March 7th, 2024

HHSC Hold Harmless Period Ending

This “hold harmless” period is ending for ISS providers on March 17, 2024.

Beginning March 18, 2024, HHSC will survey for compliance with all regulatory requirements, including off-site provision of services, and move forward with applicable enforcement actions as outlined in Title 26 Chapter 559, Subchapter H, Division 4 (Survey, Investigations & Enforcement)

Draft Amendments to ISS Licensing Rules 

HHSC has posted draft licensing rule amendments to Chapter 559 governing the Individualized Skills and Socialization program.  Comments are due to HHSC March 21, 2024.  See details for commenting and for access to the draft rules at:
These draft rule amendments include some of the following changes:
 Clarification of ANE requirements
 Clarification of medication administration and related requirements
 Clarification of staff training requirements
 Movement of all rights-related requirements into one subsection
 Expansion and clarification of all environmental provisions 
 Application of administrative penalties and any other sanctions for failure to adhere to the rules.

February 14th, 2024

Delays In Receiving ISS Licenses

Some ISS providers have been experiencing delays in receiving their license before the expiration date and concerned of the impact to their program.  HHSC acknowledged they are experiencing delays and has noted the following:    For renewals, as long as the provider has submitted a renewal application, their license is considered active even if processing that application takes HHSC beyond the expiration on their printed license.  Provider Letter PL 2021-14 discusses this issue. 
~   HHSC created a process to allow for an initial temporary license to be issued, which included a health survey be conducted. To effectively manage the workload, HHSC also created a staggered process so that not all licenses expired at the same time. This meant that all applications received before September 1, 2023 were assigned either a one year, two year or three year license, which upon renewal would be issued for three years.
~  The license renewal process does not require a survey, however, surveys will be scheduled every two years at the discretion of the region.
~  HHSC created an ISS webpage which includes access to the rules, training information and other ISS-related information:

December 15th, 2023

Clarification on Licensure Renewals 

All licensed long-term care providers must submit a renewal application in the Texas Unified Licensure Information Portal (TULIP) before their current license expires. While a re-licensure/recertification survey is part of the renewal process, it doesn’t take the place of submitting a renewal application in TULIP.

HHSC encourages providers to submit the application as soon as possible within the 120 days prior to the expiration of their license, so that if there are issues with TULIP — such as the renewal application not being in the TULIP account — the provider has time to work with TULIP Support prior to their license expiring.

If the provider is waiting on pending documentation — such as a current fire marshal report it’s better to go ahead and submit the renewal application with the deficiency and upload a letter explaining why they don’t have the required documentation.

***If the application isn’t submitted before the license expires, the provider risks providing services without a license.  This is only for licensed LTC providers.  Does not include HCS/TxHmL providers as they are contracted, not licensed.


August 18th, 2023

Transition to Individualized Skills and Socialization Survey Deadline Extended

HHSC implemented individualized skills and socialization services in the Home and Community-Based Services (HCS) and Texas Home Living (TxHmL) Medicaid 1915(c) waiver programs, effective Jan. 1, 2023.

HHSC is requesting feedback from HCS and TxHmL program providers only on the impact this change has had on individuals receiving services in the form of a short survey.

Take the survey to provide your feedback.

We thank you for your input. HHSC is extending the deadline to submit responses until Aug. 31, 2023.

All HCS and TxHmL program providers who have not submitted a response must complete the survey by this deadline. Providers who have already completed the survey do not need to submit an additional response.

July 17th, 2023

HHSC Updated the Individualized Skills and Socialization Hold Harmless Period through March 17th, 2024


On Jan. 1, 2023, HHSC implemented the DAHS Individualized Skills and Socialization program and offered an initial hold harmless period from Jan. 1, 2023, through June 30, 2023.

HHSC agreed to extend part of the hold harmless period related to the provision of off-site services.

HHSC will survey for compliance with off-site service delivery but will not move forward with enforcement action.

For all other regulatory requirements, beginning July 1, 2023, HHSC will survey for compliance and move forward with applicable enforcement actions as outlined in Title 26 Chapter 559, Subchapter H, Division 4.

