Texas personal assistance services license: the HCSSA PAS category

Where personal care starts and companion work ends

The statute defines personal assistance services as routine ongoing care that helps a person carry out the activities of daily living or the physical functions needed to live independently, including respite. The term covers personal care, some health-related services that are not professional nursing, and health-related tasks that an RN delegates to unlicensed staff.⁠¹ Personal care has a fixed list:⁠¹

• bathing, dressing and grooming;
• feeding and exercising;
• toileting and positioning;
• assisting with self-administered medications;
• routine hair and skin care;
• transfer or ambulation.

If any one of those tasks is part of what you sell, you need the license. Chapter 142 exempts “a person or organization providing sitter-companion services or chore or household services that do not involve personal care, health, or health-related services.”⁠¹ A business that only offers companionship, errands, light housekeeping or meal preparation can operate without an HCSSA license. Once an aide helps a client into the shower or onto the toilet, the exemption no longer applies.

Other exemptions founders sometimes rely on:⁠¹

• Registries. A registry that only puts consumers in touch with caregivers is exempt. To qualify it must not keep official client records, direct client services or pay the caregiver. A placement business that schedules shifts or pays the worker is directing services.
• Direct hires. An individual hired and paid directly by the client, the client’s family or a legal guardian is exempt.
• Live-in caregivers. A person whose permanent residence is in the client’s home is exempt.
• Consumer-directed services. A worker employed by a consumer, or by a consumer’s fiscal agent, under the state’s consumer-directed program is exempt.

Using the words “personal assistance services” without a PAS license is itself a violation, and so is implying that you have one.⁠¹ The same applies to “home health services” for anyone without a home health license.⁠¹ The statute sets a civil penalty of $1,000 to $2,500 for each day of unlicensed operation.⁠¹ Since September 1, 2025 (House Bill 2510), giving personal assistance services without a required license to a resident of an assisted living facility is a Class A misdemeanor. A repeat offense is a third-degree felony.⁠¹

PAS or home health: picking the category

26 TAC §558.13 lists six HCSSA categories: licensed and certified home health (with or without home dialysis), licensed home health (with or without home dialysis), hospice, and personal assistance services. You only need the category that covers what you actually provide.⁠⁸

Under §558.404, a PAS agency may perform four kinds of tasks:⁠²³

1. Personal care

   The tasks in the statutory list above.

2. RN-delegated tasks

   Health-related tasks an RN delegates to unlicensed staff, or decides need no delegation, under the Board of Nursing’s 22 TAC chapter 225.

3. Non-nursing health tasks

   Health-related tasks that the HHSC and Board of Nursing memorandum of understanding says are not professional nursing.

4. Physician-delegated tasks

   Tasks a physician delegates under Occupations Code chapter 157.

Skilled nursing and therapy are not on that list. If you want nurses or therapists to make skilled visits, you need the Licensed Home Health category, which has its own nurse-supervisor and administrator rules (see the Texas HCSSA home health guide). HHSC’s FAQ also marks the edges of PAS. A PAS agency may not fill weekly pill organizers for clients who take their own medications. RN delegation is allowed under PAS, but the agency must employ or contract the RN, who must assess the client before delegating anything.⁠⁴ Section 558.404 spells out one task in detail: tube feeding and medication through a permanently placed gastrostomy tube. Unlicensed staff may do it only after a training and competency program taught by an RN, physician, physician assistant or qualified trainer, which includes passing a written test with a score of 100 percent.⁠²³

One license can carry PAS and Licensed Home Health together, because an applicant may request one or more categories.⁠⁸ HHSC’s FAQ confirms you do not need separate entities for each category.⁠⁴

Administrator and alternate: who qualifies

Every agency must have exactly one administrator and one alternate administrator, designated in writing. HHSC does not allow more than one of either.⁠⁴⁠¹⁵ For an agency licensed only for PAS, each of them must meet at least one of these:⁠¹⁶

• a high school diploma or GED plus at least one year of experience or training in caring for people with functional disabilities;
• two years of full-time study at an accredited college or university in a health-related field;
• the home health administrator qualifications (a licensed physician, RN, social worker, therapist or nursing home administrator with one year of health-related management experience, or a diploma or GED with two years of such experience).

