Tennessee

The grounds, as Tennessee describes them

TennCare's prescribed notice form lists the grounds as options a nursing home selects, in the second person and in plain words, under "Reason for Discharge or Transfer: (select an option from the below list)":

1. "You did not pay your bill from the nursing home. The nursing home told you this. And the nursing home gave you time to pay."

2. "The nursing home is closing."

3. "The nursing home says it cannot care for you. Your needs are too high."*

4. "You got better. And you do not need care in a nursing home now."*

5. "You make the nursing home unsafe for other people."*

6. "You may endanger the health of other people in the nursing home."*

The asterisked footnote on the form states the condition attached to four of the six: "A doctor must agree if the nursing home checks this box. The doctor must also sign the third page. Or the nursing home must attach the doctor’s written order. This could be your doctor – or the doctor at the nursing home. Or it could be a nurse practitioner or physician assistant who works for one of these doctors."

The Department of Health's nursing home rule states a related duty rather than a seventh ground: where "the attending physician has ordered a resident transferred or discharged, but the resident or a representative of the resident opposes the action, the nursing home shall counsel with the resident, the next of kin, sponsor and representative, if any, in an attempt to resolve the dispute and shall not transfer the resident until such counseling has been provided."

The published process

Requesting the hearing

TennCare's notice states the route: "If you want to appeal, call 1-833-582-1224. Or fax your appeal to 615-734-5317. Or email cd.appeals.tenncare@tn.gov. Or write to TennCare’s Office of General Counsel, ATTN: Involuntary NF Discharge Appeals, 310 Great Circle Road, Nashville, TN 37243. Make sure to send a copy of these pages." The notice's own distribution block, printed later on the same form, gives a second address for the same office: "TennCare’s Commissioner’s Designee at Large ATTN: Involuntary Discharge Appeals- NF 310 Great Circle Road- 3W, Nashville, TN 37243 P: 833-582-1224 Fax: 615-734-5317 Email: cd.appeals.tenncare@tn.gov". Both are quoted; the discrepancy in the office's own name and suite number is not reconciled.

On timing and pendency, the notice states: "If you appeal within 30 days, the nursing home usually cannot make you move until you get a decision. The 30 days starts on the day you got this page. But, if you do not appeal within 30 days, you must move by the proposed date on the first page." TennCare's appeals page states that on a timely appeal "a contested case hearing will be held and a written decision will be issued on the involuntary discharge."

The notice's required contents

The notice form itself states who must receive it: "To the Nursing Home: This notice is for an involuntary discharge or transfer. Fill out this notice for the resident you want to move. Give these pages to the resident and to his or her representative. Also, send these pages to the TennCare Commissioner’s Designee, State Long Term Care (“LTC”) Ombudsman, and the District LTC Ombudsman." Its fields require the resident's name and Medicaid ID, the representative's name, phone, and address, the name, phone, and address of the place the resident is going, the current nursing home's name, address, and contact person, the date the nursing home provided notice, and the date the nursing home wants to move the resident. It requires a stated reason, selected from the list in section 01, and states: "To the Resident: The nursing home must tell you why they want you to move." It requires the appeal-rights text quoted above under "You Can Get Help", and the Long-Term Care Ombudsman's contact quoted in the docket. The form's own transmission block, headed "Notice given by the Nursing Home to:", lists the notice's recipients each with its own date line: "Resident", "Resident’s Representative", "Resident Clinical Record", "District LTC Ombudsman", "State LTC Ombudsman", "TennCare Commissioner’s Designee", and "Health Facilities Commission".

The Department of Health's rule adds a documentation duty distinct from the notice's own contents: "No resident shall be 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." Where an involuntary transfer is proposed, "the following factors shall be taken into account": "The traumatic effect on the resident." "The proximity of the proposed nursing home to the present nursing home and to the family and friends of the resident." "The availability of necessary medical and social services at the proposed nursing home." "Compliance by the proposed nursing home with all applicable Federal and State regulations."

Bed-hold and return

TennCare's own reimbursement rule states the whole of what was found: "1200-13-02-.16 BED HOLDS. Effective July 1, 2018, Medicaid bed hold days will no longer be reimbursed." No first-party source reviewed states a bed-hold period, a notice a facility must give of one, or a readmission or first-available-bed provision following a hospital stay or therapeutic leave; TennCare's Medicaid nursing facility reimbursement rules (chapter 1200-13-02) and the Department of Health's nursing home standards (chapter 1200-08-06) were the two searched, and neither states either. The absence is stated at that scope rather than filled from federal law.

The three rows above hoist the questions a facility's counsel answers in the first fifteen minutes. They are quotations from Tennessee's published sources, not a determination that any of them applies to any situation.

Notice periods and deadlines, as stated in the sources

All quoted; none calculated.

Thirty days' notice before the move — TennCare's notice: "A nursing home can move a resident 30 days after it gives this Notice to the resident, unless an appeal is pending. The nursing home can move a resident before then if an exception applies. But the nursing home must document the exception."

Five business days before an involuntary move, after the department and ombudsman are informed — the Department of Health's rule: "No involuntary transfer or discharge shall be made until the nursing home has first informed the department and the area long-term care ombudsman." Absent a disaster or a physician's emergency order, "no involuntary transfer or discharge shall be made until five (5) business days after these agencies have been notified, unless they each earlier declare that they have no intention of intervening."

