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TN Rule 0940-05-38

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TN Rule 0940-05-38 Minimum Program Requirements for Personal Support Services Agencies

Jurisdiction: TN Agency: Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS)
IDD_COMMUNITY (60%) OUTPATIENT (40%)
Plain-English summary

This regulation establishes minimum program requirements for Personal Support Services Agencies licensed by the Tennessee Department of Mental Health and Substance Abuse Services. It governs agencies that provide in-home assistance (self-care, household tasks, community access, and education services) to individuals with chronic conditions, disabilities, or acute illness who do not require nursing-level care. Operators must maintain written policies and procedures covering governance, personnel, confidentiality, medication assistance, emergency planning, abuse reporting, and service recipient rights. Agencies serving a majority population with mental illness or substance abuse must obtain licensure from TDMHSAS, while those serving primarily individuals with developmental/intellectual disabilities license through the Department of Intellectual and Developmental Disabilities.

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Regulation text
December, 2022 (Revised) 1 
RULES 
OF 
THE TENNESSEE DEPARTMENT OF MENTAL HEALTH 
AND SUBSTANCE ABUSE SERVICES 
OFFICE OF LICENSURE 
 
CHAPTER 0940-05-38 
MINIMUM PROGRAM REQUIREMENTS FOR PERSONAL SUPPORT 
SERVICES AGENCIES 
 
TABLE OF CONTENTS 
 
0940-05-38-.01 Definitions 0940-05-38-.07 Personnel Requirements 
0940-05-38-.02 Application of Rules 0940-05-38-.08 Standardized Training and Continuing 
0940-05-38-.03 Scope of Personal Support Services Agencies Education Requirements 
0940-05-38-.04 Application 0940-05-38-.09 Service Recipient Record Requirements 
0940-05-38-.05 Governance Requirements 0940-05-38-.10 Service Recipient Rights 
0940-05-38-.06 Policies and Procedures 
 
0940-05-38-.01 DEFINITIONS. 
 
(1) “Personal Support Services” means one (1) or more of the following services provided to a 
service recipient, as defined in 0940- 05-38-.01(2), in the individual’s permanent or temporary 
residence. 
 
(a) Self-care assistance with tasks such as eating, dressing, toileting, bathing, mobility, 
transfer assistance and other services and supports to maintain health and wellness; 
 
(b) Household assistance with tasks such as housekeeping, laundry, meal planning, meal 
preparation, shopping, bill paying, and use of telecommunication devices; 
 
(c) Personal assistance to service recipients to access community act ivities such as 
transportation, social, recreational or other personal activities; and/or 
 
(d) Education services. 
 
(2) “Service Recipient” means an individual who: 
 
(a) Has substantial limitations in two (2) or more major life activities because of a chronic 
condition, acute episode of illness or injury, age, physical or other disability; 
 
(b) Receives services in either a permanent or temporary residence; and 
 
(c) Depends on personal support services to perform major life activities, but does not 
require nursing level services to be provided in connection with an acute episode of 
illness or injury. 
 
(3) “Personal Support Services Agency” or “Agency” means a sole proprietorship (someone who 
owns an unincorporated business by himself or herself), partnership, corporation, limited 
liability company or limited liability partnership providing personal support services. Agency 
includes all entities that employ or subcontract with individuals who provide personal support 
services to service recipients. 
 
(4) “Personal Support Services Worker” (or “Worker”) means a person licensed as a personal 
support services agency, or an employee or an individual subcontracted by a personal 
support services agency who is providing personal support services under an ar rangement 
between a service recipient and a personal support services agency. 
MINIMUM PROGRAM REQUIREMENTS FOR PERSONAL SUPPORT CHAPTER 0940-05-38 
SERVICES AGENCIES 
 
(Rule 0940-05-38-.01, continued) 
December, 2022 (Revised) 2 
 
(5) “Chronic Condition” means a mental and/or physical impairment that is expected to last 
indefinitely. 
 
(6) “Education Services” means consultation provided by a registered nurse to the s ervice 
recipient or primary family caregiver concerning a chronic condition. 
 
(7) “Hold Out to the Public” means asserting expertise and availability through advertising, public 
notice, self-promotion, etc. 
 
