No license
Companion, sitter, chores
Company, errands, housekeeping and meals, with no personal care or health-related services.
HSC §142.003Texas · HCSSA license categories · 26 TAC Chapter 558
Texas home health vs home care: LHHS or PAS?
Texas licenses home health and non-medical home care with the same HCSSA license, in different categories. Personal assistance services (PAS) is hands-on personal care. Licensed home health services (LHHS) is skilled care, and needs a supervising nurse. Here is the difference, side by side, and how to tell which one you need.
- Rule-verified September 30, 2026
- Quoted from 26 TAC Chapter 558
- Every row cites its rule
Quick answer
In Texas, "home care" and "home health" are both licensed by HHSC as a Home and Community Support Services Agency (HCSSA). The difference is the category on the license.
Personal assistance services (PAS) is non-medical home care: personal care such as bathing, dressing and toileting, respite, and "health-related tasks provided by unlicensed personnel under the delegation of a registered nurse or that a registered nurse determines do not require delegation". The administrator does not need a license and there is no supervising nurse.
Licensed home health services (LHHS) covers skilled health services, starting with "nursing, including blood pressure monitoring and diabetes treatment", plus therapy, IV therapy and similar. It needs a supervising nurse who is an RN with recent experience, and a more experienced administrator. The HHSC license fee is the same $2,625 for either.
PAS and home health, side by side
Both categories follow the same minimum standards for every HCSSA in Chapter 558. These are the rules that differ.
| Personal assistance services (PAS) | Licensed home health services (LHHS) | |
|---|---|---|
| What it covers | Personal care (bathing, dressing, grooming, feeding, toileting, transfers and similar), respite, and health-related tasks an RN delegates or decides need no delegation. §558.2(87) | Health services: nursing, therapy, medical social service, IV therapy, dialysis, medical equipment and supplies, nutritional counseling. §558.2(53) |
| Administrator | High school diploma or GED plus one year of experience or training caring for people with functional disabilities, or two years of health-related college. §558.244(a)(3) | A licensed physician, RN, social worker, therapist or nursing home administrator with one year of health-related management, or a diploma or GED with two years. §558.244(a)(1) |
| Supervising nurse | Not required. §558.243(c)(1) | Required, with an alternate: an RN with at least one year of RN experience in the last 36 months. §558.244(c)(1) |
| Presurvey Training | Administrator and alternate. §558.13(a) | Administrator, alternate, supervising nurse and alternate supervising nurse. §558.13(a)(2) |
| Starting a client | The supervisor visits on site to decide services; an individualized service plan signed by the client or family. §558.404(f)(2) | An initial health assessment at home by a health care professional; a care plan, or a practitioner-signed plan of care reviewed every six months. §558.401(b)(2) |
| Who supervises staff | A licensed nurse, or someone with two years of college (supervisory work in care can stand in). §558.404(g)(2) | The appropriate licensed health care professional, available whenever services are provided. §558.401(d) |
| HHSC license fee | $2,625 for three years §558.3(a)(1) | $2,625 for three years (the same fee covers one or more categories) §558.3(a)(1) |
The $2,625 is HHSC’s state license fee, not a CareRulebook price.
Which license do you need?
Start from what your staff will actually do in the client’s home.
HCSSA · PAS
Hands-on personal care
Bathing, dressing, grooming, feeding, toileting, positioning, transfers, help with self-administered medication, and RN-delegated tasks.
§558.2(88), §558.404(d)HCSSA · LHHS
Skilled care
Nursing, physical, occupational, speech or respiratory therapy, medical social service, IV therapy, dialysis or nutritional counseling.
§558.2(53)Not sure? Take the short license check on our Texas guide.
What PAS caregivers can do
Section 558.404(d) lists four kinds of task under the PAS category:
- personal care;
- health-related tasks "that may be delegated by an RN, or that an RN determines do not require delegation", under a written agency policy that follows the Board of Nursing rules in 22 TAC Chapter 225;
- health-related tasks that are not the practice of professional nursing under the HHSC and Board of Nursing memorandum of understanding;
- health-related tasks delegated by a physician under Texas Occupations Code Chapter 157.
Unlicensed staff can also do g-tube feedings and give medication through a permanently placed g-tube, but only after a training and competency program taught by an RN, physician, PA or qualified trainer, with competency checked every year. §558.404(d), (h)
A PAS agency also has its own rules: a supervisor visits on site to decide services, each client has an individualized service plan, and the agency must have a written policy on supervising staff, with the client or family’s input on how often.
CareRulebook
Built for Texas PAS agencies
CareRulebook's Texas manual covers the personal assistance services category: every written policy Chapter 558 requires of a PAS agency, including RN delegation and supervision, with your details filled in and the rule quoted under each policy. It does not cover home health or hospice.
