Texas Department of Aging and Disability Services
Licensing Standards for Home and Community Support Services Agencies Handbook
Revision: 12-2

Subchapter B

§97.11  Criteria and Eligibility for Licensing

(a)
An applicant for a license must not admit a client or initiate services until the applicant completes the application process and receives an initial license.
(b)
A first-time application for a license is an application for an initial license.
(c)
An application for a license when there is a change of ownership is an application for an initial license.
(d)
A separate license is required for each place of business as defined in §97.2 of this chapter (relating to Definitions).
(e)
An agency's place of business must be located in and have an address in Texas. An agency located in another state must receive a license as a parent agency in Texas to operate as an agency in Texas.
(f)
An applicant must be at least 18 years of age.
(g)
Before issuing a license, DADS considers the background and qualifications of:
(1)
the applicant;
(2)
a controlling person of the applicant;
(3)
a person with a disclosable interest;
(4)
an affiliate of the applicant;
(5)
the administrator;
(6)
the alternate administrator; and
(7)
the chief financial officer.
(h)
DADS may deny an application for an initial license or for renewal of a license if any person described in subsection (g) of this section:
(1)
on the date of the application:
(A)
is subject to denial or refusal as described in Chapter 99 of this title (relating to Denial or Refusal of License) during the time frames described in that chapter;
(B)
has an unsatisfied final judgment in any state or other jurisdiction;
(C)
is in default on a guaranteed student loan (Education Code, §57.491); or
(D)
is delinquent on child support obligations (Family Code, Chapter 232);
(2)
for two years preceding the date of the application, has a history in any state or other jurisdiction of any of the following:
(A)
an unresolved federal or state tax lien;
(B)
an eviction involving any property or space used as an inpatient hospice agency; or
(C)
an unresolved final Medicare or Medicaid audit exception; or
(3)
for twelve months preceding the date of the application, has a history in any state or other jurisdiction of any of the following:
(A)
denial, suspension or revocation of an agency license or a license for a health care facility;
(B)
surrendering a license before expiration or allowing a license to expire instead of the licensing authority proceeding with enforcement action;
(C)
a Medicaid or Medicare sanction or penalty relating to the operation of an agency or a health care facility;
(D)
operating an agency that has been decertified in any state under Medicare or Medicaid; or
(E)
debarment, exclusion or involuntary contract cancellation in any state from Medicare or Medicaid.

§97.13  Application Procedures for an Initial License

(a)
The following staff must complete a presurvey conference seminar before submitting an application for a license:
(1)
the administrator and alternate administrator (all license categories); and
(2)
the supervising nurse and alternate supervising nurse (licensed home health services with or without home dialysis designation, licensed and certified home health services with or without home dialysis designation, and hospice services license categories).
(b)
When applying for a license, an applicant must not:
(1)
provide incorrect or false information; or
(2)
withhold information.
(c)
Upon request, DADS furnishes a person with an application packet for a license.
(d)
An applicant may request to be licensed in one or more of the following categories:
(1)
licensed and certified home health services;
(2)
licensed and certified home health services with home dialysis designation;
(3)
licensed home health services;
(4)
licensed home health services with home dialysis designation;
(5)
hospice services; or
(6)
personal assistance services.
(e)
DADS does not require an agency to be licensed in more than one category if the category for which the agency is licensed covers the services the agency provides.
(f)
An applicant must complete and furnish all documents and information that DADS requests in accordance with instructions provided with the application packet. All submitted documents must be notarized copies or originals.
(g)
Upon receipt of an application packet and license fee, DADS reviews the material to determine whether it is complete and correct. A complete and correct application packet includes all documents and information that DADS requests as part of the application process. If DADS receives a partial fee, the application packet and monies are returned to the applicant.
(1)
DADS processes the application packet in accordance with time frames established in §97.31 of this chapter (relating to Time Frames for Processing and Issuing a License).
(2)
If an applicant decides not to continue the application process for an initial license after submitting the application packet and license fee, the applicant must submit to DADS a written request to withdraw the application. DADS does not refund the license fee.
(3)
If an applicant receives a notice from DADS that some or all of the information required by this section is missing or incomplete, the applicant must submit the required information no later than 30 days after the date of the notice. If an applicant fails to submit the required information within 30 days after the notice date, DADS considers the application packet incomplete and denies the application. If DADS denies the application, DADS does not refund the license fee.
(h)
An applicant who has requested the category of licensed and certified home health services on the initial license application must also make an application for certification by CMS as a Medicare-certified agency under the Social Security Act, Title XVIII.
(1)
Pending approval by CMS, the applicant:
(A)
receives an initial license reflecting the category of licensed home health services if the applicant meets the criteria for a license; and
(B)
complies with the Medicare conditions of participation for home health agencies in 42 Code of Federal Regulations, Part 484, as if the applicant were dually certified.
(2)
If CMS certifies an agency to participate in the Medicare program during the initial license period, DADS sends a notice to the agency that the category of licensed and certified home health services has been added to the license. If the agency wants to delete the licensed home health services category once the category of licensed and certified home health services has been added, the agency must submit a written request for deletion of that category.
(3)
If CMS denies certification to an applicant or if the applicant withdraws the application for participation in the Medicare program, the agency may retain the category of licensed home health services.