HHSC’s FAQ confirms that neither has to be licensed for a PAS-only agency.⁠⁴ Both must be able to read, write and understand English. A person is barred for 12 months from serving as administrator if they ran an agency while HHSC took enforcement action against it (revocation, suspension, denial or injunction, but not penalties alone).⁠¹⁶

PAS-only agencies do not need a supervising nurse. That requirement in §558.243 applies to the home health and hospice categories.⁠¹⁵ What a PAS agency does need is a supervisor for its attendants. That person must be a licensed nurse or have two years of full-time college. Someone with a high school diploma or GED can substitute one year of full-time supervisory work in a health care facility, agency or community-based agency for each year of college.⁠²³

Training hours for first-time administrators

Anyone serving as an administrator or alternate for the first time must complete 24 clock hours of training in agency administration. Eight of those hours must come before designation, within the previous 12 months. They cover the licensing standards, Health and Safety Code chapters 142 and 250, the Rights of the Elderly statute, the ADA, FMLA and OSHA requirements, and other laws. The remaining 16 hours must be finished within the first 12 months and cover topics such as fraud prevention, client rights, emergency preparedness, abuse and neglect, and infection control.⁠¹⁹ HHSC’s Presurvey Training does not count toward these hours.⁠¹⁹ After the first year, each of them needs 12 clock hours of continuing education every 12 months.⁠²⁰

The Presurvey computer-based training

Before you submit the application, the administrator and alternate administrator must each complete HHSC’s Presurvey Training.⁠⁸ HHSC offers it online as a computer-based training. For a PAS-only agency it consists of three modules:⁠³

• Module 1: Introduction to the Presurvey Training;
• Module 2: General HCSSA Licensure Standards;
• Module 3: Personal Assistance Services.

HHSC estimates 30 minutes to an hour per module, with a quiz at the end of each. After each module, the participant prints and signs a participation certificate. A copy goes into your application, and HHSC says it will not accept the application without them.⁠³ If you later add Licensed Home Health, Module 4 and a supervising nurse who has also completed the training come with it.⁠³⁠⁸

Applying through TULIP

HHSC lists these steps for licensure:⁠²

1. Finish the Presurvey CBT

   and keep the signed certificates.

2. Register the business entity

   It must be registered with, and in good standing with, both the Texas Comptroller of Public Accounts and the Texas Secretary of State.

3. Submit Form 2021 in TULIP

   This is the application for the parent agency. Upload all the requested documents and choose the PAS category.

4. Pay the fee online

   HHSC does not begin reviewing until TULIP shows the status “payment received.”⁠⁵

5. Wait for approval

   by the HCSSA Licensing and Certification Unit.

The place of business must be a permanent physical location in Texas. HHSC does not accept a virtual office, but you may use your home address if you will direct services from there.⁠⁴⁠⁶ Each place of business needs its own license.⁠⁶ An office that only handles administrative support needs no license. HHSC’s July 2026 FAQ says an office that schedules client visits and completes clinical documentation is not an administrative support site, because those activities are not allowed there, and therefore needs a license.⁠⁴

The statute tells HHSC what to collect before approving an application:⁠¹

• evidence that you have enough money to provide services during the license term;
• a list of management personnel and their qualifications, with a plan for continuing staff training;
• a plan for transferring clients’ care if you cannot keep serving them;
• identifying information on the owner, administrator and chief financial officer for criminal background checks;
• the identity of every controlling person.

The rules also require the agency to have sufficient funds to meet its payroll.⁠³³ The applicant must be at least 18.⁠⁶ HHSC reviews the background of the applicant, controlling persons, affiliates and the CFO. It may deny the application for any of these:⁠⁶

• an unsatisfied judgment;
• delinquent child support;
• an unresolved tax lien within the past two years;
• a license denial, suspension or revocation, or a Medicare or Medicaid sanction, within the past 12 months.

How long it takes

The rules set two 45-day time frames:⁠¹¹⁠²

• Review. HHSC has up to 45 days to decide whether the application is complete. If it is not, TULIP sends one electronic notice listing what is missing.
• Response. You then have 30 days to supply the missing items, or HHSC may deny the application and keep the fee.⁠⁷
• Decision. Once the application is complete, HHSC has up to another 45 days to issue the license.

If HHSC misses its time frames without good cause, you may ask for the fee back.⁠¹¹

You may not admit a client or start services until the license has been issued.⁠⁶

Fees as published on 2026-10-12

Sources for the table: §558.3 and §558.208.⁠⁵⁠¹³ One fee covers every category on the license.⁠⁵ Fees are not refundable, including when you withdraw an application.⁠⁵⁠⁷ Statute caps HCSSA license fees at $2,625.⁠¹ The license is valid for three years from the date of issue.⁠⁹

The six-month clock: first client and Form 2020

Getting the license does not end the process. HHSC surveys a new agency only after it has started serving clients. Under §558.521, within six months of the license’s effective date you must do two things:⁠²⁶

1. Admit a client

   For a license with only the PAS category, admit and serve at least one client.

