a day care center that require refrigeration and are stored in a food refrigerator shall be:

(i) Stored in a package or container and kept inside a covered, leakproof container that is identified as a container for the storage of medicines; (P) and (ii) Located so they are inaccessible to children. (P)

(h) First Aid supplies that are in a food establishment for the employees’ use shall be:

1. Labeled as specified under 1200-23-01-.07(1); (Pf) and 2. Stored in a kit or a container that is located to prevent the contamination of food, equipment, utensils, and linens, and single-service and single-use articles. (P)

(i) Other Personal Care Items. Except as specified under 1200-23-01-.07(2)(g)2., employees shall store their personal care items in facilities as specified under 1200-23- 01-.06(3)(e)2.

(3) Stock and Retail Sale.

Poisonous or toxic materials shall be stored and displayed for retail sale so they cannot contaminate food, equipment, utensils, linens, and single-service and single-use articles by:

(a) Separating the poisonous or toxic materials by spacing or partitioning; (P) and (b) Locating the poisonous or toxic materials in an area that is not above food, equipment, utensils, linens, and single-service or single-use articles. (P)

History

• Authority: T.C.A. §§ 68-14-701 through 68-14-729.
• Administrative History: Original rule filed April 17, 2015; effective July 16, 2015. Amendments filed March 16, 2026; effective June 14, 2026.

Tenn. Comp. R. & Regs. 1200-23-01-.08 COMPLIANCE AND ENFORCEMENT

(1) Applicability (a) Public Health Protection - The department shall apply this code to promote its purpose of safeguarding public health and ensuring that food is safe, unadulterated and honestly presented when it is offered to the consumer.

(b) In enforcing the provisions of this Chapter, the department shall assess existing facilities or equipment that were in use before the effective date of this Chapter based on the following considerations:

1. Whether the facilities or equipment are in good repair and capable of being maintained in a sanitary condition;

2. Whether food-contact surfaces comply with 1200-23-01-.04(1)(a);

3. Whether the capacities of cooling, heating, and holding equipment are sufficient to comply with 1200-23-01-.04(3)(a)1.; and 4. The existence of a documented agreement with the permit holder that the facilities or equipment will be replaced as specified under 1200-23-01-.08(3)(i)6.

(c) Preventing Health Hazards, Provision for Conditions Not Addressed.

1. If necessary to protect against public health hazards or nuisances, the department may impose specific requirements in addition to the requirements contained in this Chapter that are authorized by law.

2. The department shall document the conditions that necessitate the imposition of additional requirements and the underlying public health rationale. The documentation shall be provided to the permit applicant or permit holder and a copy shall be maintained in the department’s file for the food establishment.

(d) Variances 1. Modifications and Waivers. The department may grant a variance by modifying or waiving the requirements of this Chapter if in the opinion of the department a health hazard or nuisance will not result from the variance. If a variance is granted, the department shall retain the information specified under part 2. of this subparagraph in its records for the food establishment. Variance requests shall be submitted to a committee including a food scientist and representatives from industry and state and local public health agencies appointed by the department.

2. Documentation of Proposed Variance and Justification. Before a variance from a requirement of this Chapter is approved, the information that shall be provided by the person requesting the variance and retained in the department’s file on the food establishment includes:

(i) A statement of the proposed variance of the Chapter requirement citing relevant Chapter section numbers; (Pf)

(ii) An analysis of the rationale for how the potential public health hazards and nuisances addressed by the relevant Chapter sections will be alternatively addressed by the proposal; and (Pf)

(iii) A HACCP plan if required as specified under 1200-23-01-.08(2)(c) that includes the information specified under 1200-23-01-.08(2)(d) as it is relevant to the variance requested. (Pf)

3. Conformance with Approved Procedures. If the department grants a variance as specified in 1200-23-01-.08(1)(d), or a HACCP plan is otherwise required as specified under 1200-23-01-.08(2)(c), the permit holder shall:

(i) Maintain the approved variance at the food establishment, (Pf)

(ii) Comply with the HACCP plans and procedures that are submitted as specified under 1200-23-01-.08(2)(d) and approved as a basis for the modification or waiver; (P) and (iii) Maintain and provide to the department, upon request, records specified under 1200-23-01-.08(2)(d)4. that demonstrate that the following are routinely employed;

(I) Procedures for monitoring the critical control points, (Pf)

(II) Monitoring of the critical control points, (Pf)

(III) Verification of the effectiveness of the operation or process, (Pf) and (IV) Necessary corrective actions if there is failure at a critical control point. (Pf)

(2) Plan Submission and Approval (a) When Plans Are Required. Plans drawn to scale for food establishments shall be submitted for review and approval to the department. A permit applicant or permit holder shall submit to the department properly prepared plans and specifications for review and approval before:

1. The construction of a food establishment; (Pf)

2. The conversion of an existing structure for use as a food establishment; (Pf) or 3. The remodeling of a food establishment or a change of type of food establishment or food operation as specified under 1200-23-01-.08(3)(e)3. if the department determines that plans and specifications are necessary to ensure compliance with this Chapter. (Pf)

(b) Contents of the Plans and Specifications. The plans and specifications for a food establishment, including a food establishment specified under 1200-23-01-.08(2)(c), shall include, as required by the department based on the type of operation, type of food preparation, and foods prepared, the following information to demonstrate conformance with Chapter provisions:

1. Intended menu and plans to be reviewed;

2. Anticipated volume of food to be stored, prepared, and sold or served;

3. Proposed layout, mechanical schematics, construction materials, and finish schedules;

4. Proposed equipment types, manufacturers, model numbers, locations, dimensions, performance capacities, and installation specifications;

5. Evidence that standard procedures that ensure compliance with the requirements of this Chapter are developed or are being developed; and 6. Other information that may be required by the department for the proper review of the proposed construction, conversion or modification, and procedures for operating a food establishment.

(c) When a HACCP Plan Is Required.

1. Before engaging in an activity that requires a HACCP plan, a permit applicant or permit holder shall submit to the department for approval a properly prepared HACCP plan as specified under 1200-23-01-.08(2)(d) and the relevant provisions of this Chapter if:

(i) Submission of a HACCP PLAN is required according to law;

(ii) A variance is required as specified under 1200-23-01-.03(4)(a)1.(iv), 1200- 23-01-.03(5)(b), or 1200-23-01-.04(2)(d)8.(ii);

(iii) The department determines that a food preparation or processing method requires a variance based on a plan submittal specified under 1200-23-01- .08(2)(b), an inspectional finding, or a variance request.

2. A permit applicant or permit holder shall have a properly prepared HACCP plan as specified under 1200-23-01-.03(5)(c).

(d) Contents of a HACCP Plan. For a food establishment that is required under 1200-23- 01-.08(2)(c) to have a HACCP plan, the permit applicant or permit holder shall submit to the department a properly prepared HACCP plan that includes:

1. General information such as the name of the permit applicant or permit holder, the food establishment address and contact information.

2. A categorization of the types of time/temperature control for safety foods that are to be controlled under the HACCP plan.

3. A flow diagram or chart for each specific food or category type that identifies:

(i) Each step in the process; (Pf)

(ii) The steps that are critical control points;

(iii) Ingredients, materials, and equipment used in the preparation of that food, and (iv) Formulations or recipes that delineate methods and procedural control measures that address the food safety concerns involved;

4. The ingredients, recipe or formulations, materials and equipment used in the preparation of each specific food or category type and methods and procedural control measures that address the food safety concerns. (Pf)

5. A critical control points summary for each specific food or category type that clearly identifies:

(i) Each critical control point; (Pf)

(ii) The significant hazards for each critical control point; (Pf)

(iii) The critical limits for each critical control point; (Pf)

(iv) The method and frequency for monitoring and controlling each critical control point by the designated food employee or the person in charge; (Pf)

(v) Action to be taken by the designated food employee or person in charge if the critical limits for each critical control point are not met; (Pf)

(vi) The method and frequency for the person in charge to routinely verify the food employee is following standard operating procedures and monitoring critical control points; (Pf) and (vii) Records to be maintained by the person in charge to demonstrate that the HACCP Plan is properly operated and managed. (Pf)

6. Supporting documents including but not limited to:

(i) Food employee and supervisory training plan that addresses the food safety issues of concern; (Pf)

(ii) Copies of blank records forms that are necessary to implement the HACCP plant; (Pf)

(iii) Additional scientific data or other information as required by the department, supporting the determination that food safety is not compromised by the proposal; (Pf) and, (iv) Any other supporting documents required by the department.

(e) Trade Secrets. The department shall treat as confidential in accordance with law information that meets the criteria specified in law for a trade secret which is contained on inspection report forms and in the plans and specifications submitted under subparagraphs (a) and (b) of this rule.

(f) Preoperational Inspections. The department may conduct one or more preoperational inspections to verify that the food establishment is constructed and equipped in accordance with the approved plans and approved modifications of those plans, has established standard operating procedures as specified under part (2)(b)5. of this paragraph, and is in compliance with law and this Chapter.

(3) Permit to Operate (a) Prerequisite for Operation. A person may not operate a food establishment without a valid permit to operate issued by the department.

(b) Submission 15 Calendar Days Before Proposed Opening. An applicant shall submit an application for a permit at least 15 calendar days before the date planned for opening a food establishment or the expiration date of the current permit for an existing facility or a farmers market food unit.

(c) Form of Submission. A person desiring to operate a food establishment shall submit to the department a written application for a permit on a form provided by the department.

(d) To qualify for a permit, an applicant shall:

1. Be an owner of the food establishment or an officer of the legal ownership;

2. Comply with the requirements of this Chapter;

3. As specified under 1200-23-01-.08(4)(b), agree to allow access to the food establishment and to provide required information; and 4. As specified under 1200-23-01-.09, pay the applicable permit fees at the time the application is submitted.

(e) Contents of the Application. The application for a food service establishment, excluding farmers market food units, shall include:

1. The name, mailing address, telephone number, and signature of the person applying for the permit and the name, mailing address, and location of the food establishment;

2. Information specifying whether the food establishment is owned by an association, corporation, individual, partnership, or other legal entity;

3. A statement specifying whether the food establishment:

(i) Is mobile or stationary and temporary or permanent, and (ii) Is an operation that includes one or more of the following:

(I) Prepares, offers for sale, or serves time/temperature control for safety food:

I. Only to order upon a consumer’s request, II. In advance in quantities based on projected consumer demand and discards food that is not sold or served at an approved frequency, or III. Using time as the public health control as specified under 1200-23-01-.03(5)(a)9., (II) Prepares time/temperature control for safety food in advance using a food preparation method that involves two or more steps which may include combining time/temperature control for safety food ingredients; cooking; cooling; reheating; hot or cold holding; freezing; or thawing;

(III) Prepares food as specified under item 3.(ii)(II) of this subparagraph for delivery to and consumption at a location off the premises of the food establishment where it is prepared;

(IV) Prepares food as specified under item 3.(ii)(II) of this subparagraph for service to a highly susceptible population;

(V) Prepares only food that is not time/temperature control for safety food, or (VI) Does not prepare, but offers for sale only prepackaged food that is not time/temperature control for safety food;

4. The name, title, address, and telephone number of the person directly responsible for the food establishment;

5. The name, title, address and telephone number of the person who functions as the immediate supervisor of the person specified under 4. of this subparagraph such as the zone, district or regional supervisor;

6. The names, titles, and addresses of the persons comprising the legal ownership as specified under 2. of this subparagraph including the owners and officers;

7. A statement signed by the applicant that attests to the accuracy of the information provided in the application; and 8. Other information required by the department.

(f) New, Converted, or Remodeled Establishments. For food establishments that are required to submit plans as specified under 1200-23-01-.08(2)(a), the department shall issue a permit to the applicant after:

1. A properly completed application is submitted;

2. The required fee is submitted;

3. The required plans, specifications, and information are reviewed and approved; and 4. A preoperational inspection as specified in 1200-23-01-.08(2)(f) shows that the establishment is built or remodeled in accordance with the approved plans and specifications and that the establishment is in compliance with this Chapter.

(g) Existing Establishments and Change of Ownership. As applicable, the department may issue a permit to a new owner of an existing food establishment after an application is submitted, reviewed, and approved, and an inspection shows that the establishment is in compliance with this Chapter.

(h) Denial of Application for Permit, Notice. If an application for a permit to operate is denied, the department shall provide the applicant with a notice that includes:

1. The specific reasons and Chapter citations for the permit denial;

2. The actions, if any, that the applicant must take to qualify for a permit; and 3. Advisement of the applicant’s right of appeal and the process and time frames for appeal that are provided in law.

(i) Responsibilities of the Permit Holder. Upon acceptance of the permit issued by the department, the permit holder in order to retain the permit shall:

1. Comply with the provisions of this Chapter including the conditions of a granted variance as specified under 1200-23-01-.08(1)(d)3., and approved plans as specified under 1200-23-01-.08(2)(b);

2. If a food establishment is required under 1200-23-01-.08(2)(c) to operate under a HACCP Plan, comply with the plan as specified under 1200-23-01-.08(1)(d)3.;

3. Immediately contact the department to report an illness of a food employee or conditional employee as specified under 1200-23-01-.02(2)(a)2.;

4. Immediately discontinue operations and notify the department if an imminent health hazard may exist as specified under 1200-23-01-.08(4)(d);

5. Allow representatives of the department access to the food establishment as specified under 1200-23-01-.08(4)(b);

6. Replace existing facilities and equipment specified in 1200-23-01-.08(1)(b) with facilities and equipment that comply with this Chapter if:

(i) The department directs the replacement because the facilities and equipment constitute a public health hazard or nuisance or no longer comply with the criteria upon which the facilities and equipment were accepted; or (ii) The department directs the replacement of the facilities and equipment because of a change of ownership.

7. Comply with directives of the department including time frames for corrective actions specified in inspection reports, notices, orders, warnings, and other directives issued by the department in regard to the permit holder’s food establishment or in response to community emergencies;

8. Accept notices issued and served by the department according to law;

9. Be subject to the administrative, civil, injunctive, and criminal remedies authorized in law for failure to comply with this Chapter or a directive of the department, including time frames for corrective actions specified in inspection reports, notices, orders, warnings, and other directives;

10. Post the permit in a conspicuous manner as designated by the inspector at the time of inspection, and ensure that no person except an authorized representative of the department shall modify, remove, cover or otherwise make the permit less conspicuous; and 11. In the event of a lost, misplaced or destroyed permit, immediately apply for a duplicate and forward the fee with the application for a duplicate permit.

(j) A permit may not be transferred from one person to another person, from one food establishment to another, or from one type of operation to another if the food operation changes from the type of operation specified in the application as specified under 1200-23-01-.08(3)(e)3.

(4) Inspection and Correction of Violations (a) Frequency.

1. Establishing Inspection Interval. Except as specified in parts 2. and 4. of this subparagraph, the department may inspect a food establishment at least once every 6 months.

2. The department may increase the interval between inspections beyond six months if:

(i) The food establishment is fully operating under an approved and validated HACCP plan as specified under 1200-23-01-.08(2)(d) and 1200-23-01- .08(1)(d)3.;

(ii) The food establishment is assigned a less frequent inspection frequency based on a written risk-based inspection schedule that is being uniformly applied throughout the jurisdiction; or (iii) The establishment’s operation involves only coffee service and other unpackaged or prepackaged food that is not time/temperature control for safety food such as carbonated beverages and snack food such as chips, nuts, popcorn, and pretzels; or (iv) The establishment is a farmers market food unit.

3. The department may periodically inspect throughout its permit period a temporary food establishment or farmers market food unit that prepares, sells, or services unpackaged time/temperature control for safety food and that:

(i) Has improvised rather than permanent facilities or equipment for accomplishing functions such as handwashing, food preparation and protection, food temperature control, ware washing, providing drinking water, waste retention and disposal, and insect and rodent control.

4. Performance- and Risk-Based. - Within the parameters specified in (4)(a)–(c) of this paragraph, the department shall prioritize and conduct more frequent inspections based upon its assessment of a food establishment’s history of compliance with this Chapter and the establishment’s potential as a vector of foodborne illness by evaluating:

(i) Past performance, for nonconformance with this Chapter or HACCP plan requirements that are priority items or priority foundation items;

(ii) Past performance, for numerous or repeat violations of this Chapter or HACCP plan requirements that are core items;

(iii) Past performance, for complaints investigated and found to be valid;

(iv) The hazards associated with the particular foods that are prepared, stored, or served;

(v) The type of operation including the methods and extent of food storage, preparation, and service;

(vi) The number of people served; and (vii) Whether the population served is a highly susceptible population.

(b) Access.

1. Allowed at Reasonable Times after Due Notice. After the department presents official credentials and provides notice of the purpose of, and an intent to conduct, an inspection, the person in charge shall allow the department to determine if the food establishment is in compliance with this Chapter by allowing access to the establishment, allowing inspection, and providing information and records specified in this Chapter and to which the department is entitled according to law, during the food establishment’s hours of operation and other reasonable times.

2. Refusal, Notification of Right to Access, and Final Request for Access. If a person denies access to the department, the department shall inform the person that:

(i) The permit holder shall allow access to the department as specified under 1200-23-01-.08(4)(b)1.

(ii) Access is a condition of the acceptance and retention of a food establishment permit to operate as specified under 1200-23-01-.08(3)(i)5., (iii) If access is denied, an administrative warrant may be obtained according to law, and (iv) A final request for access will be made.

3. Refusal, Reporting. If after the department presents credentials and provides notice as specified under 1200-23-01-.08(4)(b)1., explains the authority upon which access is requested, and makes a final request for access as specified in 1200-23-01-.08(4)(b)2., the person in charge continues to refuse access, the department shall provide details of the denial of access on an inspection report form.

4. Administrative Warrant to Gain Access: If denied access to a food establishment for an authorized purpose, and after complying with 1200-23-01-.08(4)(b)1.– 1200-23-01-.08(4)(b)3., the department may issue an administrative warrant to gain access.

(c) Report of Findings.

1. Documenting Information and Observations. The department shall document on an inspection report form:

(i) Administrative information about the food establishment’s legal identity, street and mailing addresses, type of establishment and operation as specified under 1200-23-01-.08(3)(e)3., inspection date, and other information such as type of water supply and sewage disposal, status of the permit, and personnel certificates that may be required; and (ii) Specific factual observations of violative conditions or other deviations from this Chapter that require correction by the permit holder including:

(I) Failure of the person in charge to demonstrate the knowledge of foodborne illness prevention, application of HACCP principles, and the requirements of this Chapter as specified under 1200-23-01- .02(1)(b), (II) Failure of food employees, conditional employees, and the person in charge to report a disease or medical condition as specified under 1200-23-01-.02(2)(a).

(III) Nonconformance with priority items or priority foundation items of this Chapter, (IV) Failure of the appropriate food employees to demonstrate their knowledge of, and ability to perform in accordance with, the procedural, monitoring, verification, and corrective action practices required by the department as specified under 1200-23-01- .08(1)(d)3., (V) Failure of the person in charge to provide records required by the department for determining conformance with a HACCP plan as specified under 1200-23-01-.08(2)(d)4.(vi), and (VI) Nonconformance with critical limits of a HACCP plan.

2. Specifying Time Frame for Corrections. The department shall specify on the inspection report form the time frame for correction of the violations as specified under 1200-23-01-.08(4)(e) and 1200-23-01-.08(4)(f)1.

3. Issuance of Report, Acknowledgment of Receipt and Posting. At the conclusion of the inspection:

(i) The department shall provide a copy of the completed inspection report and any notice to correct violations to the permit holder or to the person in charge, and request a signed acknowledgment of receipt; and (ii) The permit holder shall post the most recent completed report in a conspicuous location on the premises.

4. Refusal to Sign Acknowledgment. The department shall:

(i) Inform a person who declines to sign an acknowledgment of receipt of inspectional findings as specified in 1200-23-01-.08(4)(c)3. that:

(I) An acknowledgment of receipt is not an agreement with findings, (II) Refusal to sign an acknowledgment of receipt will not affect the permit holder’s obligation to correct the violations noted in the inspection report within the time frames specified; and (III) A refusal to sign an acknowledgment of receipt is noted in the inspection report and conveyed to the department’s historical record for the food establishment; and (ii) Make a final request that the person in charge or permit holder sign an acknowledgment of receipt of inspectional findings.

5. Public Information. Except as specified in 1200-23-01-.08(2)(e) the department shall treat the inspection report as a public document and shall make it available for disclosure to a person who requests it as provided by law.

(d) Imminent Health Hazard.

1. Ceasing Operations and Reporting.

(i) Except as specified in (ii) of this part, a permit holder shall immediately discontinue operations and notify the department if an imminent health hazard may exist because of an emergency such as a fire, flood, extended interruption of electrical or water service, sewage backup, misuse of poisonous or toxic materials, onset of an apparent foodborne illness outbreak, gross insanitary occurrence or condition, or other circumstance that may endanger public health. (P)

(ii) A permit holder need not discontinue operations in an area of an establishment that is unaffected by the imminent health hazard.

(iii) Considering the nature of the potential hazard involved and the complexity of the corrective action needed, the department may agree to continuing operations in the event of an extended interruption of electrical or water service if:

(I) A written emergency operating plan has been approved;

(II) Immediate corrective action is taken to eliminate, prevent, or control any food safety risk and imminent health hazard associated with the electrical or water service interruption; and, (III) The department is informed upon implementation of the written emergency operating plan.

(iv) Upon declaration of an imminent health hazard by the Commissioner, the permit holder shall immediately cease operations until authorized to reopen.

2. Resumption of Operations. If operations are discontinued as specified under 1200-23-01-.08(4)(e)1. or otherwise according to law, the permit holder shall obtain approval from the department before resuming operations.

(e) Violation of Priority Item or Priority Foundation Item.

1. Timely Correction.

(i) Except as specified in subpart (ii) of this part, a permit holder shall at the time of inspection correct a violation of a priority item or priority foundation item of this Chapter and implement corrective actions for a HACCP plan provision that is not in compliance with its critical limit.

(ii) Considering the nature of the potential hazard involved and the complexity of the corrective action needed, the department may agree to or specify a longer time frame, not to exceed 10 calendar days after the inspection, for the permit holder to correct violations of a priority item or priority foundation item or HACCP plan deviations.

(iii) In the case of farmers market food units, all violations of priority items must be corrected immediately, whenever possible, and in any event within twenty-four (24) hours.

2. Verification and Documentation of Correction.

(i) After observing at the time of inspection a correction of a violation of a priority item or priority foundation item or a HACCP plan deviation, the department shall enter the violation and information about the corrective action on the inspection report.

(ii) As specified under 1200-23-01-.08(4)(e)1.(ii), after receiving notification that the permit holder has corrected a violation of a priority item or priority foundation item or HACCP plan deviation, or at the end of the specified period of time, the department may verify correction of the violation.

3. Farmers Market Food Units – Time Frame for Corrections.

(i) In the case of farmers market food units, all violations of priority items must be corrected immediately whenever possible, and in any event within twenty-four (24) hours. If violations are not corrected within twenty-four (24) hours, the farmers market food unit shall immediately cease operation until authorized to resume by the department.

(f) Core Violation.

1. Except as specified in part 2. of this subparagraph, the permit holder shall correct core items by a date and time agreed to or specified by the department but no later than 90 calendar days after the inspection.

2. The department may approve a compliance schedule that extends beyond the time limits specified under part 1. of this subparagraph if a written schedule of compliance is submitted by the permit holder and no health hazard exists or will result from allowing an extended schedule for compliance.

(g) Temporary Food Establishments – Time Frame for Correction. In the case of a temporary food establishment pursuant to 1200-23-01-.01(114), all violations shall be corrected within twenty-four (24) hours. If violations are not corrected within twenty four (24) hours, the establishment shall immediately cease food service operation until authorized to resume by the department.

(5) Prevention of Foodborne Disease Transmission by Employees (a) Obtaining Information: Personal History of Illness, Medical Examination and Specimen Analysis. The department shall act when it has reasonable cause to believe that a food employee or conditional employee has possibly transmitted disease; may be infected with a disease in a communicable form that may be transmitted through food; may be a carrier of infectious agents that cause a disease that is transmissible through food; or is affected with a boil, an infected wound or an acute respiratory infection by:

1. Securing a confidential medical history of the food employee or conditional employee suspected of transmitting disease or making other investigations as deemed appropriate; and 2. Requiring appropriate medical examinations, including collection of specimens for laboratory analysis, of a suspected food employee or conditional employee.

(b) Restriction or Exclusion of Food Employee or Summary Suspension of Permit. Based on the findings of an investigation related to a food employee or conditional employee who is suspected of being infected or diseased, the department may issue an order to the suspected food employee, conditional employee or permit holder instituting one or more of the following control measures:

1. Restricting the food employee or conditional employee; 2 Excluding the food employee or conditional employee;

2. Closing the food establishment by summarily suspending a permit to operate in accordance with the law.

(c) Restriction or Exclusion Order: Warning or Hearing Not Required; Information Required in Order. Based on the findings of an investigation and to control disease transmission, the department may issue a summary order of restriction or exclusion to a suspected food employee or the permit holder without prior warning, a notice of hearing or a hearing if the order:

1. States the reasons for the restriction or exclusion;

2. States the evidence that the food employee or permit holder shall provide in order to demonstrate that the reasons for the restriction or exclusion are eliminated;

3. States that the suspected food employee or permit holder may request an appeal hearing by submitting a timely request within seven business days of the issuance of the order; and 4. Provides the name and address of the department representative to whom a request for appeal hearing may be made.

(d) Removal of Exclusions and Restrictions. The department shall release a food employee or conditional employee from restriction or exclusion upon a showing that the employee meets the conditions for reinstatement under Rule 1200-23-01-.02(2)(c).

(6) Reviews Following Inspection (a) The inspection report shall state that failure to comply with any time limits specified by the department for correction may result in cessation of operation.

(b) The citation of a violation of a priority item may be reviewed, upon receipt of a written request submitted to the department within ten (10) calendar days following the date of the inspection report. If the tenth (10th) day falls on a weekend or state holiday, the first work day following shall be treated as the tenth (10th) day. The request for review shall identify the priority item(s) being reviewed. The final determination on the review shall be made by the Commissioner of Health or the Commissioner’s designee in writing and within a reasonable time after receipt of the request for a review.

(c) The citation of a violation of a priority foundation item may also be reviewed upon the receipt of a written request submitted to the department within ten (10) calendar days following the date of the inspection report. If the tenth (10th) falls on a weekend or state holiday, the first work day following shall be treated as the tenth (10th) day. The request for review shall identify the priority foundation item(s) being reviewed. The decision of the department shall be final and made in writing within a reasonable time after receipt of the request for a review.

(d) In the event of an order of cessation of operation based upon the reviewed critical item(s), a request for a hearing may be made in writing to the Commissioner of Health received within ten (10) calendar days of the decision of the department. Except as otherwise provided by law, no action shall be taken regarding a closure on the critical item(s) under review or subject to a hearing pending the outcome of the hearing which shall be held pursuant to the Uniform Administrative Procedures Act.

(7) Permit Revocation (a) After providing an opportunity for a hearing, the Commissioner of Health or his duly authorized representative may revoke a permit for serious or repeated violations of requirements of this part or for interference with the department or its duly authorized representative in the performance of his duty.

(b) Prior to revocation, the department shall notify, in writing, the permittee of the specific reason(s) for which the permit is to be revoked, and that the permit shall be revoked at the end of ten (10) days following service of such notice, unless a written request for a hearing is filed with the department within such ten-day period. If no request for hearing is filed within the ten-day period, the revocation of the permit becomes final.

(8) Whenever a facility is required under this section to cease operations, it shall not resume operations until it is shown on re-inspection that conditions responsible for the order to cease operations no longer exist. Opportunity for re-inspection shall be offered within a reasonable time.

History

• Authority: T.C.A. §§ 68-14-701 through 68-14-729.
• Administrative History: Original rule filed April 17, 2015; effective July 16, 2015. Emergency rules filed April 9, 2024; effective through October 6, 2024. Amendments filed July 1, 2024; effective September 29, 2024. Amendments filed March 16, 2026; effective June 14, 2026.

Tenn. Comp. R. & Regs. 1200-23-01-.09 PERMIT FEES

(1) The permit fee to operate a food service establishment shall be in accordance with the following schedule:

(a) Food service establishments with 0–50 seats shall pay a permit fee of two hundred and ten dollars ($210) per year.

(b) Food service establishments with 51 or more seats shall pay a permit fee of three hundred and sixty dollars ($360) per year.

(c) Auxiliary food service establishments shall pay a permit fee of one hundred dollars ($100) per year.

(d) Temporary food service establishments shall pay a permit fee of thirty dollars ($30).

(e) Child care food service establishments and congregate meal sites funded through the commission on aging and disability that are food service establishments with 0–50 seats shall pay a permit fee of fifty dollars ($50) per year.

(f) Child care food service establishments and congregate meal sites funded through the commission on aging and disability that are food service establishments with 51 or more seats shall pay a permit fee of eighty dollars ($80) per year.

(g) School food service establishments shall pay a permit fee of eighty dollars ($80) per year.

(h) Farmers market food units shall pay a permit fee of three hundred dollars ($300).

History

• Authority: T.C.A. § 68-14-713.
• Administrative History: Emergency rule filed December 19, 2025; effective through June 17, 2026. New rule filed March 16, 2026; effective June 14, 2026.

Chapter 1200-23-02 Bed and Breakfast Establishments

Tenn. Comp. R. & Regs. 1200-23-02-.01 DEFINITIONS

(1)GENERAL - As used in these rules, unless the context requires otherwise;

(a)Approved means being accepted by the Commissioner.

(b)Bed and Breakfast Establishment means a private home, inn, or other unique residential facility offering bed and breakfast accommodations and only one daily meal and having four (4) but not more than twelve (12) guest rooms furnished for pay, with guest staying not more than fourteen (14) days, and where the innkeeper resides on the premises or property or immediately adjacent to it. Guest rooms shall be established and maintained distinct and separate from the innkeeper’s quarters.

(c)Commissioner means the Commissioner of the Department of Health, his duly appointed representative, and in the event of his absence or vacancy in the office of commissioner, the deputy commissioner.

(d)Contractor means person that enters into an agreement with another person to perform specific duties and acts as a representative of the permittee or permit applicant.

(e)Cross-Connection means “. . . any physical arrangement whereby a public water supply is connected, directly or indirectly, with any other water supply system, sewer, drain, conduit, pool, storage reservoir, plumbing fixture, or other waste or liquid of unknown or unsafe quality which may be capable of imparting contamination to the public water supply as result of backflow. Bypass arrangements, jumper connections, removable sections, swivel or changeover devices through which, or because of which, backflow could occur are considered to be crossconnections.”

(f)Employee means the permit holder, individuals having supervisory or management duties or any other individual working in a Bed and Breakfast establishment.

(g)Equipment means stoves, ovens, ranges, hoods, slicers, mixers, meatblocks, tables, counters, refrigerators, sinks, dishwashing machines, steam tables, and similar items other than utensils, used in the operation of a food service establishment.

(h)Food means any raw, cooked, or processed edible substance, ice, beverage or ingredient used or intended for use or for sale in whole or in part for human consumption.

(i)Food Contact Surface means those surfaces of equipment and utensils with which food normally comes in contact, and those surfaces from which food may drain, drip, or splash back onto surfaces normally in contact with food.

(j)Furnished for Pay to Transients or Travelers means offering sleeping accommodations by the day and/or night.

(k)Hermetically sealed container means a container designed and intended to be secure against the entry of microorganisms and to maintain the commercial sterility of its content after processing.

(l)Ice Machine means a self-serve machine in which ice is manufactured and ice is removed by the guests through use of an automatic dispensing device, such as a push lever or key.

(m)Kitchenware means all multi-use utensils other than tableware.

(n)Law means any provision of the State of Tennessee statutes and rules.

(o)Linens means all sheets, pillowcases, towels, washcloths, and other reusable cloth items which come in personal contact with occupant.

(p)Owner/Operator means the applicant, permittee, or other persons to be in charge of facilities.

(q)Permit means a written license to operate a Bed and Breakfast establishment, issued by the Department, and shall be posted, along with the most current inspection sheet, in a conspicuous place.

(r)Person means any individual, partnership, firm, corporation, agency, municipality, or state or political subdivisions.

(s)Person In Charge means the individual present in a Bed and Breakfast establishment who is the apparent supervisor at the time of inspection, or if no individual is the apparent supervisor, then any employee present.

(t)Potable Water means water that is safe for drinking.

(u)Potentially Hazardous Food means any food that consists in whole or in part of milk or milk products, eggs, meat, poultry, fish, shellfish, edible crustacea, or other ingredients, including synthetic ingredients, in a form capable of supporting rapid and progressive growth of infectious or toxigenic microorganisms. The term does not include clean, whole, uncracked, odor-free shell eggs or foods which have a pH level of 4.6 or below or a water activity (aw) value of 0.85 or less.

(v)Reconstituted means dehydrated food products recombined with water or other liquids.

(w)Regulatory Authority means the State and/or local enforcement authority or authorities having jurisdiction over the Bed and Breakfast establishment.

(x)Safe Materials means articles manufactured from or composed of materials that may not reasonably be expected to result, directly or indirectly, in their becoming a component or otherwise affecting the characteristics of any food. If materials used are food additives or color additives as defined in section 201(s) or (t) of the Federal Food, Drug, and Cosmetic Act of 1938 they are “safe” only if they are used in conformity with regulations established pursuant to

section 409 or section 706 of the Act. Other materials are “safe” only if, as used, they are not food additives or color additives as defined in section 201(s) or (t) of the Federal Food, Drug, and Cosmetic Act and are used in conformity with all applicable regulations of the Food and Drug Administration.

(y)Sanitation means effective bactericidal treatment by a process that provides enough accumulative heat or concentration of chemicals for enough time to reduce the bacterial count, including pathogens, to a safe level on utensils and equipment.

(z)Sealed means free of cracks or other openings that permit the entry or passage of moisture.

(aa)Sewage means human excreta, all water carried waste, and household wastes from residences, buildings, or commercial and industrial establishments.

(bb)Shall denotes a mandatory requirement.

(cc)Single Service Articles means cups, containers, lids, closures, plates, knives, forks, spoons, stirrers, paddles, straws, napkins, wrapping materials, toothpicks and similar articles intended for one-time, one-person use and then discarded.

(dd)Solid Waste means refuse, garbage, trash, rubbish, and any other item or items which could cause an unsanitary condition or undesirable health and safety conditions.

(ee)Tableware means multi-use eating and drinking utensils.

(ff)Utensils means any implement used in the storage, preparation, transportation, or service of food.

History

• Authority: T.C.A. §§68-14-503 and 4-5-202.
• Administrative History: Original rule filed July 3, 1991; effective August 17, 1991.

Tenn. Comp. R. & Regs. 1200-23-02-.02 BED AND BREAKFAST ESTABLISHMENTS

(1)SANITARY FACILITIES AND CONTROLS

(a)Water Supply 1.Enough potable water from an approved source for the needs of the Bed and Breakfast establishment shall be provided. When a private water supply is used, it shall be under pressure and constructed, maintained and operated in accordance with regulations under the Non-Community Water System Regulations, Division of Water Supply, Department of Environment and Conservation. 2.(i)Cold running water under pressure shall be provided to all equipment that uses water. Hot and cold running water under pressure shall be provided to all lavatories, bathing facilities, laundry facilities, and all water-using equipment where eating and drinking utensils are washed.

(ii)Within the food service operation, each lavatory shall be provided with hot and cold water tempered by means of a mixing valve or combination faucet. Any selfclosing, slow-closing, or metering faucet used shall be designed to provide a flow of water for at least fifteen (15) seconds without the need to reactivate the faucet.

Steam-mixing valves are prohibited. 3.Ice used for any purpose shall be made from water which comes from an approved source and shall be used only if it has been manufactured and handled in a sanitary manner.

(b)Self-service Ice Machines 1.Self-service ice provided for the Bed and Breakfast establishment guest shall be dispensed through use of sanitary ice machines or shall be prepackaged for individual Bed and Breakfast establishment guests from an approved source in all Bed and Breakfast establishments constructed after January 1, 1991, provided, however, that ice machines located in individual rooms shall not be prohibited. Self-service ice storage bins presently being used may be continued in use indefinitely, provided that the machines are maintained in good repair and capable of being properly cleaned. On or after January 1, 1991, when self-service ice storage bins are replaced, or additional ice machines are added, a sanitary ice-dispensing machine shall be installed. 2.Ice machines shall be easily cleanable, kept clean, and free of contaminants and rust. 3.Ice storage containers and scoops shall be smooth, constructed of impervious material designed to facilitate cleaning, and shall be stored, handled and used in a sanitary manner. 4.Tableware and Kitchenware such as multi-use ice buckets and glassware placed in individual guest rooms shall be washed, rinsed and sanitized each day. 5.In lieu of wash, rinsing and sanitizing ice buckets and glassware, single service utensils may be used. Ice buckets with plastic liners need only to be washed and rinsed.

(c)Plumbing 1.General. Plumbing shall be sized, installed and maintained according to law. There shall be no cross-connections between any safe water supply and any unsafe or questionable water supply, or any source of pollution through which the safe water supply might become contaminated. 2.Non-potable System. A non-potable water system is permitted only for purposes such as air-conditioning and fire protection and only if the system is installed according to law and the non-potable water does not contact, directly or indirectly the potable water system or equipment or utensils that come in contact with food or drink. The piping of any non-potable water system shall be durably identified so that it is readily distinguishable from piping that carries potable water. 3.Backflow. The potable water system shall be installed to preclude the possibility of backflow. Devices to protect against backflow and backsiphonage shall be installed at all fixtures and equipment where an air gap at least twice the diameter of the water inlet is not provided between the water outlet from the fixture and the fixtures flood-level rim and wherever else backflow or backsiphonage may occur. A hose shall not be attached to a faucet unless a backflow prevention device is installed.

(d)Sewage All sewage, including liquid waste, shall be disposed of by a public sewerage system or by a sewage disposal system constructed and operated according to law.

(e)Insect and Rodent Control 1.General. Effective measures intended to control the presence of rodents, flies, roaches, and other insects on the premises shall be utilized. The premises shall be kept in such condition as to prevent the harborage or feeding of insects, rodents or other vermin. 2.Openings. Openings to the outside shall be effectively protected against the entrance of rodents and shall be protected against entrance of insects by tight-fitting doors and windows. Screen or storm doors shall be self-closing, and screens for windows, doors, skylights, transoms, and other openings to the outside shall be tight fitting and free of breaks. Screening materials shall not be less than sixteen mesh to the inch.

In absence of storm or screen doors, any door leading from the kitchen area or food store room to the outside shall be self-closing.

In kitchens that cannot be closed off from the remaining facility, all exit doors leading to the outside must be self-closing and all open windows shall be screened.

(f)Garbage and Refuse 1.All containers used in guest rooms, lobbies and hallways for storage of garbage and refuse shall be constructed of durable metal or other approved types of materials, which do not leak, do not absorb liquids, shall not support combustion or melt under intense heat. Such containers shall be thoroughly cleaned on the inside and outside each time they are emptied unless liners are used. 2.All outside refuse or garbage storage containers shall be constructed of durable metal or other approved types of materials, which do not leak and do not absorb liquids, and shall be provided with tight-fitting lids or covers and shall, unless kept in a special verminproof room or enclosure, be kept covered when stored. Each container shall be cleaned at such frequency as to prevent a nuisance or odor. Liquid waste resulting from the cleaning of containers shall be disposed of in an approved manner. 3.The rooms, enclosures, areas and containers shall be adequate for storage of all refuse or garbage accumulating on the premises in accordance with these rules. Adequate cleaning facilities shall be provided and each storage room, enclosure or container shall be thoroughly cleaned after the emptying or removal of refuse or garbage Areas surrounding these rooms, enclosures and containers shall be kept clean and orderly. 4.All garbage and refuse shall, prior to disposal, be kept in durable, rust-resistant, nonabsorbent, watertight, rodent-proof standard garbage containers which shall be kept covered when filled or stored or not in continuous use. All solid waste shall be disposed of with sufficient frequency and in such a manner as to prevent insect breeding and public health nuisances. 5.All outside premises shall be maintained free of litter and unnecessary articles.

(g)Poisonous or Toxic Materials 1.General. Only such poisonous and toxic materials as are required to maintain sanitary conditions and for sanitization purposes may be used or stored in Bed and Breakfast establishments. Such materials shall be properly stored and identified and shall be used only in such manner and under such conditions as shall not constitute a hazard to employees or guests. 2.Containers of poisonous or toxic materials including insecticides and rodenticides, shall be prominently and distinctly labeled for easy identification of contents. 3.Poisonous or toxic materials shall be stored in cabinets or shelves that are used for no other purpose and in a place other than an area where linens or other articles which come in personal contact with guests are stored. Bactericides and cleaning compounds shall not be stored in the same cabinet or shelf or area of a room as are insecticides, rodenticides, or other poisonous or toxic materials. 4.Bactericides, cleaning compounds or other compounds shall not be used in a way that leaves a toxic residue, nor in a way that constitutes a hazard to employees or guests.

Poisonous or toxic materials or cleaning compounds shall be used only in full compliance with their labeling.

(h)Personnel 1.Employee health. No person while affected with any disease in a communicable form, or while a carrier of such disease, or while afflicted with boils, infected wounds, or sores shall work in any area of a Bed and Breakfast establishment in any capacity in which there is a likelihood of such a person contaminating bedding and other surfaces with pathogenic organisms, or transmitting disease to other individuals, and no person known or suspected of being affected with any such disease or condition shall be employed in such an area or capacity. When there is reason to suspect that any employee has contracted any disease in communicable form or has become a carrier of such a disease, the employee shall be (i) removed from the Bed and Breakfast establishment; or (ii) his service be restricted to some area of the establishment where there would be no danger of transmitting disease. 2.Personal cleanliness. Employees, other than clerical employees, shall thoroughly wash their hands and the exposed portions of their arms with soap and warm water before starting work, during work as often as necessary to keep them clean and after smoking, eating/drinking or using the toilet. Employees shall keep their fingernails clean.

Employees shall maintain a high degree of personal cleanliness, and conform to other good hygienic practices.

(i)Fire Safety 1.General. Fire and electrical hazards are prohibited. 2.Alarm systems. Battery operated or directly wired smoke detectors shall be installed in each sleeping room and on each guest floor of all Bed and Breakfast establishments. All smoke detectors shall be approved and maintained according to law. 3.Evacuation plan and fire prevention equipment notices.

(i)All Bed and Breakfast establishments shall post and maintain in a conspicuous place in each guest sleeping room a diagram calling attention to and advising such guest of fire escape routes and fire prevention equipment installed in the building.

Any printed matter shall be in typeface of at least twelve point. Such diagram shall include, but not be limited to the following:

(I)The locations of the nearest fire escapes or exits from such room;

(II)The locations of the nearest fire extinguishers from such rooms;

(III)If the building has a fire warning system which is activated by pulling a lever in case of fire, the locations of the nearest such levers from such rooms;

(IV)The extent to which the building has been equipped with smoke alarm or fire detection devices; and (V)The extent to which a sprinkler system has been installed in the building.

(ii)A notice shall be placed in a conspicuous location so as to be readily visible to guests as they check in the facility upon arrival. Such notice shall include but not be limited to the following:

(I)Whether the building has a fire warning system which is activated by pulling a lever in case of fire;

(II)The extent to which the building has been equipped with smoke alarms or fire detection devices; and (III)The extent to which a sprinkler system has been installed in the building.

(iii)Fire Extinguishers An approved type fire extinguisher shall be placed on each guest floor at a convenient location outside guest rooms.

(iv)Storage of Flammables Gasoline, paints or other flammables shall be stored in a well-ventilated building or area away from guest sleeping rooms.

(j)General Construction 1.Floors in establishment shall be kept clean and in good repair. The walls and ceilings of rooms and areas shall be kept clean and in good repair. 2.Toilet, Handwashing, Laundry, and Bathing Facilities (i)Establishments shall be provided with approved, adequate, sanitary toilet, handwashing, and bathing facilities. These facilities, and laundry facilities used in conjunction with guest rooms, shall be kept clean and in good repair.

(ii)All lavatories and baths shall be supplied with hot and cold running water. Each guest shall be provided individual soap and clean individual bath cloths and towels.

(iii)Clean towels and bath cloths shall be stored and handled in a sanitary manner.

(iv)Anti-slip tubs, adequate slip strips, appliques, or slip-proof mats shall be provided in each bathing facility and shall be kept clean and in good repair.

In establishments constructed after January 1, 1991 all toilets, handwashing and bathing facilities shall be provided in each guest room. 3.Telephone Service Telephone service shall be accessible to guests and staff in the event of emergencies. 4.Lighting (i)Natural and artificial lighting for general cleaning purposes and safety of quests shall be at least ten (10) footcandles in guest rooms, stairways, hallways, closets and storage areas.

(ii)Lighting in reading areas of guest rooms shall be thirty (30) footcandles. 5.Ventilation Sleeping and toilet rooms shall have sufficient ventilation to keep them free from steam condensation, excessive heat vapors, smoke, fumes or noxious odors. 6.Windows and Doors All windows and doors shall be kept clean and maintained in good repair. All doors shall be constructed and equipped with in-room security devices, such as locks, chains, or similar devices. All open windows shall require screening. 7.Beds, Linen, Furniture (i)Furniture, mattresses, curtains, draperies, etc., shall be kept clean and in good repair.

(ii)Clean bed linens in good repair shall be provided for each guest, and shall be changed between guest. When a guest is present multiple days, linens shall be changed as often as necessary or every fifth day.

(iii)Clean linens shall be stored and handled in a sanitary manner and separate from soiled linen.

(iv)Linens shall be thoroughly washed in a detergent solution containing a sanitizer equivalent to at least 50 parts per million available chlorine. Single-service articles shall be made from non-toxic materials. Single-service articles placed in sleeping rooms shall be individually wrapped or dispensed in a sanitary manner.

Single-service articles shall be used only once. 8.Storage Areas and Closets All closets shall be kept clean and in good repair.

History

• Authority: T.C.A. §§69-14-503 and 4-5-202.
• Administrative History: Original rule filed July 3, 1991; effective August 17, 1991.

Tenn. Comp. R. & Regs. 1200-23-02-.03 FOOD SERVICE AND SANITATION

(1)FOOD SERVICE UTENSILS AND EQUIPMENT.

(a)Multi-use equipment and utensils shall be constructed and repaired with safe materials, including finishing materials; they shall be corrosion resistant and non-absorbent; and they shall be smooth, easily cleanable, and durable under conditions of normal use. Single-service articles shall be made from clean, sanitary and safe materials. Equipment, utensils, and single-service articles shall not impart odors, color, or taste, nor contribute to the contamination of food.

(b)Multi-use eating and drinking utensils shall be thoroughly cleaned after each use, and the facilities needed for the operations of washing, rinsing, and sanitizing, shall be used for such cleaning. Food service utensils and equipment shall be air dried only.

(c)Pots, pans, and other utensils used in the preparation or service and storage of food/drink shall be thoroughly washed, rinsed and sanitized after each use. Cooking surfaces of equipment shall be cleaned at least once each day. Non-food contact surfaces of equipment shall be cleaned at such intervals as to keep them in a clean and sanitary condition.

(d)No polish or other substance containing poisonous materials shall be used in a manner that would leave a toxic residue on such surfaces that may constitute a hazard to employees, patrons or other persons.

(e)Wiping cloths used in the kitchen shall be kept clean. When in use, wiping cloths shall be stored in a container with the proper sanitizing solution.

(f)Containers and clean utensils shall be covered and stored, in tight, clean cabinets, or otherwise stored in such a manner as to prevent contamination. Utensils shall be handled in such a manner as to prevent contamination.

(g)Single service utensils shall be purchased only in sanitary containers, shall be stored therein in a clean, dry place until used, and shall be handled in a sanitary manner.

(h)1.Acceptable facilities such as a sink with no fewer than three (3) compartments large enough to accommodate the largest utensil(s) and/or automatic dishwashers, commercially rated, for washing/rinsing/sanitizing equipment and utensils shall be located in each establishment. 2.All facilities constructed or extensively remodeled after January 1, 1991 shall have three (3) compartment sinks with drain boards or movable dish tables or commercial automatic dishwasher. 3.Facilities existing prior to January 1, 1991 with a two compartment sink may use a suitable auxiliary container for sanitizing. Domestic dish machines in these facilities shall be acceptable provided the temperature at the utensil surface is 160 o F at the end of each complete cycle. If the temperature does not reach 160 o F utensils may be sanitized in a suitable container. When domestic machines are replaced, they shall be replaced with a commercial or commercially rated dish machine.

(i)Acceptable food storage facilities including residential kitchen cabinets, shall be kept clean and free of vermin.

(2)Food Supplies (a)General. Food shall be in sound condition, free from spoilage, filth, or other contamination and shall be safe for human consumption. Food shall be obtained from sources that comply with all laws relating to food and food labeling. The use of food in hermetically sealed containers that was not prepared in a food processing establishment is prohibited.

(b)Food Protection. Foods shall be protected from contamination while being stored, prepared, served, and during transportation. Perishable foods shall be stored at such temperatures as will protect against spoilage. Potentially hazardous food shall be maintained at safe temperatures (45 o F, or below, or 140 o F, or above) except during necessary period of preparation and service.

Frozen foods shall be kept at such temperatures as to remain frozen, except when being thawed for preparation or use. Potentially hazardous food shall be thawed: 1.In refrigerated units at a temperature not to exceed 45 o F; or 2.Under potable running water of a temperature of 70 o F or below, with sufficient water velocity to agitate and float off loose food particles into the overflow; or 3.In a microwave oven only when the food will be immediately transferred to conventional cooking facilities as part of a continuous cooking process or when the entire, uninterrupted cooking process takes place in the microwave oven; or 4.As part of the conventional cooking process.

(c)An indicating thermometer shall be located in each refrigerator and freezer. Raw fruits and vegetables shall be washed thoroughly before use. Stuffings, poultry, stuffed meats and poultry, and pork and pork products shall be thoroughly cooked to an internal temperature of 165°F before being served. Salads made of meat, poultry, potatoes, fish, shellfish, or eggs, and other potentially hazardous prepared foods, shall be prepared, preferably from chilled products, with a minimum of manual contact. Portions of food once served to an individual shall not be served again. Rare roast beef may be cooked, held and served at a temperature of 130°F.

(d)Live pets shall have current and required inoculations and shall not be allowed in any room or area in which food is prepared, stored, or served. Live pets, unless caged and restricted from the immediate eating area, shall not be allowed in the food service operation. No birds or turtles shall be permitted in food preparation areas.

(e)Refrigeration facilities, hot food storage facilities, and effective insulated facilities shall be provided as needed to assure the maintenance of all foods at required temperatures during storage, preparation, and service.

(f)Containers of food shall be stored a minimum of six (6) inches above the floor, on clean racks, shelves, or other clean surfaces, in such a manner as to be protected from splash and other contamination.

(g)Food Service Persons. Persons, while preparing or serving food or washing equipment or utensils, shall wear clean outer garments, maintain a high degree of personal cleanliness, and conform to hygienic practices. They shall wash their hands thoroughly before starting work and as often as necessary to remove soil and contamination. After visiting a toilet room, persons shall wash their hands thoroughly in a lavatory and in no case in the kitchen sink. 1.Lavatories shall be at least the number required by law, shall be installed according to law, and shall be located to permit convenient use by all employees in food preparation areas and utensil washing areas. 2.Lavatories shall be accessible to employees at all times. 3.Lavatories shall also be located in or immediately adjacent to toilet rooms or vestibules.

Sinks used for food preparation or for washing equipment or utensils shall not be used for handwashing. 4.Facilities existing prior to January 1, 1991 shall install the required number of lavatories by January 1, 1992.

(3)No person while infected with a disease in a communicable form, or while a carrier of such a disease, or while afflicted with boils, infected wounds, sores, or an acute respiratory infection, shall work in any capacity in which there is a likelihood of that person contaminating food or food-contact surfaces with pathogenic organisms. If there is reason to suspect that any person has contacted any disease in a communicable form or has become a carrier of such disease, the permittee shall notify the local health department immediately.

History

• Authority: T.C.A. §§68-14-503 and 4-5-202.
• Administrative History: Original rule filed July 3, 1991; effective August 17, 1991.

Tenn. Comp. R. & Regs. 1200-23-02-.04 GENERAL PROVISIONS

(1)Severability If any provision of this section, or the application thereof to any person or circumstance, is held invalid, the remainder of these rules, or the application of such provision to other persons or circumstances, shall not be affected thereby.

(2)Review of Plans (a)Submission of Plans. Whenever a Bed and Breakfast establishment is constructed or extensively remodeled and whenever an existing structure is converted to use as a Bed and Breakfast Establishment, at least one (1) set of properly prepared plans and specifications for such construction, remodeling, or conversion shall be submitted to the Commissioner for review and approval before construction, remodeling or conversion is begun. The plans and specifications shall indicate the proposed layout, arrangement, mechanical plans, and construction materials of work areas, sleeping areas and/or rooms and the type and model of proposed fixed equipment and facilities. The Commissioner shall approve the plans and specifications if they meet the requirements of these rules. No Bed and Breakfast establishment shall be constructed, extensively remodeled, or converted except in accordance with plans and specifications approved by the Commissioner.

(b)Pre-Operational Inspection. After plans and specifications have been approved by the Commissioner, the Bed and Breakfast establishment shall not start operations until the Commissioner has made a pre-operational inspection and has determined compliance with the approved plans and specifications and with the requirements of these rules.

History

• Authority: T.C.A. §§68-14-503 and 4-5-202.
• Administrative History: Original rule filed July 3, 1991; effective August 17, 1991.

Chapter 1200-23-03 Tattoo Artist and Tattoo Establishment

Tenn. Comp. R. & Regs. 1200-23-03-.01 DEFINITIONS

(1) “Antibacterial solution” means any solution used to retard the growth of bacteria approved for the application to human skin and includes all products so labeled.

(2) “Antiseptic” means a substance that will inhibit the growth and development of microorganisms without necessarily destroying them.

(3) “Approved” means being accepted by the Commissioner or local health officer, as appropriate under the law.

(4) “Aseptic technique” means to render or maintain free from infectious material.

(5) “Autoclave” means a device which automatically holds the temperature, pressure, and time for the purpose of sterilization.

(6) “Autoclave indicator” means chemical detection strips, markers, or tape.

(7) “Biohazardous waste” means “regulated waste” (see definition No. 46).

(8) “Blood” means human blood, human blood components, and products made from human blood.

(9) “Bloodborne pathogens” means pathogenic microorganisms present in human blood that can cause disease in humans. These pathogens include, but are not limited to, Hepatitis B virus (HBV) and human immunodeficiency virus (HIV).

(10) “Chemical detection strips, markers or tape” means the use of detection devices placed on items for sterilization to facilitate in determining that the item has been subjected to steam sterilization process.

(11) “Client” means any person desiring to receive a tattoo.

(12) “Commissioner” means the Commissioner of the Department of Health.

(13) “Contaminated” means the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface.

(14) “Contaminated laundry” means laundry which has been soiled with blood or other potentially infectious materials or which may contain sharps.

(15) “Contaminated sharps” means any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, or broken glass.

(16) “Critical item(s)” means those aspects of operation or conditions which, if in violation, constitute the greatest hazards to health and safety, including imminent health hazards. Critical violations shall include the following:

(a) Autoclave does not meet minimum time, pressure or temperature requirements;

(b) Lack of a monthly negative spore or microbiological monitoring test for quality control;

(c) Nondisposable tubes and needles are not sterilized or were sterilized greater than one (1) year ago;

(d) Work room is not equipped as required or is not stocked;

(e) Reuse of single use articles;

(f) Sterile instruments are not properly handled;

(g) Reusable instruments are not handled properly;

(h) Employees with infectious lesions on hands not restricted from tattooing;

(i) Employees not practicing proper cleanliness and good hygiene practices;

(j) Water supply not approved, hot and cold running water under pressure not available;

(k) Approved sewage and liquid waste disposal not available;

(l) Cross connection allowing back-siphonage present in plumbing system;

(m) Toilet and hand washing facilities not available for employees;

(n) Insect and rodent evidence, harborage, or outer opening present; or (o) Toxic items not properly stored, labeled, or used.

(17) “Decontamination” means the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.

(18) “Department” means the Department of Health.

(19) “Disinfectant” means a solution intended to destroy or inactivate specific viruses, bacteria, or fungi on clean, inanimate surfaces [e.g., 1:10 bleach solution] or commercially labeled disinfectant.

(20) “Easily cleanable” means that surfaces are readily accessible and made of such materials and finish and so fabricated that residue may be effectively removed by normal cleaning methods.

(21) “Engineering controls” mean controls (e.g., sharps disposal containers) that isolate or remove the bloodborne pathogens hazard from the workplace.

(22) “Exposure incident” means a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duties.

(23) “Extensively remodeled” means alteration to affect the increase or decrease of floor space or the alteration of walls in a work area.

(24) “Germicide” means an agent that kills pathogenic microorganisms.

(25) “Germicidal solution” means any solution which destroys microorganisms and is so labeled.

(26) “Handwashing facilities” means a facility providing an adequate supply of running potable water, soap dispenser, soap, and single use towels or automatic dryer.

(27) “Health officer” means an individual appointed by the Commissioner pursuant to T.C.A. § 68-2- 603.

(28) “Imminent health hazard” means any condition, deficiency, or practice, as defined by the health officer, which, if not corrected, is very likely to result in illness, injury, or loss of life to any person.

(29) “Infectious waste” means “regulated waste” (see definition No. 48).

(30) “Law” means any applicable provision of the State of Tennessee statutes and rules of any department or agency.

(31) “License” means the issuance of a license to perform tattooing to any individual, partnership, firm or corporation. “License” further means to allow or authorize any person who has satisfactorily completed all requirements set forth by law or by the local health officer to engage in the practice or business or tattooing.

(32) “Local health department” means the agency defined in T.C.A. §§ 68-2-601 et. seq.

(33) “Microbiological monitoring for quality control” means the use of a standard spore, Bacillus stearothermophilus to challenge the sterilization process.

(34) “Occupational exposure” is synonymous with “exposure incident” (see definition No. 21).

(35) “Other potentially infectious material” means the following human body fluids: semen, vaginal secretions, saliva, and any body fluid visibly contaminated with blood.

(36) “Owner/Operator” means the applicant, permittee, or other person or persons in charge of a facility.

(37) “Parenteral” means piercing mucous membranes or the skin barrier through such events as needle sticks, human bites, cuts, and abrasions.

(38) “Patron or customer” is synonymous with “client” (see definition No. 11).

(39) “Percutaneous” means infectious materials may enter the body through compromised skin surfaces (e.g., needle sticks, acne, cuts, lesions).

(40) “Permit” means the issuance of a permit to a tattoo studio or establishment to allow or authorize a tattoo establishment to be operated for the purpose of engaging in the practice or business of tattooing.

(41) “Person” means tattoo operator and/or any individual, partnership, firm, corporation, agency, municipality, or state or political subdivisions, or the federal government and its agencies and departments, depending on the context within the rules.

(42) “Personnel” means the permit holder, any person who tattoos, individuals having supervisory or management duties, or any other person employed or working in a tattoo establishment. This individual may or may be a tattoo artist.

(43) “Person in charge” means the individual present in a tattoo establishment who is the apparent supervisor at the time of inspection, or, if no individual is the apparent supervisor, then any employee present.

(44) “Personal protective equipment” means specialized clothing or equipment, such as gloves or lapcloth, worn by an employee for protection against a hazard. General work clothes not intended to function as protection against a hazard are not considered to be personal protective equipment.

(45) “Potable water” means water that is safe for drinking.

(46) “Regional Health Director” means an individual who directs the operations of a Tennessee Department of Health Region or the Regional Director’s designee.

(47) “Registration” means license or permit, as applicable.

(48) “Regulated waste” means liquid or semi-liquid blood or other potentially infectious materials, contaminated items that would release blood, or other potentially infectious materials in a liquid or semi-liquid state, if compressed, and contaminated sharps.

(49) “Safe materials” means articles manufactured and used in accordance with law.

(50) “Sanitary” means clean and free of agents of infection.

(51) “Sanitization” means an effective germicidal treatment by a process that provides enough accumulative heat or concentration of chemicals for enough time to reduce the microorganism level, including pathogens, to a safe level on utensils and equipment.

(52) “Sewage” means human excreta, all water carried waste, and household wastes from residences, buildings, or commercial and industrial establishments.

(53) “Single use” means a disposable item that is used one (1) time on one (1) client and then is properly disposed of by appropriate measures.

(54) “Solid waste” means refuse, garbage, trash, rubbish, and any other item(s) which could cause an unsanitary condition or undesirable health and safety conditions.

(55) “Sterilization” means holding in an autoclave for fifteen (15) minutes, at fifteen (15) pounds pressure, and at a temperature of two hundred fifty degrees (250° F) Fahrenheit or one hundred twenty-one degrees (121°C) Celsius.

(56) “Tattoo” means any method of placing designs, letters, figures, symbols, cosmetics, or any other marks under the skin of a person using ink or color with the aid of needles or instruments.

(57) “Tattoo artist” means any person, regardless of age, who engages in the practice/service of tattooing regardless of the type of tattoo or area to be tattooed.

(58) “Tattoo artist registration” means the issuance of a State license authorizing the person named thereon to engage in the practice/service of tattooing in the State of Tennessee after fulfilling the requirements in T.C.A. Title 62, Chapter 38 and these rules.

(59) “Tattoo establishment” means any room or space where tattooing is performed or where the business of tattooing, or any part thereof, is conducted. The term is synonymous with “tattoo parlor” and “tattoo studio.”

(60) “Tattoo operator” means any person who controls, operates, conducts, or manages any tattoo studio, whether actually engaging in tattooing or not.

(61) “Tattoo parlor” means “tattoo establishment” (see definition No. 59).

(62) “Tattoo studio” means any room or space where tattooing is practiced or where the service of tattooing is performed.

(63) “Universal precautions” means treating all blood and body fluids as if they contain bloodborne pathogens and taking proper precautions to prevent the spread of any bloodborne pathogens.

(64) “Utensil” means any implement, tool, or other similar device used in the storage, preparation, operation, or processing of a tattoo.

(65) “Waste” means solid waste, sewage, blood and body fluids or other waste resulting from the operation of a tattoo studio.

(66) “Work area” means an area where clients are tattooed.

(67) “Work practice controls” means controls that reduce the likelihood of exposure by altering the manner in which a task is performed.

(68) “Work station” means a work area (see definition No. 66).

History

• Authority: T.C.A. §§ 4-5-202, 62-38-201, et seq., and 68-1-103.
• Administrative History: Original rule filed September 26, 2000; effective December 10, 2000.

Tenn. Comp. R. & Regs. 1200-23-03-.02 PROHIBITED ACTS

(1) No person under the age of eighteen (18) years shall tattoo another person.

(2) No person shall tattoo another person who is under the influence of drugs or alcohol.

(3) No person shall tattoo another person who is under the age of eighteen (18) years. However, a minor sixteen (16) years or older may be tattooed with the written consent of a parent or legal guardian to cover up an existing tattoo, and a parent or legal guardian of such minor shall be present during the procedure.

(4) No person shall tattoo any site in which the skin surface exhibits any evidence of unhealthy conditions.

(5) No person except a duly licensed physician shall remove or attempt to remove any tattoo.

(6) During all studio operating hours, tattooing shall not be performed unless there is a currently licensed tattoo artist present in the facility.

History

• Authority: T.C.A. §§ 4-5-202, 62-38-201, et seq., and 68-1-103.
• Administrative History: Original rule filed September 26, 2000; effective December 10, 2000.

Tenn. Comp. R. & Regs. 1200-23-03-.03 MINIMUM STANDARDS FOR TATTOO ESTABLISHMENTS

(1) Each studio where tattoos are administered shall provide a work area separate from observers or visitors. A work area shall have a sink equipped with hot and cold running water for hand washing and cleaning instruments, apart from a bathroom sink.

(2) Each tattoo establishment shall be equipped with an autoclave or steam sterilizer, a sterilizing device capable of meeting sterilization as defined in 1200-23-03-.01(55). The autoclave shall be used to sterilize all nondisposable or reusable tattooing equipment.

(3) Each location shall have the facilities to properly dispose of all waste material. All materials (e.g., needles) must be disposed of in accordance with the Code of Federal Regulations, Title 29, Part 1910, Occupational Safety and Health Act, Bloodborne Pathogens and/or accepted universal precaution guidelines.

(4) The use of common towels is prohibited. Handsinks shall be equipped with a soap dispenser and single use towels.

(5) Water Supply (a) Enough potable water for the needs of the tattoo studio shall be provided from a source constructed and operated according to law.

(b) Sewage. All sewage, including liquid water, shall be disposed of by a public sewerage system or by a sewerage disposal system constructed and operated according to law.

(c) Plumbing. Plumbing shall be sized, installed, and maintained according to law. There shall be no cross-connection between the potable water supply and any other water supply or other source of contamination.

(6) Toilet Facilities (a) Toilet installation. Toilet facilities shall be designed, installed, and maintained according to law. There shall be sufficient toilet rooms and/or toilet fixtures to accommodate clients and operators.

(b) Toilet rooms. Toilet rooms opening directly into work or customer waiting areas shall be completely enclosed and shall have tight-fitting, solid doors, which shall be closed except during cleaning or maintenance.

(c) Toilet fixtures. Toilet fixtures shall be kept clean and in good repair. A supply of toilet tissue shall be provided at each toilet at all times. Easily cleanable receptacles shall be provided for waste materials. Toilet rooms shall have at least one covered waste receptacle.

(7) Lavatory Facilities (a) Lavatory installation. Lavatory facilities shall be designed, installed, and maintained according to law. Facilities shall be of sufficient number and location to permit convenient use by clients and operators.

(b) Lavatory faucets. Each lavatory shall be provided with hot and cold water tempered by means of a mixing valve or combination faucet. Any self-closing, slow-closing, or metering faucet used shall be designed to provide a flow of water for at least 15 seconds without the need to reactivate the faucet.

(c) Lavatory supplies. A soap dispenser and a supply of antiseptic, hand-cleaning soap or detergent shall be available at each lavatory. A supply of single use sanitary towels or a hand-drying device providing heated air shall be conveniently located near each lavatory. If disposable towels are used, easily cleanable waste receptacles shall be conveniently located near the handwashing facilities.

(d) Lavatory maintenance. Lavatories, soap dispensers, hand-drying devices, and all related fixtures shall be kept clean and in good repair.

(8) Solid Waste (a) Containers.

1. Garbage and refuse shall be kept in durable, easily cleaned containers that do not leak and do not absorb liquids. Containers shall be kept in a clean and sound condition and disposed of according to law.

2. Containers used in work areas shall be kept covered when not in use and after they are filled.

3. There shall be a sufficient number of containers to hold all the garbage and refuse that accumulate.

(b) Garbage and refuse shall be disposed of at such frequency to prevent the development of odor and the attraction of insects, rodents, or vermin.

(c) Disposal of infectious waste such as blood, fluids, used inks, or other liquid waste may be deposited directly into a drain connected to a sanitary sewer system. Disposable needles, scalpels, or other sharp items shall be placed intact into puncture-resistant containers with a biohazard label before disposal. Filled sharps containers shall be considered regulated waste and must be disposed of in accordance with Solid Waste Processing and Disposal Regulations (1200-01-07).

(d) Waste potentially contaminated with small amounts of blood or other infectious body fluids (e.g., gauze, wipes, disposable lap cloths), which do not meet the definition of regulated waste, shall be placed in sealed, impervious bags to prevent leakage of the contained items. These bags shall be of sufficient strength to prevent breakage or leakage and shall not contain any sharps. The waste bags shall be containerized and disposed of in an approved sanitary landfill.

(9) The premises shall be kept in such condition as to prevent the entrance, harborage, or feeding of insects, rodents, or vermin.

(10) Floors (a) Floor construction. Floors and floor coverings of all work areas, dressing rooms, locker rooms, toilet rooms and vestibules shall be constructed of smooth, nonabsorbent, durable material and maintained in good repair. Carpeting, if used as a floor covering, shall be of closely woven construction, properly installed, easily cleanable, and maintained in good repair. Carpeting is allowed in work areas, dressing rooms, locker rooms, and toilet rooms.

Carpeted flooring around the operating chair and work table in the work area must be covered by vinyl or rubber sheeting or mats so as to preclude any spillage that may occur during the tattoo operation.

(b) Mats. Mats shall be of nonabsorbent, grease resistant materials and of such size, design, and construction as to facilitate their being easily cleanable.

(11) Walls and Ceilings (a) Maintenance. Walls and ceilings, including doors, windows, skylight, and similar closures shall be constructed of smooth, nonabsorbent, durable material and be maintained in good repair.

(b) Attachments. Light fixtures, vent covers, wall-mounted fans, and similar equipment attached to walls and ceilings shall be easily cleanable and maintained in good repair.

(12) Physical Facilities. Floors, mats, walls, ceilings, and attached equipment and decorative materials shall be kept clean.

(13) Lighting (a) Permanently fixed artificial light sources shall be installed to provide at least 50 foot candles of light on all work area surfaces and at equipment washing work levels.

(b) Permanently fixed artificial light sources shall be installed to provide at a distance of 30 inches from the floor at least 10 foot candles of light in all other areas.

(14) Ventilation. All rooms shall have sufficient ventilation to keep them free of excessive heat, steam, condensation, vapors, obnoxious odors, smoke, and fumes.

(15) Living Areas. No operation of a tattoo establishment shall be conducted in any room used as living or sleeping quarters.

