Texas licensed and Medicare-certified home health
Your home health agency answers to HHSC and CMS. One manual covers both.
A certified Texas agency is surveyed against 26 TAC Chapter 558 and the Medicare Conditions of Participation at 42 CFR Part 484, and where the two differ, the stricter rule applies. We build your policy manual to both, from your agency details, with the citation next to every policy and a crosswalk from every surveyor G-tag.
- Full refund anytime before delivery
- Delivered in 7 business days
- Built from your state's own .gov citations
A business document, not legal advice.
Where Chapter 558 and the Medicare rules differ
26 TAC § 558.402(a) holds a licensed and certified agency to 42 CFR Part 484 on top of Chapter 558’s general standards. A few of the places the numbers don’t match:
| Rule | Medicare (42 CFR 484) | Texas (26 TAC 558) |
|---|---|---|
| Plan of care review | At least once every 60 days (§ 484.60(c)) | At least every six months (§ 558.401(b)(2)(B)) |
| Administrator qualifications | Hired on or after January 13, 2018: physician, RN or undergraduate degree, plus 1 year of supervisory or administrative experience in home health or a related program (§ 484.115(a)) | Also allows a high school diploma or GED with two years of management or supervisory experience in a health-related setting (§ 558.244(a)(1)), a path that fails the federal test |
| Clinical leadership | A clinical manager oversees patient care and assignments (§ 484.105(c)) | A supervising nurse and a similarly qualified alternate, designated in writing, available in person or by telephone (§ 558.243(c)) |
| Emergency preparedness | Plan, policies and training reviewed at least every 2 years; exercises every year (§ 484.102) | Annual internal review with a planned drill of the response phase (§ 558.256(k)) |
| Home health aide qualification | Training of at least 75 hours or a competency evaluation, with 12 hours of in-service every 12 months (§ 484.80) | Adds the rights of the elderly to the training content and an English reading and writing assessment (§ 558.701(d), (e)) |
The written policies your manual carries
Compiled from the current rule text and CMS’s surveyor guidance (State Operations Manual Appendix B, Rev. 245), last reviewed 2026-10-13. Each row cites the rules that require it.
| Policy | Citation |
|---|---|
| Governing body, written organizational structure and lines of authority, administrator and alternate, clinical manager, branch control, and the annual operating budget with a 3-year capital plan | 42 CFR 484.105(a)-(d), (h); 26 TAC §§ 558.242, 558.243 |
| Patient acceptance-to-service policy covering anticipated patient needs, caseload and case mix, staffing levels, and staff skills and competencies, reviewed every year | 42 CFR 484.105(i); 26 TAC §§ 558.294, 558.401(b) |
| Initial assessment within 48 hours of referral, comprehensive assessment within 5 calendar days of the start of care, updates in the last 5 days of every 60, and OASIS transmission within 30 days | 42 CFR 484.45, 484.55; 26 TAC § 558.281(1) |
| Plan of care contents, orders and verbal orders, countersignature time frames, coordination of care, and written instructions to the patient | 42 CFR 484.60; 26 TAC §§ 558.288, 558.297 |
| Home health aide qualification, competency evaluation, 12-hour annual in-service, written assignments, and supervision every 14 days for patients receiving skilled care | 42 CFR 484.80; 26 TAC §§ 558.402, 558.701 |
| Skilled professional services and supervision of LVNs, therapy assistants and social work assistants | 42 CFR 484.75; 26 TAC §§ 558.243(c), 558.299 |
| Notice of patient rights and responsibilities before care, with the Texas complaint statement and the local agency contacts for the patient's area | 42 CFR 484.50(a), (c); 26 TAC § 558.282 |
| Transfer and discharge, including the discharge-for-cause policy and Texas's five-day written notice | 42 CFR 484.50(d), 484.58; 26 TAC § 558.295 |
| Complaint investigation, and reporting abuse, neglect, exploitation and injuries of unknown source | 42 CFR 484.50(e); 26 TAC §§ 558.249, 558.250 |
| Quality assessment and performance improvement program, with the Texas committee that meets at least twice a year | 42 CFR 484.65; 26 TAC § 558.287 |
| Infection prevention and control program, bloodborne pathogens exposure control plan, and biohazardous waste | 42 CFR 484.70; 26 TAC §§ 558.285, 558.286 |
| Emergency preparedness program: risk assessment, plan, policies, communication plan, training and exercises | 42 CFR 484.102; 26 TAC § 558.256 |
| Vaccine standing orders, medication lists, sterile supplies and the dangerous drug kit | 42 CFR 484.60(b); 26 TAC §§ 558.300, 558.303 |
| Clinical records: contents, discharge summary within 5 business days, transfer summary within 2, patient copies within 4, and 5-year retention | 42 CFR 484.110; 26 TAC § 558.301 |
| Personnel qualifications for every home health discipline, criminal history and registry checks, and written agreements for services under arrangement | 42 CFR 484.105(e), 484.115; 26 TAC §§ 558.244-558.247, 558.289 |
| Licensing changes, Medicare status changes, surveys and plans of correction, and a compliance calendar | 42 CFR 484.100; 26 TAC §§ 558.216, 558.257, 558.501-558.527 |
Informational summary of current requirements, not legal advice.
