Understanding Texas HCSSA Licenses: LCHHS, LHHS, PAS, and Hospice Explained
Home Care Directory Editorial TeamMay 1, 2026
Last reviewed for accuracy: May 8, 2026.
If you have started searching for home health care in the Dallas-Fort Worth area, you have probably run into a wall of acronyms. HCSSA, LCHHS, LHHS, PAS - the terminology can be confusing, and most agency websites do not bother to explain it. But understanding what these license categories mean is genuinely important. The category printed on an agency's state license determines what services they are legally allowed to provide, which insurance they can bill, and what kind of staff they employ.
In the Dallas-Fort Worth metro area there are more than 2,300 agencies licensed by the Texas Health and Human Services Commission (HHSC) under the Home and Community Support Services Agencies (HCSSA) regulatory framework. Those 2,300-plus agencies are not all the same. Some can send a registered nurse to manage wound care after surgery. Others can only provide a caregiver to help with bathing and meal preparation. Hiring the wrong category of agency wastes time and can delay care your family member needs right now.
This guide explains each HCSSA service category in plain language so you can match the license to your loved one's actual needs.
Quick answer: In Texas, LCHHS agencies provide Medicare-certified skilled home health, LHHS agencies provide skilled home health without Medicare certification, PAS agencies provide non-medical personal care, and hospice agencies provide end-of-life comfort care. If you are comparing Dallas home health agencies, the license category is one of the fastest ways to tell whether an agency can legally provide the kind of care you need.
What Is HCSSA?
HCSSA stands for Home and Community Support Services Agencies. It is the regulatory category that the Texas Health and Human Services Commission uses to license and oversee agencies that provide home health, hospice, and personal assistance services. The Texas HHSC HCSSA overview is the clearest official explanation of the program. In general, agencies operating in Texas that send workers into a client's home for health-related or personal care services need a valid HCSSA license, unless a specific statutory exemption applies.
Find a Home Health Agency in Dallas
Browse our directory of Texas HHSC-licensed agencies, read moderated family reviews, and contact providers directly.
The HHSC does not issue a single one-size-fits-all license. Instead, each agency applies for one or more specific service categories based on the type of care they intend to deliver. An agency's service categories are listed on its license and in the public
There are four primary service categories you will encounter when searching for home health care in Dallas. For a step-by-step lookup workflow, see How to Verify a Texas Home Care Agency License.
LCHHS: Licensed and Certified Home Health Services
LCHHS is the highest tier of home health licensure in Texas. An agency with an LCHHS designation is both state-licensed by HHSC and federally certified by the Centers for Medicare and Medicaid Services (CMS). This dual credential means the agency has met Texas state standards and has also passed a federal survey confirming it meets the Medicare Conditions of Participation.
What LCHHS Agencies Provide
LCHHS agencies can provide the broadest range of clinical home health services, including skilled nursing assessments and care planning by registered nurses, wound care including surgical wound management and pressure ulcer treatment, IV therapy and infusion services, medication management including injections and medication reconciliation, physical therapy and rehabilitation, occupational therapy, speech-language pathology, medical social work, home health aide services under the supervision of a nurse or therapist, chronic disease management for diabetes, COPD, heart failure, and similar conditions, post-surgical recovery care, and ventilator care and tracheostomy management.
Why LCHHS Matters for Insurance
The federal certification component of LCHHS is critical if your loved one has Medicare. Only LCHHS agencies can bill Medicare for home health services. If a family member qualifies for Medicare home health benefits, every dollar of that benefit must flow through an agency holding an LCHHS license.
LCHHS agencies may also participate in Medicaid managed care programs and commercial insurance networks for skilled services, depending on their payer enrollment and contracts.
When You Need an LCHHS Agency
Look for an LCHHS agency if your family member has been discharged from the hospital with orders for skilled nursing or therapy at home, needs wound care or IV medication administration, has a chronic condition requiring monitoring by a registered nurse, needs physical therapy or occupational therapy at home, or has been referred for home health by their physician. A doctor's order is required to initiate LCHHS services when Medicare or Medicaid is the payer.
LHHS: Licensed Home Health Services
LHHS agencies are licensed by the state of Texas to provide skilled home health services but are not federally certified by CMS. They can employ nurses and therapists and deliver clinical care, but they cannot bill Medicare directly.
How LHHS Differs from LCHHS
The services an LHHS agency can provide are similar to LCHHS - skilled nursing, therapy, wound care - but without the Medicare certification, these agencies serve a different payer mix. LHHS agencies typically work with Medicaid managed care organizations, commercial insurance, workers' compensation, and private pay clients.
Some LHHS agencies are in the process of obtaining Medicare certification, which requires passing a federal survey. Others have chosen not to pursue certification because their client base does not require it.