§97.15  Issuance of an Initial License

(a)
DADS issues an initial license when DADS determines:
(1)
an application and license fee are complete and correct; and
(2)
an applicant meets the criteria for a license as described in §97.11 of this subchapter (relating to Criteria and Eligibility for Licensing).
(b)
An initial license is valid for two years from the date of issuance.
(c)
DADS may deny an application to renew an initial license, or revoke or suspend an initial license, if an agency fails to:
(1)
meet the requirements for an initial survey as specified in Subchapter E of this chapter (relating to Licensure Surveys); or
(2)
maintain substantial compliance with the statute and this chapter for the services authorized under the license.
(d)
DADS may deny an application for an initial license for any of the reasons specified in §97.21 of this chapter (relating to Denial of an Application or a License).
(e)
A license designates an agency's place of business from which services are to be provided and designates an agency's authorized category or categories of service.

§97.17  Application Procedures for a Renewal License

(a)
An agency license is valid for two years. In order to continue providing services to clients, an agency must renew its license.
(b)
When applying for a renewal license, an agency must not provide inaccurate or false statements or withhold information from the renewal application and attachments to the application. If an agency provides inaccurate or false statements or withholds information from a renewal application or an attachment to the application, DADS may assess the same range of penalties against the agency that apply in §97.13 of this chapter (relating to Application Procedures for an Initial License) for providing inaccurate or false statements or withholding information from an initial application for a license.
(c)
For each license period, an agency must provide services to at least one client.
(d)
DADS does not require an agency to admit a client under each category of service authorized under the license as a condition for renewal of the license.
(e)
An agency must document the provision of services and keep documentation readily available for review by a DADS surveyor.
(f)
With each renewal application, an accredited agency must submit documentation of its accreditation that the agency receives from the accreditation organization.
(g)
DADS sends written notice of expiration of a license to an agency at least 120 days before the expiration date of the license. The written notice includes an application to renew the license and instructions for completing the application.
(1)
If an agency does not receive notice of expiration from DADS at least 90 days before the expiration date of a license, the agency must notify DADS and submit a written request for a renewal application.
(2)
An agency must submit to DADS a complete and correct renewal application and the required license fee specified in §97.3 of this chapter (relating to License Fees), postmarked no later than the 45th day before the expiration date of the license.
(3)
If an agency submits a renewal application that is postmarked later than the 45th day before the expiration date of a license, but no later than the expiration date of the license, DADS assesses the late fee set out in §97.3(b) of this chapter for failure to comply with paragraph (2) of this subsection.
(4)
All documents submitted with the renewal application must be notarized copies or originals.
(h)
Upon receipt of a renewal application and the renewal license fee, DADS reviews the application to determine whether it is complete and correct. A complete and correct renewal application includes all documents, information, and the required fee that DADS requests as part of the application process.
(1)
DADS processes the renewal application according to the time frames in §97.31 of this chapter (relating to Time Frames for Processing and Issuing a License).
(2)
If an agency decides to discontinue the application process for a renewal license after submitting the renewal application and the renewal license fee, the agency must submit to DADS a notarized statement requesting to withdraw the renewal application. DADS does not refund the renewal license fee.
(3)
DADS notifies an agency, in writing, if an application does not include all documents, information, or the license fee required by this section. An agency must submit the missing documents, information, or fee to DADS postmarked no later than 30 days after the date of the notice or DADS considers the renewal application incomplete and denies the application. If DADS denies the renewal application, DADS does not refund the renewal license fee.
(4)
