Tennessee PAE Certification Form: Signing, Submission, and Review

The Tennessee PAE certification form — the Pre-Admission Evaluation that TennCare uses to decide whether someone qualifies medically for Medicaid-funded long-term care — is completed by a certified healthcare assessor, signed by a physician for nursing facility requests, and submitted electronically through TennCare’s PAE tracking system. The form scores the applicant’s functional deficits across daily-living categories, and a minimum acuity score of 9 on the state’s scale is the baseline threshold for nursing facility level of care.

Who Can Complete and Sign the Form

TennCare limits who may complete a PAE, and a form filled out by the wrong person will be rejected regardless of how well it’s documented.

For CHOICES Group 2 (home and community-based services) and PACE requests, the assessor must hold one of these licenses: physician (MD or DO), physician assistant, nurse practitioner, advanced practice nurse, registered nurse, licensed practical nurse, or licensed social worker. Beyond the professional license, TennCare requires the assessor to pass a qualifying exam on HCBS requirements, renew Qualified Assessor status every year, and use a unique Assessor Code on every PAE they complete. TennCare will reject any HCBS PAE submitted by someone who is not a current Qualified Assessor.¹

PACE PAEs have an extra layer: the assessor must be an RN, LPN, or licensed social worker employed by a PACE Organization, and must have completed TennCare’s training on long-term services and the PACE PAE application process.¹

Every assessor has to certify that the information on the PAE is accurate and acknowledge that providing false information to obtain benefits is fraud under TennCare and Title XIX of the Social Security Act.

What the Form Measures

Demographic information comes first. The substance of the PAE is the clinical and functional assessment that follows, and this is where most forms are won or lost.

Activities of Daily Living

The core ADL categories scored on the form are:

Transfer: whether the person can move between a bed, chair, or toilet without physical help.
Mobility: whether the person can move around without physical assistance from another person.
Eating: whether the person can consume prepared food and drink without physical help, tube-feeding assistance, or constant one-on-one verbal prompting.
Toileting: whether the person can use the toilet or manage incontinence, ostomy, or catheter care independently.

The form also captures deficits in communication (both expressing needs and understanding instructions), orientation to person, place, and situation, behavioral issues, and the ability to self-administer medications.¹ Cognitive screening tools such as the Brief Interview for Mental Status, the Montreal Cognitive Assessment, or the Mini-Mental State Examination are commonly used to support the orientation and communication sections.

The Acuity Score

Each category contributes a weighted value to a total acuity score. To qualify for nursing facility level of care, whether the applicant will actually live in a facility (CHOICES Group 1) or receive equivalent care at home (CHOICES Group 2), the score must reach at least 9 on the TennCare NF LOC Acuity Scale. Applicants who fall below 9 but meet one or more of the individual ADL criteria on an ongoing basis — daily or at least four days per week — may still qualify if TennCare’s Safety Determination finds they cannot be safely served in a lower-level Group 3 setting.²

Skilled Nursing and Rehabilitative Needs

Wound care, tube feeding, physical or occupational therapy, and ventilator care each get their own entries on the form. TennCare reviews and approves or denies each of these separately, so each claimed need must be documented on its own.

Clinical Documentation That Backs the Form

Every functional deficit marked on the PAE has to be backed by clinical records. This is where assessors most often run into trouble. If the form shows total dependence in both transfer and mobility but the uploaded documentation addresses only transfer, reviewers can deny the mobility portion and drop the acuity score, which can push the applicant below the qualifying threshold.¹

Nursing notes, hospital discharge summaries, therapy evaluations, and medication lists all work. What matters is specificity. A note that says “patient requires assistance” is far weaker than one describing what the person cannot do, how often they need hands-on help, and how intensive that help is.

Physician Certification for Nursing Facility PAEs

Every nursing facility PAE requires a physician (MD or DO) to sign and date the certification, confirming that the requested level of nursing facility care is medically necessary.³ The certification information on the form has to match the certification tab in the PAE tracking system, or TennCare will not process the request.¹

For HCBS requests, the Qualified Assessor’s certification and assessor code serve as the primary validation, and a separate physician signature is not always required in the same way.