The new hold harmless period related to the provision of off-site Individualized Skills and Socialization services begins July 1, 2023, and ends March 17, 2024.


March 28th, 2023

Host Home Companion Care Providers Concerning ISS & PHE Flexibilities For In-Home ISS

Clarification Concerning Information Letter No. 2023-10 (Replaces IL 2023-06) from February 2023
In-Home Individualized Skills and Socialization Information for Program Providers for COVID-19 PHE

In response to COVID-19 and to provide access to day habilitation services, the Health and Human Services Commission (HHSC) temporarily waived certain requirements in Sections 3710, 4381.3, 4381.7(6) and 4381.7(7) of the HCS Billing Requirements and the TxHmL Billing Requirements. Until the end of the COVID-19 PHE, this flexibility will continue as part of in-home individualized skills and socialization.

Effective May 12, 2023, these flexibilities will no longer be in effect:

The flexibility has allowed HCS and TxHmL program providers to provide in-home individualized skills and socialization to an individual in the individual’s residence, including those residing in their own homes or family homes, without having the required justification outlined below. Program providers and LIDDAs need to have transition plans ready for individuals who receive in-home individualized skills and socialization prior to this end date (before May 12th, 2023).

Beginning May 12th, 2023:

in order to receive in-home individualized skills and socialization, individuals must meet all requirements outlined in the HCS and TxHmL Program Rules, the HCS Billing Requirements, and the TxHmL Billing Requirements, which include:
• A physician has documented that the individual’s medical condition justifies the provision of in-home individualized skills and socialization; or
A licensed professional or behavioral support service provider has documented that the individual’s behavioral issues justify the provision of in-home individualized skills and socialization; or
• The individual is 55 years of age or older and requests to receive in-home individualized skills and socialization.
In addition, after May 11, 2023, a service provider of host home/companion care will not be permitted to provide in-home individualized skills and socialization to the individual to whom they provide host home/companion care services.

Clarification & Answer to Question From Some of Our Readers: 

This letter indicates that HHSC does not appear to prevent a host home provider from becoming an ISS provider, nor does it prevent that licensed ISS provider from providing on-site and/or off-site services to their own individuals living with them.  In other words, it would appear they can be a HH/CC provider and licensed ISS provider at the same time and they can provide ISS services to their own individuals they are serving as HH/CC providers.   They can not provide their own in-home ISS (anymore) as an HH/CC provider as of May 12th, 2023.  The only ISS they can provide after May 11th, is if they are a licensed on-site and/or off-site provider.

March 1st, 2023

Reminder Must Be Licensed As ISS Provider To Bill As Of March 1st, 2023

For HCS/TxHmL Providers, you can’t bill for On-site &/or Off-site ISS as of today March 1st, 2023, if you send someone to an ISS location or have staff providing Off-site services (previously Community DH), if they are not listed as a licensed ISS program. 

The directories may be accessed at:  to find out if the ISS program is licensed.

**You can bill for In-Home ISS as persons providing In-Home ISS do not have to be licensed!  No justification is needed for In-Home through May 11th, 2023 I believe. I believe HH/CC providers can still provide In-Home (This was part of the PHE exception prior to March 1st) up through May 11th, 2023, but I am still unclear and will inquire and update everyone when I get some kind of definitive answer.

Previous DH providers & New ISS Provider applicants: If you do not have a temporary ISS license by March 1, 2023, you may not provide or bill HCS, TxHmL, or DBMD providers for on- and off-site ISS services until the temporary license is received.  HCS/TxHmL, DBMD Providers who have individuals attending an ISS program may not send persons to the program until they confirm that the operator of the program has received the license.  There are no exceptions.

February 21st, 2023

More ISS Training

In addition to the training sessions occurring in various locations across the state, HHSC will conduct a training on ISS in Austin on April 3, 2023.
Registration information should be posted on or before March 13th, 2023.

