Computer-Based Trainings

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Before a Home and Community Support Services Agency (HCSSA) can become licensed, certain members of its staff must complete an important preliminary training called a Presurvey Conference. [40 TAC §97.13(a)]

To ensure that HCSSA license applicants can meet the requirement, the Texas Department of Aging and Disability Services (DADS) has created an online version of the HCSSA Presurvey Conference. Successfully completing this computer-based training (CBT) will fully satisfy the Presurvey Conference licensure requirement.

Skip Directly to the CBTs

Who is required to participate in the presurvey CBT?

  • Agencies providing Personal Assistance Services (PAS) only must designate an administrator and an alternate administrator who must both complete the Presurvey CBT.
  • All other agencies must designate an administrator, alternate administrator, supervising nurse, and alternate supervising nurse who must each complete the Presurvey CBT.

How long will it take to complete the CBT?

Each Presurvey CBT module will take from 30 minutes to an hour to complete; however, there is no time limit imposed on participants.

How do you verify participation?

After completing each required module, training participants must print out a participation verification certificate. Sign each of these documents, keep a copy for your agency’s records, and submit a copy with your agency’s license application. Application packets will not be accepted without these documents!

Four steps to taking the HCSSA presurvey computer-based training

  1. Turn off pop-up blocker. If you use a pop-up blocker, you MUST disable the pop-up blocker in order to take the courses. If you fail to disable your pop-up blocker, the course will not load. Click here for a PDF file with instructions on how to disable pop-up blockers. In addition, Javascript must be enabled to run the modules. If you don't have Javascript enabled on your computer, click here to view a PDF that tells you how to do so.
  2. Obtain the required materials. In order to successfully complete the Presurvey Conference CBT, participants must have access to the most current copies of all relevant regulations and laws. These regulations and laws are accessible from Module 1.
  3. Complete all required modules.
    It’s estimated that each module will require about one hour for successful completion. Each module must be completed in its entirety along with the end-of-module quiz. To begin each module, click on each module title below. After each module is completed, participants must print out and sign a participation verification form. Participants will then be returned to this page.
  4. Submit the appropriate participant verification certificates with your applications.

The modules

All training participants must complete Modules 1 and 2. Click on each to begin.

All training participants must also complete an additional module for each of their agency’s selected service categories. Click on each applicable module to begin.

Questions?

If, after taking Modules 1 and 2, you are unsure about what other modules you need to take, please contact the appropriate regional office.

  • For questions regarding your licensure application, please contact a HCSSA licensing specialist at 512-438-2630.
  • For questions regarding rules, please contact a HCSSA rule writer at 361-878-3419.
  • For questions regarding policies, please contact a HCSSA policy specialist at 512-438-3161.
  • If you have technical problems with the CBT, e-mail: cbthelp-regsrvcs@dads.state.tx.us.

A list of useful telephone numbers is available for your convenience.

PowerPoint Presentation in PDF

Overview

The purpose of this presentation is to provide information about the Form 2021 Licensing Application and the rules affecting the application located in the Texas Administrative Code (TAC), Title 40, Part 1, Chapter 97 Subchapter B licensing standards as it relates to the Home and Community Support Services Agencies (HCSSA).

This information will equip the participant to understand the licensing process and application requirements.

Who Should Submit Form 2021?

Those persons providing Home Health, Hospice or Personal Assistance Services (PAS) for pay or other considerations in a client's residence, an independent living environment or another appropriate location should submit this application.

Complete this form for all initial parent, renewal and Change of Ownership (CHOW) applications.

Objectives

In this course you will review the:

  • Texas Administrative Code (TAC), Title 40, Part 1, Chapter 97 Subchapter B; and
  • Licensing Form 2021.

Organization

  • This course is designed to provide general information on the licensing application requirements.
  • It will be helpful to print the application Form 2021 so it may be reviewed throughout this course.
  • This presentation follows Form 2021 in its content. Form 2021 is divided into sections which require specific information.
  • This presentation includes information from Title 40, Part 1, Chapter 97 Subchapter B to ensure the participant has all the required information to complete Form 2021.

It remains the full responsibility of each applicant to complete the application in its entirety with accurate information.

