Home and Community Support Services Agencies (HCSSA)
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How to become a licensed HCSSA (home health, hospice, personal assistance services) provider
The Texas Department of Aging and Disability Services (DADS) licenses, certifies and surveys home and community support services agencies (HCSSAs) for compliance with state and federal laws and regulations. Through these regulatory activities, DADS protects Texas citizens receiving home health, hospice and personal assistance services.
HCSSAs must be licensed to operate in Texas. To become licensed, an agency must:
- complete the presurvey computer-based training,
- properly complete the license application,
- include all required documents,
- pay the required license fee and
- be approved by DADS.
Required documents for an initial license
Please see the Licensing Standards for Home and Community Support Services Agencies Handbook for more information.
- Licensing fees: $1,750 for each parent or branch and $1,000 for each alternate delivery site.
- DADS Form 2021, Home and Community Support Services Agency License Application, with nonrefundable fee.
- Current Letter of Good Standing from the State Comptroller of Public Accounts or an exemption letter for the taxes from the State Comptroller's Office, if nonprofit.
- DADS Form 2022, Home and Community Support Services Agencies Licensure Criminal History Check, for all owners, administrators, alternate administrators and chief financial officers. Nonprofit and multi-level organizations must identify the controlling individuals, including: name, position, birth date and, preferably, Social Security number.
- Organizational structure of the agency denoting lines of authority down to and including the patient care level.
- Current resumes for the administrator, alternate administrator, supervising nurse and alternate supervising nurse, and required continuing education (CE) certificates for the administrator and alternate administrator. (Click here for a list of training providers.) Resumes must include the month, date, year and a detailed description of the duties performed for current and past employment.
- Plan for providing continuing training and education for personnel during the term of the license. Refer to the Texas Administrative Code, Title 40, Part 1, Chapter 97, §97.259 and §97.260.
- Job description and personnel qualifications for the administrator, alternate administrator, supervising nurse and alternate supervising nurse. Refer to Texas Administrative Code, Title 40, Part 1, Chapter 97, §97.244 and §97.259.
- Plan that provides for the orderly transfer of client care if the applicant cannot maintain delivery of home health, hospice or personal assistance services. Refer to Texas Administrative Code, Title 40, Part 1, Chapter 97, §97.217, §97.291, and §97.295.
- Certificates from the HCSSA presurvey computer-based training for the administrator, alternate administrator, supervising nurse and alternate supervising nurse.
- Copy of the legal entity documents; see below for requirements.
- Copy of the Internal Revenue Service (IRS) Tax Identification Number document/letter issued by the IRS.
- Copy of the agency’s National Provider Identification (NPI) number issued by the National Plan and Provider Enumeration System (NPPES).
Initial branch, alternate delivery site and Medicare branch applications
- DADS Form 2023, Home and Community Support Services Agency Application for Medicare Certified Branch, with the non-refundable fee.
- DADS Form 2024, Home and Community Support Services Agency Request for an Alternate Delivery Site License, with the non-refundable fee.
- DADS Form 2025, Home and Community Support Services Agency Request for a Branch License, with the non-refundable fee.
Required legal entity documents
- Corporation
- Limited partnership
- General partnership
- Sole proprietor
- Limited liability company
- City, county, state or federal government authority or hospital district/authority
- Trust, living trust, estate
Medicare certification
Participation in the state and federal Medicaid program and the federal Medicare program is voluntary. However, each agency must be certified for the appropriate Medicare program before serving clients who are eligible for this program.
Attention: Applicants seeking an initial parent or branch license to provide licensed and certified home health services (authorization to provide services to Medicare beneficiaries) should read Provider Letter 2011-03 — The Centers for Medicare and Medicaid Services (CMS) Direction Regarding Workload Prioritization. (This letter replaces provider letters 2007-17 and 2007-04.)
Accreditation agencies
- Community Health Accreditation Program (CHAP)
- The Joint Commission
- Accreditation Commission for Health Care, Inc.
Required documents for Medicare certification
These documents are required if the agency is seeking certification or is currently certified through the Medicare program.
- Printed CMS 855A Home Health Enrollment Application (Please read the instructions for how to submit this form to the fiscal intermediary) OR Online CMS 885A Home Health Enrollment Application
- CMS 1561 Health Insurance Benefit Agreement in PDF format (two copies with original signatures, completing the entire top half and signing under "Accepted for the provider of services by")
- HHS-690 Assurance of Compliance (two copies with original signatures)
- The Civil Rights packet and policies (PDF format)
- CMS 417 Hospice Request for Certification in the Medicare Program in PDF (four copies with original signatures) only if requesting the category of certified hospice
Attention: Home health and Hospices agencies that are (1) initially enrolling in Medicare, (2) adding a branch or multiple location, or (3) revalidating their enrollment information, must submit with their CMS 855 application:
- Verification of the application fee in an amount prescribed by CMS, and/or
- A letter for a request for a hardship exception to the application fee.
