What are the HCS host home requirements in Texas?

What is HCS host home/companion care?

Host home/companion care is one of the HCS residential services in Texas. The individual lives in the same home as the host home or companion care provider, and the provider helps with daily living, habilitation, medications, transportation, and safety. A unit of service is one day.

Under Section 4530 of the HCS Program Billing Requirements, the program provider records a residential location of "host home/companion care" on the individual's Individual Plan of Care (IPC) when three things are true: the program provider does not lease or own the home, a service provider provides host home/companion care, and the individual and that provider live in the same home.

Section 4550 lists the billable activities. They include help with bathing, dressing, eating, meal preparation, and housekeeping, help with mobility, reinforcing therapies, help with medications or RN-delegated tasks, habilitation, transportation, and supervising the individual's safety and security.

For the bigger picture of the waiver, see our guide to the HCS program.

Who can be a host home provider in Texas?

A host home provider must be an adult staff member or contractor of an HCS program provider, paid by that provider. The provider needs a high school diploma or equivalency certificate, or a passed written competency assessment plus written references from three people who are not relatives.

A host home provider does not contract with HHSC. The HCS program provider holds the HHSC contract, and our guide on how to become an HCS provider covers that side.

Section 3410 of the billing rules also says a qualified service provider may not have a conviction for an offense listed in Texas Health and Safety Code §250.006, may not be listed as unemployable in the Employee Misconduct Registry or as revoked or suspended in the Nurse Aide Registry, and must hold a valid driver's license to transport an individual.

Family can qualify in some cases. Section 3430 lets a relative, guardian, or managing conservator provide host home/companion care if they are otherwise qualified. A spouse cannot serve the individual, and a parent or a parent's spouse cannot serve a minor.

The individual has a say too. Under 26 TAC §565.9, a program provider must employ or contract with a qualified person the individual or legally authorized representative (LAR) chooses, if that person is willing, or document good cause not to.

• An adult, and a staff member or contractor of the program provider
• High school diploma or equivalency, or a passed competency assessment plus three non-relative references
• No disqualifying conviction and no disqualifying registry listing
• A valid driver's license if transporting the individual
• Not the individual's spouse, and not a minor's parent or parent's spouse

What background checks does a host home provider need?

The program provider runs the same checks it runs for any service provider. Under 26 TAC §565.9, that means a criminal history record before hire or contract, two registries every 12 months, and two exclusion lists every month.

The criminal history record comes from the Texas Department of Public Safety, directly or through a private agency. The program provider may not use a registered sex offender or a person convicted of an offense listed in Texas Health and Safety Code §250.006.

The Employee Misconduct Registry and Nurse Aide Registry are searched before hire and every 12 months. The federal and HHSC Office of Inspector General exclusion lists are searched before hire and every month.

What are the requirements for the home itself?

The home must be leased or owned by the host home provider or the individual, not the program provider. No more than three people in it can receive host home/companion care or a similar non-HCS service, and the host home provider must live there too.

A minor cannot receive host home/companion care in a home shared with a parent or a parent's spouse, under Section 4550(a).

The HCS residential rules in 26 TAC §565.23 apply to host home/companion care settings as well as group homes. The home must be clean and free of pests, with safe furnishings, working bathrooms and appliances, hot water no hotter than 120 degrees Fahrenheit unless a yearly assessment shows every individual in the home can regulate it, securely stored cleaners, and vaccinated pets.

Each residence also needs two means of escape, working smoke alarms in and just outside each bedroom, fire extinguishers on each level, emergency plans, and posted emergency numbers. Fire drills run at least once every 90 days, four times every 365 days, with two during sleeping hours.

The individual's bedroom door needs a lock the individual can operate. It is not required when the host home provider is also the individual's LAR, or when the person-directed plan documents a modification.

How often is a host home inspected?

The program provider inspects a host home on site before services start and every quarter after. That is more often than an HCS group home, which the program provider inspects once a year. HHSC can also make an unannounced residential survey of a host home.

Under 26 TAC §565.25(b), the inspection checks that the home is safe, accessible, suited to the individual's needs, and compliant with federal, state, and local rules. The program provider must get proof that any items found are fixed before the individual moves in, or within 30 days if the individual already lives there, and document a plan for anything that takes longer.

Under 26 TAC §565.41(o), HHSC may conduct an unannounced residential survey of a residence where host home/companion care is provided, to decide if the home is safe.

What training does a host home provider need?

Under 26 TAC §565.7, a host home provider needs training specific to the individual's needs before providing service and at least every 12 months after, plus observed competency. Medication and fire safety rules add more.

Under 26 TAC §565.23, staff who administer medications must be trained and delegated by a registered nurse, and each staff member takes part in a fire drill within 90 days of hire and at least once a year after.

Under 26 TAC §565.7, qualification is shown by documented training and observed competency, so keep both in the host home provider's file.

How do you document host home services on Form 4122?

Each billed day needs a written service log or a weekly written summary log, made within 14 calendar days and signed with the provider's title. HHSC publishes Form 4122, the Host Home/Companion Care Service Delivery Log, as a form for this. Each form covers one individual and up to seven billable service events.

Form 4122 records the individual's name, the address where the service happened, the week, and marks for activities of daily living, habilitation, assisting with, and not in home. The host home provider initials each day, adds comments, and signs.

The log must describe any unusual incident, such as a seizure, illness, or behavioral outburst, and what the provider did. Ditto marks, copied text, and vague notes like "had a good day" are not acceptable descriptions.

When the individual visits family or friends for at least a calendar day, the program provider may still bill, for no more than 14 consecutive days of the visit. The record needs the individual's name, the visit dates, and the host home provider's date and signature.

What must the program provider keep on file?

The program provider keeps proof that each host home provider is qualified, two documents showing where the provider lives, background check results, training records, quarterly inspection results, and the Form 4122 logs. It also records "host home/companion care" as the residential location on the IPC.

Under Section 3840, the two residence documents come from a driver's license or other government photo ID, a voter's registration card, a lease naming the provider, or a utility bill in the provider's name. Section 3830 lists the proof of age, education, competency, and references.

Sereniq supports HCS Host Home/Companion Care in Texas today, with Host Home as its own service type, a host home provider role, weekly Form 4122 documentation, and an optional Form 3092 MAR. There is no shift schedule or clock-in for host home providers. Sereniq keeps the records behind billing and does not submit claims.

This guide is not legal advice. Confirm every requirement with HHSC and your program provider.