Form 3230, Application for HHSC Approval to Operate a Hospital at Home Program

Instructions

Updated: 10/2025

Purpose

HHSC requires hospitals to submit Form 3230 to receive approval from HHSC to operate a hospital at home (HAH) program. Centers for Medicare and Medicaid Services (CMS) must first approve these hospitals for participation in the CMS Acute Hospital Care at Home Program.   

Procedure

When to Prepare

An applicant must submit the application form, fee, and other applicable documents. They must complete all actions required by Texas Administrative Code Title 26 (26 TAC) Section 505.54, Hospital at Home Program Application and Operational Requirements.

Initial Application

A hospital applying for initial HHSC approval to operate a HAH program must submit the following to HHSC:

• A completed Form 3230.
• A $350 application fee.
  • Make checks payable to the Texas Health and Human Services Commission.
  • Application fees are not refundable.
• A copy of the CMS approval to participate in the CMS Acute Hospital Care at Home Program.

HHSC may require an inspection or more documentation before granting approval. If HHSC approves a hospital’s application to operate a HAH program, HHSC provides the hospital with their written approval after approving the application.

Renewal Application

A hospital must apply to HHSC to renew its approval to operate the hospital's HAH program when applying to renew their license under 26 TAC Section 505.23.

To apply for renewal, a hospital must pay a non-refundable renewal application fee of $390 per 10 beds the hospital designates for the HAH program. This includes the hospital's license renewal fee.

Refer to Table 1 below for an example of the total renewal application fees due per block of 10 beds up to 100 beds.

Note: A hospital may apply for HHSC approval to designate more than 100 beds for the hospital’s HAH program table below is only to demonstrate an example of fee calculations up to 100 beds.

Table 1: Renewal Application Fee by Hospital at Home Bed Count

Ceasing Participation in the CMS Acute Hospital Care at Home Program

Hospitals must inform HHSC if they stopped participating in the HAH program by giving written notice to Health Care Regulation Health Facility Licensing.

HHSC may withdraw HHSC’s approval to operate a HAH program at any time.

Important Items to Note

• HHSC approves an application to operate a HAH program at its discretion.
• More than one hospital may share a CMS CCN number and CMS may approve all hospital locations at once. However, HHSC requires a separate Form 3230 for each licensed hospital location.
• A facility must submit one application form for each licensed hospital location, even when licensed hospitals operate under the same CMS CCN number. Multiple-license hospitals must differentiate between each location.
• HHSC must be able to confirm each hospital address by reviewing the CMS approval documentation the applicant submits with Form 3230.
• When a hospital increases the number of beds designated for its HAH program between license renewal periods, they must notify HHSC and pay a non-refundable fee of $390 per block of 10 beds the hospital adds to their program.

Mailing Address for Applications with Fees:

HHSC Accounts Receivable 
P.O. Box 149055, Mail Code 1470
Austin, Texas 78714-9055

Overnight Address for Applications with Fees:

HHSC Accounts Receivable 
4601 W. Guadalupe St., Mail Code 1470
Austin, TX 78751