Texas: healthcare licensing and regulation

Yes. Health and Human Services licenses home and community support services agencies (HSC ch. 142; 26 TAC ch. 558). Categories include licensed home health, licensed and certified home health (Medicare), hospice and personal assistance services. A license is issued for each place of business and lasts three years.

In practice: Hold the authority the state requires before the first patient is admitted there, and keep its number, category and expiry with the office it covers.

Source: HSC § 142.001HSC § 142.00826 TAC § 558.1126 TAC § 558.2726 TAC § 558.321

Last verified October 17, 2026 · Authority: Texas Health and Human Services Commission (HHSC)

Copy citation

No.

In practice: No certificate of need step for home health.

Source: HSC § 142.001HSC § 142.00826 TAC § 558.1126 TAC § 558.2726 TAC § 558.321Texas Register, September 18, 2026

Last verified October 17, 2026 · Authority: Texas Health and Human Services Commission (HHSC)

Copy citation

Each branch office holds its own branch license, which “expires on the same date as the license” of the parent. The parent’s administrator or supervising nurse visits each branch on site at least monthly; the original active clinical record is kept at the branch; a branch may offer fewer services than the parent, never more. For licensed and certified agencies, CMS approves or denies the branch location. Proposed amendments to §§ 558.27 and 558.29 were published on September 18, 2026; their adoption: Confirm with the state agency

In practice: Track each office’s authority on its own where the state licenses offices separately, and with the parent where it lists them.

Source: 26 TAC § 558.1126 TAC § 558.2726 TAC § 558.321Texas Register, September 18, 2026

Last verified October 17, 2026 · Authority: Texas Health and Human Services Commission (HHSC)

Copy citation

“The service area of a branch office must be located within the parent agency’s service area.” There is no mileage cap. Expanding a branch’s area takes 30 days’ written notice.

In practice: Check the patient’s address against the approved service area before accepting a referral.

Source: HSC § 142.001HSC § 142.00826 TAC § 558.1126 TAC § 558.2726 TAC § 558.321Texas Register, September 18, 2026

Last verified October 17, 2026 · Authority: Texas Health and Human Services Commission (HHSC)

Copy citation

A place of business “must be in Texas with a Texas address”, and an out-of-state agency must obtain a Texas parent agency license. Texas law is silent on a Texas agency serving patients across the border; the other state’s law decides.

In practice: A license in one state does not authorize care in another; the patient’s state decides.

Source: HSC § 142.001HSC § 142.00826 TAC § 558.1126 TAC § 558.2726 TAC § 558.321Texas Register, September 18, 2026

Last verified October 17, 2026 · Authority: Texas Health and Human Services Commission (HHSC)

Copy citation

An agency accredited for its services and license category by an HHSC-approved organization (The Joint Commission, CHAP, ACHC) is exempt from additional HHSC surveys “except complaint investigations” (26 TAC §558.503).

In practice: The state usually keeps its complaint authority.

Source: 26 TAC §558.503

Last verified October 17, 2026 · Authority: Texas Health and Human Services Commission (HHSC)

Copy citation

The statutory definition of home health service includes “intravenous therapy”, so a visiting infusion nursing agency needs the licensed home health category. The pharmacy exemption covers only pharmacies that furnish nothing beyond supplies. State guidance naming home infusion nursing was not found. Confirm with the state agency

In practice: Confirm the license category before staffing infusion visits in this state.

Source: HSC § 142.001HSC § 142.00826 TAC § 558.1126 TAC § 558.2726 TAC § 558.321Texas Register, September 18, 2026

Last verified October 17, 2026 · Authority: Texas Health and Human Services Commission (HHSC)

Copy citation

Member of the Nurse Licensure Compact, implemented. A nurse with a multistate license from another compact state may practice here; the agency still needs this state’s own authority to operate.

In practice: Check each nurse’s license against the patient’s state, not the agency’s.

Source: NCSBN Nurse Licensure Compact map

Last verified October 17, 2026 · Authority: Nurse Licensure Compact (NCSBN); the state board of nursing

Copy citation

No Texas license or registration specific to nurse or health care staffing agencies was found. A 2023 bill (HB 4146, 88th Legislature) would have required annual registration with HHSC; it was not shown to have been enacted.

In practice: Nursing in a Texas patient’s home is a home health service under HSC ch. 142, which needs the HCSSA license.

Source: HB 4146 (88R) bill analysisSB 1103 (87R) enrolled

Last verified October 17, 2026 · Authority: Texas Legislature; Texas Health and Human Services Commission

Copy citation

Texas is one of the six states in CMS’s Review Choice Demonstration for home health (Illinois, Ohio, Texas, North Carolina, Florida, Oklahoma). Medicare home health agencies here choose pre-claim review or postpayment review; an agency that reaches a 90% provisional affirmation rate may move to lighter review options. The earlier minimal-review choice with a 25% payment reduction was removed. The demonstration was extended five years from June 1, 2024.

Source: CMS: Review Choice Demonstration for Home Health Services

Last verified October 17, 2026 · Authority: Centers for Medicare & Medicaid Services (CMS)

Copy citation

Hospices newly enrolling in Medicare in Texas, changing ownership or reactivating are placed in CMS’s provisional period of enhanced oversight, in effect here since July 13, 2023. This is separate from CMS’s expanded prepayment review of existing hospices in the same states.

Source: CMS Medical Review: Hospice

Last verified October 17, 2026 · Effective July 13, 2023 · Authority: Centers for Medicare & Medicaid Services (CMS)

Copy citation

Texas is in Community Care Network Region 4, administered by TriWest. Agencies join by contracting with the regional third-party administrator, not with VA. VA has re-procured the network as CCN Next Generation with two regions, East and West; which administrator serves which region from 2027 was not announced in the sources reviewed.

Time-sensitive. Region assignments change with CCN Next Generation; recheck VA’s announcements during 2027.

Source: VA: Community Care Network

Last verified October 17, 2026 · Authority: U.S. Department of Veterans Affairs

Copy citation

Medicare certification under the home health Conditions of Participation (42 CFR Part 484) is a federal step for agencies that bill Medicare home health. It is separate from the state license. Where a state ties entry to certification, that state’s findings say so.

In practice: A branch serving a portion of the parent’s area is supervised and administered by the parent agency (42 CFR 484.2).

Source: 42 CFR 484.2

Last verified October 17, 2026 · Authority: Centers for Medicare & Medicaid Services (CMS)

Copy citation

For a Medicare-certified agency, “its personnel must be qualified in all States in which they provide services” (State Operations Manual § 2184).

In practice: Nurse licensure follows the patient’s state.

Source: CMS State Operations Manual § 2184

Last verified October 17, 2026 · Authority: Centers for Medicare & Medicaid Services (CMS)

Copy citation

Medicare’s home infusion therapy benefit is a separate Part B supplier benefit, not a home health benefit. It pays an accredited, qualified home infusion therapy supplier for professional services tied to specific parenteral drugs given through a pump that is durable medical equipment (42 CFR Part 486, Subpart I).

In practice: Most pharmacy-dispensed home infusion is not billable under this benefit; nursing for those patients is usually paid by other payers or under contract.

Source: 42 CFR 486 Subpart I42 CFR 486.505

Last verified October 17, 2026 · Authority: Centers for Medicare & Medicaid Services (CMS)

Copy citation