(16) Poisonous or Toxic Materials (a) Materials permitted. There shall be present in the tattoo studio only those poisonous or toxic materials necessary for maintaining the establishment and cleaning or sanitizing equipment, as well as controlling insects and rodents.

(b) Labeling of materials. Containers of poisonous or toxic materials shall be prominently and distinctly labeled according to law for easy identification of contents.

(c) Toxic items shall be separated from other forms of materials used in the process of tattooing.

(17) Premises (a) Tattoo establishments shall be kept neat, clean, and free of litter and rubbish.

(b) Only articles necessary for the operation and maintenance of the tattoo establishment shall be stored on or within the establishment.

(18) Animals. Live animals of all species shall be excluded from within the tattoo studio operational premises and from adjacent areas within the facility under the control of the permit holder.

However, this exclusion does not apply to fish in aquariums. Service animals accompanying blind or deaf persons shall be permitted in the establishment.

(19) Equipment and Utensils (a) Materials 1. Multi-use equipment and utensils shall be constructed and repaired with safe materials, including finishing materials; they shall be corrosion resistant and nonabsorbent; and they shall be smooth, easily cleanable, and durable under conditions of normal use. Single-service articles shall be made from clean, sanitary, and safe materials.

2. Re-use of single-service articles is prohibited.

(b) Design and Fabrication 1. General. All equipment and utensils, including plasticware, shall be designed and fabricated for durability under conditions of normal use and shall be resistant to denting, buckling, pitting, and chipping.

(i) Tattooing and operational surfaces shall be easily cleanable, smooth, and free of breaks, open seams, cracks, chips, pits, and similar imperfections, as well as free of difficult-to-clean internal corners and crevices.

(ii) Sinks and drain boards shall be self-draining.

2. Non-tattooing or operational surfaces. Surfaces of equipment not intended as operational surfaces, but which are exposed to splash or debris or which otherwise require frequent cleaning, shall be designed and fabricated to be smooth, washable, free of unnecessary ledges, projections, or crevices and readily accessible for cleaning. Such surfaces shall be of material and in such repair as to be easily maintained in a clean and sanitary condition.

3. Needles, needle bars, dyes, or pigments shall be designed and manufactured for the sole purpose of tattooing.

(20) Aisles and Working Spaces. Aisles and working spaces between units of equipment and walls shall be unobstructed and of sufficient width to permit employees to perform their duties readily without contamination of equipment or of operational surfaces by clothing or personal contact.

(21) Work Area. The work room is to be equipped or stocked in the following manner:

(a) A minimum of six (6) sterilized needles, six (6) needle bars, and six (6) needle tubes;

(b) A minimum of one extra package of disposable towels other than the package that is being used;

(c) A minimum of one extra box of disposable gloves other than the box being used; and (d) An extra supply of bandages, ointment or gel, and antibacterial soap.

History

• Authority: T.C.A. §§ 4-5-202, 62-38-201, et seq., and 68-1-103.
• Administrative History: Original rule filed September 26, 2000; effective December 10, 2000.

Tenn. Comp. R. & Regs. 1200-23-03-.04 TATTOO OPERATION

(1) Universal precautions, as defined in these rules, shall be observed to prevent contact with blood or other potentially infectious materials. Employees shall be trained in universal precautions.

(a) Assume all human blood, plasma, serum, body fluids (semen, saliva, breast milk, vaginal secretions and any fluid contaminated with blood) and tissues to be contaminated with Human Immunodeficiency Virus (HIV) and/or Hepatitis viruses (e.g., HBV).

(b) The most susceptible route of occupational infection for HIV and HBV is by accidental needle sticks, contamination of the mucous membranes, or through broken, abraded, or irritated skin. Use appropriate caution and maximum protection to prevent such contact.

(c) Proper decontamination procedures, emergency biohazard spill management, and proper use of biosafety equipment shall be utilized.

(d) Use aseptic technique. Thorough hand washing is essential after client contact, after handling blood and body fluids, after wearing gloves, and prior to exiting the work area.

(e) Needles and needle bar assemblies shall be sterilized prior to use. It is permissible to use sterilized disposable needles and disposable needle bar assemblies for tattooing.

(f) Nondisposable needle and nondisposable needle bar assemblies shall be soaked in a disinfectant solution for a minimum of thirty (30) minutes prior to removing the needle. Do not remove a used needle from a needle bar by hand. Needles shall be removed from needle bars through the use of gloves and pliers or similar means to prevent accidental puncture. Dispose of needles and other sharps in puncture proof, autoclavable containers, or disposable biohazard containers.

(g) After soldering a new needle to the needle bar, the completed assembly (needle and needle bar) shall be sterilized.

(h) All regulated wastes shall be disposed of in labeled, manufacturer’s color-coded waste containers.

(i) A spill kit (bleach, leak proof container, paper towels, gloves, spray bottle) is to be used to clean up infectious material spills. Small spills can be wiped up, after donning protective gloves, with paper towels and sprayed with freshly made ten percent (10%) bleach solution.

(j) Clean all work areas and equipment used in handling human biohazardous materials with proven disinfectant (e.g., 10% dilution of bleach) when concluding work to protect personnel from accidental infection.

(k) Eating, drinking, smoking, and applying cosmetics or lip balm are not permitted in the work area. Food shall be stored in cabinets or refrigerators designated and used for this purpose only. Food storage cabinets or refrigerators shall be located outside the work area.

(l) All procedures shall be performed carefully to minimize the creation of aerosols.

(m) Report all work related accidents, incidents, and unexplained illness to your supervisor and/or physician immediately.

(n) Used gloves shall be removed after each operation and prior to contacting work surfaces, door knobs, wall switches, or telephones. Dispose of used gloves in a bagged, trash container.

(2) Personnel of a tattoo establishment (a) The tattoo establishment operator shall make available, at no cost to the personnel, Hepatitis B vaccination series, as well as any routine booster dose(s) to every person who may have occupational exposure to blood or other potentially infectious material. For new personnel the vaccine shall be made available within ten (10) working days of initial work assignment.

(b) Personnel who decline to accept the Hepatitis B vaccination series must sign a form indicating their refusal.

(c) The outer clothing of all personnel shall be clean.

(d) Each tattoo artist shall use a single use lap cloth.

(e) Tattoo artist/operators shall wash their hands with antiseptic soap before and after treating each client (i.e., before glove placement and after glove removal) and after barehanded touching of inanimate objects likely to be contaminated by blood, saliva, or respiratory secretions. Hands shall be washed after removal of gloves, smoking, eating, drinking, or using the toilet.

(f) Tattoo artist/operators who have exudative lesions or weeping dermatitis, particularly on the hands, shall refrain from all direct client contact and from handling equipment until the condition resolves.

(g) Personnel shall consume food only in approved, designated areas. There shall be no eating or drinking in the operation area of the establishment.

(h) Personnel shall not use tobacco in any form while engaged in the operation or process of tattooing, nor while in areas used for equipment or utensil washing. Personnel shall use tobacco only in approved, designated areas.

(i) Personnel shall maintain a high degree of personal cleanliness and shall conform to good hygienic practices during all working periods in tattoo studios.

(3) Implementation of infection-control practices (a) Disposable latex or vinyl examination gloves shall be worn by a tattoo artist at all times while administering any tattoo. Gloves shall be changed and properly disposed of each time there is an interruption in the application of a tattoo, or whenever their ability to function as a barrier is compromised. Gloves shall be changed between clients and used gloves shall be properly disposed of as provided in these rules.

(b) Only single use supplies (or sterilized equipment) may be used to apply a tattoo and shall be disposed of after each tattoo. This subsection includes single use disposable razors; single use towels or wipes; lubricants removed from a collapsible tube; and single use paper stencils or plastic stencils soaked in a germicidal solution. If the design is drawn directly onto the skin, it shall be applied only with a single use article. Single use or individual portions of dye and ink pots or trays shall be used. After tattooing, single use items, dyes, and containers shall be discarded and the tattoo work area disinfected.

(c) When it is necessary to shave the area to be tattooed, a new blade for each patron or customer shall be used when a safety razor is employed, and the permanent part of such razor shall be treated as hereinafter set forth for the care of the straight razor or disposable safety razor. If a straight razor is used, it shall be cleaned with soap and water, rinsed in clear water, and then sterilized in an autoclave.

(d) A sterile set of needles, needle bar, and tube shall be used for each patron or customer.

Dried inks and other materials on instruments must be removed by either ultrasonic cleanser or by soaking in either detergent or disinfectant solution followed by rinsing in clean water prior to sterilization.

(e) All tubes, needles, and needle bars shall be sealed for individual client use in autoclave bags with a chemical or autoclave indicator and date (month and year) of sterilization clearly visible. After tattooing, used non-disposable instruments such as tubes shall be kept in a separate, puncture-resistant container until properly cleaned, disinfected, and sterilized using universal precautions and recognized medical methods. The needle tube of the tattooing machine shall be cleaned and sterilized in a similar method after use.

(f) Microbiological monitoring for adequate functioning of each autoclave will be done at least monthly using a commercial source of Bacillus stearothermophilus which is then tested in an accredited commercial laboratory. All laboratory reports will be logged and kept for two years and shall be available for inspection.

(g) Upon notification of a positive microbiological monitoring report (detection of viable spores), the sterilizer shall be immediately checked for proper use and function. A repeat test shall be performed within three (3) days. Upon a subsequent positive result from a repeat test, discontinue use of the sterilizer until properly serviced and a negative result obtained.

(h) Sterilizer indicator tape and/or sterilizer bags with indicator tape areas which change color will be used with all items sterilized to indicate the item has been autoclaved. All items shall be marked with the date of sterilization.

(i) Sterilized items in the sealed, autoclaved bags shall be stored in a clean, dry place, until used, for no more than one (1) year.

(j) Sterilization indicators must change color or discontinue use of autoclave until a negative spore sample is obtained.

(k) The requirement for an autoclave shall be exempt in cases where there is only the use of manufactured, pre-sterilized single use, preassembled needle and needle bar, disposable needles, needle bars and needle tubes and similar tattooing equipment, and/or the use of no other equipment or tools requiring sterilization.

(4) Minimum standards for tattooing (a) After shaving the area to be tattooed, or if the area does not need to be shaved, the site of the tattoo shall be cleaned with soap and water, rinsed with clean water, and germicidal solution applied or wiped with alcohol in a sanitary manner before the design is placed on the skin.

(b) Single use towels or gauze shall be used in preparing the site to be tattooed and shall be disposed of after use on each patron or customer. The use of roll-on or stick deodorants for tattoo site preparation is prohibited.

(c) Excess dye applied to the skin shall be removed with single use gauze pads, towels, or cotton only. The entire site shall be covered with a sterile gauze dressing or telfa pad.

(d) The stencil for transferring the design to the skin shall be maintained in a clean, sanitary condition.

(e) Records showing the date of the client’s visit, printed name, signature, address, age, design of the tattoo, its location on the body, and tattooist’s name shall be kept on the establishment premises for a minimum of 2 years.

(f) After each tattooing, written instructions shall be given to each patron or customer on the care of the skin of the tattooed site to prevent infection. A copy of these instructions shall be posted in a conspicuous place in the tattoo establishment, clearly visible to the customer or patron being tattooed. These instructions shall include, but are not limited to, bandaging, cleaning, sun exposure, scratching, and wearing of clothing over or around the tattoo site.

History

• Authority: T.C.A. §§ 4-5-202, 62-38-201, et seq., and 68-1-103.
• Administrative History: Original rule filed September 26, 2000; effective December 10, 2000.

Tenn. Comp. R. & Regs. 1200-23-03-.05 ESTABLISHMENT PERMITTING AND INSPECTION SYSTEM

(1) Application Procedures (a) Any person planning to operate a tattoo establishment shall obtain a written application for a permit on a form provided by the local health officer through the local county health department prior to operating a tattoo establishment. A new or initial application is required for tattoo establishments that have not previously been permitted or for instances when ownership changes.

(b) The local health department shall issue a tattoo establishment permit 1. After an inspection of the proposed facility reveals that the facility is in compliance with requirements of these rules and 2. Upon receiving a completed application with applicable fees.

(2) Inspection Results - Reporting and Scoring (a) Inspection results for tattoo establishments shall be recorded on standard departmental forms which summarize the requirements of the law and rules and regulations.

(b) The scoring system shall include a weighted point value for each requirement in which critical items are assigned values of either four (4) or five (5) points, with minor violations having assigned values of either one (1) or two (2) points.

(c) The rating score of the facilities shall be the total of the weighted point values for all violations subtracted from one hundred (100).

(3) Violation Correction (a) In accordance with T.C.A. § 62-38-202, correction of critical and minor violations shall be within seven (7) and fourteen (14) calendar days, respectively.

(b) Upon declaration of an imminent health hazard by the local health officer acting consistent with the provisions of Tennessee Code Annotated, Section 68-2-608(b), the local health officer shall issue an order requiring the facility to immediately cease operations until authorized to reopen. In the event of any such closure order, the operator shall be afforded an opportunity for a hearing, if requested by the operator, as promptly as is reasonable under the circumstances.

(c) In the case of temporary tattoo facilities, all critical violations shall be corrected within twenty-four (24) hours. If critical violations are not corrected within twenty-four (24) hours, the establishment shall immediately cease tattoo operation until authorized to resume by the local health officer or his duly authorized representative. Upon declaration of an imminent health hazard by the local health officer acting consistent with the provisions of Tennessee Code Annotated, Section 68-2-608(b), the health officer shall issue an order requiring the facility to immediately cease operations until authorized to reopen. In the event of any such closure order, the operator shall be afforded an opportunity for a hearing, if requested by the operator, as promptly as is reasonable under the circumstances.

(4) The inspection report shall state that failure to comply with any time limits for correction may result in cessation of operations. An opportunity for a review concerning the inspection and/or inspection report and/or on the ordered corrective action will be provided if written request is filed with the local health department in the county of the affected establishment within ten (10) calendar days following the inspection. If a request for a review is received, a review shall be held within fourteen (14) days after receipt of the request. The decision of the local health officer shall be final.

(5) If a second violation of any critical item (identical or otherwise) is committed within the period of one (1) year (calendar or otherwise), the tattoo studio shall be subject to a civil penalty of up to five hundred dollars ($500) and the tattoo studio’s permit may be revoked.

(6) Permit Revocation (a) After providing an opportunity for a hearing, the local health officer or his duly authorized representative may revoke a permit for serious or repeated violations of requirements of this part or for interference with the local health department in the performance of their duty. The violation of two (2) or more critical items within a twelve (12) month period may result in revocation of the tattoo establishment permit.

(b) Prior to revocation, the local health officer or his duly authorized representative shall notify, in writing, the permittee of the specific reason(s) for which the permit is to be revoked, and that the permit shall be revoked at the end of ten (10) days following service of such notice unless a written request for a hearing is filed with the local health officer within such tenday period. If no request for hearing is filed within the ten-day period, the revocation of the permit becomes final.

(7) License Revocation (a) After providing an opportunity for a hearing, the local health officer or his duly authorized representative may revoke an artist or operator’s license for serious or repeated violations of requirements of this part or for interference with the local health officer or his duly authorized representative in the performance of his duty.

(b) Prior to revocation, the local health officer or his duly authorized representative shall notify, in writing, the licensee of the specific reason(s) for which the license is to be revoked, and that the license shall be revoked at the end of ten (10) days following service of such notice, unless a written request for a hearing is filed with the local health officer within such ten-day period. If no request for hearing is filed within the ten-day period, the revocation of the license becomes final.

(c) When a tattoo artist or operator’s license is revoked by the local health officer, a new license shall be issued upon meeting all requirements for a new license and the submission of a new application with applicable fees.

(8) Civil penalties shall be assessed in accordance with T.C.A. § 62-38-202.

(9) Whenever a facility is required under this section to cease operations, it shall not resume operations until it is shown on re-inspection that conditions responsible for the order to cease operations no longer exist. Opportunity for re-inspection shall be offered within a reasonable time by the local health officer.

(10) Any suspension or revocation of a permit or license may be appealed to the local health officer who shall then conduct a hearing of such appeal in accordance with the Uniform Administrative Procedures Act in Title 4 of the Tennessee Code Annotated. The decision made by the local health officer concerning the appeal may be appealed to the Commissioner, such appeal to the Commissioner being limited to the issue of determining whether a material error of law was made at the hearing level.

(11) Submission of Plans and Specifications - Review - Approval.

(a) No tattoo establishment shall be constructed, extensively remodeled, or converted except in accordance with plans and specifications approved by the local health department or its duly authorized representative.

(b) Whenever a tattoo establishment is constructed or extensively remodeled and whenever an existing structure is converted to use as a tattoo establishment, plans and specifications shall be submitted to the local health department for review and approval before construction, remodeling, or conversion is begun. The plans and specifications shall indicate the proposed layout arrangement, mechanical plans, construction materials, work areas, and the type and model of proposed fixed equipment and facilities. The local health department shall approve the plans and specifications if they meet the requirements of the law, rules, and regulations.

History

• Authority: T.C.A. §§ 4-5-202, 62-38-201, et seq., 68-1-103, and 68-2-608.
• Administrative History: Original rule filed September 26, 2000; effective December 10, 2000.

Tenn. Comp. R. & Regs. 1200-23-03-.06 TATTOO ARTIST LICENSING

(1) Apprentice Tattoo Artist (a) Any tattoo artist not in business or operating prior to October 1, 1996, shall be required to obtain an apprentice license and operate from an approved tattoo establishment.

(b) A tattoo apprentice artist license shall be issued upon submitting an application with the appropriate fee.

(2) A tattoo operator or tattoo artist shall undergo a training program before receiving a permit either to operate a tattoo establishment or to apply a tattoo. The training shall include at least one of the following:

(a) The Alliance of Professional Tattooist course in sterilization;

(b) An approved local or state health department program;

(c) A course approved by the local health department in methods and techniques for the proper sterilization of instruments and materials used in tattooing; or (d) Present acceptable evidence of having satisfactorily completed an approved course of instruction in sterilization techniques and methods through a college medical sterilization course.

(3) The tattoo operator and/or tattoo artist shall be required to take and pass an examination concerning the provisions of T.C.A. Title 62, Chapter 38 before a license shall be issued. Such examination shall be either a written exam prescribed by the local health department or documentation of a similar exam given with a course as required in 1200-23-03-.06(2)(a), (c), or (d). After passing such examination and complying with the other provisions of the law and these rules, a license shall be issued.

(4) The tattoo artist license shall be issued upon proof of (a) Having passed a written examination as specified in 1200-23-03-.06(3) and/or 1200-23-03- .06(2) and (b) Having submitted an application with the appropriate fee and completion of a one-year apprenticeship.

(c) Any tattoo artist in business in the state of Tennessee on October 1, 1996, shall not be required to meet the prerequisite of a tattoo apprentice. Proof of business may be a copy of a business license, tax records, copy of another state’s tattoo artist license, or other similar city, county, state, or federal documents which show the prospective applicant as having been in business or operating on October 1, 1996, or a combination, acceptable to the State, of such documents. The local health officer shall have final approval on other forms of documentation submitted as evidence or proof.

(5) Any individual desiring to tattoo who is a physician licensed by the State of Tennessee or any person under the supervision of a physician licensed by the State of Tennessee shall be exempt from the requirements of these regulations. In order to receive such exemption, a person, other than a licensed physician, shall submit a letter stating that any and all tattooing is performed under the supervision of a licensed physician and such letter shall be signed by the supervising physician and shall be notarized.

History

• Authority: T.C.A. §§ 4-5-202, 62-38-201, et seq., and 68-1-103.
• Administrative History: Original rule filed September 26, 2000; effective December 10, 2000.

Tenn. Comp. R. & Regs. 1200-23-03-.07 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 62-38-201, et seq., and 68-1-103.
• Administrative History: Original rule filed September 26, 2000; effective December 10, 2000. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-23-03-.08 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 62-38-201, et seq., and 68-1-103.
• Administrative History: Original rule filed September 26, 2000; effective December 10, 2000. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-23-03-.09 GENERAL PROVISIONS

(1) Applicability. Chapter 1200-23-03 applies to tattoo artists and tattoo establishments. All tattoo artists and tattoo establishments shall comply with all applicable provisions of these rules at all times.

(2) Permit Revocation. When a permit to operate a tattoo establishment is revoked by the Commissioner, a new permit shall be issued upon meeting all requirements for a new permit and the submission of a new application with applicable fees.

(3) Posting of Permit. T.C.A. Section 62-38-206 requires posting of tattoo establishment permits “in a conspicuous place where it may be readily observed by the public.” This shall mean a place so designated by the inspector at the time of inspection. No person except an authorized representative of the local health officer shall modify, remove, cover up, or otherwise make the permit less conspicuous in any way.

(4) Severability. If any provision or application of any provision of these rules is held invalid, that invalidity shall not affect other provisions or applications of these rules.

History

• Authority: T.C.A. §§ 4-5-202, 62-38-201, et seq., and 68-1-103.
• Administrative History: Original rule filed September 26, 2000; effective December 10, 2000.

Chapter 1200-23-04 Hotels

Tenn. Comp. R. & Regs. 1200-23-04-.01 DEFINITIONS

(1) “Approved” means being accepted by the Commissioner.

(2) “Commissioner” means the Commissioner of the Department of Health or the Commissioner’s duly appointed representative, and in the event of a vacancy in the office of Commissioner, the Acting Commissioner.

(3) “Contractor” means a person that enters into an agreement with another person to perform specific duties and acts as a representative of the permittee or permit applicant.

(4) “Employee” means the permit holder, individuals having supervisory or management duties, or any other person working in a hotel.

(5) “Furnished for pay to transients or travelers” means offering sleeping accommodations by the day.

(6) “Hotel” means any building or establishment kept, used, maintained, or advertised to the public to be a place where sleeping accommodations are furnished for pay to transients or travelers whether or not meals are served therein, regardless of what term the owner or operator uses to describe the establishment.

(7) “Ice dispensing machines” means any machine which dispenses ice in bulk or package form.

(8) “Law” means any provision of the State of Tennessee statutes and rules.

(9) “Linens” means all sheets, pillowcases, towels, washcloths, and other reusable cloth items which come in personal contact with occupants.

(10) “Owner/Operator” means the applicant, permittee, or other persons to be in charge of facilities.

(11) “Person” means any individual, partnership, firm, corporation, agency, municipality, or state or political subdivisions, or the federal government and its agencies and departments.

(12) “Person in charge” means the individual present in a hotel, who is the apparent supervisor at the time of inspection, or if no individual is the apparent supervisor, then any employee present.

(13) “Potable water” means water that is safe for drinking.

(14) “Sanitary ice-dispensing machine” means any machine which automatically dispenses ice with no manual contact with the ice.

(15) “Self-service ice storage bin” means a self-service machine or storage bin in which ice is manufactured or stored in bulk form and the ice can be removed by the hotel guests through use of an ice scoop or similar device.

(16) “Sewage” means human excreta, all water carried waste, and household wastes from residences, buildings, or commercial and industrial establishments.

(17) “Shall” denotes a mandatory requirement.

(18) “Single-service articles” means cups, lids, closures, plates, knives, forks, spoons, stirrers, paddles, straws, napkins, wrapping materials, toothpicks, and similar articles intended to be used for one-time, one-person use and then to be discarded.

(19) “Solid waste” means, refuse, garbage, trash, rubbish, and any other item or items which could cause an unsanitary condition or undesirable health and safety conditions.

History

• Authority: T.C.A. §§ 4-5-202 and 68-14-301, et seq.
• Administrative History: Original rule filed September 9, 1999; effective November 22, 1999.

Tenn. Comp. R. & Regs. 1200-23-04-.02 MINIMUM STANDARDS FOR HOTELS

(1) Sanitary Facilities and Controls (a) Water Supply 1. Enough potable water for the needs of the hotel shall be provided from a source constructed and operated according to law.

2. Cold running water under pressure shall be provided to all equipment that uses water. Hot and cold running water under pressure shall be provided to all lavatories, bathing facilities, laundry facilities, and all water-using equipment where eating and drinking utensils are washed.

3. Ice used for any purpose shall be made from water which comes from an approved source and shall be used only if it has been manufactured, stored, transported, or handled in a sanitary manner.

4. Self-Service Ice Machines (i) Self-service ice provided for the hotel guest shall be dispensed through use of sanitary ice dispensing machines or shall be prepackaged for individual hotel guests from an approved source in all hotels constructed after July 1, 1986; provided, however, that ice machines located in individual rooms shall not be prohibited. Self-service ice storage bins presently being used may be continued in use indefinitely, provided that the machines are maintained in good repair and capable of being properly cleaned. On or after July 1, 1986, the replacement of self-service ice storage bins or additional ice machines shall require the installation of sanitary ice-dispensing machines.

(ii) Ice machines shall be easily cleanable, in good repair, clean, and free of contaminants and rust.

(iii) Ice storage containers and scoops shall be smooth, constructed of impervious material designed to facilitate cleaning, and shall be stored, handled, and used in a sanitary manner.

5. Plumbing (i) General. Plumbing shall be sized, installed, and maintained according to law. There shall be no cross-connections between any safe water supply and any unsafe or questionable water supply, or any source of pollution through which the safe water supply might become contaminated.

(ii) Non-potable System. A non-potable water system is permitted only for purposes such as air conditioning and fire protection and only if the system is installed according to law and the non-potable water does not contact, directly or indirectly, the potable water system or equipment or utensils that come in contact with food or drink. The piping of any non-potable water system shall be durably identified so that it is readily distinguishable from piping that carries potable water.

(iii) Backflow. The potable water system shall be installed to preclude the possibility of backflow. Devices to protect against backflow and backsiphonage shall be installed at all fixtures and equipment where an air gap at least twice the diameter of the water inlet is not provided between the water outlet from the fixture and the fixture’s flood-level rim and wherever else backflow or backsiphonage may occur. A hose shall not be attached to a faucet unless a backflow prevention device is installed.

(iv) Drains. There shall be no direct connection between the sewerage system and any drains originating from equipment in which ice is stored.

(b) Sewage. All sewage, including liquid waste, shall be disposed of by a public sewerage system or by a sewage disposal system constructed and operated according to law.

(c) Insect and Rodent Control 1. General. Effective measures intended to control the presence of rodents, flies, roaches, and other insects on the premises shall be utilized. The premises shall be kept in such condition as to prevent the harborage or feeding of insects, rodents, or other vermin.

2. Openings. Openings to the outside shall be effectively protected against the entrance of rodents and shall be protected against entrance of insects by tightfitting doors and windows. Screen or storm doors, excluding sliding glass doors and sliding screens, shall be self-closing, and screens for windows, doors, sliding screens, skylights, transoms, and other openings to the outside shall be tightfitting and free of breaks. Screening materials shall not be less than sixteen mesh to the inch.

3. Garbage and Refuse (i) All containers used in guest rooms, lobbies, hallways, and public assembly rooms for storage of garbage and refuse shall be constructed of durable metal or other approved types of materials, which do not leak, do not absorb liquids, do not support combustion or melt under intense heat. Such containers shall be thoroughly cleaned on the inside and outside each time they are emptied unless liners are used.

(ii) All outside refuse or garbage storage containers shall be constructed of durable metal or other approved types of materials, which do not leak nor absorb liquids, and shall be provided with tight-fitting lids or covers and shall be kept covered when stored, unless located in a special verminproof room or enclosure. Each container shall be cleaned at such frequency as to prevent a nuisance or odor. Liquid waste resulting from the cleaning of containers shall be disposed of as sewage.

(iii) Storage rooms, enclosures, areas, and containers shall be adequate for storage of all refuse or garbage accumulating on the premises in accordance with these rules. Adequate cleaning facilities shall be provided, and each storage room, enclosure, or container shall be thoroughly cleaned after the emptying or removal of refuse or garbage. Areas surrounding these rooms, enclosures, and containers shall be kept clean and orderly.

(iv) Garbage and refuse shall be disposed of often enough to prevent the development of odor and the attraction of insects and rodents. Where garbage or refuse is burned on the premises, it shall be done by controlled incineration that prevents the escape of particulate matter and in accordance with law. Areas around incineration facilities shall be kept clean and orderly.

(v) All outside premises shall be maintained free of litter and unnecessary articles.

(2) Poisonous or Toxic Materials (a) General. Only such poisonous and toxic materials as are required to maintain sanitary conditions and for sanitization purposes may be used or stored in hotels. Such materials shall be properly stored and identified and shall be used only in such manner and under such conditions as shall not constitute a hazard to employees or guests.

(b) Containers of poisonous or toxic materials, including insecticides and rodenticides, shall be prominently and distinctly labeled for easy identification of contents.

(c) Storage of Materials 1. Poisonous or toxic materials consist of the following categories:

(i) Insecticides and rodenticides, caustics, acids, polishes, and other chemicals;

(ii) Detergents, sanitizers, and related cleaning or drying agents; and (iii) Medicines and personal care items.

2. Each of the three categories set forth in part 1. of this subparagraph shall be stored and physically located separate from each other.

(i) Poisonous or toxic materials shall be stored in cabinets or shelves that are used for no other purpose or in a place other than an area where linens or other articles which come in contact with guests are stored.

(ii) To preclude contamination, poisonous or toxic materials shall not be stored above linens, drinking glasses, ice buckets, utensils, or other articles which come in personal contact with guests. This requirement does not prohibit the convenient availability of detergents or sanitizers at utensil or dishwashing stations.

3. Bactericides, cleaning compounds, or other compounds shall not be used in a way that leaves a toxic residue, nor in a way that constitutes a hazard to employees or guests. Poisonous or toxic materials or cleaning compounds shall be used only in full compliance with their labeling.

(3) Personnel (a) Employee Health. No person while affected with any disease in a communicable form, or while a carrier of such disease, or while afflicted with boils, infected wounds, or sores shall work in any area of a hotel establishment in any capacity in which there is a likelihood of such a person contaminating bedding and other surfaces with pathogenic organisms, or transmitting disease to other individuals. No person known or suspected of being affected with any such disease or condition shall be employed in such an area or capacity. When there is reason to suspect that any employee has contracted any disease in communicable form or has become a carrier of such a disease, the employee shall be 1. Removed from the hotel establishment, or 2. Their service be restricted to some area of the establishment where there would be no danger of transmitting disease.

(b) Personal Cleanliness. Employees, other than clerical employees, shall thoroughly wash their hands and the exposed portions of their arms with soap and warm water before starting work, during work as often as necessary to keep them clean, and after smoking, eating/drinking or using the toilet. Employees shall keep their fingernails clean and trimmed. Employees shall maintain a high degree of personal cleanliness and conform to other good hygienic practices.

(4) Fire Safety (a) Fire Extinguishers 1. Portable fire extinguishers shall be provided in hazardous areas, including storage, laundry, linen, and gas-fired equipment rooms.

2. Fire extinguishers shall be of a type approved by the State Fire Marshal’s office and installed and operated according to law. Fire extinguishers shall be inspected and serviced at least annually and tagged showing the date of inspection by an approved fire extinguisher servicing company or an approved fire department.

3. No soda-acid types of extinguishers are to be used.

(b) Smoke Detectors and Fire Alarms 1. All sleeping rooms and sleeping areas shall be provided with a single station smoke detector, which is installed, operated, and maintained according to law.

Smoke detectors shall be of a type approved by the State Fire Marshal’s office or local jurisdiction. Single station smoke detection shall not be required when sleeping rooms contain smoke detectors connected to a central alarm system which also alarms locally.

2. A fire alarm system of a type approved by the State Fire Marshal’s Office shall be installed, maintained, and operated, according to law in hotels having more than fifteen (15) guest rooms, exceptions being hotels (i) With all individual guest rooms having a direct exit to the outside or (ii) Buildings three (3) stories or less with each guestroom having two (2) or more directions to exit from the entrance door of the room.

3. Telephone Service. Telephone service shall be accessible to guests and staff in the event of emergencies.

(c) Electrical Hazards, Heating, and Flammable 1. Visible and/or obvious fire and electrical hazards are prohibited.

2. There shall be no storage of flammables, lawnmowers, gas-powered weed eaters, or other similar flammable operated equipment in boiler or electrical panel rooms.

3. Flammable liquids and lawn mowers shall be stored in a well ventilated, separate building or in a one hour enclosed, (6” concrete block, 5/8” sheet rock), sprinklered area away from guest sleeping rooms.

4. Draperies, curtains, and other similar loosely hanging furnishings and decorations shall be flame resistant.

5. Furnishings or decorations of an explosive or highly flammable character shall not be used.

(d) Exits and Evacuation Plans 1. Each guestroom door that opens into an interior corridor shall be self-closing.

2. Stairways and exits shall be clear of obstructions, marked, lighted, and maintained at all times.

3. A floor diagram reflecting the actual floor arrangement, exit locations, and room identifications shall be posted in a location and in an acceptable manner on or immediately adjacent to every guest room door.

(e) Plan Approval for Fire Safety 1. Plans shall be reviewed and approved by the State Fire Marshal or by any jurisdiction of local government which has certified in writing that it has adopted the fire safety/building codes allowed by T.C.A. 68-120-101(b)(2), as amended.

2. Plans for two-story hotels with twelve (12) rooms or less and all one (1)-story hotels shall be reviewed for approval by the Commissioner.

(5) General Construction (a) Lobbies and Hallways. Lobbies and hallways shall be kept clean and in good repair.

(b) Toilet Installation. Each hotel shall be provided with adequate and conveniently located toilet facilities for employees. Toilet fixtures shall be of a sanitary design and easily cleanable. Toilets shall be kept in a clean condition and in good repair. Toilet tissue shall be available at each toilet. Easily cleanable receptacles shall be provided for waste materials, and such receptacles in toilet rooms for women shall be covered.

(c) Lavatory Installation 1. Lavatories shall be installed and located to permit convenient use by employees at all times.

2. Lavatories shall be accessible to employees at all times.

3. Lavatories shall be located in or immediately adjacent to toilet rooms or vestibules.

(d) Each lavatory shall be provided with hot and cold water tempered by means of a mixing valve or combination faucet. Any self-closing, slow closing, or metering faucet used shall be designed to provide a flow of water for at least 15 seconds without the need to reactivate the faucet. Steam-mixing valves are prohibited.

(e) Lavatory Supplies. A supply of hand-cleaning soap or detergent shall be available at each lavatory. A supply of sanitary towels or a hand-drying device providing heated air shall be conveniently located near the lavatory. Common towels are prohibited. Easily cleanable waste receptacles shall be conveniently located near the handwashing facilities.

(f) Lavatory Maintenance. Lavatories, soap dispensers, hand-drying devices, and all related fixtures shall be kept clean and in good repair.

(g) Roof and Outside Walls. All gutters, roofs and outside walls and doors shall be maintained in good repair.

(h) Walkways. All walkways, porches, and hallways shall be maintained in good repair.

(i) Building Site. Only articles necessary to the operation and maintenance of the establishment shall be stored on the premises.

(j) Sleeping Rooms 1. Toilet and bathing facilities (i) Each hotel shall be provided with adequate and conveniently located toilet and bathing facilities. Except for hotels constructed before July 1, 1977, toilet and bathing facilities shall be provided for each sleeping room. Toilets and bathing facilities, including rooms and fixtures, shall be of a sanitary design, easily cleanable, and kept in a clean condition and in good repair.

Toilet tissue shall be provided and new soap shall be provided after each guest occupancy. Easily cleanable receptacles shall be provided for waste materials.

(ii) Anti-slip tubs, adequate slip strips, appliqués, or slip-proof mats shall be provided in each bathing facility and shall be kept clean and in good repair.

(iii) Each hotel shall provide adequate, conveniently located handwashing facilities at each toilet and bathroom including a lavatory or lavatories equipped with hot and cold or tempered running water, hand-cleaning soap and towels. Such facilities shall be kept clean and in good repair.

2. Heating and cooling system. The heating system shall be properly installed and maintained in good repair and shall be capable of maintaining a temperature of 68°F. The cooling system, if provided, shall be properly installed and maintained in good repair.

3. Lighting (i) Natural and artificial lighting for general cleaning purposes and safety of guests shall be at least ten (10) foot-candles in guestrooms, stairways, hallways, closets and storage areas.

(ii) Lighting in reading areas of guestrooms and public meeting rooms shall be thirty (30) foot-candles.

(iii) Lighting at bathroom mirrors shall be forty (40) foot-candles.

4. Ventilation. Sleeping and toilet rooms shall have sufficient ventilation to keep them free from steam, condensation, excessive heat vapors, smoke, fumes, or noxious odors.

5. Windows and doors. All windows and doors shall be kept clean and maintained in good repair. All doors shall be constructed and equipped with in-room security devices, such as locks, chains, or similar devices. All open windows shall require screening.

6. Furnishings (i) Equipment. Rooms used for sleeping purposes shall be provided with a minimum of soap, two clean towels, two clean washcloths of adequate size, four clothes hangers, two chairs, two drinking glasses, and two ashtrays, except in areas designated as “No Smoking.”

(ii) Ice storage containers. Ice storage containers shall be constructed of a smooth, impervious material, designed to facilitate cleaning, and shall be stored and handled in a sanitary manner.

(iii) Beds and bedding. Beds, mattresses, springs, slats, rails, pads, linens, covers, and spreads shall be clean and in good repair. Mattress pads or covers, spreads and blankets, or covering shall be changed when obviously soiled and on a systematic cleaning program established by the hotel, but not to exceed every sixty (60) days. Sheets and pillowcases shall be changed after each occupant, or daily when a room is occupied, unless otherwise requested by the occupant.

(iv) Bedding accessories. Mattress pads or covers shall be used on all mattresses. Each bed shall be provided with adequate sheets, pillows, and pillowcases. Minimum requirements are two sheets, one pillow, and one pillowcase per pillow. All beds shall be supplied with sufficient blankets or coverings to keep the occupant warm.

(v) Room furnishings. Furniture, appliances, and utensils shall be kept clean and maintained in good repair.

(vi) Window covering. All draperies, curtains, shades, venetian blinds, or other covering shall be kept clean and maintained in good repair.

7. Floors. The floors of all hotels shall be constructed of smooth, durable materials such as sealed concrete, terrazzo, ceramic tile, or wood with tight seams between tiles or planks and that is light in color. Floor coverings, such as linoleum or carpeting, shall be kept clean and maintained in good repair.

Carpeting shall be properly installed, easily cleanable, and maintained in good repair. Carpeting is prohibited in any linen or utensil washing area.

8. Walls and ceilings. Walls and ceilings including doors, windows, skylights, and similar closures shall be kept clean and maintained in good repair. The walls of toilet rooms and vestibules shall be smooth, nonabsorbent, and easily cleanable.

Exposed lines and pipes shall be installed in a way that does not obstruct or prevent cleaning. Light fixtures, vent covers, decorative material, or any similar equipment attached to walls and ceilings shall be cleanable and maintained in good repair. Concrete or pumice blocks used for interior wall construction shall be finished and sealed.

9. Storage areas and closets. All closets shall be kept clean and in good repair.

(k) Cleaning and Storage of Linens and Utensils 1. Linen room. Adequate storage areas, rooms, or cabinets shall be provided for all supplies, linens, and/or equipment and shall be kept neat, orderly, clean, and in good repair. Clean linens shall be stored in cabinets or on shelves in a linen storage room. Soiled linens shall be so handled and stored as not to come in contact with clean linens.

2. Laundry facilities (i) General. Laundry facilities shall be kept clean, orderly, and in good repair.

Any door leading from a laundry room shall be tight-fitting. Laundry facilities shall be maintained in such a way that dirty linen does not come in contact with clean linen. Maintenance and cleaning equipment shall be maintained and stored in a way that does not contaminate clean linen.

(ii) Sanitization rinse (I) Linens and mattress pads or covers shall be thoroughly washed in a detergent solution containing a sanitizer equivalent to at least fifty parts per million (50 ppm) available chlorine. Spreads and blankets may be dry cleaned in lieu of washing and sanitizing.

(II) A three-compartment sink shall be used if cleaning and sanitization of equipment or utensils is done manually. Sinks shall be large enough to permit the complete immersion of the equipment and utensils, and each compartment of the sink shall be supplied with hot and cold potable running water.

3. In lieu of manual cleaning and sanitizing, the Commissioner may approve the use of dish machines or similar means of sanitizing.

4. Glasses, utensils, coffee pots, and ice buckets shall be clean, sanitized, and kept in good repair. In lieu of sanitizing ice buckets, properly sized, single-service plastic liners may be used.

5. Single-service articles. Single-service articles shall be stored at least six (6) inches above the floor on clean shelves and in closed containers that protect them from contamination. Handling of single-service articles in bulk shall be conducted in a way that protects them from contamination. Single-service articles shall be made from non-toxic materials. Single-service articles placed in sleeping rooms shall be individually wrapped or dispensed in a sanitary manner. Re-use of single-service articles is prohibited.

(6) Review of Plans (a) Submission of Plans. Whenever a hotel is constructed or extensively remodeled and whenever an existing structure is converted to use as a hotel, at least one set of properly prepared plans and specifications for such construction, remodeling, or conversion shall be submitted to the Commissioner for review and approval before construction, remodeling, or conversion is begun. The plans and specifications shall indicate the proposed layout, arrangement, mechanical plans, and construction materials for work areas, sleeping areas and/or rooms, and the type and model of proposed fixed equipment and facilities. The Commissioner shall approve the plans and specifications if they meet the requirements of these rules. No hotel shall be constructed, extensively remodeled, or converted except in accordance with plans and specifications approved by the Commissioner.

(b) Pre-operational Inspection. After plans and specifications have been approved by the Commissioner, the hotel shall not start operations until the Commissioner has made a pre-operational inspection and has determined compliance with the approved plans and specifications and with the requirements of these rules.

History

• Authority: T.C.A. §§ 4-5-202 and 68-14-301, et seq.
• Administrative History: Original rule filed September 9, 1999; effective November 22, 1999.

Tenn. Comp. R. & Regs. 1200-23-04-.03 ESTABLISHMENT PERMITTING AND INSPECTION SYSTEM

(1) Application Procedures (a) Any person planning to operate a hotel must obtain a written application for a permit on a form provided by the Commissioner through the local county health department prior to operating a hotel. A new or initial application is required for hotels that have not previously been permitted or for instances when ownership changes.

(b) The Commissioner shall issue a hotel permit:

1. After an inspection of the proposed facility reveals that the facility is in compliance with requirements of these rules and 2. Upon receiving a completed application with applicable fees.

(2) Inspection System (a) The Commissioner shall inspect or cause to be inspected every hotel at least once every six (6) months and as often as deemed necessary by the Commissioner.

(b) Inspection results for hotels shall be recorded on standard departmental forms which summarize the requirements of the law and rules.

(c) The scoring system shall include a weighted point value for each requirement in which critical items are assigned values of either four (4) or five (5) points, with less critical items having assigned values of either one (1) or two (2) points.

(d) The rating score of the facilities shall be the total of the weighted point values for all violations subtracted from one hundred (100).

(3) Violation Correction (a) In accordance with T.C.A. 68-14-318, critical violations shall be corrected within ten (10) calendar days from the date of the inspection report. Minor or non-critical violations shall be corrected as soon as possible, but in any event by the time of the next routine inspection.

(b) Upon declaration of an imminent health hazard by the Commissioner, the facility shall immediately cease operations until authorized to reopen.

(c) The inspection report shall state that failure to comply with any time limits for correction may result in suspension of permit. An opportunity for a hearing concerning the inspection and/or inspection report and/or on the ordered corrective action will be provided, if written request is filed with the Commissioner within ten (10) calendar days following the inspection. If a request for a hearing is received, a hearing shall be held within a reasonable period of time after receipt of the request.

(4) Permit Revocation (a) After providing an opportunity for a hearing, the Commissioner or his duly authorized representative may revoke a permit for serious or repeated violations of requirements of this part or for interference with the Commissioner or his duly authorized representative in the performance of his duty.

(b) Prior to revocation, the Commissioner or his duly authorized representative shall notify, in writing, the permittee of the specific reason(s) for which the permit is to be revoked, and that the permit shall be revoked at the end of ten (10) days following service of such notice, unless a written request for a hearing is filed with the Commissioner within such ten-day period. If no request for hearing is filed within the ten-day period, the revocation of the permit becomes final.

(5) Whenever a facility is required under this section to cease operations, it shall not resume operations until it is shown on re-inspection that conditions responsible for the order to cease operations no longer exist. Opportunity for re-inspection shall be offered within a reasonable time.

History

• Authority: T.C.A. §§ 4-5-202 and 68-14-301, et seq.
• Administrative History: Original rule filed September 9, 1999; effective November 22, 1999.

Tenn. Comp. R. & Regs. 1200-23-04-.04 REPEALED

History

• Authority: T.C.A. §§ 4-5-202 and 68-14-301, et seq.
• Administrative History: Original rule filed September 9, 1999; effective November 22, 1999. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-23-04-.05 REPEALED

History

• Authority: T.C.A. §§ 4-5-202 and 68-14-301, et seq.
• Administrative History: Original rule filed September 9, 1999; effective November 22, 1999. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-23-04-.06 REPEALED

History

• Authority: T.C.A. §§ 4-5-202 and 68-14-301, et seq.
• Administrative History: Original rule filed September 9, 1999; effective November 22, 1999. Repeal filed June 24, 2024; effective September 22, 2024.

Chapter 1200-23-05 Public Swimming Pools

Tenn. Comp. R. & Regs. 1200-23-05-.01 DEFINITIONS

(1) “Alter/Alteration” means to redesign pool size, shape, piping; to change major equipment such as filter or disinfectant system; to install or remove equipment; to change classification of pool; to make any change that may affect the overall safety or effectiveness of operation, including additions or redesign of a bathhouse.

(2) “Approved” means being accepted by the Commissioner.

(3) “Bull-nosed coping” means a rounded edge of the coping that can be used as a hand-hold.

(4) “Certified lifeguard” means an individual who has a valid and current American Red Cross Lifeguard Training Certificate (or current Red Cross equivalent), or the YMCA Senior Life Saving Certificate, or the Boy Scouts of America equivalent.

(5) “Commissioner” means the Commissioner of the Department of Health or the Commissioner’s duly appointed representative, and in the event of the Commissioner’s absence or vacancy in the office of Commissioner, the Acting Commissioner.

(6) “Contractor” means a person that enters into an agreement with another person to perform specific duties and acts as a representative of the permittee or permit applicant.

(7) “Coping” means the covering which joins the top of the pool wall with the pool decking.

(8) “Deck” means the area around the pool.

(9) “Department” means the Department of Health.

(10) “Diatomaceous earth” means a type of filter media that is obtained from the fossil remains of microscopic marine plants and is used in a thin coating over filter septa or bags.

(11) “Disinfecting equipment” means any device used to mechanically supply disinfectants to the pool water.

(12) “Dive” means to plunge into the water head first.

(13) “Diving board” means a device extending over the pool for the purpose of diving to include diving towers or diving platforms.

(14) “Employee” means the permit holder, individuals having supervisory or management duties, or any other person working in a public swimming pool.

(15) “Face piping” means piping, valves, and fittings that are used to connect the filtering system together as a unit and are necessary to achieve complete filtering and backwashing functions.

(16) “Filter” means any apparatus by which water is clarified.

(17) “Filter backwash” means the process of cleaning a swimming pool filter by reversing the flow of water through it.

(18) “Filter media” means any fine grain material, carefully graded as to size, that entraps suspended particles as water passes through.

(19) “Heater” means a device through which pool water is circulated to increase the temperature.

(20) “Hydrostatic relief valve” means a device used to relieve ground water pressure imposed on the outer shell of the pool.

(21) “Hose bibb” means a water faucet with male screw threads for attachment to hose.

(22) “Law” means any provision of the State of Tennessee statutes and rules.

(23) “Lifeline” means a rope with flotation devices reaching across a pool to designate a change of slope in the pool bottom and used to separate the shallow and deep areas of the pool.

(24) “Life saving equipment unit” consists of a Ring Buoy and Shepherd’s Crook. The Ring Buoy consists of a ring at least eighteen inches (18”) in diameter made of solid, buoyant material and weighing approximately two and one-half (2½) pounds with grab line and retrieving line equal to one and one-half (1½) times the maximum width of the pool not to exceed fifty (50) feet in length. The line shall consist of one-fourth (¼) inch polypropylene, or similar type line with two (2)-inch ball or “lemon” on the free end. The Shepherd’s Crook shall be large enough to encircle the entire body and be equipped with a minimum twelve (12)-feet handle.

Where lifeguards are required, a Rescue Tube or Torpedo Buoy may be substituted for each Ring Buoy required. The Rescue Tube or Torpedo Buoy consists of a length of tube, two (2) meters of rope and strap length.

(25) “Main drain” means the outlet or outlets on the bottom of the deep portion of the pool through which the main flow of water leaves the pool.

(26) “Main drain piping” means piping connecting the main drains to the pump suction.

(27) “Multi-family residential housing swimming pool” means a private swimming pool maintained by a homeowners association solely for the use of the members of such homeowners association and their guests.

(28) “Normal operating level” means the level of the water at the mid-point of the surface skimmer throat or at overflow gutter lip.

(29) “N.S.P.I.” means the National Spa and Pool Institute.

(30) “Outlet” means main drain, skimmer, vacuum line, or overflow trough.

(31) “Overflow trough” means the gutter or trough around the top perimeter of a pool through which the water surface is skimmed. These troughs are sometimes referred to as scum gutters.

(32) “Owner/Operator” means the applicant, permittee, or other persons in charge of facilities.

(33) “Person” means any individual, partnership, firm, corporation, agency, municipality, or state or political subdivisions, or the federal government and its agencies and departments.

(34) “Person in charge” means the individual present at a public swimming pool who is the supervisor at the time of inspection, or if no individual is the supervisor, then any employee present.

(35) “Potable water” means water that is safe for human consumption.

(36) “Pool depth” means the distance between the floor of the pool and the normal operating level.

(37) “Pool facilities” is a general term that includes all areas of the pool. It includes, but is not limited to, the pool deck, bathhouse, fencing, filtration and safety equipment, sidewalks, and plumbing facilities.

(38) “Public swimming pool/ Public pool/ or Pool” means any pool (other than a residential or therapeutic type pool) which is used for bathing, swimming, diving, water sliding, swimming instruction, or for other recreational purposes to which admission may be gained with or without payment of a fee. Public swimming pools are listed in the following categories, based upon specific characteristics, usage and other factors:

(a) Type “A” means any pool intended for, or used by, the general public for recreational use, as well as pools not open to the general public, such as institutional, school, child care facilities, scouts, resident camps, day camps, country clubs, or pools of similar usage and type.

(b) Type “B” means swimming pools restricted to residents, members or registered guests, including pools at motels, apartments, trailer parks/mobile home parks, travel camps, condominiums, multi-family residential housing homeowner associations, and subdivisions or similar developments. Also included are YMCA, YWCA, health or athletic clubs, and pools of similar type and usage. When pools of this type are used by other persons, organizations, special groups, or by the general public, the requirements for lifeguards shall be the same as for Type “A” Pools.

(c) Type “C” means wading pools.

(d) Type “D” means whirlpools, hot tubs, or other pools of similar type and usage, intended for health or recreational usage.

(e) Type “E” means water flumes, water slides, lazy river, or other similar water attraction.

(39) “Public water system” means a system for the provision of piped water for human consumption if such system serves fifteen (15) or more service connections or which regularly serves twenty-five (25) or more individuals daily at least sixty (60) days out of the year. Public water system as defined is either a community or noncommunity water system.

(40) “Rate of flow” means a quantity of water flowing past a given point in a unit of time and usually measured in gallons per minute (G.P.M.).

(41) “Recirculation system” means the entire system of pipes, pumps and filters that allow water to be taken from the pool, filtered, treated, and returned to pool.

(42) “Return inlets” or “Inlet” means the fittings or openings through which filtered water enters the pool.

(43) “Return piping” means piping which conveys the filtered water under pressure from the filter to the pool.

(44) “Residential pool” means any pool that serves no more than three living units, the use of which shall be confined to the family of each residence and their private guests.

(45) “Sewage” means human excreta, all water carried waste, and household wastes from residences, buildings, or commercial and industrial establishments.

(46) “Shall” denotes a mandatory requirement.

(47) “Skimmer” means a device, other than an overflow trough, that is used to continuously remove surface water and floating debris from a pool.

(48) “Skimmer weir” means that part of a skimmer that adjusts automatically to small changes in water level to assure a continuous flow of surface water through the skimmer.

(49) “Solid waste” means, refuse, garbage, trash, rubbish, and any other item or items which could cause an unsanitary condition or undesirable health and safety conditions.

(50) “Surge tank” means a device of such material, shape, and capacity as to adequately receive the surge water from indirect or direct overflows, so constructed and located as to be easily cleaned.

(51) “Tamper-proof” requires tools to alter or remove portions of the equipment.

(52) “Therapeutic pool” means a pool used for medical treatment under the supervision of licensed medical personnel.

(53) “Tower” means an elevated platform from which a person can jump or plunge into the pool.

(54) “Turnover rate” means the number of times a quantity of water equal to the total capacity of the pool passes through the filters in a specified period of time.

(55) “Vacuum outlets” means the fittings in the pool which are used to connect the underwatersuction cleaning equipment.

(56) “Vacuum piping” means the piping which connects the vacuum fittings to the return piping.

(57) “Wading pool” means a pool, normally intended for non-swimming children, used for wading, with a maximum depth of twenty-four (24) inches.

(58) “Water slides or Water flumes” means inclined trough(s) that convey patrons in a stream of water ending in a pool. This is not intended to include water attractions that involve a boat, “log,” or other such vessels in which patrons ride and do not normally come in direct contact with the water; nor does this include swimming pool sliding equipment.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-14-301, et seq., 68-14-401, and 68-14-402.
• Administrative History: Original rule filed March 13, 2000; effective May 27, 2000.

Tenn. Comp. R. & Regs. 1200-23-05-.02 OPERATIONAL REQUIREMENTS FOR PUBLIC SWIMMING POOLS

(1) The Commissioner shall evaluate and approve or disapprove design features as appropriate for operational features not specifically addressed in these regulations.

(2) Pool Facilities (a) Bathhouse.

1. The floors and walls shall be cleaned as often as necessary to maintain sanitary conditions.

2. Plumbing fixtures shall be clean and in operating condition.

3. Toilet tissue in holders shall be provided at each commode.

4. Soap and either single service towels or air dryer devices shall be provided at lavatories.

5. Mirrors, if provided, shall be shatter resistant.

6. Facilities shall be free of trash and litter. Trash receptacle(s) shall be placed at convenient locations. Women’s bathhouse restrooms shall be equipped with covered sanitary napkin receptacles.

7. A minimum lighting level of ten (10) feet candles measured at a point three feet from the floor shall be maintained in bathhouses.

(b) Pool Enclosures. Ventilation shall be sufficient to prevent condensation and odor accumulation.

(c) Pool Surface and Facilities. The walls, bottom, fixtures, and all equipment shall be kept clean and in good repair.

(d) Walks/Decking/Pool Area. Walks, decking, and all other pool areas shall be clean and in good repair.

(3) Safety (a) Certified Lifeguards.

1. Lifeguards shall be present at Type A pools in accordance with the following square footage schedule:

Square Feet 1,800-3,000 3,001-6,000 6,001-9,000 9,001-12,000 1 lifeguard 2 lifeguards* 3 lifeguards* 4 lifeguards* One additional lifeguard per each additional 3,000 sq. feet. * With twenty-five (25) or less pool bathers, a minimum of one (1) lifeguard is required. For twenty-six (26) to fifty (50) pool bathers, a minimum of two (2) lifeguards is required. With fifty-one (51) or more pool bathers, the square footage requirements for lifeguards will apply. Further, for pools requiring more than one (1) lifeguard, the pool area lifeguard requirements can be reduced by roping or partitioning off the unused area(s) of the pool.

2. Lifeguards shall be present at all pools having a diving board or tower that is one meter or more in height above the normal operating water level.

3. Lifeguards shall observe from the lifeguard chair except during instructional activities or during life saving or emergency type situations involving swimmers.

4. “Wave” type pools shall have a minimum of two (2) lifeguards observing from lifeguard chairs. All other “wave” type pool lifeguards may observe from the pool deck.

5. Type E pools shall have an attendant or lifeguard on duty at all times at the point patrons/swimmers enter the water. If the view of the total length of the slide is not visible from the top to the bottom of the slide, then a minimum of one (1) attendant at the point of entering the water and one (1) monitor at the top of the slide shall be provided.

(b) Chemical Storage and Handling. Chemicals shall be kept in the original containers.

They shall be used and stored in accordance with label instructions.

(c) Communicable Disease. All patrons or swimmers having a communicable disease or displaying signs and symptoms of a communicable disease which can be transmitted through normal swimming pool use shall be excluded. No person having a communicable disease or displaying signs and symptoms of a communicable disease shall work at any type pool in a function in which there is a likelihood that they would transmit the disease to any other person.

(d) Depth markers. Depth markers shall be required at all Type A, B, and E pools. The depth of the water shall be plainly marked in feet on both sides and at each end at or above the water surface on the vertical pool wall and on the coping or deck next to the pool, and at maximum and minimum depths of the pool. Depth markers shall be spaced at intervals no greater than twenty (20) feet with numerals of at least four (4) inches in height and of a color contrasting with the background. Where depth markings are required, they shall be in whole foot increments of depth, except across the shallow area and corresponding deck area. The depth shall be marked to the nearest one-half (1/2) foot increment of water depth.

(e) Diving Boards/Towers. Diving board stands/towers, which were in existence and in use on or prior to May 9, 1987, at pools having dimensions less than those required by

Rule 1200-23-05-.03(3)(h) will be allowed to continue in use until the diving board stand/tower is replaced.

(f) Electrical. There shall be no visible, obvious electrical hazards at any pool.

(g) Fencing.

1. All outside pools shall be protected by a wall, building, enclosure, or chain link fence with a minimum height of four (4) feet, or other functionally equivalent barriers approved by the Commissioner.

2. All openings in the barrier shall be equipped with self-closing and self-latching hardware for the permanent locking of gates or doors.

3. Fencing and/or barriers shall be maintained in good repair.

(h) Gas Chlorination.

1. Gas chlorination equipment shall be located so that an equipment failure or malfunction will have minimum effect on evacuation of pool users in an emergency.

2. Cylinders shall be securely fastened to a wall or post.

3. Storage of any other chemicals in the chlorine enclosure shall be forbidden, except those used to check chlorine leaks.

4. When gas chlorination equipment is enclosed, the enclosure shall be provided with (i) Air-tight ducts from the bottom of the enclosure to the atmosphere in an unrestricted area, (ii) A motor driven exhaust fan capable of producing at least one air change per minute, and (iii) Automatic louvers of good design near the top of the enclosure for admitting fresh air.

5. Connections from the cylinders to the system depend on the type of chlorinator to be used and shall comply with the chlorinator manufacturer’s recommendation.

6. Electrical switches for the control of artificial lighting and ventilation within the enclosure shall be on the outside of the enclosure and adjacent to the door.

(i) General Safety. Glass, sharp objects, or any other items which might cause injury or accidents shall not be allowed in the pool or pool area. No hazardous aspects of the operation or condition of facilities or equipment, which if not corrected are very likely to result in illness or injury, shall exist.

(j) Illumination. When night swimming is allowed by the owner/operator, uniform area lighting shall be provided for the deck area and in all cases there shall be sufficient illumination to enable all areas of the pool including the main drain to be clearly observed by a person standing at the edge of the pool.

(k) Lifeguard Chairs. One lifeguard chair shall be provided for each lifeguard as required by these regulations and shall be elevated and strategically located to provide adequate coverage of all areas of the pool. Only lifeguard chairs which are designed and manufactured for such purposes shall be used.

(l) Lifeline.

1. In all Type A and B pools in which the maximum pool depth exceeds five (5) feet six (6) inches, there shall be a lifeline located at or before the five (5) feet depth area(s) separating the shallow area(s) and the deep area(s). “Wave” type pools shall be exempted from this requirement.

2. A lifeline shall be made of approved material such as polypropylene or nylon and shall be provided with floats made of soft material of contrasting color located at not more than five feet intervals. The lifeline rope shall be a minimum of threefourths (3/4) inch diameter and shall be attached to the lifeline anchors on both sides of the pool during all times that the pool is in operation, except during periods of competitive swimming or supervised training, or cleaning.

(m) Life Saving Equipment. All Type A and B pools shall be equipped with a minimum of one (1) unit of life saving equipment, located within twenty-five (25) feet of the pool, inside the fence. One (1) unit of life saving equipment as defined in 1200-23-05- .01(24), shall be provided at each lifeguard chair. Further, additional units of life saving equipment shall be readily accessible and provided in accordance with the number of “Certified Lifeguards,” Rule 1200-23-05-.02(3)(a).

(n) Main Drain. Main drain grating in all types of pools shall be in place, securely anchored, in good repair and with slots not more than one-half (1/2) inch wide.

(o) Signs. At Type A, B, and C pools, where no lifeguard is required, a warning sign with clearly legible letters at least 4 inches in height shall be placed in plain view stating “WARNING NO LIFEGUARD.” No diving sign(s) shall be displayed in conspicuous locations at all pools not meeting the minimum requirements for diving. The sign shall read “NO DIVING,” with minimum four (4)-inch lettering.

(p) Starting Blocks Used for Competitive Swimming. Starting blocks shall not be used for any purpose other than for competitive swimming nor at any time other than during competitive swimming activities.

(q) Steps, Ladders. Steps and ladders shall be maintained in good repair and be free of hazards.

(r) Telephone for Emergency. All pools shall have telephone service on the premises which can be accessed without the use of coins. A list of clearly visible emergency phone numbers to include the nearest emergency and medical services shall be posted next to the telephone.

(4) Water Quality (a) Microbiological Test. Pool water sample analysis shall be in accordance with these rules. A sample shall be considered positive and unacceptable if it exceeds four (4) total coliform bacteria per one hundred (100) milliliters of sample using the Chromagenic Substrate Test.

(b) Chemical Tests.

1. The Hydrogen Ion Concentration (pH) of the pool water shall be maintained at a level between 7.2 and 7.6 when the pool is open for operation.

2. Total alkalinity in pool water shall he at a level between eighty parts per million (80 ppm) and two hundred parts per million (200 ppm).

3. The cyanuric acid level shall not exceed one hundred parts per million (100 ppm).

(c) Sanitization.

1. Free available sanitizing residuals in pools for currently approved agents shall be as follows:

(i) Type A, B, C, & E pools Chlorine 0.5 - 3.0 ppm Bromine 2.0 - 5.0 ppm Polyhexamethyl biquanide 30 - 50 ppm (ii) Type D pools Chlorine 1.0 - 3.0 ppm Bromine 3.0 - 5.0 ppm Polyhexamethyl biquanide 30 - 50 ppm 2. Disinfectants of quality equal or superior to chlorine or bromine compounds thatare registered by the Environmental Protection Agency and approved by the Department may be used.

3. Other disinfecting methods or materials may be used if they have been adequately demonstrated to the Department to provide a satisfactory residual effect which is easily measured or where demonstration and analysis provide assurance that results are otherwise equally effective under condition of use as the chlorine concentration required herein. Disinfecting methods or materials shall not be dangerous to public health, create objectionable physiological effects, or import toxic properties to the water.

4. Sanitizing agents shall be dispensed into the pool water automatically with the exception of polyhexamethyl biquanide. The equipment shall be designed specifically for the type of disinfectant to be used. The equipment shall be of sufficient capacity to maintain the recommended disinfectant residual in the pool.

Disinfecting equipment shall be provided with controls for adjusting the rate of flow.

5. Hand chlorination is not acceptable, except for emergencies, infrequent chlorination purposes, or as approved by the Department where specific circumstances necessitate such dispensing.

(d) Testing Equipment. Testing equipment complete with reagents shall be provided at the pool for the determination of residual disinfectant, pH, total alkalinity, and cyanuric acid of the pool water. The diethyl-p-phenylenediamin (DPD) method shall be used for the determination of disinfectant residual. The range of testing equipment shall be capable of testing all levels as set forth within these rules. Reagents shall not be outdated or otherwise ineffective.

(e) Visual Tests.

1. Water shall be sufficiently clear to allow a viewer to clearly distinguish gratings (openings) of the main drain(s) when standing at the edge of the pool deck.

2. There shall be no algae visible in a pool.

3. There shall be no foreign material visible in a pool.

(f) Water Level. The water level in swimming pools with overflow gutters shall be maintained at the break over level. The water level in swimming pools with skimmers shall be maintained at the midpoint of the skimmer throat.

(g) Water Temperature. Pool temperature shall not exceed one hundred four (104ºF) degrees Fahrenheit. Type D pools shall be equipped with a non-breakable thermometer located in the water.

(5) Water/Waste Water (a) Cross-Connections. There shall be no cross-connections within any portion of the pool facilities. Hose bibbs shall be equipped with an approved anti-siphon prevention device.

(b) Sewage Disposal. Sewage shall be disposed of according to law.

(c) Water Supply. All water used in drinking fountains, lavatories, showers, or hose bibbs shall be from potable water sources. Any water supply, other than an approved public water supply, shall have water tested at least annually and as often as deemed necessary by the Commissioner.

(d) Water Supply. All water used to fill a pool shall be of a potable source or a source that is acceptable to the Commissioner.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-14-301, et seq., 68-14-401, and 68-14-402.
• Administrative History: Original rule filed March 13, 2000; effective May 27, 2000.

Tenn. Comp. R. & Regs. 1200-23-05-.03 MINIMUM DESIGN STANDARDS FOR PUBLIC SWIMMING POOLS

(1) General These design standards shall apply to all public swimming pools constructed or altered after the effective date of these rules. All definitions and requirements in the law and regulations are also considered a part of these standards. For design features not specifically addressed in these regulations (1200-23-05-.03), the Commissioner shall evaluate same and approve or disapprove said design features as appropriate.

(2) Plans and Specifications for Review (a) No person shall begin construction of a public swimming pool or shall alter or reconstruct any public swimming pool without first having submitted plans and specifications to the Department for review and having received approval. All plans and specifications shall be submitted in duplicate.

(b) No permit to operate a constructed, altered, or reconstructed swimming pool shall be issued unless said pool design has been approved by the Commissioner.

(c) All types of pools shall be designed and constructed to withstand all anticipated loads and for both full and empty conditions. A hydrostatic relief valve shall be provided in each main drain. The designer or architect or engineer shall certify the structural stability and safety of the pool in the plans and specifications submitted.

(d) Plans shall be drawn to scale and include:

1. The name of facility, location, and names and addresses of all owners and operators;

2. The perimeter, surface area, volume of the pool, total deck area, turnover rate, and maximum bather load;

3. A detailed layout of pool, including fencing, all pool facilities and related structures;

4. Top and cross-sectional diagrams with dimensions so that depths and clearances may be determined for all areas of the pool;

5. All equipment (fittings, ladders, diving boards, main drain(s), surface skimmers, overflow gutters, inlets, lights, and other applicable equipment) with spacing with dimensions;

6. Layout and slope of deck area, indicating size, location of hose bibb(s) depth markings, deck drains, and area to be lighted;

7. Plumbing diagram showing all pipe sizing and location;

8. Equipment room diagram showing layout and elevation, sump, floor drain(s), and other equipment and facilities;

9. Complete equipment list with manufacturer specifications to include model, model number, size, capacity, horsepower;

10. Source(s) of water;

11. Method of sewage disposal;

12. Design of gas chlorination system, showing location in relation to the pool and other structures; and 13. Other information as requested by the Department.

(e) After all piping has been installed and before it is covered, the owner or operator shall notify the Department so that a complete piping inspection can be conducted. The owner or contractor shall notify the Department at other specified stages of construction for interim inspections, if such a request is made.

(3) Design Standards (a) Bathhouse facilities shall be provided within two hundred (200) feet for all Type “A” pools. At Type B, C, & E pools, bathhouse facilities shall be provided within eight hundred (800) feet of the pool. Bathroom facilities used in conjunction with living or lodging can be substituted for criteria as set forth in the following subparagraph, “Bathhouse Facilities.”

(b) Bathhouse Facilities 1. Toilet and shower facilities shall be provided in the following ratios for the number of swimmers indicated or major fraction thereof:

Males Females Water Closets 1/75* 1/50* Urinals 1/75* --- Lavatories 1/100* 1/100* Showers 1/50* 1/50* *Number of swimmers 2. Hose bibbs shall be provided for flushing down dressing rooms and bathhouse interior. Each hose bibb shall be equipped with an approved anti-siphon prevention device.

3. Floors of the bathhouse shall be of impervious material, graded to drain, smooth and with a nonslip finish. Floor drains shall be located to ensure drainage of all parts of the building.

4. All dressing room booths, if provided, shall be made of durable materials.

5. Lighting and Ventilation. All bathhouse shower and dressing room areas shall be ventilated and lighted. Minimum lighting in dressing room areas shall be not less than ten foot candles at a point three feet from the floor. Ventilation shall be sufficient to prevent condensation and odor accumulation.

6. Soap dispensers shall be provided at each lavatory and shower head at the rate of one dispenser for every two lavatories and each shower head. The use of bar soap is prohibited.

7. Water under pressure shall be provided at all showerheads and lavatories. The actual rate of flow shall be in accordance with current Southern Building Codes Standards. Hot water shall be a minimum of 90ºF and shall not exceed 120ºF.

8. Towels. Single service towel holders or blower type hand dryers shall be provided at each handwashing facility at the rate of one approved dispenser per four lavatories.

9. Facilities shall be finished in light colors and designed so that good sanitation can be maintained.

(c) Coding of Piping and Equipment. All piping, valves, and equipment are to be labeled with legible print stating the following:

1. Water lines - potable;

2. Recirculation filtered, skimmer or gutter return, main drain;

3. Chemical lines - alum, chlorine (gas and solution), soda ash, acid;

4. Waste lines - backwash waste, sewer (sanitary or otherwise), deck drains; or 5. Other - Compressed air, gas (natural or bottled).