If an agency receives a written notice from DADS that a late fee is assessed in accordance with subsection (g) of this section, the agency’s late fee must be postmarked no later than 30 days after the date of the notice or DADS considers the renewal application incomplete and denies the application. If DADS denies the renewal application, DADS does not refund the renewal license fee.
(i)
If an agency submits a renewal application to DADS that is postmarked after the expiration date of the license, DADS denies the renewal application and does not refund the renewal license fee. The agency is not eligible to renew the license and must cease operation on the date the license expires. An agency whose license expires must apply for an initial license in accordance with §97.13 of this subchapter (relating to Application Procedures for an Initial License).
(j)
If an agency submits a timely renewal application in accordance with this section, and an action to revoke, suspend, or deny renewal of the license is pending, the agency may continue to operate, and the license is valid until the agency has had an opportunity for a formal hearing as described in §97.601 of this chapter (relating to Enforcement Actions). Until the action to revoke, suspend, or deny renewal of the license is completed, the agency must continue to submit a renewal application in accordance with this section. DADS issues a renewal license only if DADS determines the reason for the proposed action no longer exists.
(k)
If a license holder fails to submit a timely renewal application in accordance with this section because the license holder is or was on active duty with the armed forces of the United States of America outside the state of Texas, the license holder may renew the license pursuant to this subsection.
(1)
An individual having power of attorney from the license holder or other authority to act on behalf of the license holder may request renewal of the license. The renewal application must include a current address and telephone number for the individual requesting the renewal.
(2)
An agency may request a renewal application before or after the expiration of the license.
(3)
A copy of the official orders or other official military documentation showing that the license holder is or was on active military duty serving outside the state of Texas must be filed with DADS along with the renewal application.
(4)
A copy of the power of attorney from the license holder or other authority to act on behalf of the license holder must be filed with DADS along with the renewal application.
(5)
A license holder renewing under this subsection must pay the applicable renewal fee.
(6)
A license holder is not authorized to operate the agency for which the license was obtained after the expiration of the license unless and until the license holder actually renews the license.
(7)
This subsection applies to a license holder who is an individual or a partnership comprised of individuals, all of whom are or were on active duty with the armed forces of the United States of America serving outside the state of Texas.

§97.19  Issuance of a Renewal License

(a)
A renewal license is valid for two years. The new licensure period begins the day after the previous license expires.
(b)
Except as specified in §97.503 of this chapter (relating to Exemption From a Survey), DADS may not renew an initial license unless DADS conducts an initial survey of the agency. For renewal of an initial license, an agency must:
(1)
meet the requirements for an initial survey as specified in Subchapter E of this chapter (relating to Licensure Surveys);
(2)
demonstrate substantial compliance with the statute and this chapter for the services authorized under the license as confirmed by an initial survey; and
(3)
apply for renewal of the license in accordance with §97.17 of this subchapter (relating to Application Procedures for a Renewal License).
(c)
For renewal of a license other than an initial license, an agency must:
(1)
maintain substantial compliance with the statute and this chapter for the services authorized under the license; and
(2)
apply for renewal of the license in accordance with §97.17 of this subchapter.
(d)
DADS may deny a renewal application:
(1)
if an agency fails to meet the eligibility criteria in §97.11 of this subchapter (relating to Criteria and Eligibility for Licensing);
(2)
if the agency fails to meet the requirements for renewal of a license as specified in this section; or
(3)
for any of the reasons specified in §97.21 of this subchapter (relating to Denial of an Application or a License).
(e)
A renewal license designates an agency's place of business from which services are to be provided and designates an agency's authorized category or categories of service.