When LHHS Makes Sense
If your loved one does not have Medicare or does not qualify for Medicare home health benefits, an LHHS agency may be a good fit. Their rates are sometimes lower than LCHHS agencies because they do not carry the overhead of federal compliance requirements. They can still provide skilled nursing and therapy services under a physician's order.
PAS: Personal Assistance Services
PAS agencies provide non-medical, personal care services. They do not employ nurses or therapists, and they do not deliver clinical care. Instead, PAS agencies employ attendants and caregivers who help clients with activities of daily living.
What PAS Agencies Provide
PAS agencies provide personal care including bathing, grooming, toileting, and dressing assistance, meal planning and preparation, light housekeeping, medication reminders (but not administration), companionship and socialization, escort to medical appointments, grocery shopping and errands, and mobility assistance and transfer support.
What PAS Agencies Cannot Do
PAS caregivers are not licensed nurses. They cannot administer medications, change wound dressings, provide IV therapy, perform clinical assessments, or deliver any service that requires a nursing or therapy license. If your loved one needs both personal care and skilled nursing, you may need to work with both a PAS agency and an LCHHS or LHHS agency, or find an agency that holds multiple service categories on its license.
When PAS Is the Right Fit
PAS agencies are appropriate when your family member needs help with daily activities but does not have a skilled nursing or therapy need. Common situations include an aging parent who can no longer safely bathe or cook alone, a family caregiver who needs daytime relief, or a senior who is isolated and would benefit from regular companionship and assistance.
PAS services may be covered through Medicaid managed care or attendant-care programs for eligible individuals with an approved service plan. Many families also pay privately for PAS services, with rates in the Dallas metro area typically ranging from $22 to $35 per hour depending on the agency, shift length, and level of care.
Hospice
Hospice agencies provide comfort-focused care for individuals with a terminal illness and a life expectancy of six months or less, as certified by a physician. Hospice is not about giving up - it is about shifting the focus from curative treatment to quality of life, comfort, and dignity.
What Hospice Agencies Provide
Hospice services in Texas typically include nursing visits for symptom management and pain control, medication management related to the terminal diagnosis, medical social work, spiritual counseling, bereavement support for family members, home health aide services for personal care, medical equipment and supplies related to the terminal diagnosis, and volunteer companionship.
How Hospice Is Paid For
The Medicare Hospice Benefit covers hospice services for eligible Medicare beneficiaries. Medicaid and most commercial insurance plans also cover hospice. Families generally pay little or nothing out of pocket for covered hospice services when the patient is eligible.
Hospice and Home Health Together
It is important to understand that a patient receiving hospice care generally cannot also receive curative home health services for the same condition. However, if a hospice patient has a separate medical need unrelated to their terminal diagnosis - for example, a broken bone - they may still receive home health services for that unrelated condition through an LCHHS agency.
How to Verify an Agency's License
Before hiring any home health agency in the Dallas area, verify their HCSSA license through the HHSC TULIP provider search. You can search by agency name, city, or county and see the specific service categories listed on their license.
Skilled nursing, wound care, IV therapy, physical therapy, or other clinical services billed to Medicare
LCHHS agency
Skilled nursing or therapy billed to Medicaid managed care, commercial insurance, or private pay
LCHHS or LHHS agency
Help with bathing, meals, housekeeping, companionship, or daily activities (no clinical care)
PAS agency
Comfort-focused end-of-life care
Hospice agency
Both skilled nursing and personal care
Agency licensed in multiple categories (e.g., LCHHS + PAS)
The Bottom Line
The license an agency holds is not just a regulatory formality. It determines what services they can legally deliver, what insurance they can accept, and what level of clinical oversight they maintain. Before you sign a service agreement with any agency in the Dallas-Fort Worth area, verify their HCSSA license category and make sure it matches the type of care your family actually needs.
HCSSA stands for Home and Community Support Services Agencies. It is the licensing framework used by the Texas Health and Human Services Commission to regulate agencies that provide home health, hospice, and personal assistance services. Every agency that sends workers into a client's home for health-related or personal care must hold a valid HCSSA license.
What is the difference between LCHHS and LHHS?
Both LCHHS and LHHS agencies can provide skilled nursing and therapy services. The key difference is that LCHHS agencies are also federally certified by CMS, which means they can bill Medicare. LHHS agencies are state-licensed only and cannot bill Medicare directly.
Can a PAS agency provide nursing care?
No. PAS agencies provide non-medical personal care services only, such as bathing, meal preparation, housekeeping, and companionship. They cannot administer medications, perform wound care, or provide any service that requires a nursing or therapy license.
How do I verify a home health agency's license in Dallas?
You can verify any agency's HCSSA license through the HHSC TULIP provider search at tulip.hhs.texas.gov. Search by agency name, city, or county to see their specific service categories and license status.
Which type of agency does Medicare cover?
Medicare home health benefits can only be billed through an LCHHS agency - one that holds both a state HCSSA license and federal CMS certification. LHHS and PAS agencies cannot bill Medicare.
