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Tennessee Healthcare Staffing Agency Records: What "Immediately Available" Means

Short answer: a temporary healthcare staffing agency that places nurses, nursing assistants or medication aides in Tennessee nursing homes or assisted-care living facilities must register with the Tennessee Health Facilities Commission (TCA 68-11-2304). It must keep a file for each worker with proof of license, training, health screening, and exclusion and registry checks (Rule 0720-46-.04). Records are kept 5 years and must be "immediately available": within one business day of a written request, or within one hour during an inspection visit.

Updated October 15, 2026 · Checked against the official sources listed at the end

Who has to register

The law, TCA 68-11-2301 to 68-11-2308, covers a business that provides or procures temporary work in healthcare facilities for direct care staff. It also covers a website or phone app that connects direct care staff with facilities and takes facilities' requests. In this law, "healthcare facility" means a nursing home or an assisted-care living facility.

Direct care staff means medication aides, nursing assistants, licensed practical nurses and registered nurses who work for or contract with the agency. Nurse practitioners and advanced practice registered nurses are not included. Each separate agency location registers on its own.

Not covered: a person who works on their own behalf without an agency.
Not covered: an in-house agency run by a hospital, nursing home or assisted-care living facility (or an affiliate) that only staffs that provider or affiliates under common ownership.
The law doesn't define "temporary." The Commission's FAQ says to read it as less than 24 months for now.

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What "immediately available" means

Rule 0720-46-.01(10) defines it: available to the Commission or its agent within one business day after a written request by email, fax or in-person delivery, or within one hour of a request made during an inspection visit.

Your registration application must include a written policy and procedure that describes how your records will be immediately available to the Commission (TCA 68-11-2304(b)(5); Rule 0720-46-.02(5)(d)). If your files are spread across email, paper and old systems, one hour is hard to meet.

Checklist: each worker's file

Rule 0720-46-.04(2) says each direct care staff member's file must hold current copies of:

☐ Name, address, Social Security number and date of birth.
☐ A copy of the current license or certification, plus your verification of it, when the job needs one.
☐ Proof of employment eligibility under U.S. immigration law.
☐ Employment history.
☐ Health and medical records showing screening to rule out communicable diseases and the required immunizations.
☐ Education, training, experience and background, including proof that references were checked.
☐ Proof the person meets all licensing, certification, training and continuing education standards for the position, under federal, state and local rules.
☐ Proof the person is not, and never has been, on OIG's List of Excluded Individuals/Entities or SAM.gov's exclusion list, for anyone placed at a healthcare facility.
☐ Proof of required name and registry checks, including the abuse registry and sex offender registry checks under TCA 68-11-271 and 68-11-1004.
☐ Any extra screening a facility requires of its own employees, done before you refer the worker, with proof (Rule 0720-46-.04(3)).
☐ The worker's written agreement, which must say whether they are an employee or an independent contractor. An independent contractor's agreement must say they pay their own federal income taxes. Before placement, the worker signs a statement that they understand this relationship (Rule 0720-46-.04(4)).

Checklist: agency records

☐ Your entity's articles and bylaws (Rule 0720-46-.04(1)).
☐ The records the IRS requires for each worker, employee or contractor.
☐ Work records for each worker: date of referral and the dates and places of each placement. Time records or invoices are acceptable.
☐ Proof of current workers' compensation coverage.
☐ Your contracts with facilities, which must say whether your staff are referred as employees or independent contractors (Rule 0720-46-.04(5)).
☐ An employee dishonesty bond of at least $10,000 per occurrence, which the law requires agencies to carry (Public Chapter 432 of 2023).
☐ Your written policy on making records immediately available.

How long to keep records, and who can ask for them

Keep the records and reports the rule requires for five years, and make them immediately available to the Commission on request (Rule 0720-46-.04(6)). The law says five calendar years.

Agencies must also give records, unless privileged, to these investigators within five business days, or sooner if a court order, law or regulation says so (Rule 0720-46-.04(7)): Adult Protective Services, the Department of Health, the Commission, and law enforcement, including the Medicaid Fraud Control Unit. When a facility you staff asks, you must send it copies of the worker records this rule requires.

