Texas home health license: the HCSSA home health categories, step by step

Medicare enrollment has been closed since May 13, 2026

Start here, because it changes the business plan. On May 13, 2026, CMS imposed a nationwide moratorium on the Medicare enrollment of home health agencies. Unless a Medicare contractor received your enrollment application before that date, CMS will not enroll a new home health agency, a new branch or a new practice location anywhere in the United States, Texas included.⁠¹⁵ The moratorium runs for six months and can be extended in six-month increments. Any extension or lifting will be announced in the Federal Register.⁠¹⁵⁠¹⁷

What it means for a Texas founder:

• The state license is still available. The moratorium covers Medicare enrollment only. HHSC still issues HCSSA licenses, so you can open as a licensed (not certified) home health agency and serve clients who do not need Medicare billing.⁠⁶⁠¹⁵
• Applications filed during the moratorium are denied. A CMS-855A filed now is denied and has to be filed again after the moratorium ends. If you paid the Medicare application fee, it is refunded when the denial is due to the moratorium. An appeal can argue only that the moratorium does not apply to you.⁠¹⁵⁠¹⁷
• Accreditation does not get you around it. During the moratorium, accreditation by a CMS-approved accrediting organization will not give a new agency Medicare deemed status. CMS will also not approve a new branch for an existing deemed agency.⁠¹⁸
• Buying a young agency counts as new. A change in majority ownership within 36 months of an agency’s initial enrollment, or of its last such change, makes the agency enroll again as new, so that purchase is caught by the moratorium too. CMS does not grant individual exceptions.⁠¹⁷
• There is a screening penalty after it ends. For six months after the moratorium is lifted, agencies that apply will be screened at the “high” risk level.⁠¹⁵

As of October 12, 2026, the only Federal Register notices on this were the May 15, 2026 announcements for home health agencies and hospices. The CMS moratoria page (last modified August 27, 2026) still says the moratorium is in effect. If CMS does nothing, the first six-month period ends around mid-November 2026.⁠¹⁵⁠¹⁶ Check the Federal Register and the CMS page before you count on a date.

CMS left Medicaid and CHIP out of its own moratorium and invited each state to decide whether to impose one.⁠¹⁵ We found no official HHSC statement on a Texas Medicaid home health moratorium. If you plan to bill Texas Medicaid, ask HHSC before you plan around it.

HHSC’s “How to Become a Licensed HCSSA Provider” page still says: “As of January 30, 2019, there are no active Medicare Provider Enrollment Moratoria in Texas.”⁠¹ That was true when it was written. CMS had placed Texas home health agencies under a statewide moratorium in 2016, and that moratorium expired on January 30, 2019.⁠¹⁵ The sentence was never updated for 2026. It describes the 2019 moratorium ending, not the situation today, and the nationwide moratorium of May 13, 2026 does cover Texas.

Texas had already lost agencies before this. CMS counted 2,269 Medicare-enrolled home health agencies in Texas in 2019 and 1,893 in 2025.⁠¹⁵

Who needs the license, and who doesn’t

Chapter 142 makes it illegal to provide home health services for pay, or to present yourself to the public as a provider of them, without an HCSSA license for each place of business from which the services are directed. A Medicare-certified agency also needs the state license.⁠² “Home health service” covers nursing (including blood pressure monitoring and diabetes treatment); physical, occupational, speech or respiratory therapy; medical social services; IV therapy; dialysis; work by unlicensed staff under a licensed professional’s delegation or supervision; medical equipment and supplies (not drugs); and nutritional counseling.⁠²

HHSC reads this broadly. Its FAQ says that anything involving nursing services in the home needs an HCSSA license unless a statutory exemption applies. That includes a pharmacy that sends nurses to give home infusions; the pharmacy exemption covers only supplies.⁠¹³

Section 142.003 lists 21 exemptions. The ones most relevant to a home health founder:⁠²⁠¹³

• a nurse, therapist or medical social worker working as a sole practitioner, not through an agency;
• a physician, dentist, RN, OT or PT who makes home visits only as part of their office practice;
• a registry that only puts clients in touch with caregivers and does not keep client records, direct care or pay the caregiver;
• a person who provides one health service under contract with a licensed agency;
• an individual hired and paid directly by the client or family;
• sitter-companion, chore or household services with no personal care or health services.