National Provider Identification Number

Prior to submitting your Application Form 2021 you will need your National Provider Identification number.

The National Provider Identification (NPI) number is the standard unique health identifier for health care providers and is assigned by the National Plan and Provider Enumeration System (NPPES). To obtain an NPI, you may apply online at https://NPPES.cms.hhs.gov.

NOTE: Once you have this number you can submit your application.

Presurvey Conference CBT

To avoid delays in the application process, the applicant should ensure that the appropriate individuals have completed the presurvey computer-based training (CBT) before submission of Form 2021. The applicant must print documentation of completion for each of the required individuals and submit proof of completion with the application.

According to §97.11, the presurvey conference CBT must be completed by the individuals below:

  • the designated administrator and an alternate of a personal assistance agency; or
  • the designated administrator, alternate administrator, supervising nurse and alternate supervising nurse of all other types of agencies.

The presurvey conference CBT is on the DADS website at http://www.dads.state.tx.us/providers/hcssa/cbt.

Form 2021 Sections

The application is divided up into 14 sections

  • Section 1 – Type of Application
  • Section 2 – Legal Entity Name
  • Section 3 – Address
  • Section 4 – Doing Business As (DBA) Name
  • Section 5 – Management Information
  • Section 6 – Accreditation Status
  • Section 7 – Contracts with State Agencies
  • Section 8 – Renewals or CHOWS only
  • Section 9 – Geographic Service Areas
  • Section 10 – Ownership Disclosure
  • Section 11 – Adverse Legal History
  • Section 12 – Affidavit for Application
  • Section 13 – Affidavit of Capability
  • Section 14 – Affidavit of Financial Solvency

Begin Completing Form 2021

  • Type or print all information so that it is legible.
  • Do not use pencil or white out correctional fluid.
  • Report additional information within a section by copying and completing that section for each additional entry.
  • Submit all required supporting documentation, including the required fee.
  • Keep a copy of your completed application with the attachments and a copy of your check for your records.
  • 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.
  • Complete all sections of the application.

Section 1 Type of Application

Use the application form to:

  • apply for an Initial license or CHOW (change of 50% or more of stock/ownership) license; and
  • renew a license.

The application form must be used to update DADS about changes that affect your agency such as:

  • relocation;
  • management personnel;
  • operating hours;
  • telephone and fax numbers;
  • agency service area (expanding or reducing);
  • category(ies) of service(s) (adding or deleting);
  • ownership interests and/or stock transfer of 49% or less;
  • agency name (legal entity name and/or DBA); and
  • chief financial officer (CFO).

Types of Application

The next section of slides explain each of the application types in section one. Review each type or proceed to the type of application pertinent to your circumstances. Please read the section and its corresponding rules located both here and in the TAC Chapter 97 Subchapter Part B.

§97.11 Initial Licensure

Important facts about initial licensure

  • A first-time application for a license is an application for an initial license.
  • An application for a license when there is a CHOW is an application for an initial license.
  • A separate license is required for each place of business as defined in §97.2.
  • An agency's place of business must be located in and have an address in Texas.
  • An applicant must be at least 18 years of age.

Before issuing a license, DADS considers the background including criminal history and qualifications of:

  • the applicant;
  • a controlling person of the applicant;
  • a person with a disclosable interest;
  • an affiliate of the applicant;
  • the administrator;
  • the alternate administrator; and
  • the chief financial officer.

Initial licensure applicants must meet certain criteria

  • The applicant must not: have an unsatisfied final judgment in any state or other jurisdiction; be in default on a guaranteed student loan (Education Code, §57.491); or be delinquent on child support obligations (Family Code, Chapter 232).
  • In the last two years, the applicant must not have a history in any state or other jurisdiction of any of the following: an unresolved federal or state tax lien; an eviction involving any property or space used as an inpatient hospice agency; or an unresolved final Medicare or Medicaid audit exception.
  • In the last 12 months, the applicant must not have a history in any state or other jurisdiction of any of the following: denial, suspension, or revocation of an agency license or a license for a health care facility; surrender a license before expiration or allowance of a license to expire instead of the licensing authority proceeding with enforcement action; a Medicaid or Medicare sanction or penalty relating to the operation of an agency or a health care facility; operation of an agency that has been decertified in any state under Medicare or Medicaid; or debarment, exclusion, or involuntary contract cancellation in any state by Medicare or Medicaid.

