Tennessee rewrote what your personnel files have to prove. The rule took effect May 25.

The registry rule now reaches everyone

TDMHSAS rewrote Chapter 0940-05-06, effective May 25, 2026. The registry provision reads: "An employee on either the Abuse Registry or Sexual Offender Registry is ineligible to remain employed by or work as a volunteer or independent contractor with the licensee in any capacity."

In any capacity. Employee, volunteer, independent contractor. If your registry screening process was built around W-2 staff, it is now under-scoped, and the people it misses are usually the ones nobody thinks of as staff.

This brief is part of our seven state series. The underlying evidence, including every quote and figure with its primary source, is published on our Tennessee workforce page and in the state regulations hub.

The job description clause that is easy to miss

The same rule requires that a job description "shall include whether this employee will be designated as an employee who can be assigned as an employee to assist individuals not capable of self-preservation."

That is a specific sentence that has to exist in a specific document. It is not a policy statement or a training record. It is a field in the job description, and most Tennessee job descriptions written before May 2026 do not have it.

What 48 percent turnover does to all of this

The Tennessee LTSS Workforce Quality Improvement Survey, Year Seven, prepared by the Institute on Community Integration for TennCare, reports 48 percent caregiver and DSP turnover for calendar year 2024, a 12 percent vacancy rate, and 2,959,455 overtime hours across reporting organizations, roughly 23.1 million dollars.

One note on that number, because it matters for anyone quoting it. The widely circulated 58 to 62 percent figure is calendar year 2023, from the Year Six report, and the Year Seven state profile appendix repeats the older text verbatim. The current measured figure is 48 percent. If you are putting turnover in a board packet or a grant application, use the year, not just the number.

Now apply it. Every departure is a new job description with the self-preservation designation, a new registry check across every worker category, and a new drug screening. Half your workforce, every year.

The screening requirement that covers contractors too

For nonresidential office-based opiate treatment facilities, the rule is explicit: "Facilities shall implement drug screenings for all persons providing direct services on behalf of the Facility regardless of whether persons are employed, contracted, or volunteering."

Tennessee keeps drawing the same line. The obligation follows the work, not the employment classification.

Four things to change this month

1. Re-scope registry checks to every worker category. Employees, contractors, volunteers, students. If they are in the building, they are in scope.

2. Add the self-preservation designation field to every job description. Every one, not just the ones you are hiring for.

3. Fix your turnover number. If your board is still seeing 58 percent, they are seeing 2023 data. Use 48 percent and cite the year.

4. Attach screening to onboarding, not to hiring. Contractors do not go through hiring. They still go through onboarding.

The uncomfortable part

Turnover this high does not just cost money. It resets your compliance posture continuously. Every process that depends on institutional memory decays at 48 percent a year, which is to say it decays faster than most organizations can rebuild it.

The only durable answer is to make the process produce the document automatically, so that the person leaving does not take the compliance with them.

Questions Tennessee operators ask

When did the new Tennessee 0940 minimum program requirements take effect?
TDMHSAS Rule 0940-05-06-.04, covering minimum program requirements for all services and facilities, took effect May 25, 2026. The opioid treatment and office-based treatment chapters took effect in September 2025.

What is the current DSP turnover rate in Tennessee?
The Tennessee LTSS Workforce Quality Improvement Survey Year Seven report, prepared by the Institute on Community Integration for TennCare, reports 48 percent caregiver and direct support professional turnover for calendar year 2024, with a 12 percent vacancy rate. The 58 to 62 percent figure that still circulates is calendar year 2023 data.

Do Tennessee registry checks apply to contractors and volunteers?
Yes. Rule 0940-05-06-.04 states that an employee on either the Abuse Registry or Sexual Offender Registry is ineligible to remain employed by or work as a volunteer or independent contractor with the licensee in any capacity.

See the full Tennessee workforce page →  ·  All seven states →