§97.21  Denial of an Application or a License

(a)
DADS may deny an application for an initial license or for renewal of a license if any person described in §97.11(g) of this subchapter (relating to Criteria and Eligibility for Licensing):
(1)
fails to comply with the statute;
(2)
fails to comply with this chapter;
(3)
knowingly aids, abets, or permits another person to violate the statute or this chapter;
(4)
fails to meet the criteria for a license established in §97.11 of this subchapter; or
(5)
violates Texas Occupations Code, §102.001 (relating to Soliciting Patients; Offense) or §102.006, (relating to Failure to Disclose; Offense).
(b)
If DADS denies an application for an initial license or for renewal of a license, the applicant or agency may request an administrative hearing in accordance with §97.601 of this chapter, (relating to Enforcement Actions).

§97.23  Change of Ownership

(a)
A license issued under this chapter may not be sold or assigned to another person.
(b)
A change of ownership occurs when there is:
(1)
a change of 50% or more in the ownership of the business organization or sole proprietorship that is licensed to operate the agency; or
(2)
a change in the federal taxpayer identification number.
(c)
A change of ownership for a parent agency is a change of ownership for the parent agency's branch office or alternate delivery site and requires the submittal of an initial application and license fee for the branch office or alternate delivery site.
(d)
A change of ownership does not apply if an agency is a business entity and is simply amending its official documents to revise its name.
(e)
For agencies licensed to provide licensed and certified home health services and licensed and certified hospice services, applicable federal laws and regulations relating to change of ownership or control apply in addition to the requirements of this section.

§97.25  Application Procedures and Requirements for Change of Ownership

(a)
An application for an initial license resulting from a change of ownership must be requested at least 60 days before the effective date of the change of ownership.
(1)
To avoid a gap in the license period, a prospective new owner must submit a complete and correct application packet for a license and the appropriate license fee to DADS at least 30 days before the anticipated date of sale or other transfer of ownership, and before expiration date of the license.
(2)
An applicant must submit a complete and correct application packet to DADS in accordance with the instructions provided with the application packet.
(3)
An applicant must meet the criteria for a license as described in §97.11 of this subchapter (relating to Criteria and Eligibility for Licensing).
(4)
If an applicant submits a timely and sufficient application packet and license fee and meets all criteria for a license, DADS issues the applicant a license effective on the date of the transfer of ownership. DADS considers an applicant to have filed a timely and sufficient application for a license if the applicant submits:
(A)
a complete and correct application packet and license fee to DADS that is postmarked at least 30 days before the anticipated date of sale or other transfer of ownership, and before the expiration date of the license;
(B)
an incomplete application packet and license fee to DADS with a letter explaining the circumstances that prevented its completion that is postmarked at least 30 days before the anticipated date of sale or other transfer of ownership, and before the expiration date of the license; and DADS accepts the explanation. The applicant must submit the missing information to DADS within 30 days after the date of the letter;
(C)
a complete and correct application packet and license fee to DADS that is postmarked less than 30 days before the anticipated date of sale or other transfer of ownership, and before the expiration date of the license; and the applicant pays the late fee set out in §97.3(d) of this chapter (relating to License Fees); or
(D)
a complete and correct application packet and license fee to DADS that is received by the date of sale or other transfer of ownership, and before the expiration date of the license; and the applicant proves to DADS' satisfaction that the health and safety of the agency's clients required an emergency change of ownership.
(5)
If an applicant files a timely application packet and license fee, but DADS determines that the application packet is incomplete and a letter explaining the circumstances that prevented its completion was not filed with the application, DADS considers the application timely filed but incomplete.
(A)
DADS provides the applicant with written notification of the missing information required to complete the application and may assess the late fee set out in 97.3(d) of this chapter for failure to comply with paragraph (1) of this subsection.
(B)
An applicant must submit the required information and late fee, if assessed, no later than 30 days after the date of the notice. If an applicant fails to submit the required information within 30 days after the notice date, DADS considers the application incomplete and DADS denies the license. If DADS denies the license, DADS does not refund the license fee.
(6)
The initial license issued to the new owner is valid for two years from the date of issuance.
(7)
The previous owner's license is void on the effective date of the new owner's initial license. The previous owner's license must be surrendered to DADS within five working days after the effective date of the change of ownership.
(8)
DADS may deny issuance of a license for any of the reasons specified in §97.21 of this subchapter (relating to Denial of an Application or a License).
(b)
For agencies licensed to provide licensed and certified home health services and licensed and certified hospice services, applicable federal laws and regulations relating to change of ownership or control apply in addition to the requirements of this section.