(d) Construction Material and Finish 1. Swimming pools shall be constructed of materials that are inert, non-toxic, impervious, permanent, and enduring. The materials shall be able to withstand the design stresses and be water tight, with a smooth and easily cleaned surface. The materials shall be finished in a white or light color.

2. Sand, earth, or vinyl liners are not permitted in swimming pool construction.

3. All sections of a flume or slide for Type “E” pools shall be designed and constructed to prevent abrasion or injury. All surfaces shall be sealed and smooth.

4. Steps, ledges and/or seats inside Type A, B and C pools, located below the normal water level, shall be clearly identified or be colored in contrast with the rest of the pool shell’s interior.

(e) Deck Areas 1. Deck areas shall be continuous around the pool with a minimum width as follows:

(i) Type A: eight (8) feet;

(ii) Type B: six (6) feet;

(iii) Type C: four (4) feet;

(iv) Type D: no minimum requirement; and (v) Type E: eight (8) feet around the exit of the landing pools, four (4) feet around the starting point.

2. A minimum of three (3) feet of deck width shall be provided on the sides and rear of any piece of diving or sliding equipment and lifeguard chairs.

3. The deck shall be constructed of slip resistant material and have a finish that will be of no hazard to bare feet. It shall have a slope of not less than one-fourth (1/4) inch nor more than three-eighths (3/8) inch to the foot and shall be so designed as to conduct drainage away from the pool area in a manner not to create or maintain standing water. All deck drainage shall be “to waste.” Deck drains shall be installed where necessary to prevent standing water.

4. Hose bibbs shall be provided around the perimeter of the deck area at intervals such that all parts of the deck can be reached with a hose.

(f) Depth. The beginning depth in the shallow portion shall not be less than three (3) feet and shall not exceed three (3) feet six (6) inches, except for restricted use pools, such as competitive swimming, diving, wading pools, wave-pools, or zero entry pools.

(g) Depth Markers at All Type A, B, and E Pools. The depth of the water shall be plainly marked in feet on both sides and at each end at or above the water surface on the vertical pool wall and on the coping or deck next to the pool and at maximum and minimum depths of the pool. Depth markers shall be spaced at intervals no greater than twenty (20) feet with numerals of at least four (4) inches in height and of a color contrasting with the background. Where depth markings are required, they shall be in whole foot increments of depth; except across the shallow area and corresponding deck area. The depth shall be marked to the nearest one-half (1/2) foot increment of water depth.

(h) Diving Area/Equipment 1. Where diving boards or towers are provided, minimum dimensions of pools, maximum clearances from diving board(s), and other required dimensions for diving equipment and pools shall be in accordance with Figure 1.

2. Diving boards and towers in excess of three (3) meters in height are prohibited in a public swimming pool, except for pools specifically designed and used for competitive type diving and instruction.

3. At least fifteen (15) feet of unobstructed vertical distance shall be maintained above any diving board. This fifteen (15) feet height shall extend ten (10) feet to each side and sixteen (16) feet ahead of the front end of the board. If a pool has more than one diving board, the above distances shall be provided for each board or tower.

4. All steps, platforms, towers, and diving boards one meter in height or greater shall be provided with handrails that extend to inside of coping edge.

(i) Drinking Fountain. At least one (1) approved drinking fountain shall be provided within 200 feet of Type A pools.

(j) Electrical 1. Electrical equipment for all pool facilities shall conform with all applicable local codes and the National Fire Protection Association’s National Electric Code.

2. Overhead wiring, not in conduit, shall not pass within an area extending a distance of twenty (20) feet horizontally away from the inside edge of the pool walls, diving structures, observation stands, towers, or platforms.

(k) Equipment Room(s) or Enclosure. An enclosed area shall be provided that will prevent unauthorized access to all chemical feeders and filtration equipment. It shall be illuminated, ventilated, and sized for ease of operation and accessibility.

(l) Fencing 1. All outside pools shall be enclosed by a chain link fence or equal barrier of minimum four (4) feet in height.

2. If picket type fencing is used, the spacing between pickets shall not exceed four (4) inches. The top of the bottom rail shall not exceed four (4) inches above grade, and the top rail shall be no less than forty-three (43) inches above grade.

3. All access openings in the fence or barrier shall be equipped with gates or doors with self-closing and self-latching mechanisms and hardware for permanent locking. Fencing and/or barriers shall be maintained in good repair. All pools shall be protected by a wall, building, enclosure, or link fence with a minimum height of four (4) feet, or other functionally equivalent barriers approved by the Commissioner.

(m) Fill Spout. The fill spout shall be located underneath the diving board or within four (4) inches of a pool ladder and not protrude beyond the edge of the pool. if the pool has no diving board or ladder, the fill spout shall not extend beyond the edge of the pool coping or otherwise be located so as to create a tripping hazard.

(n) Filters 1. Diatomite Filters. The filter rate for diatomite filters shall not exceed one and onehalf (1.5) gallons per minute per square foot of filter surface area.

2. Sand-High Rate. Filter rate shall not exceed fifteen (15) gallons per minute per square foot of filter surface area. The filter(s) shall be provided with pressure gauges for determining the need for backwashing, backwash sight glass, and airrelief device. The backwash rate shall not be less than the filter rate.

3. Cartridge. Filters shall be of a disposable or washable element. Rate of flow shall not exceed 0.375 gallons per minute (G.P.M.) per square foot of filter surface area at all type pools. One extra complete set of filter units shall be on hand at all times at the pool.

4. Other Filters. Any filters other than those described above that are functionally equivalent may be approved by the Department.

5. Pool designer shall identify procedures or methods for backwashing and/or cleaning filters.

6. All type filters shall comply in all respects with the Standards of the National Sanitation Foundation covering such filters.

(o) Filter Backwash. Backwash from the filter(s) shall be piped to a sanitary sewer or other disposal method approved by the Department. In all cases of filter backwash discharge, an air-gap shall be provided with a minimum of six (6) inches between the discharge pipe and top of the sump or sewer piping. Both the sump and the exit pipe shall be sized to accommodate the backwash flow.

(p) Gas Chlorine 1. Chlorination equipment shall be located so that an equipment failure or malfunction will have minimum effect on pool users or other adjacent facilities in an emergency.

2. Facilities for securing cylinders shall be installed.

3. If installed below grade or within an enclosure, the area shall be provided with (i) An air -tight duct from the bottom of the enclosure to atmosphere in an unrestricted area, (ii) A motor driven exhaust fan capable of producing at least one air change per minute, and (iii) Automatic louvers of good design near the top of the enclosure for admitting fresh air.

4. Elemental chlorine feeders shall be activated by a booster pump and solenoids using recirculated water supplied via the recirculation system. The booster pump should be interlocked to the filter pump to prevent feeding of chlorine when the recirculation pump is not running.

5. Connections from the cylinders to the system depend on the type of chlorinator to be used and shall comply with the chlorinator manufacturer’s recommendation.

6. Electrical switches for the control of artificial lighting and ventilation within the enclosure shall be on the outside of the enclosure and adjacent to the door.

(q) Hair/Lint Strainer. A corrosion-resistant strainer (except for Vacuum Diatomite Filters and Vacuum Sand Filters) located on the vacuum side of the filtration pump shall be provided to remove solids, debris, hair, arid lint.

(r) Lifeline. In Type A and B pools where the maximum pool depth exceeds five (5) feet six (6) inches, there shall be a lifeline, provided with floats made of soft material of contrasting color located at not more than five (5) feet intervals, separating the shallow and the deep end at or before the five (5) feet-depth area. The lifeline shall be made of polypropylene or nylon, be a minimum of three-fourths (3/4) inch diameter, and be in good condition. “Wave” type pools shall be exempted from this requirement.

(s) Lifeguard Chairs. There shall be a minimum of one (1) elevated lifeguard chair provided for all Type “A” pools with a minimum of eighteen hundred (1,800) square feet of pool surface area. The number of square feet with required number of lifeguard chairs shall be as follows.

1. 1,800 - 3,000 1 lifeguard chair 3,001 - 6,000 2 lifeguard chairs 6,001 - 9,000 3 lifeguard chairs 2. An additional chair per each additional 3,000 square feet.

2. All other pools shall meet the same requirements relative to lifeguard chairs as Type “A” pools when there is a diving board of one (1) meter or more.

(t) Lighting 1. Artificial lighting shall be provided at all pools that are to be used at night or which do not have adequate natural lighting. A minimum of five (5) feet candles per square foot at the deck level shall be provided.

2. Underwater lighting shall be provided at all pools. Such lighting shall be not less than 0.5 watts per square foot of pool surface area. Lights shall be positioned so that all portions of the pool are clearly visible to an observer on the pool deck.

3. Overhead Lights. There shall be no light fixtures directly above the water surface.

(u) Main Drain 1. All pools shall be provided with main drain outlets at the deepest point of the pool. All pools shall have a minimum of two (2) interconnected main drains. Jet pump type systems shall be connected to multiple (two minimum) main drains.

2. Each floor outlet grate area shall be such that when the maximum flow of water is being pumped through the floor outlet, the velocity through the open area of the grate shall not be greater than two (2) feet per second. Floor outlet grates shall be anchored, tamper proof with slots not more than one-half (1/2) inch wide.

3. When the outlet grates are of the anti-vortex type, maximum entrance velocities may be increased to six (6) feet per second. All main drains shall be of corrosionresistant materials.

(v) Operation Instructions 1. Upon completion of the pool, the builder shall give the owner and/or operator complete written instructions on the operation and maintenance of the pool and equipment.

2. These instructions, including the valve schedule, shall be supplied in not less than two (2) copies. One copy shall be encased in a waterproof covering available to the pool operator and to the Department’s representative during inspection.

(w) Overflow Gutters 1. Overflow gutters shall be required on all pools with a surface area greater than or equal to 5,000 sq. ft. Pools of less than 5,000 sq. ft. shall have overflow gutters or be equipped with at least one skimmer for each 500 square feet or fraction thereof.

2. Overflow edge of the gutters shall be level within 1/8 inch and extend completely around the pool except at steps, ramps, or other fixtures approved prior to construction.

3. The opening into the gutter beneath the coping shall not be less than four (4) inches. The interior of the gutter shall have a width and depth of at least three (3) inches and be designed to prevent entrapment of bathers’ arms and legs. The overflow edge of the lip shall serve as a handhold and be rounded.

4. The overflow system shall be capable of continuously removing 50 percent or more of the recirculated water and returning it to the recirculation system through a surge system with a capacity of not less than one gallon for each square foot of pool surface area.

5. The gutter drain outlets shall be constructed of a non-corrosive material and shall be placed on a maximum of fifteen foot centers. The gutter bottom shall slope toward these outlets with a minimum slope of one-eighth (1/8) inch per foot or be designed to continuously flush the gutter bottom.

(x) Piping. Piping shall be stainless steel, National Sanitation Foundation (N.S.F.) swimming pool approved reenforced flex pipe or water type PVC schedule 40 or better.

Suction piping shall be designed to move the required quantity of water at a maximum velocity not to exceed six (6) feet per second. The face piping shall be sized as indicated in Tables I, II, and III. Return piping system shall circle the pool and shall not be reduced in size from the face piping size more than one standard pipe size at the “T” and one size for each two (2) inlets on each side of the “T.” Reduction of piping size and number of inlets shall be balanced by having an equal number on each side of the “T.”

(y) Pool Heaters. A heater thermostat shall be provided that will turn the heater off should the pool temperature go above one hundred four degrees Fahrenheit (104ºF) A heater bypass and valve equal in size to the return face piping requirement shall be provided when the heater core size is smaller than the return face piping.

(z) Pool Inlets 1. Inlets shall be spaced not over twenty (20) feet apart, with one inlet within 5 feet of each corner of the pool and one in each recessed area or recessed step area.

They shall be located at least twelve (12) inches below the normal operating water level.

2. Inlet fittings shall be of the adjustable rate-of-flow type. Directional flow inlets shall be used with skimmer type pools. Inlets shall not protrude from the floor or wall to create a hazard.

3. All type pools shall be required to install a minimum of two (2) inlets.

(aa) Pressure Gauges. Pressure gauge(s) shall be installed and maintained on the influent side of the filter (high rate sand filter), read in pounds per square inch (psi), and maintained in an operational condition. Pressure gauge(s) on other sand filters and other type filters shall be installed according to manufacturer specifications.

(bb) Pump and Motor 1. The pump and motor shall be of adequate size and capacity to provide the required pool turnover rate, and shall be located to eliminate the need for priming. The pump design shall be based on an assumed total dynamic head of not less than fifty (50) feet of water. The following items or systems are prohibited:

(i) Split systems (ii) Dual pumps wired to separate switches (iii) Multi-speed pumps 2. A corrosion-resistant strainer located on the vacuum side of the filtration pump shall be provided to remove solids, debris, hair, and lint.

3. Minimum size in horsepower shall conform to applicable criteria in Tables I, II, or III of these rules or by the manufacturer’s pump curve.

(cc) Rate of Flow Indicator. Public pools shall be provided with an operational rate of flow indicator that reads in gallons per minute (G.P.M.) located on the discharge line from the filter as per manufacturer specifications.

(dd) Recirculation System 1. The inlet side of the recirculating system shall be designed to achieve the required turnover rate. The recirculation system shall be designed to have the capacity to (i) Flow fifty (50) percent through the overflow or skimming facilities and fifty (50) percent through the main drains, (ii) Eighty (80) percent of the recirculation through the overflow or skimming facilities, and (iii) One hundred percent (100) through the main drain(s).

2. The recirculating system shall be designed in accordance with Tables I, II, or III of these rules.

(ee) Sewage Disposal. Sewage shall be disposed of according to law.

(ff) Sidewalls. Sidewalls of the pool design shall be as shown in Figure 1. Ledges and/or seats inside the main pool body, below the normal water level, shall conform to the minimum N.S.P.I. standards. The top of the pool wall shall be uniformly level and designed with bull nosed coping or some other acceptable means by which an adequate handhold is provided around the entire pool perimeter. All junctions of walls and floors shall be rounded with a minimum six (6) inches radius.

(gg) Sight Glass. An approved sight glass or other approved method shall be installed to observe backwash waste water from all sand filters.

(hh) Signs. Where no lifeguard is required at Type A, B, and C pools, a warning sign with clearly legible letters at least 4 inches high shall be placed in plain view stating “WARNING - NO LIFEGUARD.” No diving sign(s) shall be displayed in conspicuous locations at all pools not meeting the minimum requirements for diving. The sign shall read “NO DIVING” with minimum four (4) inches lettering.

(ii) Skimmers 1. When skimmers are required, there shall be one skimmer for the first 500 square feet of pool surface area and one skimmer for each additional 500 square feet or fraction thereof.

2. No skimmer shall be located closer than five feet to the nearest inlet.

3. When surface skimming devices are used, handholds shall be provided which consist of bull-nosed coping not over 2 1/2 inches thick or an equivalent device.

The handholds shall be no more than nine inches above the normal operating water level.

4. The skimmer weir shall be automatically adjustable and shall operate freely with continuous action to variations in water level over a range of at least four inches.

5. An easily removable and cleanable basket or screen through which all overflow water passes shall be provided to trap large solids.

6. Type C and D pool inlets and outlets shall be provided and arranged to produce complete recirculation of pool water and maintenance of the required residual of sanitizing agent. These type pools shall be provided with a means of completely draining the contents of the pool to waste without passing through the filter.

7. An equalizer line shall be installed for all Type C and D pools.

(jj) Slope. The pool shall have a uniform slope from the shallow end to the slope transition point not exceeding one (1) foot vertical to twelve (12) feet horizontal. Where the depth is greater than five feet, the slope shall not exceed one (1) foot vertical to three (3) feet horizontal.

(kk) Steps and Ladders. Two (2) or more ladders shall be provided for Type A & B pools. At least one (1) ladder shall be provided for each seventy-five (75) feet of pool perimeter.

Ladders shall have a minimum of three steps with non-slip treads. One (1) ladder may be deleted if steps are installed in the shallow end of the pool. Nonslip steps will be allowed on the shallow end and may extend inside the pool provided they are plainly marked. Where steps are used, a minimum of one (1) handrail shall be installed from the mid-point of the bottom step to the deck. Any steps over ten (10) feet wide shall have handrails on the edges and spaced not more than six (6) feet on centers. Steps shall not have a rise of more than 10 inches and a tread of 12 inches. Construction of steps and ladders shall conform to criteria as set forth in Figure 1.

(ll) Turnover Rates. Pools shall be designed to filter and disinfect the water according to the following rates.

1. All Type A and B pools shall be designed to filter and disinfect the entire volume of water in no more than 6 hours.

2. All Type C and E pools shall be designed to filter and disinfect the entire volume of water in no more than 1 hour.

3. All Class D pools shall be designed to filter and disinfect the entire volume of water in no more than 30 minutes.

(mm) Vacuum Equipment. An operational vacuum cleaning system shall be provided at all pools. Built-in vacuum outlets shall not be more than eight (8) inches below the normal operating water level.

(nn) Water Supply 1. All water used in drinking fountains, lavatories, showers, and hose bibbs shall be from a potable source.

2. All water used to fill the swimming pool shall be from a source approved by the Commissioner.

3. Hot and cold water under pressure shall be provided at shower heads and lavatories.

4. There shall be no cross-connections within any portion of the pool facilities. Hose bibbs shall be equipped with an approved anti-siphon prevention device.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-14-301, et seq., 68-14-401, and 68-14-402.
• Administrative History: Original rule filed March 13, 2000; effective May 27, 2000.

Tenn. Comp. R. & Regs. 1200-23-05-.04 ESTABLISHMENT PERMITTING AND INSPECTION SYSTEM

(1) Application Procedures (a) Any person planning to operate a public swimming pool must obtain a written application for a permit on a form provided by the Commissioner through the local county health department prior to operating a public swimming pool. A new or initial application is required for public swimming pools that have not previously been permitted or for instances when ownership changes.

(b) The Commissioner shall issue a public swimming pool permit 1. After an inspection of the proposed facility reveals that the facility is in compliance with requirements of these rules and 2. Upon receiving a completed application with applicable fees.

(2) Inspection System (a) The Commissioner shall inspect public swimming pools at least once every month while in operation or as often as required by law.

(b) Inspection results for public swimming pools shall be recorded on standard departmental forms which summarize the requirements of the law and rules and regulations.

(c) The scoring system shall include a weighted point value for each requirement in which critical items are assigned values of either four (4) or five (5) points, with less critical items having assigned values of either one (1) or two (2) points.

(d) The rating score of the facilities shall be the total of the weighted point values for all violations subtracted from one hundred (100).

(3) Violation Correction (a) In accordance with T.C.A. § 68-14-318, correction of critical violations shall be within ten (10) calendar days. All other violated items shall be corrected as soon as possible, but in any event by the time of the next routine inspection.

(b) Upon declaration of an imminent health hazard by the Commissioner, the facility shall immediately cease operations until authorized to reopen.

(c) The inspection report shall state that failure to comply with any time limits for correction may result in cessation of operations. An opportunity for a hearing concerning the inspection and/or inspection report and/or on the ordered corrective action will be provided, if a written request is filed with the Commissioner within ten (10) calendar days following the inspection. If a request for a hearing is received, a hearing shall be held within a reasonable period of time after receipt of the request. Any such hearing shall be held pursuant to T.C.A. Title 4, Chapter 5, Part 3.

(4) Permit Revocation (a) After providing opportunity for hearing, the Commissioner or his duly authorized representative may revoke a permit for serious or repeated violations of requirements of this part or for interference with the Commissioner or his duly authorized representative in the performance of his duty.

(b) Prior to revocation, the Commissioner or his duly authorized representative shall notify the permittee, in writing, of the specific reason(s) for which the permit is to be revoked, and that the permit shall be revoked at the end of ten (10) days following service of such notice, unless a written request for a hearing is filed with the Commissioner within such ten-day period. If no request for hearing is filed within the ten-day period, the revocation of the permit becomes final.

(c) Permit Revocation. When a permit to operate a public swimming pool is revoked by the Commissioner, a new permit shall be issued, upon meeting all requirements for a new permit and the submission of a new application with applicable fees.

(5) Whenever a facility is required under this section to cease operations, it shall not resume operations until it is shown on reinspection that conditions responsible for the order to cease operations no longer exist. Opportunity for reinspection shall be offered within a reasonable time.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, and 68-14-301, et seq.
• Administrative History: Original rule filed March 13, 2000; effective May 27, 2000.

Tenn. Comp. R. & Regs. 1200-23-05-.05 FEES

(1) Except as otherwise provided herein, a public swimming pool shall be assessed an initial fee and a renewal licensing fee of one hundred dollars ($100.00) each.

(2) A late penalty fee of ten dollars ($10.00) shall be accessed on all permit applications which are received by the Department after April 30th of each permitting year.

(3) A late penalty fee of ten dollars ($10.00) shall be assessed on all initial or new permit applications which are received by the Department greater than thirty (30) days from the date of the initial opening or operation of the public swimming pool.

(4) When an initial and or change of ownership application is made for a permit to operate a public swimming pool after October 1 of each year, the fee charged shall be one-half (1/2) the annual rate.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, and 68-14-301, et seq.
• Administrative History: Original rule filed March 13, 2000; effective May 27, 2000.

Tenn. Comp. R. & Regs. 1200-23-05-.06 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, and 68-14-301, et seq.
• Administrative History: Original rule filed March 13, 2000; effective May 27, 2000. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-23-05-.07 GENERAL PROVISIONS

(1) Applicability. Rule 1200-23-05, Public Swimming Pools, applies to public swimming pools. All public swimming pools shall comply with all applicable provisions of Rule 1200-23-05, Public Swimming Pools, at all times.

(2) Posting of Permit. Section 68-14-305 requires posting of permits “in a conspicuous manner.”

This shall mean at a place so designated by the inspector at the time of inspection. No person except an authorized representative of the Commissioner shall modify, remove, cover up, or otherwise make the permit less conspicuous in any way.

(3) Severability. If any provision or application of any provision of these rules is held invalid, that invalidity shall not affect other provisions or applications of these rules.

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, and 68-14-301, et seq.
• Administrative History: Original rule filed March 13, 2000; effective May 27, 2000.

Tenn. Comp. R. & Regs. 1200-23-05-.08 TABLES

Table I Main Pool (6 Hour Turnover)

Capacity (Gallons)

Minimum Face Piping, Return Line Size in Main Drain Size in Minimum Size of Pump in High Rate Filter Minimum Size Inches* Inches Horsepower** Sq. Ft Diameter 12,501-18,000 2 2½ 1 4.9 30” 18,001-23,400 2 2½ 1½ 4.9 30” 23,401-31,000 2½ 2½ 2 7.1 36” 31,001-33,000 2½ 2½ 2½ 7.1 36” 33,001-43,000 2½ 2½ 3 7.9 43,001-47,500 3 3 3 9.0 47,501-63,000 3 3 5 12.0 63,001-80,000 4 4 5-7½ 14.0 80,001-115,000 4 4 7½ 21.0 115,001-180,000 6 6 10 33.0 180,001-250,000 8 8 15 46.0 Table II Spas and Whirlpools (30 Minute Turnover)

Capacity (Gallons)

Minimum Face Piping, Return Line Size in Main Drain Size in Minimum Size of Pump in High Rate Filter Minimum Size Inches* Inches Horsepower** Sq. Ft Diameter 350-1,000 1½ 2½ ¾ 3.1 24” 1,001-1,500 2 2½ 1 4.9 30” 1,501-2,000 2 2½ 1½ 4.9 30” 2,001-2,700 2½ 2½ 2 7.1 2@30” or 1@36” 2,701-3,500 3 3 3 7.1 1@48” or 3,501-4,500 4 4 5 10.0 2@30”

Table III Wading Pools (One Hour Turnover)

Capacity (Gallons)

Minimum Face Piping, Return Line Size in Main Drain Size in Minimum Size of Pump in High Rate Filter Minimum Size Inches* Inches Horsepower** Sq. Ft Diameter 0-2,000 1½ 2½ ¾ 3.1 24” 2,001-3,000 2 2½ 1 4.9 30” 3,001-4,000 2 2½ 1½ 4.9 30” 4,001-5,000 2½ 2½ 2 7.1 2@30” or 1@36” 5,001-8,000 3 3 3 8.3 1@42” or 2@30” 8,001-12,500 4 4 5 11.0 2@36” or 3@30” * Piping other than PVC is approved for use. ** The pump curve provided by the manufacturer may indicate that a different size pump will achieve the required turnover rate.

Note: If two or more filters are used to achieve the desired area, they must be the same size.

Figure 1 Minimum Dimensions for Diving Portion of Pools (This drawing does not show the shallow portion of the pool.)

Typical position of tip of board relative to Pt.A RELATED DIVING EQUIPMENT MINIMUM DIMENSIONS MINIMUM WIDTH OF POOL AT:

MAXIMUM RADIUS

FROM VERTICAL

MAX.

DIVING

BOARD

LENGTH

MAX.

BOARD

HGT.

OVER

WATER

D D L

L PT. A PT. B PT. C R

R R 10’ 26”

(2.59m) (2.59m) (0.76m) (3.66m) (6.10m) (6.10m) (6.10m)

(2/3m) 8’6” 8’6” 2’6” 12’0” 20’0” 20’0” 20’0” 20” 12” 8” 12’ 30”

(2.74m) (2.74m) (0.81m) (3.66m) (6.10) (6.10m) (6.10m)

(3/4m) 9’0” 9’0” 3’0” 12’0” 20’0” 20’0” 20’0” 22” 12” 8” 16’ 39.37”

(3.05m) (3.05m) (1.22m) (6.10m) (6.71m) (6.71m) (6.71m)

(1m) 10’0” 10’0” 4’0” 20’0” 22’0” 22’0” 22’0” 28” 12” 8” 16’ 118.11 ”

(3.66m) (3.66m) (1.83m) (6.10m) (7.32m) (7.32m) (7.32m)

(3m) 12’0” 12’0” 6’0” 20’0” 24’0” 24’0” 24’0” 31” 12” 8”

NOTE: Placement of boards shall observe the following minimum dimensions. With multiple board installations minimum pool widths must be increased accordingly. 1 Meter or Deck Level Board to Pool Side 10’ (3.05m) 3 Meter Board to Pool Side 12’ (3.66m) 1 Meter or Deck Level Board to 3 Meter Board 10’ (3.05m) 1 Meter or Deck Level to Another Deck Level Board 8 ’ (2.44m) 3 Meter to Another 3 meter Board 10’ (3.05m)

History

• Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-14-301, et seq., 68-14-401, and 68-14-402.
• Administrative History: Original rule filed March 13, 2000; effective May 27, 2000.

Chapter 1200-23-06 Body Piercing

Tenn. Comp. R. & Regs. 1200-23-06-.01 DEFINITIONS

(1) “Antibacterial solution” means any solution used to retard the growth of bacteria approved for the application to human skin and includes all products so labeled.

(2) “Antiseptic” means a substance that will inhibit the growth and development of microorganisms without necessarily destroying them.

(3) “Antiseptic technique” means to render or maintain free from infectious material.

(4) “Autoclave” means a device which automatically holds the temperature, pressure, and time for the purpose of sterilization.

(5) “Autoclave indicator” means chemical detection strips, markers, or tape.

(6) “Biohazardous waste” means “regulated waste” (see definition No. 41).

(7) “Blood” means human blood, human blood components, and products made from human blood.

(8) “Bloodborne pathogens” means pathogenic microorganisms present in human blood that can cause disease in humans. These pathogens include, but are not limited to, Hepatitis B virus (HBV) and human immunodeficiency virus (HIV).

(9) “Chemical detection strips, markers or tape” means the use of detection devices placed on items for sterilization to facilitate in determining that the item has been subjected to steam sterilization process.

(10) “Contaminated” means the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface.

(11) “Contaminated laundry” means laundry which has been soiled with blood or other potentially infectious materials or which may contain sharps.

(12) “Contaminated sharps” means any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, or broken glass.

(13) “Critical item(s)” means those aspects of operation or conditions which, if in violation, constitute the greatest hazards to health and safety, including imminent health hazards.

(14) “Decontamination” means the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.

(15) “Disinfectant” means a solution intended to destroy or inactivate specific viruses, bacteria, or fungi on clean, inanimate surfaces [e.g., 1:10 bleach solution] or commercially labeled disinfectant.

(16) “Easily cleanable” means that surfaces are readily accessible and made of such materials and finish and so fabricated that residue may be effectively removed by normal cleaning methods.

(17) “Engineering controls” mean controls (e.g., sharps disposal containers) that isolate or remove the bloodborne pathogens hazard from the workplace.

(18) “Exposure incident” means a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duties.

(19) “Extensively remodeled” means alteration to affect the increase or decrease of floor space or the alteration of walls in a work area.

(20) “For compensation” shall include an instance in which the body piercing procedure is performed without charge, when the customer buys the body piercing ornament/jewelry or is required to provide other compensation, as well as normal payment for the procedure.

(21) “Germicide” means an agent that kills pathogenic microorganisms.

(22) “Germicidal solution” means any solution which destroys microorganisms and is so labeled.

(23) “Handwashing facilities” means a facility providing an adequate supply of running potable water, soap dispenser, soap, and single-use towels or automatic dryer.

(24) “Imminent health hazard” means any condition, deficiency, or practice, as identified by the health officer, which, if not corrected, is very likely to result in illness, injury, or loss of life to any person.

(25) “Infectious waste” means “regulated waste” (see definition No. 41).

(26) “Law” means any applicable provision of the State of Tennessee statutes and rules of any department or agency.

(27) “License” means the issuance of a license to perform body piercing to an individual, partnership, firm, association, or corporation. “License” further means to allow or authorize any person who has satisfactorily completed all requirements set forth by law and these rules to engage in the practice or business of body piercing.

(28) “Microbiological monitoring for quality control” means the use of a standard spore, Bacillus stearothermophilus, to challenge the sterilization process.

(29) “Occupational exposure” is synonymous with “exposure incident” (see definition No. 18).

(30) “Operator/Owner” means any person, firm, company, corporation or association that owns, controls, operates, conducts, or manages a body piercing establishment.

(31) “Other potentially infectious material” means the following human body fluids: semen, vaginal secretions, saliva, and any body fluid visibly contaminated with blood.

(32) “Parenteral” means piercing mucous membranes or the skin barrier through such events as needle sticks, human bites, cuts, and abrasions.

(33) “Percutaneous” means infectious materials may enter the body through compromised skin surfaces (e.g., needle sticks, acne, cuts, lesions).

(34) “Permit” means body piercing establishment permit.

(35) “Person” means operator and/or any individual, partnership, firm, corporation, or agency.

(36) “Personnel” means the permit holder, any person who body pierces, individuals having supervisory or management duties, or any other person employed or working in a body piercing establishment. This individual may or may not be a body piercing technician.

(37) “Person in charge” means the individual present in a body piercing establishment who is the apparent supervisor at the time of inspection, or, if no individual is the apparent supervisor, then any employee present.

(38) “Personal protective equipment” means specialized clothing or equipment, such as gloves or lapcloth, worn by an employee for protection against a hazard. General work clothes not intended to function as protection against a hazard are not considered to be personal protective equipment.

(39) “Pierce” or “piercing” means body piercing.

(40) “Potable water” means water that is safe for drinking.

(41) “Regulated waste” means liquid or semi-liquid blood or other potentially infectious materials, contaminated items that would release blood, or other potentially infectious materials in a liquid or semi-liquid state, if compressed, and contaminated sharps.

(42) “Safe materials” means articles manufactured and used in accordance with law.

(43) “Sanitary” means clean and free of agents of infection.

(44) “Sanitization” means an effective germicidal treatment by a process that provides enough accumulative heat or concentration of chemicals for enough time to reduce the microorganism level, including pathogens, to a safe level on utensils and equipment.

(45) “Sewage” means human excreta, all water carried waste, and household wastes from residences, buildings, or commercial and industrial establishments.

(46) “Single use” means a disposable item that is used one (1) time on one (1) patron and then is properly disposed of by appropriate measures.

(47) “Solid waste” means refuse, garbage, trash, rubbish, and any other item(s) which could cause an unsanitary condition or undesirable health and safety conditions.

(48) “Utensil” means any implement, tool, or other similar device used in the storage, preparation, operation, or body piercing process.

(49) “Waste” means solid waste, sewage, blood and body fluids or other waste resulting from the operation of a body piercing establishment.

(50) “Work area” means an area where the act of body piercing takes place.

(51) “Work practice controls” means controls that reduce the likelihood of exposure by altering the manner in which a task is performed.

(52) “Work station” means a work area (see definition No. 50).

History

• Authority: T.C.A. §§ 62-38-301, et seq., and 68-2-609.
• Administrative History: Original rule filed January 28, 2002; effective April 13, 2002. Amendments filed June 18, 2025; effective September 16, 2025. Amendments filed June 2, 2026; effective August 31, 2026.

Tenn. Comp. R. & Regs. 1200-23-06-.02 PROHIBITED ACTS

(1) No person under the age of eighteen (18) years shall perform a body piercing procedure on another person.

(2) No person shall perform a body piercing procedure on another person who is under the influence of drugs or alcohol.

(3) No person shall pierce any site in which the skin surface exhibits any evidence of unhealthy conditions.

History

• Authority: T.C.A. §§ 62-38-301, et seq.
• Administrative History: Original rule filed January 28, 2002; effective April 13, 2002. Amendments filed June 18, 2025; effective September 16, 2025.

Tenn. Comp. R. & Regs. 1200-23-06-.03 CONSENT AND BODY PIERCING OF MINORS

(1) Emancipated individuals requesting a body piercing procedure must present the marriage license or a copy of the court order and another form of identification at the time of the body piercing procedure.

(2) A parent, legal guardian, or legal custodian of an individual under age eighteen (18) who desires to give consent to a business for performance of a body piercing procedure on the individual under the age of eighteen (18) must comply with the requirements of state statute.

(3) A parent, legal guardian, or legal custodian of an individual under age eighteen (18) who desires to give consent to a business for performance of a body piercing procedure on the individual under the age of eighteen (18) shall sign a form provided by the business that:

(a) States the minor’s gender and age in years. (For minors less than one (1) year old, the age in months up to and including twelve (12) months of age shall be stated);

(b) Explains the manner in which the procedure will be performed and the methods for proper care of the affected body area following performance of the procedure; and (c) Requires signing of a statement with the exact wording as follows:

“I, the undersigned, certify that I am the parent, legal guardian, or legal custodian of the named minor and further give consent to the body piercing procedure(s) as explained. I acknowledge that I am fully aware that to falsify my legal standing as to being the minor’s parent, legal guardian or legal custodian constitutes a Class C misdemeanor. A Class C misdemeanor means imprisonment for not greater than thirty (30) days or a fine not to exceed fifty dollars ($50.00) or both. (T.C.A. § 40-35-111).”

History

• Authority: T.C.A. §§ 62-38-301, et seq.
• Administrative History: Original rule filed January 28, 2002; effective April 13, 2002. Amendments filed June 18, 2025; effective September 16, 2025.

Tenn. Comp. R. & Regs. 1200-23-06-.04 MINIMUM STANDARDS FOR BODY PIERCING ESTABLISHMENTS

(1) Submission of Plans. Whenever a body piercing establishment is constructed or extensively remodeled and whenever an existing structure is converted to use as a body piercing establishment, at least one set of properly prepared plans and specifications for such construction, remodeling, or conversion shall be submitted to the Commissioner for review and approval at least thirty (30) days before construction, remodeling, or conversion is begun. The plans and specifications shall indicate:

(a) The total area in square feet to be used for the business;

(b) All entrances and exits;

(c) The number, location and types of plumbing fixtures;

(d) Source of water supply;

(e) The lighting plan;

(f) The floor plan identifying the general layout of work areas, to include fixtures and equipment; and (g) A list of proposed fixed body piercing equipment and facilities;

(2) The Commissioner shall approve the plans and specifications, if they meet the requirements of these rules.

(3) No body piercing establishment shall be constructed, extensively remodeled, or converted except in accordance with plans and specifications approved by the Commissioner.

(4) Pre-operational Inspection. After plans and specifications have been approved by the Commissioner, the body piercing establishment shall not start operations until the Commissioner has made a pre-operational inspection and has determined compliance with the approved plans and specifications and with the requirements of these rules.

(5) Each business where body piercing procedures are performed shall provide a work area separate from observers or visitors.

(6) A work area shall have a sink equipped with hot and cold running water for handwashing and cleaning instruments, apart from a bathroom sink, which is conveniently available.

(7) The use of common towels is prohibited. Hand sinks shall be equipped with a soap dispenser and single-use towels.

(8) Each body piercing establishment shall be equipped with an autoclave or steam sterilizer, a sterilizing device capable of meeting sterilization as defined in T.C.A. § 62-38-301(20). The autoclave shall be used to sterilize all nondisposable or reusable body piercing equipment.

(9) Each location shall have the facilities to properly dispose of all waste material. All materials (e.g., needles) must be disposed of in accordance with the Code of Federal Regulations, Title 29, Part 1910, Occupational Safety and Health Act, Bloodborne Pathogens and/or accepted universal precaution guidelines.

(10) Water Supply (a) Enough potable water for the needs of the body piercing establishment shall be provided from a source constructed and operated according to law.

(b) Sewage. All sewage, including liquid waste, shall be disposed of by a public sewerage system or by a sewerage disposal system constructed and operated according to law.

(c) Plumbing. Plumbing shall be sized, installed, and maintained according to law. There shall be no cross-connection between the potable water supply and any other water supply or other source of contamination.

(11) Toilet Facilities (a) Toilet installation. Toilet facilities shall be designed, installed, and maintained according to law. There shall be sufficient toilet rooms and/or toilet fixtures to accommodate patrons, and employees, and operators.

(b) Toilet rooms. Toilet rooms opening directly into work or customer waiting areas shall be completely enclosed and shall have tight-fitting, solid doors, which shall be closed except during cleaning or maintenance.

(c) Toilet fixtures. Toilet fixtures shall be kept clean and in good repair. A supply of toilet tissue on tissue holders shall be provided at each toilet at all times. Easily cleanable receptacles shall be provided for waste materials. Toilet rooms shall have at least one covered waste receptacle.

(12) Lavatory Facilities (a) Lavatory installation. Lavatory facilities shall be designed, installed, and maintained according to law. Facilities shall be of sufficient number and location to permit convenient use by patrons, and employees, and operators.

(b) Lavatory faucets. Each lavatory shall be provided with hot and cold water tempered by means of a mixing valve or combination faucet. Any self-closing, slow-closing, or metering faucet used shall be designed to provide a flow of water for at least fifteen (15) seconds without the need to reactivate the faucet.

(c) Lavatory supplies. A soap dispenser and a supply of antiseptic, hand-cleaning soap or detergent shall be available at each lavatory. A supply of single-use sanitary towels or a hand-drying device providing heated air shall be conveniently located near each lavatory. If disposable towels are used, easily cleanable waste receptacles shall be conveniently located near the handwashing facilities.

(d) Lavatory maintenance. Lavatories, soap dispensers, hand-drying devices, and all related fixtures shall be kept clean and in good repair.

(13) Solid Waste (a) Containers.

1. Garbage and refuse shall be kept in durable, easily cleaned containers that do not leak and do not absorb liquids. Containers shall be kept in a clean and sound condition and all garbage and refuse disposed of according to law.

2. Containers used in work areas shall be kept covered when not in use and after they are filled.

3. There shall be a sufficient number of containers to hold all the garbage and refuse that accumulate.

(b) Garbage and refuse shall be disposed of at such frequency as to prevent the development of odor and the attraction of insects, rodents, or vermin.

(c) Disposal of potentially infectious waste such as blood, fluids, used inks, or other liquid waste may be deposited directly into a drain connected to a sanitary sewer system.

Disposable needles, scalpels, or other sharp items shall be placed intact into punctureresistant sharps containers with a biohazard label before disposal. Filled sharps containers shall be considered regulated waste and must be disposed of in accordance with Solid Waste Processing and Disposal Regulations (1200-01-07).

(d) Waste potentially contaminated with small amounts of blood or other infectious body fluids (e.g., gauze, wipes, disposable lap cloths), which do not meet the definition of regulated waste, shall be double-bagged in sealed, impervious bags to prevent leakage of the contained items. These bags shall be of sufficient strength to prevent breakage or leakage and shall not contain any sharps. The waste bags shall be containerized and disposed of in an approved sanitary landfill.

(14) The premises shall be kept in such condition as to prevent the entrance, harborage, or feeding of insects, rodents, or vermin.

(15) Floors (a) Floor construction. Floors and floor coverings of all work areas, dressing rooms, locker rooms, toilet rooms and vestibules shall be constructed of smooth, nonabsorbent, durable material and maintained in good repair. Carpeting, if used as a floor covering, shall be of closely woven construction, properly installed, easily cleanable, and maintained in good repair. Carpeting is allowed in work areas, dressing rooms, and locker rooms. Carpeted flooring around the operating chair and work table in the work area must be covered by vinyl or rubber sheeting or mats so as to preclude any absorption of spillage that may occur during the body piercing operation.

(b) Mats. Mats shall be of nonabsorbent, grease resistant materials and of such size, design, and construction as to facilitate their being easily cleanable.

(16) Walls and Ceilings (a) Maintenance. Walls and ceilings, including doors, windows, skylights, and similar closures shall be constructed of smooth, nonabsorbent, durable material and be maintained in good repair.

(b) Attachments. Light fixtures, vent covers, wall-mounted fans, and similar equipment attached to walls and ceilings shall be easily cleanable and maintained in good repair.

(17) Physical Facilities. Floors, mats, walls, ceilings, and attached equipment and decorative materials shall be kept clean.

(18) Lighting (a) Permanently fixed artificial light sources shall be installed to provide at least fifty (50) foot-candles of light on all work area surfaces and at equipment washing work levels.

(b) Permanently fixed artificial light sources shall be installed to provide at a distance of thirty (30) inches from the floor at least ten (10) foot-candles of light in all other areas.

(19) Ventilation. All rooms shall have sufficient ventilation to keep them free of excessive heat, steam, condensation, vapors, obnoxious odors, smoke, and fumes.

(20) Living Areas. No operation of a body piercing establishment shall be conducted in any room used as living or sleeping quarters.

(21) Poisonous or Toxic Materials (a) Materials permitted. There shall be present in the body piercing establishment only those poisonous or toxic materials necessary for maintaining the establishment and cleaning or sanitizing equipment, as well as controlling insects and rodents.

(b) Labeling of materials. Containers of poisonous or toxic materials shall be prominently and distinctly labeled for easy identification of contents.

(c) Toxic items shall be separated from other forms of materials used in the process of body piercing.

(22) Premises (a) Body piercing establishments shall be kept neat, clean, and free of litter and rubbish.

(b) Only articles necessary for the operation and maintenance of the body piercing establishment shall be stored on or within the establishment.

(23) Animals. Live animals of all species shall be excluded from within the body piercing work area and from adjacent areas within the facility under the control of the permit holder.

However, this exclusion does not apply to fish in an aquarium. Service animals accompanying blind or deaf persons shall be permitted in the establishment.

(24) Equipment and Utensils (a) Materials 1. Multi-use equipment and utensils shall be constructed and repaired with safe materials, including finishing materials; they shall be corrosion resistant and nonabsorbent; and they shall be smooth, easily cleanable, and durable under conditions of normal use. Single-service articles shall be made from clean, sanitary, and safe materials.

2. Reuse of single-service articles is prohibited.

(b) Design and Fabrication 1. General. All equipment and utensils, including plasticware, shall be designed and fabricated for durability under conditions of normal use and shall be resistant to denting, buckling, pitting, and chipping.

(i) Body piercing operational surfaces shall be easily cleanable, smooth, and free of breaks, open seams, cracks, chips, pits, and similar imperfections, as well as free of difficult-to-clean internal corners and crevices.

(ii) Sinks and drain boards shall be self-draining.

2. Surfaces of equipment not intended as operational surfaces, but which are exposed to splash or debris or which otherwise require frequent cleaning, shall be designed and fabricated to be smooth, washable, free of unnecessary ledges, projections, or crevices and readily accessible for cleaning. Such surfaces shall be constructed of such material and in such repair as to be easily maintained in a clean and sanitary condition.

3. Needles and other equipment used in body piercings shall be designed and manufactured for the sole purpose of piercing the skin.

(25) Aisles and Working Spaces. Aisles and working spaces between units of equipment and walls shall be unobstructed and of sufficient width to permit employees to perform their duties readily without contamination of equipment or of operational surfaces by clothing or personal contact.

(26) Work Area. The work room is to be continually equipped or stocked with the following materials:

(a) A minimum of six (6) sterilized piercing needles;

(b) A minimum of one extra package of disposable towels other than the package that is being used;

(c) A minimum of one extra box of disposable gloves other than the box being used; and (d) An extra supply of bandages, ointment or gel, and antibacterial soap.

History

• Authority: T.C.A. §§ 62-38-301, et seq.
• Administrative History: Original rule filed January 28, 2002; effective April 13, 2002. Amendments filed June 18, 2025; effective September 16, 2025. Amendments filed June 2, 2026; effective August 31, 2026.

Tenn. Comp. R. & Regs. 1200-23-06-.05 BODY PIERCING PROCEDURES

(1) Universal precautions, as defined in these rules, shall be observed to prevent contact with blood or other potentially infectious materials. Body piercing technicians and operators shall be trained in universal precautions.

(a) Assume all human blood, plasma, serum, body fluids (semen, saliva, breast milk, vaginal secretions and any fluid contaminated with blood) and tissues to be contaminated with Human Immunodeficiency Virus (HIV) and/or Hepatitis viruses (e.g., HBV).

(b) The most susceptible route of occupational infection for HIV and HBV is by accidental needle sticks, contamination of the mucous membranes, or through broken, abraded, or irritated skin. Use appropriate caution and maximum protection to prevent such contact.

(c) Proper decontamination procedures, emergency biohazard spill management, and proper use of biosafety equipment shall be utilized.

(d) Use aseptic technique. Thorough handwashing is essential after patron contact, after handling blood and body fluids, after wearing gloves, and prior to exiting the work area.

(e) Needles shall be sterilized prior to use. Due to the hollow nature of body piercing needles, it is not permissible to reuse needles, nondisposable or otherwise, for body piercing.

(f) Dispose of needles and other sharps in puncture proof, autoclavable containers, or disposable biohazard containers.

(g) All regulated wastes shall be disposed of in labeled, manufacturer’s color-coded waste containers.

(h) A spill kit (bleach, leak proof container, paper towels, gloves, spray bottle) is to be used to clean up potentially infectious material spills. Small spills can be wiped up, after donning protective gloves, with paper towels and sprayed with freshly made ten percent (10%) bleach solution.

(i) Clean all work areas and equipment used in handling human biohazardous materials with proven disinfectant (e.g., 10% dilution of bleach) when concluding work to protect personnel from accidental infection.

(j) Eating, drinking, smoking, inserting contacts, and applying cosmetics or lip balm are not permitted in the work area. Food shall be stored in cabinets or refrigerators designated and used for this purpose only. Food storage cabinets or refrigerators shall be located outside the work area.

(k) All procedures shall be performed carefully to minimize the creation of aerosols.

(l) Report all work related accidents, incidents, and unexplained illness to the body piercing establishment supervisor, operator, and/or physician immediately.

(m) Used gloves shall be removed after each operation and prior to contacting work surfaces, door knobs, wall switches, or telephones. Dispose of used gloves in a bagged, trash container.

(n) The operator shall maintain written records of operational equipment utilized by the business, including manufacturers, model numbers, and dates of acquisition or purchase.

(2) Body Piercing Establishment Personnel (a) The body piercing establishment operator shall make available, at no cost to the personnel, Hepatitis B vaccination series, as well as any routine booster dose(s) to every person who may have occupational exposure to blood or other potentially infectious material. For new personnel the vaccine shall be made available within ten (10) working days of initial work assignment.

(b) Personnel who decline to accept the Hepatitis B vaccination series must sign a form indicating their refusal.

(c) The outer clothing of all personnel shall be clean.

(d) Body piercing technicians/operators shall wash their hands with antiseptic soap before and after treating each patron (i.e., before glove placement and after glove removal) and after barehanded touching of inanimate objects likely to be contaminated by blood, saliva, or respiratory secretions. Hands shall be washed after removal of gloves, smoking, eating, drinking, or using the toilet.

(e) Body piercing technicians/operators who have exudative lesions or weeping dermatitis, particularly on the hands, shall refrain from all direct patron contact and from handling equipment until the condition resolves.

(f) Personnel shall consume food only in approved, designated areas. There shall be no eating or drinking in the work area of the establishment.

(g) Personnel shall not use tobacco in any form while engaged in the operation or process of body piercing a patron, nor while in areas used for equipment or utensil washing.

Personnel shall use tobacco only in approved, designated areas.

(h) Personnel shall maintain a high degree of personal cleanliness and shall conform to good hygienic practices during all working periods in body piercing establishments.

(3) Implementation of Infection-Control Practices (a) Disposable latex or vinyl examination gloves shall be worn by a technician at all times while performing a body piercing. Gloves shall be changed and properly disposed of each time there is an interruption in the body piercing process, or whenever their ability to function as a barrier is compromised. Gloves shall be changed between patrons and used gloves shall be properly disposed of as provided in these rules.

(b) Only sterilized equipment or single-use supplies, such as disposable razors, single-use towels or wipes, lubricants from a collapsible tube, may be used to perform a body piercing. After the piercing procedure, single-use items and containers shall be discarded and the work area disinfected.

(c) When it is necessary to shave the area for the piercing, a new blade for each patron or customer shall be used when a safety razor is employed, and the permanent part of such razor shall be disinfected. If a straight razor is used, it shall be cleaned with soap and water, rinsed in clear water, and then sterilized in an autoclave.

(d) A sterile set of needles shall be used for each patron.

(e) Piercing equipment, with the exception of hollow bore needles, shall be sealed for individual patron use in autoclave bags with a chemical or autoclave indicator and date (month and year) of sterilization clearly visible. After piercing, used nondisposable instruments shall be kept in a separate, puncture-resistant container until properly cleaned, disinfected, and sterilized using universal precautions and recognized medical methods.

(f) Microbiological monitoring for adequate functioning of each autoclave will be done at least weekly using a commercial source of Bacillus stearothermophilus which is then tested in an accredited commercial laboratory. All laboratory reports will be logged and kept for two (2) years and shall be available for inspection.

(g) Upon notification of a positive microbiological monitoring report (detection of viable spores), the sterilizer shall be immediately checked for proper use and function. A repeat test shall be performed within three (3) days. Upon a subsequent positive result from a repeat test, discontinue use of the sterilizer until properly serviced and a negative result is obtained.

(h) Sterilizer indicator tape and/or sterilizer bags with indicator tape areas which change color will be used with all items sterilized to indicate the item has been autoclaved. All items shall be marked with the date of sterilization.

(i) Sterilized items in the sealed, autoclaved bags shall be stored in a clean, dry place, until used, for no more than one (1) year.

(j) Sterilization indicators must change color or discontinue use of autoclave until a negative spore sample is obtained.

(k) The body piercing establishment shall be exempt from the requirement for an autoclave in cases where there is only the use of manufactured, pre-sterilized single-use, preassembled needles and similar body piercing equipment, and/or the use of no other equipment or tools requiring sterilization.

(l) Permanent ink pens or similar equipment shall not be reused, between patrons, to mark the location of piercings on the interior of the nose, mouth, male or female genital areas, mucous membranes, or similar interior cavities.

(4) Body Piercing Minimum Standards (a) Prior to piercing the area to be pierced, or if the area does not need to be shaved, the piercing site shall be cleaned with soap and water, rinsed with clean water, and germicidal solution applied or wiped with alcohol in a sanitary manner before beginning the procedure.

(b) Single-use towels or gauze shall be used in preparing the piercing site and shall be disposed of after use on each patron or customer.

(c) Records showing the date of the patron’s visit, printed name, signature, address, and age, piercing location on the body, and piercing technician’s name shall be kept on the establishment premises for a minimum of two (2) years.

(d) After each piercing, written instructions shall be given to each patron or customer on the care of the skin of the pierced site to prevent infection. A copy of these instructions shall be posted in a conspicuous place in the establishment, clearly visible to the customer or patron being pierced. These instructions shall include, but are not limited to, bandaging, cleaning, sun exposure, scratching, and wearing of clothing over or around the pierced site.

History

• Authority: T.C.A. §§ 62-38-301, et seq.
• Administrative History: Original rule filed January 28, 2002; effective April 13, 2002. Amendments filed June 18, 2025; effective September 16, 2025.

Tenn. Comp. R. & Regs. 1200-23-06-.06 ESTABLISHMENT PERMITTING AND INSPECTION SYSTEM

(1) Application Procedures (a) Any person planning to operate a body piercing establishment shall obtain a written application for a permit on a form provided by the Commissioner prior to operation. A new or initial application is required for body piercing establishments that have not previously been permitted or for instances when ownership changes.

(b) The Commissioner shall issue a body piercing establishment permit:

1. Upon receiving a completed application with applicable fees; and 2. After an inspection of the proposed facility reveals that the facility is in compliance with requirements of these rules and law.

(2) Inspection Results - Reporting and Scoring (a) The Commissioner shall conduct at least one (1) inspection of a body piercing establishment prior to issuing a permit to perform body piercing services.

(b) The Commissioner shall conduct at a minimum, an annual inspection, prior to issuing a renewal permit to operate a body piercing establishment.

(c) The Commissioner may inspect a body piercing establishment at any time the Commissioner deems necessary and shall be given access to the premises and to all records deemed relevant by the Commissioner for the inspection.

(d) Inspection results for body piercing establishments shall be recorded on standard departmental forms which summarize the requirements of the law and rules and regulations.

(e) The scoring system shall include a weighted point value for each requirement in which critical items are assigned values of either four (4) or five (5) points, with less critical items having assigned values of either one (1) or two (2) points.

(f) The rating score of the facilities shall be the total of the weighted point values for all violations subtracted from one hundred (100).

(3) Critical violations shall include the following:

(a) Autoclave does not meet minimum time, pressure or temperature requirements;

(b) Lack of a weekly negative spore or microbiological monitoring test for quality control;

(c) Nondisposable tubes and needles are not sterilized or were sterilized greater than one (1) year ago;

(d) Work room is not equipped or stocked as required;

(e) Reuse of single-use articles;

(f) Sterile instruments are not properly handled;

(g) Reusable instruments are not handled properly;

(h) Employees with infectious lesions on hands not restricted from body piercing;

(i) Employees not practicing proper cleanliness and good hygiene practices;

(j) Water supply not approved, hot and cold running water under pressure not available;

(k) Approved sewage and liquid waste disposal not available;

(l) Cross-connection allowing back-siphonage present in plumbing system;

(m) Toilet and handwashing facilities not available for employees;

(n) Insect and rodent evidence, harborage, or outer opening present; and (o) Toxic items not properly stored, labeled, or used.

(4) Violation Correction (a) The inspection report shall state that failure to comply with any time limits specified by the Commissioner for correction may result in cessation of operation. All critical and minor violations shall be corrected within seven (7) and fourteen (14) calendar days, respectively.

(b) Review of a citation of a violation of a minor item may be sought, upon submission of a written request to the Director of General Environmental Health which must be received within ten (10) calendar days following the date of the inspection report. If the tenth (10th) day falls on a weekend or state holiday, the first work day following shall be treated as the tenth (10th) day. The request for review shall identify the non-critical item(s) for which review is sought. The final determination shall be made by the Director or the Director’s Designee in writing and within a reasonable time after receipt of the request for a review.

(c) The citation of a violation of a critical item may also be reviewed upon the receipt of a written request submitted to the Director of General Environmental Health within ten (10) calendar days following the date of the inspection report. If the tenth (10th) day falls on a weekend or state holiday, the first work day following shall be treated as the tenth (10th) day. The request for review shall identify the critical item(s) for which review is being sought. The decision of the Director or the Director’s Designee shall be final and made in writing within a reasonable time after receipt of the request for a review.

(d) Upon declaration of an imminent health hazard by the Local Health Officer, the Local Health Officer shall issue an order requiring the facility to immediately cease operations until authorized to reopen following notice and opportunity for a hearing as provided in T.C.A. § 68-2-608.

(e) In the case of temporary body piercing establishments, all violations shall be corrected within twenty-four (24) hours. If violations are not corrected within twenty-four (24) hours, the establishment shall immediately cease operation until authorized to resume by the Local Health Officer. Upon declaration of an imminent health hazard by the Local Health Officer, the Local Health Officer shall issue an order requiring the facility to immediately cease operations until authorized to reopen following notice and opportunity for a hearing as provided in T.C.A. § 68-2-608.

(f) In the event of an order of cessation of operation, a request for a hearing may be made in writing to the Commissioner. The request must be received within ten (10) calendar days of issuance of the order. A hearing shall be afforded, if requested, as promptly as is reasonable under the circumstances.

(5) Permit Suspension or Revocation (a) After providing notice and an opportunity for a hearing in accordance with the Uniform Administrative Procedures Act (T.C.A. §§ 4-5-301 et seq.), the Commissioner may suspend or revoke a permit for violation of requirements of this part or for interference with the Commissioner’s authorized representative in the performance of their duty.

The violation of three (3) or more critical items within a twelve (12) month period may result in revocation of the body piercing establishment permit.

(6) License Suspension or Revocation (a) After providing notice and an opportunity for a hearing in accordance with the Uniform Administrative Procedures Act (T.C.A. §§ 4-5-301 et seq.), the Commissioner may suspend or revoke a body piercing technician’s license for violation of requirements of this part or for interference with the Commissioner’s duly authorized representative in the performance of their duty.

(7) When a body piercing technician’s license is revoked by the Commissioner, a new license may be issued upon compliance with all requirements of the order of revocation, and upon meeting all requirements for a new license and the submission of a new application with applicable fees.

(8) Whenever an establishment is required under these rules to cease operations, it shall not resume operations until it is shown on re-inspection that conditions responsible for the order to cease operations no longer exist. The Commissioner shall offer an opportunity for reinspection within a reasonable time.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-301, 62-38-301 et seq., 68-2-608, and 68-2-609.
• Administrative History: Original rule filed January 28, 2002; effective April 13, 2002.

Tenn. Comp. R. & Regs. 1200-23-06-.07 BODY PIERCING TECHNICIAN LICENSING

(1) Body Piercing Technician (a) On and after January 1, 2002, no person shall perform a body piercing procedure without being licensed as a body piercing technician.

(b) Any applicant for a body piercing technician’s license who was not in business in Tennessee or operating in Tennessee prior to January 1, 2002, shall be required to apprentice or train in the profession of body piercing as set out at 1200-23-06-.07(1)(e).

(c) In order to obtain a Tennessee license, out-of-state body piercing technicians must show proof of at least two (2) years experience as a professional body piercing technician in another state.

(d) For purposes of the above subparagraphs (b) and (c), proof of business or experience may be a copy of a business license, another state’s technician’s license, tax records, or other similar city, county, state, or federal documents which show the prospective applicant as having been in business or operation. The Commissioner shall have final approval on any and all forms of documentation submitted as evidence or proof.

(e) Any individual not meeting the requirements set out at 1200-23-06-.07(1)(b)-(d) above shall be required to apprentice or train in the profession of body piercing. Such training shall be for a minimum of one (1) year under a currently licensed body piercing technician. The apprentice training shall be evidenced by a notarized statement from the licensed body piercing technician performing such training.

(2) Each applicant for a body piercing establishment permit (i.e., the body piercing operator) and/or for a body piercing technician license shall undergo a training program before receiving a permit or license. In addition, the body piercing operator must ensure that each apprentice technician shall undergo a training program before beginning apprenticeship. The training shall include at least one of the following:

(a) The Alliance of Professional Tattooist course in sterilization;

(b) A course approved by the Commissioner in methods and techniques for the proper sterilization of instruments and materials used in body; or (c) Present acceptable evidence of having satisfactorily completed an approved course of instruction in sterilization techniques for bloodborne pathogens and methods through a college medical sterilization course.

(3) Each applicant for a body piercing establishment permit (i.e., the body piercing operator) and/or for a body piercing technician’s license shall be required to take and pass an examination concerning bloodborne pathogens, sterilization techniques and the provisions of T.C.A. Title 62, Chapter 38 before a permit or license shall be issued. In addition, the body piercing operator must ensure that each apprentice technician takes and passes the examination before beginning apprenticeship. Such examination shall be either a written exam prescribed by the Commissioner or documentation of a similar exam given with a course as required in 1200-23-06-.07(2) and approved by the Commissioner.

(4) The body piercing technician license shall be issued upon proof that the applicant:

(a) Met the requirements of 1200-23-06-.07(1);

(b) Attended a course and passed a written examination, as specified in 1200-23-06-.07(2) and 1200-23-06-.07(3); and (c) Submitted an approved application with the appropriate fee.

History

• Authority: T.C.A. §§ 62-38-301, et seq.
• Administrative History: Original rule filed January 28, 2002; effective April 13, 2002. Amendments filed June 18, 2025; effective September 16, 2025.

Tenn. Comp. R. & Regs. 1200-23-06-.08 LICENSE AND PERMIT FEES

(1) License Fees (a) A body piercing technician shall be assessed an initial licensing fee and a renewal licensing fee of one hundred forty dollars ($140.00) each. Renewal fee is due on or before January 1 of each year.

(b) A late penalty fee of one-half the fee amount shall be assessed on all (1) renewal technician license applications postmarked after January 31st of each permitting year or (2) a fee received more than thirty (30) days from the date of new application.

(c) A temporary body piercing technician shall pay a temporary license fee of fifty dollars ($50.00).

(2) Permit Fees (a) A body piercing establishment shall be assessed an initial fee and a renewal permit fee of seventy dollars ($70.00) each. Renewal fee is due on or before January 1 of each year.

(b) A temporary body piercing establishment shall be assessed a temporary permit fee of fifty dollars ($50.00).

(c) A late penalty fee of one-half the fee amount shall be assessed on all (1) renewal establishment permit applications postmarked after January 31st of each permitting year or (2) a fee received more than thirty (30) days from the date of any change in ownership or new application.

(3) A new or initial application for a permit is required for body piercing establishments that have not previously been permitted or for instances when ownership changes. A permit is not transferable.

(4) For the purposes of determining whether there has been a change of ownership of a body piercing establishment in instances of corporate ownership, the following will constitute a change of ownership:

(a) A change of ownership of the body piercing establishment by a corporation (e.g., Corporation A sells its body piercing establishment to Corporation B), or (b) A change of ownership of a corporation which owns a body piercing establishment.

(c) However, if there is no change in the federal tax identification number applicable to the corporation which owns the body piercing establishment, there is no change or ownership for permit purposes.

(5) A new or initial application for a license is required for body piercing technicians that have not previously been licensed.

History

• Authority: T.C.A. §§ 62-38-301, et seq.
• Administrative History: Original rule filed January 28, 2002; effective April 13, 2002. Amendments filed June 18, 2025; effective September 16, 2025.

Tenn. Comp. R. & Regs. 1200-23-06-.09 REPEALED

History

• Authority: T.C.A. §§ 4-5-202; 62-38-101, et seq.; and 62-38-301, et seq.
• Administrative History: Original rule filed January 28, 2002; effective April 13, 2002. Repeal filed June 24, 2024; effective September 22, 2024.

Tenn. Comp. R. & Regs. 1200-23-06-.10 GENERAL PROVISIONS

(1) Posting of Permit and License. Body piercing establishment permits and technician licenses shall be posted within the establishment in a conspicuous place where they may be readily observed by the public. This shall mean a place approved by the Commissioner at the time of inspection. No person, except an authorized representative of the Commissioner, shall modify, remove, cover up, or otherwise make the permit or license less conspicuous in any way.

(2) Body piercing establishments and technicians who also practice tattooing as prescribed by T.C.A. §§ 62-38-201 et seq., shall also be required to meet all the operational, licensing and permitting requirements as outlined in these rules. Where the rules or statute differ for tattooing and body piercing, the more stringent requirements shall take precedence.

(3) Severability. If any provision or application of any provision of these rules is held invalid, that invalidity shall not affect other provisions or applications of these rules.

History

• Authority: T.C.A. §§ 62-38-301, et seq.
• Administrative History: Original rule filed January 28, 2002; effective April 13, 2002. Amendments filed June 18, 2025; effective September 16, 2025.

Chapter 1200-23-07 Repealed

Tenn. Comp. R. & Regs. 1200-23-07-.01 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, and 68-15-201, et seq.
• Administrative History: Original rule filed October 22, 2004; effective January 5, 2005. Repeal filed May 20, 2026; effective August 18, 2026.

Tenn. Comp. R. & Regs. 1200-23-07-.05 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, and 68-15-201, et seq.
• Administrative History: Original rule filed October 22, 2004; effective January 5, 2005. Repeal filed May 20, 2026; effective August 18, 2026.

Tenn. Comp. R. & Regs. 1200-23-07-.02 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, and 68-15-201, et seq.
• Administrative History: Original rule filed October 22, 2004; effective January 5, 2005. Repeal filed May 20, 2026; effective August 18, 2026.

Tenn. Comp. R. & Regs. 1200-23-07-.03 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, and 68-15-201, et seq.
• Administrative History: Original rule filed October 22, 2004; effective January 5, 2005. Repeal filed May 20, 2026; effective August 18, 2026.

Tenn. Comp. R. & Regs. 1200-23-07-.04 REPEALED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, and 68-15-201, et seq.
• Administrative History: Original rule filed October 22, 2004; effective January 5, 2005. Repeal filed May 20, 2026; effective August 18, 2026.

1200-24 Office of the Commissioner Office on Civil Rights Compliance Division of Health Care Facilities

Chapter 1200-24-01 Transferred to 0720-40

Tenn. Comp. R. & Regs. 1200-24-01-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202 and 68-11-216(d) and Public Chapter 434, Acts of 1989.
• Administrative History: Original rule filed March 30, 1990, effective May 14, 1990. Amendment filed September 25, 1991; effective November 9, 1991. Transferred to chapter 0720-40 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-24-01-.07 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 33-2-506, and 68-11-216 and Public Chapter 913, Acts of 1992.
• Administrative History: Original rule filed March 30, 1990, effective May 14, 1990. Amendment filed July 25, 1990; effective September 8, 1990. Amendment filed September 25, 1991; effective November 9, 1991. Amendment filed September 29, 1992; effective November 13, 1992. Transferred to chapter 0720- 40 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-24-01-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202 and 68-11-216(d) and Public Chapter 434, Acts of 1989.
• Administrative History: Original rule filed March 30, 1990, effective May 14, 1990. Amendment filed September 25, 1991, effective November 9, 1991. Transferred to chapter 0720-40 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-24-01-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202 and 68-11-216(d) and Public Chapter 434, Acts of 1989.
• Administrative History: Original rule filed March 30, 1990; effective May 14, 1990. Amendment filed July 25, 1990; effective September 8, 1990. Amendment filed September 25, 1991; effective November 9, 1991. Transferred to chapter 0720-40 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-24-01-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 33-2-506, and 68-11-216 and Public Chapter 913, Acts of 1992.
• Administrative History: Original rule filed March 30, 1990, effective May 14, 1990. Amendment filed July 25, 1990, effective September 8, 1990. Amendment filed September 25, 1991, effective November 9, 1991. Amendment filed September 29, 1992, effective November 13, 1992. Transferred to chapter 0720- 40 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-24-01-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202 and 68-11-216(d) and Public Chapter 434, Acts of 1989.
• Administrative History: Original rule filed March 30, 1990, effective May 14, 1990. Amendment filed September 25, 1991, effective November 9, 1991. Transferred to chapter 0720-40 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-24-01-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202 and 68-11-216(d) and Public Chapter 434, Acts of 1989. Administrative pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-24-02 Reserved

Tenn. Comp. R. & Regs. 1200-24-02 Reserved

RULES

OF THE TENNESSEE DEPARTMENT OF HEALTH

Chapter 1200-24-03 Transferred to 0720-41

Tenn. Comp. R. & Regs. 1200-24-03-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-3-1803(1), 4-5-209, 68-1-103(b), and 68-1-113.
• Administrative History: Original rule filed February 22, 1991; effective April 8, 1991. Transferred to chapter 0720-41 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-24-03-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-3-1803(1), 4-5-209, 68-1-103(b), and 68-1-113.
• Administrative History: Original rule filed February 22, 1991; effective April 8, 1991. Transferred to chapter 0720-41 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-24-03-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-3-1803(1), 4-5-209, 68-1-103(b), and 68-1-113.
• Administrative History: Original rule filed February 22, 1991; effective April 8, 1991. Transferred to chapter 0720-41 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-24-03-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-3-1803(1), 4-5-209, 68-1-103(b), and 68-1-113.
• Administrative History: Original rule filed February 22, 1991; effective April 8, 1991. Transferred to chapter 0720-41 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-24-03-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-3-1803(1), 4-5-209, 68-1-103(b), and 68-1-113.
• Administrative History: Original rule filed February 22, 1991; effective April 8, 1991. Transferred to chapter 0720-41 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-24-04 Transferred to 0720-42

Tenn. Comp. R. & Regs. 1200-24-04-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202 and 12-4-301.
• Administrative History: Original rule filed March 30, 1992; effective May 14, 1992. Transferred to chapter 0720-42 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-24-04-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202 and 12-4-301.
• Administrative History: Original rule filed March 30, 1992; effective May 14, 1992. Amendment filed March 27, 2003; effective July 29, 2003. Transferred to chapter 0720-42 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-24-04-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202 and 12-4-301.
• Administrative History: Original rule filed March 30, 1992; effective May 14, 1992. Amendment filed March 27, 2003; effective July 29, 2003. Transferred to chapter 0720-42 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-24-05 Transferred to 0720-43

Tenn. Comp. R. & Regs. 1200-24-05-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed April 10, 2000; effective June 24, 2000. Amendment filed February 18, 2003; effective May 4, 2003. Amendments filed January 14, 2020; effective April 13, 2020. Transferred to chapter 0720-43 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-24-05-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed April 10, 2000; effective June 24, 2000. Transferred to chapter 0720-43 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-24-05-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed April 10, 2000; effective June 24, 2000. Transferred to chapter 0720-43 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-24-05-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-216, and 68-11-804.
• Administrative History: Original rule filed April 10, 2000; effective June 24, 2000. Amendment filed February 28, 2002; effective May 14, 2002. Amendments filed January 3, 2012; effective April 2, 2012. Amendments filed January 14, 2020; effective April 13, 2020. Transferred to chapter 0720-43 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-24-05-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-216.
• Administrative History: Original rule filed April 10, 2000; effective June 24, 2000. Transferred to chapter 0720-43 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-25-01 Swimming Pools Owned by Multi-Family Residential HomeownerAssociations

Tenn. Comp. R. & Regs. 1200-25-01-.01 DEFINITIONS

(1) General: As used in these rules, unless the context requires otherwise:

(a) Approved means being accepted by the Commissioner (b) Commissioner means the Commissioner of the Department of Health, his duly appointed representative, and in the event of his absence or vacancy in the office of commissioner, the deputy commissioner.

