Texas Day Activity and Health Services (DAHS) license: building, staffing and Medicaid

What Texas licenses, and what it calls it

Texas law calls the licensed setting a day activity and health services facility. It is a facility that provides a DAHS program “on a daily or regular basis but not overnight to four or more elderly persons or persons with disabilities who are not related by blood, marriage, or adoption to the owner”.⁠¹ Under the statute, an elderly person is 65 or older. A person with a disability is someone whose functioning is impaired enough to need frequent medical attention, counseling, therapy, equipment, or another person’s attendance and supervision.⁠¹ HHSC notes that these facilities “were previously called adult day care centers”. You will still see that older term in the building rules and in Medicaid handbooks.⁠³

The statute defines a DAHS program as a structured, comprehensive program for adults with functional impairments, delivered “through an individual plan of care by providing health, social, and related support services in a protective setting”.⁠¹ That is why Texas has no separate social-model adult day license. The single license comes with a nurse, a care plan for each client and a medication system. Operating an unlicensed facility is a Class A misdemeanor, and HHSC can ask a district court to stop it.⁠¹

A few boundaries matter when you plan the business:

• Adults only. HHSC describes DAHS as serving adults aged 18 or older. The eligibility handbook says facilities licensed as adult day care centers cannot serve anyone under 18.⁠⁴⁠⁶
• Ambulatory clients. For Life Safety Code purposes, a client “must be ambulatory or semi-ambulatory and must not be bedridden”. Clients also must not show behavior that is harmful to themselves or others.⁠²
• No overnight care. Once people stay overnight and receive personal care, you are in assisted living territory. See the Texas assisted living facility guide.
• In-home services are a different license. Personal care in clients’ homes falls under the HCSSA licenses. See the personal assistance services guide and the home health guide.
• Day habilitation for waiver clients now runs through DAHS licensing. See the ISS section below.

If you already hold another health care provider license, the statute entitles you to have inspections and renewals coordinated so that one inspection can cover several licensing requirements.⁠¹

The building decides your timeline

In Texas the physical plant is the first gate and usually the longest one. The applicant must “affirmatively demonstrate” compliance with the Life Safety Code, NFPA 101, 2000 edition, and with the construction standards in Subchapter C of Chapter 559.⁠² Chapter 16 of that edition (new day-care occupancies) applies to new construction, conversions of unlicensed buildings, remodeling and additions after April 1, 2007. Chapter 17 applies to facilities licensed before that date.⁠²

What the rules require on the drawings and in the field:

• Architect and engineer seals. Contract documents for new facilities, additions and remodeling must be prepared by a Texas-licensed architect. Structural, electrical, mechanical and sanitary sheets need a registered professional engineer’s seal. HHSC must be notified in writing before construction starts.⁠²
• Optional plan review. You can submit plans to HHSC before building. The statute and rule give HHSC 30 days to answer in writing. If the plans comply, HHSC cannot later change the architectural requirements for that project except for federal law or a project that is not finished within two years.⁠¹⁠² The review does not cover the Texas Accessibility Standards, which the Texas Department of Licensing and Regulation (TDLR) handles separately.⁠¹ The rules require plans for new construction and substantial renovation to go to TDLR for accessibility approval.⁠²
• Permanent construction. The facility must be a “recognized permanent type construction as distinguished from movable buildings”, on a permanent foundation.⁠²
• Fire protection. The fire alarm and smoke detection system must follow NFPA 72. A company registered with the State Fire Marshal’s Office must inspect, test and maintain it at least every six months, and the same applies to a full NFPA 13 sprinkler system. Mixed-occupancy buildings need one-hour fire barriers, and each client floor needs two remote exits.⁠²
• Plumbing and kitchen. You need at least one toilet and one lavatory per 15 clients, grab bars at every toilet, and at least one bathing unit. Kitchens follow the state food establishment rules, with a three-compartment sink if you wash dishes by hand.⁠² Hot water at client fixtures may not exceed 120°F.⁠²

Space is where many leased storefronts fail. Licensed capacity is calculated from usable floor area. The rule also requires several rooms that commercial leases rarely include.

