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Texas - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Texas Health and Human Services Commission (HHSC) funds non-medical supervision and socialization primarily through the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) waivers under the service category of Host Home/Companion Care. Providers seeking to deliver these services must secure a provisional contract through HHSC's open enrollment process, which strictly requires the completion of an online Provider Applicant Training (PAT) course and an in-person competency exam before an application can be submitted through the Contract Application and Management for Providers (CAMP) portal.

Texas does not issue a standalone "Adult Companion Services" license; instead, entities must either obtain certification as an HCS/TxHmL waiver provider or hold a Home and Community Support Services Agency (HCSSA) license with a Personal Assistance Services (PAS) category. The approval sequence mandates that applicants first establish their legal entity, obtain a National Provider Identifier (NPI), and enroll in Texas Medicaid via the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS) before HHSC will review their waiver contract application.

1. Service Definition and Scope

In Texas, companion-style services are delivered under the HCS and TxHmL Medicaid waiver programs as Host Home/Companion Care or through Personal Assistance Services (PAS). These services provide non-medical assistance, supervision, and socialization to help adults with intellectual and developmental disabilities remain safely in community settings.

The scope of Host Home/Companion Care includes assistance with activities of daily living (ADLs), instrumental activities of daily living (IADLs), and habilitation activities outlined in the individual's person-directed plan. Services must be delivered in a private residence rather than a facility-based setting.

2. Regulatory and Oversight Agencies

The Texas Health and Human Services Commission (HHSC) is the primary state agency responsible for licensing, certifying, and contracting with providers of HCBS services. HHSC's Long-Term Care Regulation division oversees HCSSA licensing and HCS/TxHmL provider certification.

The Texas Medicaid & Healthcare Partnership (TMHP) acts as the state's Medicaid claims administrator and manages the Provider Enrollment and Management System (PEMS). All prospective providers must interact with both HHSC for programmatic approval and TMHP for financial enrollment.

3. Gatekeeping Prerequisites: Who Can Even Apply

Texas utilizes an open enrollment process for HCS and TxHmL waiver contracts, meaning there is no competitive procurement or closed network, but strict structural prerequisites apply. Per 26 TAC §52.31, an applicant cannot submit a contract application without first passing a mandatory competency examination.

Before accessing the CAMP portal to apply for a provisional contract, the entity must already be fully enrolled as a Texas Medicaid provider through TMHP PEMS. This requires having an established legal entity, an NPI, and a physical business address in Texas.

4. Licensure and Certification Requirements

Providers must either obtain an HCSSA license with a PAS category or operate under an HCS/TxHmL waiver provisional contract. HCSSA licensing is governed by 26 TAC Chapter 558 and requires an initial application through the TULIP system, accompanied by a licensing fee.

For HCS/TxHmL certification, providers submit Form 5873 (Waiver and Community-based Programs and Services Application) through the CAMP portal. The state issues a provisional contract, and the provider must pass an initial certification review after beginning service delivery.

5. Medicaid Provider Enrollment

Medicaid enrollment is processed exclusively through the TMHP PEMS portal. Applicants must complete the Texas Medicaid Enrollment Application, providing detailed ownership disclosures, taxonomy codes, and proof of high-categorical risk fingerprinting if applicable.

Providers must sign the HHSC Medicaid Provider Agreement and acknowledge the Medicare Billing Acknowledgement Statement if they serve dual-eligible clients. The effective date of enrollment is tied to the approval of the PEMS application.

6. Staffing, Training and Background Checks

Direct service providers for Host Home/Companion Care must meet the qualifications outlined in 26 TAC § 565.7 and the HCS Billing Requirements. Staff must be at least 18 years old, hold a high school diploma or equivalent, and pass comprehensive background checks.

Agencies must ensure staff complete documented training specific to the individual's needs before service provision and annually thereafter. If participating in CFC PAS/HAB implementation plans, staff must complete the HHSC-approved Online Introductory Course to Person Centered Planning within 90 days of hire.

7. Documentation, Policies and Records

Providers must maintain comprehensive records demonstrating compliance with the individual's person-directed plan (PDP) and implementation plan (IP). Documentation must clearly show the dates, times, and specific habilitation or socialization activities provided.

Agencies are required to develop and implement policies covering abuse, neglect, and exploitation (ANE) reporting, emergency preparedness, and grievance procedures as mandated by 26 TAC Chapter 558 and Chapter 565.

8. Billing, Rates and Claims

Claims for HCS and TxHmL services are submitted to TMHP using specific procedure codes mapped in the Texas Long-term Care (LTC) Bill Codes Crosswalk. Providers must bill in accordance with the HCS Billing Requirements and the rates established by the HHSC Provider Finance Department.

Reimbursement is based on a fee-for-service model or daily rate depending on the specific waiver service definition. Providers must ensure that claims are submitted within 95 days of the date of service to avoid timely filing denials.

9. Approval Sequence and Timeline

The approval process begins with the applicant completing the PAT course and passing the in-person competency exam. Following this, the entity must apply for Medicaid enrollment through TMHP PEMS, which can take 60 to 90 days to process.

Once PEMS enrollment is active, the provider submits the contract application via the CAMP portal. HHSC reviews the application for completeness and issues a provisional contract, allowing the provider to begin accepting referrals and delivering services pending an initial certification review.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied if the applicant attempts to submit the CAMP application before their TMHP PEMS enrollment is fully approved and active. Failure to pass the mandatory competency exam also acts as an immediate hard stop for the application process.

During initial surveys, HHSC frequently cites providers for failing to document staff training specific to the individual's needs prior to service delivery, or for lapses in checking the Employee Misconduct Registry before hire.

11. Key Contacts and Resources

Prospective providers should utilize the HHSC website for current rules, training schedules, and portal access. The TMHP website is the primary resource for all Medicaid enrollment, billing manuals, and claims submission inquiries.

For specific questions regarding the HCS/TxHmL application process, applicants can contact the HHSC Operations Mailbox. The Texas Administrative Code (TAC) is available online for detailed regulatory review.

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