(c) Contractor means a person that enters into an agreement with another person to perform specific duties and acts as a representative of the permittee or permit applicant.

(d) Employee means the permit holder, individuals having supervisory or management duties or any other person working in a public swimming pool.

(e) Law means any provision of the State of Tennessee statutes and rules.

(f) Owner/Operator means the applicant, permittee, or other persons to be in charge of facilities.

(g) Person means any individual, partnership, firm, corporation, agency, municipality, or state or political subdivisions, or the Federal Government and its' agencies and departments.

(h) Person In Charge means the individual present in a public swimming pool who is the apparent supervisor at the time of inspection, or if no individual is the apparent supervisor, then any employee present.

(i)Potable Water means water that is safe for drinking.

(j)Sewage means human excreta, all water carried waste, and household wastes from residences, buildings, or commercial and industrial establishments.

(k) Shall denotes a mandatory requirement (l)Solid Waste means refuse, garbage, trash, rubbish, and any other item or items which could cause an unsanitary condition or undesirable health and safety conditions.

(m) Alter/Alteration means to redesign pool size, shape, piping; to change major equipment such as filter or disinfectant system; to install or remove equipment; to change classification of pool; to make any change that may effect the overall safety or effectiveness of operation, including additions or redesign of a bathhouse.

(n) Certified Lifeguard means an individual who has a valid and current American Red Cross Lifeguard Training Certificate*, or the YMCA Senior Life Saving Certificate, or Boy Scouts of America equivalent. (* or current Red Cross equivalent)

(o) Coping means the covering which joins the top of the pool wall with the pool decking.

(p) Deck means the area around the pool.

(q) Department means the Department of Health.

(r) Disinfection Equipment means any device used to mechanically supply disinfectants to the pool water.

(s) Dive means to plunge into water head first from a board or tower.

(t)Diving Board means a device extending over the pool for the purpose of diving.

(u) Filter means any apparatus by which water is clarified.

(v) Hose Bibb means a water faucet with male screw threads for attachment to hose.

(w) Lifeline means a rope with flotation devices across a pool to designate a change of slope in the pool bottom and is used to separate the shallow and deep areas of the pool.

(x) Life Saving Equipment Unit consists of a Ring Buoy and Shepherd's Crook. The ring buoy consists of a ring at least eighteen inches (18") in diameter made of solid, buoyant material and weighing approximately two and one-half (2 1/2) pounds with grab line and retrieving line equal to one and one-half (1 1/2) times the maximum width of the pool not to exceed 50 feet in length. The line shall consist of 1/4-inch polyproplene, or similar type line with two inch ball or "lemon" on the free end. The Shepherd's Crook shall be large enough to encircle the entire body with a minimum twelve (12) foot handle. Where lifeguards are required, a rescue tube may be substituted for each ring buoy required.

(y) Main Drain means the outlet or outlets at the bottom, deep portion of the pool through which the main flow of water leaves the pool.

(z) Normal Operating Level means the level of the water at the mid-point of the surface skimmer throat or at overflow gutter tip.

(aa) Overflow Trough means the gutter or trough around the top perimeter of a pool which is used to skim the surface of the water to waste or to filters. These troughs are sometimes referred to as scum gutters.

(bb) Pool Depth means the distance between the floor of the pool and the normal operating level.

(cc) Pool Facilities is a general term that includes all areas of the pool. It includes but is not limited to the pool deck, bathhouse, fences, filtration and safety equipment, sidewalks and plumbing facilities.

(dd) Public Swimming Pool, Public Pool or Pool means any pool other than a residential or therapeutic type pool which is used for bathing, swimming, instructional purposes in swimming, diving or other aquatic activities, or for other recreational purposes to which admission may be gained with or without payment of a fee.

Public swimming pools are listed in the following categories, based upon specific characteristics, usage and other factors: 1.Type "A" means any pool intended for, or used by, the general public for recreational use and pools not open to the general public such as institutional, school, child care facilities, scouts, resident camps, day camps, recreational, country clubs or pools of similar usage and type. 2.Type "B" means swimming pools restricted to residents, members or registered guest, including hotels, motels, apartments, trailer parks/mobile home parks, travel camps, condominium multi-family residential housing homeowner associations, and subdivisions or similar developments. Also included are YMCA, YWCA, health or athletic clubs, and pools of similar type and usage. When pools of this type are used by other persons, organizations, special groups or by the general public, the requirements for lifeguards shall be the same as for Type "A" Pools. 3.Type "C" means wading pools. 4.Type "D" means whirlpools, hot tubs, or other pools of similar type and usage, intended for health or recreational usage. 5.Type "E" means water flumes, water slides or other similar water attraction.

(ee) Rate of Flow means a quantity of water flowing past a given point in a unit of time. Usually measured in gallons per minute (gpm).

(ff) Residential Pool means any pool that serves no more than three living units, the use of which shall be confined to the family of each residence and their private guest.

(gg) Skimmer means a device other than an overflow trough that is used to continuously remove surface water and floating debris from a pool.

(hh) Skimmer Weir means that part of a skimmer that adjusts automatically to small changes in water level to assure a continuous flow of water to the skimmer.

(n) Therapeutic Pool means a pool used for medical treatment which is under the supervision of licensed medical personnel.

(jj) Tower means an elevated platform from which a person can jump or plunge into the pool.

(kk) Turnover rate means the number of times a quantity of water equal to the total capacity of the pool passes through the filters in a stated period. Usually stated in hour turnover rate (6 hr. turnover rate for example) or turnovers per day.

(ll) Wading Pool means a small pool normally for non-swimming children, used for wading, with a maximum depth of twenty-four (24) inches.

(mm) Water Slides or Water Flumes means inclined trough(s) that convey patrons in a stream of water ending in a pool. This is not intended to include water attractions that involve a boat, "log" or other such vessels in which patrons ride and not normally come in direct contact with the water nor does this include swimming pool sliding equipment.

History

• Authority: T.C.A. §§4—5—202, 68—14—301 through 68—14—323, 68—14—302(a), 68—14—303(3) and 68—14—403.
• Administrative History: Original rule filed February 29, 1996; effective June 28, 1996.

Tenn. Comp. R. & Regs. 1200-25-01-.02 OPERATIONAL REQUIREMENTS FOR SWIMMING POOLS OWNED BY

MULTI—FAMILY RESIDENTIAL HOMEOWNER ASSOCIATIONS.

(1) Pool Facilities (a)Bathhouse. 1.The floors and walls shall be cleaned as often as necessary to maintain sanitary conditions. 2.Plumbing fixtures shall be clean and in operating condition. 3.Toilet tissue in holders shall be provided at each commode. 4.Soap and either single service towels or air dryer devices shall be provided at lavatories. 5.Mirrors, if provided, shall be of non-breakable material. 6.Facilities shall be free of trash and litter. Trash receptacle(s) shall be placed at convenient locations. 7.Women's bathhouse restrooms shall be equipped with covered sanitary napkin receptacles. 8.A minimum lighting level of ten (10) foot candles measured at a point three (3) feet from the floor shall be maintained in bathhouses.

(b) Pool Enclosures. Ventilation shall be sufficient to prevent condensation and odor accumulation.

(c) Pool Surface and Facilities. The walls, bottom, fixtures and all equipment shall be kept clean and in good repair.

(d) Walks/Decking/Pool Area. Walks, decking, and all other pool areas shall be clean and in good repair.

(2) Safety (a)Certified Lifeguards. 1.Lifeguards shall be present at Type A pools in accordance with the following square footage schedule:

Square Feet 1,800-3,0001 lifeguard 3,001-6,0002 lifeguards* 6,001-9,0003 lifeguards* 9,001-12,0004 lifeguards* One additional lifeguard per each additional 3,000 sq. feet.* *With twenty-five (25) or less pool bathers, a minimum of one (1) lifeguard is required. For twenty-six (26) to fifty (50) pool bathers, a minimum of two (2) lifeguards is required. With fifty-one (51) or more pool bathers, the square footage requirements for lifeguards will apply. Further, for pools requiring more than one (1) lifeguard, the pool area lifeguard requirements can be reduced by roping or partitioning off the unused area(s) of the pool.

2. Lifeguards shall be present at all pools having a diving board or tower that is one (1) meter or more in height above the normal operating water level.

3. Lifeguards shall observe from the lifeguard chair except during instructional activities or during life saving or emergency type situations involving swimmers.

4. "Wave" type pools shall have a minimum of two (2) lifeguards observing from lifeguard chairs. All other "Wave" type pool lifeguards may observe from the pool deck (b) Chemical Storage and Handling. Chemicals shall be kept in the original containers. They shall be used and stored in accordance with label instructions.

(c) Communicable Disease. All patrons or swimmers suspected of having a communicable disease shall be excluded. No person having a communicable disease shall work at any type pool in a function in which there is a likelihood that he will transmit the disease to any other person.

(d) Depth markers. Depth markers at all Type A, B, and E pools. The depth of the water shall be plainly marked in feet on both sides and at each end at or above the water surface on the vertical pool wall and on the coping or deck next to the pool, and at maximum and minimum depths of the pool. Depth markers shall be spaced at intervals no greater than twenty (20) feet with numerals of at least four (4) inches in height and of a color consulting with the background. Where depth markings are required they shall be in whole foot increments of depth, except across the shallow end the depth shall be marked to the nearest one half (1/2) foot increment of water depth.

(e) Diving Boards/Towers. Diving board stands/towers, which were in existence and in use on or prior to May 9, 1987, at pools having dimensions less than those required by rule 1200— 25—1—.03(4)(h) will be allowed to continue in use until the diving board stand/tower is replaced.

(f) Electrical. There shall be no visible, obvious electrical hazards at any pool.

(g) Fencing. All pools shall be protected by a wall, building, enclosure or chain link fence with a height of four (4) feet, or other functionally equivalent barriers approved by the Commissioner. Enclosures or barriers shall be equipped with gates or doors that can be locked when the pool is not in use. Fencing and/or barriers shall be maintained in good repair (h)First Aid Kit Reserved.

(i)Gas Chlorination 1.Gas Chlorination equipment shall be located so that an equipment failure or malfunction will have effect on evacuation of pool users in an emergency 2.Cylinders shall be securely fastened to a wall or post. 3.Storage of any other chemicals in the chlorine enclosure shall be forbidden except those used to check chlorine leaks. 4.When gas chlorination equipment is enclosed, the enclosure shall be provided with air-tight ducts from the bottom of the enclosure to atmosphere in an unrestricted area, a motor driven exhaust fan capable of producing at least one air change per minute and automatic louvers of good design near the top of the enclosure for admitting fresh air. 5.Connections from the cylinders to the system depend on the type of chlorinator to be used and shall comply with the chlorinator manufacturer's recommendation. 6.Electrical switches for the control of artificial lighting and ventilation within the enclosure shall be on the outside of the enclosure and adjacent to the door (j)General Safety. No broken bottles, cans, glass, sharp objects or any other debris which might cause injury or accidents shall be in the pool or pool area. No aspects of the operation or condition of facilities or equipment which if not corrected are very likely to result in illness or injury shall exist.

(k) Illumination. When night swimming is permitted, uniform area lighting shall be provided for the deck area and in all cases there shall be sufficient illumination to enable all areas of the pool including the main drain to be clearly observed by a person standing at the edge of the pool.

(l)Lifeguard chairs. One lifeguard chair shall be provided for each lifeguard as required by these regulations and shall be elevated and strategically located to provide adequate coverage of all areas of the pool, (m) Lifeline. 1.In all Type A and B pools in which the maximum pool depth exceeds five (5) feet six (6) inches, there shall be a lifeline located at or before the five (5) feet depth area(s) separating the shallow area(s) and the deep area(s). "Wave" type pools shall be exempted from this requirement 2.A lifeline shall be made of approved material such as polypropylene or nylon and be provided with floats made of soft material of contrasting color located at not more than five (5) feet intervals. The lifeline rope shall be a minimum of three-fourths (3/4) inch diameter and be attached to the lifeline anchors on both sides of the pool during all times that the pool is in operation, except during periods of competitive swimming or supervised training.

(n)Life Saving Equipment. All type A and B pools shall be equipped with a minimum of one (1) units of life saving equipment, located within twenty-five (25) feet of the pool, inside the fence. one (1) unit of lifesaving equipment as defined in 1200—25—1—.01(1)(X), shall be provided at each lifeguard chair. Further, additional units of life saving equipment shall be readily accessible and provided in accordance with the number Of "Certified Lifeguards" under Paragraph (2) Safety, Rule 1200—25—1—.02.

(o)Main Drain. Main drain gating in all types of pools shall be in place, securely anchored, in good repair and with slots not more than one-half (1/2) inches wide.

(p)Signs. At Type A, B and C pools, where no lifeguard is required, a warning sign with clearly legible letters at least 4 inches in height shall be placed in plain view stating “WARNING - NO LIFEGUARD”. No diving sign(s) shall be displayed in conspicuous locations at all pools not meeting the minimum requirements for diving. The sign shall read. "NO DIVING" with minimum four (4) inch lettering.

(q)Starting Blocks Used for Competitive Swimming. Starting blocks shall not be used for any

purpose other than for competitive swimming nor at any time other than during competitive swimming activities.

(r)Steps, Ladders. Steps and ladders shall be maintained in good repair and be free of hazards to reduce possibility of injury.

(s)Telephone for Emergency. All pools shall have telephone service conveniently available on the premises. A list of clearly visible emergency phone numbers to include the nearest emergency and medical services shall be posted next to the telephone.

(3) Water Quality (a)Bacteriological Test. Pool water sample analysis shall be in accordance with these rules. 1.A sample shall be considered positive and unacceptable if it exceeds four (4) total coliform, bacteria per one hundred (100) milliliters of sample using the membrane filter method. 2.A sample shall be considered positive and unacceptable if total coliform bacteria in any amount are present in three (3) or more tubes using the fermentation tube method and ten (10) milliliter standard portions. 3.A sample shall be considered positive and unacceptable if the analyzed results are "too numerous to count/confluent growth" as reported from the Department Laboratory or a certified lab.

(b) Chemical Tests. 1.The Hydrogen Ion Concentration (pH) of the pool water shall be maintained at a level between 7.2 and 7.6 when the pool is open for operation. 2.Total alkalinity in pool water shall be at a level between eighty parts per million (80ppm) and two hundred parts per million (200ppm). 3.The cyanuric acid level shall not exceed one hundred parts per million (100ppm).

(c)Sanitization. 1.Free available sanitizing residuals in pools for currently approved agents shall be as follows:

(i)Type A, B, C, & E pools Chlorine 0.4 - 3.0 PPM (Ideal 1.0 - 1.5 PPM)

Bromine 0.8 - 3.0 PPM (Ideal 1.5)

(ii) Type D pools Chlorine 1.0 - 3.0 PPM (Ideal 1.0 - 1.5 PPM)

Bromine 0.8 - 3.0 PPM (Ideal 1.5) 2.Disinfectants of equal or superior quality to chlorine or bromine compounds that are registered by the Environmental Protection Agency and approved by the Department may be used. 3.Other disinfecting methods or materials may be used if they have been adequately demonstrated to the Department to provide a satisfactory residual effect winch is easily measured or where demonstration and analysis provide assurance that results are otherwise equally effective under condition of use as the chlorine concentration required herein and not be dangerous to Public health, create objectionable physiological effects, or import toxic properties to the water. 4.Sanitizing agents shall be dispensed into the pool water automatically The equipment shall be designed specifically for the type of disinfectant to be used. The equipment shall be of sufficient capacity to maintain the recommended disinfectant residual in the pool. Disinfecting equipment shall be provided with controls for adjusting the rate of flow 5.Hand chlorination is not acceptable except for emergencies, infrequent chlorination purposes, or as approved by the Department where specific circumstances necessitate such dispensing.

(d)Testing Equipment. Testing equipment complete with reagents, shall be provided at the pool for the determination of residual disinfectant, pH, total alkalinity, and cyanuric acid of the pool water The diethyl-p-phenylenediamine (DPD) method shall be used for the determination of disinfectant residual. The range of testing equipment shall be capable of testing all levels as set forth within these rules. Reagents shall not be outdated or otherwise ineffective.

(e)Visual Tests. 1.Water shall be sufficiently clear to allow a viewer to clearly distinguish gratings (openings) of the main drain(s) when standing at the edge of the pool deck 2.There shall be no algae visible in a pool. 3.There shall be no foreign material visible in a pool.

(f)Water Level. The water level in swimming pools with overflow gutters shall be maintained at the break over level. The water level in swimming pools with skimmers shall be maintained at the midpoint of the skimmer.

(g) Water Temperature. Pool temperature shall not exceed one-hundred-four (104°) degrees Fahrenheit. Type D pools shall be equipped with a non-breakable thermometer located in the water.

(4) Water/Waste Water (a) Cross-Connections. There shall be no cross-connections within any portion of the pool facilities. Hose bibbs shall be equipped with an approved backflow prevention device.

(b) Sewage Disposal. Sewage shall be disposed of according to law (c) Water Supply. All water used in drinking fountains, lavatories, showers, hose bibbs shall be from potable water sources.

(d) Water Supply. All water used to fill pool shall be of a potable source or a source that is acceptable to the Commissioner.

History

• Authority: T.C.A. §§4—5—202, 68—14—301 through 68—14—323, 68—14—302(a), 68—14—303(3) and 68—14—403.
• Administrative History: Original rule filed February 29. 1996, effective June 28, 1996

Tenn. Comp. R. & Regs. 1200-25-01-.04 POSTING OF A SIGN FOR NONCOMPLIANCE

(1) Swimming pools owned and operated by multi-family residential housing homeowner associations shall be subject to rules and regulations promulgated by the Department of Health.

(2)(a)If an inspection of a swimming pool owned and operated by a multi-family residential housing homeowner association results in a finding that minimum health and safety standards are not met, the homeowner's association shall be required to post notice within ten (10) days from the date of the inspection that such swimming pools does not comply with the minimum health and safety standards required by the Department.

(b) Such notice shall be posted in a conspicuous manner at each place of ingress and egress by the homeowner's association. Conspicuous manner shall mean at a place designated by the inspector at the time of inspection.

(c)Such notice shall be in the form of a sign of durable construction. The sign shall be printed in a color contrasting to the background and shall be printed in letters of at least one inch (1”) in height with the exception of the word "Notice" which shall be printed in letters of at least two inches (2”) in height Such notice shall include but not be limited to the following:

Notice The Swimming Pool Does Not Comply With The Minimum Health And Safety Standards Required By The Tennessee Department Of Health.

(3) Failure to post the notice as provided herein shall subject the homeowner's association to a civil penalty in the amount of fifty dollars ($50.00) for each day the notice is not posted.

History

• Authority: T.C.A. §§4—5—202, 68—14—301 through 68—14—323, 68—14—302(a), 68—14—303(3) and 68—14—403.
• Administrative History: Original rule filed February 29, 1996, effective June 28, 1996.

Tenn. Comp. R. & Regs. 1200-25-01-.05 GENERAL PROVISIONS

(1) Applicability - These rules apply only to swimming pools (1) owned and operated by multifamily residential homeowner associations and (2) constructed or altered before June 12, 1995.

(2) Loss of permit - Any establishment that loses, misplaces, or destroys the permit shall, as soon as such loss becomes apparent, immediately apply for a duplicate. Fee for the duplicate shall be three ($3.00) dollars. This fee shall accompany the application for such duplicate.

(3) Posting of permits - T.C.A. §68—14—305 requires posting of permits in a conspicuous manner".

This shall mean at a place so designated by the inspector at the time of inspection. No person except an authorized representative of the Commissioner shall modify, remove, cover up, or otherwise make the permit less conspicuous in any way.

(4) Severability - If any provision or application of any provision of these rules is held invalid, that invalidity shall not affect other provisions or applications of these rules.

History

• Authority: T.C.A. 4—5—202, 68—14—301 through 68—14—323, 68—14—302(a), 68—14—303(3), 68— 14—305 and 68—14—403.
• Administrative History: Original rule filed February 29, 1996; effective June 28, 1996.

Tenn. Comp. R. & Regs. 1200-25-01-.03 MINIMUM DESIGN STANDARDS FOR SWIMMING POOLS OWNED BY

MULTI—FAMILY RESIDENTIAL HOMEOWNER ASSOCIATIONS.

(1)General - These design standards shall apply to all swimming pools constructed or altered before June 12, 1995. All definitions and requirements in the law and regulations are also considered a

part of these standards. For design features not specifically addressed in these regulations (1200—24—1—.03), the Commissioner shall evaluate same and approve or disapprove said design features as appropriate.

(Rule 1200—25—1—.03 (2)Definitions (a) Bull-Nosed Coping means a rounded edge of the coping that can be used as a hand-hold.

(b) Diatomaceous Earth means a type of filter media that is obtained from the fossil remain of microscopic marine plants and is used in a thin coating over filter septa or bags.

(c) Face Piping means piping, valves and fittings that are used to connect the filtering system together as a unit that are necessary to achieve complete filtering and backwashing functions.

(d) Filter Backwash means the process of cleaning a swimming pool filter by reversing the flow of water through it.

(e) Filter Media means any fine grain material, carefully graded as to size, that entraps suspended particles as water passes through.

(f) Heater means a device through winch pool water is circulated to increase the temperature.

(g) Hydrostatic Relief Valve means a device used to relieve ground water pressure imposed on the outer shell of the pool.

(h) Main Drain Piping means piping connecting the main drams to the pump suction.

(i)N.S.P.I. means National Spa and Pool Institute.

(j)Outlet means main drain, vacuum or overflow.

(k) Recirculation System means the entire system of pipes, pumps and filters that allow water to be taken from the pool, filtered, treated, and returned to pool.

(1) Return Inlets or Inlet means the fittings or openings through which filtered water enters the pool.

(m) Return Piping means piping which conveys the filtered water under pressure from the filter to the pool.

(n) Skimmer means a device Other than an overflow trough that is used to continuously remove surface water and floating debris from a pool.

(0) Surge Tank means a device of such material, shape, and capacity as to adequately receive the surge water from indirect or direct overflows, so constructed and located as to be easily cleaned.

(p) Tamperproof requires tools to alter or remove portions of the equipment (q) Vacuum Outlets means the fittings in the pool which are used to connect the under-watersuction cleaning equipment (r) Vacuum Piping means the piping which connects the vacuum fittings to the return piping.

(3) Plans And Specifications For Review (a)No person shall begin construction of a public swimming pool or shall substantially alter or reconstruct any public swimming pool without first having submitted plans and specifications to the Department for review and received approval. All plans and specifications shall be submitted in duplicate.

(b) No permit to operate a swimming pool shall be issued after these rules become effective unless said pool design has been approved by the Commissioner.

(c)All type pools shall be designed and constructed to withstand all anticipated loadings and for both full and empty conditions. A hydrostatic relief value shall be provided in areas having a high water table. The designer or architect or engineer shall certify the structural stability and safety of the pool in the plans and specifications submitted.

(d) Plans shall be drawn to scale and include: 1.The name of facility, location, and names and addresses of all owners and operators; 2.The perimeter, surface area, volume of the pool, total deck area, turnover rate, and maximum bather load; 3.A detailed layout of pool, including fencing, all pool facilities and related structures; 4.Top and cross-sectional diagrams with dimensions so that depths and clearances may be determined for all areas of the pool; 5.All equipment (fittings, ladders, diving boards, main drain(s), surface skimmers, overflow gutters, inlets, lights and other applicable equipment) with spacing with dimensions; 6.Layout and slope of deck area, indicating size, location of hose bibb(s), depth markings, deck drains, and area to be lighted; 7.Plumbing diagram showing all pipe sizing and location; 8.Equipment room diagram showing layout and elevation, sump, floor drain(s) and other equipment and facilities; 9.Complete equipment list with manufacturer specifications to include model number, size, capacity, horsepower, etc;

10. Source(s) of water, 11. Method of sewage disposal;

11. Design of gas chlorination system showing location in relation to the pool and other structures; and 13. Other information as requested by the Department (e) After all piping has been installed and before it is covered, the owner or operator shall notify the Department so that a complete piping inspection can be conducted. The owner or contractor shall notify the Department at other specified stages of construction for interim inspections, if such a request is made.

(4) Design Standards (a) Bathhouses - Bathhouse facilities shall be provided within two hundred (200) feet for all Type "A" pools. At Type B, C, & E pools facilities shall be provided within eight hundred (900) feet of the pool. Bathroom facilities used in conjunction with living or lodging can be substituted for criteria as set forth in the following subparagraph, "Bathhouse Facilities."

(b) Bathhouse Facilities 1.Toilet and shower facilities shall be provided in the following ratios for the number of swimmers indicated or major fraction thereof Males Females Water Closets1/751/50 Urinals1/75*— Lavatories1/1001/100 Showers1/501/50 *Number of swimmers 2.Hose Bibbs - Shall be provided for flushing down dressing rooms and bathhouse interior. Each hose bibb shall be equipped with an approved backflow prevention device. 3.Floors - The floors of the bathhouse shall be of impervious material, graded to drain, smooth and without a slick finish Floor drains shall be located to ensure drainage of all parts of the budding. 4.All dressing room booths, if provided, shall be made of durable materials. 5.Lighting and Ventilation - All bathhouse shower and dressing room areas shall be ventilated and lighted. Minimum lighting in dressing room areas shall be not less than ten (10) foot candles at a point three (3) feet from the floor. Ventilation shall be sufficient to prevent condensation and odor accumulation. 6.Soap holders or dispensers shall be provided at each lavatory and shower head at the rate of one dispenser or bar rack for every two lavatories and each shower head. 7.Water under pressure shall be provided at all shower heads at the rate of two (2) gallons per minute, and at all lavatories. Hot water shall be a minimum of ninety (90) degrees Fahrenheit and shall not exceed one hundred twenty (120°) degrees Fahrenheit 8.Towels - Single service towel holders or blower type hand dryers shall be provided at each handwashing facility at the rate of one approved dispenser per four lavatories. 9.Facilities shall be finished in light colors, and designed so that good sanitation can be maintained.

(c) Coding Of Piping And Equipment - AD piping, valves, and equipment are to be labeled with legible print stating the following: 1Water linespotable 2.Recirculationfiltered, skimmer or gutter return, main dram 3.Chemical lines - Alum, Chlorine (gas and solution), soda ash, acid 4.Waste lines - Backwash waste, sewer (sanitary or otherwise), deck drains 5.Other - Compressed air, gas (natural or bottled), etc.

(d) Construction Material And Finish 1.Swimming pools shall be constructed of materials that are inert, non-toxic, impervious, permanent and enduring. The materials shall be able to withstand the design stresses and be water tight, with a smooth and easily cleaned surface. The materials shall be finished in a white or light color. 2.Sand, earth, or vinyl liners are not permitted in swimming pool construction. 3.All sections of a flume or slide for Type "E" pools shall be designed and constructed to prevent abrasion or injury All surfaces shall be sealed and smooth. 4.Ledges and/or seats inside Type A, B and C pools, located below the normal water level, shall be clearly identified by warning sign(s) or by being colored in contrast with the rest of the pool lining.

(e)Deck Areas 1.Deck areas shall be continuous around the pool with a minimum width as follows:

(i)Type A: eight (8) feet;

(ii) Type B: six (6) feet;

(iii) Type C: four (4) feet;

(iv) Type D: no minimum requirement; and (v)Type E: eight (8) feet around the exit of the landing pools, four (4) feet around the starting point. 2.A minimum of three (3) feet of deck width shall be provided on the sides and rear of any piece of diving or sliding equipment and lifeguard chairs. 3.The deck shall be constructed of non-slip durable material and have a finish that will be of no hazard to bare feet. It shall have a slope of not less than one-fourth (1/4) inch nor more than three-eighths (3/8) inch to the foot and shall be so designed as to conduct drainage away from the pool area in a manner not to create or maintain standing water All deck drainage shall be "to waste". Deck drams shall be installed where necessary to prevent standing water. 4.Hose bibbs shall be provided around the perimeter of the deck area at intervals such that all parts of the deck can be reached with a hose.

(f) Depth - The beginning depth in the shallow portion shall not be less than three (3) feet and shall not exceed three (3) feet six (6) inches, except for restricted use pools, such as competitive swimming, diving or wave-pool.

(g) Depth Markers At All Type A, B, And E Pools - The depth of the water shall be plainly marked in feet on both sides and at each end at or above the water surface on the vertical pool wall and on the coping or deck next to the pool and at maximum and minimum depths of the pool. Depth markers shall be spaced at intervals no greater than twenty (20) feet with numerals of at least four (4) inches in height and of a color contrasting with the background.

Where depth markings are required they shall be in whole foot increments of depth except across the shallow end the depth shall be marked to the nearest one half (1/2) foot increment of water depth.

(h) Diving Area/Equipment 1.Where diving boards or towers are provided, minimum dimensions of pools, maximum clearances from diving board(s), and other required dimensions for diving equipment and pools shall be in accordance with Figure 1. 2.Diving boards and towers in excess of three (3) meters in height are prohibited in a public swimming pool except for pools specifically designed and used for competitive type diving and instruction. 3.At least fifteen (15) feet of unobstructed vertical distance shall be maintained above any diving board. This fifteen (15) feet height shall extend ten (10) feet to each side and sixteen (16) feet ahead of the front end of the board. If a pool has more than one diving board, the above distances shall be provided for each board or tower 4.Steps leading to boards, towers or slides higher than I meter shall be provided with handrails that extend to inside of coping edge.

(i)Drinking Fountain - At least one (1) approved drinking fountain shall be provided within 200 feet of Type A pools.

(j)Electrical 1.Electrical equipment for all pool facilities shall conform with all applicable local codes and the National Fire Protection Association's National Electric Code. 2.Overhead wiring not in conduit, shall not pass within an area extending a distance of twenty (20) feet horizontally away from the inside edge of the pool walls, diving structures, observation stands, towers, or platforms.

(k) Equipment Room(s) Or Enclosure - An enclosed area shall be provided that will prevent unauthorized access to all chemical feeders and filtration equipment. It shall be illuminated, ventilated and sized for ease of operation and accessibility.

(l)Fencing - All pools shall be enclosed by a chain link fence or equal barrier of minimum four (4) foot height. If picket type fencing is used, the spacing between pickets shall not exceed five (5) inches. The top of the bottom rail shall not exceed five (5) inches above grade, and the top rail shall be no less than forty-three (43) inches above grade. Enclosures or barriers shall be equipped with gates or doors that can be locked when the pool is not in. use.

Fencing and/or barriers shall be maintained in good repair (m) Fill Spout - The fill spout shall be located underneath the diving board or within four (4) inches of a pool ladder and not protrude beyond the edge of the pool. If the pool has no diving board or ladder, the fill spout shall not extend beyond the edge of the pool coping or otherwise be located so as to create a tripping hazard.

(n) Filters 1.Diatomite Filters - The filter rate for diatomite filters shall not exceed two (2) gallons per minute per square foot of filter surface area. 2.Sand-High Rate - Filter rate shall not exceed fifteen (15) gallons per minute per square foot of filter surface area. The filter(s) shall be provided with pressure gauges for determining the need for backwashing, backwash sight glass, and air-relief device. The backwash rate shall not be less than the filter rate. 3.Cartridge - Filters shall be of a disposable or washable element. Rate of flow shall not exceed 0.2 gallons per minute (GPM) per square foot of filter surface area at all type pools. One extra complete set of filter units shall be on hand at all times at the pool. 4.Other - Any filters other than those described above that are functionally equivalent may be approved by the Department. 5.Design shall include plans for backwashing and/or cleaning filters. 6.All type filters shall comply in all respects with the Standards of the National Sanitation Foundation covering such filters.

(o) Filter Backwash - Backwash from the filter(s) shall be piped to a sanitary sewer or other disposal method approved by the Department. In all cases of filter backwash discharge, an air-gap shall be provided with a minimum of six (6) inches between the discharge pipe and top of the sump or sewer piping. Both the sump and the exit pipe shall be sized to accommodate the backwash flow.

(p) Gas Chlorine 1.Chlorination equipment shall be located so that an equipment failure or malfunction will have minimum effect on pool users or other adjacent facilities in an emergency. 2.Facilities for securing cylinders shall be installed. 3.If installed below grade or within an enclosure, the area shall be provided with an airtight duct from the bottom of the enclosure to atmosphere in an unrestricted area, a motor driven exhaust fan capable of producing at least one air change per minute and automatic louvers of good design near the top of the enclosure for admitting fresh air. 4.Elemental chlorine feeders should be activated by a booster pump using recirculated water supplied via the recirculation system. The booster pump should be interlocked to the filter pump to prevent feeding of chlorine when the recirculation pump is not running. 5.Connections from the cylinders to the system depend on the type of chlorinator to be used and shall comply with the chlorinator manufacturer's recommendation. 6.Electrical switches for the control of artificial lighting and ventilation within the enclosure shall be on the outside of the enclosure and adjacent to the door.

(q) Hair/Lint Strainer - A corrosion-resistant strainer (except for vacuum Diatomite Filters) located on the vacuum side of the filtration pump shall be provided to remove solids, debris, hair, lint, etc.

(r) Lifeline - In Type, A and B pools where the maximum pool depth exceeds five (5) feet six (6) inches, there shall be a lifeline, provided with floats made of soft material of contrasting color located at not more than five (5) feet intervals, separating the shallow and the deep end at or before the five (5) feet depth area. The lifeline shall be made of polypropylene or nylon, be a minimum of three-fourths (3/4) inch diameter and be in good condition. "Wave" type pools shall be exempted from this requirement (s) Life Guard Chairs - There shall be a minimum of one (1) elevated lifeguard chair provided for all Type "A" pools with a minimum of eighteen hundred (1,800) square feet of pool surface area. The number of square feet with required number of lifeguard chairs follow: 1.1,800 - 3,000 1 lifeguard chair 3,001 - 6,000 2 lifeguard chairs 6,001 - 9,000 3 lifeguard chairs 2.An additional chair per each additional 3,000 square feet. 3.All other pools shall meet the same requirements relative to lifeguard chairs as Type "A" pools when there is a diving board of one (1) meter or more.

(t)Lighting 1.Artificial lighting shall be provided at all pools that are to be used at night or which do not have adequate natural lighting. A minimum of five (5) foot candles. per square foot at the deck level shall be provided. 2.When underwater lighting is used, not less than 0.5 watts shall be provided per square foot of pool surface area. Lights shall be positioned so that all portions of the pool are clearly visible to an observer on the pool deck. 3.Overhead Lights - There shall be no light fixtures directly above the water surface.

(u)Main Drain 1.All pools shall be provided with a main drain outlet(s) at the deepest point of the pool.

Type C, D, and E pools shall have a minimum of two (2) interconnected main drains.

Jet pump type systems shall be connected to the interconnected main drains. 2.Each floor outlet grate area shall be such that when the maximum flow of water is being pumped through the floor outlet, the velocity through the open area of the grate shall not be greater than two (2) feet per second. Floor outlet grates shall be anchored, tamperproof with slots not more than one-half (1/2) inch wide. 3.When the outlet grates are of the anti-vortex type, maximum entrance velocities may be increased to six (6) feet per second. All main drains shall be of corrosion-resistant materials.

(v)Operation Instructions 1.Upon completion of the pool, the builder shall give the owner and/or operator complete written instructions on the operation and maintenance of the pool and equipment 2.These instructions, including the valve schedule, shall be supplied in not less than two (2) copies. One copy shall be encased in a waterproof covering available to the pool operator and to the Department's representative during inspection.

(w) Overflow Gutters 1.Overflow gutters shall be required on all pools with a surface area greater than 5,000 sq. ft. Pools of less than 5,000 sq. ft. shall have overflow gutters or be equipped with at least one skimmer for each 500 sq. ft. 2.Overflow edge of the gutters shall be level within one-eighth (1/8) inch and extend completely around the pool except at steps. 3.The opening into the gutter beneath the coping shall not be less than four (4) inches.

The interior of the gutter shall have a width and depth of at least three (3) inches and be designed to prevent entrapment of bathers' arms and legs. The overflow edge of the lip shall serve as a handhold and be rounded. 4.The overflow system shall be capable of continuously removing fifty (50) percent or more of the recirculated water and returning it to the recirculation system through a surge tank with a capacity of not less than one gallon for each square foot of pool surface area. 5.The gutter drain outlets shall be constructed of a non-corrosive material and shall be placed on a maximum of fifteen foot centers. The gutter bottom shall slope toward these outlets with a minimum slope of one-eighth (1/8) inch per foot.

(x) Piping - Piping shall be stainless steel, N.S.F. swimming pool approved re-enforced flex pipe or water type PVC schedule forty (40) or better. Piping shall be designed to move the required quantity of water at a maximum velocity not to exceed six (6) feet per second. The face piping shall be sized as indicated in Table 1. Return piping system shall circle the pool and shall not be reduced in size from the face piping size more than one standard pipe size at the "T"' and one size for each two (2) inlets on each side of the "T". Reduction of piping size and number of inlets shall be balanced by having an equal number on each side of the "T".

(y) Pool Heaters - A heater thermostat shall be provided that will turn the heater off should the pool temperature go above one hundred four (104°) degrees Fahrenheit. A heater bypass and valve equal in size to the return face piping requirement shall be provided when the heater core size is smaller than the return face piping.

(z)Pool Inlets 1 Inlets shall be spaced not over twenty (20) feet apart, with one inlet within five (5) feet of each comer of the pool and one in each recessed area or recessed step area. They shall be located at least twelve (12) inches below the normal operating water level. 2.Inlet fittings shall be of the adjustable rate-of-flow type. Directional flow inlets shall be used with skimmer type pools. Inlets shall not protrude from the floor or wall to create a hazard. 3.All type pools shall be required to install a minimum of two (2) inlets.

(aa) Pressure Gauges - Pressure gauge(s) shall be installed and maintained on the influent side of the filter (high rate sand filter), reading in pounds per square inch (psi) and maintained in an operational condition. Pressure gauge(s) on other sand filters and other type filters shall be installed according to manufacturer specifications.

(bb) Pump And Motor 1.The pump and motor shall be of adequate size and capacity to provide the required pool turnover rate, and shall be located to eliminate the need for priming. The pump design shall be based on an assumed total dynamic head of not less than fifty (50) feet of water. 2.A corrosion-resistant strainer located on the vacuum side of the filtration pump shall be provided to remove solids, debris, hair, lint, etc.

3. Minimum size in horsepower shall conform to applicable criteria in Table 1.

(cc) Rate Of Flow Indicator - Public pools shall be provided with an operational rate of flow indicator that reads in gallons per minute (GPM) located on the discharge line from the filter.

(dd) Recirculation System 1. The recirculating system shall be designed to achieve the required turn over rate. The return recirculation system shall be designed to have the capacity to:

(i)Flow fifty (50) percent through the overflow or skimming facilities and fifty (50) percent through the main drains.

(ii)Eighty (80) percent of the recirculation through the overflow or skimming facilities.

(iii)One hundred (100) percent through the main drain(s). 2.The recirculating system shall be designed in accordance with Table I below.

(ee) Sewage Disposal - Sewage shall be disposed of according to law.

(ff) Sidewalls - Sidewalls of the pool design shall be as shown in Figure 1. Ledges and/or seats inside the main pool body, below the normal water level, shall conform to the minimum N.S.P.I. standards. The top of the pool wall shall be uniformly level and designed with bull nosed coping or some other acceptable means by which an adequate handhold is provided around the entire pool perimeter All junctions of walls and floors shall be rounded with a minimum six (6) inches radius.

(gg) Sight Glass - An approved sight glass shall be installed to observe backwash waste water from all sand filters.

(hh) Signs - Where no lifeguard is required at Type A, B, & C pools, a warning sip with clearly legible letters at least 4 inches high shall be placed in plain view stating "WARNING — NO LIFEGUARD". No diving sign(s) shall be displayed in conspicuous locations at all pools not meeting the minimum requirements for diving. The sip shall read "NO DIVING" with minimum four (4) inch lettering.

(ii) Skimmers 1.When skimmers are required, there shall be one skimmer for the first five hundred (500) square feet of pool surface area and one skimmer for each additional five hundred (500) square feet or major fraction thereof. 2.No skimmer shall be located closer than five feet to the nearest Wet. 3.When surface skimming devices are used, handholds shall be provided which consist of bull-nosed coping not over two and one-half (2 1/2) inches thick or an equivalent device. The handholds shall be no more than nine (9) inches above the normal operating water level. 4.The skimmer weir shall be automatically adjustable and shall operate freely with continuous action to variations in water level over a range of at least four inches. 5.An easily removable and cleanable basket or screen through which all overflow water passes shall be provided to trap large solids. 6.Type C and D pool - Inlets and outlets shall be provided and arranged to produce complete recirculation of pool water and maintenance of the required residual of sanitizing agent These type pools shall be provided with a means of completely draining the contents of the pool to waste without passing through the filter by a gravity waste line directly from the pool or by pumping and by passing the filter 7.Type D pools shall not have any area within 10 feet of the pool that cannot be easily cleaned and/or disinfected. No deck shall be constructed so as to allow drainage into the pool or pool area 8.An equalizer line shall be installed for all Type C and D pools.

(jj) Slope - The pool shall have a uniform slope from shallow end to the slope transition point not exceeding one (1) foot vertical to twelve (12) feet horizontal. Where the depth is greater than five feet the slope shall not exceed one (1) foot vertical to three (3) feet horizontal.

(kk) Steps And Ladders - Two (2) or more ladders shall be provided for Type A & B pools. At least one (1) ladder shall be provided for each seventy-five (75) feet of pool perimeter.

Ladders shall have a minimum of three steps with non-slip treads. One (1) ladder may be deleted if steps are installed in the shallow end of the pool.

Non-slip steps will be allowed on the shallow end and may extend inside the pool provided they are plainly Marked. Where Steps are Used, a minimum of one (1) handrail shall be installed from the mid-point of the bottom step to the deck. Any steps over ten (10) feet wide shall have handrails on the edges and spaced not more than six (6) feet on centers.

Steps shall not have a rise of more than ten (10) inches and a tread of twelve (12) inches.

Construction of steps and ladders shall conform to criteria as set forth in Figure 1.

(ll) Turnover Rates - Pools shall be designed to filter and disinfect the water according to the following rates: 1.All Class A, B and E pools shall be designed to filter and disinfect the entire volume of water in no more than six (6) hours; 2.An Class C pools shall be designed to filter and disinfect the entire volume of water in no more than one (1) hour, 3.All Class D pools shall be designed to filter and disinfect the entire volume of water in no more than thirty (30) minutes.

(mm) Vacuum Equipment - An operational vacuum cleaning system shall be provided at all pools. Built in vacuum outlets shall not be more than eight (8) inches below the normal operating water level.

(nn) Water Supply 1.All water used in drinking fountains, lavatories, showers, and hose bibbs shall be from a potable source. 2.All water used to fill the swimming pool shall be from a source approved by the Commissioner. 3.Hot and cold water under pressure shall be provided at shower heads and lavatories. 4.Cross Connections - There shall be no cross connections within any portion of the pool facilities. Hose bibbs shall be equipped with an approved backflow prevention device.

TABLE I

POOL EQUIPMENT SIZING GUIDELINES

I.Main Pool:

Number of gallons in Pool = GPM Turnover II.Wading Pool:

Number of Gallons in Pool = GPM Turnover III. Spas and Whirlpools:

Number of Gallons in Pool = GPM Turnover POOL EQUIPMENT SIZING GUIDELINE ALL POOLS TURNOVER MINIMUM PVC PIPE SIZE* MINIMUM PUMP SIZE MINIMUM FILTER SIZE HIGH RATE & VACUUM SAND** G.P.M.HorsepowerFT2Diamet 1-201 1/2" (2 1/2" Main Drain)1/21.416" 21-301 1/2" (2 1/2" Main Drain)3/42.020" 31-402" (2 1/2" Main Drain)1.02.724" 41-602" (2 1/2" Main Drain)1.54.030" 61-702 1/22.04.730" 71-902 1/22.06.036" 91-1003"2.56.736" 101-1103"2.57.32-30" 111-1303"3.08.62-30" 131-1404"5.09.32-30" 141-2104"5.014.02-36" 211-2204"5.014.73-36" 221-2404"7.516.03-36" 241-3106"7.520.73-36" 311-3306"7.522.04-36" 331-4206"1028.04-36" 421-4306"1028.75-36" 431-5306"1535.35-36" 531-6308"1542.06-36" 631-6508"1543.37-36" 651-7408"2049.37-36" 741-8508"2056.78-36" 851-8708"2058.0 ALL POOLS TURNOVER MINIMUM PVC PIPE SIZE* MINIMUM PUMP SIZE MINIMUM FILTER SIZE HIGH RATE & VACUUM SAND** 871-9008"3060.0 901-9408"3065.0 941-97010"3065.0 971-105010"3070.0 1051-109010"3075.0 1091-120010"3080.0 1201-127510"3085.0 1276-135010"4090.0 1351-146910"40100.0 1470-165012"40110.0 1651-174212"40115.0 1743-187512"50125.0 1876-202512"50135.0 2026-210012"50145.0 *For Main Drain, Return. Face Piping & valves. Maximum Velocity of 8 ft/sec. ** Given 50 ft total dynamic head (T.D.H.) a 0.55 pump efficiency H.P. = G.P.M. X T.D.H. 3960 x Pump Efficiency *** Maximum 15 gals/min. per re filter surf ace area Figure 1 Minimum Dimensions for Diving Portion of Pools (This drawing does not show the shallow portion of the pool)

Typical position of tip of board Relative to PT.A RELATED DIVING EQUIPMENTMINIMUM DIMENSIONS MINIMUM WIDTH OF POOL AT:

MAXIMUM

RADIUS

FROM

VERTICAL

MAX.

DIVING

BOARD

LENGTH

MAX.

BOARD

HGT.

OVER

METER

D D L

L PT. APT. BPT. CR

R R 10’26” (2/3m)

(2.59m) 8’6”

(2.59m) 8’6”

(0.76m) 2’6”

(3.66m) 12’0”

(6.10m) 20’0”

(6.10m) 20’0”

(6.10m) 20’0”20”12”8” 12’30” (3/4m)

(2.74m) 9’0”

(2.74m) 9’0”

(0.81m) 3’0”

(3.66m) 12’0”

(6.10) 20’0”

(6.10m) 20’0”

(6.10m) 20’0”22”12”8” 16’39.37” (1m)

(3.05m) 10’0”

(3.05m) 10’0”

(1.22m) 4’0”

(6.10m) 20’0”

(6.71m) 22’0”

(6.71m) 22’0”

(6.71m) 22’0”28”12”8” 16’118.11”

(3m)

(3.66m) 12’0”

(3.66m) 12’0”

(1.83m) 6’0”

(6.10m) 20’0”

(7.32m) 24’0”

(7.32m) 24’0”

(7.32m) 24’0”31”12”8”

NOTE: Placement of boards shall observe the following minimum dimensions. With multiple board installation minimum pool widths must be increased accordingly. 1 Meter or Deck Level Board to Pool Side10’ (3.05m) 3 Meter Board to Pool Side12’ (3.66m) 1 Meter or Deck Level Board to 3 Meter Board10’ (3.05m) 1 Meter or Deck Level to another Deck Level Board8’ (2.44m) 3 Meter to another 3 Meter Board10’ (3.05m)

History

• Authority: T.C.A. §§4—5—202, 68—14—301 through 68—14—323, 68—14—302(a), 68—14—303(3) and 68—14—403.

Chapter 1200-26-01 Transferred to 0720-44

Tenn. Comp. R. & Regs. 1200-26-01-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202 and 68-11-801.
• Administrative History: Original rule filed September 19, 1990; effective November 3, 1990. Transferred to chapter 0720-44 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-26-01-.03 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202 and 68-11-801.
• Administrative History: Original rule filed September 19, 1990; effective November 3, 1990. Transferred to chapter 0720-44 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-26-01-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202 and 68-11-801.
• Administrative History: Original rule filed September 19, 1990; effective November 3, 1990. Amendment filed September 11, 1991; effective October 26, 1991. Transferred to chapter 0720-44 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Chapter 1200-27 Reserved

Tenn. Comp. R. & Regs. 1200-27 Reserved

RULES

OF THE TENNESSEE DEPARTMENT OF HEALTH

1200-28 Bureau of Administrative Services

Chapter 1200-28-01 Nursing Home Services License Fee

Tenn. Comp. R. & Regs. 1200-28-01-.01 PURPOSE

The purpose of these regulations is to establish procedures for collection of the nursing home services license fees required by Public Chapter 475, Acts of 1991.

History

• Authority: Public Chapter 1090, Acts of 1990, T.C.A. §4—5—202.
• Administrative History: Original rule filed August 30, 1990; effective October 14, 1990. Amendment filed September 25, 1991; effective November 9, 1991.

Tenn. Comp. R. & Regs. 1200-28-01-.02 DEFINITIONS

(1)The term "nursing home" shall have the same meaning as that found at T.C.A. §68—11— 201(13).

(2)The term "commissioner" means the Commissioner of the Department of Health or his designee.

(3)The term "department" means the Department of Health.

(4)The term "beds" means licensed nursing home beds physically located in Tennessee and excluding beds specifically certified as intermediate care beds for the mentally retarded.

History

• Authority: Public Chapter 1090, Acts of 1990, T.C.A. §4—5—202.
• Administrative History: Original rule filed August 30, 1990; effective October 14, 1990. Amendment filed September 25, 1991; effective November 9, 1991.

Tenn. Comp. R. & Regs. 1200-28-01-.03 CALCULATION OF FEES

(1)The license fee shall be calculated as provided in Public Chapter 475, Acts of 1991.

(2)The beds to be used for the purpose of calculating the fee shall be the number of nursing home beds, except those certified for Medicaid as ICF/MR, licensed as of July 1, 1991 that are physically located in Tennessee.

(a)The license fee shall be as follows: 1.For nursing homes which participate in the State Medicaid program, a fee of eleven hundred dollars ($1,100) per licensed bed. 2.For nursing homes which have provided, by July 1, 1991, a notice to the Tennessee Department of Health to voluntarily terminate their participation in Medicaid, and have been approved to terminate their participation, a fee shall be computed based upon the nursing homes patient census of July 1, 1991. The amount of the fee, based on that census, shall be eleven hundred dollars ($1,100) per bed (if occupied by a Medicaid patient) plus ten thousand dollars ($10,000) for each remaining one (1) to fifty (50) bed increment.

(3)Any change that reduces the number of licensed beds in a facility shall not result in a refund being issued to the nursing home.

Nursing HomeLicense Fee Monthly Fee BOULEVARD TERRACE NURSING HOME$ 110,000$ 9,166 BRADLEY COUNTY NURSING HOME$ 258,500$ 21,541 BRAKEBILL NURSING HOMES, INC.$ 244,200$ 20,350 BRANDYWOOD NURSING HOME$ 110,000$ 9,166 BRIARCLIFF HEALTH CARE CENTER$ 110,000$ 9,166 BRIGHT GLADE CONVALESCENT CENTER$ 20,000$ 1,666 BRISTOL NURSING HOME, INC.$ 132,000$ 11,000 BROOKHAVEN HEALTH CARE CENTER$ 198,000$ 16,500 BROOKMEADE, HEALTH CARE CENTER$ 80,500$ 6,708 CAMBRIDGE HOUSE$ 121,000$ 10,083 CAMBRIDGE MEDICAL CENTER$ 137,500$ 11,458 CANE CREEK CENTER, REBOUND, INC.$ 10,000$ 833 CARRIAGE HEALTH CARE$ 213,400$ 17,783 CEDARS HEALTH CARE CENTER$ 132-000$ 11,000 CENTENNIAL MEDICAL CTR. SKILLED NURSING$ 10,000$ 833 CENTERVILLE HEALTH CARE CENTER$ 145,200$ 12,100 CHATTANOOGA HEALTH CARE ASSOC., LTD.$ 126,500$ 10,541 CHEATHAM COUNTY REST HOME$ 110,000$ 9,166 CHESTER COUNTY NURSING HOME$ 96,800$ 8,066 CHRISTIAN HOME FOR THE AGED$ 111,100$ 9,258 CLAIBORNE & HUGHES HEALTH CENTER$ 172,700$ 14,391 CLAIBORNE COUNTY NURSING HOME$ 10,000$ 833 CLARKSVILLE MANOR$ 91,300$ 7,608 CLAY COUNTY MANOR$ 72,600$ 6,050 COCKE COUNTY BAPTIST CONV. CENTER$ 61,600$ 5,133 COFFEE MEDICAL CENTER NURSING HOME$ 79,200$ 6,600 COLONIAL HILL HEALTH CARE CENTER$ 97,100$ 8,091 COLONIAL HILLS NURSING CENTER$ 234,300$ 19,525 COLUMBIA HEALTH CARE CENTER$ 116,600$ 9,716 COMMUNITY CARE OF RUTHERFORD CO.$ 144,100$ 12,008 COOKEVILLE HEALTH CARE CENTER$ 74,900$ 6,241 COOKEVILLE MANOR NURSING CENTER$ 10,000$ 833 COUNTRY PLACE HEALTH CARE CENTER$ 132,000$ 11,000 COURT MANOR NURSING CENTER$ 107,800$ 8,983 COVINGTON MANOR NURSING CENTER$ 215,600$ 17,966 CRESTVIEW HEALTH CARE CENTER$ 154,000$ 12,833 CRESTVIEW NURSING HOME$ 122,100$ 10,175 CRESTWOOD NURSING HOME$ 64,900$ 5,408 CROCKETT COUNTY NURSING HOME$ 133,100$ 11,091 CUMBERLAND MANOR NURSING CENTER$ 132,000$ 11,000 DECATUR COUNTY MANOR NURSING CENTER$ 140,800$ 11,733 DECATUR HEALTH CARE$ 94,600$ 7,883 DICKSON COUNTY NURSING HOME$ 77,000$ 6,416 DOUGLAS NURSING HOME$ 79,200$ 6,600 DURHAMHENSLEY NURSING HOME, INC.$ 121,000$ 10,083 DYERSBURG MANOR NURSING CENTER$ 143,000$ 11,916 EAST TENN. HEALTH CARE CENTER$ 101,200$ 8,433 EASTLAND HEALTH CARE CENTER, INC.$ 177,100$ 14,758 ELM HURST NURSING HOME, INC.$ 77,000$ 6,416 EMERALD HODGSON HEALTH CARE CENTER$ 10,000$ 833 ERWIN HEALTH CARE CENTER$ 138,600$ 11,550 ETOWAH HEALTH CARE CENTER$132,000$ 11,000 FAIRPARK HEALTH CARE CENTER$ 39,700$ 3,308 FARRAGUT HEALTH CARE CENTER$ 62,900$ 5,241 FENTRESS CO. GENERAL HOSP. SKILLED$ 10,000$ 833 FENTRESS COUNTY NURSING HOME$ 110,000$ 9,166 FOREST COVE NURSING HOME$ 190,000$ 15,858 FORUM CONVALESCENT CENTER-TRENTON$ 10,000$ 833 FOUR OAKS HEALTH CARE CENTER$ 92,400$ 7,700 FRANKLIN COUNTY HEALTH CARE CENTER$ 132,000$ 11,000 FRANKLIN HEALTH CARE CENTER$ 44,200$ 3,683 FRANKLIN MANOR NURSING CENTER$ 10,000$ 833 FT. SANDERS SEVIER MEDICAL CTR. N.H.$ 59,400$ 4,950 GALLATIN HEALTH CARE ASSOCIATES$ 236,500$ 19,708 GENERAL CARE CONVALESCENT CENTER$ 143,000$ 11,916 GLEN OAKS CONVALESCENT CENTER$ 143,000$ 11,916 GOOD SAMARITAN CONVALESCENT$ 90,300$ 7,525 GRACELAND CARE CENTER$ 72,600$ 6,050 GRAYSTONE HOME, INC.$ 10,000$ 833 GREEN VALLEY HEALTH CARE CENTER$ 232,100$ 19,341 GREYSTONE HEALTH CARE CENTER$ 187,000$ 15,583 HAMILTON COUNTY NURSING HOME$ 743,600$ 61,966 HANCOCK MANOR NURSING HOME$ 10,000$ 833 HARBERT HILLS ACADEMY NURSING HOME$ 10,000$ 833 HARDIN COUNTY NURSING HOME$ 10,000$ 833 HARDIN HOME NURSING HOME$ 69,300$ 5,775 HARPETH TERRACE CONVALESCENT CENTER$ 96,800$ 8,066 HARTSVILLE CONVALESCENT CENTER$ 94,600$ 7,883 HCA PARKRIDGE MEDICAL CTR. SKILLED$ 10,000$ 833 HEALTH INN NURSING HOME$ 88,000$ 7,333 HEALTH INN, INC.$ 79,200$ 6,600 HELEN PATEBAIN HEALTH CARE CENTER$ 30,000$ 2,500 HENDERSONVILLE NURSING HOME$ 10,000$ 833 HENRY COUNTY NURSING HOME$ 169,400$ 14,116 HERITAGE CENTER$ 178,200$ 14,850 HERITAGE MANOR NURSING HOME$ 85,800$ 7,150 HERITAGE MANOR OF COLLIERVILLE$ 125,400$ 10,450 HERITAGE MANOR OF COLUMBIA$ 199,100$ 16,591 HERITAGE MANOR OF MEMPHIS$ 121,000$ 10,083 HERITAGE MANOR OF MONTEAGLE$ 165,000$ 13,750 HERITAGE MANOR OF RED BOILING SPRINGS$ 130,900$ 10,908 HERITAGE MANOR OF ROGERSVILLE$ 165,000$ 13,750 HERITAGE NURSING HOME, INC.$ 63,800$ 5,316 HICKMAN COUNTY HEALTH SERVICES, INC. NH$ 10,000$ 833 HIDDEN ACRES$ 66,000$ 5,500 HIGHLAND HOSPITAL SKILLED NURSING$ 10,000$ 833 HIGHLAND MANOR NURSING HOME$ 123,200$ 10,266 HILLCREST CENTRAL$ 190,300$ 15,858 HILLCREST NORTH$ 424,600$ 35,383 HILLCREST SOUTH$ 116,600$ 9,716 HILLCREST WEST$ 233,200$ 19,433 HILLHAVEN CONVALESCENT CENTER$ 30,000$ 2,500 HILLHAVEN CONVALESCENT CENTER$ 200,200$ 16,683 HILLHAVEN CONVALESCENT CENTER$ 105,600$ 8,800 HILLHAVEN CONVALESCENT CENTER-BOLIVAR$ 147,400$ 12,283 HILLHAVEN CONVALESCENT CENTER-CAMDEN$ 204,600$ 17,050 HILLHAVEN CONVALESCENT CENTER HUNTINGDON$ 204,600$ 17,050 HILLHAVEN CONVALESCENT CENTER GERMANTOWN$ 301,400$ 25,116 HILLHAVEN HEALTH CARE CENTER-RALEIGH$ 270,600$ 22,550 HILLHAVEN HEALTH CARE OF JEFFERSON CITY$ 204,600$ 17,050 HILLHAVEN/MARYVILLE CONVALESCENT CENTER$ 204,600$ 17,050 HILLSIDE MANOR$ 217,800$ 18,150 HILLVIEW HEALTH CARE CENTER$ 99,000$ 8,250 HILLVIEW NURSING HOME$ 77,000$ 6,416 HILLVIEW NURSING HOME, INC.$ 10,000$ 833 HUMBOLDT MANOR NURSING CENTER$ 88,000$ 7,333 HUMBOLDT NURSING HOME$ 132,000$ 11,000 HUMPHREYS COUNTY NURSING HOME, INC.$ 72,600$ 6,050 HUNTSVILLE MANOR$ 105,600$ 8,800 IMPERIAL MANOR CONVALESCENT CENTER$ 53,200$ 4,433 IVY HALL NURSING HOME$ 84,700$ 7,058 JACKSON MANOR, INC.$ 118,800$ 9,900 JACKSON PARK CHRISTIAN HOME$ 10,000$ 833 JACKSON MADISON HOSP/SKILLED NURSING$ 10,000$ 833 JANWYNELLA NURSING HOME, INC.$ 10,000$ 833 JEFFERSON COUNTY NURSING HOME$ 113,300$ 9,441 JOHN M. REED NURSING HOME$ 61,600$ 5,133 JOHNSON CARE HOME$ 10,000$ 833 JOHNSON'S HEALTH CARE CENTER, INC.$ 198,000$ 16,500 KINGS DAUGHTER & SONS HOME$ 118,800$ 91900 KIRBY PINES MANOR$ 20,000$ 1,666 KNOXVILLE CONVALESCENT CENTER$ 66,200$ 5,516 KNOXVILLE HEALTH CARE CENTER$ 192,500$ 16.041 LAFOLLETTE COMMUNITY NURSING HOME$ 107,800$ 8,983 LAKE CITY HEALTH CARE CENTER, INC.$ 134,200$ 11,183 LAKESHORE HEARTLAND NURSING HOME$ 10,000$ 833 LAKESHORE WEDGEWOOD NURSING HOME$ 10,000$ 833 LAUDERDALE HEALTH CARE CENTER$ 78,100$ 6,508 LAUGHLIN HEALTH CARE CENTER$ 99,000$ 8,250 LAUREL MANOR HEALTH CARE FACILITY$ 147,400$ 12,283 LAURELBROOK SANITARIUM$ 10,000$ 833 LAURELWOOD HEALTH CARE CENTER$ 80,300$ 6,691 LAWRENCEBURG HEALTH CARE CENTER$ 10,000$ 833 LAWRENCEBURG MANOR$ 167,200$ 13,933 LAYTON WATSON NURSING HOME$ 143,000$ 11,916 LEWIS COUNTY MANOR$ 122,100$ 10,175 LEXINGTON MANOR NURSING CENTER$ 133,100$ 11,091 LIFE CARE CENTER-TULLAHOMA$ $185,900$ 15,491 LIFE CARE CENTER OF ATHENS$ 140,800$ 11,733 LIFE CARE CENTER OF CHATTANOOGA$ 132,000$ 11,000 LIFE CARE CENTER OF CHURCH HILL$ 136,400$ 11,366 LIFE CARE CENTER OF COLLEGEDALE$ 136,400$ 11,366 LIFE CARE CENTER OF COPPER BASIN$ 133,100$ 11,091 LIFE CARE CENTER OF CROSSVILLE$ 119,900$ 9,991 LIFE CARE CENTER OF DONELSON$ 136,400$ 11,366 LIFE CARE CENTER OF EAST RIDGE$ 70,700$ 5,891 LIFE CARE CENTER OF ELIZABETHTON$ 173,800$ 14,483 LIFE CARE CENTER OF GREENEVILLE$ 177,100$ 14,758 LIFE CARE CENTER OF JEFFERSON CITY$ 110,000$ 9,166 LIFE CARE CENTER OF MORGAN COUNTY$ 136,400$ 11,366 LIFE CARE CENTER OF MORRISTOWN$ 177,100$ 14,758 LIFE CARE CENTER OF RED BANK$ 157,300$ 13,108 LIFE CARE CENTER-CLEVELAND$ 179,300$ 14,941 LIFE CARE CTR. OF BRUCETON HOLLOW ROCK$ 99,000$ 8,250 LIFE CARE WEST$ 158,400$ 13,200 LINCOLN & DONALSON CARE CENTERS$ 290,400$ 24,200 LITTLE CREEK SANITARIUM$ 10,000$ 833 LOUDON HEALTH CARE CENTER$ 209,000$ 17,416 MANOR HOUSE OF DOVER$ 96,800$ 8,066 MAPLEWOOD HEALTH CARE CENTER$ 171,600$ 14,300 MARGIE ANNA NURSING HOME, INC.$ 10,000$ 833 MARSHALL C. VOSS HEALTH CARE FACILITY$ 154,000$ 12,833 MARTIN HEALTH CARE$ 99,000$ 8,250 MASTERS HEALTH CARE CENTER$ 187,000$ 15,583 MAY CRAVATH WHARTON NURSING HOME$ 88,000$ 7,333 MCKENDREE VILLAGE, INC.$ 129,200$ 10,766 MCMINN MEMORIAL NURSING HOME$ 10,000$ 833 MCMINNVILLE HEALTH CARE CENTER$ 145,200$ 12,100 MCNAIRY COUNTY HEALTH CARE CENTER$ 96,800$ 8,066 MEADOWBROOK NURSING CENTER$ 91,300$ 7,608 MEHARRY MEDICAL COLLEGE HUBBARDHOSPITAL NH$ 10,000$ 833 MEMORIAL HOSP., SKILLED NURSING UNIT$ 10,000$ 833 MEMPHIS HEALTH CARE CENTER$ 198,000$ 16,500 MERIHILL HEALTH CARE CENTER$ 102,300$ 8,525 METHODIST HOSPITALS SKILLED CARE$ 10,000$ 833 METHODIST NURSING HOME OF MIDDLE TENN$ 10,000$ 833 MIDSOUTH CHRISTIAN NURSING HOME$ 150,800$ 12,566 MIDDLE TENNESSEE HEALTH CARE$ 169,400$ 14,116 MILAN HEALTH CARE, INC.$ 72,600$ 6,050 MISSION CONVALESCENT HOME$ 10,000$ 833 MONTGOMERY COUNTY NURSING HOME$ 132,000$ 11,000 MOUNTAIN CITY HEALTH CARE$ 132,000$ 11,000 MOUNTAIN CREEK MANOR$ 43,000$ 3,583 MOUNTAIN VIEW NURSING HOME$ 195,800$ 16,316 MURFREESBORO HEALTH CARE CENTER$ 199,100$ 16,591 NASHVILLE HEALTH CARE CENTER$ 88,200$ 7,350 NASHVILLE MANOR NURSING HOME$ 85,800$ 7,150 NASHVILLE METRO BORDEAUX NURSING HOME$ 699,600$ 58,300 NATIONAL HEALTH CARE CENTER OFLAWRENCEBURG$ 106,700$ 8,891 NATIONAL HEALTH CARE CENTER$ 117,700$ 9,808 NORTHHAVEN HEALTH CARE CENTER$ 105,600$ 8,800 NUCARE CONVALESCENT CENTER$ 60,500$ 5,041 NUCARE CONVALESCENT CENTER$ 156,200$ 13,016 NUCARE CONVALESCENT CENTER$ 10,000$ 833 OAK MANOR HEALTH CARE CENTER$ 60,500$ 5,041 OAK RIDGE HEALTH CARE CENTER$ 136,400$ 11,366 OAKVILLE HEALTH CARE CENTER$ 345,400$ 28,783 OAKWOOD HEALTH CARE CENTER$ 66,000$ 5,500 OBION COUNTY REST HOME$ 61,600$ 5,133 OVERTON COUNTY NURSING HOME$ 180,400$ 15,033 PALMYRA INTERMEDIATE CARE CENTER$ 60,500$ 5,041 PARIS MANOR NURSING CENTER$ 148,500$ 12,375 PARK REST HARDIN COUNTY HEALTH CENTER$ 68,200$ 5,683 PARKVIEW CONVALESCENT UNIT$ 124,300$ 10,358 PARKWOOD HEALTH CARE CENTER$ 213,400$ 17,783 PERRY COUNTY NURSING HOME$ 125,400$ 10,450 PICKETT COUNTY NURSING HOME$ 69,300$ 5,775 PINE RIDGE HEALTH CARE CENTER, INC.$ 101,200$ 8,433 PINNACLE CARE CENTER OF CASTLE HEIGHT'S$ 20,000$ 1,666 PULASKI HEALTH CARE CENTER$ 47,500$ 3,958 PURYEAR NURSING HOME$ 10,000$ 833 QUALITY CARE CENTER OF MEMPHIS$ 10,000$ 833 QUALITY CARE HEALTH CENTER$ 187,000$ 15,583 REELFOOT MANOR NURSING HOME$ 132,000$ 11,000 REGENCY HEALTH CARE CENTER$ 165,000$ 13,750 REGENCY HEALTH CARE CENTER$ 113,300$ 9,441 RESTHAVEN MANOR NURSING CENTER$ 35,300$ 2,941 RHEA NURSING HOME$ 97,900$ 8,158 RIDGETOP HAVEN$ 10,000$ 833 RIDGEVIEW TERRACE CONV. AND NURSING CENTER$ 145,200$ 12,100 RIDGEWOOD HEALTH CARE CENTER$ 136,400$ 11,366 RIVERMONT CONVALESCENT & NURSING CENTER$ 181,500$ 15,125 ROBERTSON COUNTY HEALTH CARE CENTER$ 132,000$ 11,000 ROCKWOOD HEALTH CARE CENTER$ 176,000$ 14,666 ROSEWOOD MANOR$ 232,100$ 19,341 ROSEWOOD MANOR OF COLUMBIA$ 66,000$ 5,500 ROYAL CARE INN OF ERIN, INC.$ 180,400$ 15,033 ROYAL CARE OF CLEVELAND$ 110,000$ 9,166 ROYAL CARE OF PIGEON FORGE$ 132,000$ 11,000 SCOTT COUNTY NURSING HOME$ 61,600$ 5,133 SEQUATCHIE HEALTH CARE CENTER$ 66,000$ 5,500 SERENE MANOR MEDICAL CENTER$ 82,500$ 6,875 SEVIER COUNTY HEALTH CARE CENTER, INC.$ 163,900$ 13,658 SHANNONDALE HEALTH CARE CENTER$ 90,600$ 7,550 SHELBY COUNTY HEALTH CARE CENTER$ 632,500$ 52,708 SMITH COUNTY HEALTH CARE CENTER$ 140,800$ 11,733 SMYRNA NURSING CENTER, INC.$ 97,900$ 8,158 SOMERVILLE HEALTH CARE CENTER$ 88,000$ 7,333 SPARTA HEALTH CARE CENTER$ 165,000$ 13,750 SPRING CITY HEALTH CARE CENTER$ 154,000$ 12,833 SPRING MEADOWS HEALTH CARE CENTER$ 92,400$ 7,700 SPRINGFIELD HEALTH CARE CENTER$ 117,700$ 9,808 ST. BARNABAS NURSING HOME$ 33,200$ 2,766 ST. FRANCIS HOSPITAL NURSING HOME$ 216,700$ 18,058 ST. PETER VILLA$ 16,500 STANDING STONE HEALTH CARE CENTER$ 125,400$ 10,450 STONES RIVER HOSPITAL SKILLED NURSING$ 10,000$ 833 SUNNY POINT HEALTH CARE CENTER$ 83,600$ 6,966 SWEETWATER VALLEY CONV. & NURSING HOME$ 124,300$ 10,358 SYCAMORE VIEW NURSING HOME$ 132,000$ 11,000 TENNESSEE CHRISTIAN MEDICAL CENTER SKILLED$ 10,000$ 833 THE ALLEN MORGAN NURSING CENTER$ 20,000$ 1,666 THE MEADOWS$ 30,000$ 2,500 THE WINDSOR HOUSE$ 106,700$ 8,891 THEO SPIVEY NURSING HOME$ 117,700$ 9,808 TREVECCA HEALTH CARE CENTER$ 264,000$ 22,000 TRI STATE MANOR$ 110,000$ 9,166 TRI COUNTY CONVALESCENT HOME$ 158,400$ 13,200 UNICOI COUNTY NURSING HOME$ 10,000$ 833 UNION CITY HEALTH CARE CENTER$ 132,000$ 11,000 UNION CITY MANOR NURSING CENTER$ 91,300$ 7,608 UNIVERSITY HEALTH CARE CENTER$ 10,000$ 833 VANAYER MANOR NURSING CENTER$ 132,000$ 11,000 VANCO MANOR NURSING CENTER$ 49,600$ 4,133 WARIOTA HEALTH CARE CENTER$ 74,800$ 6,233 WAYNE CARE NURSING HOME$ 10,000$ 833 WAYNE COUNTY NURSING HOME$ 119,900$ 9,991 WEAKLEY COUNTY NURSING HOME$ 152,900$ 12,741 WESLEY HIGHLAND MANOR$ 177,100$ 14,758 WEST END HEALTH CARE CENTER$ 10,000$ 833 WEXFORD HOUSE$ 143,000$ 11,916 WHITEHAVEN CARE CENTER$ 101,200$ 8,433 WOOD PRESBYTERIAN HOME, INC.$ 66,000$ 5,500 WOODBURY NURSING CENTER$ 101,200$ 8,433

History

• Authority: Public Chapter 953, Acts of 1992; T.C.A. §§68—11—201, 68—11—216, 67—1—901, 9—8—307(a)(0) and 4—5—201 et seq.
• Administrative History: Original rule filed August 30, 1990; effective October 14, 1990. Amendment filed September 25, 1991, effective November 9, 199L Repeal and new rule filed September 29, 1992; effective November 13, 1992.