(8) “Major Life Activities” means: 
 
(a) Self-care; 
 
(b) Receptive and expressive language; 
 
(c) Learning; 
 
(d) Mobility; 
 
(e) Self-direction; 
 
(f) Capacity for independent living; or 
 
(g) Economic self-sufficiency. 
 
(9) “Medication Assistance” means providing medication reminders and opening medication 
packaging, but does not mean giving the service recipient injections or any form of 
medication or medication administration that would only be appropriate and acceptable for 
persons who are authorized to do so by Title 63, Chapter 7. Medication assistance includes, 
but is not limited to, any of the following: 
 
(a) Loosening the cap on a pill bottle for oral medication; 
 
(b) Opening pill reminder box if the box is filled by the service recipient or authorized 
representative or licensed medical personnel prac ticing within the scope of their 
license; 
 
(c) Placing medication within reach of the service recipient; 
 
(d) Holding a service recipient’s hand steady to help them with drinking liquid medication; 
 
(e) Guiding the service recipient’s hand when the individual is applying eye/ear/nose drops 
and wiping the excess liquid; 
 
(f) Helping with a nasal cannula or mask for oxygen, plugging the machine in and turning 
it on; 
 
(g) Applying non-prescription cream and lotions purchased over -the-counter to ext ernal 
parts of the body. 
 
(10) “Self- administration of Medication” means the ability of a service recipient to take prescribed 
or over-the-counter medications without assistance from another person. 
 
MINIMUM PROGRAM REQUIREMENTS FOR PERSONAL SUPPORT CHAPTER 0940-05-38 
SERVICES AGENCIES 
 
(Rule 0940-05-38-.01, continued) 
December, 2022 (Revised) 3 
(11) “Written” means, as applied to licensee’s records , any genera lly accepted format, including 
electronic or paper, used for retaining business or client records. 
 
Authority: T.C.A. §§ 4- 4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, and 33- 2-
407. Administrative History: Original rule filed July 21, 2004; effective November 26, 2004. Repeal and 
new rule filed November 20, 2009; effective February 18, 2010. Repeal and new rule filed March 4, 2016; 
effective June 2, 2016. 
 
0940-05-38-.02 APPLICATION OF RULES. 
 
(1) The licensee providing personal suppor t services shall comply with and provide services that 
comply with the following rules: 
 
(a) Chapter 0940-05-02 Licensure Administration and Procedures; 
 
(b) Chapter 0940-05-38 Minimum Program Requirements for Personal Support Services 
Agencies; and 
 
(c) Chapter 0940-05-06-.03(1)-(6) Minimum Program Requirements for All Facilities -
Financial Management of All Facilities. 
 
Authority: T.C.A. §§ 4- 4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, and 33- 2-
407. Administrative History: Original rule filed July 21, 2004; effective November 26, 2004. Repeal and 
new rule filed November 20, 2009; effective February 18, 2010. Repeal and new rule filed March 4, 2016; 
effective June 2, 2016.

0940-05-38-.03 SCOPE OF PERSONAL SUPPORT SERVICES AGENCIES. 
 
(1) These rules apply to all agencies or personal support services workers who provide personal 
support services in the permanent or temporary residence of service recipients who meet the 
criteria specified in Rule 0940-05-38-.01(2). 
 
(2) The following are exempt from licensure under this chapter: 
 
(a) A person who provides personal support services to only one (1) service recipient and 
who is not in a business arrangement to provide personal support services to any other 
service recipient. Thi s exception sha ll not apply to an individual who holds themselves 
out to the public as being in the business of personal support services for 
compensation; 
 
(b) A person who provides personal support services only to members of the individual’s 
own family; 
 
(c) A person who provides only housekeeping services to a service recipient and no other 
assistance with major life activities; 
 
(d) A person who provides only transportation services and no other assistance with major 
life activities; 
 
(e) A person who provides services in homeless shelters; 
 
(f) A person who provides only delivery services, such as dry -cleaning, food, medication 
delivery, or medical equipment; and 
 
MINIMUM PROGRAM REQUIREMENTS FOR PERSONAL SUPPORT CHAPTER 0940-05-38 
SERVICES AGENCIES 
 
(Rule 0940-05-38-.03, continued) 
December, 2022 (Revised) 4 
(g) Home care organizations licensed under T.C.A., Title 68, Chapter 11, Part 2 as a home 
care organization. 
 