- 35 policies, 48 rule requirements mapped
- Live preview of your own manual before you pay
- Editable Word and PDF, delivered instantly
Preview your manual
$199CareRulebook founding price for the first 50 Texas agencies, then $249. Not an HHSC fee.
Both categories, or certified home health
One HCSSA license can carry several categories for one fee. You only need the categories that cover what you do: "HHSC does not require an agency to be licensed in more than one category if the category for which the agency is licensed includes the services the agency provides." §558.13(c)
A licensed home health agency must actually provide at least one home health service (§558.401(c)). If you want to bill Medicare, you apply for licensed and certified home health, and you "must also apply to CMS for certification as a Medicare-certified agency". Until CMS certifies you, HHSC licenses you for licensed home health and you must follow the Medicare conditions of participation. §558.13(d)
Whichever you choose, only a licensed agency may describe itself as providing personal assistance services: "A person who is not licensed to provide personal assistance services under this chapter may not indicate or imply that the person is licensed to provide personal assistance services". §558.404(b)
Myths
Do you need a nurse to run a non-medical home care agency in Texas?
No. A PAS-only agency needs no supervising nurse, and its administrator can qualify with a high school diploma or GED and a year of experience caring for people with functional disabilities. You need an RN only for the tasks an RN must delegate.
"have a high school diploma or a GED with at least one year of experience or training in caring for individuals with functional disabilities"
Can PAS caregivers do any health-related tasks?
It depends. Yes, within limits. PAS covers health-related tasks an RN delegates, or decides need no delegation, under Board of Nursing rules, and tasks that are not professional nursing. Skilled nursing and therapy need a home health license.
"health-related tasks provided by unlicensed personnel that may be delegated by an RN, or that an RN determines do not require delegation"
Do companion or sitter services need a Texas license?
It depends. Not if they are truly companion, chore or household services only. As soon as staff help with personal care, including assisting with self-administered medication, you need the PAS license.
"a person or organization providing sitter-companion services or chore or household services that do not involve personal care, health, or health-related services;"
Does the administrator of a PAS agency need to be a nurse?
No. A high school diploma or GED plus one year of experience or training caring for people with functional disabilities qualifies.
"For agencies that provide PAS only, the administrator and alternate administrator do not have to be licensed but have to meet the qualifications in 26 TAC §558.244 (a)(3)."
Frequently asked questions
What is the difference between home health and home care in Texas?
Texas licenses both through the same HCSSA license, in different categories. Personal assistance services (PAS) is non-medical home care: personal care and RN-delegated health-related tasks. Licensed home health services (LHHS) covers skilled health services such as nursing, therapy and IV therapy, and needs a supervising nurse.
Do I need a home health license for non-medical home care in Texas?
No. Non-medical home care with hands-on personal care needs an HCSSA license in the personal assistance services category. Companion, sitter, chore or household services with no personal care or health-related services need no license at all.
Is a PAS license cheaper than a home health license?
No. HHSC charges the same $2,625 for a three-year license whatever the category, and the same to renew. The costs differ elsewhere: a home health agency needs a qualified RN as supervising nurse, and an alternate.
Can a PAS agency give medications?
PAS covers assisting with self-administered medications as personal care, and health-related tasks an RN delegates or decides need no delegation under the Board of Nursing rules in 22 TAC Chapter 225. Medication administration that counts as professional nursing, and is not delegated, is nursing, a home health service.
Can I have both PAS and home health on one license?
Yes. You can request one or more categories on the same HCSSA license, for one fee. You do not need a second category if the one you hold already includes the services you provide.
What is licensed and certified home health?
A home health agency that is also certified by CMS to bill Medicare. You apply to HHSC and to CMS. While you wait for CMS, HHSC licenses you for licensed home health services, and you must follow the Medicare conditions of participation.
Does the PAS administrator need to be a nurse?
No. For a PAS-only agency, a high school diploma or GED with one year of experience or training caring for people with functional disabilities qualifies, as does two years of health-related college.
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Keep reading
Texas
How to start a home care agency in Texas
License, fees, training and the initial survey.
Texas
Administrator requirements
Who qualifies and the training hours.
Texas
Applying in TULIP
Choosing your category on Form 2021, step by step.
Texas
Every policy Chapter 558 requires
The rule-to-policy map for a PAS agency.
Sources
- 26 TAC Chapter 558, Licensing Standards for Home and Community Support Services Agencies · Texas HHSC (text via Cornell LII) · retrieved September 30, 2026
- Texas Health and Safety Code Chapter 142 · Texas Legislature · retrieved September 30, 2026