When must a Texas HCSSA run background checks on a new caregiver?

Before the caregiver has any face-to-face contact with a client — not after the first shift, not during a probationary period. Under 26 TAC § 558.247, all required checks (DPS criminal history, NAR, and EMR via SEMARC) must be completed before hire or before first client contact, whichever comes first. Emergency circumstances may allow a temporary exception but HHSC defines 'emergency' narrowly, and the check must still be completed immediately after. When in doubt, complete all checks before the caregiver starts.

What is SEMARC and why did Texas HCSSA providers have to switch to it in August 2026?

SEMARC stands for Search Engine for Multi-Agency Reportable Conduct. Effective August 3, 2026, Texas HCSSA and assisted living facility providers must run their pre-employment employability checks through SEMARC instead of the old standalone Employee Misconduct Registry (EMR) search portal. SEMARC queries both the EMR and the Nurse Aide Registry (NAR) simultaneously, so agencies complete two required checks in one search. SEMARC is accessed through the Texas Unified Licensure Information Portal (TULIP). HCSSAs that are still using the old EMR search process are now out of compliance.

Does a Texas home care agency need to re-run background checks on existing caregivers?

Yes. The Employee Misconduct Registry (EMR) — now accessed via SEMARC — must be rechecked for every direct-care employee at least every 12 months. Annual rechecks are also a best practice for DPS criminal history checks, as new charges or convictions may not appear on a check run at hire. Medicaid-participating agencies (STAR+PLUS providers) have an additional obligation: OIG exclusion screening must occur on a monthly basis for all staff, not annually.

What criminal offenses permanently bar a caregiver from working at a Texas home care agency?

Texas Health and Safety Code § 250.006 lists the convictions that bar employment in direct-contact roles at HCSSAs. Permanent disqualifiers include murder, capital murder, aggravated kidnapping, sexual assault, aggravated sexual assault, indecency with a child, continuous sexual abuse of a child, aggravated robbery, injury to a child or elderly or disabled person (serious bodily injury or death), and abuse, neglect, or exploitation as defined in HHSC rules. Other offenses create a 5-year bar running from the date of conviction or release from confinement, whichever is later. HHSC surveyors verify your screening records against this list during every Form 2020 survey.

Do these background check requirements apply to contractors and independent contractors as well as employees?

Yes. The requirements under 26 TAC § 558.247 and Texas Health and Safety Code Chapter 250 apply to any person — employee or contractor — who provides direct personal care services to clients. The legal distinction between W-2 and 1099 does not change the screening obligation. If someone enters a client's home under your agency's direction to deliver care, you are responsible for confirming they have passed all required checks before they go. This is particularly important for agencies that use staffing agencies or subcontractors: the responsibility for verification remains with the licensed HCSSA.

Texas Home Care Caregiver Background Check Requirements 2026: The Complete HCSSA Compliance Guide

Running background checks on caregivers is not optional, and in Texas it is not a one-time event. Under Texas law, a licensed HCSSA must complete a defined set of checks before any caregiver has face-to-face contact with a client — and must recheck employees on an ongoing basis as long as they are active on your roster. Missing a check or running the wrong check against the wrong registry can create a citation during your HHSC survey, exposure to administrative penalties, and — more seriously — the risk of placing a disqualified individual in a vulnerable client's home.

This guide covers the complete background check stack Texas HCSSAs must run in 2026, including the August 2026 transition to SEMARC, what each check finds, timing requirements, cost benchmarks, and how to document compliance for your HHSC survey folder.

All information is sourced from Texas Health and Safety Code Chapter 250, 26 TAC Chapter 558, and HHSC guidance current as of September 2026.

Why Texas Home Care Background Checks Are More Complex Than They Look

Most new HCSSA operators start with a familiar mental model: run a background check, check the box, hire the caregiver. Texas law requires more than that — and it requires it from more systems than one.

The complete check stack for a single caregiver hire involves four separate lookups across three government databases plus an ongoing monthly or annual recheck cycle that never fully stops. The specific systems, the timing, and the recordkeeping requirements are all defined in statute and rule — not just by best practice.

