Health Facilities Commission announces new NICU licensure category and verification timeline

The Health Facilities Commission (HFC) briefed the Perinatal Advisory Committee on a new NICU licensure category and state verification program intended to standardize levels of neonatal care across Tennessee.

Holly Vickers, Health Planner and Quality Officer for HFC, said hospitals operating level‑2 through level‑4 NICUs must apply for a provisional license beginning Dec. 1, 2025. Applications will be reviewed by HFC staff for completeness; if complete, a service license number will be assigned and the application presented to the Commission for ratification. HFC estimated verification site reviews will begin October–December 2026. Site reviews are intended to assess medical record categories (including resuscitations, neonatal abstinence syndrome, neonatal deaths, transfers in and transfers out) and will be used to finalize a facility’s level‑of‑care designation.

Vickers said the provisional license will be linked to a hospital’s license and that each licensed hospital operating NICU services must submit a separate application. Hospitals that change level of care may reapply to have the new level reflected in licensure; site reviews for designation are planned to occur within three years of ratification of the provisional license.

During questions, hospital representatives asked whether existing NICUs would be grandfathered and whether plan‑review or life‑safety surveys would be required; HFC staff said the application is new and that currently operating NICUs must file the same initial licensure application (i.e., the process treats all existing NICUs as new for purposes of the new licensure category). HFC staff also advised that certain facility changes may trigger a plan review for life‑safety code compliance and provided a plans‑review contact number.

Nathaniel Flinchbaugh, HFC deputy general counsel, clarified statutory enforcement: the statute creating the new licensure category takes effect Dec. 1. HFC follows a complaint‑driven enforcement model; if a facility is reported as operating without a license, HFC may issue a cease‑and‑desist notice, after which facilities have 30 days to apply or otherwise come into compliance. HFC said it will perform outreach to hospitals to help with submission and compliance and that its capacity to process applications will ramp up after Dec. 1.

Committee members asked about application fees and whether small hospitals could seek waivers; HFC counsel said the statute does not provide for fee waivers and that fees were being posted to HFC resources; hospital representatives requested clear, rapid communications and assistance so that hospitals—particularly smaller and rural facilities—can submit applications and avoid coverage gaps.