Texas Home Care, Home Health & Hospice Licensing
Texas has no Certificate of Need and no moratorium. New HCSSA applications are accepted year-round through the TULIP portal.
Licensing in Texas
Every home care, home health, and hospice provider in Texas needs an HCSSA license under Texas Health & Safety Code Chapter 142 and 26 TAC Chapter 558. There is no Certificate of Need and no moratorium. One HCSSA framework covers all service types; the category you pick sets what you can provide.
License routes we cover in Texas
Personal Assistance Services (PAS)
Non-medical agencies giving attendant and personal care with daily living tasks. No nurses required.
Licensed Home Health Services (LHHS)
Agencies giving skilled nursing and therapy under physician orders. State-licensed only, not Medicare-certified.
Licensed and Certified Home Health Services (L&CHHS)
Hold the Texas HCSSA license plus CMS certification. Bill Medicare and Medicaid (STAR+PLUS, STAR Kids).
Hospice Services
End-of-life palliative care. Medicare-certified (federal survey) or non-Medicare. Under its own 26 TAC 558 subchapter.
How we get you licensed
- 1Form your business and meet state prerequisites
Register your LLC or corporation with the Texas Secretary of State and get good-standing status from the Texas Comptroller first.
- 2Appoint and train required staff
Appoint an administrator and alternate. Home health and hospice also add supervising nurses. All must pass the HHSC Pre-Survey CBT (80%) with signed certificates.
- 3Submit your application through TULIP
Submit HHSC Form 2021 in TULIP and pay the non-refundable $2,625 three-year fee. Under 26 TAC §558.31, HHSC reviews in 45 days; you have 30 days to fix deficiencies, then HHSC takes up to 45 more.
- 4Admit a client and report survey readiness
Your three-year license issues. Within six months, admit one client and file HHSC Form 2020. For Medicare, L&CHHS agencies need 10 patients served, with 7 active on survey day.
- 5Pass the HHSC initial health survey
HHSC inspects records, policies, and service delivery against 26 TAC Chapter 558. The administrator or alternate must attend; the supervising nurse must be reachable. Accreditation through CHAP, ACHC, or The Joint Commission can replace this survey.
- 6Get Medicare certification (L&CHHS and Hospice only)
HHSC is not doing initial Medicare certification surveys now. Use a CMS-approved accreditor with deeming authority (ACHC, CHAP, or The Joint Commission). One combined survey meets both. Bill Medicare only after CMS issues your certification number.
How long does it take?
Typical time to a live license in Texas. Times assume a complete, accurate application; missing items add time.
- Personal Assistance / Licensed Home Health
- 3 to 6 months
- Licensed & Certified HH or Hospice (Medicare)
- 5 to 10 months total
Key Texas requirements
- Register with the Texas Secretary of State and hold Texas Comptroller good-standing before applying.
- All administrators, alternates, and supervising nurses must pass the HHSC Pre-Survey CBT (80% per module) and submit signed certificates.
- Administrator qualifications vary by category. PAS: high school diploma/GED plus one year of experience or training caring for people with functional disabilities, or two years of full-time college in a health-related field. Home health and hospice: a licensed clinical professional or nursing home administrator with one year of supervisory experience, or a high school diploma/GED with two years of management or supervisory experience in a health-related setting.
- Admit at least one client and submit Form 2020 (Notification of Readiness for Initial Survey) within six months of license issuance.
- The initial license fee is $2,625 (non-refundable) for a three-year parent or branch license; renewal is also $2,625 for three years.
- L&CHHS agencies must meet federal Medicare Conditions of Participation; since HHSC is not doing initial certification surveys, a CMS-approved accreditor survey is required before Medicare billing.
Traps that catch new owners
- Not admitting a client within six months is common; HHSC needs an active client to survey, and the clock never pauses.
- Copied or generic policy manuals cause many deficiencies; there is no template, and surveyors check they match your real operations under 26 TAC 558.
- Picking LHHS when you plan to bill Medicare is a costly error; choose L&CHHS at initial application if Medicare is the goal.
- Do not assume HHSC will run your Medicare certification survey; it is not, so budget for a CMS-approved accreditor (ACHC, CHAP, or The Joint Commission).
Texas licensing packages
Fixed price, agreed in writing before any work begins. Each package is prepared and submitted for you, fully online.
Texas Licensed and Certified Home Health Services license: Fixed-Price Application Support
Texas licensing FAQs
Does Texas require a Certificate of Need or have a moratorium?
No. Texas has no Certificate of Need for home care, home health, or hospice, and HHSC sets no enrollment moratorium. Applications are accepted year-round through TULIP.
Can one HCSSA license cover several service categories?
Yes. One HCSSA license can cover several categories chosen at application. But the personnel, training, and compliance rules apply separately to each. An agency offering both PAS and licensed home health must meet the requirements for both.
Is accreditation (ACHC, CHAP, or Joint Commission) required or optional?
For the state HCSSA survey, accreditation is optional; you can request a direct HHSC survey. But for Medicare certification it is effectively required, since HHSC is not doing initial certification surveys. One combined accreditor survey meets both the state and CMS requirements.
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