Starting a Texas Home Health or Personal Assistance Services Agency?

This page focuses on three Texas Home and Community Support Services Agency (HCSSA) options:

• Personal Assistance Services (PAS) — non-medical personal care and related assistance.
• Licensed Home Health Services (LHHS) — skilled home health services under a Texas HCSSA license.
• Licensed and Certified Home Health Services (L&CHHS) — skilled home health services under a Texas HCSSA license plus Medicare certification.

Texas also licenses other HCSSA categories, including hospice and home-dialysis designations.

Texas Home and Community Support Services Agencies are licensed and regulated by the Texas Health and Human Services Commission (HHSC) through Long-Term Care Regulation.

Applications and supporting information are generally submitted through the Texas Unified Licensure Information Portal, commonly called TULIP.

The current initial licensing fee shown for a three-year HCSSA parent-agency license is $2,625.

State fees are subject to change, so applicants should verify the current fee with Texas HHSC before submitting an application.

No. The Texas HHSC licensing fee is separate from the Home Health Forms Startup Package price and must be paid directly to Texas Health and Human Services.

Exact requirements depend on the ownership structure, service category, and application details. An initial application generally includes:

• A completed HCSSA application submitted through TULIP.
• Business and organizational information.
• Ownership and controlling-person disclosures.
• The agency's physical location, contact information, operating hours, and proposed service area.
• Identification and qualification information for required agency personnel.
• Signed completion certificates for required HCSSA Presurvey CBT modules.
• Business-registration and good-standing information when applicable.
• Required supporting documents and the state licensing fee.

Skilled-care categories have additional personnel and regulatory requirements beyond a PAS-only application.

Yes. A Texas HCSSA must designate a qualified administrator and a qualified alternate administrator.

For skilled home health categories, additional required personnel include a supervising nurse and an alternate supervising nurse.

Yes. An agency licensed for Licensed Home Health Services or Licensed and Certified Home Health Services must directly employ or contract with a qualified individual to serve as the supervising nurse, subject to the limited exception referenced in 26 TAC §558.243 for certain LHHS agencies.

The agency must also designate in writing a similarly qualified alternate supervising nurse. A PAS-only agency is not required to designate a supervising nurse solely because it holds the PAS category.

The agency must maintain a designated place of business. A separate commercial office is not necessarily required, and a residence may be used when it is the agency's actual place of business and all applicable requirements are met.

The location must satisfy requirements concerning operating hours, record accessibility, surveyor access, contact information, and display of the license after it is issued. Applicants should also verify local zoning, lease, deed-restriction, and homeowners-association requirements.

Texas HHSC states that the licensing unit may take up to 45 days to process a thoroughly complete application. The total startup process may take longer.

After an initial license is issued and the agency admits clients, additional survey requirements and deadlines may apply. Medicare certification adds separate federal certification steps.

A Personal Assistance Services agency provides routine, ongoing assistance that helps an individual perform activities of daily living or the physical functions needed to live independently.

Services may include personal care, respite services, assistance with self-administered medications, and certain health-related tasks permitted under Texas law. Depending on the task and the client's condition, an RN may be required to assess the client, delegate the task, verify caregiver competency, and provide appropriate supervision.

A properly licensed PAS agency may provide personal care and respite services. Depending on the client's needs and applicable requirements, services may include:

• Bathing and personal hygiene assistance.
• Dressing and grooming.
• Feeding assistance.
• Toileting and continence assistance.
• Positioning, transfers, and ambulation assistance.
• Routine hair and skin care.
• Exercise and range-of-motion assistance.
• Respite services.
• Assistance with self-administered medications.

Certain health-related tasks may be performed only when applicable Texas nursing-delegation, training, supervision, competency, and documentation requirements are satisfied.

A PAS-only license does not independently authorize the agency to operate as a skilled home health agency, hospice, dialysis provider, or Medicare-certified home health agency.

Professional nursing, physical therapy, occupational therapy, speech therapy, respiratory therapy, and other skilled services generally require the appropriate additional license category and properly qualified personnel.

An agency may provide only the services authorized under the categories listed on its license.

When properly licensed and staffed, Texas home health services can include skilled professional services such as nursing and therapy services. HHSC identifies home-health services including nursing; physical, occupational, speech, respiratory, or intravenous therapy; social services; and other authorized home-health services.

The exact services an agency offers must match its licensed category, qualified personnel, physician or practitioner orders when required, and the client's plan of care.

Licensed Home Health Services (LHHS) is a Texas state-licensed skilled home health category. It can provide authorized skilled services but is not, by that license alone, a Medicare-certified home health agency.

Licensed and Certified Home Health Services (L&CHHS) combines Texas HCSSA licensure with the federal requirements necessary for Medicare certification. Certified agencies must comply with applicable state rules and federal home health requirements.

Not solely because it holds the LHHS category. HHSC distinguishes state HCSSA licensure from federal Medicare certification. To participate as a Medicare home health agency, the provider must hold the appropriate certified service category and complete the Medicare certification process.

In addition to Texas HCSSA requirements, a Licensed and Certified Home Health Services agency must comply with applicable federal requirements, including 42 CFR Part 484 — Home Health Services Conditions of Participation and applicable Medicare requirements under the Social Security Act.

When a practitioner orders skilled care, HHSC states that a health professional such as an RN prepares the plan of care in conjunction with agency staff. The plan must be signed and approved by a practitioner in a timely manner, and appropriate health care personnel must provide the ordered services as specified in the plan.

For PAS-only applicants, HHSC identifies the administrator and alternate administrator as required participants. For applicants offering skilled or other non-PAS-only HCSSA categories, HHSC also requires the supervising nurse and alternate supervising nurse to complete the applicable Presurvey CBT modules and submit signed completion certificates.

No. Home Health Forms provides startup guidance, customized documents, and application-preparation assistance. Texas HHSC makes state licensing decisions, and the appropriate federal authorities determine Medicare certification.

The applicant remains responsible for providing complete and truthful information, meeting personnel and office requirements, paying applicable fees, completing required training, responding to regulator requests, and maintaining compliance with applicable laws and regulations.

Licensing approval, Medicare certification, and processing times cannot be guaranteed.

Customized policy manuals, forms, and related digital documents are generally emailed within five business days after Home Health Forms receives all company information needed to complete the customization.

LLC formation, website development, domain registration, printing, shipping, and other package components may have separate production timelines.

Cancellation and refund eligibility depends on the work already completed, customized materials produced, digital products delivered, third-party expenses paid, printing ordered, and other services already performed.