Authority: T.C.A. §§ 4- 4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, and 33- 2-
407. Administrative History: Original rule filed July 21, 2004; effective November 26, 2004. Repeal and 
new rule filed November 20, 2009; effective February 18, 2010. Repeal and new rules filed March 4, 
2016; effective June 2, 2016. 
 
0940-05-38-.04 APPLICATION. 
 
(1) To provide personal support services, an agency needs a license from either the Department 
of Mental Health and Substance Abuse Services or the Department of Intellectual and 
Developmental Disabilities. 
 
(2) An agency licensed by either Department may provide personal support services to 
individuals with physical or other disabilities. 
 
(3) An agency seeking an initial license as a personal support service agency must submit a 
written attestation at the time of application acknowledging the categorization of the majority 
of its client population base, as described in (a) and (b) below. The written attestation shall be 
on a form developed by the department to whom application for a license is made. 
 
(a) An agency with 50% or more of its client base being aged and/or having a diagnosis of 
mental illness and/or substance abuse should obtain a license from the Department of 
Mental Health and Substance Abuse Services. 
 
(b) An agency with 50% or more of its client base having a diagnosis of developmental 
disability or intellectual disability should obtain a license from the Department of 
Intellectual and Developmental Disabilities. 
 
(4) After July 1, 2 016, any agency seeking renewal of a personal support services license need 
only make application with the department that licenses 50% or more of its client base, as 
described in sections (3)(a) and (b) above. The renewing agency shall sub mit with the 
renewal application a written attestation acknowledging the categorization of the majority of 
its client population base. 
 
(5) No license shall be issued until the appropriate fee or fees are submitted by the agency 
seeking an initial or renew al license, as s et forth in Rule 0940- 05-02-.05. All fees submitted 
are non-refundable. 
 
(6) The agency should submit to the licensing department a list of the counties in which they 
provide services and the address at which the agency maintains its employ ee and service 
recipient records. 
 
Authority: T.C.A. §§ 4- 4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, and 33- 2-
407. Administrative History: Original rule filed July 21, 2004; effective November 26, 2004. Repeal and 
new rule filed Nov ember 20, 2009; effective February 18, 2010. Repeal and new rules filed March 4, 
2016; effective June 2, 2016. 
 
0940-05-38-.05 GOVERNANCE REQUIREMENTS. 
 
(1) The licensee shall comply with all federal, state, and local laws, ordinances, rules and 
regulations. 
 
MINIMUM PROGRAM REQUIREMENTS FOR PERSONAL SUPPORT CHAPTER 0940-05-38 
SERVICES AGENCIES 
 
(Rule 0940-05-38-.05, continued) 
December, 2022 (Revised) 5 
(2) The licensee shall ensure that the agency is administered and operated in accordance with 
written policies and procedures including, but not limited to, those specified in Rule 0940- 05-
38-.06. 
 
(3) The licensee shall exercise general direction over the agency and establish policies 
governing the operation of the agency and the welfare of service recipients. 
 
(4) The licensee shall designate an individual responsible for the operation of the agency. 
 
(5) The licensee shall ensure that the licensed agency serves onl y service recipients who will not 
cause the agency to violate its licensed status based on the distinct licensure category. 
 
Authority: T.C.A. §§ 4- 4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, and 33- 2-
407. Administrative History: Original rule filed July 21, 2004; effective November 26, 2004. Repeal and 
new rule filed November 20, 2009; effective February 18, 2010. Repeal and new rules filed March 4, 
2016; effective June 2, 2016. 
 
0940-05-38-.06 POLICIES AND PROCEDURES. 
 
(1) The licensee shall maintain written policies and procedures that include the following: 
 
(a) A description of services provided by the licensee. The description shall include 
enrollment and termination criteria; 
 
(b) An organizational chart which clearly shows or describes the lines of authority; 
 
(c) A policy and procedure which outlines the plan of action to be followed when the 
personal support worker is absent including, but not limited to, notice to the service 
recipient, the action that shall be taken, and the timeframes for action; 
 
(d) A schedule of fees when applicable; 
 
(e) A statement of service recipient rights as listed in 0940- 05-38-.10 and the grievance 
procedures to be followed when a suspected violation of rights has been reported; 
 
(f) A policy which ensures the confidentiality of service recipients’ information and which 
includes the following provisions: 
 
1. The licensee’s personal support services workers shall comply with applicable 
confidentiality laws and regulations; 
 
2. The service recipient shall not be required to make public statements which 
acknowledge gratitude to the licensee or for the licensee’s services; and 
 
3. Identifiable photographs of service recipients shall not be used without the written 
and signed consent of the individual or the individual’s legal guardian and/or 
conservator. 
 