Application procedures for certification

  • When an agency requests the initial license application including certification, the applicant completes and submits a CMS-855A (http://www.cms.gov/Medicare/CMS Forms/CMS-Forms/Downloads/cms855a.pdf) enrollment application and all supporting documentation to its fee-for-service contractor.
  • The fee-for-service contractor reviews the application and makes a recommendation for approval or denial to DADS, with a copy to the Centers for Medicaid and Medicare Services (CMS) Regional Office.
  • The applicant may have an approved accreditation organization conduct a certification survey. Currently DADS must complete all Tiers I, II, and III before conducting certification surveys per Provider Letter 2015-09 (http://www.dads.state.tx.us/providers/communications/2015/letters/PL2015-09.pdf).
  • If CMS certifies an agency to participate in the Medicare program, DADS sends a notice to the agency that the category of Licensed and Certified (L&C) has been added to the license.
  • 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 only.

§97.17 Renewal

Factors that affect a renewal licensure

  • In order to continue providing services to clients, an agency must renew its license and have a successful survey or be satisfactorily accredited.
  • An agency whose license expires must close and apply for an initial license. An agency license is valid for two years.
  • If an agency provides inaccurate or false statements or withholds information from the renewalapplication and/or attachments to the application, DADS may assess the penalties against the agency that apply in §97.13.
  • For each licensure period, an agency must provide services to at least one client. 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.

Renewal licensure process

  • Renewal applications must be submitted before the expiration date. DADS sends a reminder at least 120 days before the expiration.
  • If an agency does not receive the reminder 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.
  • An agency must submit to DADS a complete and correct renewal application and the required license fee specified in §97.3. The packet must be postmarked no later than the 45th day before the expiration date of the license.
  • 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).

Factors affecting a renewal application

  • The agency must cease operation on the date the license expires if DADS does not receive a renewal application postmarked before the expiration date.
  • If at the time an agency submits a timely renewal application, and an action to revoke, suspend, or deny renewal of the license is pending, the agency may continue to operate. The license is valid until the agency has had an opportunity for a formal hearing as described in §97.601.
  • DADS notifies an agency, in writing, if an application does not include all documents, information, or the license fee. 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.

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.

Special military considerations

This 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.

  • 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.
  • An agency may request a renewal application before or after the expiration of the license.
  • 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 and 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.
  • 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.

§97.23 Change of Ownership

Important factors affecting a CHOW

  • A CHOW occurs when there is a change of 50% or more in the ownership (interest and/or stock)§ or a change in the Employer Identification Number (EIN).
  • A change of ownership does not apply if an agency is amending its official documents to revise its name.
  • 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 submission of an initial application and license fee for the branch office or alternate delivery site.

§97.25 Change of Ownership

Important factors affecting a CHOW

  • An applicant must notify DADS at least 60 days before the effective date of the CHOW.
  • A prospective new owner must submit a postmarked, complete and correct application packet for a license and the appropriate license fee at least 30 days before the date of sale or other transfer of ownership, and before the expiration date of the license.
  • If an applicant submits a timely and complete 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.

Time factors when submitting CHOW application packets

  • If a complete and correct application packet and license fee to DADS is postmarked less than 30 days before the anticipated date of sale is submitted the applicant is required to pay the late fee set out in §97.3.
  • If a complete and correct application packet and license fee to DADS is received by the date of sale, the applicant must prove to DADS' satisfaction that the health and safety of the agency's clients requires an emergency CHOW.
  • If an incomplete application packet and license fee is submitted to DADS, it must contain§ a letter explaining the circumstances that prevented its completion. The letter must be postmarked at least 30 days before the anticipated date of sale.§ DADS must accept the explanation and the applicant must submit the missing information to DADS within 30 days after the date of the letter.

