Texas HCSSA License Application Checklist: Step-by-Step Guide (2026)

A Home and Community Support Services Agency (HCSSA) license — issued by the Texas Health and Human Services Commission (HHSC) — is required for any organization that provides personal care, home health, or hospice services to clients in Texas. Without one, your agency cannot legally deliver those services or receive Medicaid reimbursement from programs like STAR+PLUS, STAR Kids, Community First Choice, or HCS/TxHmL waivers.

HHSC regulates HCSSA operations under Texas Health & Safety Code Chapter 142 and 26 Texas Administrative Code (TAC) Part 1, Chapter 97.

Realistic timeline: 3–6 months from application submission to license-in-hand. Plan your launch date accordingly — you cannot serve clients or bill Medicaid until the license is issued.

The HCSSA license has several categories. Choosing the wrong one delays approval.

If you plan to bill STAR+PLUS for personal assistance services, you need at minimum a PAS license. Most full-service agencies choose Comprehensive.

Before submitting your application, you must have the following in place. HHSC will verify each of these during the application review and onsite survey.

Business Entity

• Registered legal entity in Texas (LLC, corporation, or sole proprietorship) — filed with the Texas Secretary of State
• Federal Employer Identification Number (FEIN) — IRS CP 575 or 147C confirmation letter
• Fixed Texas business address (P.O. boxes are not accepted; home offices may qualify if they are genuine workspaces)

Key Personnel

• Designated Administrator — must meet HHSC qualifications: documented healthcare management experience, no disqualifying criminal history, no exclusions on the HHS OIG exclusion list
• Designated Alternate Administrator (required as a backup)
• For home health license categories: a Designated Director of Professional Services (must be a licensed RN or physician)
• Background checks initiated through the Employee Misconduct Registry (EMR) for all key personnel — this step must happen before your application can be approved

Policies and Procedures Manual Your P&P manual must address all required topics under 26 TAC Chapter 97 before you submit. Missing sections are the leading cause of survey failure.

Required topics include:

• Client rights and responsibilities
• Client intake and referral process
• Plan of care development and updates
• Caregiver hiring standards and credentialing requirements
• Supervision and quality assurance process
• Complaint and grievance procedure
• Emergency preparedness and disaster response plan
• HIPAA / Protected Health Information policy
• EVV policy and procedure (required for all Medicaid-serving agencies since 2021)

The HHSC application requires submission of all of the following. Nothing in this list is optional.

Organizational Documents

• Articles of Incorporation or Certificate of Formation (LLCs) — certified copy from the Texas Secretary of State
• Assumed Name Certificate (DBA), if operating under a name different from the legal entity name
• FEIN confirmation letter (IRS CP 575 or 147C)
• Proof of physical Texas business address: utility bill, lease agreement, or property deed in the agency's name
• Organizational chart showing ownership structure and management reporting lines

Administrator Qualifications

• Administrator's professional resume — must clearly document qualifying healthcare management experience
• Copies of any professional licenses held (RN, LVN, social worker, etc.)
• Criminal history authorization forms for administrator and alternate administrator
• Signed attestation of no disqualifying convictions

Policies and Procedures Manual

• Complete P&P manual — all sections from Step 2 above must be present and detailed

Financial Documentation

• Proof of general liability insurance (minimum coverage requirements vary — confirm with HHSC at time of application)
• Workers' compensation coverage documentation, or written waiver if exempt
• Proof of financial resources or surety bond, if required for your license category

HHSC accepts HCSSA license applications through the TULIP portal (Texas Unified Licensure Information Portal) at hhs.texas.gov/business-and-partners.

Application fee (as of 2026): $1,700–$2,500 depending on license type. Fees are non-refundable. Confirm the current fee schedule before submitting.

