Thinking about starting a PPECC in Texas?
Starting a Texas PPECC isn't just a licensing project. It's an operating-system design problem — skilled nursing, therapy coordination, attendance, authorizations, documentation, medical records, QAPI, survey readiness, and billing evidence all need to work together before the first child walks in the door.
A PPECC is purpose-built for medically complex children
Texas PPECCs serve children who need nonresidential skilled care in a licensed, center-based environment. That is not the same as:
A Texas PPECC requires operational readiness
across 10 domains before the first child arrives
This resource helps founders map the operating record they will need.
Licensing path
HHSC licensing application, mandatory CBT training through TULIP, initial survey preparation, and provisional vs. standard license requirements.
Facility readiness
Physical plant, equipment, ADA compliance, safety requirements, and inspection baseline per Texas HHSC PPECC licensing standards.
Clinical leadership
Medical director relationship, Director of Nursing qualification, credentialing, and governance documentation.
Nursing operations
RN/LVN staffing ratios, shift patterns, competency documentation, nursing documentation standards, and plan-of-care adherence.
Therapy / rehabilitative services
PT, OT, speech-language pathology, and developmental therapy — session documentation, plan-of-care alignment, and authorization periods.
Admissions and care planning
Eligibility determination, physician orders, interdisciplinary plan of care, admission packet completeness, and enrollment documentation.
Medical records
Medical record structure, content requirements, retention policy, and audit defensibility.
Attendance and census
Daily census, transportation documentation, attendance-to-authorization reconciliation, and census reporting requirements.
QAPI and survey readiness
Quality assurance and performance improvement program, inspection preparation, corrective action readiness, and ongoing survey risk management.
Medicaid / billing evidence
TMHP provider enrollment, Medicaid documentation requirements, prior authorization, and billing evidence organization.
Every PPECC requirement traces to an official source
This resource is built around official HHSC, Texas Administrative Code, and TMHP sources — each with a URL, effective date, and retrieval date. No claim is published without a confirmed official source.
Nursing Director Qualifications
Minimum Staffing Ratio
POC Physician Signature Window
Map your operating readiness across 15 domains
The Texas PPECC Readiness Map walks founders through 15 operational domains — from licensing and facility readiness to billing evidence and survey readiness.
No PHI. No compliance determination. Planning awareness only.
49 questions across 15 operating domains. No PHI. Planning awareness only.
PPECC services are reimbursed through Texas Medicaid — CSHCN FFS (TMHP) and STAR Kids managed care. The billing code structure below is confirmed per TMHP Form F00124 (effective December 1, 2024).
Current dollar rates require direct verification from the TMHP fee portal
(public.tmhp.com/FeeSchedules).
This resource does not publish current rate amounts until they are verified from an official
current-date source.
Billing code structure confirmed via TMHP F00124 (Instructions for Completing PPECC Prior Authorization Forms), effective December 1, 2024. No current dollar amounts are published.
Ready to go further? Harbor is a PPECC-native operating record.
Once you have a picture of your operating-readiness stage, Harbor helps map and build the documentation and workflow model your PPECC will need — before workflows become scattered across paper, portals, and mismatched software.
- →Helps organize the documentation, workflows, and readiness mapping a PPECC requires.
- →Surfaces operating-model questions that need answers before a center opens — nursing, therapy, admissions, QAPI, and billing evidence.
- →Connects clinical documentation, authorization tracking, attendance, and billing evidence so they stay aligned from the first day of operations.
- →Supports medical-record readiness, plan-of-care management, survey evidence organization, and therapy coordination.
- →Provides a state-aware BuildPlan funnel that maps your operating profile and surfaces where readiness gaps are likely.
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Guidance backed by official Texas sources
Texas PPECC guidance on this site is derived from official HHSC, Texas Administrative Code, and TMHP sources — each with a URL, effective date, and retrieval date. Every requirement traces to an official primary source before it is published.
Browse the Requirements Library →This resource is for operating awareness and planning support only. It is not legal, clinical, billing, licensing, architectural, or reimbursement advice. Always verify requirements with official sources and qualified professionals. Texas PPECC licensing and Medicaid enrollment require engagement with Texas HHSC, TMHP, and qualified professionals.