§97.213 Relocation

Factors affecting relocation

  • An agency must not transfer a license from one location to another without prior notice to DADS. The agency must submit written notice to DADS to report a change in physical location at least 30 days before the intended relocation according to §97.213.
  • To obtain an exemption, an agency must notify DADS immediately if an unexpected situation beyond the agency's control makes it impossible for the agency to submit written notice to DADS no later than 30 days before the agency relocates. DADS grants or denies the exemption.
  • If DADS grants the exemption, the agency must submit written notice to DADS within 30 days after the date DADS grants the exemption.
  • If an agency reports a change in physical location, the agency must pay a fee and may be subject to a late fee, as described in §97.208.
  • DADS will send the agency a Notification of Change reflecting the new location. The agency must post the Notification of Change beside its license in accordance with §97.211.
  • An agency is exempt from the requirements when reporting a temporary relocation that results from the effects of an emergency or disaster, as specified in §97.256.

§97.218 Change in Organization

Factors affecting a change in management

  • If a change occurs in the following management personnel, an agency must submit written notice to DADS no later than seven days after the date of a change in an: administrator, alternate administrator, chief financial officer or controlling person, as defined in §97.2.§
  • When an agency has a change in management personnel, the agency must pay a fee and may be subject to a late fee, as described in §97.208. An agency is not required to pay a fee to report a change in alternate administrator, but the agency must pay a late fee, as described in §97.208, if the agency does not report the change within the time frame required.
  • DADS will use the postmark to determine whether or not to assess a late fee.
  • A change in the management personnel requires DADS evaluation and approval. DADS notifies an agency if the information the agency provides does not reflect that a person meets the required qualifications per §97.218 .

Updates

DADS requires certain updates be reported using Form 2021. Please review these individual sections if they apply located at http://www.dads.state.tx.us/handbooks/lshcssa.

Rule Application Change DADS Form 2021 Requirements
§97.213 Agency Relocation
(physical address)
Page 1 (Sections 1, 3, 4, 5a and§ 5b) and Page 20
§97.214 Mailing Address
(if different from physical address)
Page 1 (Sections 1, 3 and 5b) and Page 20
§97.214 Agency Contact Information
(telephone number) or Operating Hours
Page 1 (Sections 1, 3, 5 and 6) and Page 20
§97.215 Agency Name
(Doing Business As (DBA), not change of ownership)
Page 1 (Sections 1, 3, 4 and 5) and Page 20
§97.215 Name of Owner
(Legal Entity) (name change only, not change of ownership)
Page 1 (Sections 1, 3, and 5) and Page 20
§97.218 Agency Organization
(management – administrator or chief financial officer)
Page 1 (Sections 1, 3, 4, 5 and 6) and Page 20
§97.218 Agency Organization
(management – administrator or chief financial officer)
Page 1 (Sections 1, 3, 4, 5 and 6), Page 2 (Section 10a), Page 5 (Section 12a, 12b and new ownership information), Page 9 (Section 12b(iv) if applicable) and Page 20
§97.218 Agency Organization
(management – alternate administrator)
Page 1 (Sections 1, 3, 4, 5 and 6) and Page 20
§97.219 Category of Service
(adding or deleting)
Page 1 (Sections 1, 3, 4, and 5), Page 2 (Section 9) and Page 20
§97.220 Service Area
(expanding or reducing)
Page 1 (Sections 1, 3, 4 and 5), Page 3 (Section 11), Page 4 and Page 20

Section 2 Licensing Fees

If DADS receives a partial fee, the application packet and monies are returned to the applicant.

2. Licensing Fee: $1,750

Health and Safety Code Chapter 142, Section 142.010, authorizes the Texas Department of Aging and Disability Services to set home and community support services agency licensing fees. DADS will not consider an initial, renewal or change of ownership application as officially submitted until the applicant pays the full licensing fee. Fees paid to DADS are not refundable.

Other Fees

DADS collects other fees related to changes when an untimely Form 2021 is received. Please see §97.208 for information on late fees.

Update Change Fee
Agency Contact Information (telephone number) or Operating Hours $0
Mailing Address
(if different from physical address)
$0
Agency Relocation (physical address) $30
Agency Organization (management – administrator or chief financial officer) $30
Agency Name (Doing Business As (DBA), not change of ownership) $30
Name of Owner (Legal Entity) (name change only, not change of ownership) $30
Category of Service (adding or deleting) $30
Agency Organization
(management – alternate administrator)
$0
Service Area (expanding or reducing) $30

Section 3 Business Information

Fill out the correct information for each box on the application.