Facilities licensed before October 1, 2000 may keep the older 35/50 square-foot standard. They lose that option if they increase capacity, change ownership or relocate.⁠² Plan your capacity number before you sign a lease: the license caps how many clients you may serve, and raising capacity later requires a new Life Safety Code survey.⁠²⁠³

Before the completed-building inspection, gather the documents the surveyor will ask for. These include written approval from the local fire marshal and building inspector, the State Fire Marshal’s Fire Alarm Installation Certificate, flame-spread documentation for finishes, sprinkler approval, alarm and sprinkler service contracts, gas line pressure test results, and an architect’s or engineer’s statement that the building meets the 2000 Life Safety Code and the licensing rules.⁠² Corridors that are too narrow, ceilings below 7 feet 6 inches, a missing telephone, or fire systems that are not working can each stop occupancy approval on the day.⁠²

Who you must hire

Chapter 559 names three positions every facility must fill, and it sets qualifications for each.⁠²

• Director. The director must meet one of these: a four-year degree plus one year working with people in a human service or medically related program; an associate degree or 60 semester hours plus three years of that experience; RN licensure plus one year of experience; or the training and experience to qualify as a nursing facility administrator. The director needs 12 hours of continuing education a year and must routinely work at least 40 hours a week on the DAHS program.⁠²
• Nurse. You need a Texas-licensed RN or LVN, and at least one nurse must work at the facility at least 8 hours a day. If the facility nurse is an LVN, an RN consultant must be on site at least four hours a week while clients are present.⁠²
• Activities director. A high school diploma or equivalent, plus one of: a bachelor’s degree and one year of full-time experience with older adults or people with disabilities; 60 semester hours and two years; or an activities director’s course and two years. The activities director must also routinely work 40 hours a week.⁠²

One person may not serve as nurse, activities director and director all at once.⁠² Beyond those roles, the direct service staff-to-client ratio must be at least one to eight during all services except facility-provided transportation. Attendants must be at least 18, and drivers need the right Texas Department of Public Safety (DPS) license class for the vehicle.⁠² Every facility must also get at least four hours a month from a dietitian consultant, who signs the lunch and snack menus. This applies even when meals are delivered by a contractor.⁠²

A change of director must be filed in TULIP within 30 days before or after the change. The new director’s qualifying documents go to the HHSC regional office in the same window.⁠²

Training, screening and written plans

Direct service staff need training in fire, disaster and evacuation procedures within three workdays of starting. They then need at least 18 hours of training in their first three months, covering CPR, first aid, personal care techniques, abuse and neglect reporting, and infection control. After that, they need at least three hours of training every quarter.⁠² Staff must keep CPR certification current, and you must run an evacuation drill with staff and clients once a month.⁠² If you serve anyone with Alzheimer’s disease or a related disorder, you need a written policy requiring dementia training that covers stages of the disease, person-centered behavioral interventions and communication.⁠²

Employment screening follows Health and Safety Code Chapter 250 criminal history checks. Before offering a job, you must also search the HHSC Nurse Aide Registry and the employee misconduct registry named in the rule, then repeat both searches at least every 12 months.⁠² Under Provider Letter 2026-10, DAHS facilities have used the Search Engine for Multi-Agency Reportable Conduct (SEMARC) inside TULIP for employability checks since August 3, 2026.⁠¹² HHSC told providers that SEMARC does not replace the criminal background check or the federal and state exclusion list (LEIE) checks.⁠¹²

The policies HHSC will look for at the health survey include:

• advance directive procedures;
• client rights under Human Resources Code Chapter 102, which apply to attendees aged 55 and older;
• communicable disease and tuberculosis screening policies;
• medication storage under lock, with Schedule II drugs in a separate locked, permanently attached compartment;
• record retention for five years after services end.⁠¹⁠²