If your staff will only help with bathing, dressing, grooming and other daily activities, with no nursing or therapy, the HCSSA category you need is Personal Assistance Services (PAS); see the Texas PAS guide. It is the same license, but PAS-only agencies need no supervising nurse, and their administrator rules are lighter.⁠⁹⁠¹⁰⁠¹²

The place of business must be a permanent physical location in Texas. HHSC does not accept a virtual office, but it does accept your home address if that is where services are directed from.⁠⁴⁠¹³ An agency based in another state must get a Texas parent-agency license.⁠⁴ The license holder must be at least 18.⁠⁴

Choosing a category

Under 26 TAC §558.13, one HCSSA license can carry any of six categories. Four of them are home health:⁠⁶

You do not need more than one category if the one you hold already covers everything you provide.⁠⁶

The certified category works differently from the others. If you ask for “licensed and certified” on your first application, you must also apply to CMS for Medicare certification. While CMS decides, HHSC issues the license in the licensed home health category only, and you must meet the federal Medicare conditions of participation as if you were already certified. If CMS certifies you during the initial license period, HHSC adds the certified category. If CMS denies you, or you withdraw, you keep the licensed home health category.⁠⁶ While the 2026 moratorium lasts, CMS denies new home health enrollment applications (see above), so a new agency that asks for the certified category can expect to hold only the licensed home health category until CMS enrollment reopens.⁠⁶⁠¹⁷ Ask the HCSSA licensing unit how it handles a “licensed and certified” request filed during the moratorium.

The four people HHSC needs before you apply

HHSC looks first at four positions. You must name a person for each before you file, because each of them has to finish the Presurvey training first (next section).⁠⁶

Administrator and alternate administrator. Each agency has exactly one administrator and one alternate; HHSC does not allow more than one administrator.⁠⁹⁠¹³ For a home health agency, both must meet one of these two standards:⁠¹⁰

1. Licensed professional route

   A licensed physician, RN, licensed social worker, licensed therapist or licensed nursing home administrator, with at least one year of management or supervisory experience in a health-related setting, such as another HCSSA, a hospital, a nursing facility, a hospice or an outpatient rehab center.

2. Experience route

   A high school diploma or GED with at least two years of management or supervisory experience in such a setting.

Both must be able to read, write and understand English. A person who was administrator of an agency when HHSC revoked, suspended or denied its license (or obtained an injunction) cannot be an administrator anywhere for 12 months after that action.⁠¹⁰ A first-time administrator or alternate needs 8 clock hours of training in agency administration, completed in the 12 months before appointment, and 24 hours in total by the end of their first 12 months. After that, both need 12 hours of continuing education every year.⁠¹¹⁠²²

Certified agencies have a federal requirement on top of the state one. HHSC’s FAQ explains that an administrator of a licensed and certified agency hired after January 13, 2018 must meet 42 CFR §484.115 as well as §558.244. In HHSC’s example, an LVN who has been an administrator at another agency for over 30 years would not qualify if hired now; HHSC says she would need to be an RN.⁠¹³

Supervising nurse and alternate. Both must be RNs licensed in Texas or practicing under the Nurse Licensure Compact, with at least one year of RN experience in the last 36 months. An agency with the home dialysis designation needs more: either three years of current hemodialysis experience, or two years as an RN plus a current national certification in nephrology nursing or hemodialysis. A nephrologist or a physician experienced in caring for patients with end-stage renal disease also qualifies.⁠¹⁰ The supervising nurse, or the alternate, must always be reachable by agency staff, in person or by phone. The supervising nurse can also be the administrator if they meet the administrator standards.⁠⁹ An agency that provides only therapy, medical social services or nutritional counseling does not need a supervising nurse; a qualified licensed professional supervises instead.⁠⁹

Presurvey CBT, before you open TULIP

The Presurvey training is an online course from HHSC. It is required by 26 TAC §558.13(a) and has to be finished before you submit the application.⁠⁶⁠¹² For a home health agency, the administrator, alternate administrator, supervising nurse and alternate supervising nurse must each complete:⁠¹²

• Module 1 (Introduction) and Module 2 (General HCSSA Licensure Standards);
• Module 4 for licensed home health, Module 5 for licensed and certified home health, and Module 7 if you want the home dialysis designation.

HHSC estimates 30 minutes to an hour per module, with no time limit. After each module, each person prints a participation certificate and signs it, and you upload the certificates with the application. HHSC states that applications will not be accepted without them.⁠¹²

Filing in TULIP

All HCSSA applications go through TULIP, HHSC’s online licensing portal, on Form 2021 for the parent agency. Branch offices use Form 2025.⁠¹ Before HHSC will approve a license, your business must also be registered with and in good standing with both the Texas Comptroller and the Texas Secretary of State.⁠¹

1. Prepare the content Chapter 142 requires

   Under the statute, the application must show that you have enough money to provide services for the whole license term. It must also include a list of management personnel and their qualifications, a plan for staff training, a plan for transferring clients if you cannot continue, and identifying details of the owner, administrator and chief financial officer for criminal background checks. Controlling persons must be listed too.⁠²