Tenn. Comp. R. & Regs. 1200-28-01-.04 PAYMENT OF TAX

(1)The Department will issue after July 1, 1992 a single notice to each nursing home of the total amount of the tax due. This will constitute the only required notice. If the tax changes for any reason after July 1, 1992, the facility will be notified of the amount of the change in the tax.

(2)The nursing home tax shall be paid in equal monthly installments of one-twelfth (1/12) of the total tax.

Payments are due on or before the fifteenth of each month, beginning August 15, 1992 and ending July 15, 1993.

(3)If the tax is increased during the year due to an increase in the number of licensed beds, the amount of increase will be distributed equally across the remaining monthly for which the tax has not yet been paid. Accordingly, an adjusted bill shall be provided the nursing home.

(4)A payment shall be deemed to have been made upon the date of deposit in the United States mail.

History

• Authority: Public Chapter 953, Acts of 1992; T.C.A. §§68—11—201, 68—11—216, 67—1—901, 9—8—307(a)(0) and 4—5—201 et seq.
• Administrative History: . Original rule filed August 30, 1990, effective October 14, 1990. Amendment filed September 25, 1991; effective November 9, 1991. Repeal and new rule filed September 29, 1992, effective November 13, 1992.

Tenn. Comp. R. & Regs. 1200-28-01-.05 PENALTY AND INTEREST

A nursing home that fails to pay the required tax in accordance with this chapter shall pay the penalty imposed under Public Chapter 953, Acts of 1992. The penalty and interest shall be calculated based on total amount outstanding. The total amount outstanding shall be considered the amount(s) outstanding for all past installment period(s). The penalty and interest shall continue to accrue until the total tax due is paid along with any penalty and interest.

History

• Authority: Public Chapter 953, Acts of 1992; T.C.A. §§68—11—201, 68—11—216, 67—1—901, 9—8—307(a)(0) and 4—5—201 et seq.
• Administrative History: Original rule filed August 30,1990, effective October 14, 1990. Amendment filed September 25, 1991, effective November 9, 1991. Repeal and new rule filed September 29, 1992, effective November 13, 1992.

Tenn. Comp. R. & Regs. 1200-28-01-.06 CHALLENGES TO TAX

Any challenge to this tax shall be brought pursuant to T.C.A. §§67—1—901 et seq., and 9—8—307(a)(0).

History

• Authority: Public Chapter 953, Acts of 1992, T.C.A. §§68—11—201, 68—11—216, 67—1—901, 9—8—307(a)(0) and 4—5—201 et seq.
• Administrative History: Original rule filed August 30, 1990, effective October 14, 1990. Amendment filed September 25, 1991; effective November 9, 1991. Repeal and new rule filed September 29, 1992; effective November 13, 1992.

Chapter 1200-28-02 Annual Nursing Home Tax

Tenn. Comp. R. & Regs. 1200-28-02-.01 PURPOSE

The purpose of these regulations is to establish procedures for collection of the nursing home tax required by T.C.A. §68—11—216(d) for only those fiscal years for which the annual nursing home tax is statutorily authorized.

History

• Authority: Public Chapter 953, Acts of 1992; T.C.A. §§68—11—201, 68—11—216, 67—1—901, 9—8— 307(a)(0) and 4—5—201 et seq.
• Administrative History: Original rule filed August 30, 1990; effective October 14, 1990. Amendment filed September 25, 1991; effective November 9, 1991. Repeal and new rule filed September 29, 1992; effective November 13, 1992. Amendment filed November 15, 1993; effective March 30, 1994.

Tenn. Comp. R. & Regs. 1200-28-02-.02 DEFINITIONS

(1)The term “nursing home” shall have the same meaning as that found at T.C.A. §68—11— 201(15).

(2)The term “commissioner” means the Commissioner of the Department of Health or his designee.

(3)The term “department” means the Department of Health.

(4)The term “beds” means nursing home beds licensed by the State of Tennessee including those in state-owned or operated facilities but excluding beds specifically certified as intermediate care beds for the mentally retarded.

History

• Authority: Public Chapter 953, Acts of 1992; T.C.A. §§68—11—201, 68—11—216, 67—1—901, 9—8— 307(a)(0) and 4—5—201 et seq.
• Administrative History: Original rule filed August 30, 1990; effective October 14, 1990. Amendment filed September 25, 1991; effective November 9, 1991. Repeal and new rule filed September 29, 1992; effective November 13, 1992. Amendment filed November 15, 1993; effective March 30, 1994.

Tenn. Comp. R. & Regs. 1200-28-02-.03 CALCULATION OF TAX

(1)The nursing home tax shall be calculated as provided in T.C.A. §68—11—216(d).

(2)The beds to be used for the purpose of calculating the tax each year shall be the number of nursing home beds, except those certified for Medicaid as ICF/MR, licensed as of July 1 of each year.

(3)The nursing home tax shall be as follows:

(a)Twenty-six hundred dollars ($2,600) per bed licensed as of July 1 each year.

June, 2000 (Revised)p (b)Beds licensed after July 1 each year shall pay a prorated amount of the applicable annual tax so that the tax applies only for the days such new beds are licensed. The proration shall be calculated by multiplying the applicable tax by the percentage of days the beds are licensed during the year.

(4)Any change that reduces the number of licensed beds in a facility shall not result in a refund being issued to the nursing home.

History

• Authority: Public Chapter 953, Acts of 1992; T.C.A. §§68—11—201, 68—11—216, 67—1—901, 9—8—307(a)(0) and 4—5—201 et seq.
• Administrative History: Original rule filed August 30, 1990; effective October 14, 1990. Amendment filed September 25, 1991; effective November 9, 1991. Repeal and new rule filed September 29, 1992; effective November 13, 1992. Amendment filed November 15, 1993; effective March 30, 1994.

Tenn. Comp. R. & Regs. 1200-28-02-.04 PAYMENT OF TAX

(1)The Department will issue after July 1 each year a single notice to each nursing home of the total amount of the tax due. This will constitute the only required notice. If the tax changes for any reason after July 1 the facility will be notified of the amount of the change in the tax.

(2)The nursing home tax shall be paid in equal monthly installments of one-twelfth (1/12) of the total tax.

Payments are due on or before the fifteenth of each month, beginning August 15 each year and ending July 15 of the following year.

(3)If the tax is increased during the year due to an increase in the number of licensed beds, the amount of increase will be distributed equally across the remaining monthly for which the tax has not yet been paid. Accordingly, an adjusted bill shall be provided the nursing home.

(4)A payment shall be deemed to have been made upon the date of deposit in the United States mail.

History

• Authority: Public Chapter 953, Acts of 1992; T.C.A. §§68—11—201, 68—11—216, 67—1—901, 9—8—307(a)(0) and 4—5—201 et seq.
• Administrative History: Original rule filed August 30, 1990; effective October 14, 1990. Amendment filed September 25, 1991; effective November 9, 1991. Repeal and new rule filed September 29, 1992; effective November 13, 1992. Amendment filed November 15, 1993; effective March 30, 1994.

Tenn. Comp. R. & Regs. 1200-28-02-.05 PENALTY AND INTEREST

A nursing home that fails to pay the required tax in accordance with this chapter shall pay the penalty imposed under T.C.A. §68—11—216(d). The penalty and interest shall be calculated based on total amount outstanding. The total amount outstanding shall be considered the amount(s) outstanding for all past installment period(s). The penalty and interest shall continue to accrue until the total tax due is paid along with any penalty and interest.

History

• Authority: Public Chapter 953, Acts of 1992; T.C.A. §§68—11—201, 68—11—216, 67—1—901, 9—8—307(a)(0) and 4—5—201 et seq.
• Administrative History: Original rule filed August 30, 1990; effective October 14, 1990. Amendment filed September 25, 1991; effective November 9, 1991. Repeal and new rule filed September 29, 1992; effective November 13, 1992. Amendment filed November 15, 1993; effective March 30, 1994.

Tenn. Comp. R. & Regs. 1200-28-02-.06 CHALLENGES TO TAX

Any challenge to this tax shall be brought pursuant to T.C.A. §§67—1—901 et seq., and 9—8—307(a)(0).

History

• Authority: Public Chapter 953, Acts of 1992; T.C.A. §§68—11—201, 68—11—216, 67—1—901, 9—8—307(a)(0) and 4—5—201 et seq.
• Administrative History: Original rule filed August 30, 1990; effective October 14, 1990. Amendment filed September 25, 1991; effective November 9, 1991. Repeal and new rule filed September 29, 1992; effective November 13, 1992.

Chapter 1200-29-01 Transferred to 0720-45

Tenn. Comp. R. & Regs. 1200-29-01-.01 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201(15), and 71-5-1301, et seq.; and Public Chapter 425, Acts of 1993.
• Administrative History: Original rule filed October 26, 1992; effective December 10, 1992. Amendment filed March 7, 1994; effective May 21, 1994. Transferred to chapter 0720-45 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-29-01-.08 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-209, 68-11-201(13), and 71-5-101, et seq.; and Public Chapter 954, Acts of 1992.
• Administrative History: Original rule filed October 26, 1992; effective December 10, 1992. Transferred to chapter 0720-45 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-29-01-.02 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-209, 68-11-201(13), and 71-5-101, et seq.; and Public Chapter 954, Acts of 1992.
• Administrative History: Original rule filed October 26, 1992; effective December 10, 1992. Transferred to chapter 0720-45 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-29-01-.03 TRANSFERRED

History

• Authority: Public T.C.A. §§ 4-5-202, 4-5-204, 68-11-201(15), and 71-5-1301, et seq.; and Public Chapter 425, Acts of 1993.
• Administrative History: Original rule filed October 26, 1992; effective December 10, 1992. Amendment filed March 7, 1994; effective May 21, 1994. Transferred to chapter 0720-45 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-29-01-.04 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-209, 68-11-201(13), and 71-5-101, et seq.; and Public Chapter 954, Acts of 1992.
• Administrative History: Original rule filed October 26, 1992; effective December 10, 1992. Transferred to chapter 0720-45 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-29-01-.05 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201(15), and 71-5-1301, et seq.; and Public Chapter 425, Acts of 1993.
• Administrative History: Original rule filed October 26, 1992; effective December 10, 1992. Amendment filed March 7, 1994; effective May 21, 1994. Transferred to chapter 0720-45 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-29-01-.06 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201(15), and 71-5-1301, et seq.; and Public Chapter 425, Acts of 1993.
• Administrative History: Original rule filed October 26, 1992; effective December 10, 1992. Amendment filed March 7, 1994; effective May 21, 1994. Transferred to chapter 0720-45 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

Tenn. Comp. R. & Regs. 1200-29-01-.07 TRANSFERRED

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201(15), and 71-5-1301, et seq.; and Public Chapter 425, Acts of 1993.
• Administrative History: Original rule filed October 26, 1992; effective December 10, 1992. Amendment filed March 7, 1994; effective May 21, 1994. Transferred to chapter 0720-45 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022.

1200-30 Board of Alcohol and Drug Abuse Counselors

Chapter 1200-30-01 Rules Governing Licensure of Alcohol and Drug Abuse Counselors

Tenn. Comp. R. & Regs. 1200-30-01-.01 DEFINITIONS

(1) Advertising. Commercial communication which includes, but is not limited to, business solicitations with or without limiting qualifications, by a card, sign or device issued to a person; a sign or marking in or on any building; or, in any newspaper, magazine, directory or other printed material. Advertising also includes business solicitations communicated by an individual, radio, video or television broadcasting or any other means designed to secure public attention.

(2) Applicant. Any individual seeking licensure by the Board who has submitted an official application and paid the application fee.

(3) Board. The Board of Alcohol and Drug Abuse Counselors established by T.C.A. §§ 68-24- 604, et seq.

(4) Commissioner. The Commissioner of the Department of Health or his/her designee.

(5) Contact hour. Sixty (60) minutes in a required activity, including licensure experience and continuing education.

(6) Continuing education. Education beyond the basic initial licensure educational requirement which is related to the practice of alcohol and drug abuse counseling.

(7) Department. The Tennessee Department of Health, Division of Health Related Boards.

(8) Fee. Money, gifts, services or anything of value offered or received as compensation in return for rendering services; also, the required fee(s) pursuant to these rules.

(9) Good moral character. The quality of being well regarded in personal behavior and professional ethics.

(10) He/she, him/her. When “he” appears in the text of these rules, the word represents both the feminine and masculine genders.

(11) Hold oneself out. To represent one’s self to the public as having a particular status by means of stating on signs, mailboxes, address plates, letterhead, announcements, business cards or other instruments of professional identification.

(12) License. The document issued to an applicant who successfully completes the licensure process.

(13) Licensed Alcohol and Drug Abuse Counselor or “licensee”. Any person who has met the qualifications for licensed Alcohol and Drug Abuse Counselor and holds a current, unexpired, unsuspended or unrevoked license which has been lawfully issued by the Board.

(14) Licensure training supervision. On-going, direct clinical review for the purpose of training or teaching, by a qualified supervisor who supervises the performance of a person’s interaction with a client and provides regular documented face-to-face consultation, guidance and instructions with respect to the clinical skills and competencies of the person supervised.

Supervision may include, without being limited to, the review of case presentations, audio tapes, video tapes and direct observation.

(15) MAC. Master Addiction Counselor.

(16) NAADAC. The National Association for Addiction Professionals.

(17) Qualified Clinical Supervisor. A person who meets the requirements for a qualified clinical supervisor, as defined in Rule 1200-30-01-.10(2) or (3).

(18) Retirement. Voluntary deactivation of the Board issued license.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-24-602, 68-24-603, 68-24-604, 68-24-605, and 68-24-606.
• Administrative History: Original rule filed May 25, 1994; effective August 9, 1994. Repeal and new rule filed January 30, 1997; effective May 30, 1997. Repeal and new rule filed December 28, 1999; effective March 12, 2000. Amendment filed August 19, 2002; effective November 2, 2002. Amendments filed November 2, 2005; effective January 16, 2006. Amendment filed March 27, 2015; effective June 25, 2015. Amendments filed February 6, 2017; effective May 7, 2017.

Tenn. Comp. R. & Regs. 1200-30-01-.02 SCOPE OF PRACTICE

(1) A Level I Licensed Alcohol and Drug Abuse Counselor may provide alcohol and drug abuse counseling services in an alcohol and drug abuse treatment program or a recovery support program, or any program providing alcohol and drug abuse services other than a private practice in which the Level I Licensed Alcohol and Drug Abuse Counselor is self-employed.

Such services shall include the eight (8) domains listed in T.C.A. § 68-24-606.

(2) A Level II Licensed Alcohol and Drug Abuse Counselor may provide alcohol and drug abuse counseling services in an alcohol and drug abuse treatment program or a recovery support program, or any program providing alcohol and drug abuse services or in private practice.

Such services shall include the eight (8) domains listed in T.C.A § 68-24-606. A Level II Licensed Alcohol and Drug Abuse Counselor may apply to the Board to become a Qualified Clinical Supervisor after meeting the Board’s requirements for such credential.

(3) Counseling for alcohol and other drugs of abuse includes: the evaluation and treatment of problems, misperceptions and misconceptions of persons who abuse mood-altering chemicals. Counseling for alcohol and other drugs of abuse includes the provision of the eight (8) domains listed in T.C.A. § 68-24-606.

(4) Both Level I and Level II Licensed Alcohol and Drug Abuse Counselors may evaluate and treat persons who have been significantly affected by compulsive gambling disorder as long as the licensee has completed no less than sixty (60) additional hours of specialized Boardapproved education related to compulsive gambling disorder, annual continuing education hours or a combination thereof. The licensee’s clinically supervised counseling experience must have included contact with no less than ten (10) patients impacted by a compulsive gambling disorder under the supervision of a supervisor who had obtained no less than sixty (60) formal classroom hours of instruction related to compulsive gambling disorder.

(5) Nothing in this chapter shall be construed as permitting any person licensed as a Licensed Alcohol and Drug Abuse Counselor to perform psychological testing intended to measure and/or diagnose mental illness. Consistent with each counselor’s formal education and training, licensees may administer and utilize appropriate assessment instruments which identify elements of perceptual inability to recognize empirical facts, problems of appropriately displaying emotions and inappropriate responses to the environment of individuals, couples and families as part of the alcohol and other drugs of abuse therapy process or in the development of a treatment plan in the context of chemical abuse systems.

(6) Nothing in this chapter shall be construed as permitting an individual licensed as a Licensed Alcohol and Drug Abuse Counselor to administer, dispense, or prescribe drugs or in any manner engage in the practice of medicine as defined by Tennessee Law.

(7) The professional practice domains and transdisciplinary competencies in which Licensed Alcohol and Drug Abuse Counselors may engage are as follows:

(a) Clinical Evaluation;

(b) Treatment Planning;

(c) Referral;

(d) Service Coordination;

(e) Counseling;

(f) Client, family, and community education;

(g) Documentation; and, (h) Professional and ethical responsibilities.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, and 68-24-605 through 68-24-609.
• Administrative History: Original rule filed May 25, 1994; effective August 9, 1994. Repeal and new rule filed January 30, 1997; effective May 30, 1997. Repeal and new rule filed December 28, 1999; effective March 12, 2000. Amendment filed August 5, 2011; effective November 3, 2011. Repeal and new rule filed March 27, 2015; effective June 25, 2015.

Tenn. Comp. R. & Regs. 1200-30-01-.03 NECESSITY OF LICENSURE

(1) Only persons who are licensed by the Board may represent themselves or practice as Licensed Alcohol and Drug Abuse Counselors or hold themselves out to the public as being licensed by means of using a title on signs, mailboxes, address plates, letterheads, announcements, telephone listings, business cards, or other instruments of professional identification.

(2) No person shall hold himself out to the public by a title or description of services incorporating the words licensed Alcohol and Drug Abuse Counselor unless he is licensed by the Board.

Nothing in this rule shall prohibit a person from stating or using the educational degrees which he has obtained.

(3) The provisions of this chapter do not apply to a person who is preparing for the practice of alcohol and drug abuse counseling under a qualified supervisor in a training institution or facility or supervisory arrangement pursuant to these rules and such person is designated by such titles as “alcohol and drug abuse counseling intern”, “alcohol and drug abuse counseling trainee” or other designations clearly indicating a training status.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-24-605, and 68-24-606.
• Administrative History: Original rule filed May 25, 1994; effective August 9, 1994. Repeal and new rule filed January 30, 1997; effective May 30, 1997. Repeal and new rule filed December 28, 1999; effective March 12, 2000. Amendment filed March 27, 2015; effective June 25, 2015.

Tenn. Comp. R. & Regs. 1200-30-01-.04 QUALIFICATIONS FOR LICENSURE

(1) Licensure by examination.

(a) Prior to submitting an application to become a Level I Licensed Alcohol and Drug Abuse Counselor, each of the following minimum qualifications must be met:

1. The applicant must have attained twenty-one (21) years of age.

2. The applicant must be highly regarded as possessing good moral character and professional ethics, as specified in Rule 1200-30-01-.13.

3. The applicant must have a high school diploma or a high school equivalency diploma.

4. The applicant must have completed six thousand (6000) hours of experience where the applicant has performed all of the eight (8) domains, as listed in T.C.A. § 68-24-606, while providing alcohol and drug abuse counseling services under the direct supervision of a Qualified Clinical Supervisor who meets the requirements of the rules of the Board.

5. The applicant must have completed two hundred seventy (270) total hours of alcohol and drug abuse counseling education and training within the eight domains, as listed in T.C.A. § 68-24-606. Six (6) hours of the 270 total hours of education shall pertain to alcohol and drug abuse counseling professional ethics.

6. The applicant must have completed a written philosophy of treatment, as defined in the licensure application.

7. The applicant must pass a jurisprudence examination approved by the Board.

8. The applicant must pass the National Certified Addiction Counselor (NCAC)

Level I written examination that is administered by the National Certification Commission for Addiction Professionals (NCC AP) or the Master Addiction Counselor (MAC) written examination.

(b) Prior to submitting an application to become a Level II Licensed Alcohol and Drug Abuse Counselor, each of the following minimum qualifications must be met:

1. The applicant must have attained twenty-one (21) years of age.

2. The applicant must be highly regarded as possessing good moral character and professional ethics, as specified in Rule 1200-30-01-.13.

3. The applicant must:

(i) Have a bachelor’s degree in a behavioral health related field or higher level degree in a non-behavioral health related field from an accredited institution of higher learning, and submit an official transcript, have completed two (2) years of full time or four thousand (4000) hours of experience while providing alcohol and drug abuse counseling services under the direct supervision of a Qualified Clinical Supervisor who meets the requirements of the rules of the Board and have alcohol and drug abuse counseling education and training within the eight domains, as listed in T.C.A. § 68-24-606; OR (ii) Have a master’s or higher level degree in a behavioral health related field from an accredited institution of higher learning, and submit an official transcript, and have completed one (1) year of full time experience or two thousand (2000) hours of experience while providing alcohol and drug abuse counseling services under the direct supervision of a Qualified Clinical Supervisor who meets the requirements of the rules of the Board and have alcohol and drug abuse counseling education and training within the eight domains, as listed in T.C.A. § 68-24-606.

4. The applicant must have completed a written philosophy of treatment, as defined in the licensure application.

5. The applicant must pass a jurisprudence examination approved by the Board.

6. The applicant must pass the National Certified Addiction Counselor (NCAC)

Level II written examination that is administered by the National Certification Commission for Addiction Professionals (NCC AP) or the Master Addiction Counselor (MAC) written examination.

7. Each person currently licensed in good standing as a Licensed Alcohol and Drug Abuse Counselor before January 1, 2016 shall thereafter be licensed as a Level II Licensed Alcohol and Drug Abuse Counselor. The Board will not impose any additional fee or require any additional application for the issuance of a license pursuant to this section.

(c) Education. The education requirement must be completed prior to the date of application.

1. The Level I applicant must:

(i) Have a high school diploma or a high school equivalency diploma, a certified or notarized copy of which is to be included in the application.

(ii) Have completed two hundred seventy (270) total hours of alcohol and drug abuse counseling education and training within the eight (8) domains, as listed in T.C.A. § 68-24-606 while providing alcohol and drug abuse counseling services under the direct supervision of a Qualified Clinical Supervisor. Six (6) hours of the 270 total hours of education shall pertain to alcohol and drug abuse counseling professional ethics. There is no time limit in which this education must have been obtained.

2. The Level II applicant must:

(i) Have a bachelor’s degree in a behavioral health related field or higher level degree in a non-behavioral health related field from an accredited institution of higher learning, and submit an official transcript, have completed two (2) years of full time or four thousand (4000) hours of experience while providing alcohol and drug abuse counseling services under the direct supervision of a Qualified Clinical Supervisor who meets the requirements of the rules of the Board and have completed (270) total hours of alcohol and drug abuse counseling education and training within the eight domains, as listed in T.C.A. § 68-24-606. There is no time limit in which the two hundred seventy (270) total hours of alcohol and drug abuse counseling education and training within the eight (8) domains must have been obtained; OR (ii) Have a master’s or higher level degree in a behavioral health related field from an accredited institution of higher learning, and submit an official transcript, and have completed one (1) year of full time experience or two thousand (2000) hours of experience while providing alcohol and drug abuse counseling services under the direct supervision of a Qualified Clinical Supervisor who meets the requirements of the rules of the Board and have completed (270) total hours of alcohol and drug abuse counseling education and training within the eight domains, as listed in T.C.A. § 68-24-606. There is no time limit in which the two hundred seventy (270) total hours of alcohol and drug abuse counseling education and training within the eight (8) domains must have been obtained.

3. Applicants must furnish documentation of six (6) contact hours of education in ethics. This six (6) hour requirement may be part of the two hundred and seventy (270) contact hours of education required for licensure.

4. Applicants seeking to evaluate and treat persons who have been significantly affected by compulsive gambling disorder under Rule 1200-30-01-.02(2) shall have no less than sixty (60) additional hours of specialized education relating to compulsive gambling disorder. Such education shall be in the form of formal classroom hours, annual continuing education hours, or a combination of such hours.

(d) Experience.

1. The Level I applicant must have completed six thousand (6000) hours of experience during which the applicant has performed all of the eight (8) domains, as listed in T.C.A. § 68-24-606, over a time period of a minimum of three (3) years, which may be paid or “volunteer” (unpaid), or a combination thereof, while providing alcohol and drug abuse counseling services under the direct supervision of a Qualified Clinical Supervisor who meets the requirements of the rules of the Board.

2. The Level II applicant must:

(i) Have a bachelor’s degree in a behavioral health related field or higher level degree in a non-behavioral health related field from an accredited institution of higher learning, and have completed two (2) years of full time or four thousand (4000) hours of experience while providing alcohol and drug abuse counseling services under the direct supervision of a Qualified Clinical Supervisor who meets the requirements of the rules of the Board;

OR (ii) Have a master’s or higher level degree in a behavioral health related field from an accredited institution of higher learning, and have completed one (1) year of full time experience or two thousand (2000) hours of experience while providing alcohol and drug abuse counseling services under the direct supervision of a Qualified Clinical Supervisor who meets the requirements of the rules of the Board.

3. In order for “volunteer” (unpaid), clinically supervised counseling experience to be given credit, the “volunteer” experience must have been accrued in a facility or agency where the institution or agency head authorized the volunteer program, specifically appointed/designated in writing the person as a participant in that volunteer program, and where the services and duties were performed and supervised pursuant to written guidelines, i.e., a “job description”.

4. Applicants seeking to evaluate and treat persons who have been significantly affected by compulsive gambling disorder under Rule 1200-30-01-.02(2) shall provide evidence that a portion of the clinically supervised counseling experience included contact with no less than ten (10) patients impacted by a compulsive gambling disorder.

(e) An applicant shall successfully complete the examinations as required in Rule 1200-30- 01-.08. The applicant shall also provide to the Board an authorization for release of examination scores along with his/her application.

(2) Individuals seeking licensure by reciprocity as a Level I or Level II Licensed Alcohol and Drug Abuse Counselor must meet the following qualifications:

(a) The applicant must have attained twenty-one (21) years of age.

(b) The applicant must be highly regarded as possessing good moral character and professional ethics, as specified in rule 1200-30-01-.13.

(c) The applicant must hold a current license or equivalent from another state. The other state’s standards for licensure must be comparable to or exceed the requirements for the level of licensure sought in Tennessee.

(d) An applicant shall successfully complete the jurisprudence examination as required in

Rule 1200-30-01-.08.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-24-602, 68-24-603, 68-24-605, 68-24-606, and 68-24-608.
• Administrative History: Original rule filed May 25, 1994; effective August 9, 1994. Repeal and new rule filed January 30, 1997; effective May 30, 1997. Repeal and new rule filed December 28, 1999; effective March 12, 2000. Amendment filed June 15, 2004; effective August 29, 2004. Amendments filed August 5, 2011; effective November 3, 2011. Amendments filed March 27, 2015; effective June 25, 2015. Amendments filed February 6, 2017; effective May 7, 2017.

Tenn. Comp. R. & Regs. 1200-30-01-.05 LICENSURE PROCESS

(1) To become licensed as an Alcohol and Drug Abuse Counselor in Tennessee an applicant must comply with the following procedures and requirements:

(a) Licensure by examination.

1. An application packet shall be requested from the Department.

2. Applications will be accepted by the Board administrator throughout the year.

Supporting documents required by the application instructions and these rules must be received by the Board administrator within sixty (60) days of receipt of the application or the file will be closed and to resume the licensure process a new application must be filed. Application files which are completed on or before the thirtieth (30th) day prior to a Board meeting will ordinarily be processed at that meeting.

3. An applicant shall respond truthfully and completely to every question or request for information contained in the application form. The applicant shall submit the application along with all required documentation and fees to the Board. It is the intent of this rule that all steps necessary to accomplish the filing of the required documentation be completed prior to filing an application and that all documentation be filed simultaneously.

4. At the time the application is submitted, an applicant shall pay the nonrefundable application fee as provided in these rules.

5. An applicant shall submit a certified copy of his birth certificate which indicates that the applicant is at least twenty-one (21) years of age at the time of application.

6. An applicant shall attach to his application a signed passport style photograph taken within the preceding twelve (12) months. The back of the photograph is to be signed by the applicant.

7. An applicant shall submit evidence of good moral character and professional ethics. Such evidence shall include two (2) recent (dated within the preceding twelve (12) months), original, signed letters from mental health professionals, one of which must be a licensed Alcohol and Drug Abuse Counselor in good standing, attesting to the applicant’s personal character and professional ethics and typed on the signator’s letterhead. The applicant shall also submit a signed and notarized affidavit stating the applicant is in compliance with alcohol and drug abuse counselor ethical standards and these rules.

8. A Level I applicant shall submit verification of having completed a minimum of three (3) years clinically supervised substance abuse counseling experience (6000 contact hours) during which all eight (8) domains have been performed pursuant to T.C.A. § 68-24-606. This experience may have been acquired at any time prior to the submission of the application. The Board may ask for additional documentation to substantiate this required experience. Actual time spent in a recognized counselor internship or counselor trainee program may be substituted for up to one (1) of the three (3) years of experience.

9. For Level II applicants:

(i) Have a bachelor’s degree in a behavioral health related field or higher level degree in a non-behavioral health related field from an accredited institution of higher learning, and submit an official transcript, have completed two (2) years of full time or four thousand (4000) hours of experience while providing alcohol and drug abuse counseling services under the direct supervision of a Qualified Clinical Supervisor who meets the requirements of the rules of the Board and have completed two hundred seventy (270) total hours of alcohol and drug abuse counseling education and training within the eight domains, as listed in T.C.A. § 68-24- 606.

(ii) Have a master’s or higher level degree in a behavioral health related field from an accredited institution of higher learning, and submit an official transcript, and have completed one (1) year of full time experience or two thousand (2000) hours of experience while providing alcohol and drug abuse counseling services under the direct supervision of a Qualified Clinical Supervisor who meets the requirements of the rules of the Board and have completed two hundred seventy (270) total hours of alcohol and drug abuse counseling education and training within the eight domains, as listed in T.C.A. § 68-24-606.

10. An applicant shall submit a notarized photocopy of his high school diploma or high school equivalency diploma. If the applicant indicates holding a college degree, the applicant must request that a transcript from his degree granting institution be submitted directly from the school to the Board. The institution granting the degree must have been accredited at the time the degree was granted. The transcript must show that the degree has been conferred and carry the official seal of the institution and reference the name under which the applicant has applied for licensure.

11. An applicant shall successfully complete the examinations as required by Rule

Tenn. Comp. R. & Regs. 1200-30-01-.06 FEES

(1) The fees authorized by statute are established by the Board as follows:

(a) Application Fee. A nonrefundable fee to be paid by all applicants including those seeking licensure by reciprocity. It must be paid each time an application for licensure is filed. The application fee shall accompany a submitted application, as set out in these rules.

(b) Endorsement/Verification Fee. A nonrefundable fee for each certification of legal, documented, written verification of an individual’s record.

(c) Late Renewal Fee. A nonrefundable fee to be paid when an individual fails to timely renew a license.

(d) License Fee. A nonrefundable fee to be paid prior to the issuance of the license.

(e) Reinstatement Fee. A nonrefundable fee to be paid by all individuals each time a reinstatement application is filed.

(f) Renewal Fee. A nonrefundable fee to be paid biennially by all licensees. This fee also applies to individuals who reactivate a retired or lapsed license.

(g) Replacement License Fee. A nonrefundable fee to be paid when an individual requests a replacement for a lost or destroyed license.

(h) State Regulatory Fee. A nonrefundable fee to be paid by all licensees upon application and biennially upon renewal.

(2) Except for the renewal fees processed online via the Internet, all fees established by paragraph (3) of this rule must be submitted to the Board by certified or personal check or postal money order. Such checks or money orders are to be made payable to the Board of Alcohol and Drug Abuse Counselors.

(3) Fee Schedule.

Type Amount (a) Application Fee $250.00 (b) Endorsement/Verification Fee $ 30.00 (c) Late Renewal Fee $ 90.00 (d) License Fee $ 50.00 (e) Reinstatement Fee $100.00 (f) Renewal (Biennial) Fee $325.00 (g) Replacement License Fee $ 35.00 (h) State Regulatory Fee $ 10.00

History

• Authority: T.C.A. §§ 4-3-1011, 4-5-202, 4-5-204, 68-24-602, 68-24-603, 68-24-605, and 68-24-606.
• Administrative History: Original rule filed May 25, 1994; effective August 9, 1994. Repeal and new rule filed January 30, 1997; effective May 30, 1997. Repeal and new rule filed December 28, 1999; effective March 12, 2000. Amendment filed August 19, 2002; effective November 2, 2002. Amendment filed September 17, 2004; effective December 1, 2004. Amendment filed November 26, 2008; effective February 9, 2009. Amendments filed February 6, 2017; effective May 7, 2017.

Tenn. Comp. R. & Regs. 1200-30-01-.07 APPLICATION REVIEW, APPROVAL, DENIAL, INTERVIEW

(1) Initial review of each application to determine whether or not the application file is complete may be delegated to the Board’s administrator, provided that final approval of the application is ratified by the Board. In no event may an application be finally approved or denied without ratification by the Board.

(2) If an application is incomplete when received by the Board or the reviewing member determines additional information is required from an applicant before an initial determination can be made, the Board shall notify the applicant of the information required. The applicant shall cause the requested information to be received by the Board on or before the sixtieth (60th) day after receipt of the notification.

(a) Such notification shall be sent by certified mail return receipt requested.

(b) If the requested information is not timely received, the application shall be closed and the applicant notified. No further action shall take place until a new application is received pursuant to the rules governing the licensure process, including another payment of all fees.

(3) If a completed application is initially denied by the reviewing Board member, the applicant shall be informed of the initial decision and that a determination shall be made by the Board at its next meeting. If the Board confirms the initial denial, the following shall occur:

(a) A notification of the denial shall be sent to the applicant by certified mail return receipt requested. Specific reasons for denial will be stated, such as incomplete information, unofficial records, examination failure or other matters rendering the application insufficient for licensure and such notification shall contain all the specific statutory or

rule authorities for the denial.

(b) The notification, when appropriate, shall contain a statement which sets forth the applicant’s right to request a hearing pursuant to the Tennessee Administrative Procedures Act (T.C.A. §§ 4-5-301, et seq.) to contest the denial and the procedure necessary to perfect the appeal.

1. An applicant has a right to a contested case hearing only if the licensure denial was based on subjective or discretionary criteria.

2. An applicant may be granted a contested case hearing if licensure denial is based on an objective, clearly defined criteria only if, after review and attempted resolution by the Board, the licensure application cannot be approved and the reasons for continued denial present a genuine issue of fact and/or law which is appropriate for appeal.

3. Any appeal request must be made in writing to the Board within thirty (30) days of the receipt of the notice of denial.

(4) After review of the application, an applicant may be asked to appear before the Board for an interview.

(5) The initial determination procedures of this rule will not apply if the full Board reviews and makes final determination on the application during its meeting.

(6) The Board may delay a decision on eligibility to take the written examination for any applicant for whom additional clarifying information is needed. The Board shall make this request for additional information in writing within sixty (60) days from the date of the official review of the application.

(7) If the Board finds it has erred in the issuance of a license, it will give written notice by certified mail of the intent to revoke the license. The notice will allow the applicant the opportunity to meet the requirements of licensure within thirty (30) days from date of receipt of the notification. If the applicant does not concur with the stated reason(s) and the intent to revoke the license, the applicant shall have the right to a contested case hearing as provided by these rules.

(8) Abandonment of Application.

(a) An application shall be deemed abandoned and the file closed if:

1. The application has not been completed by the applicant within one hundred and twenty (120) days after it was initially reviewed and received by the Board; or 2. The applicant fails to pass the written examination within twelve (12) months after being notified of eligibility.

(b) An application submitted subsequent to the abandonment of a prior application shall be treated as a new application.

(9) Request to re-open application - When an application has been closed pursuant to paragraph (8) of this rule, the Board may consider re-opening the application upon receipt of a written request and appropriate notarized documentation from the applicant stating the extenuating circumstances and/or the medical condition that caused the Board’s deadline to not be met.

If applicable, a letter must accompany such request from the applicant’s personal physician attesting to the medical condition that caused the Board’s deadline to not be met.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-24-602, 68-24-603, and 68-24-605.
• Administrative History: Original rule filed May 25, 1994; effective August 9, 1994. Repeal and new rule filed January 30, 1997; effective May 30, 1997. Repeal and new rule filed December 28, 1999; effective March 12, 2000. Amendment filed July 31, 2000; effective October 14, 2000. Amendment filed November 26, 2008; effective February 9, 2009. Amendments filed February 6, 2017; effective May 7, 2017.

Tenn. Comp. R. & Regs. 1200-30-01-.08 EXAMINATIONS

In addition to having filed an application, an individual seeking licensure by examination as a Level I Licensed Alcohol and Drug Abuse Counselor shall be required to successfully complete the Board’s written and jurisprudence examinations. An individual seeking licensure by examination as a Level II Licensed Alcohol and Drug Abuse Counselor must meet all educational requirements and shall be required to successfully complete the Board’s written and jurisprudence examinations.

(1) Written examination.

(a) The written examination adopted by the Board is the examination developed by NAADAC and administered by its designated testing agency.

(b) The Board shall include with its application materials information regarding the written examination.

(c) Passing scores on the examination are determined by NAADAC and are adopted by the Board as constituting successful completion of the written examination.

(d) NAADAC will notify both the Board and the candidate of his or her passing or failing status.

(2) Jurisprudence Examination. All applicants for licensure must successfully complete the Board's jurisprudence examination as a prerequisite to licensure.

(a) The Board shall include a jurisprudence examination with all applications for licensure that are mailed from the Board’s administrative office, or the applicant may obtain the jurisprudence examination from the Board’s Internet web page that can be accessed at www.Tennessee.gov.

(b) The applicant shall include a completed jurisprudence examination when his/her completed application for licensure is returned to the Board’s administrative office.

(c) There is no fee for the jurisprudence examination.

(d) The scope and content of the examination shall be determined by the Board but limited to statutes and regulations governing the practice of alcohol and drug abuse counselors (T.C.A. §§ 68-24-604, et seq., and Chapter 1200-30-01 of the rules of the Tennessee Department of Health) and the NAADAC Code of Ethics. Copies of the applicable statutes, regulations, and the NAADAC Code of Ethics are available upon request from the Board’s administrative office.

(e) The format of the examination shall be “open-book.”

(f) Correctly answering ninety percent (90%) of the examination questions shall constitute successful completion of the jurisprudence exam.

(3) Re-examination.

(a) Written Examination. Applicants who fail to pass the written examination may apply to NAADAC for re-examination. Hand-scoring and/or appeal questions are to be directed to NAADAC.

(b) Jurisprudence Examination.

1. Applicants who fail to successfully complete the jurisprudence examination must continue to retake the examination until it has been successfully completed before the application will be deemed complete and presented to the Board for review.

2. It is not required that an applicant repeat the written examination in order to repeat the jurisprudence examination.

(4) If an applicant neglects, fails, or refuses to take any of the required examinations or fails to successfully complete the examinations within twelve (12) months after being approved, the application will be deemed abandoned. Such applicant may thereafter make a new application accompanied by the required fee. The applicant shall meet the requirements in effect at the time of the new application.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-24-602, 68-24-603, 68-24-605, 68-24-606, and 68-24-608.
• Administrative History: Original rule filed May 25, 1994; effective August 9, 1994. Repeal and new rule filed January 30, 1997; effective May 30, 1997. Repeal and new rule filed December 28, 1999; effective March 12, 2000. Amendment filed August 19, 2002; effective November 2, 2002. Amendment filed June 15, 2004; effective August 29, 2004. Amendment filed November 26, 2008; effective February 9, 2009. Amendments filed March 27, 2015; effective June 25, 2015. Amendments filed February 6, 2017; effective May 7, 2017.

Tenn. Comp. R. & Regs. 1200-30-01-.09 RENEWAL OF LICENSE

(1) Renewal application.

(a) The due date for license renewal is the expiration date indicated on the licensee’s renewal certificate.

(b) Methods of Renewal 1. Internet Renewals - Individuals may apply for renewal and pay the necessary fees via the Internet. The application to renew can be accessed at: https://apps.tn.gov/hlrs/ 2. Paper Renewals - For individuals who have not renewed their license online via the Internet, a renewal application form will be mailed to each individual licensed by the Board to the last address provided to the Board. Failure to receive such notification does not relieve the licensee from the responsibility of meeting all requirements for renewal.

(c) To be eligible for renewal, an individual must submit the following to the Board on or before the expiration date:

1. A completed and signed renewal application form; and 2. The biennial renewal fees as provided in these rules.

(d) Renewals may be issued administratively or by the Board.

(e) Licensees who fail to comply with the renewal rules or notification received by them concerning failure to timely renew shall have their licenses processed pursuant to rule

Tenn. Comp. R. & Regs. 1200-30-01-.10 SUPERVISION

(1) Pursuant to Rule 1200-30-01-.04, an applicant for licensure as a Level I or Level II Licensed Alcohol and Drug Abuse Counselor shall present documentation, at the time the application is submitted, of completion of clinical experience hours that have been supervised by a supervisor who meets the requirements of paragraph (2) or (3).

(a) One hundred (100) hours of the six thousand (6000) hour requirement shall be face-toface supervision.

1. No more than fifty (50) hours of the one hundred (100) hours may occur during any calendar year in which part of the six thousand (6000) supervised hours transpire.

2. No less than twelve (12) hours of the one hundred (100) hours may occur during any calendar year in which part of the six thousand (6000) supervised hours transpire.

(b) Group supervision may occur provided that the applicant has a minimum of six (6) face-to-face individual supervision hours per year.

(c) A Supervisor seeking to supervise an alcohol and drug abuse counselor subject to

Rule 1200-30-01-.04(1)(d)4. shall obtain no less than sixty (60) formal classroom hours of instruction related to compulsive gambling disorder prior to undertaking such supervision.

(d) Documentation includes, but is not limited to, dates of supervision, beginning and ending times, names of clinicians present, topic areas discussed, clinical recommendations, follow-up on previous recommendations, professional issues/concerns, professional development needs/accomplishments, and number of cases reviewed per clinical participant with signatures of supervisor and all supervision participants.

(e) The supervisor shall follow methods of supervision used in accordance with a standard practice (e.g., Family Systems, Transactional Analysis, Reality Therapy, Gestalt, Psychodrama, etc.) or a combination of standard practices of the supervisor's choice.

(f) The supervisor shall maintain copies of records of supervision for eight (8) years. This documentation must be produced for inspection and verification, if requested in writing by the Board during its verification process.

(g) Failure to conduct supervision in accordance with these rules or falsification of the records of supervision is considered a breach of professional conduct and may result in disciplinary action as provided in Rule 1200-30-01-.15.

(2) Before supervision may begin, the supervisor of an applicant for licensure as an alcohol and drug abuse counselor shall obtain from the Board a Certificate of Qualified Clinical Supervision by meeting the following requirements:

(a) The supervisor has been a Level II Licensed Alcohol and Drug Abuse Counselor for at least five (5) years. The supervisor’s license must be currently active, unencumbered, and unconditioned, and the supervisor must cease supervising if his or her license becomes encumbered and/or conditioned; and (b) The supervisor has two (2) years of experience supervising alcohol and drug abuse counselors and has received thirty six (36) contact (clock) hours of supervision (by a qualified supervisor) of his or her supervisory work by supervision of at least one (1) person doing alcohol and drug abuse counseling and has obtained a minimum of thirty (30) hours of training specific to alcohol and drug clinical supervision, including six (6) hours of supervision ethics.

(3) An applicant whose supervisor meets the requirements of paragraph (2) but is not licensed in Tennessee as an alcohol and drug abuse counselor may submit, with the licensure application, an approval request to the Board that documents the supervisor’s qualifications.

This request must include means by which verification of the qualifications may be independently confirmed (e.g., contact data for other state licensing or certification agencies, NAADAC, or proof of supervision).

(4) Supervision that is consistent with the regulations that were effective prior to the effective date of this rule amendment will be accepted as qualified supervision.

(a) Licensees providing clinical supervision when these rules become effective will be permitted to continue supervising applicants whose supervision had already begun.

(b) Under no circumstances shall a licensee begin providing new clinical supervision without meeting the requirements of paragraphs (2) or (3).

(5) Conflict of Interest - Supervision provided by the applicant's parents, spouse, former spouse, siblings, children, cousins, in-laws (present or former), aunts, uncles, grandparents, grandchildren, stepchildren, employees, present or former counselor, present or former romantic partner, or anyone sharing the same household shall not be acceptable toward fulfillment of licensure requirements. Any exceptions must be approved by the Board prior to such supervision. For the purposes of this rule, a supervisor shall not be considered an employee of the applicant, if the only compensation received by the supervisor consists of payments for the actual supervisory hours.

(6) Accountability – In all cases the specific terms of the supervisory arrangement are the responsibility of the qualified supervisor upon whom it is incumbent to assure appropriate supervisory time. Likewise, it is the responsibility of the applicant to obtain supervision. The education, training, experience, and ongoing performance of the applicant must be considered by the supervisor. The arrangements for supervision must be agreed to by both the qualified supervisor and the applicant. Ultimately, the qualified supervisor of record must protect the welfare of the client and assure compliance with Tennessee law and professional ethics.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-24-605, and 68-24-608.
• Administrative History: Original rule filed May 25, 1994; effective August 9, 1994. Repeal and new rule filed January 30, 1997; effective May 30, 1997. Repeal and new rule filed December 28, 1999; effective March 12, 2000. Amendment filed December 5, 2003; effective February 18, 2004. Amendment filed November 2, 2005; effective January 16, 2006. Amendment filed August 5, 2011; effective November 3, 2011. Amendments filed March 27, 2015; effective June 25, 2015.

Tenn. Comp. R. & Regs. 1200-10-01-.10 .

(2) Reinstatement of Expired License (a) Reinstatement of an expired license may be accomplished upon filing a reinstatement application and payment of reinstatement, renewal and late renewal fees pursuant to

rule 1200-30-01-.06.

(b) An applicant for reinstatement must comply with the continuing education requirements of rule 1200-30-01-.12.

(c) If requested, an applicant for reinstatement shall appear before the Board for an interview.

(3) Anyone submitting a signed renewal or reinstatement application which is found to be untrue may be subject to disciplinary action as provided in these rules.

(4) Application procedures shall be governed by Rule 1200-30-01-.07, and applicant review and licensure decisions shall be governed by Rule 1200-30-01-.15.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-24-605, and 68-24-606.
• Administrative History: Original rule filed May 25, 1994; effective August 9, 1994. Repeal and new rule filed January 30, 1997; effective May 30, 1997. Repeal and new rule filed December 28, 1999; effective March 12, 2000. Amendment filed December 13, 2000; effective February 26, 2001. Amendment filed August 19, 2002; effective November 2, 2002. Amendment filed October 18, 2004; effective January 1, 2005.

Tenn. Comp. R. & Regs. 1200-30-01-.11 LICENSURE RETIREMENT AND REACTIVATION

(1) License holders who wish to retain their licenses, but not actively practice alcohol and drug counseling, may avoid expiration of licensure and/or compliance with the licensure renewal process by licensure retirement. A license may be retired by obtaining from and submitting to the Board an affidavit of retirement form along with any documentation which may be required.

(2) Any licensee whose license has been retired may reactivate the license by:

(a) Paying the licensure renewal fee.

(b) If requested, appearing before the Board for an interview regarding continued competence in the event of licensure retirement in excess of two (2) years.

(c) Successfully completing the written examination for licensure if licensure retirement was in excess of five (5) years and the Board determines that re-examination is necessary to protect the public.

(d) Complying with the continuing education requirements.

(3) Application procedures shall be governed by Rule 1200-30-01-.07, and applicant review and licensure decisions shall be governed by Rule 1200-30-01-.15.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-24-605, and 68-24-606.
• Administrative History: Original rule filed May 25, 1994; effective August 9, 1994. Repeal and new rule filed January 30, 1997; effective May 30, 1997. Repeal and new rule filed December 28, 1999; effective March 12, 2000. Amendment filed December 13, 2000; effective February 26, 2001.

Tenn. Comp. R. & Regs. 1200-30-01-.12 CONTINUING EDUCATION

Level I Licensed Alcohol and Drug Abuse Counselors and Level II Licensed Alcohol and Drug Abuse Counselors must complete thirty (30) contact hours of alcohol and drug abuse continuing education every two (2) calendar years. Eighteen (18) hours must be face to face and twelve (12) hours may be via multi-media with at least six (6) of the thirty (30) hours relating to ethics. A Qualified Clinical Supervisor (QCS) must complete a minimum of ten (10) additional contact hours of training every two (2) years, in addition to the normal thirty (30) contact hours necessary to maintain licensure. Such additional contact hours must be specific to alcohol and drug clinical supervision. Six (6) hours of the ten (10) additional total hours of continuing education must be specific to clinical supervision ethics. Beginning January 1, 2020, Level I, Level II Licensed Alcohol and Drug Abuse Counselors, and Qualified Clinical Supervisors (QCS) must complete a Board approved training program relative to suicide prevention at least once every four (4) years.

(1) Continuing education for new licensees - For new licensees, submitting proof of successful completion of all education and training requirements required for licensure in Tennessee, pursuant to subparagraphs 1200-30-01-.04(1)(c) and 1200-30-01-.05(1)(a), shall be considered proof of sufficient preparatory education to constitute continuing education credit for the calendar year in which such education and training requirements were completed. An applicant applying for initial licensure on or after January 1, 2020 is not required to complete a training program on suicide prevention for two (2) years after the date of initial licensure if the applicant can demonstrate successful completion of a two (2) hour academic training program that meets criteria established by the Board and that was completed no more than two (2) years prior to the application for initial licensure.

(2) The following organizations and entities are authorized to present, sponsor, or approve continuing education courses, events, and activities related to the practice of alcohol and drug abuse counseling:

(a) Nationally or regionally accredited institutions of higher education (b) NAADAC (The National Association for Addiction Professionals)

(c) TAADAC (The Tennessee Association of Alcohol and Drug Abuse Counselors)

(d) Tennessee Department of Health (e) TAADAS (The Tennessee Association of Alcohol, Drug and Other Addiction Services)

(f) TAMHO (The Tennessee Association of Mental Health Organizations)

(g) Tennessee Department of Mental Health.

(3) Continuing education program approval process for providers of education.

(a) All providers of continuing education not authorized by paragraph (2) must request and receive approval of their program content by the Board to fulfill the continuing education requirements set forth in this rule. Providers who intend to offer more than one (1) presentation of the same course, event, or activity during one (1) calendar year may combine in a single application the information required by subparagraph (3)(b) for the multiple presentations.

(b) Application for approval shall contain the topic, credentials of the speaker or presenter, a brief description of program content or content objectives, the date and length in minutes of each presentation, the place of instruction and the sponsoring institution or organization. Application for approval of Multi-Media courses, as provided in subparagraph (5)(c), shall submit this information on an annual basis as applicable, and shall also submit a brief description of the course format.

(c) All applications for approval must be submitted to the Board at least thirty (30) days prior to a regularly scheduled meeting of the Board that precedes the educational offering. The Board shall review each application and shall rule on whether the offering(s) in whole or in part shall be accepted as valid for the purposes of the continuing education requirements of this rule. The decision of the Board shall be final in all such matters.

(4) Documentation.

(a) On a Board provided form, each licensee must check a box and/or enter his signature which indicates attendance and completion of all the required contact hours of continuing education and that such hours were obtained.

(b) Each licensee shall retain independent documentation of attendance and completion of all continuing education courses. This documentation must be retained for a period of three (3) years from the end of the renewal period in which the course is completed.

This documentation must be produced for inspection and verification, if requested in writing by the Board during its verification process.

(c) Documentation of continuing education includes:

1. A certificate verifying the individual’s attendance at the continuing education program.

2. An original letter on official institution letterhead from the instructor of the graduate level course verifying that the course was completed and listing the number of credit hours of attendance completed by the individual.

3. An official transcript verifying credit hours earned. One semester academic credit hour is equivalent to fifteen (15) contact hours. One quarter academic credit hour is equivalent to twelve (12) contact hours.

4. A certificate or letter verifying successfully passing a written post experience examination to evaluate material retention upon completion of a Multi-Media course, as provided in subparagraph (5)(c). The certificate or letter must include the contact hours awarded (continuing education units must be converted to contact hours), date completed, program title, licensee's name, and license number.

(5) It is the licensee’s responsibility, using his professional judgment, to determine whether or not a particular educational/training experience is applicable and appropriate to his professional development and meets the standards specified in these rules.

(a) If a person submits documentation for training that is not clearly identifiable as appropriate continuing education, the Board may request a written description of the training and how it applies to the individual’s professional practice. If the Board determines that the training cannot be considered appropriate continuing education, the individual will be given ninety (90) days to replace the hours not allowed. Those hours will be considered replacement hours and cannot be counted during the next year.

(b) Continuing education credit or contact hours of training will not be allowed for the following:

1. Regular work activities, administrative staff meetings, case staffing/reporting, etc.;

2. Membership in, holding office in, or participation on boards or committees, business meetings of professional organizations or banquet speeches;

3. Independent, unstructured or self-structured learning; or 4. Training specifically related to policies and procedures of an agency.

(c) Multi-Media 1. Notwithstanding the provisions of part (5)(b)3., continuing education courses may be presented in the traditional lecture and classroom formats or, in accordance with paragraphs (2) and (3) and with successful completion of a written post experience examination to evaluate material retention, courses may be presented in Multi-Media formats. Multi-Media courses may include courses utilizing:

(i) The Internet (ii) Closed circuit television (iii) Satellite broadcasts (iv) Correspondence courses (v) Videotapes (vi) CD-ROM (vii) DVD (viii) Teleconferencing (ix) Videoconferencing (x) Distance learning 2. A maximum of six (6) contact hours may be granted for multi-media courses during each calendar year.

(d) Voluntary Provision of Healthcare Services.

1. Level I, Level II Licensed Alcohol and Drug Abuse Counselors, and Qualified Clinical Supervisors (QCS) may satisfy one (1) hour of continuing education requirement through the performance of one (1) hour of voluntary provision of healthcare services.

2. The maximum amount of annual hours of continuing education that a licensed alcohol and drug abuse counselor or clinical supervisor may receive by performing voluntary healthcare services is three (3) hours.

3. Documentation of such voluntary healthcare services must include an official letter on official institution, facility, clinic, or non-profit letterhead verifying that the voluntary healthcare services were completed and listing the number of hours of attendance completed by the individual.

(6) Continuing education for reactivation of license.

(a) Reactivation of retired license.

1. Any individual requesting reactivation of a license which has been retired one or more years shall so indicate on a Board-provided form which indicates the attendance and completion of fifteen (15) continuing education hours. The continuing education hours must have been begun and successfully completed within twelve (12) months immediately preceding the date of the requested reinstatement.

2. The Board, upon receipt of a written request and explanation, may waive or condition any or all of the contact hours requirement for reactivation of a retired license in emergency situations.

(b) Reactivation of revoked license – No person whose license has been revoked for failure to comply with the continuing education contact hours requirement may be reinstated without complying with the requirement. The continuing education hours will accumulate at the same rate and are required the same as those for licenses which are active. A license which has been revoked for noncompliance with the continuing education requirement shall also be subject to the late renewal fee.

(c) Reactivation of expired license – No person whose license has expired as a result of failure to comply with the renewal requirements of rule 1200-30-01-.09 may be reinstated without complying with the requirements of this rule. The continuing education hours will accumulate at the same rate and are required the same as those for licenses which are active. A license which has expired as a result of failure to comply with the renewal requirements of rule 1200-30-01-.09 shall also be subject to the late renewal fee.

(d) Any licensee requesting reactivation of either a retired or revoked license shall indicate on a Board provided form that he has complied with the continuing education requirement pursuant to this rule and that such continuing education hours were begun and successfully completed within twelve (12) months immediately preceding the date of requested reinstatement.

(e) Continuing education hours obtained as a prerequisite for reactivating either a retired or revoked license may not be counted toward the current licensure renewal year requirement.

(7) Waiver of continuing education.

(a) The Board may grant a waiver of attendance and completion of the required hours of continuing education, if it can be shown that the failure to comply was not attributable to the individual or was beyond the physical capabilities of the individual, e.g., disability, residence abroad, military service or other good cause. A request for waiver must be received by the Board on or before the license expiration date.

(b) Waiver requests will be considered only on an individual basis and may be made by submitting the following items to the Board:

1. A written request for a waiver which specifies what requirement is sought to be waived and an explanation of the reason(s) for the request, dated and signed by the licensee.

2. Any documentation which supports the reason(s) for the waiver requested or which may be subsequently requested.

(c) An approved waiver is effective only for the calendar year for which the waiver of the requirement is sought, unless otherwise specified in writing by the Board.

(8) Violations.

(a) Any licensee who falsely attests to attendance and completion of the hours of continuing education may be subject to disciplinary action pursuant to the provisions of these rules.

(b) Any licensee who fails to obtain the required continuing education hours may be subject to disciplinary action pursuant to the provisions of these rules.

(c) Continuing education hours obtained as a result of compliance with the terms of enforcement action taken by the Board shall not be counted toward the continuing education hours required to be obtained in any renewal cycle.

(d) Prior to the institution of any disciplinary proceedings, a letter shall be issued to the last known address of the individual stating the facts or conduct which warrant the intended action.

(e) The licensee has thirty (30) days from the date of notification to show compliance with all lawful requirements for the retention of the license.

(f) Any licensee who fails to show compliance with the required continuing education hours in response to the notice contemplated by subparagraph (d) above may be subject to disciplinary action.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-125, 63-6-712, 68-24-602, 68-24-603, 68-24-605, and 68- 24-606.
• Administrative History: Original rule filed May 25, 1994; effective August 9, 1994. Repeal and new rule filed January 30, 1997; effective May 30, 1997. Repeal and new rule filed December 28, 1999; effective March 12, 2000. Amendment filed September 13, 2001; effective November 27, 2001. Amendment filed August 19, 2002; effective November 2, 2002. Amendments filed October 18, 2004; effective January 1, 2005. Amendment filed November 2, 2005; effective January 16, 2006. Amendment filed May 18, 2007; effective August 1, 2007. Amendment filed July 3, 2007; effective September 16, 2007. Amendments filed August 5, 2011; effective November 3, 2011. Amendments filed March 27, 2015; effective June 25, 2015. Amendments filed February 6, 2017; effective May 7, 2017. Amendments filed May 7, 2019; effective August 5, 2019. Amendments filed October 26, 2020; effective January 24, 2021.

Tenn. Comp. R. & Regs. 1200-30-01-.13 PROFESSIONAL ETHICS

(1) Licensed Alcohol and Drug Abuse Counselors and individuals under their supervision shall conduct their professional practice in conformity with the NAADAC Code of Ethics, adopted October 9, 2016, and these rules.

(2) Each applicant or license holder is responsible for being familiar with and following these standards.

(3) In the event an applicant, license holder, or other individual has a question regarding legal, ethical and professional standards, neither the Board nor its administrative personnel shall consider such questions unless presented with a proper petition for a declaratory order.

(4) A licensee must report any other licensee believed to be practicing in such a way as to indicate impairment, potential harm to clients, and/or to cause undue negative reflection or harm to his profession. Such reporting shall be made to the Department of Health, Division of Health Related Boards, Investigative Section.

(a) A licensee who is aware of unethical conduct or unprofessional modes of practice must report such inappropriate behavior, unless constrained by the need to protect patient confidentiality.

(b) A licensee shall cooperate with the Department’s Investigative Section and promptly supply necessary information unless constrained by the need to protect patient confidentiality.

(c) In the event a supervisor suspects the person being supervised is guilty of unethical conduct, the supervisor shall adhere to the standards of the profession and shall report such conduct.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-210, and 68-24-602 through 68-24-606.
• Administrative History: Original rule filed May 25, 1994; effective August 9, 1994. Repeal and new rule filed January 30, 1997; effective May 30, 1997. Repeal and new rule filed December 28, 1999; effective March 12, 2000. Amendments filed May 7, 2019; effective August 5, 2019.

Tenn. Comp. R. & Regs. 1200-30-01-.14 LICENSE

(1) Display of license. Every person who has received a license from the Board shall produce the license when required by the Department or its authorized representatives.

(2) Replacement license and/or renewal certificate. A licensee whose license or renewal certificate has been lost or destroyed may be issued a replacement document upon receipt of a written request. Such request shall be accompanied by an affidavit (signed and notarized) stating the facts concerning the loss or destruction of the original document, the required fee, and a passport type recent (within the past twelve (12) months) photograph.

(3) Change of name and/or address.

(a) Any licensee who has had a change of name shall file in writing with the Department his current mailing address, giving both old and new names. Such requests must be received no later than thirty (30) days after such change has occurred and must reference the individual’s former and present name, profession, and license number.

(b) Any licensee who has had a change of address shall file in writing with the Board his current mailing address, giving both old and new addresses. Such requests must be received no later than thirty (30) days after such change has occurred and must reference the individual’s name, profession, and license number.

(4) Requests for verification of license must be made in writing to the Board.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-106, 63-1-108, 68-24-605, and 68-24-606.
• Administrative History: Original rule filed May 25, 1994; effective August 9, 1994. Repeal and new rule filed January 30, 1997; effective May 30, 1997. Repeal and new rule filed December 28, 1999; effective March 12, 2000.

Tenn. Comp. R. & Regs. 1200-30-01-.15 DISCIPLINARY ACTIONS AND CIVIL PENALTIES

(1) Complaints against licensed Alcohol and Drug Abuse Counselors shall be investigated by the Department. Upon a finding by the Department that a licensed Alcohol and Drug Abuse Counselor may have violated any provision of these rules a notice of charges may be issued.

The Board, upon a finding of violation of these rules, may impose any of the following actions separately or in any combination deemed appropriate to the offense:

(a) Private censure. A written action issued to the licensed Alcohol and Drug Abuse Counselor for minor infractions. Such action is informal and advisory in nature and does not constitute a formal disciplinary action.

(b) Public censure or reprimand. A written action issued to a licensed Alcohol and Drug Abuse Counselor for single incident and less severe violations. It is a formal disciplinary action and a copy will be provided to persons making an inquiry.

(c) Probation. A formal disciplinary action which places a licensed Alcohol and Drug Abuse Counselor on close scrutiny for a fixed period of time. This action may be combined with conditions which must be met before probation will be lifted and/or which restrict the individual’s activities during the probationary period.

(d) Suspension. A formal disciplinary action which suspends an individual’s right to represent himself as a licensed Alcohol and Drug Abuse Counselor for a fixed period of time. It contemplates the reentry of the individual into the practice under the license previously issued.

(e) Revocation for cause. This is the most severe form of disciplinary action which removes an individual from the practice of the profession and terminates the license previously issued. No petition for reinstatement and no new application for licensure from a person whose license has been revoked shall be considered prior to the expiration of at least one (1) year, unless otherwise stated in the Board’s revocation order.

(f) Conditions. Any action deemed appropriate by the Board to be required of a disciplined licensee during any period of probation or suspension or as a prerequisite to the lifting of probation or suspension.

(2) Once ordered, probation, suspension, revocation, assessment of a civil penalty, or any other condition of any type of disciplinary action may not be lifted unless and until the licensee petitions, pursuant to paragraph (3) of this rule, and appears before the Board after the period of initial probation, suspension, revocation, or other conditioning has run and all conditions placed on the probation, suspension, revocation, have been met, and after any civil penalties assessed have been paid.

(3) Order of Compliance - This procedure is a necessary adjunct to previously issued disciplinary orders and is available only when a petitioner has completely complied with the provisions of a previously issued disciplinary order, including an unlicensed practice civil penalty order, and wishes or is required to obtain an order reflecting that compliance.

(a) The Board will entertain petitions for an Order of Compliance as a supplement to a previously issued order upon strict compliance with the procedures set forth in subparagraph (b) in only the following three (3) circumstances:

1. When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued reflecting that compliance; or 2. When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued lifting a previously ordered suspension or probation; or 3. When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued reinstating a license previously revoked.

(b) Procedures 1. The petitioner shall submit a Petition for Order of Compliance, as contained in subparagraph (c), to the Board’s Administrative Office that shall contain all of the following:

(i) A copy of the previously issued order; and (ii) A statement of which provision of subparagraph (a) the petitioner is relying upon as a basis for the requested order; and (iii) A copy of all documents that prove compliance with all the terms or conditions of the previously issued order. If proof of compliance requires testimony of an individual(s), including that of the petitioner, the petitioner must submit signed statements from every individual the petitioner intends to rely upon attesting, under oath, to the compliance. The Board’s consultant and administrative staff, in their discretion, may require such signed statements to be notarized. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, the petition.

2. The Board authorizes its consultant and administrative staff to make an initial determination on the petition and take one of the following actions:

(i) Certify compliance and have the matter scheduled for presentation to the Board as an uncontested matter; or (ii) Deny the petition, after consultation with legal staff, if compliance with all of the provisions of the previous order is not proven and notify the petitioner of what provisions remain to be fulfilled and/or what proof of compliance was either not sufficient or not submitted.

3. If the petition is presented to the Board the petitioner may not submit any additional documentation or testimony other than that contained in the petition as originally submitted.

4. If the Board finds that the petitioner has complied with all the terms of the previous order an Order of Compliance shall be issued.

