Disability and Aging, Dept. Of

Plain English Breakdown

The bill summary and text do not provide specific details on enforcement mechanisms or penalties.

Family Caregiver Guidelines and Employment Protections

This bill requires the Tennessee Department of Disability and Aging and TennCare to create guidelines for hiring family caregivers and prohibits certain restrictions on their employment.

What This Bill Does

• Requires the commissioner of disability and aging to develop guidelines for service providers to hire qualified family members as caregivers.
• Prohibits the department from preventing or dissuading Medicaid-participating agencies from hiring family caregivers based on specific criteria, such as familial relationships or guardianship status.
• Allows family caregivers to be employed without restrictions related to place of residence, age, or type of waiver program for individuals with disabilities.
• Requires TennCare to develop similar guidelines and prohibitions for providers delivering TennCare services under contract.
• Authorizes both departments to create rules implementing these requirements.

Who It Names or Affects

• Service provider agencies that participate in Medicaid
• Individuals who are family caregivers of people with disabilities
• The Tennessee Department of Disability and Aging
• TennCare and its contracted providers

Terms To Know

Medicaid-participating service provider agency

An organization that provides services to individuals receiving Medicaid benefits.

Person-centered planning process

A method of developing a support plan for an individual with disabilities based on their unique needs and preferences.

Limits and Unknowns

• The bill does not specify how the guidelines will be enforced or what penalties may apply if they are violated.
• It is unclear how these changes will impact existing employment practices in service provider agencies.
• The effectiveness of the rules created by the departments to implement this act remains to be seen.

Official Summary Text

DEPARTMENT OF DISABILITY AND AGING

This bill requires the commissioner of di
sability and aging to develop guidelines for service providers for hiring a qualified family member as a family care giver. The guidelines must be disseminated to medicaid-participating service provider agencies annually and published on the department o
f
disability and aging's website.

This bill prohibits the department from prohibiting otherwise qualified individuals from employment as a family care giver at a service provider agency based on the following criteria:



A family relation between a family care giver and individual with a disability receiving services.



Place of residence of the family care giver or individual with a disability receiving services.



The age of the individual with a disability receiving services.



The parental or spousal relationship between the family care giver and the individual with a disability receiving services.



The guardianship or conservatorship status of the family care giver unless explicitly prohibited in guardianship or conservatorship documents.



The waiver program in which the individual with a disability receiving services is enrolled or participating that includes all waiver programs operating under the division of TennCare and waiver authorities granted by the federal centers for medicare and medicaid services including employment and community first choices; choices; the Katie Beckett program; the self-determination waiver; the comprehensive aggregate cap waiver; and the statewide waiver.



The separate and additional employment of an unrelated care giver also providing services to an individual with a disability through employment with a medicaid-participating service provider agency.

This bill also prohibits the department from (i) preventing or dissuading medicaid-participating service provider agencies
from hiring family care givers to provide long-term services and support or home and community based services to an individual with a disability receiving services; or (ii) reducing or otherwise altering the type or extent of benefits granted to an indivi
d
ual with a disability based on the familial status of the individual providing the services without engaging in the person-centered planning process.

This bill prohibits a family care giver from being compensated for care provided in excess of the amount
of long-term supports and services or home and community based services or benefits designated to an individual with a disability within the person receiving support's person-centered practice.

TENNCARE

This bill requires the director of TennCare to de
velop guidelines for providers for hiring a qualified family member as a family care giver. The guidelines must be disseminated to medicaid-participating provider agencies annually and published on the bureau of TennCare's website.

This bill places the
same prohibitions on the bureau of TennCare, and any provider that delivers TennCare services under contract with the bureau, that it does on the department of disability and aging as described above. A family care giver must not be compensated for care
p
rovided in excess of the amount of long-term services and supports or home and community based services or benefits designated to an individual with a disability within the person receiving support's person-centered practice.

RULEMAKING

This bill author
izes the department of disability and aging and the director of TennCare to promulgate rules to effectuate this bill.

ON MARCH 24, 2025, THE SENATE ADOPTED AMENDMENT #1 AND PASSED SENATE BILL 1178, AS AMENDED.

AMENDMENT #1 revises the provisions in the
bill prohibiting the department and the bureau of TennCare
, and any provider that delivers TennCare services under contract with the bureau,
from prohibiting
otherwise qualified individuals from employment as a family care giver at a service provider age
ncy based on
t
he guardianship or conservatorship status of the family caregiver unless explicitly
prohibited
in guardianship or conservatorship documents
to, instead, apply such unless
explicitly permitted in
such
documents
.