(g) The plans and procedures to be followed in the event of an emergency including, but 
not limited to, fire evacuation and natural disaster emergencies; 
 
(h) Policy and procedures to be followed in the reporting and investigation of suspected or 
alleged abuse or neglect of a service recipient, or other critical incidents. The 
procedures shall include provisions for corrective action, if any, to be taken as a result 
MINIMUM PROGRAM REQUIREMENTS FOR PERSONAL SUPPORT CHAPTER 0940-05-38 
SERVICES AGENCIES 
 
(Rule 0940-05-38-.06, continued) 
December, 2022 (Revised) 6 
of such reporting and investigation, a nd reporting to the department’s Office of 
Licensure and to any authority as required by law; 
 
(i) Requirement that personal support services workers comply with procedures for 
detection and prevention of communicable diseases according to procedures of the 
Tennessee Department of Health; 
 
(j) Receipt and disbursement of money on behalf of service recipients; 
 
(k) Access by department licensure staff to personal support services workers to discuss 
investigation of any service provided under this chapter; 
 
(l) Procedures to be followed if a worker will be providing medication assistance if the 
licensee provides that service. Written policy shall minimally include the following 
elements: 
 
1. Medication assistance shall be provided only after written authorizat ion has been 
obtained from the service recipient or the service recipient’s authorized 
representative. 
 
2. Medication assistance training shall be provided to personal support services 
workers prior to providing ass istance and training shall be documented in the 
personal support service worker’s record. 
 
3. Personal support workers shall have procedures for collecting information about 
medications taken by service recipients. 
 
(m) Polices to ensure that licensees or personal support services workers providi ng 
transportation to service recipients meet the following requirements: 
 
1. All vehicles shall be maintained and operated in a safe manner; 
 
2. All licensees or personal support services workers providing transport ation shall 
possess an appropriate driver ’s license from the Tennessee Department of 
Safety and documentation of such license shall be maintained in the licensee’s 
records; and 
 
3. All vehicles used for service recipient transportation and owned by the lic ensee 
or personal support services worker shall be adequately covered by vehicular 
liability insurance for personal injury to occupants of the vehicle, and 
documentation of such insurance shall be maintained in the facility’s records. 
 
(n) Polices to address use of devices such as a hoyer lift or gait belt, after training, to 
assist the service recipient in getting out of or into bed, a chair, toilet or shower but not 
as part of a therapeutic regimen. 
 
(o) Polices to address categorization of the majority ( over fifty -percent (50%)) of the 
agency’s client population base. 
 
(p) Policy that the agency will cooperate with the department when investigating any case 
of alleged abuse, neglect, mistreatment, misappropriation or exploitation of a service 
recipient. 
 
(q) Policy that an alternate plan for staffing will be prepared in case of absence or the 
assigned personal support services worker. 
MINIMUM PROGRAM REQUIREMENTS FOR PERSONAL SUPPORT CHAPTER 0940-05-38 
SERVICES AGENCIES 
 
(Rule 0940-05-38-.06, continued) 
December, 2022 (Revised) 7 
 
Authority: T.C.A. §§ 4- 4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, and 33- 2-
407. Administrative History: Original rule filed July 21, 2004; effective November 26, 2004. Repeal and 
new rule filed November 20, 2009; effective February 18, 2010. Repeal and new rules filed March 4, 
2016; effective June 2, 2016. 
 
0940-05-38-.07 PERSONNEL REQUIREMENTS. 
 
(1) The licensee shall maintain a personnel file for each personal support services worker with 
the following information: 
 
(a) A written, signed and dated job description including the employment requirements and 
job responsibilities for each staff position held; 
 
(b) Verification that the worker meets the respective employment requirements for each 
position held; 
 
(c) Evidence of a criminal background check, as required by T.C.A. § 33-2-1202. 
 