§97.27  Application and Issuance of a Branch Office License

(a)
An agency with a current license to provide licensed home health services, licensed and certified home health services, or personal assistance services may qualify for a branch office license if the parent agency:
(1)
is found to be in substantial compliance with the statute and this chapter; and
(2)
has no enforcement action pending against the license.
(b)
Upon request, DADS furnishes a parent agency with an application packet for a branch office license.
(c)
An agency must submit to DADS a complete and correct application packet and the required license fee for a branch office license in accordance with the instructions provided with the application packet. A complete and correct application packet includes all documents and information that DADS requests as part of the application process.
(d)
DADS reviews an application packet for a branch office license to determine whether it is complete and correct.
(1)
DADS processes an application packet for a branch office license according to the time frames in §97.31 of this chapter (relating to Time Frames for Processing and Issuing a License).
(2)
If an agency receives a notice from DADS that some or all of the information required by this section is missing or incomplete, the agency must submit the required information no later than 30 days after the date of the notice. If an agency fails to submit the required information within 30 days after the notice date, DADS considers the application for a branch office license incomplete and denies the application. If DADS denies the application, DADS does not refund the license fee.
(e)
A designated survey office conducts a review of an agency's request to establish a branch office. The survey office makes a recommendation to approve or disapprove the branch office request.
(f)
DADS approves or denies the application for a branch office license after considering the designated survey office's recommendation. If DADS denies the application, DADS sends the agency a written notice:
(1)
informing the agency of its decision; and
(2)
providing the agency with an opportunity to appeal its decision through a formal hearing process as described in §97.601 of this chapter (relating to Enforcement Actions).
(g)
CMS approves or denies the branch location if an agency is licensed to provide licensed and certified home health services.
(h)
A branch office license expires on the same expiration date as the parent agency's license, and the agency may renew it with the parent agency's license.
(i)
DADS mails the branch office license to the parent agency. The branch office must post the license in a conspicuous place on the licensed branch office premises.
(j)
A branch office must comply with §97.321 of this title (relating to Standards for Branch Offices) and the additional standards that relate to the agency's authorized categories under the license.
(k)
DADS may conduct a survey of a branch office after issuance of the license to verify compliance with the statute and this chapter.

§97.29  Application and Issuance of an Alternate Delivery Site License

(a)
An agency with a current license to provide hospice services may qualify for an alternate delivery site license if the parent agency:
(1)
is found to be in substantial compliance with the statute and this chapter; and
(2)
has no enforcement action pending against the license.
(b)
Upon request, DADS furnishes a parent agency with an application packet for an alternate delivery site license.
(c)
An agency must submit to DADS a complete and correct application packet and the required license fee for an alternate delivery site in accordance with instructions provided with the application packet. A complete and correct application packet includes all documents and information that DADS requests as part of the application process.
(d)
DADS reviews an application packet for an alternate delivery site to determine whether it is complete and correct.
(1)
DADS processes an application packet for an alternate delivery site according to the time frames in §97.31 of this chapter (relating to Time Frames for Processing and Issuing a License).
(2)
If an agency receives a notice from DADS that some or all of the information required by this section is missing or incomplete, the agency must submit the required information no later than 30 days after the date of the notice. If an agency fails to submit the required information within 30 days after the notice date, DADS considers the application for an alternate delivery site license incomplete and denies the application. If DADS denies the application, DADS does not refund the license fee.
(e)
A designated survey office conducts a review of an agency's request to establish an alternate delivery site. The survey office makes a recommendation to approve or deny the alternate delivery site request.
(f)
If an agency provides licensed-only hospice services, DADS approves or denies the application for an alternate delivery site after considering the designated survey office's recommendation. If DADS denies the application, DADS sends the agency a written notice:
(1)
informing the agency of its decision; and
(2)
providing the agency with an opportunity to appeal its decision through a formal hearing process as described in §97.601 of this chapter (relating to Enforcement Actions).
(g)
CMS approves or denies the application for an alternate delivery site if an agency is licensed to provide licensed and certified hospice services.
(h)
An alternate delivery site license expires on the same expiration date as the parent agency's license, and the agency may renew it with the parent agency's license.
(i)
DADS mails an alternate delivery site license to the parent agency. The alternate delivery site must post the license in a conspicuous place on the licensed alternate delivery site premises.
(j)
An alternate delivery site must comply with §97.403 of this chapter (relating to Standards Specific to Agencies Licensed to Provide Hospice Services) and §97.322 of this chapter (relating to Standards for Alternate Delivery Sites).
(k)
The designated survey office conducts a survey after issuance of the license to verify compliance with §97.403 and §97.322 of this chapter.
(l)
The designated survey office may recommend that a licensed alternate delivery site seek a license as a parent agency, under but not exclusive of the following conditions:
(1)
the alternate delivery site is the hospice's principal place of business as defined in §97.2 of this chapter (relating to Definitions); or
(2)
the alternate delivery site is located outside the geographical area served by the parent agency.

