How to Become a Nursing Facility Provider

In order to become a nursing facility provider, you must first apply for a license. Facilities may wish to be private pay (facility with no certification) or Medicaid- and /or Medicare-certified.

As a prerequisite for participating in the Title XIX Medicaid Nursing Facility Program and receiving reimbursement for eligible Medicaid residents, a provider must have an allocation of Medicaid beds or have entered into a lease agreement with a nursing facility owner that has an allocation of Medicaid beds. The following links to the Nursing Facility Requirements for Licensure and Medicaid Certification outline various ways to obtain Medicaid beds.

Nursing Facility License

Initial

  • The DADS Architectural unit will review facility plans to ensure that construction meets state and federal Life Safety Code standards. For information regarding plan reviews, contact the Architectural unit at 512-438-2371.
  • Initial applications should be submitted to DADS 60 days before the anticipated opening date of the facility. Refer to the Required documents and forms section of this website for a list of required forms, documents and instructions.
  • A Life Safety Code inspection will be conducted after DADS has received the required documents and forms, the owner has been approved and the applicant has submitted a written request for a Life Safety Code inspection.
  • When the Life Safety Code inspection has been approved, the applicant may admit one to three residents. The applicant must submit a written request for a health inspection.
  • When the facility has passed the health inspection, the license will be issued.

Change of Ownership

  • A completed change of ownership application must be submitted 30 days before the change of ownership effective date. Refer to the Required Documents and Forms Section of this website for a list of required forms, documents and instructions.
  • DADS will issue a 90-day temporary license and schedule a health inspection after the agency has received the required documents and forms and the owner has been approved.
  • A health inspection will be conducted within 90 days of issuance of the temporary license. If the facility is found to be in substantial compliance, a permanent license will be issued.

Renewal

A preprinted renewal application and instructions will be mailed to the owner 120 days before the license expires. Renewal applications must be submitted 45 days before the license expiration date. An applicant for license renewal who submits an application during the 45-day period ending on the date the current license expires must pay a late fee of an amount equal to one-half of the total basic renewal fee.

If you do not receive a preprinted renewal application, or have a question about renewing your license, please call Regulatory Services Licensing and Credentialing at 512-438-2630. DADS will accept and process only preprinted renewal applications.

Updates

For information regarding reporting the following updates, refer to Form 3720-N (Application for Nursing Facility License). (Form 3720-N Instructions):

  • Management company
  • Relocation of a facility
  • Replacement of facility
  • Change of real estate owner, lien holder or other encumbrance changes
  • Changes of ownership interests or stock transfers of 5 to 49 percent

Time Frames

Click on the information below to view the relevant section of the Texas Administrative Code.

Required Documents and Forms


Applications and required fees should be sent to:

Regular Mail
Accounts Receivable
Mail Code E-411
Texas Department of Aging and Disability Services
P.O. Box 149030
Austin, TX 78714-9030

Overnight delivery
Accounts Receivable
Mail Code E-411
Texas Department of Aging and Disability Services
701 West 51st St.
Austin, TX 78751
Phone: 512-438-2630

Required Owner Documents

Licensure Requirements

top of page

Nursing Facility Certification for Medicaid

In order to become a Medicaid nursing facility provider, a nursing facility owner must be licensed and have an allocation of Medicaid beds. For initial certification and change of ownership follow the instructions under Nursing Facility License and Nursing Facility Medicaid Provider Agreement .

The following links outline various ways to obtain Medicaid beds.

top of page

Application for Nursing Facility Medicaid Provider Agreement

Form 3720N, Application for Nursing Facility License and Participation in the Title XIX Medicaid, is used for the following types of applications for participation in the Title XIX Medicaid program:

  • Initial Medicaid enrollment
  • Change of ownership
  • Report changes and updates
  • Management company changes
  • Relocation of a facility
  • Replacement of facility
  • Change of real estate owner, lien holder or other encumbrance changes
  • Changes of ownership interests or stock transfers of less than 50 percent
Submit application requests to:

Regular Mail
Regulatory Services
Licensing and Credentialing
Mail Code E342
Texas Department of Aging and Disability Services
P.O. Box 149030
Austin, TX 78714-9030

Overnight delivery
Regulatory Services
Licensing and Credentialing
Mail Code E342
Texas Department of Aging and Disability Services
701 West 51st St.
Austin, TX 78751
Phone: 512-438-2630
Fax: 512-438-2730 

In addition, an Electronic Data Interchange (EDI) agreement must be entered into with the Texas Medicaid Healthcare Partnership (TMHP) in order to submit claims for reimbursement. 1-888-863-3638, Option 3.

Time Frames

Click on the information below to view the relevant section of the Texas Administrative Code.

Requirements

top of page

Nursing Facility Certification for Medicare

Note: A new facility or a licensed-only facility requesting Medicare-only certification must contact the regional director in their area for further direction regarding access to care.

Initial Medicare Certification Required Documents and Forms

To qualify for Medicare payments, a facility must be in compliance with the Nursing Facility Requirements. The following forms/statements/letters must have the original signatures of an authorized representative.

