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LUCKIEST, thanks for your response; yes I have an attorney and accountant. I have pulled the agency directory from both the local resources and the CMS gov website that reports quality data stats for the agencies. I actually tried to obtain a certificate of need through the state regulation board, however I was denied. In Tennessee they require 3 components, one of which is based on 1.5% of the patient population for each county served. Unfortunately, unlike in many states it is not a democratic process of competitve commercial business. I was denied because there are enough agencies in the area to provide the needs of the patient population based on the 1.5% data. However, I was offering a specialty service which was not provided. I am trying a different approach, in addition, I am working with a physician as a consult to provide this service in my community. I have always been a patient advocate in healthcare, and I feel the patients and clients in the community are the ones who are being underserved, despite the 1.5% statistics. The CMS which regulates at a Federal level has recommended a 2.5% patient population base. Despite the fact that Tennessee has a great governor (Phil Bredesen) he will be featured in Esquire magazine this month; the state health plan has not been revised based on Governor Bredesen's recommendations nor federal recommendations at this point. Hopefully, in 2009 this will be completed.

Great advice Greg; you are correct, I appreciate the advice, especially regarding the physician and conflict of interest with referrals. Trish