2. Request the survey

   Send HHSC Form 2020, Notification of Readiness for Initial Survey. It must list each client’s name, admission date and category of service.

HHSC revised Provider Letter 2021-18 effective June 1, 2026. Form 2020 now goes to the regional HCSSA mailbox for your survey office (for example, [email protected] for Region 1). The letter warns that a late request “may result in enforcement action, including license revocation or denial of license renewal.”⁠²⁷ When the surveyor arrives, have these ready:⁠²⁶

• a client list;
• the record of every client admitted so far;
• all the policies chapter 558 requires;
• every employee’s personnel file.

If you combine PAS with Licensed Home Health on the first license, the client you serve before the survey must be a home health client.⁠²⁶ An agency accredited by The Joint Commission, CHAP or ACHC can send its accreditation documents to the survey office within the same six months instead of being surveyed.⁠²⁵⁠²⁶⁠³²

Hiring attendants: background checks and registries

Your attendants do not need a state credential. The rule allows any unlicensed person aged 18 or older who has shown competency in the assigned tasks. Someone under 18 also qualifies if they are a high school graduate or enrolled in a vocational program and have shown competency.⁠²³ For unlicensed applicants and employees whose duties include face-to-face contact with clients, §558.247 requires three checks:⁠¹⁸

• Criminal history. Run a criminal history check under Health and Safety Code chapter 250. Do not hire anyone with a conviction that bars employment under §250.006. For other convictions, document whether you consider them a reason not to hire.
• Registries. Before hiring, or before the first face-to-face contact with a client, search the Nurse Aide Registry and the Employee Misconduct Registry. Do not hire anyone listed as unemployable on either one.
• Annual recheck. Search both registries again at least every 12 months. Discharge anyone immediately once you learn they are listed or have a disqualifying conviction.

HHSC changed how these searches are done twice in 2026:

• TULIP searches. Provider Letter 2026-03 (March 10, 2026) says the Employee Misconduct Registry and Nurse Aide Registry searches must be run in TULIP as two separate searches. Keep the downloaded results as your proof.⁠²⁹
• SEMARC. Provider Letter 2026-10 says the Search Engine for Multi-Agency Reportable Conduct (SEMARC), also run in TULIP, replaces the Employee Misconduct Registry search. SEMARC also checks DFPS, Texas Education Agency and Texas Juvenile Justice Department records. HCSSAs must use SEMARC plus the Nurse Aide Registry from August 3, 2026.⁠²⁸
• Hold-harmless period. The October 2, 2026 revision extended the hold-harmless period. HHSC will not survey for SEMARC compliance until January 7, 2027.⁠²⁸

Section 558.247 still names the Employee Misconduct Registry because, according to the letter, the rule amendments for SEMARC are still in process.⁠¹⁸⁠²⁸

Your written staffing policies must cover these points:⁠¹⁷

• orientation and job-specific training;
• a way to show competency when education or experience does not prove it;
• annual performance evaluations;
• training in pediatric care for staff who serve children;
• a signed statement from every direct-care worker that they will follow agency policy.

HHSC’s FAQ adds that a client’s family member may be the paid attendant as far as licensing rules go. Medicaid program rules may say otherwise.⁠⁴

What the PAS rules require once you have clients

Section 558.404 sets out the paperwork a surveyor will look for in each client file:⁠²³

• On-site visit. A record of the supervisor’s visit to the home, where the services you provide were decided.
• Individualized service plan. A plan signed by the client or family and the agency that covers:
  • the services, supplies and equipment;
  • where services will be given;
  • frequency and duration;
  • the planned start date;
  • charges, if the client pays any part;
  • the plan of supervision.
• Service records. Records showing that services were delivered according to that plan.
• Supervision policy. A written policy on supervising attendants, with input from the client or family on how often supervision happens.

