A source-backed operating-readiness guide for founders and operators exploring the Texas Prescribed Pediatric Extended Care (PPECC) model. Covers what a PPECC is, the 15-domain operating model, and how to think about preparation — licensing through survey readiness.
A Texas Prescribed Pediatric Extended Care Center (PPECC) is a licensed facility that provides medical and support services to medically fragile children outside of a hospital or institutional setting. PPECCs operate under Texas Health and Safety Code Chapter 248A and are licensed and inspected by the Texas Health and Human Services Commission (HHSC).
PPECCs serve children who require a level of medical supervision and skilled nursing care that exceeds what most home-based or standard childcare settings can provide — but whose medical needs are stable enough that they do not require continuous hospital-level inpatient care. Services typically include nursing, therapy (physical, occupational, speech-language), plan-of-care coordination, transportation, and daily living support.
Medicaid funding for Texas PPECCs flows through two channels: the Children with Special Health Care Needs (CSHCN) Services Program (fee-for-service, billed to TMHP) and STAR Kids (managed care, billed through the child's MCO). A PPECC may serve children enrolled in either channel. Prior authorization is required.
Browse sourced PPECC requirements in the Requirements Library →
PPECC founders often come from a clinical or advocacy background and underestimate how many distinct operational systems must be in place before the first child is admitted — and before the first claim can be filed.
HHSC licenses the facility. TMHP or the child's MCO funds it. But neither the licensing process nor the prior-authorization process tells you how to run the organization once it opens. That gap — between regulatory compliance and operational execution — is where most new PPECCs struggle.
The operating-readiness domains below are interdependent. A clinical staffing decision in nursing affects the plan-of-care model. A billing-code selection affects attendance documentation requirements. Survey readiness depends on whether every other domain has been consistently executed from the first day of operations.
The 15-domain readiness model on this site is designed to surface these interdependencies early — as planning awareness, not as compliance determination.
Every Texas PPECC must operate across these 15 domains from day one. Each domain has sourced requirements in the Requirements Library and maps to one or more questions in the Readiness Map.
Planning awareness only. This is not compliance advice. Verify current requirements with official sources and qualified professionals.
Business entity formation, letter of credit, NPI, tax registration, and initial organizational structure before submitting a license application.
Physical space meeting HHSC standards for square footage, sanitation, fire safety, and accessibility. Architectural plans typically require HHSC review prior to construction or renovation.
HHSC license application, TULIP portal submission, application fees, and pre-licensure inspection. The license is required before any child can be admitted.
Medical Director and Nursing Director (DON) must meet HHSC qualification standards. These roles carry specific credential and experience requirements under 26 TAC Chapter 550.
Minimum staffing ratios (at least one staff per three minors receiving nursing services), census-tier staffing tables, nursing policies, and shift documentation. The 1:3 floor is a regulatory minimum — higher ratios may be required at higher census levels.
Physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services where clinically indicated. Therapy documentation must connect to the plan of care.
Admission procedures under 26 TAC §550.604, intake documentation, eligibility screening, and guardian communication before the first service date.
The interdisciplinary plan of care (POC) must be physician-signed before the first service date. HHSC licensing standards and TMHP prior-authorization requirements both impose signing and renewal timelines on the POC.
Medical record content, retention, confidentiality, and access requirements under 26 TAC Chapter 550. Survey surveyors will review medical records for compliance with the full care record.
Daily attendance logs are both an operational requirement and the source of billing evidence. Whether a day is billed at a per-diem or hourly rate depends on documented service duration.
A Quality Assessment and Performance Improvement program is required under 26 TAC Chapter 550. QAPI must include an annual evaluation, measurable indicators, and data-driven improvement activities.
If the PPECC provides transportation services, transportation log documentation, transportation stability documentation in the plan of care, and billing evidence for T2002 claims are required.
Prior authorization is required before services begin. CSHCN (FFS) and STAR Kids (managed care) each have distinct prior-authorization workflows, required documents, and PA renewal cycles.
Documentation supporting T1025 (per-diem) or T1026 (hourly) billing must be established from the first service date. T1025 and T1026 may not both be billed on the same service day. Current dollar rates require verification from the TMHP fee portal.
HHSC PPECC inspections are unannounced. Survey readiness is not a pre-opening checklist — it is the ongoing state of operations from the first day of admission. A plan of correction must be submitted within 10 days of a deficiency citation.
Every requirement published on this site traces to an official primary source — a Texas statute, administrative code section, HHSC CBT module, or TMHP official form — with a URL, citation, effective date, and retrieval date.
The statute, TAC section, HHSC document, or TMHP form from which the requirement is drawn.
The specific section number, form number, or module reference — not just the top-level document.
When the version of the rule or document was effective, where ascertainable.
When PPECC Starter last confirmed the source was accessible and contained the stated requirement.
Public-copy approved — verified from primary source. Public-copy approved with caveat — verified, with a stated limitation. Needs citation — included with limited framing only.
Claims that cannot be verified from an accessible primary source are withheld. Dollar rates, licensed counts, and enforcement-record claims are not published until human-verified.
PPECC Starter is designed to be honest about the boundaries of what it publishes. The following content areas are not included in the current version of this site — and the reason why is documented.
public.tmhp.com/FeeSchedules). This site does not publish dollar rates until they are verified from a current official source.This resource is an early-stage operating reference. It will expand as additional content areas pass the source-verification standard. Founders should always verify current requirements directly with official sources.
Once you have mapped your operating-readiness stage, Harbor helps organize the documentation, workflows, and operating model your PPECC will need — before workflows become scattered across paper, portals, and mismatched software.