You also need a written emergency preparedness and response plan. It must include a risk assessment and a section for each of eight core emergency management functions, and you must review it at least annually.⁠²

The licensing sequence in TULIP

All applications go through the Texas Unified Licensure Information Portal (TULIP).⁠³ The rules and HHSC’s October 2024 process map set this order:

1. Prepare the entity and property documents

   HHSC requires proof of your IRS tax ID and formation papers that fit your structure. A sole proprietor files a county assumed name certificate, and an LLC files its regulations. You also need evidence of your right to possess the building, such as a deed or lease, plus the names of the real estate owners of record.⁠²⁠³

2. Apply online with the fee

   HHSC only processes applications received at least 60 days before the requested license date. Its page asks that you submit the application 45 days before the building is expected to meet the Life Safety Code and architectural requirements.⁠²⁠³ Upload the local fire authority’s written approval and a dated notice to the local health authority that construction will be complete by a specific date.⁠²

3. Background review

   HHSC reviews the applicant, everyone with a disclosable interest, affiliates and controlling persons. It will not license a new facility if any of them had a revocation, a Medicare or Medicaid exclusion, or a court injunction in the past five years.⁠² HHSC tells you within 30 days if the application is incomplete. It may deny an application that stays incomplete for 120 days.⁠²

4. Life Safety Code inspection

   Tell HHSC in TULIP that you are ready, either with the application or within 120 days of filing it. HHSC creates your federal ASPEN facility ID and sends the regional office to inspect.⁠²⁠⁵ If you do not meet the requirements within 120 days after that first inspection, the application is denied.⁠²

5. Admit one to three clients

   Once the building is approved, you may admit at least one but no more than three people. You then notify HHSC that you are ready for the health inspection.⁠²⁠³

6. Health survey

   This unannounced inspection checks operations and client care against Subchapter D. Failing to meet those standards within 120 days of the first health inspection also leads to denial.⁠²⁠³

7. License issued

   HHSC issues the three-year license within 30 days after it finds all requirements met, and it sends the license by email.⁠²⁠¹⁰ Post it in a public area of the facility.⁠²

If HHSC misses its own processing deadlines, 26 TAC 559.15 lets you ask the program director for a full refund of the filing fee. It also lists the good-cause exceptions HHSC can use to deny the refund.⁠²

Fees and filing windows

The fee figures do not all agree. Human Resources Code §103.007 still says $75 for an initial license and $50 for a renewal.⁠¹ HHSC’s fee page repeats the $75 three-year fee and also mentions a $50 fee for a two-year license tied to renewal procedures.⁠³ The official sources do not say which fee applies to a standard renewal. The $50 figure is tied to a two-year license issued under the renewal procedures rule, so ask HHSC Licensing and Credentialing (512-438-2630) which amount and license term apply to you before you pay.

Inspections, renewal and changes after licensure

The statute and rule require HHSC to inspect each facility at least every two years after the initial inspection.⁠¹⁠² HHSC’s provider page says DAHS facilities are inspected yearly.⁠³ In either case, care-related visits are generally unannounced.⁠² Complaints alleging abuse, neglect or exploitation must be inspected within 14 days, and other complaints investigated within 45 days.⁠¹ After an inspection, you have 10 working days to file a plan of correction. You also have 10 days from receiving the statement of violations to request informal dispute resolution.⁠²

Administrative penalties can reach $500 per violation, and each day counts as a separate violation. For many violations you can avoid the penalty by correcting the problem within 45 days of notice. That option does not apply to violations involving actual harm, immediate threats, or widespread staffing, medication or emergency-preparedness failures.⁠¹

