How to start a private duty nursing agency in Texas

Texas requires a Home and Community Support Services Agency (HCSSA) license with the licensed home health (or licensed and certified home health) category; independent RNs/LVNs may also enroll from Texas Health and Human Services Commission (HCSSA license); TMHP (Medicaid enrollment) to operate a private duty nursing agency.

License required

Yes

License

Home and Community Support Services Agency (HCSSA) license with the licensed home health (or licensed and certified home health) category; independent RNs/LVNs may also enroll

Issuing agency

Texas Health and Human Services Commission (HCSSA license); TMHP (Medicaid enrollment)

Regulation

Texas Medicaid Provider Procedures Manual, Home Health Nursing and PDN Services Handbook §2.10; 26 TAC Chapter 558 (HCSSA)

1. Obtain an HHSC HCSSA license with the home health services category (licensed-only home health agencies select CCP-only services at enrollment)
2. Enroll with Texas Medicaid through TMHP's PEMS portal, providing license information
3. Alternatively, an RN or LVN may enroll independently (one independent nurse may not be authorized for more than 16 hours/day)
4. Keep written policies for consent to treatment in the parent's absence (Texas Family Code ch. 32)
5. Obtain prior authorization; bill T1000 with required modifiers

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 →

Model

hybrid

State vendor

HHAeXchange (since 2023-10-01)

Services in scope

• personal care
• home health

Alternate EVV allowed

Yes

Program

https://www.hhs.texas.gov/providers/long-term-care-providers/long-term-care-provider-resources/electronic-visit-verification-evv

Texas EVV requirements →

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.

Nursing care agencies (private duty nursing) — active organization NPIs (NPPES)

1,352 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

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

All Texas Private duty nursing Medicaid rates, ranked →

• TX Community Living Assistance & Support Services (CLASS) Waiver (1915(c))
• TX Deaf Blind with Multiple Disabilities Waiver (1915(c))
• TX Home and Community-Based Services (HCS) Program Waiver (1915(c))
• TX Home Living Program Waiver (1915(c))
• TX Medically Dependent Children Program (MDCP) Waiver (1915(c))
• Texas Healthcare Transformation and Quality Improvement Program (1115)
• TX Youth Empowerment Services (YES) Waiver (1915(c))

Texas waivers and waiting lists →