  • CMS Form 855A, Medicare Enrollment Application — Mail the 855A directly to the Medicare administrative contractor, Trailblazer, unless you have single intermediary status with CMS.

    TrailBlazer Health Enterprises LLC
    Medicare Part A Provider Enrollment
    P.O. Box 650458
    Dallas, TX  75265-0458

    Effective March 25, 2011, an application fee is required with submission of CMS Form 855A.  Information pertaining to the enrollment application fee may be obtained at the following web address: http://www.cms.gov/mlnmattersarticles/downloads/MM7350.pdf

Send the following forms directly to DADS:

  • CMS Form 1561, Health Insurance Benefit Agreement (Print name, sign and date only the section titled "Accepted for the Provider of Services By.") [Three originals and one copy]
  • Copy of Certificate of Formation (from TX Secretary of State) [two copies]
  • Proof of IRS Tax Identification Number (Form CP-575 or LTR 147C) [two copies]
  • Management Company Agreement (if applicable) [two copies]
  • Letter requesting a Medicare participation date (when adding Medicare to a Medicaid facility) [two copies]
  • Floor plan that includes all room numbers and the capacity of each room
  • Proposed configuration form
  • National Provider Identification Number (confirmation e-mail) [two copies]
  • Letter indicating the fiscal year end date (two copies)
  • Assumed Name Certificate (two copies)
  • DADS Form 3697, Transfer Agreement (legal entity and DBA name must appear on the first and last pages) [two copies]
  • Civil Rights Packet (one original)
DADS Medicare forms should be mailed to the following address:

Regular Mail
Regulatory Services
Licensing and Credentialing
Mail Code E-342
Texas Department of Aging and Disability Services
P.O. Box 149030
Austin, TX 78714-9030

Overnight delivery
Regulatory Services
Licensing and Credentialing
Mail Code E-342
Texas Department of Aging and Disability Services
701 West 51st St.
Austin, TX 78751
Phone: 512-438-2630

Medicare Change of Ownership Required Documents and Forms

To qualify for Medicare payments, your facility must be in compliance with the Nursing Facility Requirements. The following forms/letters must have original signatures by an authorized representative. If the new owner does not accept assignment of the current provider agreement, the Prospective Owner Intentions Regarding Medicare Certification, Form 3695, must be mailed immediately after reading the State Operations Manual 3210.5 (PDF format) and 42 CFR 489.18 (PDF format).

Send the following forms directly to DADS:

DADS Medicare forms should be mailed to the following address:

Regular Mail
Regulatory Services
Licensing and Credentialing
Mail Code E-342
Texas Department of Aging and Disability Services
P.O. Box 149030
Austin, TX 78714-9030

Overnight delivery
Regulatory Services
Licensing and Credentialing
Mail Code E-342
Texas Department of Aging and Disability Services
701 West 51st St.
Austin, TX 78751
Phone: 512-438-2630

Medicare Requirements

top of page

Surveys and Investigations of Complaints and Incidents

DADS surveys nursing facilities annually to ensure that they are in compliance with state licensure and federal certification regulations. DADS also investigates self-reported incidents from facilities and complaints from residents, family members, friends and others. Surveyors initiate investigation of complaints and incidents in facilities within 24 hours, 14 days, 30 days or 45 days, 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.

DADS conducts on-site investigations for all complaints received. If DADS determines that the facility has investigated a self-reported incident, has determined the cause and has made the necessary changes to remove the problem, DADS may elect not to conduct an on-site investigation. If surveyors find a state licensure violation or federal deficiency during a visit, survey staff make a follow-up visit to ensure that the facility has corrected the violation or deficiency and is in compliance with the regulations. DADS does not notify facilities before conducting surveys or investigations. For information on how to report a complaint, please visit the DADS Consumer Rights and Services website.

DADS has surveyors from a number of professional disciplines, including registered nurses, social workers, nutritionists, pharmacists, architects, engineers and Life Safety Code specialists. A team of specialists conducts the annual facility survey. DADS assigns one or more surveyors from specific areas of expertise to investigate complaints and incidents based on the nature of the complaint or incident and facility size.

Survey Reports

When the survey team completes the survey, inspection, investigation, follow-up or other visit, it writes a report of the findings that details the facility’s failures to comply with state or federal regulations, which are called violations and deficiencies, respectively. The facility must make survey reports available to all facility residents and visitors. Interested parties may also request survey team visit results from Consumer Rights and Services at 1-800-458-9858.

Enforcement Actions

Once the survey team completes the report, DADS staff review the findings to determine if an enforcement action is necessary due to noncompliance with a condition of participation or repeat deficiencies. An array of enforcement actions are available under state licensing laws, including actions against a facility’s license and monetary sanctions such as an administrative penalty or civil penalty.

State regulations give facilities the right to request an informal dispute resolution of the cited violations/deficiencies and to appeal enforcement actions.

top of page

Updated: September 15, 2014