The National Provider Identification (NPI) is the standard unique health identifier for health care providers and is assigned by the National Plan and Provider Enumeration System (NPPES).

Section 4 and 5 Name and Address

Fill in the blanks on the application

Ensure Item 4 indicates the name the agency that your agency will be DBA.

This is the same name as the legal entity name unless otherwise filed with the Secretary of State as an assumed name.

Fill in the physical address and mailing address in this section of the application. Please include city, county and zip code. The mailing address is where the agency receives its correspondence.

Section 6 Management Information

Fill out all the required information. Do not leave any blanks on the form.

Remember PAS agencies must designate an administrator and an alternate administrator and all other types of agencies must designate an administrator, alternate administrator, supervising nurse and alternate supervising nurse.

Section 7 Accreditation Status

DADS recognizes three accrediting organization and the links to their websites are listed below. This section of the application informs DADS of the status of your accreditation.§ Please check yes or no on the application for each question.

Links

Section 8 Contracts with State Agencies

Follow the directions on the application for each blank.

Section 9 Categories of Service

Each of these categories are defined and reviewed during the presurvey conference CBT. If you have questions please review the CBT. Complete this section on the application by checking the category(ies) of service you offer.

Each of these categories of service are explained in the required CBT Presurvey Conference

Section 10 Renewal or CHOW Only

Fill out the blanks in this section of the application completely.

Section 11 Geographic Service Area

This section is divided up into regions. Please check the box for each county you serve.

REGION 1 – LUBBOCK

REGION 2 – ABILENE

REGION 3 – METROPLEX

REGION 4 – TYLER

REGION 5 – BEAUMONT

REGION 6 – HOUSTON

REGION 7 – AUSTIN

REGION 8 – SAN ANTONIO

REGION 9 – ABILENE

REGION 10 – El PASO

REGION 11 – CORPUS CHRISTI

If an agency is Medicare certified, all of its counties must be contiguous

Section 12 Ownership and Control Interest Disclosure

  • In section 12, check the type of organizational structure of your agency. If you are hospital based please check the box on the application.
    • Check one of the boxes on the application for Profit or Nonprofit.
    • Do not forget to submit the copy of the Secretary Franchise Tax Certification of Account Status
  • In section 12b (i), you must disclose information about the owner/applicant and affiliates. Fill out the application with each owner applicants information. Report both the organization/individual and stockholders/investors that have ownership in the applicant/agency.
  • On the application section 12b (ii), complete a separate section for each legal business entity and disclose the name, address, Tax ID number (EIN) and contact person information for the management company.
    • DADS requires that management company controlled organizations be reported. This is any organization that exercises operational or managerial control over the day-to-day operations of the HCSSA.
  • On the application section 12b (iii), please complete each space with the requested information.
  • On the application section 12b (iv), list the information requested for each officer, director or partner.
  • On the application section 12b (v), list the information requested for each facility/agency license held in any state.
  • On the application section 12b (vi), list the information requested if the owner/applicant is a subsidiary of another organization.
  • On the application section 12b (vii), provide the information requested for those individuals with ownership interest in the parent organization.

Section 13 Adverse Legal History

  • DADS requires in section 13 (a) that the owner/applicant must disclose the following data concerning each owner/applicant, applicant's affiliates and the managers of the applicant/owner. Check the appropriate boxes on the application and provide needed attachments if you answered "yes".
  • DADS requires in section 13 (b) that an owner/applicant disclose the information below for certain individuals listed below. Check the appropriate boxes on the application and provide needed attachments if you answered "yes".
  • DADS requires in section 13(c) that an owner/applicant disclose the information listed below. This includes all of the individuals identified in Item 12b (i), as well as the administrator, alternate administrator and chief financial officer. Check the appropriate boxes on the application and provide needed attachments if you answered "yes."

Section 14 Affidavit for Application

This affidavit states all the information you are submitting is true and correct. Complete the affidavit.

  • It must be signed by the owner or a person having signing authority.
  • The affidavit must be signed by someone over the age of 18 and legally competent, qualified and authorized to make the affidavit.
  • The affidavit must be notarized.