(d) Evidence that the worker’s stat us on the Tennessee registry of persons who have 
abused, neglected or misappropriated the property of vulnerable individuals (“Abuse 
Registry”) maintained by the Department of Health, has been checked pursuant to 
T.C.A. § 68-11-1004(b). No employee or volunteer who is listed on the Abuse Registry 
may be hired or otherwise permitted to provider services; 
 
(e) Evidence of the worker’s status on the state’s sexual offender registry. No individual or 
volunteer who is listed on the state’s sexual offender regist ry may be hired or otherwise 
permitted to provide services; 
 
(f) The worker’s date of birth; 
 
(g) Annual performance evaluation reports evaluating, at a minimum, the ability of personal 
support services workers to provide daily supports to service recipients; 
 
(h) A worker notice that outlines the general relationship betwe en an agency and the 
personal support services worker that includes the following: 
 
1. The status of the personal support services agency as an employer or contractor 
of services; 
 
2. The responsibility of the personal support services agency for the payment of the 
personal support services worker’s wages, taxes, social security, workers 
compensation and unemployment compensation payments, and overtime pay for 
hours worked in excess of forty (40) hours in a week; and 
 
3. Duties, responsibilities, obligations and legal liabilities of the agency and the 
service recipient including, but not limited to, insurance and personnel 
management. 
 
(i) The personal support service worker’s work history containing a continuous description 
of activities over the past five (5) years; and 
 
(j) Personal references from at least three (3) individuals, one of whom shall have known 
the personal support service worker/applicant for at least five (5) years. 
 
MINIMUM PROGRAM REQUIREMENTS FOR PERSONAL SUPPORT CHAPTER 0940-05-38 
SERVICES AGENCIES 
 
(Rule 0940-05-38-.07, continued) 
December, 2022 (Revised) 8 
(2) The licensee shall have written personnel policies. The personnel poli cies shall, at a 
minimum address the following: 
 
(a) That all personal support services workers shall be eighteen (18) years of age or older; 
 
(b) That all personal support services work ers shall practice infection control procedures 
and standard precautio ns that will protect the service recipient from infectious 
diseases; 
 
(c) That all personal support services workers shall submit to a criminal background check 
every two (2) years or wi thin ten (10) days of employment or within ten (10) days of a 
change of responsibilities that includes direct contact with or direct responsibility for 
service recipients, as required by T.C.A. § 33-2-1202; 
 
(d) That evidence of the status of every persona l support services worker on the 
Tennessee registry of persons who hav e abused, neglected or misappropriated the 
property of vulnerable individuals (“Abuse Registry”) maintained by the Department of 
Health shall be checked annually and prior to direct cont act with service recipients. No 
employee or volunteer who is listed on the Abuse Registry may be hired or otherwise 
permitted to provider services; 
 
(e) That evidence of the status of every personal support services worker on the 
Tennessee Sexual Offender Registry shall be checked annually and prior to direct 
contact with service recipients; 
 
(f) That the personal support services worker shall demonstrate the following prior to 
providing personal support services: 
 
1. Language skills sufficient to read and understand instructions; prepare and 
maintain written reports and records; 
 
2. Language skills sufficient to communicate with the service recipient; and 
 
3. Documented training specific to meeting individual service recipient needs in the 
area of self -care, household management and community living, and 
methodologies for service delivery. 
 
(g) That personal support services workers shall have access to consultation for any of the 
services provided under this chapter. Consultation may include providing the personal 
support service worker access to or consultation with a regist ered nurse, other agency 
staff or the primary family caregiver to assist the staff in providing personal support 
services; and 
 
(h) That the personal support service worker shall neither borrow, receive nor take funds 
or other personal property from the service recipient. 
 
(3) The licensee shall have proof of liability insurance coverage for the agency, workers and 
others who provide personal support services. 
 
(4) The licensee shall maintain a current roster of all personal support workers at all times 
including workers kept on an on-call or back-up basis. 
 
Authority: T.C.A. §§ 4- 4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, and 33- 2-
407. Administrative History: Original rule filed July 21, 2004 ; effective November 26, 2004. Repeal and 
MINIMUM PROGRAM REQUIREMENTS FOR PERSONAL SUPPORT CHAPTER 0940-05-38 
SERVICES AGENCIES 
 
(Rule 0940-05-38-.07, continued) 
December, 2022 (Revised) 9 
new rule filed November 20, 2009; effective February 18, 2010. Repeal and new rules filed March 4, 
2016; effective June 2, 2016. 
 
