Key terms for Texas PPECC founders and operators — licensing, clinical, billing, regulatory, and source-status vocabulary. Planning awareness only.
PPECC / Prescribed Pediatric Extended Care Center
A licensed facility in Texas that provides medical and support services — including nursing, therapy, plan-of-care coordination, and daily living support — to medically fragile children in a non-hospital, non-institutional setting. PPECCs are licensed by HHSC under Texas Health and Safety Code Chapter 248A and 26 TAC Chapter 550. Medicaid funding requires prior authorization through CSHCN (FFS) or STAR Kids (managed care). See also: HHSC, CSHCN, STAR Kids.
Source: Texas Health and Safety Code §248A.001; 26 TAC Chapter 550.
TULIP / HHSC Licensing Portal
The Texas Unified Licensure Information Portal — the HHSC online portal used by healthcare providers, including PPECCs, to submit license applications, renewals, change-of-ownership filings, and related documents to HHSC licensing staff. The initial PPECC license application is submitted through TULIP.
Source: HHSC PPECC Licensing Standards CBT — Application Channel Module.
PPECC Licensing Fee
HHSC charges a fee for the initial PPECC license application ($2,625) and for capacity increases ($1,312.50). Late license renewals incur a $50/day penalty (maximum $500). These are government fees paid to HHSC, not reimbursement rates.
Source: HHSC PPECC Licensing Standards CBT — Fees Module.
Letter of Credit
A financial instrument required as part of the HHSC PPECC license application. Texas requires a $250,000 FDIC-insured letter of credit secured from an FDIC-insured institution before the application is submitted. This is a bank-issued instrument, not a cash reserve.
Source: HHSC PPECC Licensing Standards CBT — Fees Module.
Survey / HHSC PPECC Inspection
HHSC PPECC inspections are unannounced. Surveyors review the facility, records, policies, and operations against 26 TAC Chapter 550 standards. A deficiency citation requires a plan of correction within 10 days. Survey readiness must be maintained from the first day of operations — it is not a one-time pre-opening checklist.
Source: HHSC PPECC Inspection Process CBT; 26 TAC §550 (plan of correction requirements).
Medical Director
A licensed physician required by HHSC standards to oversee the medical program at a PPECC. The Medical Director must meet qualification standards specified in 26 TAC Chapter 550. This is a named leadership role, not an advisory or courtesy title.
Source: 26 TAC Chapter 550 (Medical Director requirements).
Nursing Director / DON / Director of Nursing
A registered nurse required by HHSC to lead nursing operations at a PPECC. The DON must meet credential and experience requirements under 26 TAC Chapter 550. This role is distinct from floor nursing staff — it carries administrative and supervisory responsibility over the nursing program.
Source: 26 TAC Chapter 550 (Nursing Director requirements).
Plan of Care / POC / Interdisciplinary Plan of Care
A physician-signed document that establishes the services, goals, and care approach for each enrolled child. The POC must be signed before the first service date. HHSC licensing standards and TMHP prior-authorization requirements each impose signing timelines and renewal cycles on the POC. The plan is developed interdisciplinarily — nursing, therapy, and the attending physician each contribute. See also: prior authorization.
Source: 26 TAC §550.607; TMHP PA Form F00122.
Nursing Staffing Ratio
At no time shall PPECC nursing staff fall below one staff member per three minors receiving nursing services (1:3 minimum). A census-tier staffing table in 26 TAC §550.410(d)(2) specifies total staff requirements at different census levels — higher census levels may require ratios exceeding the 1:3 floor.
Source: 26 TAC §550.410(d), effective October 16, 2024.
Nursing Assessment on Admission
A nursing assessment must be completed within a defined timeframe following a child's admission to the PPECC. The assessment timing requirement is established in 26 TAC §550.605 — a separate section from the admissions procedures themselves (§550.604).
Source: 26 TAC §550.605, effective October 16, 2024.
QAPI / Quality Assessment and Performance Improvement
A required program under 26 TAC Chapter 550. QAPI must include an annual evaluation, measurable performance indicators, and data-driven improvement activities. HHSC surveyors will review QAPI program records during inspections. Having a QAPI program on paper is not the same as running one with documented data — both are required.
Source: 26 TAC Chapter 550 (QAPI requirements).