Renewal applications appear in TULIP 120 days before expiry.⁠³ Paying the fee or passing a renewal survey does not renew the license on its own. HHSC will not accept a renewal after the expiration date, so a missed deadline means starting over with an initial application.⁠² Each renewal needs the latest annual local fire marshal inspection report and a letter notifying the local health authority.⁠²

Other events need HHSC approval or notice:

• Change of ownership. A change in tax ID counts as a change of ownership. The license cannot be transferred: the buyer files a signed, notarized change of ownership affidavit and receives a 90-day temporary license, followed by a three-year license.⁠²⁠³ The rule names the affidavit as HHSC Form 1092, while HHSC’s how-to page links Form 3725; confirm which form TULIP asks for.⁠²⁠³
• Relocation. Clients may not move until the new building passes the Life Safety Code inspection.⁠²
• Information changes. Changes in ownership interests or management must be reported in TULIP within 30 days.⁠³
• Permanent closure. Give at least five days’ written notice and say where client records will be kept.⁠²

How Texas DAHS facilities get paid

The license only lets you operate. Public funding comes through separate contracts, and HHSC says a provider “must be licensed as a DAHS facility to apply for an HHS contract”.⁠³ HHSC’s DAHS page lists the federal authorities behind the program as Title XIX (42 CFR 440.130(d)) and Title XX (45 CFR Part 96).⁠⁴

• Title XIX and Title XX contracts with HHSC. Medicaid recipients are financially eligible for Title XIX DAHS. People without Medicaid who meet the Community Care Services Eligibility income and resource limits qualify for Title XX DAHS.⁠⁶ Only providers with Title XX contracts may serve Title XX clients, and each region decides based on available funding.⁠⁸ Contracting follows 26 TAC Chapter 52. You apply to the Community Care Services Contracts Unit using the Form 5830 checklist, and you must complete program orientation before HHSC puts you on the regional choice list.⁠³
• STAR+PLUS managed care. DAHS is a Medicaid state plan service for STAR+PLUS members. To serve them, a facility must be licensed, credentialed by the managed care organization (MCO) and hold an MCO contract.⁠⁷ The state plan limits DAHS to 10 hours a day and 230 hours a month. It must be reauthorized at least every 12 months, and authorization cannot rest on a primary diagnosis of mental illness or intellectual disability.⁠⁷

The unit of service is half a day: three to under six hours counts as one unit, six hours or more counts as two, and no one may be authorized for more than 10 units a week.⁠⁶ Contracted facilities must offer services at least 10 hours a day, Monday through Friday, except holidays. The service includes a hot midday meal served between 11 a.m. and 1 p.m. that should supply one-third of the adult recommended daily allowance.⁠⁶ Clients qualify through a chronic medical diagnosis, a physician’s order on Form 3055, and a health assessment on Form 3050 showing a functional limitation and the potential for therapeutic benefit.⁠⁶ For Medicaid recipients, a facility can admit a client before HHSC approves the case, but it takes the revenue risk if the person is found ineligible.⁠⁶

Individualized Skills and Socialization: the second use of this license

On March 1, 2023, Texas replaced day habilitation in the HCS, TxHmL and DBMD waivers with a new service called Individualized Skills and Socialization (ISS).⁠¹¹ HHSC made the change to meet the federal CMS rules on home and community-based settings. ISS licensing rules are in 26 TAC Chapter 559, Subchapter H, effective January 1, 2023.⁠¹⁰ As a result, former day habilitation providers now license through the DAHS program, even though their clients do not fit the traditional DAHS model.

HHSC offers three license types:⁠¹⁰

• DAHS: traditional DAHS only.
• DAHS with ISS: traditional DAHS plus ISS.
• DAHS-ISS Only: ISS services only.