0940-05-38-.08 STANDARDIZED TRAINING AND CONTINUING EDUCATION REQUIREMENTS. 
 
(1) The licensee shall ensure and document that: 
 
(a) Individuals who provide personal support services demonstrate basic competency in 
the following skill/knowledge areas prior to beginning work with service recipients: 
 
1. Observing, reporting and documenting changes in service recipient’s daily liv ing 
skills; 
 
2. Abuse, neglect, exploitation, detection, reporting and prevention; 
 
3. Service recipient rights; 
 
4. Universal health precautions, including infection control; 
 
5. How to assist service recipients with personal hygiene; 
 
6. Service recipient safety; and 
 
7. Procedures to be followed in the event of an emergency or disaster that at least 
includes emergency transportation, emergency medical care and staff coverage 
in such events; 
 
(b) Individuals who provide medication assistance receive docum ented training in 
medication assistance performed by, or under the general supervision of, a registered 
nurse and consistent with T.C.A. § 63-7-102; 
 
(c) Individuals who provide personal support services receive training on job related topics 
at least annually; and 
 
(d) Documented training specific to meeting individual service recipient needs in the areas 
of self -care, household management and co mmunity living, and methodologies for 
service delivery. 
 
Authority: T.C.A. §§ 4 -4-103, 33- 1-302, 33- 1-305, 33- 1-309, 33- 2-301, 33- 2-302, 33- 2-404, and 33- 2-
407. Administrative History: Original rule filed November 20, 2009; effective February 18, 2010. Repeal 
and new rules filed March 4, 2016; effective June 2, 2016. 
 
0940-05-38-.09 SERVICE RECIPIENT RECORD REQUIREMENTS. 
 
(1) The licensee shall ensure that each service recipient’s record includes at least the following 
information: 
 
(a) Name, address, telephone number, gender, and date of birth; 
 
(b) Date of service enrollment; 
 
(c) Name, address, and telephone number of an emergency contact person; 
 
(d) Written fee agreement. If the licensee charges fees for personal support services, a 
written agreement dated and signed by the service recipient or the service recipient’s 
MINIMUM PROGRAM REQUIREMENTS FOR PERSONAL SUPPORT CHAPTER 0940-05-38 
SERVICES AGENCIES 
 
(Rule 0940-05-38-.09, continued) 
December, 2022 (Revised) 10 
legal representative (conservator, parent, guardian or legal custodian) or person paying 
for services prior to the provision of services. The written agreement shall include at 
least the following information: 
 
1. The fee or fees to be paid by the service recipient; 
 
2. The services covered by such fees; and 
 
3. Any additional charges for services not covered by the basic service fee. 
 
(e) Written acknowledgement that the service recipient or service recipient’s legal 
representative (conservator, parent, guardian or legal custodian) has been informed of 
the service recipient’s rights and responsibilities and the agency’s general rules 
affecting the service recipients; 
 
(f) A written service plan based on a needs assessment which indicates type, frequency, 
duration, and amount of personal support servi ces provided to assist the service 
recipient in performing major life duties. 
 
(g) Consent for services by the service recipient or service recipient’s legal representative 
(conservator, parent, guardian, or legal custodia n), surrogate decision maker under 
T.C.A. § 33-3-219 or attorney-in-fact under a durable power of attorney for health care, 
when applicable; 
 
(h) If applicable, address, phone number or e- mail address to reach the service recipient’s 
legal representative ( conservator, parent, guardian or l egal custodian) or surrogate 
decision maker under T.C.A. § 33- 3-219 or attorney -in-fact under a durable power of 
attorney for health care; 
 
(i) Documentation of party responsible for payment of services; 
 
(j) A record of services actually delivered with dates and times documented; 
 
(k) Documentation of medical problems, illnesses and treatments, accidents, seizures, 
adverse incidents and follow-up, while the service recipient receives services; 
 
(l) Documentation of all funds received and disbursed on behalf of the service recipient; 
 
(m) An alternate plan for staffing in case of absence of the personal support services 
worker; 
 
(n) Written authorization by the service recipient or the service recipient’s authorized 
representative if the agency is providing medication assistance; 
 
