Background Check Requirements for Home Care Workers in Tennessee

Employee screening statute. Tenn. Code Ann. § 68-11-233 requires home care organizations providing home health or hospice services to run a criminal background check on every applicant for a paid direct-care position before hire — either fingerprints for a TBI/FBI check or a professional background screening organization, service, or registry covering the applicant's states of residence for the past 7 years. (The similar § 68-11-256 covers nursing homes and assisted-care living facilities, not home care organizations.) Source ↗

Registry screening. Regardless of the criminal check path, employers must screen the Tennessee Abuse Registry, the Tennessee and national sex offender registries, the OIG exclusion list, and the Tennessee felony offender database before hire. Source ↗

Abuse registry bar. Placement on the Tennessee Abuse Registry (substantiated abuse, neglect, or misappropriation) is an absolute bar to employment in direct care positions statewide. Source ↗

Personal support services. Non-medical personal support services agencies are licensed separately under Title 33, and Tenn. Code Ann. § 33-2-421 requires a criminal background check and reference check on personal support services workers before they provide services. Source ↗

No universal federal mandate. There is no federal law requiring criminal background checks for private-pay home care workers; requirements are set state by state. HHS OIG found wide variation in state home health background check requirements, and Medicare Conditions of Participation for home health agencies defer to state law on screening. Source ↗

National Background Check Program (ACA Section 6201). Section 6201 of the Affordable Care Act created the CMS National Background Check Program, which awarded grants to more than 25 states to build fingerprint-based, comprehensive background check systems for direct patient access employees of long-term care providers, including home health agencies and personal care providers. Source ↗

FCRA obligations. When an agency uses a consumer reporting agency (third-party background check vendor), the federal Fair Credit Reporting Act requires a standalone written disclosure, the applicant's written authorization, and the pre-adverse action / adverse action notice process (copy of the report and Summary of Rights) before rejecting a candidate based on the report. Source ↗

OIG exclusion list (LEIE). Home care providers that bill Medicare or Medicaid must not employ or contract with individuals excluded from federal health care programs. HHS OIG maintains the List of Excluded Individuals/Entities (LEIE); CMS and state Medicaid agencies expect screening at hire and monthly thereafter, and payments tied to excluded persons are subject to recovery and civil monetary penalties. Source ↗