Hospice providers must be licensed as a Home and Community Support Services Agency (HCSSA) and must have the category of hospice on their license.

A hospice agency with a license to provide hospice services may qualify for an alternate delivery site (ADS) license if the parent agency:

  1. Is in substantial compliance with Health and Safety Code, Chapter 142 and Texas Administrative Code, Title 40, Part 1, Chapter 97 (relating to the Licensing Standards for Home and Community Support Services Agencies); and
  2. Has no enforcement action pending against its license.

A hospice agency may obtain the Texas Department of Aging and Disability Services (DADS) Form 2024 application for an ADS license here. On the application, an agency may request to operate an inpatient unit at the ADS location.

Applications and Required Fees

The applications and required fees must be sent to:

Regular mail
Texas Health and Human Services ARTS
Mail Code 1470
P.O. Box 149055
Austin, TX 78714

Overnight delivery
Texas Health and Human Services ARTS
Mail Code 1470
P.O. Box 149055
Austin, TX 78714

Licensing fees: $1,000 for an initial (includes change of ownership) alternate delivery site license and $600 for a renewal alternate delivery site license.

Please see the Licensing Standards for Home and Community Support Services Agencies Handbook for more information.

How to Apply for an ADS License Without an Inpatient Unit

To apply for an ADS license without an inpatient unit, a hospice agency must:

DADS considers an application for an ADS license complete and correct when the agency receives all of the documents, fees and information that requested as part of the application process described in 40 TAC §97.29 (relating to Application and Issuance of an Alternate Delivery Site License).

DADS processes an application for an ADS license according to the time frames in 40 TAC §97.31(b) (relating to Time Frames for Processing and Issuing a License).

How to Apply for an ADS License with an Inpatient Unit

To apply for an ADS license with an inpatient unit, a hospice agency must:

  • Complete Form 2024, Home and Community Support Services Agency Request for an Alternate Delivery Site License. In Section 7 (Categories of Services) check the box for Hospice Alternate Delivery Site with inpatient unit.
  • Include all of the required documents and information that DADS requests as part of the application process
  • Pay the required license fee
  • Send in the completed application to DADS
  • Contact the DADS Architectural Unit at 512-438-2311 to request a Life Safety Code survey
  • Be approved by DADS

DADS considers an application for an ADS license complete and correct when the agency receives all of the documents, fees and information requested as part of the application process described in 40 TAC §97.29 (relating to Application and Issuance of an Alternate Delivery Site License).

DADS processes an application for an ADS license according to the time frames in 40 TAC §97.31(b) (relating to Time Frames for Processing and Issuing a License).

NOTE: The ADS license expires on the same expiration date as the parent hospice license. The agency may renew the ADS license with the parent agency—s license.

How to Request an Initial Licensure Health Survey for an ADS with an Inpatient Unit

After DADS issues a license for an ADS location with an inpatient unit, the hospice agency must provide inpatient services to a client and submit Form 2020-A, Notification of Readiness for a Health Survey of a Hospice Inpatient Unit, to the designated survey office.

A hospice agency is not required to request an initial licensure health survey of an ADS location with an inpatient unit if the agency is exempt from the health survey as specified in 40 TAC §97.503 (relating to Exemption From a Survey). To demonstrate that the agency is exempt, the agency must send the accreditation documentation from the Joint Commission (JC) (formerly the Joint Commission on Accreditation of Healthcare Organization (JCAHO)) or the Community Health Accreditation Program, Inc. (CHAP) to the DADS designated survey office. The agency must send the accreditation documentation for the agency's new inpatient unit no later than seven days after the agency receives the accreditation documentation (refer to 40 TAC §97.29(i)). In addition, for a licensed and Medicare-certified agency to be exempt from an initial licensure health survey of its new inpatient unit, the DADS Licensing unit must receive verification of the agency's deemed status for the new inpatient unit from the Centers for Medicare & Medicaid Services (CMS) Regional Office (RO).

NOTE: A hospice agency is not required to request an initial licensure health survey of an ADS location without an inpatient unit.

Medicare Certification of the ADS

For information on initial Medicare certification surveys, refer to Provider Letter (PL) 15-10: Centers for Medicare & Medicaid Services (CMS) Direction Regarding Workload Prioritization. A licensed-only hospice agency that has applied for and requested Medicare certification of the hospice parent location and ADS location (with or without an inpatient unit) may submit a written request to CMS via DADS for an exception to the priority assignment of the Medicare certification survey if a lack of Medicare certification would cause significant "access-to-care" problems for patients served by the agency. However, before DADS will forward the request to CMS for approval, the agency must provide data and other evidence that effectively establishes the probability of serious, adverse patient healthcare access consequences. DADS will communicate with CMS before forwarding the request to the CMS RO. For further guidance on "access-to-care" procedures, please refer to Regional S&C letter No. 10-01.

A non-deemed parent Medicare-certified hospice agency may submit an application to DADS for an ADS license and apply to CMS for Medicare certification of the ADS as a multiple location (with or without an inpatient unit) or an inpatient unit only. The hospice agency—s application for an ADS license may include a request to only operate an inpatient unit at the licensed ADS location. Or the hospice agency—s application for an ADS license may request to operate a multiple location (with or without an inpatient unit) from which the hospice will also provide the home levels of hospice services.

IMPORTANT: DADS will process the application for a licensed-only hospice ADS location, with or without an inpatient unit. The agency—s application and request for Medicare certification of an ADS as a multiple location (with or without an inpatient unit) or an inpatient unit only will not be conducted by DADS.

A deemed or non-deemed Medicare-certified hospice agency may go through a CMS-approved national accrediting organization (AO) with deeming authority such as JC, CHAP or the Accreditation Commission for Health Care (ACHC) to request a Medicare certification survey for a multiple location (with or without an inpatient unit) or for an inpatient unit only.

IMPORTANT: The hospice agency must contact the national AO directly for information regarding the Medicare certification and accreditation process.

Accrediting Organizations

A hospice agency going through a CMS-approved national AO with deeming authority to obtain Medicare certification of the agency—s multiple location (with or without an inpatient unit) or inpatient unit (only after receiving its license for an ADS location) must complete and submit a Form CMS-855A to its Medicare Administrative Contractor (MAC). Once DADS receives the agency—s Form CMS-855A from the MAC with the approval, DADS notifies the parent hospice agency. After the agency receives notification from DADS, the agency must contact an AO to perform the federal health survey. After the AO conducts the federal health survey, the AO must send the federal survey results to CMS. CMS then sends the survey results to DADS. DADS must ensure that the following documents are received before forwarding the hospice agency—s request for Medicare certification to CMS for approval of a multiple location (with or without an inpatient unit) or inpatient unit only.

Multiple Locations (Deemed)

  • Medicare General Enrollment Form CMS-855A
  • MAC Approval Letter
  • AO Approval Letter
  • Documentation listed at State Operations Manual Section 2088

Inpatient Unit (Deemed)

  • Medicare General Enrollment Form CMS-855A
  • MAC Approval Letter
  • AO Approval Letter

CMS will either approve or deny the agency's application for Medicare certification of a multiple location (with or without an inpatient unit) or inpatient unit only and send a letter directly to the parent hospice agency's location. CMS will also send notification to DADS and DADS will enter the results of the CMS letter into the DADS database.

NOTE: A hospice may not bill Medicare for services provided from a new multiple location or new inpatient unit until the new location or unit has been approved by CMS.