2. Expect a background review

   HHSC reviews the applicant, its controlling persons, anyone with a disclosable interest, affiliates and the CFO. It may deny the application over certain history. Within the last two years: an unresolved tax lien or an unresolved final Medicare or Medicaid audit exception. Within the last 12 months: a license denial, suspension or revocation, a Medicare or Medicaid sanction, or exclusion from Medicare or Medicaid. HHSC may also ask about your compliance record in other states.⁠²⁠⁴

3. Pay in the portal

   HHSC does not start reviewing until TULIP shows “payment received.”⁠³

4. First 45-day period

   HHSC has up to 45 days to decide whether the application is complete. If it is not, HHSC sends one electronic notice listing what is missing. You then have 30 days to answer, or HHSC may deny the application and keep the fee.⁠⁵⁠⁸

5. Second 45-day period

   From the date the application is complete, HHSC has up to 45 days to issue the license.⁠⁸ If HHSC misses these deadlines without good cause, you can ask for the license fee back. Good cause includes applications running 15% or more above the same quarter of the previous year.⁠⁸

6. No clients before the license

   You may not admit a client or start services until you hold the initial license.⁠⁴ The initial license lasts three years.⁠⁷

Fees as published

The fee is the same no matter how many categories you hold. Each branch’s physical address needs its own license and fee. HHSC does not refund fees.⁠³⁠²⁰ Chapter 142 lets HHSC set fees between $600 and $2,625, so the current fee is already at that maximum.⁠² Adding the certified category later is a change of category, reported on Form 2021 for the $30 change fee.⁠¹⁠²⁰

After the license: the six-month survey deadline

Getting the license starts a deadline. When you enroll your first client, you notify your HHSC regional office and ask for the initial health survey using Form 2020, Notification of Readiness for Initial Survey. HHSC says this request must be made within six months of the date the initial license was issued.⁠¹ If your agency holds more than one category, it must enroll clients and be surveyed in the highest one.⁠¹ If you fail the initial survey requirements, HHSC may refuse to renew the license, or suspend or revoke it.⁠⁷

HHSC’s process map shows a second route. If your agency is accredited, the accrediting organization’s documentation is verified with CMS and HHSC does not do its own health survey.⁠¹⁴ Chapter 142 also lets HHSC treat accreditation from a body such as The Joint Commission or CHAP as meeting licensing requirements, but the license fee is still due.⁠²

Medicare certification, once enrollment reopens

When CMS accepts new home health enrollments again, the Texas route works like this, according to HHSC’s page and process map:

• Survey by an accrediting organization. HHSC states that its Survey Operations is not doing initial Medicare certification surveys, because of CMS workload priorities. HHSC will not treat the certification application as complete until an accrediting organization confirms the initial certification survey.⁠¹ HHSC lists three: the Community Health Accreditation Partner, The Joint Commission, and the Accreditation Commission for Health Care.⁠¹
• Federal paperwork. Submit the CMS-855A home health enrollment application, on paper or online in PECOS, to your Medicare Administrative Contractor (MAC), with the CMS application fee paid through Pay.gov or a hardship exception request. You also need the CMS-1561 Health Insurance Benefit Agreement and proof that you submitted the civil rights clearance through the HHS Office for Civil Rights portal.⁠¹
• Approvals in sequence. The MAC sends HHSC a recommendation. The HHSC licensing specialist sends the 855A and a recommendation to the MAC, the MAC sends both to CMS, and once CMS approves, HHSC adds the licensed and certified category to your license.⁠¹⁴
• Already licensed? An agency that already holds a license applies in TULIP with Form 2021, “Change-Update Category of Service,” and uploads the CMS-1561 and the civil rights clearance.⁠¹

HHSC’s page also links Provider Letter 15-09 on prioritizing initial certification surveys. HHSC itself notes that the letter has not been updated to say the earlier moratorium expired.⁠¹

Certificate of need

Chapter 142 and the HCSSA licensing rules we reviewed set no certificate of need or other need-based approval for home health agencies. HHSC’s list of steps to become licensed doesn’t include one either: the training, the application, documents, fees, good standing with the Comptroller and Secretary of State, and HHSC approval.⁠¹⁠² We did not find an official statement that says outright that Texas has no certificate-of-need requirement for home health. If a lender or investor needs that in writing, ask the HCSSA licensing unit at 512-438-2630.⁠²¹ As of October 12, 2026, the federal moratorium described above is the larger obstacle to opening a Medicare agency.