Admissions Procedures
The process for admitting a minor to a PPECC, governed by 26 TAC §550.604. Admissions procedures cover intake documentation, eligibility screening, guardian communication, and the sequence of steps before the first service date. Nursing assessment timing post-admission is a separate requirement under §550.605.
Source: 26 TAC §550.604; §550.605, effective October 16, 2024.
Rehabilitative Services / Therapy Services
Physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services provided at a PPECC when clinically indicated in the child's plan of care. Therapy documentation must be maintained in the medical record and aligned with the plan of care. Therapy services contribute to the interdisciplinary care model.
Source: 26 TAC Chapter 550 (therapy and rehabilitative services requirements).
Medical Records
Required documentation for each enrolled child, maintained under 26 TAC Chapter 550. Medical records must meet content, retention, confidentiality, and access standards. Surveyors review medical records to confirm compliance with nursing, therapy, plan of care, and documentation requirements. Complete medical records are also the foundation of billing evidence.
Source: 26 TAC Chapter 550 (medical records requirements).
Transportation Services
If the PPECC provides transportation for enrolled children, transportation log documentation is required. The plan of care must also include transportation stability documentation. T2002 is the TMHP billing code for PPECC transportation services (per diem). Transportation services are optional — not every PPECC provides them.
Source: 26 TAC Chapter 550; TMHP CSHCN Services Handbook Chapter 33.
HHSC / Texas Health and Human Services Commission
The state agency that licenses, inspects, and regulates PPECCs in Texas. HHSC administers 26 TAC Chapter 550 (PPECC standards) under the authority of Texas Health and Safety Code Chapter 248A. HHSC also publishes PPECC licensing CBT modules used as reference material throughout this site.
Texas Administrative Code / TAC
The official compilation of Texas state agency rules. PPECC operational standards are found in Title 26 (Health and Human Services), Part 1 (HHSC), Chapter 550. 26 TAC §550 is the primary regulatory source for day-to-day PPECC operating requirements. The current version effective October 16, 2024 governs nursing, admissions, plan of care, medical records, QAPI, and other operational domains.
26 TAC Chapter 550
The section of the Texas Administrative Code that contains the operational standards for PPECCs. Chapter 550 covers licensing, facility standards, staffing, clinical leadership, nursing operations, plan of care, medical records, admissions, QAPI, transportation, and survey/enforcement. The current version was effective October 16, 2024.
Source: 26 Texas Administrative Code Chapter 550, effective October 16, 2024.
TMHP / Texas Medicaid & Healthcare Partnership
The Texas Medicaid fiscal agent that processes fee-for-service Medicaid claims,
manages prior authorization for the CSHCN Services Program, and publishes the
PPECC provider enrollment and billing guidance. TMHP publishes the official PPECC
PA forms (F00124, F00142) and the CSHCN Services Handbook.
TMHP also administers the fee schedule portal at public.tmhp.com/FeeSchedules.
CSHCN / Children with Special Health Care Needs Services Program
The Texas Medicaid fee-for-service channel through which PPECC services are billed directly to TMHP. CSHCN billing uses TMHP claims submission and follows CSHCN Services Handbook Chapter 33. The CSHCN channel has an annual T1026 hourly billing limit of 400 hours per child. Contrast with STAR Kids.
STAR Kids / Managed Care for Children with Disabilities
The Texas Medicaid managed-care program for children with disabilities, including many PPECC-eligible children. Under STAR Kids, PPECC services are billed through the child's Medicaid managed-care organization (MCO), not directly to TMHP. Prior authorization requirements under STAR Kids follow MCO-specific workflows. Contrast with CSHCN.
Prior Authorization / PA
Written approval from the payer (TMHP or the child's MCO) that PPECC services are medically necessary for a specific child. Prior authorization must be obtained before services begin — retroactive authorization is generally not available. The PA process requires a physician-signed plan of care (Form F00122), a CCP Prior Authorization Request Form, and a Nursing Addendum to the plan of care, confirmed via TMHP F00124 and F00142 (December 2024). PA periods expire and must be renewed.
Source: TMHP F00124; TMHP F00142, effective December 1, 2024.
CCP PA Request Form / Community Care for Aged/Disabled PA Request
One of three required documents for PPECC prior authorization under the STAR Kids pathway. Confirmed as required via TMHP F00124 and F00142 (December 2024).