(o) Written documentation that the service recipient has evaluated the quality of personal 
support services provided at least semi -annually. Each agency shall develop an 
evaluation form for the service recipient, or legal representative of the service recipient, 
to fill out and sign to acknowledge this requirement has occurred; 
 
(p) A written consumer notice outlining general service responsibilities as well as general 
notification of the agency’s responsibilities as an employer or c ontractor provided to 
service recipients before beginning service, which shall include, at a minimum the 
duties, responsibilities, obligations and legal liabilities of the personal support services 
agency; the personal support services worker; and the serv ice recipient. The 
MINIMUM PROGRAM REQUIREMENTS FOR PERSONAL SUPPORT CHAPTER 0940-05-38 
SERVICES AGENCIES 
 
(Rule 0940-05-38-.09, continued) 
December, 2022 (Revised) 11 
description shall clearly set forth the service recipient’s responsibility, if any, for the 
following: 
 
1. Day to day supervision of the personal support services worker; 
 
2. Assigning duties to the personal support services worker; 
 
3. Hiring, firing and discipline of the personal support services worker; 
 
4. Provision of equipment or materials for use by the personal support services 
worker; 
 
5. Performing a criminal background check on the personal support services 
worker; 
 
6. Checking the personal support services worker’s references; and 
 
7. Ensuring credentials and appropriate licensure/certification of a personal support 
services worker; and 
 
(q) Copy of legal document granting another individual or corporation authority to act as 
the service recipient’s legal representative/conservator/power of attorney/durable 
power of attorney for health care/mental health care. 
 
Authority: T.C.A. §§ 4 -4-103, 33- 1-302, 33- 1-305, 33- 1-309, 33- 2-301, 33- 2-302, 33- 2-404, and 33- 2-
407. Administrative History: Original rule filed November 20, 2009; effective February 18, 2010. Repeal 
and new rule filed March 4, 2016; effective June 2, 2016. 
 
0940-05-38-.10 SERVICE RECIPIENT RIGHTS. 
 
(1) The following rights shall be afforded to all individuals receivi ng personal support services 
from the licensee: 
 
(a) Service recipients have the right to be fully informed before the initiation of services 
about their rights and responsibilities and about any limitation on these rights imposed 
by the rules of the licensee. The licensee shall ensure that the service recipient is given 
oral and/or written rights information that includes at least the following: 
 
1. A statement of the specific rights guaranteed the service recipient by these rules 
and applicable state laws; 
 
2. A description of the licensee’s grievance procedures; 
 
3. A listing of available advocacy services; and 
 
4. A copy of all agency rules and regulations pertinent to the service recipient. The 
information shall be pres ented in a manner that promoted understanding by the 
service recipient of his or her rights, and the individual shall be given an 
opportunity to ask questions about the information. If the service recipient is 
unable to understand the information at the time of admission to service but lat er 
becomes able to do so, the information shall be presented to the service 
recipient at that time. If the service recipient is likely to continue indefinitely to be 
unable to understand the information, the licensee shall promptly attempt to 
provide the r equired information to a guardian or other appropriate person or an 
agency responsible for protecting the service recipients’ rights. 
MINIMUM PROGRAM REQUIREMENTS FOR PERSONAL SUPPORT CHAPTER 0940-05-38 
SERVICES AGENCIES 
 
(Rule 0940-05-38-.10, continued) 
December, 2022 (Revised) 12 
 
(b) Service recipients have the right to voice grievances to the licensee and to outside 
representatives of their choice with freedom from restraint, interference, coercion, 
discrimination, or reprisal; 
 
(c) Service recipients have the right to be treated with consideration, respect and full 
recognition of their dignity, and individuality; 
 
(d) Service recipients have the right to be protected by the licensee from neglect, physical, 
verbal, and emotional abuse (including corporal punishment), and from all forms of 
misappropriation and/or exploitation; and 
 
(e) Service recipients have the right to be assisted by the licensee i n the exercise of their 
civil rights. 
 
Authority: T.C.A. §§ 4 -4-103, 33- 1-302, 33- 1-305, 33- 1-309, 33- 2-301, 33- 2-302, 33- 2-404, and 33- 2-
407. Administrative History: Original rule filed November 20, 2009; effective February 18, 2010. Repeal 
and new rules filed March 4, 2016; effective June 2, 2016.