Current Bill Text

HOUSE BILL 712
By Hale

SENATE BILL 1178
By Akbari

SB1178
002413
- 1 -

AN ACT to amend Tennessee Code Annotated, Title 52
and Title 71, relative to family caregiving.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 52, Chapter 2, Part 10, is amended by
adding the following as a new section:
(a) The commissioner shall develop guidelines for service providers for hiring a
qualified family member as a family care giver. The guidelines must be:
(1) Disseminated to medicaid-participating service provider agencies
annually; and
(2) Published on the department's website.
(b) The department shall not:
(1) Prohibit otherwise qualified individuals from employment as a family
care giver at a service provider agency based on:
(A) A family relation between a family care giver and individual
with a disability receiving services;
(B) Place of residence of the family care giver or individual with a
disability receiving services;
(C) The age of the individual with a disability receiving services;
(D) The parental or spousal relationship between the family care
giver and the individual with a disability receiving services;

- 2 - 002413

(E) The guardianship or conservatorship status of the family care
giver unless explicitly prohibited in guardianship or conservatorship
documents;
(F) The waiver program in which the individual with a disability
receiving services is enrolled or participating which includes all waiver
programs operating under the division of TennCare and waiver authorities
granted by the federal centers for medicare and medicaid services
including:
(i) Employment and community first choices;
(ii) Choices;
(iii) The Katie Beckett program;
(iv) The self-determination waiver;
(v) The comprehensive aggregate cap waiver; and
(vi) The statewide waiver; and
(G) The separate and additional employment of an unrelated care
giver also providing services to an individual with a disability through
employment with a medicaid-participating service provider agency;
(2) Prevent or dissuade medicaid-participating service provider agencies
from hiring family care givers to provide long-term services and support or home
and community based services to an individual with a disability receiving
services; or
(3) Reduce or otherwise alter the type or extent of benefits granted to an
individual with a disability based on the familial status of the individual providing
the services without engaging in the person-centered planning process.

- 3 - 002413

(c) A family care giver shall not be compensated for care provided in excess of
the amount of long-term supports and services or home and community based services
or benefits designated to an individual with a disability within the person receiving
support's person-centered practice.
SECTION 2. Tennessee Code Annotated, Title 71, Chapter 5, Part 1, is amended by
adding the following as a new section:
(a) The director of TennCare shall develop guidelines for providers for hiring a
qualified family member as a family care giver. The guidelines must be:
(1) Disseminated to medicaid-participating provider agencies annually;
and
(2) Published on the bureau of TennCare's website.
(b) The bureau of TennCare, and any provider that delivers TennCare services
under contract with the bureau, shall not:
(1) Prohibit otherwise qualified individuals from employment as a family
care giver at a provider agency based on:
(A) A family relation between a family care giver and individual
with a disability receiving services;
(B) Place of residence of the family care giver or individual with a
disability receiving services;
(C) The age of the individual with a disability receiving services;
(D) The parental or spousal relationship between the family care
giver and the individual with a disability receiving services;
(E) The guardianship or conservatorship status of the family care
giver unless explicitly prohibited in guardianship or conservatorship
documents;

- 4 - 002413

(F) The waiver program in which the individual with a disability
receiving services is enrolled or participating which includes all waiver
programs operating in this state under the bureau of TennCare and
waiver authorities granted by the federal centers for medicare and
medicaid services, including:
(i) Employment and community first choices;
(ii) Choices;
(iii) The Katie Beckett program;
(iv) The self-determination waiver;
(v) The comprehensive aggregate cap waiver; and
(vi) The statewide waiver; and
(G) The separate and additional employment of an unrelated care
giver also providing services to an individual with a disability through
employment with a medicaid-participating provider agency;
(2) Prevent or dissuade medicaid-participating provider agencies from
hiring family care givers to provide long-term services and support or home and
community based services to an individual with a disability receiving services;
and
(3) Reduce or otherwise alter the type or extent of benefits granted to an
individual with a disability based on the familial status of the individual providing
the services without engaging in the person-centered planning process.
(c) A family care giver shall not be compensated for care provided in excess of
the amount of long-term services and supports or home and community based services
or benefits designated to an individual with a disability within the person receiving
support's person-centered practice.

- 5 - 002413

SECTION 3. The department of disability and aging and the director of TennCare are
authorized to promulgate rules to effectuate this act. The rules must be promulgated in
accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
SECTION 4. For the purposes of promulgating rules, this act takes effect upon
becoming law, the public welfare requiring it. For all other purposes, this act takes effect July 1,
2025, the public welfare requiring it.