5. If the petition is denied either initially by staff or after presentation to the Board and the petitioner believes compliance with the order has been sufficiently proven the petitioner may, as authorized by law, file a petition for a declaratory order pursuant to the provisions of T.C.A. § 4-5-223 and rule 1200-10-01-.11.

(c) Form Petition Petition for Order of Compliance Board of Alcohol and Drug Abuse Counselors Petitioner’s Name:

Petitioner’s Mailing Address:

Petitioner’s E-Mail Address:

Telephone Number:

Attorney for Petitioner:

Attorney’s Mailing Address:

Attorney’s E-Mail Address:

Telephone Number:

The petitioner respectfully represents, as substantiated by the attached documentation, that all provisions of the attached disciplinary order have been complied with and I am respectfully requesting: (circle one)

1. An order issued reflecting that compliance; or 2. An order issued reflecting that compliance and lifting a previously ordered suspension or probation; or 3. An order issued reflecting that compliance and reinstating a license previously revoked.

Note – You must enclose all documents necessary to prove your request including a copy of the original order. If any of the proof you are relying upon to show compliance is the testimony of any individual, including yourself, you must enclose signed statements from every individual you intend to rely upon attesting, under oath, to the compliance. The Board’s consultant and administrative staff, in their discretion, may require such signed statements to be notarized. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, this petition.

Respectfully submitted this the day of , 20 .

Petitioner’s Signature (4) Order Modifications - This procedure is not intended to allow anyone under a previously issued disciplinary order, including an unlicensed practice civil penalty order, to modify any findings of fact, conclusions of law, or the reasons for the decision contained in the order. It is also not intended to allow a petition for a lesser disciplinary action, or civil penalty other than the one(s) previously ordered. All such provisions of Board orders were subject to reconsideration and appeal under the provisions of the Uniform Administrative Procedures Act (T.C.A. §§ 4-5-301, et seq.). This procedure is not available as a substitute for reconsideration and/or appeal and is only available after all reconsideration and appeal rights have been either exhausted or not timely pursued. It is also not available for those who have accepted and been issued a reprimand.

(a) The Board will entertain petitions for modification of the disciplinary portion of previously issued orders upon strict compliance with the procedures set forth in subparagraph (b) only when the petitioner can prove that compliance with any one or more of the conditions or terms of the discipline previously ordered is impossible. For purposes of this rule the term “impossible” does not mean that compliance is inconvenient or impractical for personal, financial, scheduling or other reasons.

(b) Procedures 1. The petitioner shall submit a written and signed Petition for Order Modification on the form contained in subparagraph (c) to the Board’s Administrative Office that shall contain all of the following:

(i) A copy of the previously issued order; and (ii) A statement of why the petitioner believes it is impossible to comply with the order as issued; and (iii) A copy of all documents that proves that compliance is impossible. If proof of impossibility of compliance requires testimony of an individual(s), including that of the petitioner, the petitioner must submit signed and notarized statements from every individual the petitioner intends to rely upon attesting, under oath, to the reasons why compliance is impossible.

No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, the petition.

2. The Board authorizes its consultant and administrative staff to make an initial determination on the petition and take one of the following actions:

(i) Certify impossibility of compliance and forward the petition to the Office of General Counsel for presentation to the Board as an uncontested matter; or (ii) Deny the petition, after consultation with legal staff, if impossibility of compliance with the provisions of the previous order is not proven and notify the petitioner of what proof of impossibility of compliance was either not sufficient or not submitted.

3. If the petition is presented to the Board the petitioner may not submit any additional documentation or testimony other than that contained in the petition as originally submitted.

4. If the petition is granted a new order shall be issued reflecting the modifications authorized by the Board that it deemed appropriate and necessary in relation to the violations found in the previous order.

5. If the petition is denied either initially by staff or after presentation to the Board and the petitioner believes impossibility of compliance with the order has been sufficiently proven the petitioner may, as authorized by law, file a petition for a declaratory order pursuant to the provisions of T.C.A. § 4-5-223 and rule 1200- 10-01-.11.

(c) Form Petition Petition for Order Modification Board of Alcohol and Drug Abuse Counselors Petitioner’s Name:

Petitioner’s Mailing Address:

Petitioner’s E-Mail Address:

Telephone Number:

Attorney for Petitioner:

Attorney’s Mailing Address:

Attorney’s E-Mail Address:

Telephone Number:

The petitioner respectfully represents that for the following reasons, as substantiated by the attached documentation, the identified provisions of the attached disciplinary order are impossible for me to comply with:

Note – You must enclose all documents necessary to prove your request including a copy of the original order. If any of the proof you are relying upon to show impossibility is the testimony of any individual, including yourself, you must enclose signed and notarized statements from every individual you intend to rely upon attesting, under oath, to the reasons why compliance is impossible. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, this petition.

Respectfully submitted this the day of , 20 .

Petitioner’s Signature (5) Civil penalties.

(a) Purpose. The purpose of this paragraph is to set out a schedule designating the minimum and maximum civil penalties which may be assessed pursuant to T.C.A. § 63-1-134.

(b) Schedule of civil penalties.

1. A “Type A” civil penalty may be imposed whenever the Board finds the person who is licensed, permitted, or authorized by the Board is guilty of a willful and knowing violation of statutes regarding the licensing of alcohol and drug abuse counselors, T.C.A. §§ 68-24-601, et seq. or rules promulgated pursuant thereto, to such an extent that there is, or is likely to be, an imminent, substantial threat to the health, safety and welfare of an individual patient or the public.

2. A “Type B” civil penalty may be imposed whenever the Board finds the person who is licensed, permitted, or authorized by the Board is guilty of a violation of statutes regarding the licensing of alcohol and drug abuse counselors, T.C.A. §§ 68-24-601, et seq. or rules promulgated pursuant thereto in such manner as to impact directly on the care of patients or the public.

3. A “Type C” civil penalty may be imposed whenever the Board finds the person who is licensed, permitted, or authorized by the Board is guilty of a violation of statutes regarding the licensing of alcohol and drug abuse counselors, T.C.A. §§ 68-24-601, et seq., or rules promulgated pursuant thereto, which are neither directly detrimental to the patients or the public, nor directly impact their care, but have only an indirect relationship to patient care or the public.

(c) Amount of civil penalties.

1. “Type A” civil penalties shall be assessed in the amount of not less than five hundred dollars ($500) nor more than one thousand dollars ($1000).

2. “Type B” civil penalties may be assessed in the amount of not less than one hundred dollars ($100) nor more than five hundred dollars ($500).

3. “Type C” civil penalties may be assessed in the amount of not less than fifty dollars ($50) nor more than one hundred dollars ($100).

(d) Procedures for assessing civil penalties.

1. The Division of Health Related Boards may initiate a civil penalty assessment by filing a Memorandum of Assessment of Civil Penalty. The Division shall state in the memorandum the facts and law upon which it relies in alleging a violation, the proposed amount of the civil penalty and the basis for such penalty. The Division of Health Related Boards may incorporate the Memorandum of Assessment of Civil Penalty with a Notice of Charges.

2. Civil penalties may also be initiated and assessed by the Board during consideration of any Notice of Charges. In addition, the Board may, upon good cause shown, assess a type and amount of civil penalty which was not recommended by the Division of Health Related Boards.

3. In assessing the civil penalties pursuant to these rules the Board may consider the following factors:

(i) Whether the amount imposed will be a substantial economic deterrent to the violator;

(ii) The circumstances leading to the violation;

(iii) The severity of the violation and the risk of harm to the public;

(iv) The economic benefits gained by the violator as a result of noncompliance; and (v) The interest of the public.

4. All proceedings for the assessment of civil penalties shall be governed by the Administrative Procedures Act, T.C.A. §§ 4-5-301, et seq.

(6) Grounds for refusal to issue or renew or to suspend or revoke licenses or other disciplinary action - The Board may either refuse to issue or renew any license or may suspend or revoke or otherwise discipline any licensee for one (1) or more of the following reasons:

(a) Making false statements or representations or being guilty of fraud or deceit in obtaining licensure, or being guilty of fraud or deceit in the practice of alcohol or other drugs of abuse counseling.

(b) The inability to perform or the consistent unsatisfactory performance of the expected functions of a licensed Alcohol and Drug Abuse Counselor.

(c) Knowingly assisting another in the procurement of licensure or renewal of a license through false statements or misrepresentation.

(d) Misrepresentation of professional qualifications, certification, accreditation, affiliations or employment experiences.

(e) Violations of the provisions of these rules or any lawful order of the Board.

(f) Engaging in malpractice, negligence, incompetence or conduct not authorized in the course and scope of practice.

(g) Violation of standards of patient confidentiality, as prescribed by state and federal law.

(h) Conviction of a felony or conviction of any crime involving moral turpitude.

(i) Habitual intoxication or personal misuse of any drugs or the use of intoxicating liquors, narcotics, controlled substances or other drugs or stimulants in such a manner as to adversely affect the person’s ability to practice.

(j) Any other breach of the NAADAC Code of Ethics or these rules.

(k) When an applicant has had licensure disciplinary action taken or is under investigation by another state or territory of the United States or by any other entity assigned to the Division of Health Related Boards as provided in Rule 1200-10-01-.01(3) for any acts or omissions which would constitute grounds for discipline of a license issued by this Board. A certified copy of the initial or final order or other equivalent document memorializing the disciplinary action or investigation from the disciplining state, territory, or licensing authority shall constitute prima facie evidence of violation of this

section and be sufficient grounds upon which to deny, restrict or condition licensure or renewal and/or discipline a license issued by this Board.

(l) When any applicant's application indicates a problem in the areas of mental, physical, moral or educational criteria for licensure or renewal which the Board determines may create a potential threat to the public health, safety or welfare.

(7) The Board has the authority to:

(a) Take appropriate disciplinary actions as the result of complaints received or investigations conducted.

(8) Reconsiderations and Stays. The Board authorizes the member who chaired the Board for a contested case to be the agency member to make the decisions authorized pursuant to rule

Tenn. Comp. R. & Regs. 1360-04-01-.18 regarding petitions for reconsiderations and stays in that case.

(9) All proceedings for disciplinary action against a licensee under this chapter shall be conducted in accordance with the Tennessee Uniform Administrative Procedures Act, compiled in Title 4, Chapter 5 of the Tennessee Code Annotated and the rules and regulations promulgated pursuant thereto.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-217, 4-5-223, 63-1-122, 68-24-605, 68-24-606, and 68-25- 606.
• Administrative History: Original rule filed May 25, 1994; effective August 9, 1994. Repeal and new rule filed January 30, 1997; effective May 30, 1997. Repeal and new rule filed December 28, 1999; effective March 12, 2000. Amendment filed December 29, 1999; effective March 13, 2000. Amendment filed July 31, 2000; effective October 14, 2000. Amendment filed December 13, 2000; effective February 26, 2001. Amendment filed August 19, 2002; effective November 2, 2002. Amendment filed August 23, 2004; effective November 6, 2004. Amendment filed May 18, 2007; effective August 1, 2007. Amendment filed July 3, 2007; effective September 16, 2007.

Tenn. Comp. R. & Regs. 1200-30-01-.16 BOARD MEETINGS, CONSULTANTS, DECLARATORY ORDERS, AND

SCREENING PANELS.

(1) Any Board member having an immediate personal, private, or financial interest in any matter pending before the Board shall disclose the fact in writing and any such Board member shall not vote upon such matter.

(2) All requests, applications, notices, other communications and correspondence shall be directed to the Board, as provided in these rules. Any requests or inquiries requiring a decision or official action, except documents relating to recommendations for disciplinary actions or hearing requests, must be received fourteen (14) days prior to a scheduled Board meeting. Such documentation not timely received shall be set over to the next Board meeting or handled by the Board if it concerns a recommendation for disciplinary action.

(3) All records of the Board, except those made confidential by law, are open for inspection and examination, under the supervision of an employee of the Department.

(4) Declaratory orders. The Board adopts, as if fully set out herein, rule 1200-10-01-.11 of the Division of Health Related Boards, as it may from time to time be amended, as its rule governing the declaratory order process. All declaratory order petitions involving statutes, rules or orders within the jurisdiction of the Board shall be addressed by the Board pursuant to this rule. Declaratory order petition forms can be obtained from the Board’s administrative office.

(5) Screening Panels - The Board adopts, as if fully set out herein, rule 1200-10-01-.13, of the Division of Health Related Boards and as it may from time to time be amended, as its rule governing the screening panel process.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-223, 4-5-224, 4-5-225, 10-7-504, 63-1-138, 68-24-605, 68-24- 606, and 45 C.F.R. Part 2.
• Administrative History: Original rule filed May 25, 1994; effective August 9, 1994. Repeal and new rule filed January 30, 1997; effective May 30, 1997. Repeal and new rule filed December 28, 1999; effective March 12, 2000. Amendment filed May 18, 2007; effective August 1, 2007.

Tenn. Comp. R. & Regs. 1200-30-01-.17 ADVERTISING

(1) Policy Statement. The lack of sophistication on the part of many of the public concerning alcohol and drug abuse counseling services, the importance of the interests affected by the choice of an alcohol and drug abuse counselor, and the foreseeable consequences of unrestricted advertising by alcohol and drug abuse counselors which is recognized to pose special possibilities for deception, require that special care be taken by alcohol and drug abuse counselors to avoid misleading the public. The alcohol and drug abuse counselor must be mindful that the benefits of advertising depend upon its reliability and accuracy. Since advertising by alcohol and drug abuse counselors is calculated and not spontaneous, reasonable regulation designed to foster compliance with appropriate standards serves the public interest without impeding the flow of useful, meaningful, and relevant information to the public.

(2) Definitions (a) Advertisement - Informational communication to the public in any manner designed to attract public attention to the practice of an alcohol and drug abuse counselor who is licensed to practice in Tennessee.

(b) Licensee - Any person holding a license to practice as a Licensed Alcohol and Drug Abuse Counselor in the State of Tennessee. Where applicable this shall include partnerships and/or corporations.

(c) Material Fact - Any fact which an ordinary reasonable and prudent person would need to know or rely upon in order to make an informed decision concerning the choice of practitioners to serve his or her particular needs.

(3) Advertising Content. The following acts or omissions in the context of advertisement by any licensee shall constitute unethical conduct, and subject the licensee to disciplinary action pursuant to Rule 1200-30-01-.15:

(a) Claims that the services performed, personnel employed, or office equipment used are professionally superior to that which is ordinarily performed, employed, or used, or that convey the message that one licensee is better than another when superiority of services, personnel, or equipment cannot be substantiated.

(b) The misleading use of an unearned degree.

(c) Promotion of professional services which the licensee knows or should know are beyond the licensee's ability to perform.

(d) Techniques of communication which intimidate, exert undue pressure or undue influence over a prospective client.

(e) Any appeals to an individual's anxiety in an excessive or unfair manner.

(f) The use of any personal testimonial attesting to a quality or competency of a service or treatment offered by a licensee that is not reasonably verifiable.

(g) Utilization of any statistical data or other information based on past performances for prediction of future services, which creates an unjustified expectation about results that the licensee can achieve.

(h) The communication of personal identifiable facts, data, or information about a client without first obtaining patient consent.

(i) Any misrepresentation of a material fact.

(j) The knowing suppression, omission or concealment of any material fact or law without which the advertisement would be deceptive or misleading.

(k) Misrepresentation of credentials, training, experience, or ability.

(l) Failure to include the corporation, partnership or individual name, address, and telephone number of licensees in any advertisement. Any corporation, partnership or association which advertises by use of a trade name or otherwise fails to list all licensees practicing at a particular location shall:

1. Upon request provide a list of all licensees practicing at that location; and 2. Maintain and conspicuously display a directory listing all licensees practicing at that location.

(m) Failure to disclose the fact of giving compensation or anything of value to representatives of the press, radio, television or other communicative medium in anticipation of or in return for any advertisement (for example, newspaper article) unless the nature, format or medium of such advertisement makes the fact of compensation apparent.

(n) After thirty (30) days of the licensee’s departure, the use of the name of any licensee formerly practicing at or associated with any advertised location or on office signs or buildings. This rule shall not apply in the case of a retired or deceased former associate who practiced in association with one or more of the present occupants if the status of the former associate is disclosed in any advertisement or sign.

(o) Stating or implying that a certain licensee provides all services when any such services are performed by another licensee.

(p) Directly or indirectly offering, giving, receiving, or agreeing to receive any fee or other consideration to or from a third party for the referral of a client in connection with the performance of professional services.

(q) Making false, deceptive, misleading or fraudulent statements regarding fees.

(4) Advertising Records and Responsibility (a) Each licensee who is a principal partner, or officer of a firm or entity identified in any advertisement, is jointly and severally responsible for the form and content of any advertisement. This provision shall also include any licensed or certified professional employees acting as an agent of such firm or entity.

(b) Any and all advertisements are presumed to have been approved by the licensee named therein.

(c) A recording of every advertisement communicated by electronic media, and a copy of every advertisement communicated by print media, and a copy of any other form of advertisement shall be retained by the licensee for a period of two (2) years from the last date of broadcast or publication and be made available for review upon request by the Board or its designee.

(d) At the time any type of advertisement is placed, the licensee must possess and rely upon information which, when produced, would substantiate the truthfulness of any assertion, omission or representation of material fact set forth in the advertisement or public communication.

(5) Use of Titles - Any person who possesses a valid, current and active license issued by the Board that has not been suspended or revoked has the right to use the title “Licensed Alcohol and Drug Abuse Counselor” and to practice alcohol and drug abuse counseling, as described in T.C.A. §§ 68-24-608 and 68-24-609. Any person licensed by the Board to whom this rule applies must use the title authorized by this rule in “advertising” [as that term is defined in rule 1200-30-01-.01(1)] he or she publishes or the failure to do so will constitute an omission of a material fact which makes the advertisement misleading and deceptive and subjects the licensed alcohol and drug abuse counselor to disciplinary action pursuant to rule 1200-30-01- .15.

(6) Advertising Conduct (a) Licensees who engage others to create or place public statements that promote their professional practice, products, or activities retain professional responsibility for such statements.

(b) If licensees learn of deceptive statements about their work made by others, licensees must make reasonable efforts to correct such statements.

(c) Licensees do not compensate employees of press, radio, television or other communication media in return for publicity in a news item.

(d) A paid advertisement relating to the licensee’s activities must be identified as such, unless it is already apparent from the context.

(7) Severability. It is hereby declared that the sections, clauses, sentences and parts of these rules are severable, are not matters of mutual essential inducement, and any of them shall be rescinded if these rules would otherwise be unconstitutional or ineffective. If any one or more sections, clauses, sentences or parts shall for any reason be questioned in court, and shall be adjudged unconstitutional or invalid, such judgment shall not affect, impair or invalidate the remaining provisions thereof, but shall be confined in its operation to the specific provision or provisions so held unconstitutional or invalid, and the inapplicability or invalidity of any section, clause, sentence or part in any one or more instances shall not be taken to affect or prejudice in any way its applicability or validity in any other instance.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-145, 63-1-146, 68-24-605, 68-24-606, 68-24-608, and 68- 24-609.
• Administrative History: Original rule filed May 25, 1994; effective August 9, 1994. Repeal and new rule filed January 30, 1997; effective May 30, 1997. Repeal and new rule filed December 28, 1999; effective March 12, 2000. Amendment filed May 18, 2007; effective August 1, 2007. Amendment filed November 26, 2008; effective February 9, 2009.

Tenn. Comp. R. & Regs. 1200-30-01-.18 CONSUMER RIGHT-TO-KNOW REQUIREMENTS

(1) Malpractice reporting requirements. The threshold amount below which medical malpractice judgments, awards or settlements in which payments are awarded to complaining parties need not be reported pursuant to the “Health Care Consumer Right-To-Know Act of 1998” shall be ten thousand dollars ($10,000).

(2) Criminal conviction reporting requirements. For purposes of the “Health Care Consumer Right-To-Know Act of 1998”, the following criminal convictions must be reported:

(a) Conviction of any felony.

(b) Conviction or adjudication of guilt of any misdemeanor, regardless of its classification, in which any element of the misdemeanor involves any one or more of the following:

1. Sex.

2. Alcohol or drugs.

3. Physical injury or threat of injury to any person.

4. Abuse or neglect of any minor, spouse or the elderly.

5. Fraud or theft.

(c) If any misdemeanor conviction reported under this rule is ordered expunged, a copy of the order of expungement signed by the judge must be submitted to the Department before the conviction will be expunged from any profile.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-51-101, et seq., and 68-24-605.
• Administrative History: Original rule filed December 29, 1999; effective March 13, 2000.

Tenn. Comp. R. & Regs. 1200-30-01-.19 PROFESSIONAL PEER ASSISTANCE

(1) The Board has the prerogative to refer for assessment(s), and if needed, treatment, for the presenting problem(s) of any licensee or applicant voluntarily or involuntarily coming before the Board.

(2) As an alternative to disciplinary action, or as part of a disciplinary action, the Board shall utilize the services of a professional assistance program, as approved by the Board, for situations regarding licensee substance abuse, chemical abuse, or lapses in professional and/or ethical judgments. Information regarding persons entering the program upon referral by this Board shall be confidential.

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-136, 68-24-605, and 68-24-606.
• Administrative History: Original rule filed July 20, 2001; effective October 3, 2001.

Chapter 1200-30-02 Transferred to 0940-06-03

Tenn. Comp. R. & Regs. 1200-30-02-.01 TRANSFERRED TO 0940-6-3

History

• Authority: T.C.A. §§4-5-202 and 68-24-30 and Executive Order 44 (February 23, 2007).
• Administrative History: Original rule filed August 17, 1997; effective October 27, 1997. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-6-3 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-30-02-.02 TRANSFERRED TO 0940-6-3

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. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-6-3 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-30-02-.03 TRANSFERRED TO 0940-6-3

History

• Authority: T.C.A. §§4-5-202, 68-1-104(l), and 68-24-301 and Executive Order 44 (February 23, 2007).
• Administrative History: Original rule filed August 7, 1997; effective October 27, 1997. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-6-3 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-30-02-.04 TRANSFERRED TO 0940-6-3

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. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-6-3 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-30-02-.05 TRANSFERRED TO 0940-6-3

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. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-6-3 on May 15, 2008.

Chapter 1200-30-03 Transferred to 0940-06-04

Tenn. Comp. R. & Regs. 1200-30-03-.01 TRANSFERRED TO 0940-6-4

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 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. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-6-4 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-30-03-.02 TRANSFERRED TO 0940-6-4

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 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. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-6-4 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-30-03-.03 TRANSFERRED TO 0940-6-4

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 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. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-6-4 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-30-03-.04 TRANSFERRED TO 0940-6-4

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 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. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-6-4 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-30-03-.05 TRANSFERRED TO 0940-6-4

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 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. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-6-4 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-30-03-.06 TRANSFERRED TO 0940-6-4

History

• Authority: T.C.A. §§ 4-5-202, 4-5-204, 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. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-6-4 on May 15, 2008.

Tenn. Comp. R. & Regs. 1200-30-03-.07 TRANSFERRED TO 0940-6-4

History

• Authority: T.C.A. §§ 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. Per Executive Order 44 (February 23, 2007), rule was transferred to 0940-6-4 on May 15, 2008.

Chapter 1200-31-01 Reserved

Tenn. Comp. R. & Regs. 1200-31-01 Reserved

RULES

OF THE TENNESSEE DEPARTMENT OF HEALTH

CHILDREN’S SERVICES

Authority: T.C.A. §§4-3-1007; 4-4-102; 4-5-217 and Executive Order No. 58; 4-5-226(b)(2); 37-5-101; 37-5-105; 37-5- 106 and 37-5-112(a). Administrative History: Chapter 1200-31-1 has been assigned a new control number, removed and renumbered to Chapter 0250-7-10 filed and effective June 3, 1999.

Chapter 1200-32-01 Non-Smoker Protection Act Rules

Tenn. Comp. R. & Regs. 1200-32-01-.01 PURPOSE

(1) The Non-Smoker Protection Act (“Act”) requires that on and after October 1, 2007, smoking be prohibited in all enclosed public places within the State of Tennessee. It is the purpose of these rules to supplement the provisions of that Act and provide the mechanisms by which the Department of Health (“Department”) shall implement the enforcement duties placed upon it by T.C.A. § 39-17-1801 et seq.

History

• Authority: T.C.A. § 39-17-1811.
• Administrative History: Public necessity rule filed September 28, 2007; effective through March 11, 2008. Original rule filed December 27, 2007; effective March 11, 2008.

Tenn. Comp. R. & Regs. 1200-32-01-.02 PUBLIC PLACES REGULATED

(1) The Department shall be responsible for the enforcement activities required by the Act in the following enclosed public places:

(a) All health care facilities licensed, permitted or certified pursuant to Tennessee Code Annotated, Title 68, Chapter 11; and (b) All enclosed public places for which a license, permit or certification must be obtained from any health related board assigned to the Department’s Division of Health Related Boards pursuant to Tennessee Code Annotated, 68-1-101 before a health related profession may be practiced therein; and (c) All enclosed public places for which a license, permit or certification must be obtained from the Department’s Division of Emergency Medical Services; and (d) All other enclosed public places over which the Department has regulatory

authority pursuant to Tennessee Code Annotated, Title 62, Title 68 or otherwise, including, but not limited, to the following:

1. Restaurants 2. Indoor swimming pools 3. Food Service Establishments 4. Hotels 5. Bed and Breakfasts 6. Fast Food Establishments 7. Primary Health Care Centers 8. County and District Health Departments 9. Tattoo and Body Piercing Parlors 10. Organized Camps (2) For enforcement purposes as to the establishments listed above that choose to be an “age-restricted venue,” and consistent with the liberal construction required pursuant to T.C.A. § 39-17-1812, the age requirement contained in the definition of “agerestricted venue,” set forth in T.C.A. § 39-17-1802(2), is intended to apply also to employees of such venues.

(3) To the extent that the Department of Labor and Workforce Development has concurrent jurisdiction over those enclosed public places identified above, all documentation of violations of the Act created or collected by that Department during its normal inspection or regulatory duties may be forwarded to the Department of Health for processing and disposition.

History

• Authority: T.C.A. §§ 39-17-1802, 39-17-1806 and 39-17-1811.
• Administrative History: Public necessity rule filed September 28, 2007; effective through March 11, 2008. Original rule filed December 27, 2007; effective March 11, 2008.

Tenn. Comp. R. & Regs. 1200-32-01-.03 SIGNAGE

(1) The “No Smoking” signs or the international “No Smoking” symbol required by T.C.A. § 39-17-1805 to be posted at every entrance to every public place and place of employment where smoking is prohibited shall be clearly and conspicuously placed at a height, location and in such a size as to be easily seen by a person with normal vision entering the establishment and shall not be obscured in any way.

History

• Authority: T.C.A. §§ 39-17-1805 and 39-17-1811.
• Administrative History: Public necessity rule filed September 28, 2007; effective through March 11, 2008. Original rule filed December 27, 2007; effective March 11, 2008.

Tenn. Comp. R. & Regs. 1200-32-01-.04 VIOLATIONS

(1) During its routine inspections, investigations, surveys or other required regulatory activities in the enclosed public places under its jurisdiction or in response to complaints of violations of the Act occurring in any of those enclosed public places, the Department shall document and collect necessary information on any of the following listed violations of the Act:

(a) Any persons knowingly smoking in a place where it is prohibited; or (b) Any owners, managers, operators or persons who otherwise control a public place who knowingly fail to do any of the following:

1. Communicate the smoking prohibition to existing and prospective employees. For purposes of enforcement of this rule, the existence of a written policy, handout or statement for distribution to all employees and prospective employees or a sign posted in any area(s) necessarily frequented by all employees either or both of which communicates the smoking prohibition constitutes compliance; and/or 2. Post no smoking sign or the universal no smoking symbol at every entrance to the public place as required by T.C.A. § 39-17-1805 and

rule 1200-32-01-.03; and/or 3. Either themselves or through their employees inform any person violating the Act of the appropriate provisions of the law.

History

• Authority: T.C.A. §§ 39-17-1803, 39-17-1805, 39-17-1806 and 39-17-1811.
• Administrative History: Public necessity rule filed September 28, 2007; effective through March 11, 2008. Original rule filed December 27, 2007; effective March 11, 2008.

Tenn. Comp. R. & Regs. 1200-32-01-.08 REPEALED

History

• Authority: T.C.A. §§ 4-4-103 and 10-7-506(a).
• Administrative History: Public necessity rule filed September 28, 2007; effective through March 11, 2008. Original rule filed December 27, 2007; effective March 11, 2008. Repeal filed October 5, 2012; effective January 3, 2013.

Tenn. Comp. R. & Regs. 1200-32-01-.05 COMPLAINTS

(1) Any person wishing to file a complaint against any person or public place where smoking is prohibited for not complying with the provisions of this Act may do so in one of the following ways:

(a) By a telephone call to the Department; or (b) By submitting a complaint via the Internet; or (c) In writing to the Department.

History

• Authority: T.C.A. §§ 39-17-1806 and 39-17-1811.
• Administrative History: Public necessity rule filed September 28, 2007; effective through March 11, 2008. Original rule filed December 27, 2007; effective March 11, 2008.

Tenn. Comp. R. & Regs. 1200-32-01-.06 PENALTIES

(1) A person who knowingly smokes in an area where smoking is prohibited by the provisions of the Act shall be subject to a civil penalty of fifty dollars ($50).

(2) A person who owns, manages, operates or otherwise controls any public place where smoking is prohibited pursuant to the provisions of the Act and who knowingly fails to comply with any provision of the Act shall be subject to the following:

(a) For a first violation in any twelve-month period, a written warning from the Department, as appropriate;

(b) For a second violation in any twelve-month period, a civil penalty of one hundred dollars ($100); and (c) For a third or subsequent violation in any twelve-month period, a civil penalty of five hundred dollars ($500).

(3) Each day on which a knowing violation of the Act occurs shall be considered a separate and distinct violation.

(4) The Department may, in those instances when a reported violation cannot be substantiated, issue advisory letters to the public place wherein the violation was alleged to have occurred.

(1200-32-01-.06, continued)

History

• Authority: T.C.A. §§ 39-17-1807 and 39-17-1811.
• Administrative History: Public necessity rule filed September 28, 2007; effective through March 11, 2008. Original rule filed December 27, 2007; effective March 11, 2008.

Tenn. Comp. R. & Regs. 1200-32-01-.07 ENFORCEMENT PROCESS, APPEALS AND PAYMENT OF PENALTIES

(1) Upon receipt of verification of a violation of the Act the Department shall issue a written notice to the offender of the violation and the penalty applicable to the violation. The written notice may be issued by certified mail, delivery service, or personal service.

(2) Any person receiving a notice of violation and penalty who wishes to contest the determination of the violation and/or the assessment of the penalty must, within ten (10) business days of receipt of the notice, file a written request for an appeal with the Department.

(3) Any hearing held in response to a request for an appeal timely received by the Department shall be conducted pursuant to the provisions of the Uniform Administrative Procedures Act complied at Tennessee Code Annotated, Title 4,

Chapter 5 and the Administrative Procedures Division of the Secretary of State’s rules governing contested case proceedings compiled at Chapter 1360-4-1.

(a) In contested cases pursuant to this rule, the Department shall have the burden of proof by a preponderance of the evidence to establish that a person violated the Act.

(4) Civil Penalty Payments (a) Any person who is assessed a civil penalty pursuant to the Act who does not timely file an appeal of that assessment must pay such civil penalty on or before the thirtieth (30th) day after receipt of the notice of violation and penalty.

(b) If the assessed civil penalty is timely appealed, the assessed penalty must be paid no later than thirty (30) days after the date of a final order affirming the assessed penalty.

(c) Payment of any civil penalty shall be made by check or money order made payable to “Treasurer, State of Tennessee” and mailed or delivered in person to the Department.

History

• Authority: T.C.A. § 4-5-102(3), 68-1-103, 68-1-104, Tenn. Const. Art. 1 § 8 and 39-17-1811.
• Administrative History: Public necessity rule filed September 28, 2007; effective through March 11, 2008. Original rule filed December 27, 2007; effective March 11, 2008.

Chapter 1200-33-01 Commercial Breeders

Tenn. Comp. R. & Regs. 1200-33-01-.01 PURPOSE

The rules of this chapter implement the Commercial Breeder Act, T.C.A. § 44-17-701, et. seq.

History

• Authority: T.C.A. § 44-17-713 [effective January 1, 2010]; and Chapter 591 of the Public Acts of 2009.
• Administrative History: Emergency rule filed December 22, 2009; effective through June 20, 2010. Emergency rule filed December 22, 2009, expired effective June 21, 2010; rule reverted to its original status. Original rule filed April 22, 2010; effective July 21, 2010.

Tenn. Comp. R. & Regs. 1200-33-01-.02 DEFINITIONS

In addition to the definitions contained in T.C.A. Section 44-17-702, the following definitions are applicable to this chapter:

(1) “Applicant” means a person who has submitted or is in the process of submitting a completed application to obtain a commercial breeder’s license;

(2) “Commissioner” means the commissioner of health or the commissioner’s designee;

(3) “Department” means the department of health;

(4) “Licensee” means a person who holds a current, unexpired license as a commercial breeder issued by the commissioner;

(5) “Premises” means the indoor or outdoor facilities where the dogs and cats receive shelter, food and other care as well as the real property on which the facilities are located.

History

• Authority: T.C.A. §44-17-713 [effective January 1, 2010]; and Chapter 591 of the Public Acts of 2009.
• Administrative History: Emergency rule filed December 22, 2009; effective through June 20, 2010. Emergency rule filed December 22, 2009, expired effective June 21, 2010; rule reverted to its original status. Original rule filed April 22, 2010; effective July 21, 2010.

Tenn. Comp. R. & Regs. 1200-33-01-.03 APPLICATION FOR LICENSE

(1) Any person seeking licensure as a commercial breeder shall complete an application on a form prescribed by the commissioner and submit the completed application to the commissioner.

(2) Applications for licensure are available upon request from the commissioner.

(3) Any application submitted which lacks required information or reflects a failure to meet any of the requirements for licensure will be returned to the applicant with written notification of the information that is lacking or the reason(s) the application does not meet the requirements for licensure and will be held in “pending” status until satisfactorily completed within a reasonable period of time, not to exceed sixty (60) days from the date the application is submitted.

History

• Authority: T.C.A. §§44-17-703(a) and 44-17-713 [effective January 1, 2010]; and Chapter 591 of the Public Acts of 2009.
• Administrative History: Emergency rule filed December 22, 2009; effective through June 20, 2010. Emergency rule filed December 22, 2009, expired effective June 21, 2010; rule reverted to its original status. Original rule filed April 22, 2010; effective July 21, 2010.

Tenn. Comp. R. & Regs. 1200-33-01-.04 LICENSURE AND RENEWAL

(1) Licensure.

(a) A person may submit an application to be licensed as a commercial breeder to the commissioner, along with the required application and initial licensing fee.

(b) An applicant for licensure shall provide evidence satisfactory to the commissioner that the applicant:

1. Possesses or maintains, under his or her immediate control, twenty (20) or more unsterilized adult female dogs or cats for the purpose of selling the offspring as companion animals;

2. Has a valid sales tax registration number and is in good standing with the Tennessee department of revenue;

3. Has never been convicted of a violation of T. C. A. §39-14-212 or convicted of any other criminal offense involving an animal provided in T. C. A. Title 39,

Chapter 14, Part 2, for a period of ten (10) years immediately preceding the date of the application;

4. Does not operate or maintain a controlling interest in any releasing agency as defined in T. C. A. §44-17-702(8); and 5. Has premises for the companion animals that comply with the requirements contained in 9 CFR §3.1 through 3.19 (a copy of which is attached to the regulations as Appendix A and incorporated herein by reference) determined through an inspection conducted by the department.

(c) An applicant shall submit to a criminal background check and submit the results of the check to the commissioner as a part of the application for licensure. The applicant shall ensure that all employees working on the premises who have direct contact with the dogs and cats shall submit to a criminal background check.

(2) Renewal.

(a) A license issued to a commercial breeder pursuant to this chapter shall expire one (1) year from the date of its issuance and shall become invalid on such date unless renewed. Any licensee seeking to renew a license after the license expiration date shall file a new application.

(b) A commercial breeder may renew a current, valid license by submitting a renewal form approved by the commissioner, the required renewal fee, and any other information required for renewal, to the commissioner no earlier than one hundred and twenty (120) days nor later than thirty (30) days prior to the expiration date of the license.

(c) Any portion of a licensee’s renewal submitted by mail to the commissioner shall be deemed to have been submitted on the date of the official postmark on such mail.

History

• Authority: T.C.A. §§44-17-704, 44-17-705, 44-17-707, and 44-17-713 [effective January 1, 2010]; and Chapter 591 of the Public Acts of 2009.
• Administrative History: Emergency rule filed December 22, 2009; effective through June 20, 2010. Emergency rule filed December 22, 2009, expired on June 21, 2010; rule reverted to its original status. Original rule filed April 22, 2010; effective July 21, 2010.

Tenn. Comp. R. & Regs. 1200-33-01-.05 FEES

(1) Application and initial license fee.

(a) Between twenty (20) and forty (40) unsterilized adult female cats or dogs.... $500.00 (b) Forty-one (41) or more unsterilized adult female cats or dogs....................$1,000.00 (2) Renewal fee.

(a) Between twenty (20) and forty (40) unsterilized adult female cats or dogs.....$500.00 (b) Forty-one (41) or more unsterilized adult female cats or dogs....................$1,000.00 (3) Duplicate license ............................................................................................$25.00

History

• Authority: T.C.A. §§44-17-703(b), 44-17-705(a), and 44-17-713 [effective January 1, 2010]; and Chapter 591 of the Public Acts of 2009.
• Administrative History: Emergency rule filed December 22, 2009; effective through June 20, 2010. Emergency rule filed December 22, 2009, expired on June 21, 2010; rule reverted to its original status. Original rule filed April 22, 2010; effective July 21, 2010.

Tenn. Comp. R. & Regs. 1200-33-01-.06 ANNUAL REPORT

(1) Each licensee shall submit an annual report to the commissioner by July 1st of each year on a form prescribed by the commissioner in compliance with T. C. A. §44-17-707.

History

• Authority: T.C.A. §§44-17-707, and 44-17-713 [effective January 1, 2010]; and Chapter 591 of the Public Acts of 2009.
• Administrative History: Emergency rule filed December 22, 2009; effective through June 20, 2010. Emergency rule filed December 22, 2009, expired on June 21, 2010; rule reverted to its original status. Original rule filed April 22, 2010; effective July 21, 2010.

Tenn. Comp. R. & Regs. 1200-33-01-.07 INSPECTION OF PREMISES AND ACCESS TO RECORDS

(1) Inspection of Premises.

(a) During an inspection or reinspection of the licensee’s premises, the licensee shall allow the department inspectors to photograph the premises and the companion animals; and (b) During an inspection or reinspection of a licensee’s premises, each licensee shall provide any documentation requested by a department inspector at the time of the request.

(2) Access to Records.

(a) During an inspection or reinspection of the licensee’s premises, the licensee shall provide copies of the following records to the department inspector upon request:

1. Each companion animal acquired, held, maintained, bred at the premises and sold, traded, bartered, given away or disposed of from the premises;

2. The name and address of the person from whom each companion animal was acquired;

3. The date each companion animal was acquired and removed from the premises;

4. A description of each companion animal showing age (including date of birth), size, color, distinctive markings, sex, breed and vaccination information. Records shall also include any other significant identification for each animal including an official tag number, tattoo, or microchip number;

5. The name and address of the person to whom any companion animal is sold, traded, bartered or given, showing the method of disposition;

6. Any statements, notes, correspondence, memoranda, facsimile, records or reports about the prevention, control, and treatment of any companion animal diseases, injuries or conditions as they relate to the condition of the premises; and 7. Any statements, certifications, correspondence, memoranda, facsimile, or reports from a licensed veterinarian about the companion animals required by 9 CFR §3.1 through 3.19.

(b) Each licensee shall maintain the records for a period of one (1) year from the date that the companion animal is acquired by the licensee or born on the licensee’s premises.

History

• Authority: T.C.A. §§44-17-704, 44-17-705(a), 44-17-708, and 44-17-713 [effective January 1, 2010]; and Chapter 591 of the Public Acts of 2009.
• Administrative History: Emergency rule filed December 22, 2009; effective through June 20, 2010. Emergency rule filed December 22, 2009, expired on June 21, 2010; rule reverted to its original status. Original rule filed April 22, 2010; effective July 21, 2010.

Tenn. Comp. R. & Regs. 1200-33-01-.08 STANDARDS OF CARE

(1) Each licensee shall comply with 9 CFR §3.1 through 3.19, T.C.A. Title 44, Chapter 17, Part 7, the rules contained in this chapter and all other applicable federal or state laws or rules relative to the premises.

(2) Each licensee shall ensure that any act that constitutes the practice of veterinary medicine will be performed by an individual licensed as a veterinarian by the Board of Veterinary Medical Examiners.

(3) A licensee may allow the companion animal into the breeder’s residence at the licensee’s discretion as long as the licensee complies with the standards of care provided in this rule.

History

• Authority: T.C.A. §44-17-713 [effective January 1, 2010]; and Chapter 591 of the Public Acts of 2009.
• Administrative History: Emergency rule filed December 22, 2009; effective through June 20, 2010. Emergency rule filed December 22, 2009, expired June 21, 2010; rule reverted to its original status. Original rule filed April 22, 2010; effective July 21, 2010. Withdrawal of 1200-33-01-.08(3) filed July 16, 2010; paragraph (4) became (3).

Tenn. Comp. R. & Regs. 1200-33-01-.09 APPENDIX A

Code of Federal Regulations Title 9. Animals and Animal Products

Chapter I. Animal and Plant Health Inspection Service, Department of Agriculture Subchapter A. Animal Welfare

Part 3. Standards Specifications for the Humane Handling, Care, Treatment, and Transportation of Dogs and Cats Facilities and Operating Standards § 3.1 Housing facilities, general.

(a) Structure; construction. Housing facilities for dogs and cats must be designed and constructed so that they are structurally sound. They must be kept in good repair, and they must protect the animals from injury, contain the animals securely, and restrict other animals from entering.

(b) Condition and site. Housing facilities and areas used for storing animal food or bedding must be free of any accumulation of trash, waste material, junk, weeds, and other discarded materials. Animal areas inside of housing facilities must be kept neat and free of clutter, including equipment, furniture, and stored material, but may contain materials actually used and necessary for cleaning the area, and fixtures or equipment necessary for proper husbandry practices and research needs. Housing facilities other than those maintained by research facilities and Federal research facilities must be physically separated from any other business. If a housing facility is located on the same premises as another business, it must be physically separated from the other business so that animals the size of dogs, skunks, and raccoons are prevented from entering it.

(c) Surfaces-- (1) General requirements. The surfaces of housing facilities--including houses, dens, and other furniture-type fixtures and objects within the facility--must be constructed in a manner and made of materials that allow them to be readily cleaned and sanitized, or removed or replaced when worn or soiled. Interior surfaces and any surfaces that come in contact with dogs or cats must:

(i) Be free of excessive rust that prevents the required cleaning and sanitization, or that affects the structural strength of the surface; and (ii) Be free of jagged edges or sharp points that might injure the animals.

(2) Maintenance and replacement of surfaces. All surfaces must be maintained on a regular basis.

Surfaces of housing facilities--including houses, dens, and other furniture-type fixtures and objects within the facility--that cannot be readily cleaned and sanitized, must be replaced when worn or soiled.

(3) Cleaning. Hard surfaces with which the dogs or cats come in contact must be spot-cleaned daily and sanitized in accordance with § 3.11(b) of this subpart to prevent accumulation of excreta and reduce disease hazards. Floors made of dirt, absorbent bedding, sand, gravel, grass, or other similar material must be raked or spot-cleaned with sufficient frequency to ensure all animals the freedom to avoid contact with excreta. Contaminated material must be replaced whenever this raking and spotcleaning is not sufficient to prevent or eliminate odors, insects, pests, or vermin infestation. All other surfaces of housing facilities must be cleaned and sanitized when necessary to satisfy generally accepted husbandry standards and practices. Sanitization may be done using any of the methods provided in § 3.11(b)(3) for primary enclosures.

(d) Water and electric power. The housing facility must have reliable electric power adequate for (Appendix A, continued) heating, cooling, ventilation, and lighting, and for carrying out other husbandry requirements in accordance with the regulations in this subpart. The housing facility must provide adequate running potable water for the dogs' and cats' drinking needs, for cleaning, and for carrying out other husbandry requirements.

(e) Storage. Supplies of food and bedding must be stored in a manner that protects the supplies from spoilage, contamination, and vermin infestation. The supplies must be stored off the floor and away from the walls, to allow cleaning underneath and around the supplies. Foods requiring refrigeration must be stored accordingly, and all food must be stored in a manner that prevents contamination and deterioration of its nutritive value. All open supplies of food and bedding must be kept in leakproof containers with tightly fitting lids to prevent contamination and spoilage. Only food and bedding that is currently being used may be kept in the animal areas. Substances that are toxic to the dogs or cats but are required for normal husbandry practices must not be stored in food storage and preparation areas, but may be stored in cabinets in the animal areas.

(f) Drainage and waste disposal. Housing facility operators must provide for regular and frequent collection, removal, and disposal of animal and food wastes, bedding, debris, garbage, water, other fluids and wastes, and dead animals, in a manner that minimizes contamination and disease risks.

Housing facilities must be equipped with disposal facilities and drainage systems that are constructed and operated so that animal waste and water are rapidly eliminated and animals stay dry. Disposal and drainage systems must minimize vermin and pest infestation, insects, odors, and disease hazards. All drains must be properly constructed, installed, and maintained. If closed drainage systems are used, they must be equipped with traps and prevent the backflow of gases and the backup of sewage onto the floor. If the facility uses sump or settlement ponds, or other similar systems for drainage and animal waste disposal, the system must be located far enough away from the animal area of the housing facility to prevent odors, diseases, pests, and vermin infestation. Standing puddles of water in animal enclosures must be drained or mopped up so that the animals stay dry. Trash containers in housing facilities and in food storage and food preparation areas must be leakproof and must have tightly fitted lids on them at all times. Dead animals, animal parts, and animal waste must not be kept in food storage or food preparation areas, food freezers, food refrigerators, or animal areas.

(g) Washrooms and sinks. Washing facilities such as washrooms, basins, sinks, or showers must be provided for animal caretakers and must be readily accessible. § 3.2 Indoor housing facilities.

(a) Heating, cooling, and temperature. Indoor housing facilities for dogs and cats must be sufficiently heated and cooled when necessary to protect the dogs and cats from temperature or humidity extremes and to provide for their health and well-being. When dogs or cats are present, the ambient temperature in the facility must not fall below 50 °F (10 °C) for dogs and cats not acclimated to lower temperatures, for those breeds that cannot tolerate lower temperatures without stress or discomfort (such as shorthaired breeds), and for sick, aged, young, or infirm dogs and cats, except as approved by the attending veterinarian. Dry bedding, solid resting boards, or other methods of conserving body heat must be provided when temperatures are below 50 °F (10 °C). The ambient temperature must not fall below 45 °F (7.2 °C) for more than 4 consecutive hours when dogs or cats are present, and must not rise above 85 °F (29.5 °C) for more than 4 consecutive hours when dogs or cats are present. The preceding requirements are in addition to, not in place of, all other requirements pertaining to climatic conditions in parts 2 and 3 of this chapter.

(b) Ventilation. Indoor housing facilities for dogs and cats must be sufficiently ventilated at all times when dogs or cats are present to provide for their health and well-being, and to minimize odors, drafts, ammonia levels, and moisture condensation. Ventilation must be provided by windows, vents, fans, or air conditioning. Auxiliary ventilation, such as fans, blowers, or air conditioning must be provided when the ambient temperature is 85 °F (29.5 °C) or higher. The relative humidity must be maintained at a level that ensures the health and well-being of the dogs or cats housed therein, in accordance with the (Appendix A, continued) directions of the attending veterinarian and generally accepted professional and husbandry practices.

(c) Lighting. Indoor housing facilities for dogs and cats must be lighted well enough to permit routine inspection and cleaning of the facility, and observation of the dogs and cats. Animal areas must be provided a regular diurnal lighting cycle of either natural or artificial light. Lighting must be uniformly diffused throughout animal facilities and provide sufficient illumination to aid in maintaining good housekeeping practices, adequate cleaning, adequate inspection of animals, and for the well-being of the animals. Primary enclosures must be placed so as to protect the dogs and cats from excessive light.

(d) Interior surfaces. The floors and walls of indoor housing facilities, and any other surfaces in contact with the animals, must be impervious to moisture. The ceilings of indoor housing facilities must be impervious to moisture or be replaceable (e.g., a suspended ceiling with replaceable panels). § 3.3 Sheltered housing facilities.

(a) Heating, cooling, and temperature. The sheltered part of sheltered housing facilities for dogs and cats must be sufficiently heated and cooled when necessary to protect the dogs and cats from temperature or humidity extremes and to provide for their health and well-being. The ambient temperature in the sheltered part of the facility must not fall below 50 °F (10 °C) for dogs and cats not acclimated to lower temperatures, for those breeds that cannot tolerate lower temperatures without stress and discomfort (such as short-haired breeds), and for sick, aged, young, or infirm dogs or cats, except as approved by the attending veterinarian. Dry bedding, solid resting boards, or other methods of conserving body heat must be provided when temperatures are below 50 °F (10 °C). The ambient temperature must not fall below 45 °F (7.2 °C) for more than 4 consecutive hours when dogs or cats are present, and must not rise above 85 °F (29.5 °C) for more than 4 consecutive hours when dogs or cats are present. The preceding requirements are in addition to, not in place of, all other requirements pertaining to climatic conditions in parts 2 and 3 of this chapter.

(b) Ventilation. The enclosed or sheltered part of sheltered housing facilities for dogs and cats must be sufficiently ventilated when dogs or cats are present to provide for their health and well-being, and to minimize odors, drafts, ammonia levels, and moisture condensation. Ventilation must be provided by windows, doors, vents, fans, or air conditioning. Auxiliary ventilation, such as fans, blowers, or airconditioning, must be provided when the ambient temperature is 85 °F (29.5 °C) or higher.

(c) Lighting. Sheltered housing facilities for dogs and cats must be lighted well enough to permit routine inspection and cleaning of the facility, and observation of the dogs and cats. Animal areas must be provided a regular diurnal lighting cycle of either natural or artificial light. Lighting must be uniformly diffused throughout animal facilities and provide sufficient illumination to aid in maintaining good housekeeping practices, adequate cleaning, adequate inspection of animals, and for the well-being of the animals. Primary enclosures must be placed so as to protect the dogs and cats from excessive light.

(d) Shelter from the elements. Dogs and cats must be provided with adequate shelter from the elements at all times to protect their health and well-being. The shelter structures must be large enough to allow each animal to sit, stand, and lie in a normal manner and to turn about freely.

(e) Surfaces.

(1) The following areas in sheltered housing facilities must be impervious to moisture:

(i) Indoor floor areas in contact with the animals;

(ii) Outdoor floor areas in contact with the animals, when the floor areas are not exposed to the direct sun, or are made of a hard material such as wire, wood, metal, or concrete; and (Appendix A, continued)

(iii) All walls, boxes, houses, dens, and other surfaces in contact with the animals.

(2) Outside floor areas in contact with the animals and exposed to the direct sun may consist of compacted earth, absorbent bedding, sand, gravel, or grass. § 3.4 Outdoor housing facilities.

(a) Restrictions.

(1) The following categories of dogs or cats must not be kept in outdoor facilities, unless that practice is specifically approved by the attending veterinarian:

(i) Dogs or cats that are not acclimated to the temperatures prevalent in the area or region where they are maintained;

(ii) Breeds of dogs or cats that cannot tolerate the prevalent temperatures of the area without stress or discomfort (such as short-haired breeds in cold climates); and (iii) Sick, infirm, aged or young dogs or cats.

(2) When their acclimation status is unknown, dogs and cats must not be kept in outdoor facilities when the ambient temperature is less than 50 °F (10 °C).

(b) Shelter from the elements. Outdoor facilities for dogs or cats must include one or more shelter structures that are accessible to each animal in each outdoor facility, and that are large enough to allow each animal in the shelter structure to sit, stand, and lie in a normal manner, and to turn about freely. In addition to the shelter structures, one or more separate outside areas of shade must be provided, large enough to contain all the animals at one time and protect them from the direct rays of the sun. Shelters in outdoor facilities for dogs or cats must contain a roof, four sides, and a floor, and must:

(1) Provide the dogs and cats with adequate protection and shelter from the cold and heat;

(2) Provide the dogs and cats with protection from the direct rays of the sun and the direct effect of wind, rain, or snow;

(3) Be provided with a wind break and rain break at the entrance; and (4) Contain clean, dry, bedding material if the ambient temperature is below 50 °F (10 °C). Additional clean, dry bedding is required when the temperature is 35 °F (1.7 °C) or lower.

(c) Construction. Building surfaces in contact with animals in outdoor housing facilities must be impervious to moisture. Metal barrels, cars, refrigerators or freezers, and the like must not be used as shelter structures. The floors of outdoor housing facilities may be of compacted earth, absorbent bedding, sand, gravel, or grass, and must be replaced if there are any prevalent odors, diseases, insects, pests, or vermin. All surfaces must be maintained on a regular basis. Surfaces of outdoor housing facilities--including houses, dens, etc.--that cannot be readily cleaned and sanitized, must be replaced when worn or soiled. § 3.5 Mobile or traveling housing facilities.

(a) Heating, cooling, and temperature. Mobile or traveling housing facilities for dogs and cats must be sufficiently heated and cooled when necessary to protect the dogs and cats from temperature or humidity extremes and to provide for their health and well-being. The ambient temperature in the mobile or traveling housing facility must not fall below 50 °F (10 °C) for dogs and cats not acclimated to lower (Appendix A, continued) temperatures, for those breeds that cannot tolerate lower temperatures without stress or discomfort (such as short-haired breeds), and for sick, aged, young, or infirm dogs and cats. Dry bedding, solid resting boards, or other methods of conserving body heat must be provided when temperatures are below 50 °F (10 °C). The ambient temperature must not fall below 45 °F (7.2 °C) for more than 4 consecutive hours when dogs or cats are present, and must not exceed 85 °F (29.5 °C) for more than 4 consecutive hours when dogs or cats are present. The preceding requirements are in addition to, not in place of, all other requirements pertaining to climatic conditions in parts 2 and 3 of this chapter.

(b) Ventilation. Mobile or traveling housing facilities for dogs and cats must be sufficiently ventilated at all times when dogs or cats are present to provide for the health and well-being of the animals, and to minimize odors, drafts, ammonia levels, moisture condensation, and exhaust fumes. Ventilation must be provided by means of windows, doors, vents, fans, or air conditioning. Auxiliary ventilation, such as fans, blowers, or air conditioning, must be provided when the ambient temperature within the animal housing area is 85 °F (29.5 °C) or higher.

(c) Lighting. Mobile or traveling housing facilities for dogs and cats must be lighted well enough to permit proper cleaning and inspection of the facility, and observation of the dogs and cats. Animal areas must be provided a regular diurnal lighting cycle of either natural or artificial light. Lighting must be uniformly diffused throughout animal facilities and provide sufficient illumination to aid in maintaining good housekeeping practices, adequate cleaning, adequate inspection of animals, and for the wellbeing of the animals. § 3.6 Primary enclosures.

Primary enclosures for dogs and cats must meet the following minimum requirements:

(a) General requirements.

(1) Primary enclosures must be designed and constructed of suitable materials so that they are structurally sound. The primary enclosures must be kept in good repair.

(2) Primary enclosures must be constructed and maintained so that they:

(i) Have no sharp points or edges that could injure the dogs and cats;

(ii) Protect the dogs and cats from injury;

(iii) Contain the dogs and cats securely;

(iv) Keep other animals from entering the enclosure;

(v) Enable the dogs and cats to remain dry and clean;

(vi) Provide shelter and protection from extreme temperatures and weather conditions that may be uncomfortable or hazardous to all the dogs and cats;

(vii) Provide sufficient shade to shelter all the dogs and cats housed in the primary enclosure at one time;

(viii) Provide all the dogs and cats with easy and convenient access to clean food and water;

(ix) Enable all surfaces in contact with the dogs and cats to be readily cleaned and sanitized in accordance with § 3.11(b) of this subpart, or be replaceable when worn or soiled;

(x) Have floors that are constructed in a manner that protects the dogs' and cats' feet and legs from (Appendix A, continued) injury, and that, if of mesh or slatted construction, do not allow the dogs' and cats' feet to pass through any openings in the floor;

(xi) Provide sufficient space to allow each dog and cat to turn about freely, to stand, sit, and lie in a comfortable, normal position, and to walk in a normal manner; and (xii) Primary enclosures constructed on or after February 20, 1998 and floors replaced on or after that date, must comply with the requirements in this paragraph (a)(2). On or after January 21, 2000, all primary enclosures must be in compliance with the requirements in this paragraph (a)(2). If the suspended floor of a primary enclosure is constructed of metal strands, the strands must either be greater than 1/8 of an inch in diameter (9 gauge) or coated with a material such as plastic or fiberglass. The suspended floor of any primary enclosure must be strong enough so that the floor does not sag or bend between the structural supports.

(b) Additional requirements for cats.

(1) Space. Each cat, including weaned kittens, that is housed in any primary enclosure must be provided minimum vertical space and floor space as follows:

(i) Prior to February 15, 1994 each cat housed in any primary enclosure shall be provided a minimum of 2 1/2 square feet of floor space;

(ii) On and after February 15, 1994:

(A) Each primary enclosure housing cats must be at least 24 in. high (60.96 cm);

(B) Cats up to and including 8.8 lbs (4 kg) must be provided with at least 3.0 ft (0.28 m );

(C) Cats over 8.8 lbs (4 kg) must be provided with at least 4.0 ft (0.37 m );

(iii) Each queen with nursing kittens must be provided with an additional amount of floor space, based on her breed and behavioral characteristics, and in accordance with generally accepted husbandry practices. If the additional amount of floor space for each nursing kitten is equivalent to less than 5 percent of the minimum requirement for the queen, such housing must be approved by the attending veterinarian in the case of a research facility, and, in the case of dealers and exhibitors, such housing must be approved by the Administrator; and (iv) The minimum floor space required by this section is exclusive of any food or water pans. The litter pan may be considered part of the floor space if properly cleaned and sanitized.

(2) Compatibility. All cats housed in the same primary enclosure must be compatible, as determined by observation. Not more than 12 adult nonconditioned cats may be housed in the same primary enclosure. Queens in heat may not be housed in the same primary enclosure with sexually mature males, except for breeding. Except when maintained in breeding colonies, queens with litters may not be housed in the same primary enclosure with other adult cats, and kittens under 4 months of age may not be housed in the same primary enclosure with adult cats, other than the dam or foster dam.

Cats with a vicious or aggressive disposition must be housed separately.

(3) Litter. In all primary enclosures, a receptacle containing sufficient clean litter must be provided to contain excreta and body wastes.

(4) Resting surfaces. Each primary enclosure housing cats must contain a resting surface or surfaces that, in the aggregate, are large enough to hold all the occupants of the primary enclosure at the same time comfortably. The resting surfaces must be elevated, impervious to moisture, and be able to be easily cleaned and sanitized, or easily replaced when soiled or worn. Low resting surfaces that do not allow the space under them to be comfortably occupied by the animal will be counted as part (Appendix A, continued) of the floor space.

(5) Cats in mobile or traveling shows or acts. Cats that are part of a mobile or traveling show or act may be kept, while the show or act is traveling from one temporary location to another, in transport containers that comply with all requirements of § 3.14 of this subpart other than the marking requirements in § 3.14(a)(6) of this subpart. When the show or act is not traveling, the cats must be placed in primary enclosures that meet the minimum requirements of this section.

(c) Additional requirements for dogs-- (1) Space.

(i) Each dog housed in a primary enclosure (including weaned puppies) must be provided a minimum amount of floor space, calculated as follows: Find the mathematical square of the sum of the length of the dog in inches (measured from the tip of its nose to the base of its tail) plus 6 inches; then divide the product by 144. The calculation is: (length of dog in inches + 6) x (length of dog in inches + 6) = required floor space in square inches. Required floor space in inches/144 = required floor space in square feet.

(ii) Each bitch with nursing puppies must be provided with an additional amount of floor space, based on her breed and behavioral characteristics, and in accordance with generally accepted husbandry practices as determined by the attending veterinarian. If the additional amount of floor space for each nursing puppy is less than 5 percent of the minimum requirement for the bitch, such housing must be approved by the attending veterinarian in the case of a research facility, and, in the case of dealers and exhibitors, such housing must be approved by the Administrator.

(iii) The interior height of a primary enclosure must be at least 6 inches higher than the head of the tallest dog in the enclosure when it is in a normal standing position: Provided That, prior to February 15, 1994, each dog must be able to stand in a comfortable normal position.

(2) Compatibility. All dogs housed in the same primary enclosure must be compatible, as determined by observation. Not more than 12 adult nonconditioned dogs may be housed in the same primary enclosure. Bitches in heat may not be housed in the same primary enclosure with sexually mature males, except for breeding. Except when maintained in breeding colonies, bitches with litters may not be housed in the same primary enclosure with other adult dogs, and puppies under 4 months of age may not be housed in the same primary enclosure with adult dogs, other than the dam or foster dam.

Dogs with a vicious or aggressive disposition must be housed separately.

(3) Dogs in mobile or traveling shows or acts. Dogs that are part of a mobile or traveling show or act may be kept, while the show or act is traveling from one temporary location to another, in transport containers that comply with all requirements of § 3.14 of this subpart other than the marking requirements in § 3.14(a)(6) of this subpart. When the show or act is not traveling, the dogs must be placed in primary enclosures that meet the minimum requirements of this section.

(4) Prohibited means of primary enclosure. Permanent tethering of dogs is prohibited for use as primary enclosure. Temporary tethering of dogs is prohibited for use as primary enclosure unless approval is obtained from APHIS.

(d) Innovative primary enclosures not precisely meeting the floor area and height requirements provided in paragraphs (b)(1) and (c)(1) of this section, but that provide the dogs or cats with a sufficient volume of space and the opportunity to express species-typical behavior, may be used at research facilities when approved by the Committee, and by dealers and exhibitors when approved by the Administrator.

(Approved by the Office of Management and Budget under control number 0579–0093)

(Appendix A, continued) § 3.7 Compatible grouping.

Dogs and cats that are housed in the same primary enclosure must be compatible, with the following restrictions:

(a) Females in heat (estrus) may not be housed in the same primary enclosure with males, except for breeding purposes;

(b) Any dog or cat exhibiting a vicious or overly aggressive disposition must be housed separately;

(c) Puppies or kittens 4 months of age or less may not be housed in the same primary enclosure with adult dogs or cats other than their dams or foster dams, except when permanently maintained in breeding colonies;

(d) Dogs or cats may not be housed in the same primary enclosure with any other species of animals, unless they are compatible; and (e) Dogs and cats that have or are suspected of having a contagious disease must be isolated from healthy animals in the colony, as directed by the attending veterinarian. When an entire group or room of dogs and cats is known to have or believed to be exposed to an infectious agent, the group may be kept intact during the process of diagnosis, treatment, and control. § 3.8 Exercise for dogs.

Dealers, exhibitors, and research facilities must develop, document, and follow an appropriate plan to provide dogs with the opportunity for exercise. In addition, the plan must be approved by the attending veterinarian. The plan must include written standard procedures to be followed in providing the opportunity for exercise. The plan must be made available to APHIS upon request, and, in the case of research facilities, to officials of any pertinent funding Federal agency. The plan, at a minimum, must comply with each of the following:

(a) Dogs housed individually. Dogs over 12 weeks of age, except bitches with litters, housed, held, or maintained by any dealer, exhibitor, or research facility, including Federal research facilities, must be provided the opportunity for exercise regularly if they are kept individually in cages, pens, or runs that provide less than two times the required floor space for that dog, as indicated by § 3.6(c)(1) of this

subpart.

(b) Dogs housed in groups. Dogs over 12 weeks of age housed, held, or maintained in groups by any dealer, exhibitor, or research facility, including Federal research facilities, do not require additional opportunity for exercise regularly if they are maintained in cages, pens, or runs that provide in total at least 100 percent of the required space for each dog if maintained separately. Such animals may be maintained in compatible groups, unless:

(1) Housing in compatible groups is not in accordance with a research proposal and the proposal has been approved by the research facility Committee;

(2) In the opinion of the attending veterinarian, such housing would adversely affect the health or wellbeing of the dog(s); or (3) Any dog exhibits aggressive or vicious behavior.

(c) Methods and period of providing exercise opportunity.

(1) The frequency, method, and duration of the opportunity for exercise shall be determined by the attending veterinarian and, at research facilities, in consultation with and approval by the Committee.

(Appendix A, continued)

(2) Dealers, exhibitors, and research facilities, in developing their plan, should consider providing positive physical contact with humans that encourages exercise through play or other similar activities. If a dog is housed, held, or maintained at a facility without sensory contact with another dog, it must be provided with positive physical contact with humans at least daily.

(3) The opportunity for exercise may be provided in a number of ways, such as:

(i) Group housing in cages, pens or runs that provide at least 100 percent of the required space for each dog if maintained separately under the minimum floor space requirements of § 3.6(c)(1) of this

subpart;

(ii) Maintaining individually housed dogs in cages, pens, or runs that provide at least twice the minimum floor space required by § 3.6(c)(1) of this subpart;

(iii) Providing access to a run or open area at the frequency and duration prescribed by the attending veterinarian; or (iv) Other similar activities.

(4) Forced exercise methods or devices such as swimming, treadmills, or carousel-type devices are unacceptable for meeting the exercise requirements of this section.

(d) Exemptions.

(1) If, in the opinion of the attending veterinarian, it is inappropriate for certain dogs to exercise because of their health, condition, or well-being, the dealer, exhibitor, or research facility may be exempted from meeting the requirements of this section for those dogs. Such exemption must be documented by the attending veterinarian and, unless the basis for exemption is a permanent condition, must be reviewed at least every 30 days by the attending veterinarian.

(2) A research facility may be exempted from the requirements of this section if the principal investigator determines for scientific reasons set forth in the research proposal that it is inappropriate for certain dogs to exercise. Such exemption must be documented in the Committee-approved proposal and must be reviewed at appropriate intervals as determined by the Committee, but not less than annually.

(3) Records of any exemptions must be maintained and made available to USDA officials or any pertinent funding Federal agency upon request.

(Approved by the Office of Management and Budget under control number 0579–0093) § 3.9 Feeding.

(a) Dogs and cats must be fed at least once each day, except as otherwise might be required to provide adequate veterinary care. The food must be uncontaminated, wholesome, palatable, and of sufficient quantity and nutritive value to maintain the normal condition and weight of the animal. The diet must be appropriate for the individual animal's age and condition.

(b) Food receptacles must be used for dogs and cats, must be readily accessible to all dogs and cats, and must be located so as to minimize contamination by excreta and pests, and be protected from rain and snow. Feeding pans must either be made of a durable material that can be easily cleaned and sanitized or be disposable. If the food receptacles are not disposable, they must be kept clean and must be sanitized in accordance with § 3.11(b) of this subpart. Sanitization is achieved by using one of the methods described in § 3.11(b)(3) of this subpart. If the food receptacles are disposable, they must (Appendix A, continued) be discarded after one use. Self-feeders may be used for the feeding of dry food. If self-feeders are used, they must be kept clean and must be sanitized in accordance with § 3.11(b) of this subpart.

Measures must be taken to ensure that there is no molding, deterioration, and caking of feed. § 3.10 Watering.

If potable water is not continually available to the dogs and cats, it must be offered to the dogs and cats as often as necessary to ensure their health and well-being, but not less than twice daily for at least 1 hour each time, unless restricted by the attending veterinarian. Water receptacles must be kept clean and sanitized in accordance with § 3.11(b) of this subpart, and before being used to water a different dog or cat or social grouping of dogs or cats. § 3.11 Cleaning, sanitization, housekeeping, and pest control.

(a) Cleaning of primary enclosures. Excreta and food waste must be removed from primary enclosures daily, and from under primary enclosures as often as necessary to prevent an excessive accumulation of feces and food waste, to prevent soiling of the dogs or cats contained in the primary enclosures, and to reduce disease hazards, insects, pests and odors. When steam or water is used to clean the primary enclosure, whether by hosing, flushing, or other methods, dogs and cats must be removed, unless the enclosure is large enough to ensure the animals would not be harmed, wetted, or distressed in the process. Standing water must be removed from the primary enclosure and animals in other primary enclosures must be protected from being contaminated with water and other wastes during the cleaning. The pans under primary enclosures with grill-type floors and the ground areas under raised runs with mesh or slatted floors must be cleaned as often as necessary to prevent accumulation of feces and food waste and to reduce disease hazards pests, insects and odors.

(b) Sanitization of primary enclosures and food and water receptacles.

(1) Used primary enclosures and food and water receptacles must be cleaned and sanitized in accordance with this section before they can be used to house, feed, or water another dog or cat, or social grouping of dogs or cats.

(2) Used primary enclosures and food and water receptacles for dogs and cats must be sanitized at least once every 2 weeks using one of the methods prescribed in paragraph (b)(3) of this section, and more often if necessary to prevent an accumulation of dirt, debris, food waste, excreta, and other disease hazards.

(3) Hard surfaces of primary enclosures and food and water receptacles must be sanitized using one of the following methods:

(i) Live steam under pressure;

(ii) Washing with hot water (at least 180 °F (82.2 °C)) and soap or detergent, as with a mechanical cage washer; or (iii) Washing all soiled surfaces with appropriate detergent solutions and disinfectants, or by using a combination detergent/disinfectant product that accomplishes the same purpose, with a thorough cleaning of the surfaces to remove organic material, so as to remove all organic material and mineral buildup, and to provide sanitization followed by a clean water rinse.