Section 14 Affidavit for Capability

This affidavit attests that you have read, understand and are able to meet the requirements listed in Title 40 Texas Administrative Code Chapter 97 and Health and Safety Code Chapter 142. Complete the affidavit.

  • It must be signed by the owner or a person having signing authority for all types of applications.
  • This affidavit attests that you are over 18 years of age and personally acquainted with all the facts stated in your application.
  • This affidavit requires you to have a notary.

Section 14 Affidavit of Financial Solvency

This affidavit attests that your agency as the provider of services states and declares that it has the financial resources to meet its proposed budget and to provide the services required during the term of the license. Complete the affidavit.

  • It must be signed and completed by the owner or a person having signing authority for initial and CHOW applications.
  • This affidavit attests that you are over 18 years of age and personally acquainted with all the facts stated in your application.
  • This affidavit requires you to have a notary.

Document Checklist for Initial and CHOW Applications

The following documents must be submitted with the application packet:

  • Completed application Form 2021;
  • Completed Affidavit of Capability;
  • Completed Affidavit of Financial Solvency;
  • Non-refundable licensing fee;
  • Completed entity documents for business organizations;
  • Franchise tax account status from the State Comptroller's Office or exemption letter;
  • Proof of National Provider Identification Number;
  • Proof of Tax ID Number (EIN);
  • Organizational structure of the agency;
  • Job descriptions for the agency administrator and alternate administrator;
  • Job description for the supervising nurse and alternate supervising nurse;
  • A written plan to provide annual continuing education for management personnel;
  • Current resume or curriculum vitae for the agency administrator and the alternate administrator;
  • Current resume or curriculum vitae for the supervising nurse and alternate supervising nurse;
  • Presurvey Conference CBT certificates;
  • Form 2022, criminal history check, for each owner, administrator, alternate administrator and chief financial officer;
  • Copies of the initial 8 hour administrator training certificates; and
  • Written plan for the orderly transfer of care for the patients/clients.

Document Checklist for CHOW Applications

The following additional documents must be submitted for a CHOW:

  • Notarized copy of previous owner's affidavit;
  • Notarized copy of sales agreement;
  • Notarized copy of bill of sale;
  • Accreditation status; and
  • Contract status with all state agencies.
  • Document Checklist for Medicare Applications

Document Checklist for Medicare Applications

The following documents must be submitted:

If you are requesting hospice you must also complete this form:

Additional information concerning these documents maybe found on page 18 of Form 2021

Document Checklist for Renewal Applications

The following documents must be submitted:

  • Completed Form 2021 application;
  • Non-refundable licensing fee of $1,750;
  • Letter of accreditation (if applicable);
  • Contract program and contract numbers (if applicable);
  • Completed Form 2022, Criminal History Check;
  • Current resume or curriculum vitae of the agency's administrator and alternate administrator;
  • Current resume or curriculum vitae of the agency's supervising nurse/therapist and alternate supervising nurse/therapist;
  • Proof of Tax ID Number; and
  • National Provider Identification number.

In addition, one of the following must be submitted: (as filed with the Texas Secretary of State)

  • copy of the articles of incorporation and assumed name certificate (if applicable);
  • copy of the articles of organization and assumed name certificate (if applicable);
  • copy of the informal or formal partnership agreement and assumed name certificate (if applicable); or
  • copy of the will, letters, testamentary or trust agreement.

Additional information concerning these documents maybe found on page 19 of Form 2021

Where to Send Application Packet

Regular Mail

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

Overnight Delivery

Regulatory Services Accounts Receivable
Mail Code E-411
Department of Aging and Disability Services
701 West 51st St.
Austin, TX§ 78751

Application Processing Time Frames

An application from an agency is processed in accordance with the following general time frames:

  • If DADS receives an incomplete application, the DADS HCSSA Licensing Unit 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.
  • DADS will issue a license or deny the application within 45 days of receipt of a complete application, which includes all required documentation and fees.§ The processing of the application with DADS mail room and DADS Account Receivable could take up to 10 days from the date mailed.

Congratulations!

You have completed this presentation. Take time to review the application and to ensure that all the required documentation is in the application packet before mailing.

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Updated: October 7, 2015