How to Become a NF Provider | Texas Health and Human Services

Texas Health and Human Services licenses, certifies and surveys nursing facilities for compliance with state and federal laws and regulations. Through these regulatory activities, HHS protects Texans receiving care. To become a nursing facility provider, you must first apply for a license from HHS.

Facilities might wish to be private pay (facility with no certification) or Medicaid- and Medicare-certified. As a prerequisite for participating in the Title XIX Medicaid Nursing Facility Program and receiving reimbursement for eligible residents on Medicaid, a provider must have an allocation of Medicaid beds or have entered into a lease agreement with a nursing facility owner that has an allocation of Medicaid beds. The following links to the Nursing Facility Requirements for Licensure and Medicaid Certification outline various ways to get Medicaid beds:

What is a Nursing Facility?

A nursing facility is an institution that provides organized and structured nursing care and service and is subject to licensure under Texas Health and Safety Code, Chapter 242. Facility is also referred to as a nursing home or nursing facility.

Becoming Licensed in Texas

Nursing facilities must be licensed to operate in Texas.

To become licensed, a provider must submit through the TULIP website:

A completed application.
Upload all required documents.
Pay the required license fee(s).
Be registered with and in good standing from the Texas State Comptroller of Public Accounts.
Be registered with and in good standing with the Texas Secretary of State.
Approved by HHS Licensing and Certification Unit.

Process Maps

The following process maps provide an overview of the licensure and certification process.

Types of Applications

Initial

An application that has never been issued an HHS licensure number to operate in Texas must contact the HHS Architectural Unit, which reviews facility plans to ensure construction meets state and federal Life Safety Code standards. For information regarding plan reviews, contact the architectural unit at 512-438-2371.

When ready, the provider must submit an online application to HHS 60 days before the anticipated opening date of the facility. A Life Safety Code inspection will be conducted after HHS has received the required documents and forms, the owner has been approved and the applicant has submitted a written request for a Life Safety Code inspection.

When the Life Safety Code inspection has been approved, the applicant can admit one to three residents. The applicant must submit a written request for a health inspection with a statement that the facility has admitted one to three residents and is ready for a health survey

When the facility has passed the health inspection, the license will be issued.

Change of Ownership

A completed change of ownership application must be submitted 30 days before the change of ownership effective date.

Refer to the required documents and forms section of this website for a list of required forms, documents and instructions. HHS will issue a 90-day temporary license and schedule a health inspection after the agency has received the required document and forms and the owner has been approved.

A health inspection will be conducted within 90 days of issuance of the temporary license. If the facility is found to be in substantial compliance, a permanent license will be issued.

Renewal

Renewal applications are generated 120 days before the license expires and are accessible through the provider's TULIP account. Renewal applications must be submitted 45 days before the license expiration date. If the applicant submits a renewal application during the 45-day period ending on the date the current license expires, they must pay an additional late fee in the amount equal to one-half of the total basic renewal fee. If you cannot access a renewal application or have a question about renewing your license, call Regulatory Services Licensing and Credentialing at 512-438-2630.

Relocation of a Facility

A facility chooses to relocate to a new building.

Closure

Provider chooses to voluntarily withdraw and cease operations.

Capacity Increase

Requests to increase the capacity at the facility must complete a Life Safety Code survey.

Change of Information

If certain information provided on the initial or renewal application changes after HHS issues the license, the provider must report the change to HHS Licensing Unit through the online TULIP application within 30 days.

Required Documents and Fees

Required Licensing Documents

Fire Marshal Inspection.
Health Authority Letter (for initial license and change of ownership only).
National Provider Identification Number (confirmation email).
Property documents (deed, lease, sublease, mortgage or lien information).
Management company agreement (if applicable).
Health Authority Letter (for initial license and change of ownership only), Form 3604: Ownership Transfer Affidavit (change of ownership only).
Submit written letter announcing readiness for Life Safety Code inspection (for initial license only).
Submit written letter announcing facility has one to three residents and is ready for health inspection (for initial license only).

Required Entity Documents

Sole Proprietor

Copy of Social Security card
Proof of IRS tax ID number (Form CP-575 or LTR 147C), if applicable

Corporation

Proof of IRS tax ID number (Form CP-575 or LTR 147C)
Company agreement

Limited Partnership

Limited partnership agreement or regulations of limited partnership
Proof of IRS tax ID number (Form CP-575 or LTR 147C)

General Partnership

General partnership agreement
Proof of IRS tax ID number (Form CP-575 or LTR 147C)

Limited Liability Company

Company agreement of organization
Proof of IRS tax ID number (Form CP-575 or LTR 147C)

City, County, State or Federal Government Authority or Hospital District/Authority

Documents that authorize the formation of and establish the existence of the governmental authority or hospital district authority (can be obtained from the appropriate authority such as the city council, county commissioners court or state and federal legislative branch)
By-laws and regulations of the governmental authority or hospital district authority

Trust, Living Trust, Estate

Copy of will and letters
Testamentary and trust agreement
Proof of IRS Tax ID number (Form CP5-75 or LTR 147C)

