Alright, let's talk about how to start a PAS agency in Texas! That is non-medical homecare, PAS stands for Personal Attendant Services. PAS is a category within the Home and Community Support Service Agency (HCSSA) licensure. The licensing authority is the Texas Health and Human Services Commission (HHSC). So, you want to become a HCSSA with a PAS category – that’s “Home Care” in Texas.

And that again means non-medical, so you're not sending out nurses or physical therapists, you're sending out unlicensed personnel to people's homes, to assist them with their activities of daily living, homemaking, companionship, transportation, etc.

The first step is to determine who's going to be the Administrator and who's going to be the Alternate Administrator.  You do have to have both of those for your license. And the administrator is usually in charge of the whole operation, while the alternate administrator can have a position within the company, or they can just be by name only, have an employee file, and only be active in case there is a need for the State (HHSC) to come in for a survey or a state-reportable incident needs to be reported in the absence of the Administrator.

The qualifications for Administrator and Alternate are that they either need to be a physician or registered nurse, a social worker or a licensed nursing facility administrator - OR they need to have a high school diploma or GED, AND either two years of supervisory/management experience in a health related setting, or one year of experience being a caregiver for a person with functional disabilities, or dementia or it could be a family member or professional, or completed two years of full time study adequate accredited college or university in a health related setting.

Once you have your two people in place, then you're going to pick a name. And this is really important because it needs to be unique. The first thing you'll do in regard to that is you're going to get on the HHSC website and do a provider search to make sure that no one else in Texas is operating with that name. Once you've got it picked out and you're happy with it, then you got to go to the web and find a domain and you want. It needs to be a unique domain. If you want your agency to be “ABC Homecare”, and ABChomecare.com is already taken, you may want to rethink that, because you want it to be easy for people to find you. I would not select ABChomecare.net or.org, because people will do a search and not end up finding YOU. Once you have that domain picked out, go ahead and purchase it because you will need the web address for your license.

Then you want to get a dedicated business phone number, you could use your own personal cell phone number, but be mindful that it's going to be listed on the state website, and anybody will be able to access that at any time. So, I recommend having a business number, even if it's just a Google number, that you can answer on your primary cell phone. If you don't want to have a dedicated phone just yet. A Google number is smart, because you can eventually transfer it to a land line and their system is pretty flexible.

Then determine your business address. If you're going to work from home, which a lot of people do now, that's perfectly fine. But be mindful that you need a dedicated space because when the surveyor comes to do their survey. You really don't want them walking around your home all willy-nilly, dealing with your dogs and such. So, you definitely want a dedicated space for them. Also, you've got to hire people. And while a lot of people are doing virtual hiring now, just be mindful that you may want to have an outside space that you can use for interviewing if you want to meet them in person, and for training/education. At your primary business address, you'll be keeping all of your records, and receiving official correspondence by mail, so make sure that your work space can be secured from unauthorized people. Once you set that up, you can change it later with minimal effort.

Then both the Administrator and the Alternate Administrator to the HHSC website and find the Computer-Based Trainings (CBTs) for Administrators. For a PAS license you’ll need to do modules 1, 2, and 3 and save the certificates because that will be uploaded with your license application.

Both the Administrator and Alternate Administrator must take an initial 24 hours of administrative continuing education units meeting the specific requirements in the TAC 558.259 within the first 12 months of operations. I recommend taking the first 8 hours prior to opening your agency so that you KNOW what the state requirements are for Administrators. I have a PAS specific Initial 8 hour course HERE, and will have the additional 16 hours by end of 2024. 

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Next you'll want to go to TULIP, the Texas Unified Licensure Information Portal to live and create an account. Use an email that you check regularly. Now if you've gotten an email with your domain, that's great, whichever email you use, make sure that you can and do access it so you don't miss these emails, because the state will communicate with you about your license when they have questions or things that they need.

You also need three policies that you're going to upload as part of that application. One is the policy about the organizational structure of your company, the second is a policy on transferring a client or agency closure, and the third is about your plan for continued education of the administrative staff. HHS wants to know that you have a structure already set up. And that if something happens that you have a plan for what to do with your clients, because you are responsible for your clients once you've signed them up. The state wants to know what's your plan, what you're going to do, your endgame.

Then you're going to submit the application for the new license. And that can be a complex situation. It has to be 100% accurate, they will check through every little detail with a fine-toothed comb. The new licenses are good for three years. So the cost for that before the credit card fees is $2,625 for a three-year license.  You'll only have to renew that every three years.  I would recommend doing that with a credit card and not an ACH bank draft, because things can get a little glitchy with the state system that accepts your money, which is different from the actual HHSC.

Once you’ve submitted it, HHSC has 45 days to approve your license. As long as the application is perfect, and your background check is adequate, then they will approve it and they must send you your license within 45 days. The process does include background checks for all involved parties, so be mindful that there's no major criminal records or fraud ever, in their in their record.

So you've got 45 days to wait and to get ready, and you're going to want to go back and check that application regularly. Just to make sure everything is accepted and pending. Hopefully, you've gotten an email if they have a question or need a clarification, but check just in case.

Next, you're going to have to create your logo. You've got your name and your website, and you already have an idea about your logo, you're going to want to finish that up, and get a good quality, digital format.

Then you want to get your policies and procedures ready, learn how you're going to run your business, what forms you're going to use, etc. And then you need to select an EMR (Electronic Medical Record) and a software system for client/employee/schedule management. If you're going to do just Medicaid, if you're going to get a contract for Medicaid and only do the PHC (Primary Home Care) portion, you can use Vesta, which is the free EVV system (electronic visit verification), but everything has to be electronic. The state no longer wants you working on paper. There's dozens of different electronic medical record software systems out there, and they’re always happy to do a demo with you. But you do need to work toward that, because that's going to help you to run your business from start to finish.

Then you’ll set up your website and create marketing collateral and a marketing plan. I always recommend that you get the website first, since you can use a lot of that same material for your brochure, and your business card, and then it all matches for branding purposes. Then you've got to learn how to recruit and hire quality caregivers, and learn how to sell your business and sell yourself and sign on clients so that you can be a successful agency. (I call this Administrator Training, and I have a video course coming soon)