The four elements are:

Texas DPS criminal history check (Texas Health and Safety Code Chapter 250)
Employee Misconduct Registry (EMR) — now accessed via SEMARC (effective August 3, 2026)
Nurse Aide Registry (NAR) — also accessed via SEMARC
OIG exclusion screening — required for Medicaid-participating agencies (STAR+PLUS providers); best practice for all

Each addresses a different gap that the others don't cover. Understanding why each exists makes it easier to build a compliant process that holds up under HHSC survey scrutiny.

Legal Authority: 26 TAC § 558.247 and Chapter 250

The specific HCSSA regulation is 26 TAC § 558.247, which requires agencies to search the Nurse Aide Registry, search the Employee Misconduct Registry, and conduct a criminal history check in compliance with Texas Health and Safety Code Chapter 250 — all before hiring an unlicensed applicant or before first face-to-face client contact, whichever comes first.

Texas Health and Safety Code Chapter 250 governs how the criminal history check is conducted and which convictions disqualify a person from employment. Chapter 250 applies to any facility or agency providing direct care to elderly individuals or persons with disabilities — which covers every licensed HCSSA.

The definitions matter here. An "unlicensed applicant" under Chapter 250 means anyone who will have direct contact with clients and who is not a licensed healthcare professional (such as an RN or LVN) already subject to licensing-board background checks. For most HCSSA caregivers — personal care attendants, homemakers, companions — this covers every hire.

Applies to Contractors, Not Just Employees

The regulation does not distinguish between W-2 employees and 1099 contractors. If a person enters your clients' homes to deliver personal assistance services under your agency's direction and oversight, you are responsible for verifying their background — regardless of how they are classified for tax purposes. See our Texas Home Care Employer Compliance Guide 2026 for the legal analysis of caregiver classification, but on the background check question, the screening obligation follows the work, not the pay stub.

Check 1: Texas DPS Criminal History (Chapter 250)

What It Does

The DPS criminal history check queries Texas Department of Public Safety records for criminal convictions. This is the primary check that determines whether a caregiver has a disqualifying offense under § 250.006 (covered in detail below).

How to Run It

Texas HCSSAs have two methods:

Method A — DPS Internet Access: The fastest and most common approach for HCSSA agencies. Access the DPS secure website (idp.dps.texas.gov) and submit a name-and-date-of-birth-based query. Results are returned electronically. This method returns all Texas DPS criminal history records matching the identifying information you submit.

Method B — Mail to Crime Records: Submit a written request with $10 per name to the DPS Crime Records Service. Slower (days to weeks vs. minutes) and rarely used for hire-before-start-date scenarios.

Method C — Fingerprint-Based Check: Available through the Fingerprint-Based Applicant Clearinghouse of Texas (FACT) at approximately $15 per applicant. Fingerprint checks are more accurate than name/DOB checks because they eliminate false positives and false negatives from common names or name changes. While FACT fingerprinting is mandatory for child care licensing in Texas, it is not currently mandated for HCSSA caregiver hires — but agencies choosing to use it for its higher accuracy are compliant with Chapter 250. Fingerprinting also allows enrollment in FBI Rap Back, which provides ongoing notifications when an enrolled employee has a new arrest anywhere in the country.

Cost

Name/DOB check via DPS internet: approximately $10–$15 per name depending on access method
Fingerprint-based FACT check: approximately $15–$30 per applicant (varies by fingerprint site)
Third-party background screening companies: typically $20–$50 per report, often bundling the DPS check with DFPS and national database searches

The Out-of-State Problem

The DPS criminal history check returns Texas records only. If a caregiver applicant lived in another state within the past 10 years and committed an offense there, a Texas-only DPS check will not surface it. HHSC guidance directs HCSSAs to obtain criminal history from other states when the applicant has recently lived outside Texas.

For out-of-state history, options include:

Fingerprint-based FBI national criminal history check (via FACT)
State-by-state requests to the relevant state criminal records agency
Third-party background screening companies that include multi-state database searches

Document your process for out-of-state applicants in your policy and procedure manual. An HHSC surveyor reviewing your hiring records may ask how you handled a caregiver who listed a prior address in another state.

Checks 2 and 3: EMR and NAR via SEMARC (New as of August 2026)

What Changed in August 2026

Effective August 3, 2026, Texas HCSSA and assisted living facility providers must complete their pre-employment employability checks through SEMARC — the Search Engine for Multi-Agency Reportable Conduct — rather than the old standalone Employee Misconduct Registry search portal or the separate Nurse Aide Registry lookup.