Nursing Facility Fee Schedule

Fee Schedule
Type of Application	Fee
Initial License (three-year standard license fee) Issued to entities who have previously held a license in Texas.	$375 + $15 per bed
Initial License (one-year probationary license fee) Issued to entities who never held a license in Texas.	$125 + $ 5 per bed
License renewal	$375 + $15 per bed
Relocation	$375 + $15 per bed
Licensed capacity increase	$15 per bed
Change of ownership (three year) Issued to entities who have previously held a license in Texas.	$375 + $15 per bed
Change-of-ownership probationary (one year) Issued to entities who never held a license in Texas.	$125 + $ 5 per bed
Alzheimer Certification	$300
Change of administrator	$20
Real estate change	No fee
Management company	No fee
Share transfer	No fee
Reopen	No fee
Other update	No fee

Nursing Facility Medicaid Provider Agreement with HHS

An applicant seeking to obtain a contract must enroll in Texas Medicaid. Visit Texas Medicaid Provider Enrollment to read the enrollment requirements.

As of Jan. 1, 2019, Medicaid Contracting for Nursing Facilities is completed through the Contract Administration and Provider Monitoring section of the HHSC Medicaid / CHIP division. For additional information, call 512-438-3390 or email HHSC CAPM NF ICF Contracts.

Email general questions regarding Medicaid Enrollment.

Required Medicare Documents

Note: A new facility or a licensed-only facility requesting Medicare-only certification must contact the regional director in their area for further direction regarding access to care.

To qualify for Medicare payments, a facility must be in compliance with the nursing facility requirements. The following forms, statements and letters must have the original signatures of an authorized representative.

CMS Form 855A, Medicare Enrollment Application (PDF) — Mail the 855A directly to the Medicare administrative contractor. Read the brochure (PDF) to learn more.

Upload the following forms directly to HHS TULIP application:

CMS Form 1561, Health Insurance Benefit Agreement (PDF) (Print name, sign and date only the section titled "Accepted for the Provider of Services By") [initials or change of ownership].
Two copies of proof of IRS tax ID number (Form CP-575 or LTR 147C) [initials or change of ownership].
Management company agreement (if applicable) [initials or change of ownership].
Letter requesting a Medicare participation date (when adding Medicare to a Medicaid facility) [initials only].
Floor plan that includes all room numbers and the capacity of each room (initials only).
National Provider Identification Number (confirmation email).
Letter indicating the fiscal year end date (initials only).
HHS Form 3697, Transfer Agreement (legal entity and doing business as name must appear on the first and last pages).
Civil Rights Clearance for Certification in the Medicare Provider Applicants (copy of evidence of successful electronic submission through the U.S. Department of Health and Human Services Office for Civil Rights Assurance of Compliance portal)

Time Frames for applications

Initial

Completed applications for a license must be submitted 60 days before the requested date of issuance.

Change of Ownership

Completed applications for a change of ownership must be submitted 30 days before the anticipated date of the sale or transfer.

Renewal

Completed renewal applications must be submitted 45 days before the current license expires. An applicant for license renewal who submits an application during the 45-day period ending on the date the current license expires must pay a late fee.

Rules and Statutes

Licensure Requirements

Medicaid Requirements

Medicare Requirements

Surveys and Investigations of Complaints and Incidents

HHS surveys nursing facilities yearly to ensure they are in compliance with state licensure and federal certification regulations. HHS also investigates self-reported incidents from facilities and complaints from residents, family members, friends and others. Surveyors initiate investigation of complaints and incidents in facilities within 24 hours, 14 days, 30 days or 45 days, depending on the priority assigned by the intake program specialist who receives the complaint or incident report. The priority is based on the immediacy and seriousness of the allegation.

HHS conducts on-site investigations for all complaints received. If HHS determines the facility has investigated a self-reported incident, has determined the cause and has made the necessary changes to remove the problem, HHS can elect not to conduct an on-site investigation. If surveyors find a state licensure violation or federal deficiency during a visit, survey staff make a follow-up visit to ensure the facility has corrected the violation or deficiency and is in compliance with the regulations. HHS does not notify facilities before conducting surveys or investigations. For information on how to report a complaint, visit HHS Complaint and Incident Intake.

HHS has surveyors from many professional disciplines, including registered nurses, social workers, nutritionists, pharmacists, architects, engineers and Life Safety Code specialists. A team of specialists conducts the yearly facility survey. HHS assigns one or more surveyors from specific areas of expertise to investigate complaints and incidents based on the nature of the complaint or incident and facility size.

Survey Reports

When the survey team completes the survey, inspection, investigation, follow-up or other visit, it writes a report of the findings that details the facility's failures to comply with state or federal regulations, which are called violations and deficiencies. The facility must make survey reports available to all facility residents and visitors. Interested parties can also request survey team visit results from Complaint and Incident Intake at 800-458-9858.

Enforcement Actions

Once the survey team completes the report, HHS staff review the findings to determine if an enforcement action is necessary because of noncompliance with a condition of participation or repeat deficiencies. Many enforcement actions are available under state licensing laws, including actions against a facility's license and monetary sanctions such as an administrative or civil penalty.

State regulations give facilities the right to request an informal dispute resolution of the cited violations and deficiencies and to appeal enforcement actions.