 Very Important:  Surveys of ISS Providers With Temporary Licenses

In case this information was overlooked by new ISS providers:

  • Once HHSC issues a temporary license, HHSC may conduct a survey at any time.
  • HHSC may conduct a survey of any licensed Individualized Skills and Socialization Providers prior to March 1, 2023.
    • i.e. if HHSC issues a temporary license on Feb. 21, 2023, HHSC may conduct an initial survey on Feb. 27, 2023.
  • HHSC conducts unannounced surveys of ISS Providers.
  • For on-site ISS providers, the address on the license must match the address for service provision.
  • ISS providers must allow HHSC surveyors access to the on-site location and off-site activity locations.

Please refer to Texas Administrative Code Title 26, Chapter 559 for more info on the LTCR survey process.

February 10th, 2023

How Do I Find A Licensed ISS Provider?

HHSC has now posted directories on the DAHS webpage to help people find a licensed ISS Provider.

The directories may be accessed at:


Please note the following:

  • There are 2 directories:  DAHS with ISS and DAHS-ISS Only.
  • The DAHS with ISS Directory is intended to reflect entities licensed as just a DAHS, and entities licensed as DAHS with ISS.
    • At this time, this particular directory lists all entities as just having a DAHS license. This is because the commission has yet to approve any DAHS with ISS licenses.  The process for approving a DAHS with ISS application takes longer than that of a provider applying as an ISS-only entity.  According to HHSC, the entity must undergo an LSC and Health survey before a license is issued to a DAHS with ISS entity.  Once these have been approved, they will be listed in this directory as DAHS with ISS.
  • Entities listed in the DAHS – ISS Only Directory, currently reflect a 6-month license.  This is because these licenses are considered ‘temporary’ at this time. Once the health survey is conducted the entities will receive a one, two or three-year license

February 5th, 2023

HHSC LTCR Updates the ISS FAQ’s

HHSC Long-term Care Regulation updated the Individualized Skills and Socialization frequently asked questions document on Feb. 01, 2023.

Read the FAQ here.

January 27th, 2023

FYI- somehow I missed this alert back in November for Licensed ISS providers.  Please be sure to log in and set up your account.

PL 22-32 letter issued 11/28/22 to ISS providers that was sent out concerning Blackboard Connect Emergency System

The purpose of this letter was to inform providers of the emergency communication system called Blackboard Connect, how it will be used, and your responsibility in signing up for the system if you are an ISS provider. This system will be used to send emergency and outreach notifications through email, phone, voice and text if available.

The rules require program providers to assign a designee to enroll in and respond to requests through the system. The designee should be someone who is associated with the licensed building or someone who is responsible for communicating emergency communications. However, you may also have other designees, such as corporate headquarters staff, sign up.

Blackboard Connect sign-up process:

Go to this link and click “Sign Me Up!”

If you have any questions, please contact the Policy and Rules Section by email at or call (512) 438-3161.

Rember, this also applies to HCS, TxHmL and ICF providers among other services.

January 16th, 2023

Questions concerning ISS and to the recently published IL 2022-03 ISS Automatic Service Authorizations and EVV for In-Home ISS in OHFM Settings  HHSC asked the 3 IDD associations to send them a list of questions.  If you have not already, please send your questions to your provider associations (PPAT, PACSTX, and TCDD).
Questions to which answers have been received are as follows:
  • The ‘new’ IPC referenced in IL 2022-03 will most likely not be ready until March.  They did not have answers as to what providers should do in the interim or even how service logs should be revised until new ones are available. (The letter does indicate that those individuals receiving DH at the time of the switch to ISS (March 1st, 2023) will initially roll over automatically to ISS ).
  • After Feb. 28th this would apply to all current clients as far as IPC units are concerned. Persons who don’t have any Day Hab units/days on their plan as of Feb. 28th, 2023 and want ISS hours, will have to do a new PDP and request IPC hours.   Providers will have a new IPC form, with ISS on it, before March 1st, 2023.
  • To date, no provider has been issued an ISS license.
  • Providers can confirm that an entity has an ISS license by checking the DAHS directory on the DAHS webpage:
 Unfortunately, no definitive answers have been obtained or decisions reached concerning processes related to service authorizations, IPC revisions and renewals and the automatic addition of ISS units.   It was agreed that a separate meeting on this topic was needed to address some of these issues.
TULIP-related Issues:  Concerns were expressed about challenges accessing TULIP, completing the application and receiving timely and productive assistance from TULIP.  We were told to submit concerns to Stephanie Allred and, depending on the issue, Ms. Allred or her team would address, or Ms. Allred would escalate to TULIP Support:  Ms. Allred may be reached at:

ISS FAQs and Upcoming Webinars:

Last Friday HHSC posted updated FAQs for the new service. Read the FAQ here.