SEMARC is accessed through the Texas Unified Licensure Information Portal (TULIP). A single SEMARC search queries both the EMR and the NAR simultaneously. For agencies that were running two separate lookups before, SEMARC consolidates the process.

HCSSAs that have not yet updated their hiring process to use SEMARC are now out of compliance. If your pre-hire checklist still references the old standalone EMR URL or portal, update it.

The Employee Misconduct Registry (EMR)

The EMR is an HHSC database of unlicensed healthcare workers with substantiated findings of abuse, neglect, exploitation, or misappropriation against a client at a licensed LTCR (long-term care regulatory) facility or agency. A person listed in the EMR is permanently unemployable at any HCSSA, nursing facility, assisted living facility, intermediate care facility, or other LTCR provider in Texas.

A finding ends up in the EMR when HHSC's Provider Investigations division substantiates an allegation through its investigation process. The EMR does not record arrests or charges — only substantiated findings. If a caregiver was terminated for suspected abuse and the investigation did not result in a substantiated finding, they may not appear in the EMR.

The permanence of an EMR listing makes the check essential at every hire. A caregiver can be listed after leaving a previous employer, and a name/DOB DPS check will not surface it — only the EMR check does.

The Nurse Aide Registry (NAR)

The NAR is an HHSC database of nurse aides who have completed a state-approved training and competency evaluation program. For HCSSA purposes, the NAR check serves two functions:

Confirming credentials: For caregivers who hold a Nurse Aide (NA) certification, the NAR confirms their certification is current and not revoked.
Checking for findings: Nurse aides with substantiated findings of abuse, neglect, exploitation, or misappropriation will have those findings noted in the NAR alongside their credentials.

Most HCSSA personal care attendants and homemakers are not certified nurse aides — but the NAR check is still required for all applicants, both to confirm whether they hold a certification and to check for any findings.

The SEMARC Search Process

Log into the Texas Unified Licensure Information Portal (TULIP) using your HCSSA provider credentials
Navigate to the SEMARC employability status check section
Enter the applicant's first name, last name, and SSN (Social Security Number)
SEMARC returns a combined employability status — checking both EMR and NAR records — in a single result

Save a copy of each SEMARC search result in the employee's personnel file as documentation of your pre-hire screening.

Annual Recheck Requirement

The EMR (via SEMARC) must be rechecked for every active direct-care employee at least every 12 months. A person who was clear at hire may be listed in the EMR after a substantiated finding at another agency occurs later. Annual rechecks are how you catch this.

Build the 12-month recheck schedule into your compliance calendar, and document it the same way you document the initial hire check. An HHSC surveyor reviewing your personnel files during a triennial survey may ask to see evidence of annual SEMARC rechecks for long-tenured caregivers.

Disqualifying Offenses Under § 250.006

Texas Health and Safety Code § 250.006 lists the convictions that bar a person from employment in direct client contact roles at a Chapter 250-covered agency. Understanding this list is important for two reasons: it tells you what your DPS check results actually mean, and it determines whether you must terminate an existing employee who is convicted after hire.

Permanent Bars

The following convictions create a permanent bar to employment at a Texas HCSSA:

Murder or capital murder (Texas Penal Code Chapter 19)
Aggravated kidnapping
Sexual assault or aggravated sexual assault
Indecency with a child
Continuous sexual abuse of a young child
Injury to a child, elderly individual, or disabled individual where the offense caused serious bodily injury or death
Abandoning or endangering a child (certain circumstances)
Robbery or aggravated robbery where death or serious bodily injury of an elderly or disabled person resulted
Abuse, neglect, exploitation, or misappropriation as defined in the applicable HHSC regulations

Time-Limited Bars (5 Years)

Certain other offenses create a bar for 5 years from the date of conviction or the date of release from confinement, whichever is later. These include various assault offenses, certain drug offenses, and other crimes identified in § 250.006 as incompatible with direct care roles.

Your Obligation When a Disqualifying Record Appears

If a DPS criminal history check returns a conviction that falls within § 250.006, you may not hire the applicant — and if an existing employee is convicted of a § 250.006 offense during employment, you must terminate their direct client contact role. Document the decision and retain the supporting records.

Do not rely on the applicant's self-disclosure alone. The Chapter 250 DPS check is the required verification step, not a supplementary one.