Registration and renewal basics

Apply on the Commission's form. The application lists controlling persons, owners, and the people who manage the agency, plus your records policy (Rule 0720-46-.02(5)).
A controlling person signs an affidavit that the agency doesn't restrict workers' job options, makes sure workers meet licensing, training and background check rules, carries workers' compensation, and knows the law (Rule 0720-46-.02(6)).
Fees are not refundable: a $180 application fee plus a yearly fee based on staff count, from $1,040 for fewer than 25 staff to $3,060 for 200 or more (Rule 0720-46-.02(4)).
A registration lasts one year and expires on the anniversary of the date it was issued (Rule 0720-46-.03).
Send your renewal so it arrives at least 60 days before expiration. If you miss it, you can renew within 60 days after, with a late penalty of $100 per month, up to twice the renewal fee.
A registration can't be sold or transferred. If a controlling person changes, the agency is sold, or management is transferred, the registration is void and a new one is needed.
Send a copy of your current registration to any member of the public who asks.

Biannual reports

Registered agencies file two reports a year (TCA 68-11-2305). The Commission's registry page lists January 31 for July through December, and July 31 for January through June. Each report lists every worker's name, license or certification, assigned facility, time assigned and hours worked, plus average bill rates and pay rates by staff category.

In each report, the agency also attests that every worker had a current, unrestricted license or certification and met the training and continuing education standards for the whole period, and that every worker completed all required background and abuse registry checks. The worker files above are what back those statements up.

Penalties

The Commission may suspend or revoke a registration, or fine up to $5,000 per violation, for not following the law or rules (TCA 68-11-2306).
The Commission must revoke the registration of an agency that knowingly sends a facility a worker with an illegally or fraudulently obtained license, certificate, criminal records check or other required item.
Late biannual reports: $100 for each day out of compliance, which the Commission may waive for good cause.
The rule sets civil penalty ranges of $1,000 to $5,000 for willful violations that threaten public health and safety, $500 to $1,000 for violations that directly affect patient care, and $100 to $500 for others (Rule 0720-46-.08).

Contract rules to know

The law bans non-compete clauses and contract buy-outs for your workers, fees or damages when a facility hires your worker permanently, and recruiting a facility's current staff. Contract terms that break these rules are void (TCA 68-11-2303; Rule 0720-46-.05).

How Pact helps (and what it doesn't do)

Pact keeps each worker's license, immunizations, TB screening, BLS card, training, background check and monthly OIG exclusion checks on one page per person, so staff can pull a full file during an inspection. Workers upload documents from their phone, Pact reminds them before anything expires, and facilities get a share link to a worker's packet with no login. $10 per active worker a month, $250 minimum, first month free.

Pact doesn't register your agency, file your biannual reports, or check SAM.gov. Run the SAM search and Tennessee registry checks yourself and upload the dated results so they sit in the same file. The Commission and its rules are the final word.

Common questions

What does "immediately available" mean for Tennessee staffing agencies?

Available to the Health Facilities Commission or its agent within one business day after a written request by email, fax or in-person delivery, or within one hour of a request made during an inspection visit (Rule 0720-46-.01(10)).

How long must a Tennessee staffing agency keep worker records?

Five years under Rule 0720-46-.04(6). The statute says five calendar years.

Do we have to check SAM.gov as well as OIG?

Yes. Rule 0720-46-.04(2)(h) requires documentation that each worker placed at a healthcare facility is not, and never has been, on OIG's LEIE or SAM's exclusion list.

Does a staffing app need to register in Tennessee?

If it operates a website or phone app that connects direct care staff with Tennessee nursing homes or assisted-care living facilities and accepts their requests for staff, the law includes it in the definition of a temporary healthcare staffing agency.

When is the renewal due?

The renewal application must be received at least 60 days before the registration expires. Registrations last one year from the date issued.

Sources

Related guides

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