(4) Pens, runs, and outdoor housing areas using material that cannot be sanitized using the methods provided in paragraph (b)(3) of this section, such as gravel, sand, grass, earth, or absorbent bedding, must be sanitized by removing the contaminated material as necessary to prevent odors, diseases, pests, insects, and vermin infestation.

(Appendix A, continued)

(c) Housekeeping for premises. Premises where housing facilities are located, including buildings and surrounding grounds, must be kept clean and in good repair to protect the animals from injury, to facilitate the husbandry practices required in this subpart, and to reduce or eliminate breeding and living areas for rodents and other pests and vermin. Premises must be kept free of accumulations of trash, junk, waste products, and discarded matter. Weeds, grasses, and bushes must be controlled so as to facilitate cleaning of the premises and pest control, and to protect the health and well-being of the animals.

(d) Pest control. An effective program for the control of insects, external parasites affecting dogs and cats, and birds and mammals that are pests, must be established and maintained so as to promote the health and well-being of the animals and reduce contamination by pests in animal areas. § 3.12 Employees.

Each person subject to the Animal Welfare regulations (9 CFR Parts 1, 2, and 3) maintaining dogs and cats must have enough employees to carry out the level of husbandry practices and care required in this subpart. The employees who provide for husbandry and care, or handle animals, must be supervised by an individual who has the knowledge, background, and experience in proper husbandry and care of dogs and cats to supervise others. The employer must be certain that the supervisor and other employees can perform to these standards. § 3.13 Consignments to carriers and intermediate handlers.

(a) Carriers and intermediate handlers must not accept a dog or cat for transport in commerce more than 4 hours before the scheduled departure time of the primary conveyance on which the animal is to be transported. However, a carrier or intermediate handler may agree with anyone consigning a dog or cat to extend this time by up to 2 hours.

(b) Carriers and intermediate handlers must not accept a dog or cat for transport in commerce unless they are provided with the name, address, and telephone number of the consignee.

(c) Carriers and intermediate handlers must not accept a dog or cat for transport in commerce unless the consignor certifies in writing to the carrier or intermediate handler that the dog or cat was offered food and water during the 4 hours before delivery to the carrier or intermediate handler. The certification must be securely attached to the outside of the primary enclosure in a manner that makes it easily noticed and read. Instructions for no food or water are not acceptable unless directed by the attending veterinarian. Instructions must be in compliance with § 3.16 of this subpart. The certification must include the following information for each dog and cat:

(1) The consignor's name and address;

(2) The tag number or tattoo assigned to each dog or cat under §§ 2.38 and 2.50 of this chapter;

(3) The time and date the animal was last fed and watered and the specific instructions for the next feeding(s) and watering(s) for a 24–hour period; and (4) The consignor's signature and the date and time the certification was signed.

(d) Carriers and intermediate handlers must not accept a dog or cat for transport in commerce in a primary enclosure unless the primary enclosure meets the requirements of § 3.14 of this subpart. A carrier or intermediate handler must not accept a dog or cat for transport if the primary enclosure is obviously defective or damaged and cannot reasonably be expected to safely and comfortably contain the dog or cat without causing suffering or injury.

(Appendix A, continued)

(e) Carriers and intermediate handlers must not accept a dog or cat for transport in commerce unless their animal holding area meets the minimum temperature requirements provided in §§ 3.18 and 3.19 of this subpart, or unless the consignor provides them with a certificate signed by a veterinarian and dated no more than 10 days before delivery of the animal to the carrier or intermediate handler for transport in commerce, certifying that the animal is acclimated to temperatures lower than those required in §§ 3.18 and 3.19 of this subpart. Even if the carrier or intermediate handler receives this certification, the temperatures the dog or cat is exposed to while in a terminal facility must not be lower than 45 °F (2.2 °C) for more than 4 consecutive hours when dogs or cats are present, as set forth in § 3.18 , nor lower than 45 °F (2.2 °C) for more than 45 minutes, as set forth in § 3.19 , when moving dogs or cats to or from terminal facilities or primary conveyances. A copy of the certification must accompany the dog or cat to its destination and must include the following information:

(1) The consignor's name and address;

(2) The tag number or tattoo assigned to each dog or cat under §§ 2.38 and 2.50 of this chapter;

(3) A statement by a veterinarian, dated no more than 10 days before delivery, that to the best of his or her knowledge, each of the dogs or cats contained in the primary enclosure is acclimated to air temperatures lower than 50 °F (10 °C); but not lower than a minimum temperature, specified on a certificate, that the attending veterinarian has determined is based on generally accepted temperature standards for the age, condition, and breed of the dog or cat; and (4) The signature of the veterinarian and the date the certification was signed.

(f) When a primary enclosure containing a dog or cat has arrived at the animal holding area at a terminal facility after transport, the carrier or intermediate handler must attempt to notify the consignee upon arrival and at least once in every 6–hour period thereafter. The time, date, and method of all attempted notifications and the actual notification of the consignee, and the name of the person who notifies or attempts to notify the consignee must be written either on the carrier's or intermediate handler's copy of the shipping document or on the copy that accompanies the primary enclosure. If the consignee cannot be notified within 24 hours after the dog or cat has arrived at the terminal facility, the carrier or intermediate handler must return the animal to the consignor or to whomever the consignor designates. If the consignee is notified of the arrival and does not accept delivery of the dog or cat within 48 hours after arrival of the dog or cat, the carrier or intermediate handler must return the animal to the consignor or to whomever the consignor designates. The carrier or intermediate handler must continue to provide proper care, feeding, and housing to the dog or cat, and maintain the dog or cat in accordance with generally accepted professional and husbandry practices until the consignee accepts delivery of the dog or cat or until it is returned to the consignor or to whomever the consignor designates. The carrier or intermediate handler must obligate the consignor to reimburse the carrier or intermediate handler for the cost of return transportation and care.

(Approved by the Office of Management and Budget under control number 0579–0093) § 3.14 Primary enclosures used to transport live dogs and cats.

Any person subject to the Animal Welfare regulations (9 CFR parts 1, 2, and 3) must not transport or deliver for transport in commerce a dog or cat unless the following requirements are met:

(a) Construction of primary enclosures. The dog or cat must be contained in a primary enclosure such as a compartment, transport cage, carton, or crate. Primary enclosures used to transport dogs and cats must be constructed so that:

(1) The primary enclosure is strong enough to contain the dogs and cats securely and comfortably and to withstand the normal rigors of transportation;

(Appendix A, continued)

(2) The interior of the primary enclosure has no sharp points or edges and no protrusions that could injure the animal contained in it;

(3) The dog or cat is at all times securely contained within the enclosure and cannot put any part of its body outside the enclosure in a way that could result in injury to itself, to handlers, or to persons or animals nearby;

(4) The dog or cat can be easily and quickly removed from the enclosure in an emergency;

(5) Unless the enclosure is permanently affixed to the conveyance, adequate devices such as handles or handholds are provided on its exterior, and enable the enclosure to be lifted without tilting it, and ensure that anyone handling the enclosure will not come into physical contact with the animal contained inside;

(6) Unless the enclosure is permanently affixed to the conveyance, it is clearly marked on top and on one or more sides with the words “Live Animals,” in letters at least 1 inch (2.5 cm.) high, and with arrows or other markings to indicate the correct upright position of the primary enclosure;

(7) Any material, treatment, paint, preservative, or other chemical used in or on the enclosure is nontoxic to the animal and not harmful to the health or well-being of the animal;

(8) Proper ventilation is provided to the animal in accordance with paragraph (c) of this section; and (9) The primary enclosure has a solid, leak-proof bottom or a removable, leak-proof collection tray under a slatted or mesh floor that prevents seepage of waste products, such as excreta and body fluids, outside of the enclosure. If a slatted or mesh floor is used in the enclosure, it must be designed and constructed so that the animal cannot put any part of its body between the slats or through the holes in the mesh. Unless the dogs and cats are on raised slatted floors or raised floors made of mesh, the primary enclosure must contain enough previously unused litter to absorb and cover excreta. The litter must be of a suitably absorbent material that is safe and nontoxic to the dogs and cats.

(b) Cleaning of primary enclosures. A primary enclosure used to hold or transport dogs or cats in commerce must be cleaned and sanitized before each use in accordance with the methods provided in § 3.11(b)(3) of this subpart. If the dogs or cats are in transit for more than 24 hours, the enclosures must be cleaned and any litter replaced, or other methods, such as moving the animals to another enclosure, must be utilized to prevent the soiling of the dogs or cats by body wastes. If it becomes necessary to remove the dog or cat from the enclosure in order to clean, or to move the dog or cat to another enclosure, this procedure must be completed in a way that safeguards the dog or cat from injury and prevents escape.

(c) Ventilation.

(1) Unless the primary enclosure is permanently affixed to the conveyance, there must be:

(i) Ventilation openings located on two opposing walls of the primary enclosure and the openings must be at least 16 percent of the surface area of each such wall, and the total combined surface area of the ventilation openings must be at least 14 percent of the total combined surface area of all the walls of the primary enclosure; or (ii) Ventilation openings on three walls of the primary enclosure, and the openings on each of the two opposing walls must be at least 8 percent of the total surface area of the two walls, and the ventilation openings on the third wall of the primary enclosure must be at least 50 percent of the total surface area of that wall, and the total combined surface area of the ventilation openings must be at least 14 percent of the total combined surface area of all the walls of the primary enclosure; or (Appendix A, continued)

(iii) Ventilation openings located on all four walls of the primary enclosure and the ventilation openings on each of the four walls must be at least 8 percent of the total surface area of each such wall, and the total combined surface area of the openings must be at least 14 percent of total combined surface area of all the walls of the primary enclosure; and (iv) At least one-third of the ventilation area must be located on the upper half of the primary enclosure.

(2) Unless the primary enclosure is permanently affixed to the conveyance, projecting rims or similar devices must be located on the exterior of each enclosure wall having a ventilation opening, in order to prevent obstruction of the openings. The projecting rims or similar devices must be large enough to provide a minimum air circulation space of 0.75 in. (1.9 cm) between the primary enclosure and anything the enclosure is placed against.

(3) If a primary enclosure is permanently affixed to the primary conveyance so that there is only a front ventilation opening for the enclosure, the primary enclosure must be affixed to the primary conveyance in such a way that the front ventilation opening cannot be blocked, and the front ventilation opening must open directly to an unobstructed aisle or passageway inside the conveyance. The ventilation opening must be at least 90 percent of the total area of the front wall of the enclosure, and must be covered with bars, wire mesh, or smooth expanded metal having air spaces.

(d) Compatibility.

(1) Live dogs or cats transported in the same primary enclosure must be of the same species and be maintained in compatible groups, except that dogs and cats that are private pets, are of comparable size, and are compatible, may be transported in the same primary enclosure.

(2) Puppies or kittens 4 months of age or less may not be transported in the same primary enclosure with adult dogs or cats other than their dams.

(3) Dogs or cats that are overly aggressive or exhibit a vicious disposition must be transported individually in a primary enclosure.

(4) Any female dog or cat in heat (estrus) may not be transported in the same primary enclosure with any male dog or cat.

(e) Space and placement.

(1) Primary enclosures used to transport live dogs and cats must be large enough to ensure that each animal contained in the primary enclosure has enough space to turn about normally while standing, to stand and sit erect, and to lie in a natural position.

(2) Primary enclosures used to transport dogs and cats must be positioned in the primary conveyance so as to provide protection from the elements.

(f) Transportation by air.

(1) No more than one live dog or cat, 6 months of age or older, may be transported in the same primary enclosure when shipped via air carrier.

(2) No more than one live puppy, 8 weeks to 6 months of age, and weighing over 20 lbs (9 kg), may be transported in a primary enclosure when shipped via air carrier.

(3) No more than two live puppies or kittens, 8 weeks to 6 months of age, that are of comparable size, (Appendix A, continued) and weighing 20 lbs (9 kg) or less each, may be transported in the same primary enclosure when shipped via air carrier.

(4) Weaned live puppies or kittens less than 8 weeks of age and of comparable size, or puppies or kittens that are less than 8 weeks of age that are littermates and are accompanied by their dam, may be transported in the same primary enclosure when shipped to research facilities, including Federal research facilities.

(g) Transportation by surface vehicle or privately owned aircraft.

(1) No more than four live dogs or cats, 8 weeks of age or older, that are of comparable size, may be transported in the same primary enclosure when shipped by surface vehicle (including ground and water transportation) or privately owned aircraft, and only if all other requirements of this section are met.

(2) Weaned live puppies or kittens less than 8 weeks of age and of comparable size, or puppies or kittens that are less than 8 weeks of age that are littermates and are accompanied by their dam, may be transported in the same primary enclosure when shipped to research facilities, including Federal research facilities, and only if all other requirements in this section are met.

(h) Accompanying documents and records. Shipping documents that must accompany shipments of dogs and cats may be held by the operator of the primary conveyance, for surface transportation only, or must be securely attached in a readily accessible manner to the outside of any primary enclosure that is part of the shipment, in a manner that allows them to be detached for examination and securely reattached, such as in a pocket or sleeve. Instructions for administration of drugs, medication, and other special care must be attached to each primary enclosure in a manner that makes them easy to notice, to detach for examination, and to reattach securely. Food and water instructions must be attached in accordance with § 3.13(c) .

(Approved by the Office of Management and Budget under control number 0579–0093) § 3.15 Primary conveyances (motor vehicle, rail, air, and marine).

(a) The animal cargo space of primary conveyances used to transport dogs and cats must be designed, constructed, and maintained in a manner that at all times protects the health and well-being of the animals transported in them, ensures their safety and comfort, and prevents the entry of engine exhaust from the primary conveyance during transportation.

(b) The animal cargo space must have a supply of air that is sufficient for the normal breathing of all the animals being transported in it.

(c) Each primary enclosure containing dogs or cats must be positioned in the animal cargo space in a manner that provides protection from the elements and that allows each dog or cat enough air for normal breathing.

(d) During air transportation, dogs and cats must be held in cargo areas that are heated or cooled as necessary to maintain an ambient temperature and humidity that ensures the health and well-being of the dogs or cats. The cargo areas must be pressurized when the primary conveyance used for air transportation is not on the ground, unless flying under 8,000 ft. Dogs and cats must have adequate air for breathing at all times when being transported.

(e) During surface transportation, auxiliary ventilation, such as fans, blowers or air conditioning, must be used in any animal cargo space containing live dogs or cats when the ambient temperature within the animal cargo space reaches 85 °F (29.5 °C). Moreover, the ambient temperature may not exceed 85 °F (29.5 °C) for a period of more than 4 hours; nor fall below 45 °F (7.2 °C) for a period of more than 4 (Appendix A, continued) hours. The preceding requirements are in addition to, not in place of, all other requirements pertaining to climatic conditions in parts 2 and 3 of this chapter.

(f) Primary enclosures must be positioned in the primary conveyance in a manner that allows the dogs and cats to be quickly and easily removed from the primary conveyance in an emergency.

(g) The interior of the animal cargo space must be kept clean.

(h) Live dogs and cats may not be transported with any material, substance (e.g., dry ice) or device in a manner that may reasonably be expected to harm the dogs and cats or cause inhumane conditions. § 3.16 Food and water requirements.

(a) Each dog and cat that is 16 weeks of age or more must be offered food at least once every 24 hours. Puppies and kittens less than 16 weeks of age must be offered food at least once every 12 hours. Each dog and cat must be offered potable water at least once every 12 hours. These time periods apply to dealers, exhibitors, research facilities, including Federal research facilities, who transport dogs and cats in their own primary conveyance, starting from the time the dog or cat was last offered food and potable water before transportation was begun. These time periods apply to carriers and intermediate handlers starting from the date and time stated on the certificate provided under § 3.13(c) of this subpart. Each dog and cat must be offered food and potable water within 4 hours before being transported in commerce. Consignors who are subject to the Animal Welfare regulations (9 CFR parts 1, 2, and 3) must certify that each dog and cat was offered food and potable water within the 4 hours preceding delivery of the dog or cat to a carrier or intermediate handler for transportation in commerce, and must certify the date and time the food and potable water was offered, in accordance with § 3.13(c) of this subpart.

(b) Any dealer, research facility, including a Federal research facility, or exhibitor offering any dog or cat to a carrier or intermediate handler for transportation in commerce must securely attach to the outside of the primary enclosure used for transporting the dog or cat, written instructions for the in-transit food and water requirements for a 24–hour period for the dogs and cats contained in the enclosure. The instructions must be attached in a manner that makes them easily noticed and read.

(c) Food and water receptacles must be securely attached inside the primary enclosure and placed so that the receptacles can be filled from outside the enclosure without opening the door. Food and water containers must be designed, constructed, and installed so that a dog or cat cannot leave the primary enclosure through the food or water opening.

(Approved by the Office of Management and Budget under control number 0579–0093)

[FN1]

These minimum standards apply only to live dogs and cats, unless stated otherwise.

Code of Federal Regulations Currentness § 3.17 Care in transit.

(a) Surface transportation (ground and water). Any person subject to the Animal Welfare regulations transporting dogs or cats in commerce must ensure that the operator of the conveyance, or a person accompanying the operator, observes the dogs or cats as often as circumstances allow, but not less than once every 4 hours, to make sure they have sufficient air for normal breathing, that the ambient temperature is within the limits provided in § 3.15(e) , and that all applicable standards of this subpart are being complied with. The regulated person must ensure that the operator or person accompanying the operator determines whether any of the dogs or cats are in obvious physical distress and obtains any veterinary care needed for the dogs or cats at the closest available veterinary facility.

(Appendix A, continued)

(b) Air transportation. During air transportation of dogs or cats, it is the responsibility of the carrier to observe the dogs or cats as frequently as circumstances allow, but not less than once every 4 hours if the animal cargo area is accessible during flight. If the animal cargo area is not accessible during flight, the carrier must observe the dogs or cats whenever they are loaded and unloaded and whenever the animal cargo space is otherwise accessible to make sure they have sufficient air for normal breathing, that the animal cargo area meets the heating and cooling requirements of § 3.15(d) , and that all other applicable standards of this subpart are being complied with. The carrier must determine whether any of the dogs or cats are in obvious physical distress, and arrange for any needed veterinary care as soon as possible.

(c) If a dog or cat is obviously ill, injured, or in physical distress, it must not be transported in commerce, except to receive veterinary care for the condition.

(d) Except during the cleaning of primary enclosures, as required in § 3.14(b) of this subpart, during transportation in commerce a dog or cat must not be removed from its primary enclosure, unless it is placed in another primary enclosure or facility that meets the requirements of § 3.6 or § 3.14 of this

subpart.

(e) The transportation regulations contained in this subpart must be complied with until a consignee takes physical delivery of the dog or cat if the animal is consigned for transportation, or until the animal is returned to the consignor. § 3.18 Terminal facilities.

(a) Placement. Any person subject to the Animal Welfare regulations (9 CFR parts 1, 2, and 3) must not commingle shipments of dogs or cats with inanimate cargo in animal holding areas of terminal facilities.

(b) Cleaning, sanitization, and pest control. All animal holding areas of terminal facilities must be cleaned and sanitized in a manner prescribed in § 3.11(b)(3) of this subpart, as often as necessary to prevent an accumulation of debris or excreta and to minimize vermin infestation and disease hazards.

Terminal facilities must follow an effective program in all animal holding areas for the control of insects, ectoparasites, and birds and mammals that are pests to dogs and cats.

(c) Ventilation. Ventilation must be provided in any animal holding area in a terminal facility containing dogs or cats, by means of windows, doors, vents, or air conditioning. The air must be circulated by fans, blowers, or air conditioning so as to minimize drafts, odors, and moisture condensation. Auxiliary ventilation, such as exhaust fans, vents, fans, blowers, or air conditioning must be used in any animal holding area containing dogs and cats, when the ambient temperature is 85 °F (29.5 °C) or higher.

(d) Temperature. The ambient temperature in an animal holding area containing dogs or cats must not fall below 45 °F (7.2 °C) or rise above 85 °F (29.5 °C) for more than four consecutive hours at any time dogs or cats are present. The ambient temperature must be measured in the animal holding area by the carrier, intermediate handler, or a person transporting dogs or cats who is subject to the Animal Welfare regulations (9 CFR parts 1, 2, and 3), outside any primary enclosure containing a dog or cat at a point not more than 3 feet (0.91 m) away from an outside wall of the primary enclosure, and approximately midway up the side of the enclosure. The preceding requirements are in addition to, not in place of, all other requirements pertaining to climatic conditions in parts 2 and 3 of this chapter.

(e) Shelter. Any person subject to the Animal Welfare regulations (9 CFR parts 1, 2, and 3) holding a live dog or cat in an animal holding area of a terminal facility must provide the following:

(1) Shelter from sunlight and extreme heat. Shade must be provided that is sufficient to protect the dog or cat from the direct rays of the sun.

(2) Shelter from rain or snow. Sufficient protection must be provided to allow the dogs and cats to (Appendix A, continued) remain dry during rain, snow, and other precipitation.

(f) Duration. The length of time any person subject to the Animal Welfare regulations (9 CFR parts 1, 2, and 3) can hold dogs and cats in animal holding areas of terminal facilities upon arrival is the same as that provided in § 3.13(f) of this subpart. § 3.19 Handling.

(a) Any person subject to the Animal Welfare regulations (9 CFR parts 1, 2, and 3) who moves (including loading and unloading) dogs or cats within, to, or from the animal holding area of a terminal facility or a primary conveyance must do so as quickly and efficiently as possible and must provide the following during movement of the dog or cat:

(1) Shelter from sunlight and extreme heat. Sufficient shade must be provided to protect the dog or cat from the direct rays of the sun. The dog or cat must not be exposed to an ambient air temperature above 85 °F (29.5 °C) for a period of more than 45 minutes while being moved to or from a primary conveyance or a terminal facility. The temperature must be measured in the manner provided in § 3.18(d) of this subpart. The preceding requirements are in addition to, not in place of, all other requirements pertaining to climatic conditions in parts 2 and 3 of this chapter.

(2) Shelter from rain and snow. Sufficient protection must be provided to allow the dogs and cats to remain dry during rain, snow, and other precipitation.

(3) Shelter from cold temperatures. Transporting devices on which live dogs or cats are placed to move them must be covered to protect the animals when the outdoor temperature falls below 50 °F (10 °C). The dogs or cats must not be exposed to an ambient temperature below 45 °F (7.2 °C) for a period of more than 45 minutes, unless they are accompanied by a certificate of acclimation to lower temperatures as provided in § 3.13(e) . The temperature must be measured in the manner provided in § 3.18(d) of this subpart. The preceding requirements are in addition to, not in place of, all other requirements pertaining to climatic conditions in parts 2 and 3 of this chapter.

(b) Any person handling a primary enclosure containing a dog or cat must use care and must avoid causing physical harm or distress to the dog or cat.

(1) A primary enclosure containing a live dog or cat must not be placed on unattended conveyor belts, or on elevated conveyor belts, such as baggage claim conveyor belts and inclined conveyor ramps that lead to baggage claim areas, at any time; except that a primary enclosure may be placed on inclined conveyor ramps used to load and unload aircraft if an attendant is present at each end of the conveyor belt.

(2) A primary enclosure containing a dog or cat must not be tossed, dropped, or needlessly tilted, and must not be stacked in a manner that may reasonably be expected to result in its falling. It must be handled and positioned in the manner that written instructions and arrows on the outside of the primary enclosure indicate.

(c) This section applies to movement of a dog or cat from primary conveyance to primary conveyance, within a primary conveyance or terminal facility, and to or from a terminal facility or a primary conveyance.

(Approved by the Office of Management and Budget under control number 0579–0093)

[FN1]

These minimum standards apply only to live dogs and cats, unless stated otherwise.

Chapter 1200-34-01 Pain Management Clinics

Tenn. Comp. R. & Regs. 1200-34-01-.01 DEFINITIONS

In addition to the definitions contained in T.C.A. § 63-1-301, the following definitions are applicable to this

chapter:

(1) “Administrative Office” means the Tennessee Department of Health, Division of Health Related Boards, at which the Pain Management Clinic registry office for administrative support of daily functions is located at 665 Mainstream Drive, Nashville, TN 37243.

(2) “Adjacent” means within 1,000 feet.

(3) “Advisory Panel” means a panel selected by the Commissioner and convened at his or her discretion for advisory purposes and to issue recommendations to the Commissioner.

(4) “Applicant” means a medical doctor licensed under Title 63, Chapter 6 or an osteopathic physician licensed under Title 63, Chapter 9, who has submitted or is in the process of submitting an application for a license to operate a pain management clinic.

(5) “Certificate Holder” means a medical doctor licensed under Title 63, Chapter 6; osteopathic physician licensed under Title 63, Chapter 9; advanced practice registered nurse licensed under Title 63, Chapter 7, who meets the requirements contained in T.C.A. § 63-7-126; or a physician assistant licensed under Title 63, Chapter 19, who practices in this state with an unrestricted, unencumbered license, who was issued a pain management clinic certificate prior to July 1, 2017, and who may continue to operate that certificate as a license under Title 63, Chapter 1 until its expiration.

(6) “Commissioner” means the Commissioner of Health or his designee.

(7) “Controlled Substance” means a drug, substance, or immediate precursor identified, defined or listed in title 39, chapter 17, part 4 and title 53, chapter 11.

(8) “Department” means the Tennessee Department of Health.

(9) “Licensee” means any person licensed under Title 63 by one of the Tennessee Department of Health, Division of Health Related Boards.

(10) “Medical Director” means an individual who meets the definitions of Title 63, Chapter 1,

Section 301(4) and 301(8), and holds a license to operate a pain management clinic issued by the Department.

(11) “Medical Record” shall have the same meaning as set forth in T.C.A. § 63-2-101.

(12) “Owner” means a medical doctor licensed under Title 63, Chapter 6; osteopathic physician licensed under Title 63, Chapter 9; advanced practice registered nurse licensed under Title 63, Chapter 7, who meets the requirements contained in T.C.A. § 63-7-126; or a physician assistant licensed under Title 63, Chapter 19.

(13) “Pain Agreement” means a written document signed by the patient which, at a minimum, addresses patient responsibility for proper use and safeguarding of medications, describes the clinic’s drug screening policy, provides that prescriptions for controlled substances may only be filled at one pharmacy to be identified by the patient, and addresses the use of controlled substances prescribed by other providers.

(14) “Pain Management Clinic” means a privately-owned clinic, facility, or office in which the majority of patients are prescribed or dispensed opioids, benzodiazepines, barbiturates, or carisoprodol for ninety (90) days or more in a twelve-month period for pain unrelated to cancer or palliative care. For purposes of determining if a clinic, facility, or office qualifies as a pain management clinic, the entire clinic, facility, or office caseload of patients who received medical care services from all medical doctors, osteopathic physicians, advance practice registered nurses, and physician assistants who serve in the clinic, facility, or office shall be counted. Pain Management clinic also means a privately-owned clinic, facility, or office which advertises in any medium for pain management services of any type.

(15) “Substance Use Disorder Risk Assessment” means the assessment of an individual’s unique risk for addiction, abuse, misuse, diversion or another adverse consequence resulting from prescription medication intended to treat pain. Substance use disorder risk assessment may be accomplished through a standardized written or orally-delivered questionnaire or through a clinical interview.

(16) “Unencumbered” means an active license that is not suspended or on probation and that does not have any conditions, restrictions, or limitations.

(17) “Urine Drug Screen” means urinalysis performed using a commercial test kit in a pain management or other clinic or at a reference laboratory that tests for the presence of at least the controlled substance(s) being prescribed as well as marijuana, one or more of the opioids, benzodiazepines, cocaine and methamphetamines and may include any additional controlled substances at the discretion of the clinic

History

• Authority: T.C.A. §§ 63-1-301, 63-1-303, 63-1-306, 63-1-316, and 63-1-318.
• Administrative History: Emergency rule filed September 30, 2011; effective March 28, 2012. Emergency rule filed September 30, 2011 and effective through March 28, 2012; on March 29, 2012 the emergency rule expired and reverted to its previous status. Permanent rules 1200-34-01-.01 through .10 filed December 27, 2011; to have been effective March 26, 2012. The Government Operations Committee filed a seven-day stay of effective date of the rules; new effective date April 2, 2012. On March 26, 2012, the Government Operations Committee withdrew its stay; new effective date March 26, 2012. Emergency rule filed May 25, 2017 and effective through November 21, 2017. The emergency rule expired on November 22, 2017 and reverted to its previous status. Repeal and new rules filed August 28, 2017; effective November 26, 2017.

Tenn. Comp. R. & Regs. 1200-34-01-.02 LICENSURE PROCESS

(1) Before operating or practicing in a pain management clinic as defined in T.C.A. § 63-1-301(7) on or after July 1, 2017, the Medical Director of that clinic shall first obtain a Pain Management Clinic License from the Department, except as provided in Rule 1200-34-01- .04(2).

(2) An applicant shall obtain an application from the Administrative Office, respond truthfully and completely to every question or request for information contained in the application, and submit it along with all documentation and fees required by the application and rules to the Administrative Office. When available, this may be accomplished through an online application.

(3) An applicant shall submit all of the following as part of their application:

(a) The initial licensure fee, state regulatory fee, and inspection fee provided in Rule 1200- 34-01-.06;

(b) Proof that the Medical Director meets the statutory requirements defined in T.C.A. § 63- 1-301(8) to be a pain management specialist;

(c) The names, and if licensed by the Department, the licensure numbers, of every person with any ownership interest in the pain management clinic for which the applicant seeks licensure and each person’s percentage of ownership;

(d) Information regarding the form of business entity the clinic will be established as and whether there is already an existing medical practice at the clinic’s proposed location;

(e) The physical mailing address of the clinic for which the applicant seeks licensure;

(f) Identification of any other licenses or applications, including pending or denied applications, for pain management clinics associated with the applicant including as an owner, employee or contractor;

(g) The names, and if licensed by the Department, the licensure numbers, of every employee of the clinic;

(h) The names, and if licensed by the Department, the license numbers of every person with whom the clinic has contracted for services, including persons involved in daily operation of the clinic;

(i) The Drug Enforcement Administration (“DEA”) Registration numbers for each individual employed by the clinic or with whom the clinic has contracted who holds a DEA registration;

(j) The result of a criminal background check, submitted to the Administrative Office, directly from the vendor identified in the application, for the following personnel:

1. The Medical Director;

2. Each person with any ownership interest;

3. Each person who holds a DEA registration who will be providing services at that clinic; and 4. Where any disclosure required in 1200-34-01-.02(4)(a)-(d) has yielded an affirmative answer, that employee or individual or company with whom the clinic has contracted who has clinical contact with patients, contact with onsite patient information or specimens, and/or has management responsibilities;

(k) The name, license number, and address, of every pharmacy in which either the Medical Director or any owner of the clinic has any ownership interest that is greater than one percent (1%), and the percentage of that ownership interest;

(l) Proof that all supervising physicians who are supervising any of the advanced practice registered nurses or physician assistants providing services at the pain management clinic are pain management specialists;

(m) A statement of verification that the Medical Director has read and understood the statutes and rules governing pain management clinics, as well as the Tennessee Chronic Pain Guidelines (https://www.tn.gov/content/dam/tn/health/healthprofboards/pain-managementclinic/ChronicPainGuidelines.pdf), and the Tennessee Pain Clinic Guidelines (https://www.tn.gov/content/dam/tn/health/healthprofboards/pain-managementclinic/Pain_Clinic_Guidelines.pdf); and (n) Any other information requested by the Department.

(4) An applicant shall disclose the circumstances and produce any documentation requested by the Department surrounding any of the following:

(a) Whether any owner has ever been convicted of, pled nolo contendere to, or received deferred adjudication for an offense that constitutes a felony;

(b) Whether any employee, or person with whom the clinic contracts who has clinical contact with patients, contact with onsite patient information or specimens, and/or has management responsibilities has ever been convicted of any felony;

(c) Whether any owner, employee, or person with whom the clinic contracts who has clinical contact with patients, contact with onsite patient information or specimens, and/or has management responsibilities is under indictment for any offense involving the sale, diversion, or dispensing of controlled substances under any state or federal law;

(d) Whether any owner, employee, or person with whom the clinic contracts who has clinical contact with patients, contact with onsite patient information or specimens, and/or has management responsibilities has ever been convicted of any offense involving the sale, diversion, or dispensing of controlled substances under any state or federal law;

(e) Whether any owner, employee, or person with whom the clinic contracts who has clinical contact with patients, contact with onsite patient information or specimens, and/or has management responsibilities has ever applied for or held any license issued by any jurisdiction, under which that license holder may prescribe, dispense, administer, supply, or sell a controlled substance, which has been restricted, disciplined, or denied;

(f) Whether any owner, employee, or person with whom the clinic contracts who has clinical contact with patients, contact with onsite patient information or specimens, and/or has management responsibilities has ever been subject to disciplinary action by any licensing entity for conduct that was the result of inappropriately prescribing, dispensing, administering, supplying, or selling a controlled substance;

(g) Loss or restriction of privileges at any hospital or health care facility on the part of the Medical Director;

(h) Whether any owner, medical director, employee or person with whom the clinic contracts who has clinical contact with patients, contact with onsite patient information or specimens, and/or has management responsibilities is under any board order requiring advocacy from a professional assistance program that monitors for substance abuse;

(i) Whether any owner, employee, or person with whom the clinic contracts who has clinical contact with patients, contact with onsite patient information or specimens, and/or has management responsibilities has ever had a DEA registration that was surrendered for cause or disciplined.

(5) Where appropriate, the applicant shall cause to be submitted from the DEA, documentation regarding any surrender for cause, revocation, or other discipline of a DEA registration certificate.

(6) An applicant shall submit a separate application for licensure for each clinic location regardless of whether the clinic is operated under the same business name, ownership, or management as another clinic. Each clinic location shall be licensed separately.

History

• Authority: T.C.A. §§ 63-1-301, 63-1-303, 63-1-306, 63-1-309, 63-1-316, and 63-1-401.
• Administrative History: Emergency rule filed September 30, 2011; effective through March 28, 2012. Emergency rule filed September 30, 2011 and effective through March 28, 2012; on March 29, 2012 the emergency rule expired and reverted to its previous status. Permanent rules 1200-34-01-.01 through .10 filed December 27, 2011; to have been effective March 26, 2012. The Government Operations Committee filed a sevenday stay of effective date of the rules; new effective date April 2, 2012. On March 26, 2012, the Government Operations Committee withdrew its stay; new effective date March 26, 2012. Emergency rule filed May 25, 2017 and effective through November 21, 2017. The emergency rule expired on November 22, 2017 and reverted to its previous status. Repeal and new rules filed August 28, 2017; effective November 26, 2017. Administrative corrections made to URLs on September 7, 2018.

Tenn. Comp. R. & Regs. 1200-34-01-.03 APPLICATION REVIEW, APPROVAL, AND DENIAL

(1) Administrative staff shall determine when an application file is complete.

(2) If an applicant does not complete the application process within ninety (90) days after the Department receives the application because the application lacks the required information or fails to meet the prerequisites for licensure, then the application will be closed, the licensure fee will not be refunded, and the applicant shall be required to reapply in order to pursue licensure.

(3) Any applicant who has successfully complied with all requirements governing the licensure process shall then be subject to an inspection of the clinic. The applicant must successfully pass the inspection prior to being eligible for licensure. Upon inspection, if evidence is found that any practice act or any requirement of these rules has been violated, the application may be denied, and the Department may use the evidence in a separate disciplinary matter against any of the licensees involved. Representations in the application which are deemed by the Department to be untrue or incompletely disclosed may also subject the applicant to disciplinary action before his or her licensing board, and may subject the pain management clinic application to denial, and a previously issued pain management clinic license or certificate to revocation or other disciplinary action.

(4) The Department will conduct its eligibility inspection within 90 business days from the date the application is deemed complete by administrative staff. If the applicant does not initially pass the inspection, the Department, at its discretion, may re-inspect the clinic subject to a payment of a re-inspection fee. Such re-inspection may take place beyond the 90 business days from the application completion date. If the applicant maintains a current practice at a certified or licensed pain management clinic and the application is for a new location, the Department may inspect the current practice and approve the license at the new location, subject to a re-inspection and re-inspection fee at the new location after the practice has moved to the new location.

(5) If the application is denied, or the license is issued with conditions or restrictions, the following shall occur:

(a) A notification of the denial shall be sent from the Administrative Office by certified mail, return receipt requested, which shall contain reasons for the denial, condition, or restriction, as well as the statutory or rule authority for the denial, condition, or restriction.

(b) The notification, when appropriate, shall also contain a statement of the applicant’s right to a contested case hearing under the Tennessee Administrative Procedures Act (T.C.A. §§ 4-5-101, et. seq.) to contest the denial, condition, or restriction. An applicant has a right to a contested case hearing only if the denial, condition, or restriction was based upon subjective or discretionary criteria, and only if the request for the contested case hearing is made in writing and received by the Department’s Office of General Counsel on or before the thirtieth (30th) day after receipt of the notice by the applicant.

(6) If the Department finds that it has erred in the issuance of a license, the Administrative Office will give written notice by certified mail of its intent to revoke the license. The notice will allow the Medical Director the opportunity to meet the requirements for licensure within thirty (30) days from the date of receipt of the notification. If the Medical Director does not concur with the stated reason and the intent to revoke the license, the Medical Director shall have the right to proceed according to T.C.A. § 63-1-316(j).

History

• Authority: T.C.A. §§ 63-1-303, 63-1-304, and 63-1-316.
• Administrative History: Emergency rule filed September 30, 2011; effective through March 28, 2012. Emergency rule filed September 30, 2011 and effective through March 28, 2012; on March 29, 2012 the emergency rule expired and reverted to its previous status. Permanent rules 1200-34-01-.01 through .10 filed December 27, 2011; to have been effective March 26, 2012. The Government Operations Committee filed a seven-day stay of effective date of the rules; new effective date April 2, 2012. On March 26, 2012, the Government Operations Committee withdrew its stay; new effective date March 26, 2012. Emergency rule filed May 25, 2017 and effective through November 21, 2017. The emergency rule expired on November 22, 2017 and reverted to its previous status. Repeal and new rules filed August 28, 2017; effective November 26, 2017.

Tenn. Comp. R. & Regs. 1200-34-01-.04 LICENSURE RENEWAL

(1) Renewal.

(a) A pain management clinic license, unless another time is given at the time of licensure, shall expire two (2) years from the date of issuance. All licenses must be renewed on or before the last day of the two (2) year licensure cycle.

(b) A Medical Director may renew a current, valid license prior to its expiration date by submitting the following to the Department:

1. A renewal application form prescribed by the Department;

2. The required renewal fee;

3. Proof of having a medical director who meets the requirements contained in these rules and is a pain management specialist;

4. An attestation that the clinic is not owned wholly or partly by a person who has been convicted of, pleaded nolo contendere to, or received deferred adjudication for:

(i) An offense that constitutes a felony; or (ii) An offense that constitutes a misdemeanor, the facts of which relate to the distribution of illegal prescription drugs or a controlled substance as defined in § 39-17-402;

5. An attestation that no owner, employee or person with whom the clinic contracts who has clinical contact with patients, contact with onsite patient information or specimens, and/or has management responsibilities:

(i) Has been convicted of an offense involving the sale, distribution, or dispensing of controlled substances under state or federal law;

(ii) Has been denied, by any jurisdiction, a license under which that person may prescribe, dispense, administer, supply, or sell a controlled substance;

(iii) Has been subject to disciplinary action by any licensing entity for conduct that was the result of inappropriately prescribing, dispensing, administering, supplying, or selling a controlled substance;

6. Proof the Medical Director has maintained the status of pain management specialist;

7. Any other information requested by the Department.

(2) A clinic whose certificate was renewed before July 1, 2017, and continued operation on that certificate as a license until its expiration, shall have its Medical Director apply as a new applicant for licensure under this part, and must meet all requirements for licensure in order to continue operation beyond the expiration date of the certificate. In order for the Department to timely process the application and inspect the clinic, the Medical Director must have submitted a complete application as a new applicant a minimum of ninety (90) days before the expiration of the clinic’s certificate. For purposes of an expired certificate, there shall be no grace period for operation between expiration of the certificate and the initial licensure date.

(3) Late Renewal and Reapplication.

The pain management clinic may renew its license within sixty (60) days after the license expiration date with payment of the renewal fee and late renewal penalty fee, and after having completed all of the other requirements for renewal. After the sixty (60) day grace period, the Medical Director may reapply for a new license, but must cease operations until such time as a new license is granted.

History

• Authority: T.C.A. §§ 63-1-303, 63-1-306, 63-1-307, 63-1-308, 63-1-309, and 63-1-316.
• Administrative History: Emergency rule filed September 30, 2011; effective through March 28, 2012. Emergency rule filed September 30, 2011 and effective through March 28, 2012; on March 29, 2012 the emergency rule expired and reverted to its previous status. Permanent rules 1200-34-01-.01 through .10 filed December 27, 2011; to have been effective March 26, 2012. The Government Operations Committee filed a sevenday stay of effective date of the rules; new effective date April 2, 2012. On March 26, 2012, the Government Operations Committee withdrew its stay; new effective date March 26, 2012. Emergency rule filed May 25, 2017 and effective through November 21, 2017. The emergency rule expired on November 22, 2017 and reverted to its previous status. Repeal and new rules filed August 28, 2017; effective November 26, 2017.

Tenn. Comp. R. & Regs. 1200-34-01-.05 EXEMPTIONS

(1) A pain management clinic is not a clinic, facility, or office which provides interventional pain management as defined in T.C.A. § 63-6-244 and whose clinic, facility, or office does not provide chronic non-malignant pain treatment to a majority of the patients of a clinic, facility, or office for ninety (90) days or more in a twelve-month period.

(2) A pain management clinic is not a medical or dental school, an osteopathic medical school, a nursing school, a physician assistant program, or an outpatient clinic associated with any of the foregoing schools or programs, including, but not limited to, clinics that have an agreement to train residents by members of that clinic who are appointed as adjunct faculty of the school or program.

(3) A pain management clinic is not a hospital as defined in T.C.A. § 68-11-201, including any outpatient facility or clinic of a hospital if such outpatient facility or clinic is regulated under title 68.

(4) A pain management clinic is not hospice services as defined in T.C.A. § 68-11-201.

(5) A pain management clinic is not a nursing home as defined in T.C.A. § 68-11-201.

(6) A pain management clinic is not a facility maintained or operated by this state.

(7) A pain management clinic is not a hospital or clinic maintained or operated by the federal government.

History

• Authority: T.C.A. §§ 63-1-301 and 63-1-302.
• Administrative History: Emergency rule filed September 30, 2011; effective through March 28, 2012. Emergency rule filed September 30, 2011 and effective through March 28, 2012; on March 29, 2012 the emergency rule expired and reverted to its previous status. Permanent rules 1200-34-01-.01 through .10 filed December 27, 2011; to have been effective March 26, 2012. The Government Operations Committee filed a seven-day stay of effective date of the rules; new effective date April 2, 2012. On March 26, 2012, the Government Operations Committee withdrew its stay; new effective date March 26, 2012. Emergency rule filed May 25, 2017 and effective through November 21, 2017. The emergency rule expired on November 22, 2017 and reverted to its previous status. Repeal and new rules filed August 28, 2017; effective November 26, 2017.

Tenn. Comp. R. & Regs. 1200-34-01-.06 FEES

(1) Initial licensure fee......................................................................................$1,500.00 (2) Renewal fee..............................................................................................$1,500.00 (3) State Regulatory fee......................................................................................$10.00 (4) Inspection fee............................................................................................$1,500.00 (5) Re-inspection fee........................................................................................$1,000.00 (6) The late renewal penalty fee is five hundred dollars ($500.00) per month for each month or fraction of a month that renewal is late.

(7) The Inspection fee is to be paid with the initial licensure fee upon application, and again biennially within thirty (30) days following the random biennial inspection.

(8) A re-inspection fee shall be assessed and shall be paid by the Medical Director any time an investigator is forced to return to the clinic to complete his or her inspection due to actions or omissions on the part of the Medical Director or anyone working in the pain management clinic. A re-inspection fee shall also be assessed and shall be paid by the Medical Director any time the Department re-inspects a clinic which did not pass an inspection. Payment of the re-inspection fee must be remitted to the Department within thirty (30) days of the reinspection date.

History

• Authority: T.C.A. §§ 63-1-303, 63-1-306, 63-1-308, and 63-1-316.
• Administrative History: Emergency rule filed September 30, 2011; effective through March 28, 2012. Emergency rule filed September 30, 2011 and effective through March 28, 2012; on March 29, 2012 the emergency rule expired and reverted to its previous status. Permanent rules 1200-34-01-.01 through .10 filed December 27, 2011; to have been effective March 26, 2012. The Government Operations Committee filed a seven-day stay of effective date of the rules; new effective date April 2, 2012. On March 26, 2012, the Government Operations Committee withdrew its stay; new effective date March 26, 2012. Emergency rule filed May 25, 2017 and effective through November 21, 2017. The emergency rule expired on November 22, 2017 and reverted to its previous status. Repeal and new rules filed August 28, 2017; effective November 26, 2017.

Tenn. Comp. R. & Regs. 1200-34-01-.07 LICENSURE INACTIVATION

(1) If the Medical Director and/or owners of a pain management clinic determine that the site will close and cease operation, or that the site will no longer provide services that meet the statutory definition of a pain management clinic, the Medical Director must notify the Department. If the Department has not been notified of a closure and appears at the clinic for an inspection or investigation, the Medical Director may be held responsible for the inspection fee or the actual cost of the investigation.

(2) The Medical Director shall notify the Department and inactivate the pain management clinic license as follows:

(a) Obtain from the Administrative Office an official inactivation form;

(b) Complete and submit that form, along with any supporting documentation that may be required by the Administrative Office.

(3) Upon successful completion and submission of the required forms to the administrative office, the Department shall register the pain management clinic license as inactivated. A clinic that has inactivated its license shall not operate as a pain management clinic, and doing so shall subject the practitioners in that clinic to penalties from the Department.

History

• Authority: T.C.A. §§ 63-1-303, 63-1-304, 63-1-305, and 63-1-316.
• Administrative History: Emergency rule filed September 30, 2011; effective through March 28, 2012. Permanent rules 1200-34-01-.01 through .10 filed December 27, 2011; to have been effective March 26, 2012. The Government Operations Committee filed a seven-day stay of effective date of the rules; new effective date April 2, 2012. On March 26, 2012, the Government Operations Committee withdrew its stay; new effective date March 26, 2012. Emergency rule filed May 25, 2017 and effective through November 21, 2017. The emergency rule expired on November 22, 2017 and reverted to its previous status. Repeal and new rules filed August 28, 2017; effective November 26, 2017.

Tenn. Comp. R. & Regs. 1200-34-01-.08 INSPECTIONS AND INVESTIGATIONS

(1) Upon application for licensure as a pain management clinic, the Medical Director shall pay the Inspection fee and permit the Department to conduct an inspection of the clinic which may include, in addition to inspection of the physical site, review of medical records, business records, and any other documents the Department may require.

(2) The Medical Director, owners, officers, employees, authorized representatives of the pain management clinic, and independent contractors working at the pain management clinic shall allow Department representatives access to the pain management clinic and shall provide copies of all documentation, including but not limited to medical records and business records, requested by the Department, in connection with an inspection or investigation of the pain management clinic. The Medical Director shall be responsible for the pain management clinic remitting payment of the biennial inspection fee to the Department within thirty (30) days of the inspection.

(3) If a clinic does not pass an inspection, at its discretion, the Department may re-inspect the clinic and assess a re-inspection fee. The Department may require submission of a corrective action plan prior to the re-inspection.

(4) Failure or refusal of the Medical Director to grant the Department access to the pain management clinic to perform an audit, inspection, or investigation shall constitute grounds for immediate suspension of the pain management clinic’s license as contemplated in T.C.A. § 4-5-320(c).

History

• Authority: T.C.A. §§ 63-1-303, 63-1-304, 63-1-305, and 36-1-316.
• Administrative History: Emergency rule filed September 30, 2011; effective through March 28, 2012. Emergency rule filed September 30, 2011 and effective through March 28, 2012; on March 29, 2012 the emergency rule expired and reverted to its previous status. Permanent rules 1200-34-01-.01 through .10 filed December 27, 2011; to have been effective March 26, 2012. The Government Operations Committee filed a seven-day stay of effective date of the rules; new effective date April 2, 2012. On March 26, 2012, the Government Operations Committee withdrew its stay; new effective date March 26, 2012. Emergency rule filed May 25, 2017 and effective through November 21, 2017. The emergency rule expired on November 22, 2017 and reverted to its previous status. Repeal and new rules filed August 28, 2017; effective November 26, 2017.

Tenn. Comp. R. & Regs. 1200-34-01-.09 NOTIFICATIONS AND REPORTING

(1) A pain management clinic license shall not be assignable or transferable. However, the Department recognizes that some circumstances may cause a Medical Director to depart from a clinic. While best practice would be for the new Medical Director to seek licensure from the Department while the current Medical Director is still actively serving at his clinic’s licensed location, in the event that the current Medical Director no longer meets the requirements contained in T.C.A. §§ 63-1-301, et seq. and these rules to be a Medical Director, or departs from a clinic, the Department will allow a grace period during which a clinic may continue to operate provided the following occurs:

(a) The clinic may continue to operate on the current Medical Director’s license for a grace period of up to thirty (30) calendar days from the date that the current Medical Director no longer met the requirements contained in T.C.A. §§ 63-1-301, et seq. and these rules to be a Medical Director, or the date the current Medical Director departs the clinic, provided the clinic notifies the Department, on a form prescribed by the Department, within ten (10) business days of the identity of another pain management specialist who will serve as the interim Medical Director for the clinic;

(b) During this grace period after which the current Medical Director no longer meets the requirements of this part or has departed from the clinic, which shall total no more than thirty (30) calendar days, both the pain management clinic license and the interim Medical Director, are liable for any actions or inactions occurring at or caused by the pain management clinic;

(c) The new Medical Director shall submit a completed pain management clinic application immediately upon agreement to assume the duties of medical director at the clinic;

(d) Should the clinic have difficulty obtaining a new medical director, it may apply for a waiver of up to an additional sixty (60) calendar days in which to operate with the int erim Medical Director. The waiver form shall be promulgated by the Department. The waiver will only be granted upon good cause shown, demonstrated reasonable efforts to locate and retain a new medical director, and a reasonable belief by the Department that public health will be harmed by not granting the waiver. Both the pain management clinic license and the interim Medical Director are liable for any actions or inactions occurring at or caused by the pain management clinic during any granted grace period;

(e) Upon expiration of thirty (30) calendar days, or upon the expiration of ninety (90) calendar days if a waiver was applied for and granted, if a new pain management clinic license has not been issued by the Department, the clinic must cease operation. Each day of continued operation would constitute a separate violation for any licensee who continues to work in the clinic;

(f) Notwithstanding these provisions, if the current Medical Director of a clinic chooses to inactivate the license, the clinic must cease operating as a pain management clinic immediately upon inactivation. Prior to inactivating the license, the Medical Director shall have the responsibility to notify all patients receiving care at the clinic and arrange for continuity of care; and (g) In the event the clinic is unable to find a permanent new Medical Director during the grace period, the individual serving as interim Medical Director may apply for a pain management clinic license to be issued for a term of six (6) months. At its discretion, and upon such request by the interim Medical Director applicant, the Department may issue a pain management clinic license for a term of six months. The fee for such a license shall be proportional to the annual fee, but other than the term, the license shall be modified in no other manner; upon issuance of the truncated license, the interim Medical Director applicant shall become the licensee.

(2) The Medical Director shall notify the Department within thirty (30) days of the occurrence if any of the following occur to any person who owns, is an employee of, or is a person with whom the clinic contracts who has clinical contact with patients, contact with onsite patient information or specimens, and/or has management responsibilities:

(a) That person has applied for any state or federal license, registration, or certificate that has been denied;

(b) That person has held any state or federal license, registration, or certificate that has been restricted or subject to disciplinary action relative to prescribing, dispensing, administering, supplying or selling a controlled substance; or (c) That person has been convicted of a felony or any offense involving the sale, diversion, or dispensing of controlled substances under state or federal law related to operation of or work in the clinic.

(3) In the event that the name of the clinic changes, the Medical Director shall notify the Department of the name change within ten (10) business days after the name change occurs.

(4) In addition to the reporting requirements above, the Medical Director shall make an annual report to the Department on a form promulgated for such reporting. The report shall be due to the Department sixty (60) days prior to the pain management clinic’s certificate or license anniversary date and shall cover the previous twelve (12) months. The report shall include the following:

(a) Whether the pain management clinic is associated with a hospital;

(b) Whether the pain management clinic is adjacent to a pharmacy;

(c) The names of each physician, physician assistant, and advanced practice registered nurse who worked in the clinic each month during the preceding year along with their license numbers;

(d) The number of patients seen by the clinic for each month in the preceding year;

(e) The number of patients seen in each month who received controlled substances for chronic nonmalignant pain from a practitioner at the clinic;

(f) A list of all controlled drug samples which were dispensed in the preceding year or a copy of the clinic’s log pursuant to Title 21 C.F.R. § 1304.11, with regard to those samples;

(g) A list of all owners of the clinic and their percentage of interest in the clinic for each month in the preceding year;

(h) The names of any employees hired or separated within the preceding year as well as the license number of that employee if any are or were licensees; and (i) A summary of each advertisement for that clinic location and, where more than one location exists, each advertisement for the larger organization as a whole. For purposes of this rule, an advertisement is any material or spoken word, which is: (1) paid for in consideration of any kind; (2) intended to promote a clinic’s services; or (3) created or given in any manner not in association with a bona fide, unpaid—other than customary coverage of expenses—media encounter, interview, or professional continuing medical education event.

History

• Authority: T.C.A. §§ 63-1-303, 63-1-306, 63-1-309, 63-1-316, 63-1-317, and 63-1-319.
• Administrative History: Emergency rule filed September 30, 2011; effective through March 28, 2012. Emergency rule filed September 30, 2011 and effective through March 28, 2012; on March 29, 2012 the emergency rule expired and reverted to its previous status. Permanent rules 1200-34-01-.01 through .10 filed December 27, 2011; to have been effective March 26, 2012. The Government Operations Committee filed a sevenday stay of effective date of the rules; new effective date April 2, 2012. On March 26, 2012, the Government Operations Committee withdrew its stay; new effective date March 26, 2012. Emergency rule filed May 25, 2017 and effective through November 21, 2017. The emergency rule expired on November 22, 2017 and reverted to its previous status. Repeal and new rules filed August 28, 2017; effective November 26, 2017.

Tenn. Comp. R. & Regs. 1200-34-01-.10 MEDICAL DIRECTOR RESPONSIBILITIES

(1) Clinic Operation and Personnel.

(a) The Medical Director of a pain management clinic shall:

1. Oversee all of the pain management services provided at the clinic;

2. Be on-site at the clinic at least twenty percent (20%) of the clinic’s weekly total number of operating hours;

3. Ensure that each supervising physician for each of the health care providers working at the clinic complies with the supervision requirements contained in Tenn. Comp. Rules and Regulations Chapter 0880-03 and Chapter 0880-06, or

Rule 1050-02-.15, as applicable, and is a pain management specialist;

4. Ensure that all health care providers employed by or working at the pain management clinic comply with applicable state and federal laws and rules relative to the prescribing of controlled substances in the pain management clinic;

5. Ensure the establishment of protocols for the health care providers employed by or working at the pain management clinic as provided in Tenn. Comp. Rules and Regulations Chapter 0880-03 and Chapter 0880-06 and ensure that providers comply with such protocols, as well as any other established policies and procedures;

6. Identify a pain management specialist who has agreed to provide coverage in the event that the Medical Director is unable to fulfill his or her duties on a temporary

basis because of illness, vacation, or unavailability. Such coverage may be provided on a temporary, short-term basis and serving in this capacity will not be considered to count against the limit of four (4) pain management clinics at which a pain management specialist may serve as medical director. The Medical Director maintains all responsibility during any period where coverage is provided, but the covering physician shall only share responsibility for those times during which he or she is providing coverage;

7. Establish quality assurance policies and procedures, which, at a minimum, include, but are not limited to:

(i) Documentation of the background, training, licensure, and certifications for all pain management clinic staff providing patient care;

(ii) A written drug screening policy and compliance plan for patients to include random urine drug screening as clinically indicated, but at a minimum, upon each new admission and once every six (6) months thereafter;

(iii) Use of substance use disorder risk assessment tools upon new patient admission and periodic review or re-assessment;

(iv) Evaluating and monitoring the quality and appropriateness of patient care, the methods of improving patient care as well as identifying and correcting deficiencies, and the opportunities to improve the clinic’s performance and quality of care;

(v) Medication counts for any controlled substances prescribed by the clinic to the clinic’s patients;

(vi) Use of pain agreements and periodic review of such agreements;

(vii) Health care provider access to and review of patient information contained in the controlled substance monitoring database in accordance with T.C.A. §§ 53-10-301 - 53-10-309, as clinically indicated, but at a minimum upon each new admission and once every six (6) months thereafter;

(viii) Documentation of requests for records from other health care providers;

(ix) Creation of a written process for clinical practice evaluation and evidence of regular appropriate supervisory action based on results of the clinical practice evaluation;

8. Establish an infection control program to provide a sanitary environment for the prevention, control, and investigation of infections and communicable diseases, including, but not limited to:

(i) Written infection control policies and procedures;

(ii) Creation of written policies that are consistent with the Centers for Disease Control and Prevention’s guidelines for minimum prevention for outpatient settings; and (iii) A log of incidents related to infectious and communicable diseases and the corrective action taken;

9. Establish written policies and procedures to assure patient access to their medical records and continuity of care should the pain management clinic close.

(2) Records, Reporting Requirements, and Patient Billing Procedures.

(a) The Medical Director shall ensure that each health care provider employed by or working at a certified or licensed pain management clinic shall maintain complete and accurate medical records of patient consultation, examination, diagnosis, and treatment, which shall include, but not be limited to the following:

1. Patient medical history and physical examination;

2. Diagnostic, therapeutic, and laboratory results, evaluations and consultations, and records from other health care providers, as available, or attempts to obtain such;

3. Documentation of informed consent and discussion of risks and benefits of treatment provided;

4. Treatments, treatment options, and treatment objectives;

5. Medications prescribed (including date, type, dosage and quantity prescribed);

6. Instructions and agreements;

7. Periodic reviews;

8. A notation indicating whether the controlled substance monitoring database had been accessed for a particular patient;

9. Results of urine drug screens to be performed as clinically indicated, but at a minimum upon each new admission and once every six (6) months thereafter.

(b) The Medical Director’s responsibilities shall include having a system in place to ensure adequate medical documentation and responsibility for addressing inadequate documentation. Medical records must at all times be available to clinicians to review onsite, but may be maintained at a separate location.

(3) The Medical Director shall take appropriate steps, including having a system in place, to ensure that adequate billing records are maintained for the pain management clinic and shall ensure that adequate billing records are maintained for all patients and for all patient visits.

Billing records shall be made for all methods of payment. Billing records shall be made available to the Department upon request.

Billing records shall include, but not be limited to the following:

(a) The amount paid for the co-pay and/or remainder of services;

(b) Method of payment;

(c) Date of the delivery of services;

(d) Date of payment; and (e) Description of services.

(4) The Medical Director shall ensure that patient medical records shall be maintained for ten (10) years from the date of the patient’s last treatment at the clinic.

(5) The Medical Director shall ensure that patient billing records shall be maintained for seven (7) years from the date of the patient’s last treatment at the clinic.

(6) The Medical Director shall ensure that all health care providers employed by or working at the pain management clinic are properly licensed and certified at all times.

(7) The Medical Director shall ensure the delivery of quality care and quality services at the clinic.

(8) The Medical Director shall ensure that all monetary transactions at the pain management clinic shall be in accordance with T.C.A. § 63-1-310 which provides that a pain management clinic may accept only a check or credit card in payment for services provided at the clinic; except that payment may be made in cash or money order for a co-pay, coinsurance, or deductible when the remainder of the charge for the services will be submitted to the patient’s insurance plan for reimbursement.

(9) The Medical Director shall ensure that patients have access to their medical records at any time upon request of the patient in keeping with T.C.A. §§ 63-2-101, et seq. and especially in the event that the clinic closes. The Medical Director shall also ensure that the Department has access to the records upon request.

History

• Authority: T.C.A. §§ 63-1-303, 63-1-306, 63-1-309, and 63-1-310.
• Administrative History: Emergency rule filed September 30, 2011; effective through March 28, 2012. Emergency rule filed September 30, 2011 and effective through March 28, 2012; on March 29, 2012 the emergency rule expired and reverted to its previous status. Permanent rules 1200-34-01-.01 through .10 filed December 27, 2011; to have been effective March 26, 2012. The Government Operations Committee filed a seven-day stay of effective date of the rules; new effective date April 2, 2012. On March 26, 2012, the Government Operations Committee withdrew its stay; new effective date March 26, 2012. Emergency rule filed May 25, 2017 and effective through November 21, 2017. The emergency rule expired on November 22, 2017 and reverted to its previous status. Repeal and new rules filed August 28, 2017; effective November 26, 2017.

Tenn. Comp. R. & Regs. 1200-34-01-.11 TRAINING REQUIREMENTS

(1) Each physician serving as the Medical Director or a supervising physician to an advanced practice registered nurse or physician assistant at the clinic shall meet the statutory requirements to be a pain management specialist, and shall complete the requisite continuing education to maintain that status.

(2) Each health care provider providing pain management services at a clinic shall complete ten (10) hours in continuing education courses during each health care provider’s licensure renewal cycle which shall be a part of the continuing education requirements established by each of the health care provider’s respective boards. The ten (10) continuing education hours shall address at least one or more of the following topics related to pain medicine:

(a) Prescribing controlled substances;

(b) Drug screening or testing;

(c) Pharmacological and non-pharmacological pain management;

(d) Completing a pain management focused history and physical examination and maintaining appropriate progress notes;

(e) Comorbidities with pain syndromes; and (f) Substance abuse and misuse including diversion, prevention of same, and risk assessment for abuse.

(3) Each health care provider providing pain management services at a clinic shall, in addition to the ten (10) hours of continuing education outlined above, thoroughly read the Tennessee Chronic Pain Guidelines and the Tennessee Pain Clinic Guidelines promulgated by the Department.

History

• Authority: T.C.A. §§ 63-1-303 and 63-1-306.
• Administrative History: Emergency rule filed May 25, 2017 and effective through November 21, 2017. The emergency rule expired on November 22, 2017 and reverted to its previous status. Original rules filed August 28, 2017; effective November 26, 2017.

Tenn. Comp. R. & Regs. 1200-34-01-.12 LICENSURE DISCIPLINE AND CIVIL PENALTIES

(1) Upon a finding that a pain management clinic is in violation of any provision of the Tennessee Pain Management Clinic Act (T.C.A. §§ 63-1-301, et seq.) or the rules promulgated pursuant thereto, the Commissioner may impose any of the following actions separately or in any combination which is deemed appropriate to the offense:

(a) Private Censure - This is a written action issued to the Medical Director for minor or near infractions. It is informal and advisory in nature and does not constitute a formal disciplinary action.

(b) Reprimand - This is a written action issued on a Medical Director’s pain management clinic license for one time and less severe violations. It is a formal, public disciplinary action.

(c) Probation - This is a formal disciplinary action which places a Medical Director’s pain management clinic license on close scrutiny for a period of time.

1. This action may be combined with any other formal disciplinary action and include conditions and requirements which must be met before probation can be lifted and/or which restrict or condition the clinic’s activities during the probationary period.

2. Once ordered, probation may not be lifted unless and until the Medical Director petitions, pursuant to paragraph (2) of this rule, after the period of initial probation has run and all conditions placed on the probation have been met and the Commissioner is satisfied that a further probationary period is not warranted such that the probation may be lifted.

(d) Licensure Suspension - This is a formal disciplinary action which suspends the right of the Medical Director and his staff to operate the pain management clinic for a fixed period of time. It contemplates the reopening of the practice under the license previously issued at that location.

1. Once ordered, a suspension may not be lifted unless and until the Medical Director petitions, pursuant to paragraph (2) of this rule, after the period of initial suspension has run and:

(i) All conditions placed on the suspension have been met; and (ii) The Commissioner is satisfied that the Medical Director and his staff are competent to return to practice and that no further period of suspension is warranted such that the suspension should be lifted.

2. The clinic must be completely closed during the period of licensure suspension. If any licensee admits or sees any new or existing patients during the suspension, that shall be considered a violation of the suspension, and the length of suspension shall toll for any time during which the practice was open in violation of the suspension.

(e) Revocation - This is a formal disciplinary action which closes a clinic and terminates the license previously issued to operate that location as a pain management clinic.

(f) Conditions - Any action deemed appropriate by the Commissioner to be required of a disciplined Medical Director and/or clinic in any of the following circumstances:

1. During any period of probation or suspension; or 2. As a prerequisite to the lifting of probation or suspension; or 3. As a stand-alone requirement(s) in any disciplinary order.

(g) Civil penalty - A monetary disciplinary action assessed by the Commissioner pursuant to paragraph (4) of this rule.

(h) Summary Suspension - This is a formal disciplinary action which immediately and entirely suspends the rights of the Medical Director and his staff to operate the pain management clinic until it is lifted or until a final disposition of the matter after a full hearing. This type of suspension may be ordered ex-parte, pursuant to the notice procedures contained in T.C.A. § 4-5-320 upon a finding that the public health, safety or welfare imperatively requires emergency action.

(i) Assessment of costs in disciplinary proceedings shall be as set forth in T.C.A. § 63-1- 144.

(j) The Commissioner, at his discretion, may convene an advisory panel of one or more to make a recommendation to the Commissioner prior to the Commissioner’s determination. The Commissioner shall not be bound by the recommendation of the advisory panel.

(2) Order of Compliance - This procedure is a necessary adjunct to previously issued disciplinary orders and is available only when a petitioner has completely complied with the provisions of a previously issued disciplinary order and wishes or is required to obtain an order reflecting that compliance.

(a) The Commissioner will entertain petitions for an Order of Compliance as a supplement to a previously issued order upon strict compliance with the procedures set forth in subparagraph (b) only when the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued reflecting that compliance or is seeking to have a suspension or probation lifted.

(b) Procedures 1. The petitioner shall submit a Petition for Order of Compliance, as contained in subparagraph (c), to the Administrative Office that shall contain all of the following:

(i) A copy of the previously issued order; and (ii) A statement of which provision of subparagraph (a) the petitioner is relying upon as a basis for the requested order; and (iii) A copy of all documents that prove compliance with all the terms or conditions of the previously issued order. If proof of compliance requires testimony of an individual(s), including that of the petitioner, the petitioner must submit signed, sworn to, and notarized statements from each individual the petitioner intends to rely upon attesting, under oath, to the petitioner’s compliance. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, the petition.

2. The administrative staff may make an initial determination on the petition before it is heard by the Commissioner and take one of the following actions:

(i) Certify compliance and have the matter scheduled for presentation to the Commissioner as an uncontested matter; or (ii) Deny the petition, after consultation with legal staff, if compliance with all of the provisions of the previous order is not proven and notify the petitioner of what provisions remain to be fulfilled and/or what proof of compliance was either not sufficient or not submitted.

3. If the petition is presented to the Commissioner, the petitioner may not submit any additional documentation or testimony other than that contained in the petition as originally submitted.

4. If the Commissioner finds that the petitioner has complied with all the terms of the previous order an Order of Compliance shall be issued.

5. If the petition is denied either initially by staff or after presentation to the Commissioner and the petitioner believes compliance with the order has been sufficiently proven the petitioner may, as authorized by law, file a petition for a declaratory order pursuant to the provisions of T.C.A. § 4-5-223.

(c) Form Petition Petition for Order of Compliance Pain Management Clinic Petitioner’s Name: ______________________________ Petitioner’s Mailing Address: ______________________________ ______________________________ ______________________________ Petitioner’s E-Mail Address: ______________________________ Telephone Number: ______________________________ Attorney for Petitioner: ______________________________ Attorney’s Mailing Address: ______________________________ ______________________________ ______________________________ Attorney’s E-Mail Address: ______________________________ Telephone Number: ______________________________ The petitioner respectfully represents, as substantiated by the attached documentation that all provisions of the attached disciplinary order have been complied with and I am respectfully requesting: (circle one)

1. An order issued reflecting that compliance; or 2. An order issued reflecting that compliance and lifting a previously ordered suspension or probation.

Note - You must enclose all documents necessary to prove your request including a copy of the original order. If any of the proof you are relying upon to show compliance is the testimony of any individual, including yourself, you must enclose signed statements from every individual you intend to rely upon attesting, under oath, to the compliance. The Committee’s consultant, the Disciplinary Coordinator, and legal staff, in their discretion, may require such signed statements to be notarized. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, this petition.

Respectfully submitted this the _______ day of ______________, 20.

Petitioner’s Signature __________________________ (3) Order Modifications - This procedure is not intended to allow anyone under a previously issued disciplinary order, including an unlicensed practice civil penalty order, to modify any findings of fact, conclusions of law, or the reasons for the decision contained in the order. It is also not intended to allow a petition for a lesser disciplinary action, or civil penalty other than the one(s) previously ordered. All such provisions of Commissioner Orders were subject to reconsideration and appeal under the provisions of the Uniform Administrative Procedures Act (T.C.A. §§ 4-5-301, et seq.). This procedure is not available as a substitute for reconsideration and/or appeal and is only available after all reconsideration and appeal rights have been either exhausted or not timely pursued. It is also not available for those who have accepted or been issued a reprimand.

