Personal Attendant Services, usually shortened to PAS, cover help with the everyday tasks that become difficult with age or disability. That includes bathing, dressing, grooming, feeding, and mobility, along with household tasks like light cleaning, laundry, and shopping. PAS does not include skilled nursing, wound care, or other medical treatment. That distinction matters because it determines which provider type is actually equipped to help.
How PAS is accessed in Texas
PAS is available to STAR+PLUS members who meet functional eligibility requirements. For members already receiving Supplemental Security Income, PAS is typically delivered through Community First Choice. For members who qualify through the separate STAR+PLUS HCBS waiver, PAS is one of the core services included in the care plan. In both cases, the number of hours authorized is determined by a standardized functional assessment, not chosen freely by the member or the provider.
The three ways PAS can be delivered
This is the part most families are never told clearly. There are actually three distinct models for delivering PAS in Texas, and the right one depends on how much day to day management a family wants to take on.
| Model | Who hires and supervises | Who handles payroll |
|---|---|---|
| Agency model | The provider agency | The provider agency |
| Consumer Directed Services | The member or representative | A financial management agency |
| Service Responsibility Option | The member or representative | The provider agency |
The agency model
In this model, a licensed provider like a home care agency employs, trains, and supervises the attendant directly. If an attendant is unavailable, the agency arranges backup coverage. This is the lowest effort option for families, since the agency handles hiring, scheduling, payroll, and supervision entirely.
Consumer Directed Services
Often shortened to CDS, this model puts the member or their legally authorized representative in charge of interviewing, hiring, training, and if needed, dismissing the attendant. This is the path that allows many family members, including adult children, to become paid attendants. A separate financial management agency still handles payroll, tax withholding, and paperwork behind the scenes, so the family is not personally responsible for that part.
The Service Responsibility Option
This is a hybrid that fewer families know about. Under this option, a provider agency remains the attendant's official employer for payroll and tax purposes, but the member or representative still interviews, selects, and manages the attendant's day to day work. It offers more control over who provides care than the standard agency model, without taking on the administrative burden of CDS.
There is no universally correct choice
Some families want maximum control over who enters their home and are comfortable managing that relationship directly. Others want the supervision, backup coverage, and administrative simplicity of a full agency model. Both are legitimate, and the right answer depends on the family, not on which model is more common.
What to check before choosing a provider
- Confirm the provider is properly licensed and meets Texas contracting requirements for attendant services
- Ask how attendants are trained and how ongoing supervision actually works
- Ask what happens if your regular attendant is sick or unavailable
- If considering Consumer Directed Services, ask which financial management agency handles payroll and how quickly they process it
- Ask how the provider communicates with your managed care organization and service coordinator
Providers delivering PAS under the standard agency model must meet requirements set out in the Texas Administrative Code governing attendant care contracting, covering things like staff qualifications, training, and supervision standards. A provider that cannot clearly explain how they meet these requirements is worth a second look before committing.
Not sure which model fits your situation?
Our care coordinators can walk you through how the agency model works day to day, and how it compares to managing an attendant yourself.