What’s changed for Texas home health agencies
Acceptance-to-service is a written policy now
Since January 1, 2025, 42 CFR 484.105(i) requires a written patient acceptance-to-service policy, applied the same way to every referral and reviewed every year. CMS added the surveyor guidance (G990, G992) on August 5, 2026, and HHSC passed it to Texas certified agencies in Provider Letter 2026-15 on September 2, 2026.
Two rulebooks, and the stricter one wins
26 TAC § 558.402(a) binds a licensed and certified agency to 42 CFR Part 484 on top of Chapter 558's general standards. Where they differ, the manual follows the stricter rule and cites both.
Aide supervision runs on a 14-day clock
For patients receiving skilled care, an RN or other skilled professional assesses the aide's services at least every 14 days, with no more than one virtual assessment per patient in a 60-day episode (42 CFR 484.80(h)).
New Medicare enrollment is paused
CMS put a six-month national moratorium on new home health agency enrollment, including new branches and practice locations, effective May 13, 2026 (QSO-26-11-HHA & Hospice). CMS can lift or extend it. It affects new enrollments only, not the compliance duties of agencies already certified.
Chapter 558 has a rewrite pending
HHSC proposed amendments to Chapter 558 in the September 18, 2026 Texas Register (Proposed Rule 22R045), including the home health sections. The earliest it can be adopted is October 18, 2026. Your manual is built on the rules in effect and marks what the proposal would change.
Surveyors ask for documents at entrance
CMS's surveyor guidance (Appendix B) has surveyors request the organizational chart, admission packet, complaint log, QAPI activities and the emergency preparedness plan. The manual produces each one or tells you where it lives.
What the manual doesn’t include
The manual covers what HHSC and CMS require in writing. It leaves out the separate jobs below, and we’d rather say so up front:
- Clinical nursing and therapy procedures (wound care, catheter care, infusion and the like). The manual adopts the clinical reference you already use and lists the procedures your staff perform.
- OASIS item-by-item coding guidance or OASIS training.
- Medicare billing: PDGM, claims, value-based purchasing, quality reporting or HHCAHPS.
- The CMS notice forms themselves. The manual says when to issue them.
- Accreditation standards (ACHC, CHAP, The Joint Commission), which are proprietary.
- Texas Medicaid program rules, EVV and managed care contract terms.
- Home dialysis, psychoactive treatment, home IV therapy, outpatient therapy or hospice standards.
- A full 75-hour aide training curriculum. The manual covers the program rules and the competency evaluation checklist.
- Procedures for RN delegation under 22 TAC Chapter 224 or for pronouncing death. The manual marks whether your nurses do either and says to write the procedure first.
- A HIPAA privacy and security program (we sell one separately: HIPAA Binder for home health agencies (opens in a new tab)). The manual covers how clinical records are handled and protected.
One manual for your license and your certification survey.
Made to order from your agency details, built to 26 TAC Chapter 558 and 42 CFR Part 484, delivered within 7 business days, with a full refund anytime before delivery.
Texas Home Health Policy Manual
Launch price$949one-time
Launch price · $1,295 from January 1
The written policies a Texas home health agency needs for its HHSC license and its Medicare certification survey, built from your agency details to 26 TAC Chapter 558 and the 42 CFR Part 484 Conditions of Participation, with the citation next to every policy.
- Acceptance-to-service, assessment, OASIS and plan of care policies (§§ 484.55, 484.60, 484.105(i))
- Home health aide competency, in-service and supervision program (§ 484.80, § 558.701)
- Patient rights, complaints, abuse reporting, transfer and discharge (§ 484.50, Chapter 558)
- QAPI, infection control and emergency preparedness built to CMS and HHSC rules
- A crosswalk from every surveyor G-tag to the policy that answers it
- Editable Word + PDF, delivered within 7 business days
Delivered within 7 business days, with a full refund anytime before delivery and free edits for 30 days after. The manual is a self-prepared operational document you adopt for your own agency, not legal advice, and not a guarantee of any survey result: those decisions belong to HHSC and CMS.
Texas home health manual FAQ
Sources
- www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-484
- www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/som107ap_b_hha.pdf
- www.cms.gov/files/document/r245soma.pdf
- www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/som107ap_z_emergprep.pdf
- texas-sos.appianportalsgov.com/rules-and-meetings?chapter=558&interface=VIEW_TAC&part=1&title=26
- www.hhs.texas.gov/providers/long-term-care-providers/home-community-support-services-agencies-hcssa
Requirements last reviewed 2026-10-13. Regulations and CMS guidance change; verify current requirements with HHSC and CMS before relying on them.