Home Care Agency Licensure in Texas

One statute, four categories. A Texas HCSSA license (Health & Safety Code ch. 142; 26 TAC ch. 558) is issued in categories: Licensed Home Health (LHH), Licensed and Certified Home Health (L&CHH, Medicare), Personal Assistance Services (PAS, non-medical), and Hospice — agencies pick categories matching their services. Source ↗

Licensing agency. Texas Health and Human Services Commission (HHSC) Long-Term Care Regulation licenses and surveys HCSSAs; applications run through the TULIP online licensure system. Source ↗

Three-year license. HCSSA licenses run on a three-year cycle with fees of roughly $2,600 per license period plus branch-office fees; a pre-survey computer-based training and a designated administrator/alternate meeting ch. 558 qualifications are prerequisites. Source ↗

Survey process. New agencies get an initial on-site survey after serving clients (within the first license period); thereafter HHSC conducts unannounced standard surveys at least every three years plus complaint/self-report investigations, with statements of deficiencies requiring plans of correction under Subchapter G (Licensure Surveys) and Subchapter H (Enforcement). Source ↗

Employee screening. HCSSAs must run Employee Misconduct Registry and Nurse Aide Registry checks plus criminal history checks under Tex. Health & Safety Code ch. 250 before hiring unlicensed staff — a standard survey focus. Source ↗

Statutes and rules hub. HHSC maintains a consolidated HCSSA statutes and rules page (ch. 142, 26 TAC 558, and related requirements) — the authoritative starting point for survey-readiness policy work. Source ↗

No federal home care license. There is no federal license for home care or home health agencies. Licensure is a state function: each state (and DC) decides whether and how to license home health agencies and non-medical personal care/companion agencies, so requirements vary dramatically by jurisdiction. Source ↗

Medicare certification (42 CFR Part 484). Agencies that bill Medicare for skilled home health must be certified as meeting the Medicare Conditions of Participation at 42 CFR Part 484 (patient rights, comprehensive assessment, QAPI, skilled professional services, home health aide standards, and more), on top of any state license. Source ↗

Accreditation with deemed status. Most new Medicare home health agencies obtain certification through a CMS-approved accrediting organization with deeming authority — ACHC, CHAP, or The Joint Commission — whose surveys substitute for the state agency's Medicare certification survey. Source ↗

State survey agencies enforce both. State survey agencies (usually the state health department) operate under agreements with CMS to survey Medicare-certified agencies, and most also run the state licensure survey program — initial surveys, renewal/recertification surveys, complaint investigations, and plan-of-correction enforcement per the CMS State Operations Manual. Source ↗