Aides, renewal and changes

Home health aides. An aide working in a licensed home health agency must qualify in one of several ways. They include one year of full-time direct care in a hospital or nursing facility, a training and competency program of at least 75 hours (including at least 16 hours of supervised clinical experience), or a listing on the HHSC nurse aide registry with no finding of abuse, neglect or misappropriation.⁠¹⁹ Certified agencies must also meet the federal aide rules in 42 CFR Part 484.⁠¹

Renewal. Chapter 142 requires the renewal application and fee no later than 45 days before the license expires. A renewal filed after that date is charged a late fee, and HHSC will not accept an application after the license has expired.⁠¹⁠²⁠³

Changes. Report changes through TULIP on Form 2021. Moving the office requires at least 30 days’ notice before the move. A certified agency also files Form 6325, the Medicare relocation questionnaire.⁠¹³⁠²⁰ Under the 2026 moratorium, CMS may treat a move that amounts to a new operation (new area, new patients, new staff) as a new enrollment.⁠¹⁷

Contacts. HCSSA licensing and certification: 512-438-2630. Policy and rule questions: 512-438-3161.⁠²¹ See the Texas state page for the other care licenses HHSC issues, and home health licensing across states for comparison.

Sources

1. 1
   Texas Health and Human Services Commission, How to Become a Licensed HCSSA Provider Checked 12 Oct 2026 · Back to text ↑
2. 2
   Texas Legislature, Texas Health and Safety Code, Chapter 142: Home and Community Support Services Checked 12 Oct 2026 · Back to text ↑
3. 3
   Texas Secretary of State, Texas Administrative Code, 26 TAC §558.3, License Fees Checked 12 Oct 2026 · Back to text ↑
4. 4
   Texas Secretary of State, Texas Administrative Code, 26 TAC §558.11, Criteria and Eligibility for Licensing Checked 12 Oct 2026 · Back to text ↑
5. 5
   Texas Secretary of State, Texas Administrative Code, 26 TAC §558.12, General Application Checked 12 Oct 2026 · Back to text ↑
6. 6
   Texas Secretary of State, Texas Administrative Code, 26 TAC §558.13, Obtaining an Initial License Checked 12 Oct 2026 · Back to text ↑
7. 7
   Texas Secretary of State, Texas Administrative Code, 26 TAC §558.15, Issuance of an Initial License Checked 12 Oct 2026 · Back to text ↑
8. 8
   Texas Secretary of State, Texas Administrative Code, 26 TAC §558.31, Time Frames for Processing and Issuing a License Checked 12 Oct 2026 · Back to text ↑
9. 9
   Texas Secretary of State, Texas Administrative Code, 26 TAC §558.243, Administrative and Supervisory Responsibilities Checked 12 Oct 2026 · Back to text ↑
10. 10
    Texas Secretary of State, Texas Administrative Code, 26 TAC §558.244, Administrator Qualifications and Conditions and Supervising Nurse Qualifications Checked 12 Oct 2026 · Back to text ↑
11. 11
    Texas Secretary of State, Texas Administrative Code, 26 TAC §558.259, Initial Educational Training in Administration of Agencies Checked 12 Oct 2026 · Back to text ↑
12. 12
    Texas Health and Human Services Commission, Computer-Based Trainings: HCSSA Presurvey Training Checked 12 Oct 2026 · Back to text ↑
13. 13
    Texas Health and Human Services Commission, Home and Community Support Services Agencies: Frequently Asked Questions (updated July 2026) Checked 12 Oct 2026 · Back to text ↑
14. 14
    Texas Health and Human Services Commission, Licensure and Certification process map: HCSSA Initial, Parent Agency (1/2024) Checked 12 Oct 2026 · Back to text ↑
15. 15
    Centers for Medicare & Medicaid Services, Federal Register, Announcement of Nationwide Temporary Moratoria on Enrollment of Home Health Agencies (HHAs), 91 FR 27954 Checked 12 Oct 2026 · Back to text ↑
16. 16
    Centers for Medicare & Medicaid Services, Provider Enrollment Moratoria Checked 12 Oct 2026 · Back to text ↑
17. 17
    Centers for Medicare & Medicaid Services, Home Health and Hospice Nationwide Moratorium Q&As (revised July 9, 2026) Checked 12 Oct 2026 · Back to text ↑
18. 18
    Centers for Medicare & Medicaid Services, QSO-26-11-HHA & Hospice: Six-Month National Moratoria on Hospice and HHA Enrollment Checked 12 Oct 2026 · Back to text ↑
19. 19
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20. 20
    Texas Secretary of State, Texas Administrative Code, 26 TAC §558.208, Reporting Changes in Application Information and Fees Checked 12 Oct 2026 · Back to text ↑
21. 21
    Texas Health and Human Services Commission, Home and Community Support Services Agencies (HCSSA) Checked 12 Oct 2026 · Back to text ↑
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