§97.31  Time Frames for Processing and Issuing a License

(a)
General.
(1)
In this section, the date of an application is the date the DADS' Home and Community Support Services Agencies (HCSSA) Licensing Unit receives the application.
(2)
DADS considers an application for an initial license complete when DADS receives, reviews, and accepts the information described in §97.13 of this subchapter (relating to Application Procedures for an Initial License).
(3)
DADS considers an application for a renewal license complete when DADS receives, reviews, and accepts the information described in §97.17 of this subchapter (relating to Application Procedures for a Renewal License). An agency may continue to operate in accordance with §97.17(j) of this subchapter.
(4)
DADS considers an application for a change of ownership license complete when DADS receives, reviews, and accepts the information described in §97.25 of this subchapter (relating to Change of Ownership).
(5)
DADS considers an application for a branch office license complete when DADS receives, reviews, and accepts the information described in §97.27 of this subchapter (relating to Application and Issuance of a Branch Office License).
(6)
DADS considers an application for an alternate delivery site license complete when DADS receives, reviews, and accepts the information described in §97.29 of this subchapter (relating to Application and Issuance of an Alternate Delivery Site License).
(b)
Time frames. An application from an agency for an initial, renewal, change of ownership, branch office, or alternate delivery site license is processed in accordance with the following time frames:
(1)
The first time frame begins on the date DADS' HCSSA Licensing Unit receives an application and ends on the date a license is issued. If DADS' HCSSA Licensing Unit receives an incomplete application, the first time frame ends on the date DADS' HCSSA Licensing Unit sends a written notice to the agency that the application is incomplete. The written notice describes the specific information that the applicant must submit to complete the application. The first time frame is no longer than 45 days.
(2)
The second time frame begins on the date DADS' HCSSA Licensing Unit receives the last item necessary to complete the application and ends on the date the license is issued. The second time frame is no longer than 45 days.
(3)
If an agency is subject to a proposed or pending enforcement action on its license on or within 45 days before the expiration date of the license, DADS may suspend issuance of a renewal license until a formal hearing as described in §97.601 of this chapter (relating to Enforcement Actions) is complete.
(c)
Reimbursement of fees.
(1)
If DADS does not process the application in the time frames stated in subsection (b) of this section, the applicant has the right to request that DADS reimburse the license fee. If DADS does not agree that the established time frames have been violated or finds that good cause existed for exceeding the established time frames, DADS denies the request.
(2)
DADS considers that good cause for exceeding the established time frames exists if:
(A)
the number of applications to be processed exceeds by 15% or more the number of applications processed in the same quarter for the preceding year;
(B)
another public or private entity used in the application process caused the delay; or
(C)
other conditions existed giving good cause for exceeding the established time frames.
(d)
Appeal. If DADS denies the request for reimbursement of the license fee as authorized by subsection (c) of this section, the applicant may appeal the denial. In order to appeal, the applicant must send a written request for reimbursement of the license fee to the DADS commissioner. The request must include that the application was not processed within the established time frame. DADS' HCSSA Licensing Unit provides the DADS commissioner with a written report of the facts related to the processing of the application and good cause for exceeding the established time frame. The DADS commissioner makes the final decision and provides written notification of the decision to the applicant and DADS' HCSSA Licensing Unit.