Submission steps:

1. Create an account in the TULIP portal
2. Select "New HCSSA License Application"
3. Complete all application screens: agency information, service types, administrator details, key personnel
4. Upload all required documents from Steps 2 and 3
5. Pay the application fee electronically
6. Submit and record your application confirmation number

After submission, HHSC will review your application. If they need additional information, you have 30 days to respond before the application is closed.

After your application clears administrative review, HHSC will schedule an onsite initial survey. A surveyor visits your office and verifies that your operations match what you documented in your application.

What the surveyor checks:

• Physical office meets HHSC requirements and matches your registered address
• Policies and procedures manual is complete, current, and accessible on-site
• Staff records contain all required documentation (credentials, background checks, training records)
• Administrator is present and can speak knowledgeably to compliance procedures
• Required client-facing postings are displayed (client rights, complaint procedure)
• EVV policy is documented and your EVV vendor is identified

How to prepare:

• Organize your P&P manual in a binder with tabbed sections — one per topic in 26 TAC Chapter 97
• Prepare sample caregiver files with all required documentation (application, background check, credentials, hire paperwork)
• Conduct an internal mock survey 2–3 weeks before your scheduled date using the HHSC HCSSA standards as your checklist
• Have your EVV vendor documentation ready: contract, system access confirmation, and training records

Timeline from application to license:

1. Wrong business address format. HHSC requires a physical address. A P.O. box triggers an automatic deficiency. A home office is acceptable if it is a genuine workspace and is your registered business address.

2. Incomplete policies and procedures manual. The most common reason for survey failure. Agencies often write general policies that don't address specific topics — particularly EVV, incident reporting, and supervision standards. The surveyor's checklist directly mirrors 26 TAC Chapter 97.

3. Administrator qualifications not clearly documented. HHSC requires demonstrated healthcare management experience. If your administrator's resume doesn't clearly show it, HHSC will flag a deficiency before ever scheduling a survey.

4. Submitting before EMR background checks are initiated. The Employee Misconduct Registry check is an administrative prerequisite. Applications submitted before this step is initiated will not be approved.

5. Missing EVV policy. Since 2021, all agencies serving Medicaid clients must have a written EVV policy. Omitting it from the P&P manual is an immediate survey deficiency.

6. Underestimating the timeline. Agencies that assume 60-day turnaround consistently miss their launch dates. The process realistically takes 3–6 months. Build buffer into your financial projections and client commitment dates.

7. Letting insurance lapse during the review period. If your general liability insurance expires while HHSC is reviewing your application, it can reset the process. Keep coverage continuous from application through licensure.

Getting the license is step one. Maintaining it requires consistent operational attention.

Annual requirements:

• HCSSA license renewal — renewal fees and updated documentation submitted before expiration
• Caregiver credential renewals on schedule (CPR, first aid, TB test, background check recertification per HHSC timelines)

Ongoing operational requirements:

• EVV data submission for every Medicaid visit — through Sandata (for most STAR+PLUS agencies) or the MCO-specified EVV system in your service area
• Incident reporting — certain client incidents must be reported to HHSC within defined timeframes
• HHSC surveys — may occur unannounced at any time; some license categories have mandatory annual surveys
• MCO credentialing maintenance — if billing STAR+PLUS, each managed care organization (Superior, Molina, Aetna Better Health, UHC Community Plan) requires separate credentialing, with its own renewal cycle

Completing the HCSSA application opens the door. Running a compliant, financially healthy home care agency is the ongoing challenge — and it starts on day one of operations.

Many Texas agencies that successfully license find themselves immediately overwhelmed by the daily demands: EVV exceptions, caregiver onboarding documentation, billing submission cycles, MCO credentialing renewals, and scheduling gaps.

Atlas Care provides trained back-office specialists who handle these functions for Texas home care agencies — HIPAA-trained, experienced with HHAeXchange and Sandata EVV portals, and familiar with STAR+PLUS billing requirements.

See how Atlas Care supports Texas agencies from day one →

Also useful: Texas STAR+PLUS & Medicaid Payer Guide → | EVV Compliance for Home Care Agencies →