Texas Health and Human Services licenses, certifies and surveys home and community support services agencies for compliance with state and federal laws and regulations. Through these regulatory activities, HHS protects Texas citizens receiving home health, hospice and personal assistance services.
What is a HCSSA?
Home and community support services agencies provide services to people in a residence or independent-living environment such as:
- Physical, occupational, speech, respiratory or intravenous therapy
- Social services
- Personal assistance services
- Nutritional counseling
- Terminal and palliative care (through hospice agencies)
What is Hospice?
Hospice is a program of palliative care consisting of medical, social and support services to terminally ill patients, when curative treatment is no longer possible. Hospice agencies and inpatient facilities provide intervention services that focus primarily on the reduction or abatement of physical, psychological or spiritual symptoms of a terminal illness for people under their care. They also provide support services for people they're caring for and their families.
Becoming Licensed in Texas
HCSSAs must be licensed to operate in Texas. To become licensed, an agency must:
- Complete the pre-survey, computer-based training.
- Properly complete the license application.
- Upload all required documents.
- Pay the required license fee(s).
- Be registered with and be in good standing from the State Comptroller of Public Accounts.
- Be registered with and be in good standing from the Secretary of State of Texas.
- Be approved by HHS/HCSSA Licensure and Certification Unit.
Types of Applications
An initial application is an application that has never been issued an HHS license number to operate in Texas. Changes of ownerships are also considered an initial application.
Change of Ownership
A change of ownership happens when the agency changes the tax identification number.
A renewal application for a current license holder must be submitted on or before the licensure expiration date. A late fee can apply. Any application submitted after the licensure expiration date will not be accepted.
Changes of Information
If certain information provided on an initial or renewal application changes after HHS issues the license, an agency must report the change to HHS/HCSSA Licensing unit. The agency must use the appropriate Home and Community Support Services Agency License Application, (Form 2021, 2024 and 2025), to report the change. To avoid a late fee, a change must be reported within the time frame specified for the type of change.
- Initial licensing fees: $1,750 for each parent agency, branch or change of ownership and $1,000 for each alternate delivery site.
- Renewal licensing fees: $1,750 for each parent agency, branch and a license renewal fee for each alternate delivery site of $600.
- A renewal late fee of $875, in addition to the licensing fee, will be assessed if the renewal application for each parent agency and branch is submitted less than 45 days before the licensure expiration date with a renewal late fee of $300, in addition to the license fee for each alternate delivery site if submitted less than 45 days before the licensure expiration date.
- A late fee of $250 for each license, in addition to the licensing fee, will be assessed if the change-of-ownership application is submitted less than 30 days before the effective date of the change of ownership.
- All HCSSAs must pay a $30 standard fee when reporting most changes to HHS/HCSSA Licensure Unit.
- If a HCSSA does not report a change of information in a timely manner to the HHS/HCSSA Licensure Unit, the HCSSA must pay a late fee of $100, if applicable. This late fee is in addition to the $30 fee, if applicable.
Category of Services
Licensed and Certified Home Health
Must accept a person for home health services based on a reasonable expectation that their medical, nursing and social needs can be met adequately in their residence. Certified home health agencies must comply with the requirements of the Social Security Act and the regulations in Title 42 of the Code of Federal Regulations, Part 484.
Licensed Home Health
Must accept a person for home health services based on a reasonable expectation that the their medical, nursing and social needs can be met adequately in their residence.
Licensed and Certified Home Health with Home Dialysis Designation
Must accept a person for home health services based on a reasonable expectation that their medical, nursing and social needs can be met adequately in the client's residence. For a residence to receive a home dialysis designation, it must meet the licensing standards specified in Texas Administrative Code §97.405. Certified Home health agencies must comply with the requirements of the Social Security Act and the regulations in Title 42 of the Code of Federal Regulations, Part 484.
Licensed Home Health with Home Dialysis Designation
Must accept a person for home health services based on a reasonable expectation that their medical, nursing and social needs can be met adequately in their residence. For a residence to receive a home dialysis designation, it must meet the licensing standards specified in 40 TAC §97.405.
Services, including those provided by unlicensed personnel under the delegation of a registered nurse or physical therapist, provided to the person in care or their family as part of a coordinated program. These services include palliative care for terminally ill people and support services for them and their families. Hospice services are available 24 hours a day, seven days a week.
Personal Assistance Services
Routine ongoing care or service required by a person in a residence or independent-living environment that enables them to engage in the activities of daily living or to preform functions required for independent living, including respite.
Time Frames for Applications
An application from an agency for an initial, renewal and change of ownership: parent, branch office or alternate delivery site license is processed in accordance with three general time frames:
- Upon receipt of a thoroughly complete application in the HHS/HCSSA Licensing unit has up to 45 days to process the application.
- If HHS/HCSSA Licensing unit receives an incomplete application, the HHS/HCSSA Licensing unit will notify the HCSSA applicant in writing using the parent agency email address of any deficient items in the application. The applicant must respond with complete and correct information within 30 days from the date of notification or the application will be denied.
- Upon receipt of the application deficiency response in the HHS/HCSSA Licensing unit, the licensing unit will issue or deny the license within 45 days unless other matters prevent the approval or denial of the application, for example a pending survey or enforcement recommendation.
NOTE: After an initial license is issued, the agency must notify the HHS regional office upon enrolling its first person under their care (If more than one category, the agency must enroll and provide surveys to the highest category) and request an initial health survey using the HHSC Form 2020, Notification of Readiness for Initial Survey. This survey request must be completed within six months of the issuance of the initial license. After an agency is issued a new change-of-ownership license, the agency must notify the HHS regional office within six months of the effective date of their new license. After an initial license is issued for an alternate delivery site with or without an inpatient unit, the hospice agency must notify the HHS regional office upon enrolling its first person under their care and request an initial health survey.