On January 26, 2023, from 9:00 to 10:30 HHSC will conduct its quarterly LTC webinar which will focus on ISS.  To register for the webinar, go to:

January 12th, 2023

Information Letter No. 2023-03 Individualized Skills and Socialization Automatic Service Authorizations

Effective January 1, 2023, individualized skills and socialization became an available service in the HCS and TxHmL Programs.  For the time period of January 1, 2023 to February 28, 2023 both day habilitation and individualized skills and socialization will be allowable program services.

Day habilitation will no longer be a Medicaid-billable service in the HCS or TxHmL Programs for dates of service beginning March 1, 2023, and ongoing.

On January 9, 2023, HHSC will automatically add units of individualized skills and socialization for all individuals with day habilitation (including individuals receiving in-home day habilitation through the COVID-19 flexibility) currently authorized on their individual plan of care (IPC). The units will be available for billing immediately for the provision of on-site, off-site, or in-home individualized skills and socialization and will be visible to program providers in the Medicaid Eligibility Service Authorization Verification (MESAV). The added units will be authorized beginning January 1, 2023 through the end of the individual’s current IPC period. For individuals with an IPC period that must be renewed between January 1, 2023 – April 30, 2023, the added units will be authorized until December 31, 2023.
These units for individualized skills and socialization will not be visible to program providers or service coordinators on the IPC in the Long-term Care Online Portal (LTCOP) on the Texas Medicaid & Healthcare Partnership (TMHP) website nor on the dashboard until a revision or renewal IPC is entered. This automatic service authorization will give service coordinators additional time to meet with the individual’s service planning team (SPT) to update the individual’s person-directed plan (PDP) and for program providers to update the individual’s implementation plan (IP) as this new service takes effect. HHSC is implementing this process to minimize disruption to an individual’s desired services.

Service Plan Revisions
At the individual’s next service planning team meeting to complete a revision or renewal IPC (whichever occurs first) for individuals receiving individualized skills and socialization, service coordinators should update the individual’s PDP to reflect the new individualized skills and socialization service. During the service planning team meeting, any new goals related to the provision of on-site and off-site individualized skills and socialization should be discussed and documented in the new action plan. Until the PDP is updated, the individual’s current day habilitation goals, frequency, and duration should be followed for the individualized skills and socialization service.

Following the update to the PDP, the IPC and IP must be updated in accordance with applicable HCS or TxHmL Program rules with the appropriate units of individualized skills and socialization. HHSC will update the IPC and IP form to add individualized skills and socialization by March 1, 2023.
All individual’s PDPs, IPCs, and IPs must be updated with the appropriate units of individualized skills and socialization in accordance with applicable HCS or TxHmL Program rules by December 31, 2023.
For new enrollees and current enrollees who are not currently receiving day habilitation, individualized skills and socialization will need to be added, once the IPC and IP form have been updated, to the individual’s service plan because units will not be auto-authorized for these individuals. Day habilitation can be added and delivered until February 28, 2023.

To read more, please click on link below, for Information Letter 2023-03 related to ISS automatic service authorizations and EVV


January 3rd, 2023

Easier Format For ISS Licensing Rules effective Jan. 1, 2023

The link below provides a format that is easier to read and understand the newly adopted licensing rules rather than those when published as adopted in the Texas Register

HHSC Bulletin:

Effective Jan. 1, 2023, HHSC adopts new Individualized Skills and Socialization rules for providers who want to deliver individualized skills and socialization services. New rules provide guidance regarding:

  • applying for an Individualized Skills and Socialization license;
  • provider requirements; and
  • HHSC survey and enforcement actions.

