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Texas - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In Texas, Respite Care Services are primarily funded through Medicaid 1915(c) waiver programs such as Texas Home Living (TxHmL), Home and Community-based Services (HCS), and STAR+PLUS, and are overseen by the Texas Health and Human Services Commission (HHSC). The service provides short-term relief to unpaid primary caregivers, ensuring the individual receiving care maintains necessary supervision and support.

To become a provider, agencies must first obtain the appropriate licensure, such as a Home and Community Support Services Agency (HCSSA) license, and then complete the Medicaid enrollment process through the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS). The most significant structural precondition is that providers must secure a contract with HHSC through an open enrollment process for specific waivers like TxHmL or HCS, or contract directly with Managed Care Organizations (MCOs) for STAR+PLUS.

1. Service Definition and Scope

Respite Care Services in Texas are defined as short-term relief care provided to individuals to allow their unpaid primary caregiver to step away temporarily. This service ensures the individual continues to receive necessary supervision, support, and assistance with activities of daily living during the caregiver's absence.

The service can be delivered in various settings, including the individual's home, a provider's home, or a facility setting, depending on the specific waiver program rules. It is crucial that the respite provider is not the primary caregiver and does not live with the member receiving services.

2. Regulatory and Oversight Agencies

The Texas Health and Human Services Commission (HHSC) is the primary state agency responsible for licensing, contracting, and overseeing Medicaid waiver programs that include Respite Care Services. HHSC manages the regulatory compliance and quality assurance for these services.

The Texas Medicaid & Healthcare Partnership (TMHP) handles the Medicaid provider enrollment process and claims processing through its Provider Enrollment and Management System (PEMS).

3. Gatekeeping Prerequisites: Who Can Even Apply

Before applying to provide Respite Care Services, applicants must meet specific structural preconditions. For waiver programs like TxHmL and HCS, HHSC awards contracts on a noncompetitive basis through an open enrollment process to eligible applicants meeting qualifications.

For managed care programs like STAR+PLUS, providers must first enroll in Texas Medicaid through PEMS and then complete separate contracting and credentialing applications with the specific Managed Care Organizations (MCOs) operating in their service areas.

4. Licensure and Certification Requirements

Providers of Respite Care Services typically must obtain a Home and Community Support Services Agency (HCSSA) license from HHSC, specifically with the appropriate categories such as Personal Assistance Services (PAS).

The licensure process involves submitting an application, paying the required fees, and passing an initial on-site survey to demonstrate compliance with state regulations.

5. Medicaid Provider Enrollment

All prospective Respite Care Services providers must enroll in Texas Medicaid using the TMHP Provider Enrollment and Management System (PEMS). This system manages the submission of applications, supporting documentation, and revalidation processes.

Long-Term Care (LTC) providers must take additional steps after PEMS enrollment, such as submitting proof of enrollment to HHSC to finalize their specific waiver or program contracts.

6. Staffing, Training and Background Checks

Agencies must ensure that all staff providing Respite Care Services meet specific qualifications, including age requirements, background checks, and completion of mandated training. Staff cannot be the primary caregiver or reside with the individual receiving care.

Training requirements typically include direct support skills, incident reporting, rights and dignity, and medication administration, which must be documented and available for state surveyors.

7. Documentation, Policies and Records

Providers must maintain comprehensive documentation, including individualized service plans, daily service logs, and administrative policies. These records must demonstrate that services were delivered as authorized and in compliance with state rules.

Agencies are required to have state-mapped clinical and administrative policy manuals that cover emergency procedures, client rights, and incident management.

8. Billing, Rates and Claims

Billing for Respite Care Services is processed through the TMHP Claims Management System for fee-for-service or directly through MCOs for managed care programs. Providers must use the specific procedure codes and modifiers designated by HHSC for the applicable waiver program.

Rates are established by HHSC and vary depending on the setting (in-home vs. facility) and the specific waiver program. Providers must adhere to strict filing deadlines to ensure reimbursement.

9. Approval Sequence and Timeline

The approval process begins with obtaining the necessary HCSSA licensure from HHSC, which can take several months depending on survey scheduling. Once licensed, the provider applies for Medicaid enrollment through TMHP PEMS.

After Medicaid enrollment is approved, the provider must complete the open enrollment contracting process with HHSC for waivers or credentialing with MCOs, adding additional months to the total timeline before services can be billed.

10. Common Denials and Survey Findings

Applications for licensure or Medicaid enrollment are frequently delayed or denied due to incomplete documentation, failure to meet physical site compliance for facility-based respite, or errors in the PEMS application.

During surveys, common findings include inadequate staff training records, failure to conduct required background checks, and insufficient documentation of service delivery in client logs.

11. Key Contacts and Resources

Providers should utilize the official resources provided by HHSC and TMHP for guidance on licensure, enrollment, and billing. The TMHP Provider Relations Team and the HHSC Long-Term Care provider portals are essential tools.

For managed care contracting, providers must contact the specific MCOs operating in their region directly.

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