You also need a written backup policy so that care continues when an attendant cannot come. A family member or other designee of the client may serve as backup only after signing a written agreement, and the agency may not pressure the client to accept backup.⁠²¹ Clients must also be told how to get care after hours.⁠²¹

Other duties that come with the license:

• Drug testing. Give a written statement of your drug-testing policy for direct-contact staff to each person who applies for services.⁠¹
• Disaster planning. Help clients register with 2-1-1 for disaster evacuation as needed.⁠¹
• Emergency alerts. Your administrator and alternate must be enrolled in HHSC’s AlertMedia emergency system.⁠⁴
• Abuse reporting. Report suspected abuse, neglect or exploitation by your staff to HHSC’s Complaint and Incident Intake within 24 hours. File Form 3613 with your own investigation no later than the 10th day after the report.⁠⁴
• Workplace violence. A PAS-only agency that employs two or more RNs must run a workplace violence program under SB 240 (2023) and SB 463 (2025).⁠⁴

Service area and branch offices

You choose the service area and identify it to HHSC. Services may not be provided outside it, except that you may follow an existing client elsewhere in Texas for up to 60 consecutive days. To expand the area, apply in TULIP at least 30 days before the expansion. Report a reduction within 10 days after it takes effect.⁠¹⁴

A PAS agency can add branch offices. It qualifies once the parent is in substantial compliance, has no pending enforcement action and has met its initial survey requirements.⁠¹² Each branch must meet these conditions:⁠²²⁠¹²

• it lies within the parent’s service area;
• it keeps the original active client records on site;
• the parent’s administrator or alternate visits in person at least monthly;
• it offers no category the parent does not hold.

A branch license costs $2,625 and expires with the parent license.⁠⁵⁠¹²

Renewal and later surveys

TULIP opens the renewal application at least 120 days before the license expires. Submit it, with payment, no later than the 45th day before expiration, or HHSC adds the late fee.⁠¹⁰⁠¹ If the license expires before you file, HHSC denies the renewal, and you must stop operating and apply for a new initial license.⁠¹⁰ To be eligible for renewal, you must have served at least one client during the license period.⁠¹⁰ After the initial survey, HHSC surveys again within 18 months and then at least every 36 months. Complaint investigations can happen at any time.⁠²⁴⁠¹

Medicaid: PHC, CAS, Family Care and managed care

The PAS license is a prerequisite for the state’s attendant programs, but it is not a contract. HHSC’s Primary Home Care and Community Attendant Services pages say the provider must hold an HCSSA license in one of three categories (Licensed Home Health, Licensed and Certified Home Health, or Personal Assistance Services) and have a separate HHSC contract.⁠³⁰⁠³¹ Primary Home Care, Community Attendant Services and Family Care come as one contract, and the contractor must agree to serve all three programs. The application uses checklist Form 5830 and goes to HHSC Eligibility Operations Provider Contract Management. A new contractor must complete program orientation before HHSC adds it to the regional choice list.⁠³⁰⁠³¹

HHSC’s FAQ also lists STAR+PLUS managed care, Community First Choice, Personal Care Services, CLASS and the Medically Dependent Children Program among the Medicaid programs delivered by HCSSA-licensed agencies.⁠⁴ The HHSC licensing pages do not set out managed care organizations’ own credentialing requirements. Ask each health plan, and your HHSC contract manager, what they require beyond the license.⁠²

Recent changes and what is pending

• September 1, 2025. House Bill 2510 made it a crime to give personal assistance services to assisted living residents without a required license.⁠¹
• March 10, 2026. Provider Letter 2026-03 moved registry searches to TULIP as separate searches.⁠²⁹
• June 1, 2026. HHSC changed how Form 2020 survey requests are submitted (regional mailboxes).⁠²⁷
• August 3, 2026. SEMARC took the place of the Employee Misconduct Registry search for HCSSAs. HHSC will not survey for it until January 7, 2027.⁠²⁸
• Pending. HHSC says it is amending chapter 558 for SEMARC and for the workplace violence laws.⁠⁴⁠²⁸ The licensing rules quoted here were last amended effective April 25, 2021, and are cited from the Secretary of State’s rules site as of October 12, 2026.⁠²³

For questions about a license application, HHSC lists its HCSSA licensing specialists at 512-438-2630.⁠³⁠⁴ For the other Texas care licenses, see the Texas state page and the non-medical home care overview.