Read the new rules in Title 26 of the Texas Administrative Code, Chapter 559, Subchapter H.

HHSC also published Provider Letter 2023-01 New Regulatory Rules for Long-term Care Regulation (LTCR) Individualized Skills and Socialization Services. This PL provides guidance to Individualized Skills and Socialization providers about the new rules.

Read PL 2023-01.

December 23rd, 2022


The Individualized Skills and Socialization rules are now published.
See below for the link and pages on which the rules begin for DBMB. TxHmL and HCS, as well as the license rules.
Note:  The other set of rule changes (i.e., changes being made to align with the other federal HCBS Settings rule) have not yet been published as adopted.
To view the rules, click on the following link and then scroll to the pages presented below for each program.
DBMD:  Adopted rules start on page 157 of the pdf
TxHmL:  Adopted rules start on page 164 of the pdf
HCS: Adopted rules start at bottom of page 174 of the pdf (actual rules begin at top of page 175)
License Rules:  Adopted rules start on page 188 of the pdf

December 18th, 2022

HHSC Adds Individualized Skills and Socialization to Email and Text Updates

HHSC added an option to the HHSC email and text update GovDelivery system that subscribers can select to receive updates related to the Individualized Skills and Socialization services program. Users can select to receive Individualized Skills and Socialization program alerts from the “Provider Alerts” drop-down menu.

To sign up for updates, select this link Texas Health and Human Services Commission (

For questions about Individualized Skills and Socialization, please email LTCRPolicy@hhs.texas.

November 28th, 2022

Webinar for New Licensing Process Nov. 30th, 2022 Extended to 2 hrs

All providers interested in the new licensing process for the Day Activity Health Services Individualized Skills and Socialization program are invited to a 2-hour webinar on Nov. 30. Originally it was a 1 hr session but has now been extended to have enough time for questions and explanations.

HHSC Long-Term Regulation staff will discuss how to navigate TULIP, the licensing system, explain the license application process and provide an overview of the survey process. There will also be a Q&A session as time allows.

Register for the webinar: Licensing Process Webinar

November 19th, 2022

DAHS ISS Licensing Application Available!

On Dec. 1, 2022, HHSC will launch the Day Activity Health Services (DAHS) Individualized Skills and Socialization License Application in the Texas Unified Licensure Information Portal (TULIP).

Link to TULIP:

Email with questions related to TULIP functionality or if you have issues gaining access.

Email with questions related to the DAHS Individualized Skills and Socialization licensing application

October 13th, 2022

Licensing Application Process For ISS:  

* HHSC will conduct a TULIP Navigation training webinar in the near future to assist providers in how to use TULIP.
HHSC has stated that the application will look very much like the DAHS application with certain sections marked as not necessary for an ISS application and several new ISS-specific questions/sections added.
-The Information Letter (IL) related to potential prohibitive settings/locations for an ISS setting/location should be published soon.
This letter will include instructions for providers which believe their ISS setting/location will need to undergo the heightened scrutiny process to contact HHSC.  HHSC will, in turn, conduct a review which will also have to be approved by CMS.  If approved, the prospective ISS provider may proceed with the license application process. 
The application will include questions that request verification that approval was secured.
-HHSC has stated that a directory of all licensed providers will be available for providers to confirm the license status of ISS providers.
*If an application is completely and correctly filled out, the provider will receive a temporary license (good for 180 days) until HHSC surveys the site/location.
The effective date of one’s license will be the date the temporary license is issued.
*The license fee will be paid via the process/portal.
-Community centers will be required to pay the license fee if they apply for an ISS license.

October 2nd, 2022

Register for Individualized Skills and Socialization Provider Portal Trainings

Individualized Skills and Socialization Provider applicants are required to complete HHSC Individualized Skills and Socialization Provider Trainings. Below are two computer-based trainings, which will assist Individualized Skills and Socialization Providers with applying for a license and preparing for an inspection.

