How to start a hospice in Texas

Texas requires a HCSSA license with hospice services category (parent, branch, alternate delivery site, inpatient unit) from Texas Health and Human Services Commission (HHSC), Long-Term Care Regulation — HCSSA Licensing to operate a hospice. Fee: $2,625. Processing time: HHSC has up to 45 days to process a complete application in TULIP; deficiencies must be answered within 30 days, then HHSC issues or denies within 45 days. The initial health survey must be requested (Form 2020) within six months of the initial license.

License required

Yes

License

HCSSA license with hospice services category (parent, branch, alternate delivery site, inpatient unit)

Issuing agency

Texas Health and Human Services Commission (HHSC), Long-Term Care Regulation — HCSSA Licensing

Fee

$2,625

Fee details

Initial three-year license: parent agency, branch or change of ownership $2,625; alternate delivery site $1,000. $30 fee for most reported changes; $100 late fee for late change reports; $250 late fee if a CHOW application is filed less than 30 days before the change. Fees are non-refundable.

Renewal

Every 3 years · HHSC is phasing in a three-year term. Renewal: two-year license $1,750 (ADS $600); three-year license $2,625 (ADS $900). Late fee if filed less than 45 days before expiration: $875 / $1,312.50 (ADS $300 / $450). Renewals filed after expiration are not accepted.

Processing time

HHSC has up to 45 days to process a complete application in TULIP; deficiencies must be answered within 30 days, then HHSC issues or denies within 45 days. The initial health survey must be requested (Form 2020) within six months of the initial license.

Accreditation

Initial Medicare certification surveys must come from an accrediting organization (e.g., CHAP, ACHC, The Joint Commission) because HHSC is not performing them under CMS workload priorities.

Medicare oversight

CMS places hospices in this state that newly enroll in Medicare, reactivate, or change ownership into a Provisional Period of Enhanced Oversight (medical review such as prepayment review). It began 2023-07-13 for Texas.

Medicare certification

Medicare certification is separate from the state license (state survey or CMS-approved accreditor). CMS imposed a nationwide 6-month moratorium on new Medicare hospice enrollments (including new practice locations) effective 2026-05-13, extendable in 6-month increments; applications received by the Medicare contractor before that date are still processed, accreditation cannot be used for deemed-status entry during the moratorium, and a hospice undergoing a non-exempt ownership change within 36 months of enrollment must re-enroll as new and is therefore blocked. The federal notice leaves Medicaid/CHIP hospice moratoria to each state.

Regulation

Texas Health and Safety Code ch. 142; 26 TAC Chapter 558 (Subchapter H hospice standards)

1. Complete HHSC's pre-survey computer-based training
2. Apply online in TULIP (Form 2021 for a parent agency) selecting the hospice category, and pay the fee
3. Answer any deficiency notice within 30 days
4. After the license issues, admit the first patient and request the initial health survey (Form 2020) within six months
5. Inpatient hospice units: request a Life Safety Code survey from the HHS Architectural Unit
6. For Medicare: HHSC Survey Operations is not doing initial certification surveys, so use a CMS-approved accrediting organization

Training

• Pre-survey computer-based training before applying

Program

Texas Medicaid and CHIP (Texas Health and Human Services Commission, HHSC)

Enrollment portal

Provider Enrollment and Management System (PEMS), run by TMHP

Fiscal agent

Texas Medicaid & Healthcare Partnership (TMHP), the claims administrator for HHSC

Application fee

Under the ACA, institutional providers owe an application fee on initial applications, new practice locations, revalidation and re-enrollment. PEMS says at the end of the application whether a fee is due, and the application cannot be processed without it. Proof of a fee paid to Medicare or another state must be submitted with the application. The amount changes each calendar year. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.

Fingerprinting

Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check. The TMHP provider manual section we reviewed does not list a separate state fingerprint process.

Site visit

Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. TMHP's manual notes that moderate- and high-risk providers cannot bill for a new practice location until it is approved and added to the enrollment record.

Revalidation

Revalidation is due by the end of the enrollment period, called the 'revalidation due date'. Most providers have a five-year period, but some get shorter periods based on risk or other factors. Revalidation is filed online in PEMS only, opens up to 180 days before the due date, and repeats provider screening. It is not complete until every deficiency is resolved. If the period ends first, TMHP automatically disenrolls the provider. Group administrators can revalidate for their performing providers.

Full Texas Medicaid enrollment guide →

CON program

No

Texas certificate of need details →

State minimum wage

$7.25 an hour

Effective

2009-07-24

Scheduled increases

No scheduled change found in the official sources reviewed.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Hospice agencies (community based) — active organization NPIs (NPPES)

2,869 (as of Sep 13, 2026)

Medicare-certified hospices (CMS Care Compare)

1,053 (as of Aug 19, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

3,915,559 (as of Jun 1, 2026)

All Texas Hospice Medicaid rates, ranked →