Source: TMHP F00142, effective December 1, 2024.
400-Hour Annual Limit / CSHCN T1026 Limit
Under the TMHP CSHCN program, T1026 (hourly) billing for a child is limited to 400 hours per calendar year. Children who reach this limit may require a STAR Kids MCO authorization or another pathway for continued services. T1025 (per-diem) billing and STAR Kids billing are not subject to this same cap.
Source: TMHP CSHCN Services Handbook Chapter 33, §33.6.
The entries below describe billing-code structure only.
Current dollar rates are not published here — they require direct verification
from the TMHP fee schedule portal (public.tmhp.com/FeeSchedules).
T1025 / PPECC Per-Diem Billing Code
The TMHP procedure code for PPECC services on days when services exceed four hours. T1025 is billed on a per-diem (daily) basis. T1025 and T1026 may not both be billed on the same service day — the service duration on each day determines which code applies. Current T1025 dollar rates require direct verification from the TMHP fee portal.
Source: TMHP F00124; TMHP F00142, effective December 1, 2024.
Dollar rates not published — verify at TMHP fee portalT1026 / PPECC Hourly Billing Code
The TMHP procedure code for PPECC services on days when services are four hours or less. T1026 is billed on an hourly basis, limited to 12 hours/day and 400 hours/calendar year under the CSHCN program. T1025 and T1026 may not both be billed on the same service day. Current T1026 dollar rates require direct verification from the TMHP fee portal.
Source: TMHP F00124; TMHP F00142; CSHCN Services Handbook Chapter 33, §33.6, effective December 1, 2024.
Dollar rates not published — verify at TMHP fee portalT2002 / PPECC Transportation Code
The TMHP procedure code for PPECC transportation services, billed on a per-diem basis. T2002 billing requires documentation of transportation services provided. The T2002 daily unit does not count toward the 400-hour annual T1026 limit. Transportation services are optional — not every PPECC bills T2002. Current T2002 dollar rates require direct verification from the TMHP fee portal.
Source: TMHP F00124; CSHCN Services Handbook Chapter 33, §33.6.
Dollar rates not published — verify at TMHP fee portalBilling Evidence
The documentation that supports a Medicaid billing claim for PPECC services. For T1025/T1026, billing evidence includes daily attendance records that document service duration, the plan of care, nursing notes, and therapy documentation. Billing evidence must connect clinical and attendance records to the claim submitted. Poor billing evidence is a common survey and audit finding.
Authorization Tracking
The practice of monitoring active prior-authorization dates, authorized service hours, and PA renewal deadlines for each enrolled child. Authorization tracking prevents service-date billing errors that arise when services are provided outside an authorized PA period. For T1026, it also tracks utilization against the 400-hour annual limit.
These terms describe the source-verification status of requirements published on this site. They are used internally to govern what can be published and how.
Public-Copy Approved
The requirement has been verified from an accessible official primary source (statute, TAC section, HHSC CBT module, or TMHP official form) with a URL, section citation, effective date, and retrieval date. The public-facing description is within the bounds of what the source actually states.
Public-Copy Approved With Caveat
Verified from an accessible source, but with a stated limitation — for example, one source document confirmed the requirement while a secondary source was inaccessible. The public-facing description notes the limitation.
Caveat present on affected requirementsNeeds Citation
The requirement is included in the library with limited public framing — typically because only a chapter-level source has been confirmed but a specific section has not been independently verified. The underlying regulatory fact is not in dispute; the section-level citation is not yet complete.
Blocked Claim
A claim that cannot be verified from an accessible primary source. Blocked claims are excluded from all public-facing pages and the Requirements Library. Examples: current T1025/T1026/T2002 dollar rates (TMHP fee portal interactive only), the exact count of licensed PPECCs (HHSC annual report not accessible to automated verification), and OIG enforcement-record content (OIG document not accessible). Blocked claims will be added to the site once human verification is complete.
Not published until human-verifiedGuardian Communication
Communication with the parent or legal guardian of an enrolled child, required at multiple points: at admissions, during plan-of-care development, for authorization renewals, and during any change in services or condition. Guardian communication records may be reviewed during an HHSC inspection.