  • Prelicensure Training for Individualized Skills and Socialization Providers
    This training was designed for providers who wish to offer individualized skills and socialization services. Prior to surveys or inspection, an entity must submit an application for a Day Activity and Health Services license. Information about the requirements to obtain a license will be shared. Register for the training.
  • Preparing for an Inspection
    This training was designed to assist Individualized Skills and Socialization Providers to prepare for an inspection. In this course, information about the inspection process and licensure rules will be shared. Register for the training.

Email questions to LTCR Policy.

September 24th, 2022

HHSC Moved The Individualized Skills and Socialization Webpage

The Individualized Skills and Socialization webpage moved from the Resources webpage to the main Long-term Care Providers webpage. This was done so its location is consistent with other Long-term Care Regulation programs and is easier to find.

Individualized Skills and Socialization can be found under the “Community-based Programs” heading.

August 23rd, 2022

No Public Hearing on ISS Licensing Rules

There is no scheduled public hearing on the proposed license rules for the new ISS service. However, providers can submit written comments on the proposed license rules.
Written comments on the proposal may be submitted to:
HHSC Long-term Care Regulation Policy and Rules,
Mail Code E-370, 701 W. 51st Street, Austin, Texas 78751,
Or you may email them to:

Comments must be submitted no later than 31 days after the date the rules were published in the Texas Register; i.e., 31 days after August 12, 2022.. Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate “Comments on Proposed Rule 22R050” in the subject line.

Public Hearing on ISS Program Rules

HHSC will conduct a public hearing on the proposed HCS, TxHmL and DBMD ISS program rules on September 7, 2022 from 8:00 am. until Noon.  To register for the virtual hearing, go to:

For a copy of the proposed ISS license rules or go to:

August 13th, 2022

Proposed Licensing Rules for Individualized Skills & Socialization (ISS)
The proposed rules governing the above-referenced rules were published in the Texas Register a few days ago.
See page 2 for instructions for submitting comments.  Interested stakeholders have 31 days from today to submit comments to HHSC.
FYI:  For those of you attending the PPAT (Private Provider’s Association of Texas) Conference,    HHSC is conducting a 2-hour session at PPAT’s conference on ISS.  This is session members and other interested stakeholders will not want to miss.  If you have not registered for the conference, please do so at:

August 8th, 2022
ISS Resources page

Texas HHSC has developed the Individualized Skills and Socialization Provider Portal, an online source of information for providers of individualized skills and socialization.

The Individualized Skills and Socialization Provider Portal will allow providers to:

  • Complete and review trainings on the Individualized Skills and Socialization service.
  • Find and review provider letters and other information and releases related to Individualized Skills Socialization.
  • Link to rules and other services related to Individualized Skills and Socialization.

Provider Communications

August 6th, 2022

See Draft/Proposed Rules for ISS in HCS and TxHmL below:

Proposed ISS Rules   (Main portion of  rules start on page 13-52)

Rule Review:  When reviewing the proposed HCS and TxHmL Individualized Skills and Socialization rules, note the following:
  • The anticipated adoption date is October, 2022 with an effective date of November 2022.  These dates also apply to the proposed rules for the DBMD waiver program.
  • Very few changes were made from comments HHSC received during the informal comment period earlier this year. Though we had been apprised of such before this positing, know that any comments you submitted during the informal comment period will need to be resubmitted.
  • Carefully review the introduction to the HCS and TxHmL rules on pages 1 -4, including the sections on Issues and Alternatives and Stakeholder Involvement on page 3.
  • Carefully review the preamble to the rules before reading the actual rules and pay attention to the sections on Impact to Small Businesses.
  • The proposed HCS and TxHmL rules are included in one document.  To help you navigate the document, the following is offered:
~  Introduction to the HCS and TxHmL proposed rules:  Pages 1-4.
~  Preamble to proposed TxHmL rules:   Pages 5-12;  Pages 10-11 contain statements about impact on small businesses.
~  Proposed TxHmL rules:  Pages 13-28.
~  Preamble to proposed HCS rules:  Pages 29 – 36;  Page 34 addresses impact on small businesses.
~  Proposed HCS rules:  Pages 37 – 52