Health Facilities Commission warns recertification backlog likely to outlast statutory deadline, seeks staff and funding
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Summary
Health Facilities Commission executive director Logan Grant told the House Finance committee the agency faces a surge to about 1,500 complaints a year, a shortage of surveyors and that current resources — including $6.6 million for contract surveyors and an uncertain CMS match — are unlikely to eliminate the recertification backlog by the statutory deadline of Dec. 31, 2026.
Logan Grant, executive director of the Tennessee Health Facilities Commission, told the House Finance, Ways and Means Committee on Feb. 10 that the agency is seeing complaint volumes “more regularly … upwards of 1,500 complaints a year,” a rise he attributes to federal changes in filing methods and increased reporting channels.
Grant said the commission requested seven items that were not included in the governor’s budget, most notably additional surveyor positions dedicated to immediate‑jeopardy complaints and to reducing the agency’s recertification backlog. He said HFC currently has 9 of 85 surveyor positions vacant and that staffing constraints force the agency to reassign personnel from recertification work to immediate complaint investigations.
To buy time, HFC moved $6,600,000 in existing funds to hire contract surveyors and requested a 75% match from CMS (about $1,800,000). Grant warned the committee those CMS funds are uncertain and that contract surveys can cost “up to $60,000 per recertification.” He also told members that only a small number of private firms currently hold the federal certification necessary to perform CMS‑compliant recertification surveys, so competition for those contractors will be high.
Grant outlined additional staffing and operational requests the commission sought but did not receive in the governor’s budget: restoration of positions in licensure to support NICU quality regulations and ambulatory surgery center oversight, two positions funded from CON fees, an extra paralegal to support five litigation attorneys, and two surveyor positions shifted back from life safety to survey units. He described an $80,000 recurring item to support NICU reverification — a 50% state match with the provider — recommended by a technical advisory group.
On Certificate of Need (CON) reform, Grant said the commission has begun phasing certain services to licensure: NICUs, burn units and MRI/PET services were included in the first round. New requirements include accreditation for MRI/PET within two years of licensure, burn‑unit accreditation within five years, and NICU reverification every three years. Grant said the next phase of phase‑outs will begin Dec. 1, 2027.
Committee members pressed HFC on contingency plans if federal regulators decline to adopt recommended flexibilities. Grant said the agency would “be in a pretty tough spot” without federal regulatory flexibilities and noted that similar pressures affect other states. Lawmakers also pressed HFC on public complaint filing: the committee was told a new website filing mechanism exists and that staff would circulate the link and instructions to members.
The committee closed the HFC segment after detailed questioning about staffing, the reserve fund and information‑system limitations. Grant emphasized that while the commission has used one‑time funds to hire contract surveyors, permanent, recurring positions are the most effective way to address ongoing workload pressures.
The committee did not vote on any bill during the presentation; follow‑up includes monitoring whether the General Assembly will consider statutory changes or budget allocations to address HFC staffing and the recertification deadline.