A plain DAHS license does not authorize ISS. HCS, TxHmL and DBMD providers that deliver ISS directly need one of the two ISS licenses, including providers that only offer off-site services. Each on-site location needs its own license.⁠¹⁰ Licensed capacity counts everyone served at one time, whatever the funding source.⁠¹⁰ ISS applicants must complete HHSC’s ISS provider training and TULIP training before applying.⁠⁹

Since September 9, 2024, HHSC has issued temporary initial licenses to DAHS-ISS Only applicants before the health survey. Traditional DAHS and DAHS with ISS applicants still need the Life Safety Code survey, one to three admissions and a passing health survey before licensure.⁠¹⁰ Subchapter H requires an administrator with a written delegation policy, and service providers must be 18 or older with a high school diploma or a documented competency evaluation with three written references. Off-site staffing ratios come from the waiver program rules (26 TAC 260.507, 262.917 and 263.2017), and on-site you must keep enough staff for health, safety and each person’s plan. Subchapter H also requires a written emergency response plan reviewed at least annually.⁠² The subchapter has no square-footage or Life Safety Code standard, so ask HHSC which building approvals apply to an on-site ISS location before you lease space.

Recent and pending changes

• July 10, 2024 rule rewrite. Most of Subchapters B and D, including fees, staffing, training and application procedures, took their current form on July 10, 2024 (49 TexReg 4910 and 4914).⁠² The construction sections in Subchapter C still refer to the former Department of Aging and Disability Services (DADS), so read them alongside the newer sections.⁠²
• SEMARC in TULIP since August 3, 2026. DAHS and DAHS-ISS providers now check employability through TULIP. The Nurse Aide Registry search is still required.⁠¹²
• Training and emergency communication. HHSC’s July 2026 provider webinar reminded ISS providers that training for service providers on abuse, neglect and exploitation must be held at least biannually (26 TAC 559.227). DAHS directors and their designees, and the service provider or designee at DAHS-ISS facilities, must also sign up for the AlertMedia emergency notification system.⁠¹²
• Chapter review. The sources checked do not show whether HHSC has proposed further amendments to Chapter 559, so check the Texas Register and ask HHSC before relying on the rule text above.

For other Texas care licenses, see the Texas state overview.

Sources

1. 1
   Texas Legislature, Texas Human Resources Code, Chapter 103: Day Activity and Health Services Checked 12 Oct 2026 · Back to text ↑
2. 2
   Texas Secretary of State, Texas Administrative Code, Title 26, Part 1, Chapter 559: Day Activity and Health Services Requirements Checked 12 Oct 2026 · Back to text ↑
3. 3
   Texas Health and Human Services Commission, How to Become a Day Activity and Health Services (DAHS) Provider Checked 12 Oct 2026 · Back to text ↑
4. 4
   Texas Health and Human Services Commission, Day Activity and Health Services (DAHS) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Texas Health and Human Services Commission, Licensure process map: DAHS or DAHS with Individualized Skills and Socialization, Initial (10/2024) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Texas Health and Human Services Commission, Community Care Services Eligibility Handbook, 4200: Day Activity and Health Services Checked 12 Oct 2026 · Back to text ↑
7. 7
   Texas Health and Human Services Commission, STAR+PLUS Handbook, 10100: Long Term Services and Supports Checked 12 Oct 2026 · Back to text ↑
8. 8
   Texas Health and Human Services Commission, Day Activity and Health Services Provider Manual, 3000: Eligibility Requirements Checked 12 Oct 2026 · Back to text ↑
9. 9
   Texas Health and Human Services Commission, Individualized Skills and Socialization Checked 12 Oct 2026 · Back to text ↑
10. 10
    Texas Health and Human Services Commission, Individualized Skills and Socialization: Frequently Asked Questions (revised 09/02/2025) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Texas Health and Human Services Commission, Your Day Habilitation Service is Changing (revised 03/2023) Checked 12 Oct 2026 · Back to text ↑
12. 12
    Texas Health and Human Services Commission, DAHS and ISS Provider Webinar with LTCR, July 30, 2026 (presentation) Checked 12 Oct 2026 · Back to text ↑

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