Changes of Information
Changes in Physical Location or Mailing Address
An HCSSA must not transfer a license from one location to another without prior notice to HHS. Changes in a physical address must be submitted in writing no later than 30 days before the effective date of the change, unless HHS grants the HCSSA an exemption from the 30-day time frame as specified in 40 TAC §97.213(b).
Changes in Phone Number or Operating Hours
Changes in phone number or operating hours must be submitted in writing no later than seven days after the change.
Fax Number and Email Address
Report as soon as possible.
Change in HCSSA Name
If a HCSSA intends to change its name (legal entity or doing business as) but does not undergo a change of ownership, the HCSSA must report the name change no later than seven days after the effective date of the name change. Attach copies of the legal documents pertaining to legal entity or doing business as change.
Change in Certification Status
If a HCSSA decides to voluntarily withdraw from the Medicare program, the HCSSA must notify HHS in writing no later than five days after the decision to withdraw is made. A HCSSA should use HHS Form 2021 to provide written notice.
Changes in Management Personnel
Changes in administrator, alternate administrator or chief financial officer must be submitted in writing no later than seven days after the date of change. Additional documentation might be required.
Changes in Controlling Person
Changes in controlling person (stock transfers) as defined in 40 TAC §97.2 must be submitted in writing no later than seven days after the date of change. Attach copies of the legal and notarized documents pertaining to the stock transfer.
Adding or Deleting Service Categories
To add or delete a category of service to its license, a HCSSA must submit written notice at least 30 days before the addition or deletion of the category of service. Additional documentation is required for adding the categories of home health or hospice.
Expanding or Reducing Service Areas
A HCSSA can expand its service area at any time during the licensure period by submitting written notice at least 30 days before the expansion. A HCSSA can reduce its service area at any time during the licensure period by submitting written notice no later than 10 days after the reduction.
A HCSSA must notify HHS in writing within five days before the permanent closure of the HCSSA, branch office or alternate delivery site.
Parent, Branch, Alternate Delivery Site and Medicare Branch Applications
Visit the TULIP website to access the applications and instructions page.
- Form 2021, Home and Community Support Services Agency Application for Parent (initials, renewals, change of ownership and changes of information to the parent agency), fees are non-refundable.
- Form 2023, Home and Community Support Services Agency Application for Initial Medicare Certified Branch, fees are non-refundable.
- Form 2024, Home and Community Support Services Agency Request for an Alternate Delivery Site License (initials, renewals, change of ownership and changes of information to the alternate delivery site, to include In-patient unit), fees are non-refundable. An Inpatient Hospice unit must contact the HHS Architectural Unit at 512-438-2311 to request a Life Safety Code survey before approval and an Impatient Hospice unit must notify their HHSC regional office upon enrolling its first person under their care and request an initial health survey.
- Form 2025, Home and Community Support Services Agency Request for a Branch License, (initials, Renewals, Change of Ownership and Changes of Information to the branch office), fees are non-refundable.
Rules and Statutes
HCSSA providers are responsible for reading and understanding these regulations before becoming a licensed provider.
Participation in the state and federal Medicaid program and federal Medicare program is voluntary. However, each agency must be certified for the appropriate Medicare program before serving people who are eligible.
Attention: Applicants seeking an initial parent or alternate delivery site license to provide licensed and certified home health or hospice services (authorization to provide services to people using Medicare services) should read Provider Letter No. 15-09, Direction from the Centers for Medicare & Medicaid Services (CMS) on Prioritization of Initial Medicare Certification Surveys (Home Health) [PDF] and Provider Letter No. 15-10, Direction from the Centers for Medicare & Medicaid Services (CMS) on Prioritization of Initial Medicare Certification Surveys (Hospice) [PDF].
Required Documents for Medicare Certification
These documents are required if the agency is seeking certification or is currently certified through the Medicare program.
- Printed CMS 855A Home Health Enrollment Application (PDF) [Please read the instructions for how to submit this form to the fiscal intermediary].
- Online CMS 885A Home Health Enrollment Application.
- CMS 1561 Health Insurance Benefit Agreement (PDF) [with original signatures, completing the entire top half and signing under "Accepted for the provider of services by"].
- Civil Rights Clearance for Medicare Provider Applicants (copy of evidence of successful electronic submission through HHS Assurance of Compliance portal).
- CMS 417 Hospice Request for Certification in the Medicare Program (PDF) [with original signatures] only if requesting the category of certified hospice.
Attention: Home health and Hospices agencies that are (1) initially enrolling in Medicare, (2) adding a branch or multiple location, or (3) revalidating their enrollment information, must submit with their CMS 855 application:
- Verification of the application fee in an amount prescribed by CMS and/or
- A letter for a request for a hardship exception to the application fee.
The provider must pay the application fee electronically through Pay.gov, with a credit or debit card. The application fee applies to CMS 855 applications that the agency's Regional Home Health Intermediary/Medicare Administrative contractor.
The following links provides additional information and the current application fee process:
- Medicare Enrollment Application
- Hospice Request for Certification in the Medicare Program (PDF)
- Health Insurance Benefit Agreement for Medicare Home Health (PDF)
- Medicare Conditions of Participation for Home Health and Hospice
- Office for Civil Rights
- Email the Oasis Help Desk
- Texas Department of Public Safety
- HCSSA Training Classes
- Board of Nursing
- Taxable Entity Search