Check 4: OIG Exclusion Screening (STAR+PLUS Providers)

Why This Is a Separate Check

The federal Office of Inspector General (OIG) maintains a database of individuals and entities excluded from participating in Medicare, Medicaid, and other federal healthcare programs. Separately, the Texas HHSC Office of Inspector General maintains a state exclusion database. Neither the DPS criminal history check nor SEMARC searches either list.

If you are a STAR+PLUS or STAR Kids Medicaid provider — or if you are in the process of obtaining MCO credentialing to serve Medicaid clients — OIG exclusion screening is not optional.

What Happens If You Miss It

Employing an OIG-excluded individual and billing Medicaid for services they delivered creates federal compliance liability. Medicaid providers are responsible for ensuring no excluded person delivers covered services, regardless of whether the agency knew about the exclusion at the time. The exposure — civil monetary penalties — is why many attorneys characterize this as the single most underappreciated compliance risk for small home care agencies.

How to Screen

Federal OIG exclusion database (LEIE):
Search at exclusions.oig.hhs.gov. Free, publicly accessible, updated monthly. Allows searching by name, NPI, or SSN.

Texas HHSC OIG exclusion database:
Search at oig.hhs.texas.gov/search-exclusions. Covers individuals and entities excluded by Texas Medicaid enforcement actions. Also free and publicly accessible.

Frequency

Monthly — not annually. The federal OIG LEIE is updated monthly, and Medicaid program rules require providers to screen all employees, contractors, and vendors on a monthly basis. An employee who was clear when hired can appear on the exclusion list after a subsequent administrative action.

Many compliance programs manage this by building a monthly batch-search process into the billing or HR calendar — either using the OIG's downloadable exclusions file or a compliance screening service.

For agencies that are not yet STAR+PLUS credentialed but are pursuing Medicaid enrollment, begin the monthly OIG screening discipline before your first Medicaid client. Most MCO credentialing packets ask you to attest to an ongoing exclusion screening program.

See our Texas TMHP Provider Enrollment Guide 2026 for the full STAR+PLUS credentialing sequence.

Timing: The Rule Is Before First Client Contact

The clearest compliance point under 26 TAC § 558.247 is the timing requirement: all required checks must be completed before the caregiver has any face-to-face contact with a client. Not during the first week. Not as soon as the DPS check comes back. Before.

This creates a practical constraint: your hiring workflow must sequence the background checks ahead of the start date, not alongside it. Build at least 2–3 business days into your hiring timeline for check completion, even if you are running checks electronically. Allow more time for out-of-state hires requiring multi-state verification.

Emergency Exception

Chapter 250 acknowledges that genuine emergencies can arise — a scheduled caregiver fails to show, a client is in immediate need, and the only available replacement has not yet completed their background check. The statute allows an exception but does not define "emergency" broadly. The check must be completed immediately after the emergency circumstance resolves. Document the emergency justification in the employee file.

This exception is not intended to serve as a general workaround for a hiring backlog. HHSC surveyors are familiar with the pattern of agencies that habitually rely on emergency exceptions, and a personnel file with multiple emergency-justified starts is likely to draw scrutiny.

Documentation: What HHSC Looks for in Your Personnel Files

HHSC surveyors reviewing your personnel records during a Form 2020 survey or a triennial renewal survey will ask to see documentation that each background check was completed before hire. What to maintain in each caregiver's personnel file:

Document	What to Keep	Retention
DPS criminal history check result	Printed or electronic result with date stamp, employee name, and outcome	Duration of employment + 5 years
SEMARC employability check	PDF or screenshot of SEMARC result with date and name visible	Duration of employment + 5 years
Annual SEMARC recheck results	Each annual recheck result with date	Duration of employment + 5 years
OIG LEIE search result	Monthly screenshot or batch export showing employee name searched and result	Duration of employment + 5 years (STAR+PLUS providers)
Texas OIG exclusion search result	Same as federal LEIE	Duration of employment + 5 years (STAR+PLUS providers)
Out-of-state check documentation	Whatever records you obtained, with source and date	Duration of employment + 5 years

If a check returned a finding and you made a hire decision (either not hiring the applicant, or confirming a non-disqualifying offense did not bar them), document your analysis in writing and keep it with the check result.

A surveyor who asks "show me the background check documentation for this caregiver" needs to see a file that is organized, complete, and dated.