(a) The Commissioner will entertain petitions for modification of the disciplinary portion of previously issued orders upon strict compliance with the procedures set forth in subparagraph (b) only when the petitioner can prove that compliance with any one or more of the conditions or terms of the discipline previously ordered is impossible. For purposes of this rule the term “impossible” does not mean that compliance is inconvenient or impractical for personal, financial, scheduling or other reasons.

(b) Procedures 1. The petitioner shall submit a written and signed Petition for Order Modification on the form contained in subparagraph (c) to the Administrative Office that shall contain all of the following:

(i) A copy of the previously issued order; and (ii) A statement of why the petitioner believes it is impossible to comply with the order as issued; and (iii) A copy of all documents that prove that compliance is impossible. If proof of impossibility of compliance requires testimony of an individual(s), including that of the petitioner, the petitioner must submit signed, sworn to, and notarized statements from each individual the petitioner intends to rely upon attesting, under oath, to the reasons why compliance is impossible.

No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, the petition.

2. The administrative staff may make an initial determination on the petition before the Commissioner hears it and take one of the following actions:

(i) Certify impossibility of compliance and forward the petition to the Office of General Counsel for review and presentation to the Commissioner; or (ii) Deny the petition, after consultation with legal staff, if impossibility of compliance with the provisions of the previous order is not proven and notify the petitioner of what proof of impossibility of compliance was either not sufficient or not submitted.

3. If the petition is presented to the Commissioner, the petitioner may not submit any additional documentation or testimony other than that contained in the petition as originally submitted.

4. If the petition is granted, the Commissioner may issue a new order reflecting the authorized modifications that he deems appropriate and necessary in relation to the violations found in the previous order.

5. If the petition is denied either initially by staff or after presentation to the Commissioner and the petitioner believes impossibility of compliance with the order has been sufficiently proven the petitioner may, as authorized by law, file a petition for a declaratory order pursuant to the provisions of T.C.A. § 4-5-223.

(c) Form Petition Petition for Order Modification Pain Management Clinic Petitioner’s Name: _______________________________ Petitioner’s Mailing Address: _______________________________ _______________________________ _______________________________ Petitioner’s E-Mail Address: _______________________________ Telephone Number: _______________________________ Attorney for Petitioner: _______________________________ Attorney’s Mailing Address: _______________________________ _______________________________ _______________________________ Attorney’s E-Mail Address: _______________________________ Telephone Number: _______________________________ The petitioner respectfully represents that for the following reasons, as substantiated by the attached documentation, the identified provisions of the attached disciplinary order are impossible for me to comply with: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Note - You must enclose all documents necessary to prove your request including a copy of the original order. If any of the proof you are relying upon to show impossibility is the testimony of any individual, including yourself, you must enclose signed and notarized statements from every individual you intend to rely upon attesting, under oath, to the reasons why compliance is impossible. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, this petition.

Respectfully submitted this the ____ day of ___________, 20. _____________________________________ Petitioner’s Signature (4) Civil Penalties (a) Purpose - The purpose of this paragraph is to set out a schedule designating the minimum and maximum civil penalties which may be assessed pursuant to T.C.A. §§ 63-1-134 and 63-1-316.

(b) Schedule of Civil Penalties 1. A Type A civil penalty may be imposed whenever the Commissioner finds the medical director, an owner, or clinic staff guilty of a willful and knowing violation of Tenn. Code Ann. §§ 63-1-301, et seq., or regulations promulgated pursuant thereto, to such an extent that there is, or is likely to be an imminent, substantial threat to the health, safety and welfare of an individual client or the public or in such a manner as to impact directly on the care of patients or the public.

2. A Type B civil penalty may be imposed whenever the Commissioner finds a medical director, an owner, or clinic staff is guilty of a violation of Tenn. Code Ann. §§ 63-1-301, et seq., or regulations promulgated pursuant thereto, which are neither directly detrimental to the patients or public, nor directly impact their care.

(c) Amount of Civil Penalties 1. Type A Civil Penalties shall be assessed in the amount of not less than $500 or more than $1,000.

2. Type B Civil Penalties may be assessed in the amount of not less than $100 and not more than $500.

(d) Procedures for Assessing Civil Penalties 1. The Department may initiate a civil penalty assessment by filing a Memorandum of Assessment of Civil Penalty. The Department shall state in the memorandum the facts and law upon which it relies in alleging a violation, the proposed amount of the civil penalty and the basis for such penalty. The Department may incorporate the Memorandum of Assessment of Civil Penalty with a Notice of Charges which may be issued attendant thereto.

2. Civil Penalties may also be initiated and assessed by the Commissioner or his designee during consideration of any Notice of Charges. In addition, the Commissioner or his designee may, upon good cause shown, assess a type and amount of civil penalty which was not recommended by the Department.

3. In assessing the civil penalties pursuant to these rules the Commissioner or his designee may consider the following factors:

(i) Whether the amount imposed will be a substantial economic deterrent to the violator;

(ii) The circumstances leading to the violation;

(iii) The severity of the violation and the risk of harm to the public;

(iv) The economic benefits gained by the violator as a result of noncompliance; and, (v) The interest of the public.

4. All proceedings for the assessment of civil penalties shall be governed by the contested case provisions of Title 4, Chapter 5, Tennessee Code Annotated.

(5) At the conclusion of a hearing, should the Commissioner determine to hold the case under advisement and make a recommendation as to requirements to be met by the pain management clinic in order to avoid suspension, revocation, or other discipline of a license or suspension of admissions, such recommendations shall be a public record and shall be considered formal discipline.

(a) Should the Commissioner make such a recommendation, the clinic must present proof of having met those requirements to the Commissioner for a determination regarding whether they have been satisfactorily met.

(b) Should the Commissioner determine that the recommended requirements have not been met, the Commissioner shall make a finding and record of this determination, and shall impose appropriate formal discipline.

(c) Should the clinic comply with the recommendations, the Commissioner has the

authority to impose a lesser sanction as outlined in his recommendation, or no sanction at all, provided however, that both the initial recommendations and final order shall be a public record and shall be considered formal discipline.

History

• Authority: T.C.A. §§ 63-1-303, 63-1-306, and 63-1-316.
• Administrative History: Emergency rule filed May 25, 2017 and effective through November 21, 2017. The emergency rule expired on November 22, 2017 and reverted to its previous status. Original rules filed August 28, 2017; effective November 26, 2017.

Tenn. Comp. R. & Regs. 1200-34-01-.13 COMMISSIONER SUSPENSIONS OF TREATMENT OF NEW OR EXISTING

PATIENTS.

(1) In cases where the Commissioner determines that the conditions of any pain management clinic are, or are likely to be, detrimental to the health, safety, or welfare of any patient, the Commissioner may suspend treatment of any new or existing patients in whole or part at the Commissioner’s sole discretion, pending a prompt hearing and in accordance with the requirements and provisions set out at T.C.A. § 63-1-318. The Commissioner may also convene an advisory panel, at his discretion, to make recommendations regarding the conditions of any clinic.

(2) The following is a non-exhaustive list of conditions which are, or are likely to be, detrimental to the health, safety, or welfare of a patient:

(a) Where there is gross deviation or a pattern of deviation from the Chronic Pain Guidelines or Pain Clinic Guidelines promulgated by the Department;

(b) Where there is a pattern of negligence or a pattern of noncompliance with normal standards of care;

(c) Where there is dispensing of schedule II or schedule III drugs in violation of T.C.A. § 63-1-313;

(d) Where a provider in the clinic demonstrates active, untreated impairment or substance use disorder.

History

• Authority: T.C.A. §§ 63-1-303 and 63-1-318.
• Administrative History: Emergency rule filed May 25, 2017 and effective through November 21, 2017. The emergency rule expired on November 22, 2017 and reverted to its previous status. Original rules filed August 28, 2017; effective November 26, 2017.

Tenn. Comp. R. & Regs. 1200-34-01-.14 UNLICENSED PAIN MANAGEMENT CLINICS

(1) When the Department has reason to believe that a health care provider’s office is operating as an unlicensed pain management clinic, such health care provider shall produce satisfactory evidence to the Department that the majority of its patient population is not receiving chronic nonmalignant pain treatment to avoid establishment of a rebuttable presumption that the clinic is operating as an unlicensed pain management clinic. For purposes of this determination, patients seen within the preceding twelve (12) months will be considered in determining the percentage of patients receiving chronic non-malignant pain treatment.

(2) Upon request from the Department the health care provider’s office shall produce medical records, business records, and any information responsive to the list below, within ten (10) business days. After initial review, the Department may ask for any necessary additional information to be produced within another ten (10) business days from the Department’s request for additional information. Evidence which will be required by the Department during this process may, at the discretion of the Department, include:

(a) A complete list of every patient seen at the clinic to include a listing of all dates during the preceding twelve (12) months when that patient was seen or treated;

(b) A complete list of every patient seen at the clinic within the preceding twelve (12) months which delineates each patient’s diagnosis as well as what was prescribed to that patient, the drug name, drug strength, number of pills to be dispensed, and number of days of intended use;

(c) A complete list of all the billing codes which were submitted for each patient seen by the clinic as well as copies of the bills with remittances during the preceding twelve (12) months; and (d) A complete list of every clinic patient seen by the clinic during the preceding twelve (12) months who did not receive chronic non-malignant pain treatment with a description of the type of services that patient did receive.

(3) After being provided any of the patient lists above, should the Department need to review charts of any of the clinic’s patients to assist in making its determination, the clinic will be notified of the names and given ten (10) business days to produce those patients’ charts.

(4) Should the health care provider’s office be unable to provide satisfactory evidence, the Department shall notify the clinic of such determination in writing. The clinic shall be prohibited from admitting any new patients to the practice, and all owners and practitioners who worked at the clinic shall be subject to revocation of their licenses.

(5) The Commissioner may issue a determination, or at the Commissioner’s discretion, may convene an advisory panel to meet regarding whether the clinic was operating as an unlicensed pain management clinic and to make a recommendation to the Commissioner prior to the Commissioner’s determination. The Commissioner shall not be bound by the recommendation of the advisory panel.

(6) The Department has discretion to await the Commissioner’s determination and the recommendations of the Advisory Panel before proceeding against the health care practitioners at the clinic for providing services in an unlicensed pain management clinic.

History

• Authority: T.C.A. §§ 63-1-311, 63-1-315, and 63-1-317.
• Administrative History: Emergency rule filed May 25, 2017 and effective through November 21, 2017. The emergency rule expired on November 22, 2017 and reverted to its previous status. Original rules filed August 28, 2017; effective November 26, 2017.

Tenn. Comp. R. & Regs. 1200-34-01-.15 FINANCIAL REQUIREMENT

(1) Licensed pain management clinics shall be required to hold as surety either bonds or liability insurance in an amount at least equal to one year’s operating expense.

(2) The bond or insurance must remain in force as long as the Medical Director’s pain management clinic license is active. Upon notice of cancellation for any reason, the Medical Director shall cease operating, and shall cause all the staff to cease operating, the clinic.

(3) Proof of such surety shall be produced to the Department upon request.

History

• Authority: T.C.A. § 63-1-316.
• Administrative History: Emergency rule filed May 25, 2017 and effective through November 21, 2017. The emergency rule expired on November 22, 2017 and reverted to its previous status. Original rules filed August 28, 2017; effective November 26, 2017.

Tenn. Comp. R. & Regs. 1200-34-01-.16 ADVERTISING

(1) The vulnerability on the part of some patients concerning pain management services, and the foreseeable consequences of unrestricted advertising by pain clinics, requires that special care be taken in advertising for pain management services.

(2) The following statements, acts, or omissions in the context of advertisements by or for any clinic shall not be permitted:

(a) Any communication, including the use of personal testimonials, attesting to the quality of a service or treatment offered at the clinic, or the competency of those at the clinic rendering the service or treatment, with regard to potential results of any service or treatment that is not reasonably verifiable, if that communication is in exchange for consideration of any form.

(b) Any communication which creates an unjustified expectation concerning the potential results of that treatment.

(c) Failure of the pain management clinic to include all the following in the advertisement:

1. The licensure or certification number of the clinic as well as the official name in which the clinic is licensed;

2. The name of the medical director.

(d) Use of the name of any licensee formerly practicing at or associated with any pain management clinic after thirty (30) days from that licensee’s departure, including use of the name on any signage for the office or building.

(e) Stating or implying that a certain licensee provides, or will be providing, all services when any such services are regularly, or will be, performed by another licensee.

(f) Directly or indirectly offering, giving, receiving, or agreeing to receive any fee or other consideration to or from a third party for the referral of a patient in connection with the performance of professional services.

(3) A copy of every advertisement, whether communicated through electronic or printed media, must be kept in as close to the original communication method as possible for at least two (2) years from the last date of communication and shall be submitted to the Department for review upon request.

(4) The Medical Director is responsible for all advertising content which must also be in compliance with the rules of the Tennessee Board of Medical Examiners.

History

• Authority: T.C.A. §§ 63-1-311 and 63-1-317.
• Administrative History: Emergency rule filed May 25, 2017 and effective through November 21, 2017. The emergency rule expired on November 22, 2017 and reverted to its previous status. Original rules filed August 28, 2017; effective November 26, 2017.

Tenn. Comp. R. & Regs. 1200-34-01-.17 INFECTIOUS DISEASE AND BUILDING STANDARDS

Each pain management clinic shall meet all health and safety standards necessary to protect the health and welfare of patients seeking medical assistance from the clinic.

History

• Authority: T.C.A. §§ 63-1-311 and 63-1-317.
• Administrative History: Emergency rule filed May 25, 2017 and effective through November 21, 2017. The emergency rule expired on November 22, 2017 and reverted to its previous status. Original rules filed August 28, 2017; effective November 26, 2017.

Chapter 1200-35-01 Inspection and Copying of Department Records

Tenn. Comp. R. & Regs. 1200-35-01-.01 PURPOSE

The purpose of these rules is to establish procedures to accommodate requests to inspect and/or copy records maintained by the Tennessee Department of Health, to the extent that such records are public records open to inspection by citizens of the State of Tennessee under the Tennessee Public Records Act, T.C.A. §10-7-501, et seq., while preserving the confidentiality of confidential records and/or confidential information as provided in Federal or State law. These rules do not govern charges made for copies of records made pursuant to a law other than the Tennessee Public Records Act. In addition, these rules establish procedures and standard fees for recovering the cost of providing copies of public records upon request.

History

• Authority: T.C.A. §§ 10-7-503, 10-7-504 and 10-7-506.
• Administrative History: Original rule filed October 5, 2012; effective January 3, 2013.

Tenn. Comp. R. & Regs. 1200-35-01-.02 DEFINITIONS

As used in these rules, the following terms are defined as follows:

(1) “Commissioner” means the Commissioner of the Tennessee Department of Health.

(2) “Confidential record” means any Department record that is considered confidential or privileged under Federal or State law, including without limitation, and without waiving any privilege or any right to confidentiality available under Federal or State law, as follows:

(a) Any record or portion of any record that is not subject to public inspection or is defined as confidential under the Public Records Act;

(b) Any record or portion of any record that is not subject to discovery or admissible into evidence in any Federal or State court proceeding or in any action for damages under the provisions of 23 U.S.C. § 409;

(c) Any record or portion of any record that is otherwise protected as confidential or privileged under any Federal or State law or regulation or pursuant to any court order;

(d) Any record that is protected under the attorney/client privilege;

(e) Any record that is protected under the attorney work product doctrine; and (f) Any record that is protected under any other statutory or common law privilege.

(3) “Department” means the Tennessee Department of Health.

(4) “Non-routine record” means a record, in any form, that cannot be readily produced for public inspection or copied upon request without more than minimal assistance or processing from the Records Custodian, and including without limitation:

January, 2013 2 (a) Archived records;

(b) Microfilmed records;

(c) Audio recordings;

(d) Records accessed only through the manipulation of electronically or digitally stored information;

(e) Oversized pages or bound volumes that cannot be fed automatically into and copied on a standard office photocopier; and (f) Records containing or located within files containing material that may be a confidential record under Federal or State law.

(5) “OORC” means the Office of Open Records Counsel.

(6) “Public record” means any Department record that is open to inspection by any citizen of the State of Tennessee under the provisions of the Public Records Act, and is not otherwise considered a confidential record under Federal or State law.

(7) “Public Records Act” means the Tennessee Public Records Act as codified in T.C.A. § 10-7- 501, et seq.

(8) “Record” means any document or stored information, in any form, that has been generated or received and maintained by the Department pursuant to law or in connection with the transaction of the Department’s official business.

(9) “Record available for a fee” means a record generated by the Department in connection with official business that the Department also offers for sale to other governmental agencies, bidders, and/or individuals as a service to the public, including without limitation as follows:

(a) Specialized output including but not limited to maps, tables, html and xtml documents and spreadsheets;

(b) Custom and specialized aggregations or records and data;

(c) Custom reports not otherwise produced;

(d) Data sets; and (e) Vital Records.

(10) “Records Custodian” means an employee of the Department who has direct supervisory

authority over the specific division, section or office of the Department where the requested Department records are maintained.

(11) “Redacted record” means a record that has been edited to remove information that is confidential under Federal or State law.

(12) “Routine record” means a public record, in any form, that can be readily produced for public inspection or copied upon request with minimal assistance from the Records Custodian, including without limitation:

January, 2013 3 (a) An unbound paper record of standard letter or legal size which can be automatically fed into and copied on a standard office photocopier;

(b) Any electronically or digitally stored record that can be readily accessed and printed on a standard office printer; provided, however, that such a record shall not be considered a routine record if each separate screen-page of the record must be printed as a separate page.

History

• Authority: T.C.A. §§ 8-4-604, 10-7-503, 10-7-504, 10-7-506, and 68-3-102.
• Administrative History: Original rule filed October 5, 2012; effective January 3, 2013.

Tenn. Comp. R. & Regs. 1200-35-01-.03 MAKING A REQUEST

(1) Business Hours.

(a) A request to inspect or copy public records of the Department pursuant to the Public Records Act shall be made, and any inspection or copying shall be conducted, during the Department’s normal business hours of 8:00 a.m. to 4:30 p.m., Monday through Friday, excluding holidays.

(2) Notice of Requests.

(a) Notice of a request to inspect or copy public records of the Department, other than a record available for purchase, may be made orally or in writing to the appropriate Records Custodian where the requested records are maintained.

(b) The Department may request the notice to be made or confirmed in writing if, in the judgment of the Department, the request is for any non-routine record or for multiple routine records that cannot be readily produced for inspection in the specific office where the request has been made. The Department may require a request for copies of public records to be made in writing.

(c) Any form of written notice, e.g., letter, facsimile transmission or e-mail, will be acceptable.

(d) The notice shall identify the record or records requested for inspection or copying with as much specificity as reasonably possible.

(e) Any record available for purchase may be obtained by contacting the appropriate office where the record is offered for sale to the public.

History

• Authority: T.C.A. §§ 8-4-604, 10-7-503 and 10-7-506.
• Administrative History: Original rule filed October 5, 2012; effective January 3, 2013.

Tenn. Comp. R. & Regs. 1200-35-01-.04 INSPECTION AND COPYING OF PUBLIC RECORDS

(1) Preliminary Review of Request.

(a) Upon receiving a request to inspect a Department record, other than a record available for purchase, the Records Custodian shall make a preliminary assessment of the nature and scope of the request. If the Records Custodian determines that it is not practicable to make the record promptly available for inspection and/or copying, the Records Custodian shall, within seven business days:

1. Make the information available to the requestor; or January, 2013 4 2. Deny the request in whole or in part by providing a completed records request response in the form provided by OORC stating the basis for any denial; or 3. Provide the requestor with a completed records request response form in the form provided by OORC stating the time reasonably necessary to produce the record.

(b) To preserve a record of the request, the Department may ask the requestor to submit the request in writing, in accordance with Rule 1200-35-01-.03(2) above; provided, that failure to put the request in writing shall not prevent the requestor from making a personal inspection of records at the appropriate office during normal business hours.

(c) In processing a request for the inspection of non-routine records, the Department will first determine whether the requested records exist within the custody of the Department. If the requested records exist within the custody of the Department, the Department will locate and review the requested records as soon as reasonably practicable, taking into consideration the nature and/or volume of the request and the availability of Department staff.

(d) If the requested records either do not exist within the custody of the Department, or are confidential records, the requestor shall be so advised; provided, however, that nothing in this Chapter shall be construed to require the Department to generate a detailed description of each confidential record withheld from inspection, such as may be required with respect to the production of documents in discovery under the Tennessee Rules of Civil Procedure.

(e) If a requested record contains confidential information (e.g., certain information maintained in personnel records) but is otherwise a public record, the Department will generate a copy of the record from which the confidential information has been removed and the redacted record will be made available for inspection. As provided in

Rule 1200-35-01-.05(1) below, the Department may require reimbursement for the employee time associated with making the redacted record for copying.

(f) If the requested record or information is available in an electronic or digital database or other non-printed form, and providing access to the record will require development of a program/application or the reloading of backup files to produce the record or put it into a readable format, the Department may require reimbursement for any employee time and/or other costs associated with developing the program or application and producing the record for copying, as provided in Rule 1200-35-01-.05(2) below.

(2) Form of Record Produced.

(a) Nothing in this Chapter shall be construed to require the Department to make any public record available for inspection in the exact form requested by the requestor, e.g., the Department may make a public record maintained in electronic or digital form available for inspection in printed form.

History

• Authority: T.C.A. § 8-4-604, §§10-7-503, 10-7-504 and 10-7-506.
• Administrative History: Original rule filed October 5, 2012; effective January 3, 2013. 1200-35-01.-05 PAYMENT OF COSTS FOR REPRODUCTION OF PUBLIC RECORDS. (1) The Department adopts the “Schedule of Reasonable Charges for Copies of Public Records” and any successor schedule developed by the Office of the Open Records Counsel for copies of public records made pursuant to the Tennessee Public Records Act, T.C.A. § 10-7- January, 2013 5 501 et. seq. Any charges not specifically listed or in addition to the amounts specified in the Schedule must be documented by the Records Custodian. (2) If the requested records exist electronically, but not in the format requested or a new or modified computer program or application is necessary to put the records in a readable and reproducible format or it is necessary to access backup files, the custodian shall charge the requesting party the actual costs incurred in producing the records in the format requested or in creating or modifying a computer program or application necessary to put the records in a readable and reproducible format or in accessing backup files. (3) Electronic records will be produced only in a read-only format. (4) If the custodian utilizes an outside vendor to produce copies of the requested records because the Department is unable to produce the copies, the cost charged by the vendor to the Department shall be recovered from the requesting party. (5) Delivery and/or shipping costs incurred may be included in the total amount charged for the records release if appropriate. (6) Payment must be made in advance in the form of a check or money order made payable to the “Treasurer, State of Tennessee”. (7) The Department adopts the “Frequent and Multiple Requests Policy” and any successor policy developed by the Office of the Open Records Counsel for copies of public records made pursuant to the Tennessee Public Records Act, T.C.A. § 10-7-501, et. seq. A Records Custodian may aggregate such requests on any level, whether by agency, department, bureau, division, office or otherwise. (8) A Records Custodian may waive or reduce charges governed by these rules if: (a) Charges total less than Ten Dollars ($10.00); (b) The person requesting the copies is indigent pursuant to Federal poverty guidelines and signs a statement to that effect; or (c) The person requesting the copies does so on behalf of a government agency. (9) The Commissioner may waive or reduce charges governed by these rules if the charges exceed Ten Dollars ($10.00). A person requesting such reduction or waiver must do so in writing submitted to the Records Custodian. Authority: T.C.A. §§ 4-4-103, 4-5-218(b) and (d), 8-4-604 and 10-7-506(a).

1200-36 Office of the Chief Medical Examiner

Chapter 1200-36-01 Investigation of Deaths Resulting from Opiate, Illegal or Illicit Drug Overdose

Tenn. Comp. R. & Regs. 1200-36-01-.01 PURPOSE

A complete autopsy is preferred and usually necessary for optimal investigation of deaths resulting from opiate, illegal or illicit drug overdose. The rules in this chapter set forth protocol for uniform investigations of deaths resulting from such drugs.

History

• Authority: T.C.A. §§ 38-7-102, 68-3-502(d) and Chapter 916 of the Public Acts of 2012.
• Administrative History: Original rule filed June 17, 2013; effective November 28, 2013.

Tenn. Comp. R. & Regs. 1200-36-01-.02 DEFINITIONS

(1) “Admission blood” means the blood obtained from an individual, whether alive or deceased, upon admission to the hospital.

(2) “Autopsy” means the examination and dissection of a dead body by a physician authorized by law for the following purposes: determining the cause, mechanism, or manner of death, or the seat of disease, confirming clinical diagnoses, obtaining specimens for specialized testing, retrieving physical evidence, identifying the deceased, or educating medical professionals and students.

(3) “Body” means the body of a deceased human or the parts or remains thereof.

(4) “Chain of Custody” means the methodology of tracking specified materials, substances, or bodies for the purpose of maintaining control and accountability from initial collection to final disposition for all such items and providing accountability at each stage in handling, testing, and storing specimens and reporting test results.

(5) “County Medical Examiner” means a physician licensed to practice medicine in the state of Tennessee and appointed by the county mayor.

(6) “County Medical Investigator” means a licensed emergency medical technician, paramedic, registered nurse, physician’s assistant or person registered by or a diplomat of the American Board of Medicolegal Death Investigators (AMBDI) and approved by the county medical examiner as qualified to serve under the supervision of a County Medical Examiner and assist the County Medical Examiner in death investigations.

(7) “Forensic Pathologist” means a licensed physician who is certified in forensic pathology by the American Board of Pathology or who, prior to 2006, has completed a training program in forensic pathology that is accredited by the Accreditation Council on Graduate Medical Education (ACGME) or its international equivalent or has been officially “qualified for examination” in forensic pathology by the American Board of Pathology (ABP).

November, 2013 2 (8) “Regional Forensic Center” means a facility accredited by the National Association of Medical Examiners (NAME) that provides forensic autopsy and death investigative services to one or more counties.

(9) “Scene” means the location where the death occurred and/or where the body was discovered.

(10) “Toxicology” means the identification and analysis of drugs and poisons.

History

• Authority: T.C.A. §§ 38-7-102, 68-3-502(d), and Chapter 916 of the Public Acts of 2012.
• Administrative History: Original rule filed June 17, 2013; effective November 28, 2013.

Tenn. Comp. R. & Regs. 1200-36-01-.03 REQUIRED REPORTING OF DEATHS RESULTING FROM OPIATE, ILLEGAL OR

ILLICIT DRUG OVERDOSE.

(1) Any physician, undertaker, law enforcement officer, or other person having knowledge or reasonable suspicion of the death of any person resulting from opiate, illegal or illicit drugs shall immediately notify the county medical examiner or the district attorney general, the local police or the county sheriff, who in turn shall notify the county medical examiner. The notification shall be directed to the county medical examiner in the county in which the death occurred.

(2) The county medical examiner or county medical investigator shall report the death to the regional forensic center.

(3) The regional forensic center shall:

(a) Forward reports of such deaths to the Office of the Chief Medical Examiner; and (b) Send the final autopsy report of such deaths to the Office of the Chief Medical Examiner.

History

• Authority: T.C.A. §§ 38-7-102, 68-3-502(d) and Chapter 916 of the Public Acts of 2012.
• Administrative History: Original rule filed June 17, 2013; effective November 28, 2013.

Tenn. Comp. R. & Regs. 1200-36-01-.04 INVESTIGATION OF DEATHS

(1) The county medical investigator or the county medical examiner shall arrive as soon as practicable upon receiving a report pursuant to 1200-36-01-.03(1).

(2) After arrival at the scene, the county medical investigator or the county medical examiner shall document in writing:

(a) Any usage of medications, illicit drugs and drug paraphernalia by the decedent;

(b) Any acute attempts of resuscitation performed on the decedent;

(c) Interviews with witnesses at the scene;

(d) Medical and mental health history of decedent; and (e) An inventory of any medications found at the scene and document the name of the person to whom the medication was prescribed, the prescription number, pharmacy, the name of the prescribing medical practitioner, dosage, date filled, amount of November, 2013 3 medication issued, amount of medication remaining, and any instructions for the administration of the medication.

(3) Prior to ordering an autopsy, county medical examiners and/or investigators shall consult with the regional forensic center receiving the body. Interpretation of postmortem toxicology testing requires correlation with history, scene and autopsy findings; thus whenever possible, a forensic autopsy shall be ordered.

(4) If an autopsy is ordered, the county medical examiner shall send the following items with the body using chain of custody pursuant to the policy of the regional forensic center that will receive the body:

(a) All items listed in paragraph (2);

(b) Scene photos;

(c) Report of investigation;

(d) Order for autopsy;

(e) All admission blood and urine samples taken from the decedent and held at the hospital laboratory; and (f) If the decedent was transferred to a hospital, a copy of the decedent’s hospital medical records.

(5) The county medical investigator will document the chain of custody for all items sent with the body.

(6) The county medical examiner or investigator shall remain with the body at any non-hospital scenes until transportation arrives and removes the body.

(7) The death certificate will be signed by the forensic pathologist who performs the forensic examination.

History

• Authority: T.C.A. §§ 38-7-102, 68-3-502(d) and Chapter 916 of the Public Acts of 2012.
• Administrative History: Original rule filed June 17, 2013; effective November 28, 2013.

1200-37 Community Health Services Division

Chapter 1200-37-01 Primary Care Services

Tenn. Comp. R. & Regs. 1200-37-01-.01 DEFINITIONS

(1) For the purpose of these regulations the terms used herein are defined as follows:

(a) “Adult” means an individual aged eighteen or over.

(b) “Applicant” means an individual seeking primary care services.

(c) “Citizen” means a citizen of the United States, whether native-born or naturalized.

(d) “Clinic” means a site under the control of the Department or a county health department at which primary care services are offered to the public and which is not a federally qualified health center (FQHC).

(e) “Department” means the Tennessee Department of Health.

(f) “Emergency” means a medical or dental condition manifesting itself by acute systems of sufficient severity (including pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the patient’s health in serious jeopardy, serious impairment to bodily functions or serious dysfunction of any bodily organ or part.

(g) “Exempt Services” means those services which are not subject to eligibility verification under the Eligibility Verification for Entitlements Act, T.C.A. §§ 4-58-101 et seq.

(h) “Federal public benefit”

1. Has the same meaning as provided in 8 U.S.C § 1611; and 2. Does not mean a benefit listed in 8 U.S.C. § 1611 (b).

(i) “Primary Care Services” means the basic level of health care generally rendered by general practitioners, family practitioners, internists, obstetricians, and pediatricians and advanced practice nurses and is offered at clinics.

(j) “Program Director” means the Department employee responsible for the overall supervision of primary care services for the Department.

(k) “Provider” means a health care professional working in a clinic.

(l) “Qualified alien” means: an alien who, at the time the alien applies for, receives, or attempts to receive a Federal public benefit, is:

1. Lawfully admitted for permanent residence under the Immigration and Nationality Act [8 U.S.C. §§ 1101 et seq.];

2. Granted asylum under section 208 of such Act [8 U.S.C. § 1158];

3. Admitted to the United States under section 207 of such Act [8 U.S.C. § 1157];

4. Paroled into the United States under section 212(d)(5) of such Act [8 U.S.C. § 1182 (d)(5)] for a period of at least 1 year;

5. One whose deportation is being withheld under section 243(h) of such Act [8 U.S.C. § 1253] (as in effect immediately before the effective date of section 307 of division C of Public Law 104–208) or section 241(b)(3) of such Act [8 U.S.C. § 1231(b)(3)] (as amended by section 305(a) of division C of Public Law 104–208);

6. Granted conditional entry pursuant to section 203(a)(7) of such Act [8 U.S.C. § 1153(a)(7)] as in effect prior to April 1, 1980; or 7. A Cuban and Haitian entrant (as defined in section 501(e) of the Refugee Education Assistance Act of 1980); or 8. An alien:

(i) who has been battered or subjected to extreme cruelty in the United States by a spouse or a parent, or by a member of the spouse or parent’s family residing in the same household as the alien and the spouse or parent consented to, or acquiesced in, such battery or cruelty, but only if (in the opinion of the agency providing such benefits) there is a substantial connection between such battery or cruelty and the need for the benefits to be provided; and (ii) who has been approved or has a petition pending which sets forth a prima facie case for:

(I) status as a spouse or a child of a United States citizen pursuant to clause (ii), (iii), or (iv) of section 204(a)(1)(A) of the Immigration and Nationality Act [8 U.S.C. § 1154(a)(1)(A)(ii), (iii), (iv)], (II) classification pursuant to clause (ii) or (iii) of section 204(a)(1)(B) of the Act [8 U.S.C. § 1154(a)(1)(B)(ii), (iii)], (III) suspension of deportation under section 244(a)(3) of the Immigration and Nationality Act [8 U.S.C. § 1254(a)(3)] (as in effect before the title III–A effective date in section 309 of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996), (IV) status as a spouse or child of a United States citizen pursuant to clause (i) of section 204(a)(1)(A) of such Act [8 U.S.C. § 1154(a)(1)(A)(i)], or classification pursuant to clause (i) of section 204(a)(1)(B) of such Act [8 U.S.C. § 1154(a)(1)(B)(i)]; or (V) cancellation of removal pursuant to section 240A(b)(2) of such Act [8 U.S.C. § 1229b(b)(2)]; or (iii) whose child has been battered or subjected to extreme cruelty in the United States by a spouse or a parent of the alien (without the active participation of the alien in the battery or cruelty), or by a member of the spouse or parent’s family residing in the same household as the alien and the spouse or parent consented or acquiesced to such battery or cruelty, and the alien did not actively participate in such battery or cruelty, but only if (in the opinion of the agency providing such benefits) there is a substantial connection between such battery or cruelty and the need for the benefits to be provided; and (iv) who meets the requirements of subpart (ii) of this part; or (v) who has been granted nonimmigrant status under section 101(a)(15)(T) of the Immigration and Nationality Act (8 U.S.C. §1101(a)(15)(T)) or who has a pending application that sets forth a prima facie case for eligibility for such nonimmigrant status.

(m) “SAVE program” means the systematic alien verification for entitlements program created pursuant to the federal Immigration Reform and Control Act of 1986, compiled in 8 U.S.C. §§ 1101 et seq., and operated by the United States department of homeland security, or any successor program thereto.

(n) “SEVIS system” means the student and exchange visitor information system created pursuant to section 641 of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, Public Law 104-208 (as amended), and operated by the United States department of homeland security, or any successor program thereto.

(o) “State or local public benefit”

1. Means any public benefit as defined in 8 U.S.C. § 1621, that is provided or administered by a state governmental entity or a local health department; and 2. Does not mean a benefit listed in 8 U.S.C. § 1621(b).

History

• Authority: T.C.A. §§ 4-58-102, 68-1-103, 68-1-106, 68-2-603, 8 U.S.C. § 1641(b), and 2013 Acts, Pub. Chap. 120.
• Administrative History: Emergency rule filed July 19, 2013; effective through January 15, 2014. Original rule filed July 25, 2013; effective December 29, 2013.

Tenn. Comp. R. & Regs. 1200-37-01-.02 APPLICABILITY OF THIS PART

This part shall apply to all primary care services offered in clinics, provided, however, that it shall not apply to:

(1) Applicants under the age of eighteen;

(2) Exempt services;

(3) Emergency Services, including emergency dental services; or (4) Prenatal care.

History

• Authority: T.C.A. §§ 4-58-102, 4-58-106, 4-58-110, 68-1-103, 68-1-106, and 68-2-603.
• Administrative History: Emergency rule filed July 19, 2013; effective through January 15, 2014. Original rule filed July 25, 2013; effective December 29, 2013.

Tenn. Comp. R. & Regs. 1200-37-01-.03 APPLICATION FOR PRIMARY CARE SERVICES

Each adult applicant for services under this program shall attest to his/her status as a citizen or qualified alien and shall submit to verification of that status as follows:

(1) Applicants claiming to be citizens shall present one of the following:

(a) A valid Tennessee driver license or photo identification license issued by the department of safety;

(b) A valid driver license or photo identification license from another state where the issuance requirements are at least as strict as those in Tennessee, as determined by the department of safety;

(c) An official birth certificate issued by a state, jurisdiction or territory of the United States, including Puerto Rico, United States Virgin Islands, Northern Mariana Islands, American Samoa, Swains Island, and Guam; provided, that Puerto Rican birth certificates issued before July 1, 2010, shall not be recognized under this rule;

(d) A United States government-issued certified birth certificate;

(e) A valid, unexpired United States passport;

(f) A United States certificate of birth abroad (DS-1350 or FS-545);

(g) A report of birth abroad of a citizen of the United States (FS-240);

(h) A certificate of citizenship (N560 or N561);

(i) A certificate of naturalization (N550, N570 or N578);

(j) A United States citizen identification card (I-197, I-179);

(k) Any successor document of subparagraphs (1)(e) through (1)(j) above; or (l) A social security number that the entity or local health department may verify with the social security administration in accordance with federal law.

(2) Applicants claiming to be qualified aliens shall present two forms of documentation of identity and immigration status as determined by the United States Department of Homeland Security to be acceptable for verification through the SAVE program or SEVIS system.

(3) Where an applicant claiming to be a qualified alien presents only one form of documentation of identity described in (2) above, the clinic shall attempt to verify the applicant’s status through the SAVE program or SEVIS system.

(4) If an applicant who claims eligibility as a qualified alien is unable to present two (2) forms of documentation as described in paragraph (2) above, then the applicant shall present at least one (1) such document that the entity or local health department shall then verify through the SAVE program or SEVIS system.

(5) Any document submitted pursuant to paragraphs (1) or (2) of this rule shall be presumed to be proof of eligibility until final verification is received from the SAVE program or SEVIS system.

(6) If the SAVE program or SEVIS system indicates that the applicant is not a citizen or qualified alien, the clinic shall deny future primary care services and shall pursue any appropriate action under T.C.A. §§ 4-58-104 or 4-58-105.

History

• Authority: T.C.A. §§ 4-58-102, 4-58-104, 4-58-105, 4-58-106, 4-58-107, 4-58-108, 4-58-109, 4-58-110, 68-1-103, 68-1-106, 68-2-603, and 2013 Acts, Pub. Chap. 120.
• Administrative History: Emergency rule filed July 19, 2013; effective through January 15, 2014. Original rule filed July 25, 2013; effective December 29, 2013.

Tenn. Comp. R. & Regs. 1200-37-01-.04 RECONSIDERATION OF DENIAL

(1) Applicants denied or removed from primary care services may request reconsideration.

(a) The applicant must request reconsideration in writing, directed to the Program Director, within twenty one (21) calendar days of denial or removal. The Program Director will issue a reconsidered decision in writing within fourteen (14) days of the request for reconsideration. The Program Director’s review is limited to a determination of whether or not the applicant meets eligibility criteria. The decision of the Program Director is final.

History

• Authority: T.C.A. §§ 4-58-102, 4-58-108, 4-58-110, 68-1-103, 68-1-106, and 68-2-603.
• Administrative History: Emergency rule filed July 19, 2013; effective through January 15, 2014. Original rule filed July 25, 2013; effective December 29, 2013.

1200-38 Division of Health Planning

Chapter 1200-38-01 Hospital Cooperation Act of 1993

Tenn. Comp. R. & Regs. 1200-38-01-.01 PURPOSE AND DEFINITIONS

The rules in this chapter implement the law relative to Cooperative Agreements and the granting of Certificates of Public Advantage pursuant to the Hospital Cooperation Act of 1993, T.C.A. §§ 68-11-1301 through 68-11-1309.

Pursuant to the Act, the Department is responsible for active state supervision to protect the public interest and to assure that the reduction in competition of health care and related services continues to be outweighed by clear and convincing evidence of the likely benefits of the Cooperative Agreement, including but not limited to improvements to population health, access to services and economic advantages to the public. The COPA will be denied or terminated if the likely benefits of the Cooperative Agreement fail to outweigh any disadvantages attributable to a potential reduction in competition resulting from the Cooperative Agreement by clear and convincing evidence.

(1) “Advisory Group” means the group of stakeholders from Applicants geographic service area, as specified in the Application, appointed by the Commissioner, in consultation with appropriate constituencies and government agencies, to recommend Measures to be considered for inclusion in an Index to objectively track Public Advantage of a single Cooperative Agreement.

(2) “Applicant” means the parties to a Cooperative Agreement who submit an Application to the Department in accordance with 1200-38-01.02.

(3) “Application” means the written materials submitted to the Department in accordance with 1200-38-01.02, by entities who desire to apply for a Certificate of Public Advantage.

(4) “Attorney General” means the Attorney General and Reporter for the State of Tennessee.

(5) “Certificate of Public Advantage (“COPA” or the “Certificate”)” means the written approval by the Department which governs the Cooperative Agreement.

(6) “Certificate Holder” means the entity holding the Certificate of Public Advantage issued by the Department.

(7) “Commissioner” means the Commissioner of the Department of Health.

(8) “Cooperative Agreement” means an agreement among two (2) or more hospitals for the consolidation by merger or other combination of assets, offering, provision, operation, planning, funding, pricing, contracting, utilization review or management of health services or for the sharing, allocation or referral of patients, personnel, instructional programs, support services and facilities or medical, diagnostic or laboratory facilities or procedures or other services traditionally offered by hospitals, including any parent or subsidiary at the time the transaction occurs or at any time thereafter.

(9) “Department” means the Department of Health.

(10) “Hospital” means an institution required to be licensed as a hospital pursuant to § 68-11-201, or defined as a psychiatric hospital in § 68-11-102; or any parent of a hospital, hospital subsidiary or hospital affiliate that provides medical or medically-related diagnostic and laboratory services or engages in ancillary activities supporting those services.

(11) “Independent Provider” means a licensed provider in private practice and not employed by any Applicant providing medical services to patients residing or working in the Applicants’ geographic service area.

(12) “Index” means a set of Measures used to objectively track the progress of a Cooperative Agreement over time to ensure Public Advantage. The components of the Index may be assigned differential weightings and modified from time to time as determined by the Department.

(13) “Intervenor" means any hospital, physician, allied health professional, healthcare provider or other person furnishing goods or services to, or in competition with, hospitals, insurer, hospital service corporation, medical service corporation, hospital and medical services corporation, preferred provider organization, health maintenance organization or any employer or association that directly or indirectly provides health care benefits to its employees or members.

(14) “Measure” means some number of factors or benchmarks, which may be binary, a range or continuous factors.

(15) “Plan of Separation” means the written proposal submitted with an Application to return the parties to a Cooperative Agreement to a pre-consolidation state, which includes a plan for separation of any combined assets, offering, provision, operation, planning, funding, pricing, contracting, utilization review or management of health services or any combined sharing, allocation, or referral of patients, personnel, instructional programs, support services and facilities or medical, diagnostic or laboratory facilities or procedures or other services traditionally offered by hospitals, including any parent or subsidiary at the time the consolidation occurs or thereafter.

(16) “Population" means the entirety of the human population residing or domiciled in the geographic service area set out in the proposed Cooperative Agreement unless otherwise defined.

(17) Public Advantage” means the likely benefits accruing from a Cooperative Agreement which outweigh, by clear and convincing evidence, the likely disadvantages attributable to a reduction in competition likely to result from the Cooperative Agreement.

History

• Authority: T.C.A. §§ 68-11-1301 through 68-11-1309.
• Administrative History: Emergency rule filed July 14, 2015; effective through January 10, 2016. New rule filed October 6, 2015; effective January 4, 2016. Amendments filed December 10, 2018; effective March 10, 2019.

Tenn. Comp. R. & Regs. 1200-38-01-.02 APPLICATION PROCESS

(1) Letter of Intent. At least forty-five (45) days prior to filing an Application, the parties to the proposed Cooperative Agreement shall file a letter of intent.

(a) Contents. A letter of intent shall contain the following:

1. A brief description of the proposed Cooperative Agreement, including the location of the entities and parties to the Cooperative Agreement;

2. A list that includes all assets, ownership interests, subsidiaries and affiliated businesses currently owned or operated, in whole or in part, by any party to the Cooperative Agreement that the parties propose to be included in the COPA or any assets, ownership interests, subsidiaries and affiliated businesses currently owned or operated, in whole or part, by any party to the Cooperative Agreement that will be divested, sold or affected as a result of the Cooperative Agreement;

3. A list of all business interests or units for which each party to the Cooperative Agreement has any ownership interest or a management contract that is not proposed to be included in the Cooperative Agreement;

4. The name, address and contact information of the parties to the proposed Cooperative Agreement including the executive officers, each party’s respective board members and each party’s general counsel;

5. A description of the entities’ governing structure under the Cooperative Agreement;

6. The anticipated date of submission of the Application; and the anticipated effective date of the proposed Cooperative Agreement; and 7. The geographic service area and Population covered by the Cooperative Agreement.

(b) Amendment. The parties shall amend the letter of intent if material changes occur prior to submission of the parties’ Application.

(c) Expiration. A letter of intent expires six (6) months after the date of receipt by the Department, if no Application was timely filed with the Department.

(d) Public Record. The Department shall post letters of intent on the Department’s website until an Application is filed or until the letter of intent expires.

(2) Application.

(a) Parties seeking a COPA shall apply to the Department in writing. Parties shall submit the following information in the Application:

1. A descriptive title;

2. A table of contents;

3. An executive summary which includes:

(i) Goals for change to be achieved by the Cooperative Agreement;

(ii) Benefits and advantages to parties and the public including but not limited to:

(I) Population health;

(II) Access to health care and prevention services; and (III) Healthcare operating costs, including avoidance of capital expenditures, and reduction in operating expenditures that will result in lower costs for the parties and to the public; and (IV) Improvements in patient outcomes.

(iii) Description of how the Cooperative Agreement better prepares and positions the parties to address anticipated future changes in health care financing, organization and accountability initiatives; and (iv) Potential disadvantages of the Cooperative Agreement, including but not limited to:

(I) Closure or consolidation of programs and facilities and the potential impact on access to services;

(II) Reducing selected administrative and clinical functions and loss of jobs;

(III) Narrowing of traditional payer networks leading to reduction of patient choice in choosing physicians and other services; and (IV) Negative impact on Independent Providers due to the anticipated increased market concentration in physician and health care services controlled by the Applicants.

4. The names of each party to the Application and the address of the principal business office of each party;

5. A verified statement signed by the Chairperson of the Board of Directors and Chief Executive Officer of each party to the Application; or, if one or more of the Applicants is an individual, signed by the individual Applicant; attesting to the accuracy and completeness of the enclosed information;

6. A description of the prior history of dealings between the parties to the Application, including, but not limited to, their relationship as competitors and any prior joint ventures or other collaborative arrangements between the parties. If the parties have engaged in prior joint ventures, the parties should describe why they believe such efforts would not be successful in achieving the goals they seek through a Cooperative Agreement. If the parties have not engaged in any joint ventures or collaborative arrangements, the parties should describe why alternative arrangements were not attempted to achieve the goals they seek through a Cooperative Agreement;

7. A detailed description of the proposed geographic service area, not limited to the boundaries of the State of Tennessee. If the proposed geographic service area differs from the geographic service areas where the parties have conducted business over the five (5) years preceding the Application, a description of how and why the proposed geographic service area differs and why changes are proposed;

8. Identification of whether any services or products of the proposed Cooperative Agreement are currently being offered or capable of being offered by other providers or purchasers in the geographic service area described in the Application;

9. Explanation of how the Cooperative Agreement will assure continued competitive and independent operation of the services or products of entities not a party to the Cooperative Agreement, including the potential for new entry;

10. A statement of whether there will be a Public Advantage or adverse impact on population health, quality, access, availability or cost of health care to patients and payers as a result of the Cooperative Agreement;

11. A statement of whether the projected levels of cost, access to health care or quality of health care could be achieved in the existing market without the granting of a COPA; and, for each of the above, an explanation of why or why not;

12. A report used for public information and education that is documented to have been disseminated prior to submission of the Application and submitted as part of the Application. The report must include the following:

(i) A description of the proposed geographic service area, services and facilities to be included in the Cooperative Agreement;

(ii) A description of how health services will change if the Application is accepted;

(iii) A description of improvements in patient access to health care including prevention services for all categories of payers and advantages patients will experience across the entire geographic service area regarding costs, availability or accessibility upon initiation of the Cooperative Agreement and/or findings from studies conducted by hospitals and other external entities, including health economists, clinical services and population health experts, that describe how proposed Cooperative Agreement plans are: effective with respect to resource allocation implications; efficient with respect to fostering cost containment, including, but not limited to, eliminating duplicate services and future service and facility plans; and equitable with respect to maintaining quality and competition in health services within the geographic service area, assuring patient access to and choice of insurers and providers within the health care system;

(iv ) Findings from geographic service area assessments that describe major health issues and trends, specific population health disparities and comparisons to state and other similar regional areas proposed to be addressed;

(v) Impact on the health professions workforce including long-term employment and wage levels and recruitment and retention of health professionals; and (vi) A record of community stakeholder and consumer views of the proposed Cooperative Agreement collected through a public participatory process including meetings and correspondence in which this report or its components were used. Applicants should also provide a summary of the number and location of events organized by the Applicants; number of speakers; the name, title, and affiliated organization of the speakers and whether the speaker is speaking on behalf of the organization or in the speaker’s personal capacity; and communications used by the Applicants to maximize public involvement in the process. Transcripts or minutes of any meetings held during these public forums shall be included in the report.

13. A signed copy of the Cooperative Agreement, including:

(i) A description of any consideration passing to any person under the Cooperative Agreement including the amount, nature, source and recipient;

(ii) A detailed description of any merger, lease, change of control or other acquisition or change in ownership of the assets of any party to the Cooperative Agreement;

(iii) A list of all services and products and all service locations that are the subject of the Cooperative Agreement, including those not occurring within the boundaries of the State of Tennessee, and including, but not limited to, hospitals or other inpatient facilities, insurance products, physician practices, pharmacies, accountable care organizations, psychiatric facilities, nursing homes, physical therapy and rehabilitation units, home care agencies, wellness centers or services, surgical centers or services, dialysis centers or services, cancer centers or services, imaging centers or services, support services or any other product, facility or service;

(iv) A description of each party’s contribution of capital, equipment, labor, services or other value to the transaction;

(v) A description of the competitive environment in the parties’ geographic service area, including:

(I) Identification of all services and products likely to be affected by the Cooperative Agreement and the locations of the affected services and products;

(II) The parties’ estimate of their current market shares for services and products and the projected market shares if the COPA is granted;

(III) A statement of how competition among health care providers or health care facilities will be reduced for the services and products included in the Cooperative Agreement; and (IV) A statement regarding the requirement(s) for any Certificate(s) of Need resulting from the Cooperative Agreement.

(vi) Impact on the geographic service area’s health care industry workforce, including long-term employment and wage levels and recruitment and retention of health professionals;

(vii ) Description of financial performance, including:

(I) A description and summary of all aspects of the financial performance of each party to the transaction for the preceding five (5) years including debt, bond rating and debt service and copies of external certified public accountants annual reports;

(II) A copy of the current annual budget for each party to the Cooperative Agreement and a three (3) year projected budget for all parties after the initiation of the Cooperative Agreement. The budgets must be in sufficient detail so as to determine the fiscal impact of the Cooperative Agreement on each party. The budgets must be prepared in conformity with generally accepted accounting principles (GAAP) and all assumptions used must be documented;

(III) A detailed explanation of the projected effects including expected change in volume, price and revenue as a result of the Cooperative Agreement, including;

I. Identification of all insurance contracts and payer agreements in place at the time of the Application and description of pending or anticipated changes that would require or enable the parties to amend their current insurance and payer agreements;

II. A description of how pricing for provider insurance contracts are calculated and the financial advantages or disadvantages impacting insurers, insured consumers and the parties of the Cooperative Agreement (including the Applicants’ employed and contracted physicians, if any) if the COPA is granted including changes in percentage of risk-bearing contracts;

III. The following policies:

A. Policy that assures no restrictions to Medicare and/or Medicaid patients, B. Policies for free or reduced fee care for uninsured and indigent, C. Policies for bad debt write-off; and D. Policies that assure parties to the Cooperative Agreement will maintain or exceed existing level of charitable programs and services.

(IV) Identification of existing or future business plans, reports, studies or other documents of each party that:

I. Discuss each party’s projected performance in the market, business strategies, capital investment plans, competitive analyses and financial projections including any documents prepared in anticipation of the Cooperative Agreement; and II. Identification of plans that will be altered, eliminated or combined under the Cooperative Agreement or subsequent COPA (viii) A description of the plan to systematically integrate health care and preventive services among the parties of the Cooperative Agreement, in the proposed geographic service area, to address the following:

(I) A streamlined management structure to include a description of a single board of directors, centralized leadership and operating structure;

(II) Alignment of the care delivery decisions of the system with the interest of the community;

(III) Clinical standardization;

(IV) Alignment of cultural identities of the parties to the Cooperative Agreement;

(V) Implementation of risk-based payment models to include risk, a schedule of risk assumption and proposed performance metrics to demonstrate movement toward risk assumption and a proposed global spending cap for hospital services; and (VI) Collaboration with Independent Providers in the geographic service area.

(ix) A detailed description of each of the benefits the Applicants propose will be achieved through the Cooperative Agreement, and for each benefit described provide:

(I) A description specifically describing how the Applicants intend to achieve the benefit;

(II) A description of what the parties have done in the past with respect to achieving or attempting to achieve the benefits independently or through collaboration;

(III) An explanation of why the benefit can best be achieved through a Cooperative Agreement and not through other less anticompetitive arrangements;

(IV) A description of how the Applicants propose that the Commissioner measure and monitor achievement of the proposed benefit including:

I. Proposed measures and suggested baseline values with rationale for each measure to be considered by the Commissioner in developing a plan to monitor achievement of the benefit;

II. The projected levels and trajectory for each measure that would be achieved over the next five (5) years in the absence of the Cooperative Agreement.

III. The basis for the metrics proposed to measure the benefits; and IV. A plan for how the requisite data for assessing the benefit will be identified and obtained.

(x) A description of the plan, including economic metrics, that details anticipated efficiencies in operational costs and shared services to be gained through the Cooperative Agreement including:

(I) Proposed use of any cost savings to reduce prices borne by insurers and consumers;

(II) Proposed use of cost savings to fund low or no-cost services such as immunizations, mammograms, chronic disease management and drug and alcohol abuse services to achieve long-term population health improvements; and (III) Other proposed uses of savings to benefit advancement of health and quality of care and outcomes.

(xi) Proposed Measures and suggested baseline values with rationale for each Measure to be considered by the Department in development of an Index.

Proposed Measures are to be used to continuously evaluate the Public Advantage of the results of actions approved in the COPA through the Cooperative Agreements under active supervision of the Department.

Measures should include elements that reflect both the anticipated benefits and potential disadvantages if the COPA is approved, including measures detailed in item (2)(a)13.(ix)(IV) of this rule. They should include source and projected trajectory over each of the first five (5) years of the Cooperative Agreement and the trajectory if the COPA is not granted.

Proposed Measures may include:

(I) Improvements in the geographic service area population’s health that exceed Measures of national and state improvement;

(II) Continuity in availability of services throughout the geographic service area;

(III) Access and use of preventive and treatment health care services throughout the geographic service area;

(IV) Operational savings projected to lower health care costs to payers and consumers; and (V) Improvements in quality of services as defined by surveys of the Joint Commission.

14. An explanation of the reasons for the exclusion of any information set forth in

section 1200-38-01-.02, the Application Process, including an explanation of why the item is not applicable to the Cooperative Agreement or to the parties;

15. A detailed description of the total cost resulting from the Cooperative Agreement, including, but not limited to, new costs for consultants, capital costs and management costs. The description should identify costs associated with the implementation of the Cooperative Agreement, including documentation of the availability of the necessary funds. The description should identify which costs are borne by each party;

16. A timetable for implementing all components of the Cooperative Agreement;

17. The Department shall require a Plan of Separation be submitted with the Application. The Plan of Separation shall be updated annually by the parties to the Cooperative Agreement. The parties shall provide an independent opinion from a qualified organization verifying the Plan of Separation can be operationally implemented without undue disruption to essential health services provided by the parties; and 18. The name, address and telephone number of the person(s) authorized to receive notices, reports and communications with respect to the Application.

(3) Additional Department Requirements.

(a) The Department may request additional information from the parties prior to deeming the Application complete or issuing a final decision. The Application shall not be deemed complete nor shall the one hundred twenty (120) day review period commence until all information is received by the Department.

(b) The Department shall notify the parties in writing when the Application is deemed complete.

(c) The parties shall submit simultaneously a copy of the Application and copies of all additional related materials to the Attorney General and to the Department. The Department is entrusted with the active and continuing oversight of all Cooperative Agreements.

(d) The Department may waive any of the requirements or timeframes that it finds, at its sole discretion, due to the nature of a particular Cooperative Agreement, are inapplicable to its analysis of the Cooperative Agreement.

(e) The Application and accompanying documents are public records pursuant to T.C.A. § 10-7-503 and are subject to public inspection in accordance with § 10-7-503, except for records which are confidential pursuant to state or federal law. The parties shall specify any portion of the Application which the parties contend is exempt from the Public Records Act. The parties shall include the specific authority for said exemption.

Applicants shall submit two (2) copies of the Application. The first copy shall include all requested information. The second copy shall contain all requested information; however, the parties shall redact confidential information wherever possible. Nothing in this subsection shall limit or deny access to otherwise public information because an Application or accompanying document contains confidential information.

History

• Authority: T.C.A. § 68-11-1303.
• Administrative History: Emergency rule filed July 14, 2015; effective through January 10, 2016. New rule filed October 6, 2015; effective January 4, 2016. Amendments filed December 10, 2018; effective March 10, 2019.

Tenn. Comp. R. & Regs. 1200-38-01-.03 TERMS OF CERTIFICATION

All COPAs shall be governed by terms of certification.

The terms of certification shall include:

(1) Charges.

(a) Parties to a Cooperative Agreement who have applied to the Department for a COPA shall pay all charges incurred in the examination of the Application and, in the event the COPA is approved, all charges incurred for the review and ongoing supervision of the Cooperative Agreement, including all expenses of the Department, including, but not limited to, experts and examiners employed in the review and ongoing supervision of the Application and COPA.

(b) The compensation of the Department, experts and examiners designated by the Commissioner for examining the Cooperative Agreement and all records shall be fixed by the Commissioner at an amount commensurate with usual compensation for like services.

(c) The Department shall develop a formula to include charges incurred in the examination of the Application and charges incurred for review and ongoing supervision and invoice COPA Applicants and holders Department’s costs at a regular interval.

(2) Evaluation of the Application by the Department that demonstrates Public Advantage in accordance with the standards set forth in these rules.

(a) Benefits to include:

1. Enhancement of the quality of Hospital and hospital-related care provided to Tennessee citizens;

2. Preservation of hospital facilities in geographical proximity to the communities traditionally served by those facilities;

3. Gains in the cost containment and cost-efficiency of services provided by the Hospitals involved;

4. Improvements in the utilization of Hospital resources and equipment;

5. Avoidance of duplication of Hospital resources;

6. Demonstration of population health improvement of the region served according to criteria set forth in the Cooperative Agreement and approved by the Department;

7. The extent to which medically underserved populations have access to and are projected to utilize the proposed services; and 8. Any other benefits that may be identified.

(b) Disadvantages to include:

1. The extent of any likely adverse impact on the ability of health maintenance organizations, preferred provider organizations, managed health care organizations or other healthcare payers to negotiate appropriate payment and service arrangements with Hospitals, physicians, allied healthcare professionals or other healthcare providers;

2. The extent of any reduction in competition among physicians, allied health professionals, other healthcare providers or other persons furnishing goods or services to, or in competition with, hospitals that is likely to result directly or indirectly from the Cooperative Agreement;

3. The extent of any likely adverse impact on (i) patients in the quality and availability of healthcare services and (ii) patients and payers in the price of healthcare 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 Cooperative Agreement.

(3) Ongoing Supervision through the use of an Index tracking demonstration of Public Advantage.

(a) An Index will be created and used for the Department to evaluate the proposed and continuing Public Advantage of the COPA, (b) The Index will include measures of the cognizable benefits and disadvantages in the following categories:

1. Population Health;

2. Access to Health Services;

3. Economic; and 4. Other Cognizable Benefits.

(c) Each category may be comprised of Measures for subcategories of the Index which shall be recommended separately by the Advisory Group and the parties to the Cooperative Agreement for the COPA. The Department retains exclusive authority to add to, modify, or to accept or reject recommendations when creating the Index.

(d) The Department shall establish a baseline score at the outset of the Index composition to allow for the future demonstration of a Public Advantage. Subsequently, established ranges for the score should demonstrate whether:

1. Advantage is clear and convincing; the COPA continues in effect, 2. Advantage is not clear and convincing; a modification to the Cooperative Agreement under the terms of certification will be necessary, 3. Advantage is not evident; COPA is terminated.

(e) Advisory Group 1. Recommendations. The Advisory Group shall recommend to the Commissioner Measures to be considered for inclusion in an Index to objectively track the Public Advantage of a Cooperative Agreement.

2. Meetings. The Advisory Group shall hold at least four (4) meetings with stakeholders to obtain community input and comment, with guidance from the Department.

(i) All meetings shall be open in accordance with T.C.A. §§ 8-44-101 through 8-44-111.

(ii) One (1) meeting shall provide for comment from internal stakeholders, such as persons employed by or agents of the parties to the Cooperative Agreement, its affiliates, contractors or vendors, staff clinicians or other persons deriving income from their activities with any of the parties to the Cooperative Agreement.

(iii) One (1) meeting shall provide for comment from external stakeholders, such as competing health care providers, non-staff clinicians, payers including self-insured employers, governmental agencies, nongovernmental agencies, and other parties who derive income from health or health care services or are who are not employed or affiliated with and do not derive income from the parties to the Cooperative Agreement.

(iv) One (1) meeting shall provide for comment from other members of the community not represented in the internal or external stakeholder groups, including, current or potential patients, customers or other entities who are not affiliated, competing with or otherwise contracting with the parties to the Cooperative Agreement.

(v) The final meeting shall be open to all persons expressing an interest in the Cooperative Agreement and shall be held following the completion of the Advisory Group’s recommendation of Measures to be considered for inclusion in the Index.

(vi) The Advisory Group, in consultation and with the approval of the Department, may elect to alter the number and composition of the meetings previously described.

(vii) The Department may provide guidance to the Advisory Group.

3. Completion of Duties.

(i) The Advisory Group’s service shall conclude when the Department receives the Advisory Group’s recommendation of Measures proposed for inclusion in the Index.

(ii) The Commissioner shall have the authority to convene, change the composition of, dismiss and reconvene the Advisory Group if necessary.

(4) A commitment to pass on or reinvest a portion of cost savings and efficiencies gained through the Cooperative Agreement to the citizens in the affected geographic service area.

(5) Additional conditions of reporting and operations determined by the Department to demonstrate Public Advantage.

History

• Authority: T.C.A. §§ 68-11-1303 and 68-11-1307.
• Administrative History: Emergency rule filed July 14, 2015; effective through January 10, 2016. New rule filed October 6, 2015; effective January 4, 2016. Amendments filed December 10, 2018; effective March 10, 2019.

Tenn. Comp. R. & Regs. 1200-38-01-.04 NOTICE AND HEARING

(1) Prior to acting on an Application for a Certificate, the Department shall hold at least one (1) public hearing which will afford the right to any interested parties to express their views regarding an Application, and may gather additional feedback through other means from the community as needed.

(2) The Department shall give notice of the completed Application to interested parties by publishing a notice in the Tennessee administrative register in accordance with the Uniform Administrative Procedures Act, compiled in Tennessee Code Annotated, title 4, chapter 5.

The notice shall include a brief summary of the requested action, how to access the Application and information concerning the time and place of the public hearing. The notice shall be published at least fifty (50) days prior to the date set for the public hearing.

History

• Authority: T.C.A. § 68-11-1303.
• Administrative History: Emergency rule filed July 14, 2015; effective through January 10, 2016. New rule filed October 6, 2015; effective January 4, 2016.

Tenn. Comp. R. & Regs. 1200-38-01-.05 ISSUANCE AND MAINTENANCE OF COPA

(1) After consultation with and agreement from the Attorney General, the Department shall issue a Certificate for a Cooperative Agreement if it determines the Applicants have demonstrated by clear and convincing evidence 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.

(2) The Department shall grant or deny the Application within one hundred twenty (120) days of the date of filing of the Application. An Application shall not be deemed filed until the Application is complete. The Department shall act promptly to determine whether the Application is complete and may request additional documents or information from the Applicants necessary to make the Application complete. The Department’s decision as to whether the Application should be granted or denied shall be in writing and set forth the basis for the decision. The Department shall furnish a copy of the decision to the Applicants, the Attorney General and any Intervenor. Prior to granting the COPA, the parties and Department will agree upon terms of certification and specific conditions that assure Public Advantage.

(3) The Department shall maintain on file all effective COPAs.

History

• Authority: T.C.A. §§ 68-11-1301 and 68-11-1303.
• Administrative History: Emergency rule filed July 14, 2015; effective through January 10, 2016. New rule filed October 6, 2015; effective January 4, 2016.

Tenn. Comp. R. & Regs. 1200-38-01-.06 ACTIVE SUPERVISION BY TERMS OF CERTIFICATION

(1) The Department shall maintain active supervision in accordance with the terms of certification described in 1200-38-01-.03. The Department shall not be bound by measures, indices or other conditions found outside of the COPA.

(2) Periodic Reports. The Department shall maintain active supervision in addition to requesting COPA holders to submit periodic reports to the Department in a format determined by the Department. The periodic reports shall be filed with the Department on January 1 and July 1 (or the following business day) each year. The reports should include the name, address, telephone number and other contact information for the party responsible for completing future reports who may be contacted by the Department to monitor the implementation of the Cooperative Agreement.

(3) Update Plan of Separation. The parties to the Cooperative Agreement shall update the parties’ Plan of Separation annually and submit the updated Plan of Separation to the Department. The parties shall provide an independent opinion from a qualified organization which states the Plan of Separation can be operationally implemented without undue disruption to essential health services provided by the parties.

(4) Modification of Index. The Department retains the right to modify any Measure, Index or condition under the COPA at any time.

(5) The Department shall conduct a public hearing in the geographic service area where a COPA is in effect at least once every three (3) years to afford the public the opportunity to express their views regarding the operation of the Cooperative Agreement.

(6) Departmental Review. At least annually, the Department shall review such documents necessary to determine compliance with the terms of the COPA and calculate the Index. In addition to any required documents, the parties shall provide the Department with the most recent verifiable values available for those Measures that are included in the Index (except any Measures or factors which the Department itself regularly generates, receives or holds).

(Rule 1200-38-01-.06, continued).

The Department reserves the right to request supplemental information when needed, as determined by the Department.

(7) A Department representative may make periodic onsite inspections of the Certificate Holder’s locations as necessary in regard to compliance with COPA.

(8) Parties to the COPA must timely pay all applicable fees and invoices for initiation and maintenance of the COPA.

(9) The Department shall make public and in writing its determinations of compliance, and the Index score and trends.

(10) Failure to meet any of the terms of the COPA shall result in termination or modification of the COPA.

History

• Authority: T.C.A. § 68-11-1303.
• Administrative History: Emergency rule filed July 14, 2015; effective through January 10, 2016. New rule filed October 6, 2015; effective January 4, 2016. Amendments filed December 10, 2018; effective March 10, 2019.

Tenn. Comp. R. & Regs. 1200-38-01-.07 MODIFICATION/TERMINATION/ENFORCEMENT

(1) If the Department determines that the benefits no longer outweigh the disadvantages by clear and convincing evidence, the Department may first seek modification of the Cooperative Agreement with the consent of the parties.

(2) If modification is not obtained, the Department may terminate the COPA by written notice to the Certificate Holder and the Certificate Holder may appeal in the same manner as if the COPA were denied.

(3) The COPA shall remain in effect until such time as the Certificate Holder has submitted, the Department has approved and the Certificate Holder has completed the Plan of Separation.

(4) Voluntary Termination. The Certificate Holder shall notify the Department forty-five (45) days prior to voluntary termination of the Cooperative Agreement.

History

• Authority: T.C.A. §§ 68-11-1303 and 68-11-1306.
• Administrative History: Emergency rule filed July 14, 2015; effective through January 10, 2016. New rule filed October 6, 2015; effective January 4, 2016. Amendments filed December 10, 2018; effective March 10, 2019.

Tenn. Comp. R. & Regs. 1200-38-01-.08 HEARING AND APPEALS

(1) Applicant or Certificate Holder. Any Applicant or Certificate Holder aggrieved by a decision of the Department denying an Application, refusing to act on an Application or terminating a Certificate is entitled to judicial review of the Department’s decision by the chancery court of Davidson County, as specified in T.C.A. 68-11-1303.

(2) Intervenor. An Intervenor aggrieved by a decision of the Department to grant or deny the Application shall have the right to appeal the Department’s decision, except that there shall be no stay of the Department’s decision granting an Application unless the chancery court of Davidson County shall have issued a stay of the Department’s decision in accordance with § 68-11-1304, which shall be accompanied by an appeal bond from the Intervenor. If the Intervenor shall appeal the Department’s decision and the appeal is unsuccessful, the Intervenor shall be responsible for the costs of the appeal and attorneys’ fees of the Applicants.

History

• Authority: T.C.A. § 68-11-1303.
• Administrative History: Emergency rule filed July 14, 2015; effective through January 10, 2016. New rule filed October 6, 2015; effective January 4, 2016.