Sources

1. 1
   Texas Legislature, Texas Health and Safety Code, chapter 142 (Home and Community Support Services) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Texas Health and Human Services Commission, How to Become a Licensed HCSSA Provider Checked 12 Oct 2026 · Back to text ↑
3. 3
   Texas Health and Human Services Commission, HCSSA Computer-Based Trainings (Presurvey Training) Checked 12 Oct 2026 · Back to text ↑
4. 4
   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 ↑
5. 5
   Texas Secretary of State, 26 TAC §558.3, License Fees Checked 12 Oct 2026 · Back to text ↑
6. 6
   Texas Secretary of State, 26 TAC §558.11, Criteria and Eligibility for Licensing Checked 12 Oct 2026 · Back to text ↑
7. 7
   Texas Secretary of State, 26 TAC §558.12, General Application Checked 12 Oct 2026 · Back to text ↑
8. 8
   Texas Secretary of State, 26 TAC §558.13, Obtaining an Initial License Checked 12 Oct 2026 · Back to text ↑
9. 9
   Texas Secretary of State, 26 TAC §558.15, Issuance of an Initial License Checked 12 Oct 2026 · Back to text ↑
10. 10
    Texas Secretary of State, 26 TAC §558.17, Application Procedures for a Renewal License Checked 12 Oct 2026 · Back to text ↑
11. 11
    Texas Secretary of State, 26 TAC §558.31, Time Frames for Processing and Issuing a License Checked 12 Oct 2026 · Back to text ↑
12. 12
    Texas Secretary of State, 26 TAC §558.27, Application and Issuance of an Initial Branch Office License Checked 12 Oct 2026 · Back to text ↑
13. 13
    Texas Secretary of State, 26 TAC §558.208, Reporting Changes in Application Information and Fees Checked 12 Oct 2026 · Back to text ↑
14. 14
    Texas Secretary of State, 26 TAC §558.220, Service Areas Checked 12 Oct 2026 · Back to text ↑
15. 15
    Texas Secretary of State, 26 TAC §558.243, Administrative and Supervisory Responsibilities Checked 12 Oct 2026 · Back to text ↑
16. 16
    Texas Secretary of State, 26 TAC §558.244, Administrator Qualifications and Conditions and Supervising Nurse Qualifications Checked 12 Oct 2026 · Back to text ↑
17. 17
    Texas Secretary of State, 26 TAC §558.245, Staffing Policies Checked 12 Oct 2026 · Back to text ↑
18. 18
    Texas Secretary of State, 26 TAC §558.247, Verification of Employability and Use of Unlicensed Persons Checked 12 Oct 2026 · Back to text ↑
19. 19
    Texas Secretary of State, 26 TAC §558.259, Initial Educational Training in Administration of Agencies Checked 12 Oct 2026 · Back to text ↑
20. 20
    Texas Secretary of State, 26 TAC §558.260, Continuing Education in Administration of Agencies Checked 12 Oct 2026 · Back to text ↑
21. 21
    Texas Secretary of State, 26 TAC §558.290, Backup Services and After-Hours Care Checked 12 Oct 2026 · Back to text ↑
22. 22
    Texas Secretary of State, 26 TAC §558.321, Standards for Branch Offices Checked 12 Oct 2026 · Back to text ↑
23. 23
    Texas Secretary of State, 26 TAC §558.404, Standards Specific to Agencies Licensed to Provide Personal Assistance Services Checked 12 Oct 2026 · Back to text ↑
24. 24
    Texas Secretary of State, 26 TAC §558.501, Survey and Investigation Frequency Checked 12 Oct 2026 · Back to text ↑
25. 25
    Texas Secretary of State, 26 TAC §558.503, Exemption From a Survey Checked 12 Oct 2026 · Back to text ↑
26. 26
    Texas Secretary of State, 26 TAC §558.521, Requirements for an Initial Survey Checked 12 Oct 2026 · Back to text ↑
27. 27
    Texas Health and Human Services Commission, Provider Letter 2021-18 (revised June 1, 2026), Requirement to Request an Initial Survey Within Six Months After Issuance of an Initial License Checked 12 Oct 2026 · Back to text ↑
28. 28
    Texas Health and Human Services Commission, Provider Letter 2026-10 (revised October 2, 2026), LTCR Provider Responsibilities for SEMARC Checked 12 Oct 2026 · Back to text ↑
29. 29
    Texas Health and Human Services Commission, Provider Letter 2026-03, Employability Status Checks Checked 12 Oct 2026 · Back to text ↑
30. 30
    Texas Health and Human Services Commission, Primary Home Care (PHC) Checked 12 Oct 2026 · Back to text ↑
31. 31
    Texas Health and Human Services Commission, Community Attendant Services (CAS) Checked 12 Oct 2026 · Back to text ↑
32. 32
    Texas Health and Human Services Commission, Process map: HCSSA Initial, Parent Agency Checked 12 Oct 2026 · Back to text ↑
33. 33
    Texas Secretary of State, 26 TAC §558.252, Financial Solvency and Business Records Checked 12 Oct 2026 · Back to text ↑

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