Administrative Penalties for Non-Compliance

HHSC has authority under Texas Health and Safety Code § 142.0015 to impose administrative penalties on licensed HCSSAs for regulatory violations, including background check failures. Penalties can range from a formal citation requiring a Plan of Correction to monetary fines depending on severity and recurrence.

A missing background check is classified as a serious deficiency during an HHSC survey — it directly affects client safety under the regulatory framework. A first-time deficiency typically results in a citation with a Plan of Correction requirement. Repeated deficiencies or patterns of non-compliance escalate. See our Texas HCSSA Survey Preparation 2026 Guide for a full walkthrough of the survey process and how deficiency citations work.

Practical Compliance Checklist for Each New Hire

Use this checklist for every caregiver hire. Complete all items before the caregiver's first client visit.

DPS criminal history check completed (name/DOB via DPS internet or FACT fingerprint)
Result reviewed against § 250.006 disqualifying offenses
Out-of-state criminal history obtained (if applicant lived outside Texas)
SEMARC employability check completed (checks EMR + NAR simultaneously)
Outcome documented and saved in personnel file
Federal OIG LEIE search completed (STAR+PLUS providers)
Texas HHSC OIG exclusion search completed (STAR+PLUS providers)
All results retained in personnel file with date stamps
Annual recheck date added to compliance calendar

Keeping Up with Ongoing Requirements

Background checks are not a hire-and-done process. The ongoing compliance calendar for an active HCSSA looks like this:

Task	Frequency	Notes
SEMARC recheck (EMR + NAR)	Every 12 months per active caregiver	Required by rule
DPS criminal history recheck	Annually recommended	Not explicitly required by rule on schedule; required at hire
Federal OIG LEIE screening	Monthly for all staff	STAR+PLUS providers
Texas HHSC OIG screening	Monthly for all staff	STAR+PLUS providers

As your caregiver roster grows, this calendar can become a meaningful administrative task — especially the monthly OIG screening cycle. Agencies with 20–30 active caregivers are running 20–30 name searches every month on top of annual SEMARC rechecks for the full roster.

This is one of the operational loads that agency management software helps absorb. Atlas Care Software's Nora AI includes a Credential Guardian that tracks caregiver compliance document expiration dates and flags upcoming renewal deadlines — so the monthly and annual checks don't fall through the cracks. More at Caregiver Credential Tracking Software.

Budget Planning: What Background Checks Cost

For new agencies planning startup costs, here is a realistic per-caregiver cost range for the full check stack:

Check	Cost Range	Notes
DPS criminal history (name/DOB)	$10–$15 per person	Via DPS internet or Crime Records
DPS FACT fingerprint (optional upgrade)	$15–$30 per person	Includes Rap Back enrollment option
SEMARC check (EMR + NAR)	Free	HHSC-provided system via TULIP
Federal OIG LEIE	Free	oig.hhs.gov/exclusions
Texas HHSC OIG	Free	oig.hhs.texas.gov
Third-party screening vendor (bundle)	$20–$60 per hire	Varies; may include national databases

For an agency hiring 10 caregivers in its first year, budget $100–$600 for background checks depending on the method used. Annual recheck costs on a 10-person roster are typically $100–$150 (DPS-only; SEMARC and OIG checks are free).

See our Texas Home Care Agency Startup Costs 2026 for a full pre-launch budget breakdown, including the criminal history check line item in the context of your total first-year compliance spend.

Putting It All Together

Background checks are a core operational requirement of running a Texas HCSSA — not an optional layer of due diligence. The checks required before first client contact (DPS, EMR, NAR via SEMARC), the transition to SEMARC in August 2026, the annual recheck cycle, and the monthly OIG screening for Medicaid-participating agencies are all defined in statute and rule.

The agencies that struggle with this are usually those that treat background checks as a one-time hire event rather than an ongoing compliance function. Building the process into your caregiver onboarding workflow — with documented timelines, saved results, and a recurring compliance calendar — is what makes it manageable at 5 caregivers, at 20 caregivers, and beyond.

For a step-by-step view of everything that comes before background checks in the agency startup sequence, see our Texas HCSSA Licensing Guide 2026. For what HHSC inspects during your first survey — including how your personnel files get reviewed — see the Texas HCSSA Survey Preparation Guide 2026.