Who we serve · Home Health & Hospice (HCSSA)
Workplace Violence Prevention for Home Health & Hospice (HCSSA)
Home & community support services agencies (HCSSAs) are covered under Texas Health & Safety Code Chapter 331 when they employ two or more registered nurses, since SB 463 took effect September 1, 2025, in every service category, not just home health. Originally covered agencies have been required to comply since September 1, 2024; newly covered agencies have been required to comply since September 1, 2026. HHSC’s guidance, Provider Letter PL 2024-10, predates SB 463 and speaks only to agencies with a home health category of service, so read it with the amended statute.
Home health and hospice risk is a field-environment risk: lone clinicians entering patients’ homes, unpredictable household conditions, and travel between visits. A fixed-worksite plan does not fit. VIGILO builds a program around lone-worker exposure, pre-visit risk screening, and field response protocols.
Where the mandate applies
How Chapter 331 reaches your setting
- A home & community support services agency (HCSSA), any service category since SB 463 (2025), is covered under HSC Chapter 331 if it employs two or more registered nurses; HHSC guidance is Provider Letter PL 2024-10.
- The statute’s test is the number of registered nurses the agency employs. It does not define “employs” or limit the count to direct-care roles, so administrative RNs count toward the two-RN trigger.
- The committee needs a registered nurse who provides direct care. The physician seat applies unless the agency has no direct-care physician on staff (§331.002(c)).
- HHSC proposed an amendment to 26 TAC §558.243 on September 18, 2026 (comments due October 19, 2026) that would write the Chapter 331 program into the HCSSA licensing rules; it is not adopted yet.
- Agencies covered before SB 463 have been required to comply since September 1, 2024, and agencies newly covered by SB 463 since September 1, 2026; compliance is checked at the licensure survey.
- The risk is a field-environment risk (lone clinicians in patients’ homes, unpredictable settings, and travel), so the plan must address lone-worker exposure, not a fixed worksite.
- Chapter 331 has no fine schedule; enforcement is a licensure-survey deficiency plus post-incident litigation discovery.
Speaking the language of surveyors
The six-part surveyor framework, answered
Surveyors follow a tracer: they pull the thread from policy to plan to committee to training to record to corrective action. This module is organized around exactly what they ask, what they review, and what gets a facility cited.
What surveyors ask
- Do you employ two or more RNs, the Chapter 331 trigger that, since SB 463, brings an HCSSA in any service category into scope?
- Have you counted every registered nurse the agency employs, whatever the job title, and documented how contracted nurses were treated?
- Does your plan address the field environment (lone clinicians in patients’ homes, unpredictable settings, and travel between visits), not just a fixed worksite?
- Is your committee properly composed, including a registered nurse who provides direct patient care?
- Is training delivered at least annually to a distributed, often-remote workforce, and did you complete the annual plan evaluation to your governing body?
What surveyors review
- Confirmation of covered status under Chapter 331 as amended by SB 463 (the two-employed-RN trigger).
- A plan addressing the home and field environment: lone-worker risk, patient-home conditions, and travel.
- Committee charter, roster (confirming the required direct-care RN), and minutes.
- Training rosters across a distributed field workforce, including make-up records.
- The annual plan evaluation report to the governing body.
Required documentation
| Document | Why surveyors want it |
|---|---|
| Covered-status determination (Ch. 331) | Documents the two-RN count, its date, and how contracted nurses were treated |
| Field-environment written plan | Lone clinicians in homes, unpredictable settings, travel risk |
| WVP committee charter + RN-direct-care member | Must reflect direct patient care |
| Annual training records (distributed workforce) | Field staff reached at least annually, with make-up tracking |
| Annual plan evaluation to governing body | Statutory recurring obligation under Ch. 331 / PL 2024-10 |
Common deficiencies
- Assuming an HCSSA is exempt when it employs two or more RNs: a direct misread of the Chapter 331 trigger, which since SB 463 reaches every HCSSA service category.
