Adult Day Care Centers, now officially known as Day Activity and Health Services (DAHS) facilities in Texas, play a vital role in providing daytime care and support for elderly individuals and adults with disabilities. For those looking to establish or manage such centers, particularly program coordinators, understanding the licensing process is paramount. The Texas Health and Human Services Commission (HHSC) meticulously regulates these facilities to ensure the safety and well-being of Texans receiving long-term care services. This guide provides a comprehensive overview of the DAHS facility licensing process in Texas, crucial for anyone involved in operating or coordinating programs within these centers.
Understanding DAHS Facilities in Texas
A DAHS facility delivers essential day activity and health services on a scheduled basis, excluding overnight care. These services cater to four or more individuals who are elderly or have disabilities and are not related to the facility owner by blood, marriage, or adoption. It’s important to recognize that “adult day care centers” and “DAHS facilities” are synonymous under Texas regulations, with DAHS being the current official terminology.
The Necessity of Licensing for DAHS Facilities
Operating a DAHS facility in Texas mandates obtaining a license from the HHSC. This licensing requirement ensures that all facilities adhere to stringent state and federal regulations designed to protect vulnerable adults. The licensing process is thorough, encompassing several critical aspects:
- Application Submission: Providers must complete and submit an online license application via the TULIP website.
- Background Checks: Comprehensive background checks are mandatory for all individuals and corporations holding responsibility within the facility.
- Licensure Fee Payment: The prescribed licensure fee must be paid as part of the application process.
- Facility Inspections: Passing both a Life Safety Code inspection and a health survey is essential to demonstrate compliance with safety and health standards.
Maintaining a license hinges on continuous compliance. Inspections, surveys, follow-up visits, and investigations into complaints or incidents must consistently demonstrate the facility’s adherence to state licensure laws and rules.
Step-by-Step Licensing Process for Texas DAHS Facilities
To provide a clearer picture of the licensing journey, process maps are available that visually outline the steps involved. However, understanding the different types of license applications is equally important:
Initial Application
This application type is for facilities that are entering the DAHS sector for the first time and have never been assigned an HHSC licensure number. Crucially, the TULIP online application must be submitted at least 45 days before the facility anticipates meeting Life Safety Code and architectural requirements. Following HHSC’s confirmation of building compliance, the facility can initially admit a limited number of clients (one to three). Subsequently, an unannounced inspection is conducted to verify full compliance with all licensing mandates.
Change of Ownership Application
When a DAHS facility undergoes a change in its tax identification number, it’s considered a change of ownership. Applications for this type of change must be submitted 30 days prior to the anticipated ownership transition.
Renewal Application
License renewal is a periodic requirement. Renewal applications are automatically generated within the provider’s TULIP account 120 days before the current license expiration date. To avoid penalties, these applications must be submitted at least 45 days before the license expires. Late submissions, within the final 45-day period, incur an additional late fee equivalent to half the basic renewal fee. For assistance with renewal applications or access issues, contacting Regulatory Services Licensing and Credentialing at 512-438-2630 is recommended.
Relocation Application
Moving a DAHS facility to a new physical location, even if it’s an existing building, necessitates filing a relocation application.
Closure Application
Facilities choosing to voluntarily cease operations and withdraw their license must submit a closure application.
Capacity Increase Request
Any DAHS facility seeking to increase its client capacity must undergo a Life Safety Code survey to ensure the facility can safely accommodate more individuals.
Change of Information Updates
Maintaining accurate and up-to-date information with HHSC is crucial. License holders are required to report any changes to specific details provided in their initial or renewal applications within 30 days via the TULIP online system. Reportable changes include:
- Management company agreement modifications (if applicable).
- Changes in real estate ownership, lien holders, or encumbrances.
- Shifts in ownership interests or stock transfers.
- Director or manager changes.
- Updates to phone or fax numbers.
Essential Documents and Fees for Licensure
A comprehensive application necessitates submitting specific documents and paying the required fees.
Required Application Documents:
- Fire marshal inspection report confirming safety compliance.
- Health authority letter verifying adherence to health standards.
- Payment of the licensure fee.
- Property documents, such as deeds, leases, subleases, mortgage, and lien information, establishing legal rights to the facility premises.
- Form 3725, Licensure Change of Ownership Affidavit (specifically for change of ownership applications).
Required Entity Documents:
The specific entity documents required vary depending on the legal structure of the applicant organization. These may include:
For Corporations:
- Proof of IRS tax identification number.
- Company agreement or bylaws outlining the corporation’s operational framework.
For Limited Partnerships:
- Proof of IRS tax identification number.
- Limited partnership agreement detailing the partnership structure and terms.
For General Partnerships:
- Proof of IRS tax identification number.
- General partnership agreement outlining the partnership terms and responsibilities.
For Sole Proprietorships:
- Assumed Name Certificate (issued by the county) if operating under a name different from the owner’s.
- Proof of IRS tax identification number.
For Limited Liability Companies (LLCs):
- Proof of IRS tax identification number.
- Regulations of organization, also known as an operating agreement, detailing the LLC’s structure and operations.