Thirty days before a facility closes or reduces bed capacity — the same rule: a nursing home that intends to close, cease doing business, or reduce its licensed bed capacity by ten percent or more "shall notify both the department and the area long-term care ombudsman at the earliest moment of the decision, but not later than thirty (30) days before the action is to be implemented."

Thirty days to appeal, with pendency — TennCare's notice, quoted in full above: "If you appeal within 30 days, the nursing home usually cannot make you move until you get a decision. The 30 days starts on the day you got this page."

This page does not calculate how the thirty-day notice period and the five-business-day agency-notification period relate to each other in a particular case. What any of these periods means for a particular case is for the hearing office to determine.

Source map

Captured: all four, in tools/packets/tennessee-packet.txt. Pending: the ombudsman's own transfers-and-discharges FAQ and contact page, and TennCare's appeal form, per the packet's pending list.

Change log

2026-09-15 — Deepened to a full page. Captured, by curl with a browser user-agent through the existing recipe (tools/recipes/tennessee.json, recipe 218e67906405): a fourth source, TennCare's reimbursement rule 1200-13-02-.16 (Bed Holds), sliced from the Secretary of State's chapter PDF the same way source 2's rule .05 already is. Sources 1 through 3 were recaptured unchanged through the standing recipe; source 3's capture differed only in a page's dynamic-video-modal HTML comment, not in content. Wrote section 01 (the grounds, as Tennessee describes them) and section 02 (the published process: requesting the hearing, the notice's required contents, bed-hold and return, and the notice-periods register). Findings, continuing the baseline page's numbering: (1) Tennessee's prescribed notice is written to the resident in plain second-person sentences and states the grounds in that voice rather than in regulatory language; this page quotes the notice as published, because it is the document the reader will be holding. (2) Two different addresses for the appeal appear across the state's own documents: the notice's appeal instructions say to write to "TennCare's Office of General Counsel, ATTN: Involuntary NF Discharge Appeals, 310 Great Circle Road, Nashville, TN 37243", while the notice's own distribution block names "TennCare's Commissioner's Designee at Large" at "310 Great Circle Road- 3W". Both are quoted in section 02; reconciled nowhere. (3) The state layers two clocks that run in different directions: the health department's rule bars any involuntary move until five business days after the department and the area ombudsman have been informed, and the notice states the facility may move the resident thirty days after the notice unless an appeal is pending. Both are quoted; neither is calculated against the other. (4) The rule requires the facility to counsel with the resident and family in an attempt to resolve the dispute before transferring, and to weigh stated factors including "The traumatic effect on the resident." (5) The ombudsman contacts here are the ones TennCare prints on its notice; the Commission on Disability and Aging's own contact page was not captured, and the ombudsman program's transfers-and-discharges FAQ returned HTTP 404 at the path found. (6) The rule chapter captured for source 2 is the August 2021 revision published by the Secretary of State; the rule's own history line ends with an amendment effective July 1, 2007. (7) New: TennCare's own reimbursement rule states "Effective July 1, 2018, Medicaid bed hold days will no longer be reimbursed" — the whole of what TennCare's rules state about bed-hold. No source reviewed states a bed-hold notice, period, or readmission provision; the absence is recorded in section 02 rather than filled from federal law. Capture-pending: the ombudsman's own transfers-and-discharges FAQ and contact page, and TennCare's appeal form, per the source map. Recipe: tools/recipes/tennessee.json extended with source 4; digest changed from 9e4e3a443a3f to 218e67906405. Internet Archive: not yet submitted for the new source. Reviewer: Carrie Schluter, reviewed 2026-09-15. Corrections: hello@fieldassembly.net.

2026-08-30 — Baseline page built from the first Tennessee packet: docket, lede, source map, change log. Not yet captured or written: section 01 (the grounds, as Tennessee describes them) and section 02 (the published process, including the notice's required contents in full, bed-hold and return, and the notice-periods register). Findings: (1) Tennessee's prescribed notice is written to the resident in plain second-person sentences and states the grounds in that voice rather than in regulatory language; this page quotes the notice as published, because it is the document the reader will be holding. (2) Two different addresses for the appeal appear across the state's own documents: the notice's appeal instructions say to write to "TennCare’s Office of General Counsel, ATTN: Involuntary NF Discharge Appeals, 310 Great Circle Road, Nashville, TN 37243", while the notice's transmission block and TennCare's appeals page name "TennCare’s Commissioner’s Designee" at 310 Great Circle Road, one giving the suite as 3W. All stand as published, reconciled nowhere. (3) The state layers two clocks that run in different directions: the health department's rule bars any involuntary move until five business days after the department and the area ombudsman have been informed, and the notice states the facility may move the resident thirty days after the notice unless an appeal is pending. Both are quoted; neither is calculated against the other. (4) The rule requires the facility to counsel with the resident and family in an attempt to resolve the dispute before transferring, and to weigh stated factors including "The traumatic effect on the resident." (5) The ombudsman contacts here are the ones TennCare prints on its notice; the Commission on Disability and Aging's own contact page was not captured, and the ombudsman program's transfers-and-discharges FAQ returned HTTP 404 at the path found. (6) The rule chapter captured is the August 2021 revision published by the Secretary of State; the rule's own history line ends with an amendment effective July 1, 2007. (7) No first-party statement of a Tennessee Medicaid bed-hold period was captured. Capture pending: per the source map. Internet Archive: not yet submitted. Reviewer: Carrie Schluter, reviewed 2026-08-30. Corrections: hello@fieldassembly.net.