- Counting only nurses in direct-care roles: the statute’s test is the number of registered nurses the agency employs, with no job-duty limit.
- A plan written for a fixed worksite that ignores lone-worker and patient-home risk in the field.
- Training that cannot reach a distributed field workforce, leaving gaps in the annual record.
- The annual governing-body evaluation skipped.
How to prepare
- Count every registered nurse the agency employs, whatever the job title, and document the covered-status determination, including how contracted nurses were treated.
- Build the plan around the field environment: lone-worker protocols, pre-visit risk screening, check-in procedures, and travel.
- Compose a committee with the required direct-care RN and set its meeting cadence.
- Create a training delivery and make-up process that reaches remote field staff at least annually.
- Calendar the annual evaluation and report it to your governing body.
How VIGILO helps
VIGILO builds a home-health and hospice program for the field environment, through the WVP Foundation Package and the Annual Compliance Subscription:
- A covered-status determination against the statute’s two-RN test, documented for your file.
- A facility-specific written plan addressing lone-worker, patient-home, and travel risk, not a fixed-worksite template.
- A compliant committee charter with the required direct-care RN, plus facilitation and minutes.
- Annual and orientation training, English and Spanish, with a make-up process built for a distributed field workforce.
- The annual plan evaluation prepared and documented to your governing body, every year.
Texas SB 240 compliance
See the full statute breakdown, the covered-facilities matrix, and the implementing rules on our Texas SB 240 compliance hub.
Recommended path
Start with the audit, then the services that fit this setting
Survey-Readiness Audit
A scored gap report against Chapter 331, the HHSC rule for your license class, and the Joint Commission requirements.
Flat fee · $500 to $1,500
Details →Workplace Violence Prevention Programs
The complete, facility-specific program of record: committee, plan, training, and binder.
Flat fee · $2,500 to $6,000
Details →De-Escalation Training
Bilingual (English / Spanish) de-escalation and threat-response training for clinical settings.
$1,500 to $2,500 / training day
Details →Serving every covered healthcare facility class across Texas. See all settings we serve →
Home Health & Hospice (HCSSA) compliance FAQ
Frequently asked questions
Are home health and hospice agencies covered by Texas Chapter 331?
A home & community support services agency (HCSSA) is covered by HSC Chapter 331 if it employs two or more registered nurses, and since SB 463 took effect on September 1, 2025, that test reaches every HCSSA service category, not just home health. Agencies covered under the original home-health reading have been required to comply since September 1, 2024; agencies newly covered by SB 463 have been required to comply since September 1, 2026. HHSC's guidance is Provider Letter PL 2024-10. A covered agency must maintain a committee, written plan, at-least-annual training, a confidential anti-retaliation reporting policy, post-incident response, and an annual plan evaluation reported to the governing body.
How are registered nurses counted for the two-RN trigger?
The statute covers an HCSSA that “employs at least two registered nurses.” It does not define “employs” or limit the count to nurses in direct-care roles, and HHSC Provider Letter PL 2024-10 repeats the test without defining it. The conservative reading counts every registered nurse the agency employs, including RNs in administrative roles. Contracted and staffing-agency nurses are not addressed, so document how you treated them, and build the program if the count is close.
How is a home health workplace violence plan different from a hospital plan?
Home health and hospice risk is a field-environment risk: lone clinicians entering patients’ homes, unpredictable household conditions, animals and weapons, and travel between visits. A fixed-worksite hospital plan does not address lone-worker exposure. A defensible HCSSA plan includes pre-visit risk screening, check-in procedures, and field-specific response protocols.
Is VIGILO a security or escort service for home health clinicians?
No. VIGILO provides compliance, training, and consulting only: we build and document your WVP program and train your field staff in de-escalation and lone-worker safety. We do not provide security guard, escort, patrol, or investigative services and do not guarantee safety outcomes.
Would your agency program hold up under survey?
A Survey-Readiness Audit scores your committee, plan, training, and governing-body reporting against Chapter 331, the Joint Commission, and OSHA, in one document.