Texas senior care regulation is split across the Texas Health and Human Services Commission, Long-Term Care Regulation for skilled nursing and the Texas Health and Human Services Commission, Long-Term Care Regulation (Assisted Living Facilities, Type A and Type B) for assisted living. Memory care carries a separate designation on top of the assisted living license. The full guide below covers nursing home licensing, assisted living and memory care, hospice licensure where applicable, common survey citation patterns, and how the state Long-Term Care Ombudsman fits in. Always verify specifics with each agency before acting.
Texas regulates nursing homes, assisted living, and hospice through the Health and Human Services Commission, Long-Term Care Regulation division. Assisted living splits into Type A (residents who self-evacuate) and Type B (residents who cannot), with material staffing and inspection differences between the two. Memory care marketing in Texas requires an Alzheimer's certification under 26 TAC Chapter 92, Subchapter K. Hospice carries a state license in addition to Medicare certification.
Regulatory reality in Texas
Texas runs the second largest SNF regulatory program in the country by community count, and the Type A versus Type B split inside assisted living is the single most operationally consequential decision a new ALF operator makes. Type B carries a night attendant requirement that materially changes the staffing model, and memory care marketing without the Alzheimer's certification under 26 TAC Chapter 92 Subchapter K is a citation risk that catches communities switching from independent living. HHSC has also been one of the most active states on federal hospice fraud cases, which affects survey scrutiny for any operator with adjacent hospice service lines.
Skilled nursing licensure in Texas
Skilled nursing facilities in Texas are licensed by the Texas Health and Human Services Commission, Long-Term Care Regulation, which also acts as the State Survey Agency on behalf of CMS. Texas SNFs hold CMS Certification Numbers issued through the State Survey Agency at HHSC LTC Regulation. Texas operates one of the largest SNF survey workloads in the country.
Federal survey results are published on Medicare.gov Care Compare, tied to the community's CMS Certification Number (CCN). The state survey agency also publishes state-level enforcement information.
Common nursing home survey deficiency tags in Texas
The following F-tag patterns are commonly cited on standard and complaint surveys in Texas. The list is descriptive, not a prediction, and does not substitute for reading a community's actual recent survey results.
- F-tag 689 Free of Accident Hazards / Adequate Supervision
- F-tag 880 Infection Prevention and Control Program
- F-tag 600 Free from Abuse and Neglect
- F-tag 656 Comprehensive Care Plans
- F-tag 812 Food Safety and Sanitation
Assisted living licensure in Texas
Assisted living in Texas is regulated by the Texas Health and Human Services Commission, Long-Term Care Regulation (Assisted Living Facilities, Type A and Type B). Admissions teams should know which agency takes complaints about a tour or move-in conversation, since it is often a different agency than the one taking complaints about clinical care.
Memory care in Texas
Texas requires an Alzheimer's certification under 26 TAC Chapter 92, Subchapter K, for assisted living communities marketing themselves as serving residents with Alzheimer's disease or related disorders. The certification is filed with HHSC LTC Regulation and requires specific staff training and program disclosure.
Source: official memory care rule reference.
Hospice licensure in Texas
Texas requires a state hospice license issued by HHSC in addition to Medicare certification. Texas distinguishes between licensed hospices providing inpatient hospice care and those providing routine home hospice.
Source: state hospice licensure reference.
The Long-Term Care Ombudsman in Texas
The Texas State Long-Term Care Ombudsman Program (HHSC) is the right first call for many family concerns about resident rights. The ombudsman office is independent of the survey agency and supports residents and their families through complaint processes when the issue is dignity, autonomy, or quality of life rather than a clinical or regulatory matter.
Phone coverage and admissions in Texas senior care
Senior care admissions live on the phone, and Texas's regulatory framework adds specific reasons that phone responsiveness matters to the community itself. State surveyors, ombudsman investigators, hospital discharge planners, and adult protective services workers all reach communities through their general intake line. A missed call from any of those callers, especially during a complaint investigation window, is a meaningful operational risk. See the senior living hub for how Jonson is built around senior admissions workflows.
Frequently asked questions about Texas senior care regulations
What is the difference between a Type A and Type B assisted living facility in Texas?
Type A ALFs serve residents who can self-evacuate without staff assistance. Type B ALFs serve residents who cannot self-evacuate and require night attendant staffing. Memory care communities are almost always Type B because cognitive impairment affects evacuation capability.
Does Texas have a separate memory care license?
Texas does not issue a separate license, but communities marketing as Alzheimer's or memory care must obtain an Alzheimer's certification under 26 TAC Chapter 92, Subchapter K. Without it, the community cannot advertise as serving residents with Alzheimer's disease or related dementias.
Where can I see Texas nursing home survey results?
CMS Medicare.gov Care Compare publishes the most recent standard and complaint survey results tied to the CCN. HHSC also publishes Texas-specific enforcement information through its Long-Term Care Provider Search.
How is hospice fraud handled in Texas?
Texas has been an active state for federal hospice fraud enforcement. HHSC coordinates with the Texas Attorney General Medicaid Fraud Control Unit and the federal OIG. Operators should expect heightened survey scrutiny of length-of-stay and live-discharge patterns.
Sources and official references
- HHSC Nursing Facilities main page
- HHSC Assisted Living Facilities main page
- Texas Long-Term Care Ombudsman
- 26 TAC Chapter 92 (assisted living regulations)
- CMS Medicare.gov Care Compare
This page summarizes commonly-referenced Texas senior care regulatory requirements as of 2026. It is not legal or clinical advice. Verify every detail directly with the relevant state agency and consult counsel for legal questions specific to a community. The ombudsman office is the right first call when the concern is resident rights rather than clinical care.