For City, County, State, or Federal Government Authorities or Hospital Districts/Authorities:
- Documents authorizing the formation and establishing the legal existence of the governmental authority or hospital district (obtained from the relevant city council, county commissioners court, or state or federal legislative branch).
- Bylaws or regulations governing the governmental authority or hospital district.
- Proof of IRS tax identification number.
For Trusts, Living Trusts, or Estates:
- Will or letters testamentary, and the trust agreement itself, outlining the legal framework.
- Proof of IRS tax identification number for the trust or estate.
Fee Schedule:
The standard licensure fee for a three-year license is $75. A reduced fee of $50 applies to two-year licenses issued in specific renewal situations. These fees are payable with each initial application, change of ownership application, and license renewal application. Late renewal applications submitted within 45 days of the license expiration date are subject to a $25 late fee in addition to the standard license fee.
License Application Timeframes
Adhering to specified submission deadlines is critical to ensure timely processing of license applications:
Initial Applications:
Completed initial license applications must be submitted 60 days before the desired license issuance date.
Change of Ownership Applications:
Change of ownership applications must be submitted 30 days prior to the anticipated date of sale or transfer.
Renewal Applications:
Renewal applications need to be submitted 45 days before the current license expiration date. As mentioned, late renewal applications within the 45-day window before expiration incur a $25 late fee.
Relevant Rules and Statutes
Operating DAHS facilities in Texas is governed by specific rules and statutes outlined in Title 26 Chapter 559 of the Texas Administrative Code. Familiarity with these regulations is essential for compliance.
Licensure Inspections and Complaint Investigations
HHSC conducts annual inspections of DAHS facilities to verify ongoing compliance with state licensure regulations. Beyond routine inspections, HHS also investigates self-reported incidents from facilities and complaints received from clients, family members, and other concerned parties. The initiation timeframe for complaint and incident investigations varies based on the severity and urgency, ranging from 24 hours to 45 days, as determined by the intake program specialist.
All complaints trigger on-site investigations. However, in cases of self-reported incidents where the facility has already conducted a thorough investigation, identified the root cause, and implemented corrective actions, HHS may choose not to conduct an on-site investigation. If violations are identified during any visit, follow-up inspections are conducted to ensure corrective actions and compliance. DAHS facilities are not notified in advance of inspections or investigations. To report a complaint, individuals can visit the HHS Complaint and Incident Intake page.
HHS employs inspectors from diverse professional backgrounds, including registered nurses, social workers, nutritionists, pharmacists, architects, engineers, and Life Safety Code specialists. The expertise of inspectors assigned to a facility visit is tailored to the nature of the complaint or incident and the facility’s size.
Alt text: Licensed Day Activity and Health Services (DAHS) facility in Texas, emphasizing state-regulated adult day care for safety and compliance.
Inspection Reports and Enforcement Actions
Following an inspection, investigation, or follow-up visit, the inspection team compiles a report detailing any regulatory non-compliance, termed “violations.” Facilities are obligated to make these inspection reports accessible to clients and visitors. Interested parties can also request inspection results from Complaint and Incident Intake at 800-458-9858.
Based on the inspection report findings, HHS staff determine if enforcement actions are necessary. State licensing laws authorize various enforcement actions, ranging from actions against the facility’s license to facility closure in severe cases. Facilities have the right to request an informal dispute resolution for cited violations and to appeal enforcement actions.
Contracting with HHS to Provide Services
For DAHS providers interested in contracting with HHS to provide services and receive reimbursement, licensure as a DAHS facility is a prerequisite. The specific rules governing DAHS licensure are detailed in Title 26 Chapter 559 of the Texas Administrative Code.
Eligibility for contracting hinges on meeting specific criteria. Minimum eligibility requirements for contracting are outlined in Title 40 of the TAC. Further information on the HHS provider enrollment process and requirements can be found on the HHS website.
To initiate the contracting process for Community Services programs, providers must complete an application. A checklist is available to ensure all necessary documents are included with the contract application. Applications, completed forms, and required information can be submitted via:
- Email: [email protected]
- Fax: 512-206-3979
- Regular mail:
Texas Health and Human Services Commission
Community Care Services Contracts Unit
Mail Code W-357
P.O. Box 149030
Austin, TX 78714-9030 - Overnight/Express delivery:
Texas Health and Human Services Commission
Community Care Services Contracts Unit
Mail Code W-357
909 West 45th Street
Austin, TX 78751
For inquiries regarding the contract enrollment process, the Community Care Services Contracts Unit can be reached at 512-438-3550.
New DAHS contractors are required to complete a program orientation or provide verification of prior orientation completion in another region for the same contract type, as per 40 Texas Administrative Code Section 49.302(b). Regional Enrollment and Monitoring staff will schedule this orientation after contract award.
Conclusion
Navigating the DAHS facility licensing process in Texas requires meticulous attention to detail and adherence to HHSC regulations. While there isn’t a specific “Adult Day Care Center Program Coordinator License,” understanding the facility licensing requirements is crucial for program coordinators, as they play a vital role in ensuring that licensed facilities operate smoothly and provide high-quality care within regulatory frameworks. By understanding these guidelines, both prospective providers and program coordinators can contribute to the well-being of Texas seniors and adults with disabilities through compliant and effectively run Adult Day Care Centers.