The provider must pay the application fee electronically through Pay.gov, either via credit card or debit card. The application fee applies to CMS 855 applications that the agency's Regional Home Health Intermediary/Medicare Administrative contractor (MAC) receives on or after March 25, 2011.
The following links provides additional information and the current application fee process:
- CMS Home Health Center page: http://www.cms.gov/center/hha.asp
- CMS Hospice Center page: http://www.cms.gov/center/hospice.asp
- Implementation of Provider Enrollment Provisions: http://www.cms.gov/mlnmattersarticles/downloads/MM7350.pdf
Time frames
An application from an agency for an initial parent, branch office or alternate delivery site license is processed in accordance with three general time frames:
- Upon receipt of a thoroughly complete application in the DADS HCSSA Licensing Branch (this will be after it has gone through the mail room and accounting; about 10 days from mailing), DADS will issue or deny the license within 45 days.
- If DADS receives an incomplete application, the DADS HCSSA Licensing Branch will notify the HCSSA applicant in writing of any deficient items in the application. The applicant must respond with complete and correct information within 30 days from the date of the letter or the application will be denied.
- Upon receipt of the application deficiency response in the DADS HCSSA Licensing Branch, DADS will issue or deny the license within 45 days.
Once a license is issued, the agency must notify the DADS regional office upon enrolling its first client and request an initial health survey using DADS Form 2020, Notification of Readiness for Initial Survey. This survey request must be completed within six months of the issuance of the initial license. Licensing surveys will continue to be done at regular intervals and must be passed in order for the agency's license to be renewed. For an agency to retain its license, any inspection, survey, follow-up visit or complaint/incident investigation must show that the agency is in compliance with the current state licensure or federal certification laws and rules, or both.
State and federal regulations and requirements
Click here for a list of all applicable state and federal regulations and requirements. HCSSA providers are responsible for reading and understanding these regulations prior to becoming a licensed provider.
Related links
- Printed CMS 855A Home Health Enrollment Application (Please read the instructions for how to submit this form to the fiscal intermediary) OR Online CMS 885A Home Health Enrollment Application
- Hospice Request for Certification in the Medicare Program
- Health Insurance Benefit Agreement for Medicare Home Health
- Medicare Conditions of Participation for Home Health and Hospice
- Office for Civil Rights
- Oasis Help Desk
- Texas Department of Public Safety
- HCSSA Training Classes
- Board of Nursing
- Taxpayer search
Regular surveys and investigations of complaints and incidents
DADS conducts on-site surveys of HCSSAs after issuance of the initial license, 18 months after the initial survey and every 36 months thereafter to ensure that they are in compliance with state licensure and federal certification regulations. Initial surveys for some changes of ownership may be conducted by desk review.
DADS conducts on-site investigations or desk reviews for all self-reported incidents received from agencies and complaints from clients, family members, friends and others. Surveyors initiate investigation of complaints and incidents in agencies within 24 hours, 2 days, 10 days, 45 days, 90 days or at the time of the next on-site survey, depending on the priority assigned by the intake program specialist who receives the complaint or incident report. The priority is based on the immediacy and seriousness of the allegation. Complaint and complainant information is confidential and is not shared with the agency.
If surveyors find a state licensure violation or federal deficiency during a visit, survey staff may make a follow-up visit to ensure that the agency has corrected the violation or deficiency and is in compliance with the regulations. All surveys and investigations are unannounced. DADS does not notify agencies prior to conducting surveys, follow-up visits or investigations. For information on how to report a complaint, please visit the DADS Consumer Rights and Services Complaint Intake section website.
Survey reports
When the surveyor completes the survey, investigation, follow-up or other visit, he or she writes a report of the findings detailing the agency’s noncompliance with state or federal regulations, which are called violations and deficiencies, respectively. Interested parties may request survey results by contacting the Consumer Rights and Services Complaint Intake section at 1-800-458-9858.
Enforcement actions
Once the surveyor completes the report, the HCSSA program manager reviews the findings to provide guidance to the surveyor and to determine if an enforcement action is necessary due to noncompliance with a federal condition of participation or a state licensure violation. An array of enforcement actions are available under state licensing laws, including actions against an agency’s license and monetary sanctions called administrative penalties. For HCSSAs with a Medicare provider agreement, recommended sanctions may include revocation of the Medicare provider number.
State and federal regulations give agencies the right to request an informal review of deficiencies to refute the cited violations/deficiencies and to appeal enforcement actions.
Updated: December 21, 2011