Starting a home health business in Texas requires a Home and Community Support Services Agency (HCSSA) license issued by the Texas Health and Human Services Commission (HHSC). The initial license covers three years and costs $2,625 for a parent agency or branch location. Before you file paperwork or hire staff, you need to choose a business structure, complete mandatory training, and prepare an application that meets specific staffing and operational standards.
Choose Your Service Category
Texas doesn’t issue a one-size-fits-all home health license. When you apply through the Texas Unified Licensure Information Portal (TULIP), you must select one or more service categories that match the care you plan to provide. Your options are:
- Personal Assistance Services (PAS): Non-medical help with daily living activities like bathing, dressing, meal preparation, and light housekeeping. This is the simplest category and requires the least clinical staffing.
- Licensed Home Health Services (LHHS): Skilled nursing, physical therapy, occupational therapy, speech therapy, and medical social services delivered in a patient’s home. This category requires licensed clinical staff.
- Licensed and Certified Home Health Services (L&CHHS): The same skilled services as LHHS, but with Medicare certification. If you want to bill Medicare for patient care, you must select this category.
- Home Dialysis Designation: An add-on to either LHHS or L&CHHS for agencies that will provide home dialysis services.
- Hospice Services: End-of-life care, available in both Medicare-certified and non-Medicare versions.
You cannot provide services outside your licensed categories. If you start with PAS and later want to offer skilled nursing, you’ll need to add the appropriate category to your license. Many new owners begin with Personal Assistance Services because it has lower startup costs and simpler staffing requirements, then expand into licensed or certified categories as the business grows.
Set Up Your Business Entity
Before applying for a HCSSA license, you need a legally formed business. Most home health agencies in Texas operate as a limited liability company (LLC) or corporation. File your formation documents with the Texas Secretary of State, obtain a federal Employer Identification Number (EIN) from the IRS, and register for applicable state taxes with the Texas Comptroller of Public Accounts.
You’ll also want a dedicated business bank account and a physical office location. HHSC requires your agency to have an identifiable office where records are maintained and staff can be reached. A home office can work in some cases, but it must meet the state’s requirements for accessibility and record storage.
Complete Mandatory Presurvey Training
Texas requires specific staff members to complete computer-based presurvey training before you can even submit your license application. HHSC will reject application packets that don’t include signed training certificates.
If you’re applying for Personal Assistance Services only, your designated administrator and alternate administrator must both complete the training. For all other service categories, four people need to complete it: your administrator, alternate administrator, supervising nurse, and alternate supervising nurse.
Every trainee must complete Module 1 (Introduction) and Module 2 (General HCSSA Licensure Standards). Beyond those two core modules, each trainee must also complete the module that corresponds to your chosen service category. Module 3 covers Personal Assistance Services, Module 4 covers Licensed Home Health Services, Module 5 covers Licensed and Certified Home Health Services, Module 6 covers Hospice, and Module 7 covers Home Dialysis. After finishing each module, print the verification certificate, sign it, keep a copy, and include a copy in your application packet.
Administrators and alternate administrators also have separate educational training requirements outlined in the Texas Administrative Code. HHSC offers an OASIS training class worth six clock hours that counts toward partial fulfillment of those administrator training hours.
Designate Qualified Leadership
Your administrator is the person responsible for the day-to-day management of the agency and must meet qualifications set out in the Texas Administrative Code (26 TAC ยง558.244). The qualifications vary by service category but generally combine education and relevant healthcare or management experience. You’ll also need an alternate administrator who meets the same standards and can step in when the primary administrator is unavailable.
For agencies offering licensed or certified services, you must designate a supervising nurse and alternate supervising nurse. These are registered nurses who oversee clinical operations, ensure care plans are followed, and supervise other clinical staff. PAS-only agencies are not required to have a supervising nurse.
Apply Through TULIP
All HCSSA license applications are submitted through the Texas Unified Licensure Information Portal (TULIP). Your application packet must include:
- The completed application with your selected service categories
- Signed presurvey training certificates for all required staff
- Documentation of administrator qualifications
- The initial licensing fee of $2,625 for a parent agency or branch (or $1,500 for an alternate delivery site)
After HHSC receives your application, they review it for completeness and schedule an initial survey (inspection) of your agency. During this survey, inspectors verify that your office, policies, staffing, and operational procedures comply with state regulations. You should have your policies and procedures manual, emergency plans, infection control protocols, and personnel files in order before the survey takes place.
Licensing Fees and Ongoing Costs
The $2,625 initial fee covers a three-year license period. When it’s time to renew, you’ll pay $1,750 for a two-year renewal or $2,625 for a three-year renewal. Submit your renewal application at least 45 days before your license expires. Late renewal applications trigger an additional fee of $875 (two-year) or $1,312.50 (three-year).
Beyond the license itself, most operational changes require a $30 reporting fee to the HCSSA Licensure Unit. If you fail to report a change on time, you’ll owe a $100 late fee on top of the $30 standard fee. Changes of ownership carry their own fee schedule, with costs starting at $1,500.
Budget for other startup costs as well. You’ll need general liability insurance and professional liability (malpractice) coverage for clinical staff. If you plan to enroll as a Medicaid provider, HHSC may require a surety bond of at least $50,000 from a company licensed by the Texas Department of Insurance. Workers’ compensation insurance, while not legally mandated for all Texas employers, is strongly expected in healthcare settings and often required by contracts with managed care organizations.
Hire and Credential Your Staff
Your staffing needs depend on which service categories you selected. A PAS-only agency can operate with attendants who provide non-medical care, supervised by your administrator. An agency offering licensed home health services needs registered nurses, licensed vocational nurses, and potentially therapists, all of whom must hold active Texas licenses.
Every employee must pass a criminal background check through the Texas Department of Public Safety and the federal Office of Inspector General exclusion list. Texas law requires these checks before staff have direct contact with clients. You’ll also need to verify professional licenses, maintain training records, and ensure all clinicians meet continuing education requirements.
Pursue Medicare or Medicaid Enrollment
A HCSSA license alone doesn’t let you bill Medicare or Medicaid. These are separate enrollment processes with their own requirements.
For Medicare, you must hold a Licensed and Certified Home Health Services (L&CHHS) license category. After receiving your state license, you apply for Medicare certification through the Centers for Medicare and Medicaid Services (CMS). This triggers a federal survey conducted by HHSC on behalf of CMS to verify you meet the Medicare Conditions of Participation. The process can take several months.
For Texas Medicaid, you enroll through the Texas Medicaid and Healthcare Partnership (TMHP). Medicaid enrollment requires a valid HCSSA license and compliance with additional provider agreement terms. Many Medicaid home health services in Texas are delivered through managed care organizations, so you’ll also need to negotiate contracts with one or more of the state’s Medicaid managed care plans to receive patient referrals.
Build Your Referral Network
Having a license and enrolled payer status means nothing without patients. Home health referrals primarily come from hospitals, physicians, skilled nursing facilities, and case managers. Start building relationships with discharge planners at local hospitals, primary care practices, and specialists who treat patients with chronic conditions. Many referral sources want to see that you are licensed, insured, bonded (if applicable), and enrolled with the relevant payers before they’ll send patients your way.
Joining your local home health association and attending healthcare networking events helps establish credibility. An online presence matters too. Many families search for home health agencies by name or location after receiving a referral, and a professional website with clear information about your services, service area, and accepted insurance gives them confidence to follow through.