PASRR Screening Runs Alongside

Anyone seeking admission to a Medicaid-certified nursing facility in Tennessee also has to complete a Pre-Admission Screening and Resident Review (PASRR) Level I screen before admission, regardless of who is paying. This is a separate federal requirement under 42 CFR §483.102 that operates in parallel with the PAE.⁴

The Level I screen identifies whether the applicant has a serious mental illness or an intellectual disability. A positive screen triggers a Level II evaluation, which must be finished before admission. Medicaid will not reimburse the nursing facility for any days of care provided before PASRR is complete — either through a negative Level I screen or a Level II finding that nursing facility placement is appropriate.³

Submitting the PAE

Healthcare providers and Managed Care Organizations submit completed PAEs electronically through TennCare’s online PAE tracking system. Electronic submission is the standard method and allows real-time tracking as the review progresses.¹

Paper submission is available in limited circumstances. The PAE certification form itself lists three ways to return a completed paper form:

Fax: 615-741-9260
U.S. Mail: Bureau of TennCare, Division of Long Term Care, P.O. Box 450, Nashville, TN 37202-0450
Other delivery: 310 Great Circle Road, Nashville, TN 37243

Providers without tracking-system access should contact TennCare to arrange access rather than defaulting to paper.

Review Timeline and Notice of Determination

After submission, TennCare staff review the PAE and its supporting documentation. Reviews typically finish within roughly eight business days of receipt, though volume and completeness affect that pace.

If the clinical documentation is insufficient to support a claimed deficit, TennCare issues a Request for Information, and the review pauses until the provider supplies more records. A slow response stalls the whole process and can push back the approval date.

When review is complete, the applicant receives a formal Notice of Determination. An approval specifies the level of care and CHOICES group, so the applicant can move forward with a nursing facility or arrange home-based services through their MCO. A denial notice includes appeal information.¹

How Long an Approval Lasts

An approved PAE is valid for 90 calendar days from the approval date. If services have not started within that window, the PAE must be updated — the physician (for nursing facility care) or Qualified Assessor (for HCBS) has to certify that the applicant’s condition remains consistent with the original assessment. If the condition has changed significantly, a completely new PAE is required.²

A PAE that goes unused for 365 days from the approval date expires permanently, and a new PAE must be submitted from scratch. The same rule governs the gap between the PAE’s approved effective date and the Medicaid Only Payer Date: more than 90 days requires recertification, and more than 365 days requires a brand-new PAE.¹

A PAE also expires when the person is discharged from a nursing facility, with a few exceptions: transferring to another facility, returning from a hospital stay directly to the same or another facility, returning from a therapeutic leave of no more than 10 days, or transitioning to CHOICES Group 2 with MCO and TennCare approval before discharge.²

If the PAE Is Denied

The applicant has 60 days from the date they learn of the denial to file a medical appeal. Print and complete the TennCare Medical Appeal form and submit it one of three ways:⁵

Mail: TennCare Member Medical Appeals, PO Box 593, Nashville, TN 37202-0593
Email: TMMA.Contact.Center@tn.gov
Fax: 1-888-345-5575 (toll-free)

Keep a copy of whatever you submit. If you fax, save the confirmation page. The 60-day window is firm, so file on time and supplement the record afterward rather than waiting to assemble more documentation first.

Consequences of False Information on the Form

Because the PAE directly drives eligibility for Medicaid-funded services, inflating deficits or fabricating documentation carries serious exposure. Under 18 U.S.C. § 1035, knowingly making false statements in connection with the delivery of or payment for health care benefits is a crime, punishable by up to five years in prison, a fine, or both.⁶

On the civil side, the federal False Claims Act allows the government to recover treble damages plus a per-claim penalty. As of mid-2025, that penalty runs from $14,308 to $28,619 for each false claim.⁷ For a provider filing multiple fraudulent PAEs, these penalties compound quickly. TennCare’s own assessor certification language explicitly warns that providing false information to obtain benefits is fraud under both the state TennCare program and federal Medicaid law.

1
TennCare. LTSS PAE Manual
2
Legal Information Institute. Tennessee Comp Rules 1200-13-01-.10 – Medical (Level of Care) Eligibility Criteria for TennCare Reimbursement of Care in Nursing Facilities, CHOICES HCBS and PACE
3
Tennessee Department of State. Notice of Rulemaking Hearing – Department of Finance and Administration
4
eCFR. 42 CFR 483.102
5
TennCare. How to File a Medical Appeal
6
Office of the Law Revision Counsel. 18 U.S. Code 1035 – False Statements Relating to Health Care Matters
7
Federal Register. Civil Monetary Penalties Inflation Adjustments for 2025